Community Learning Disability Nursing - Essay Example

 Over several decades, various authors attempted to compose a comprehensive definition of Learning Disability, but only few had certainty due to its heterogeneous nature. The increasing awareness of health care professionals to the arising needs of persons with learning disability focused the limelight to perusal of knowledge on learning disability. After several debates, in the latter part of the 20th century, the National Joint Committee on Learning Disabilities (1990) finally defined it as “a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities…” It can further be classified to reading disability (word recognition, fluency, and comprehension), mathematics disability and written expression disability. All of which must be identified specifically in order to be precisely addressed on intervention stage. Recognition to the existence of such condition is an immense step towards a more complex branch of medicine and its early identification to an individual or child is the gateway to better prognosis and higher chance of coping and development. Research divulged that South Asian population has higher prevalence on learning disability than the rest yet the Black and other ethnic minority, who even with early recognition, are deprived on access to health care for such conditions (Department of Health 2007). Studies show that 67 percent of children identified with reading disability at earlier age can develop into average or above average readers with early intervention from health care providers (Fletcher et al. 2007) thus promoting early assessment and intervention in the community. The Department of Health (2007) stated that “there are about 210,000 people with severe learning disabilities in England and about 1.2 million people with mild to moderate learning disabilities”. In addition Hall (2004) estimated it to be 25–30 per 1000 with mild and 3–4 per 1000 with severe learning disability in the UK. This number, though not alarming as it seem, deemed the necessity of learning disability nursing’s genesis in the clinical place and community. Gates and Barr (2009) provided a clear definition of learning disability nursing as they stated: “Learning disability nursing is a person-centered profession with the primary aim of supporting the well being and social inclusion of people with learning disabilities through improving or maintaining physical and mental health.” They comprehensively delineated the purpose of this profession to include the assessment of the health care needs of this population in order to aid them on their optimum level of independence. This task is achieved by the nurse by enhancing skills and competence required to meet the evolving needs of these people from birth to death and through collaboration with other agencies and associates. This branch of nursing does not focus only on clinical manifestations of physical health nor specific on mental health, but rather encompass the total well-being of a person in all aspects – physical, psychological, social, spiritual, and emotional (Gates and Barr 2009). Department of Health (2007) in UK reported that the incidence of wide range physical and mental health conditions among people with learning disabilities ceaselessly escalated. These are true to those in the population requiring special attention from biomedicine. Aside from the physical and psychological punches are the psychosocial dilemmas of inequality in access not only to health care services but also in other resources. It then stipulates that learning disability nurses work to dismantle this barrier for the persons with learning disability to pass through to take up a gratifying life. Community Learning Disability Nursing Recently, community nurses provide support on issues regarding their physical care needs, aging, and sexuality (Parahoo & Barr 1996, quoted in Sines et al. 2009). Particularly the main responsibility of community learning disability nurse involves consultancy, assessment, treatment, training, care planning, health promotion, and promoting access to services (Sines, et al. 2009). In addition to direct clinical and therapeutic role, nurses are involved with activities in delivering healthcare such as health promotion, health facilitation, teaching, and service development (Department of Health 2007). It involves formulation and implementation of a written care plan, utilizing a structured approach with continuous evaluation and re-examination taking into consideration the collaboration with the family members and health team and the concept of person-centered planning (Gates and Barr 2009). As with any nursing health care delivery, utilization of a care plan is indispensable. Comprehensive assessment must be done in order to identify specific problems and sub-problems occurring which may not be ready recognized by the person with learning disability. This process will provide a clearer picture of what specialized intervention that needs to be done. Failure to achieve this process further depreciates the uniqueness of their role and weakens their contribution for the development of the person (Sines et al. 2009). As critical as the other components of a nursing care plan is the continuous evaluation and reassessment to further evolve the nursing process parallel to the constant changes of the person with learning disabilities’ needs. Furthermore, collaboration is one of the key elements of success in this field of nursing. Creating strong liaison with other agencies or services offers better support for the person with learning disability (Sines et al 2009). Some of the basic services that must be linked with are the professionals delivering primary health care and acute care services, community children’s services, behavior support, mental health services, and palliative care services for some. Community learning disability nurses’ roles are often times perceived by their colleagues from multidisciplinary agencies as broad and varied which is agreed upon by most nurses themselves. As key players in delivering learning disability services, nurses adapts with the community they are in including absorption of political influences, cultural norms, and community care policies. With this comes the shift of the model utilized by the community nurses from medical model to social-educational model which is mostly used in community settings (Powell & Murray 2004). At times, community learning disability nurses may act as forensic nurses on cases of abuse. This may be present in all settings as the Department of Health (2007) reported that persons with learning disability have higher risk on being abused in several forms compared to others. Each decade marks a gradual increase in the number of community nurses attending to the persons with learning disability. Even so, their profession faces various challenges. The major contest is the justification of their role as community learning disability nurses with the multiplicity of tasks undertaken. Though their roles individually replicate those of other caregivers or agencies, community learning disability nurses had it rolled into one. Another issue is their ability to handle pediatric learning disability as studies show that there are only few who deals with children of this condition. And finally is the lack of recognition to the unique role of community learning disability nurse as one of the key players in the learning disability service concomitant with the need for role clarity (Sines et al. 2009). Ensuring quality health care delivery for person with learning disability is not the community nurses’ sole responsibility; rather, it requires involvement of service providers too. Provision of first-rate person-centered care can be achieved by staff development assessment, providing training and educational updates measuring at par the competencies required (Department of Health 2007). Specialization of this practice therefore boosts the morale of nurses who chose this career path and eventually, the confusion of their role will be ended. In 2011, the number of nurses choosing this career path continues to shoot up. This scenario made the four government health departments of UK to commit in developing professional framework for learning disability nursing for the entire UK focusing on four areas: “practice outcomes, roles and responsibilities; education and training; professional development and career pathways; workforce planning for health and social care” (UK-wide Framework for Learning Disability Nursing, 2011). This framework will focus on modernizing the workforce in congruence to the demands of the contemporary era. A structure will be designed to provide innovative practices through boosting clinical expertise and knowledge to ensure that the learning disability nursing in UK is at its best at providing quality health care for people with learning disabilities. This way, learning disability nurses will pursue on being the key player in this branch and simultaneously having a rewarding career path (UK-wide Framework for Learning Disability Nursing, 2011). Person-centered Planning in Community Learning Disability Nursing During the era of prolonged hospital confinement, goal oriented planning approach is widely utilized stripping off the individuality of patients with learning disability. The birth of normalization theory prioritized their rights to respect, autonomy, relationship development, and possession of a significant social role (Gates and Barr 2009). Person-centered planning places the person at the center and the planning process is designed to explore on their individualized necessity (Sanderson et al 2002). This kind of nursing assessment is important in person-centered planning discussion (Sines et al. 2009) for this serves as the basis on preparing actions essential for each need. Heller et al. (1996) stated that “the empowerment model suggests that interventions be designed to mobilize resources on behalf of individuals and to empower individuals to deal more effectively with their environment”. They further discussed that empowerment strategies encompasses a dual focus for the person with learning disability’s skills and behavior and for the nurse’s role in helping relationship. In person-centered planning, those with disabilities are aimed to develop access and control on available resources and services, behaviors to effectively interact with others, problem-solving skills, and decision-making abilities. Person-centered planning is an effective way to deal with many, but not all, tribulations of focus and direction that afflict people with learning disability. In same way, it helps the nurses assist them to attain personal fulfillment in their lives including their career for some. In order to obtain success in person-centered planning, as Marrone et al. (1997) articulated, core values must be known by heart at be practices all throughout the process. He indicated the seven core values to be: (1) it must be person-driven and not just person-centered; (2) it needs to engage a facilitative advocate – a person willing to help and has started a relationship with the person with learning disability; (3) it should transpire a power relationship transformation between the assertive community nurse to the submissive person with learning disability; (4) it involves action as well as planning; (5) it should be optimistic in nature focusing on dreams and aspirations; (6) the weight of facilitation must be on the process and not on the meeting; and lastly (7) getting multiple perspectives gives a sturdy foundation for the process. They further reiterate that absence or failure to observe this core values results to ineffectiveness of any person-centered plans. Indeed, learning disability nursing is a value-based profession (Department of Health 2007). Continues review of the created plan is required to meet the evolving needs of the person as they encounter constant changes in their lives such as maturity from childhood, to adolescent, to adulthood; behavioral and life style changes; and support transitions when primary care givers are changed or lost (Gates and Barr 2009). Recent developments in the role of learning disability nurses involves acquiring new roles particularly as nurse prescribers and clinicians who act as responsible carer for the confined person with learning disability. This acquisition was made possible through the implementation of Mental Health Act of 2007 (Pattinson, 2011). Partnership and Collaboration Penrod (2007) and her team of researcher who worked with people suffering from dementia deemed the necessity of partnership and collaboration amongst the community learning disability nurse, person with disability, families, friends, and other providers or agencies of services to render a holistic approach management. As earlier mentioned, collaboration and team work is strongly required in delivery of care so as to the planning stage. The community learning disability nurse, in alliance with other services or support staff, gets to know the person better while working in partnership with family members and friends to identify their individual preferences and personal choices (Gates and Barr 2009). An interdisciplinary team approach has been recognized in the delivery of healthcare for clients with special needs such as the elderly and person with learning disability. Yet, proper training and education to cultivate the knowledge, attitude, and skills of health care workers that are required to efficiently function in this setting has been sluggish (Clark et al. 2008). Improvement of persons with disabilities’ condition necessitates organizational cultures where learning is apparent constantly (Firth-Cozens 2001). Culture originates for an individual to the entire team and to make room for learning requires synchrony within the two. For this to transpire, Reith (1998, quoted in Firth-Cozens 2001) provided four major themes that recurred in his mental health inquiries: first is the attention and meticulousness to detail, second is the real essence of teamwork as a community learning disability nurse deals with inter-agency cooperation and valuable liaison, third is the capacity to listen and understand all members of the support team, and finally is the attention of nurses to the personality, behavior, and needs of the person with disability together with their families. All these, together with an open communication for evaluation, feedback, and suggestions within the team significantly increase the detection of weaknesses and determination of strengths. Through it improvement of health care services are sure to follow. Another advantage of working in a team with good teamwork is the decrease in stress levels for the health professionals and service providers. Real teams are defined as “ones with clearly defined roles whose members work together to achieve them, with different roles for different members, and recognized externally as a functional team” (Firth-Cozens 2001). As social beings, each individual craves for social nurturing from colleagues and peers through recognition and acceptance. Attaining this need results in work satisfaction thereby it decreases the tension at work and lowers stress levels. Its reciprocal counterpart however is a stressful working environment if the nurse works outside of a team or as a mere individual with no one to collaborate with. Individual and organizational learning is needed in promoting patient safety in health care delivery. Nevertheless, being part of a well functioning team makes its delivery more efficient and stable while providing a beneficial therapy for the person with disability and a more conducive working environment for the community nurses. Good teams are those with open communication where both strengths and weaknesses are discussed and worked upon in a professional manner. All the same, good management from team leaders and an upright organizational culture contribute to achievement of this goal (Firth-Cozens 2001). It must be put into mind that when referring to “team”, it does not exclude the role of the person with disability and their families but they are also key players to make the process successful. All could have been better if this is the perfect world, but reality calls the shot. A well functioning team with real teamwork may be like rare species in a rainforest; more often, what we have are teams with both individual and group tensions. Tension among health providers may occur due to indifferences and colliding of personal tensions from varying demands of their roles (Donnellon, 1996). This may occur between team leaders or managers and subordinates or across other discipline such as nurses and doctors or other health service providers. But differences do not occur only from the carers, it can occur even between the health care providers and the person with learning disability. An example was cited by Todd and Gilbert (1995): differences arise when dealing with autonomy and informed consent. There were cases, according to them, when the person with learning disability fails to fully express his preferences making it difficult for the health care provider to identify their subjective needs. The health care provider is then compelled to render care according to her own preference or on what he think is necessary setting aside the choice of the person with disability thus endangering his chance for autonomy. Social Policy for Learning Disability De-institutionalization of the 1970’s marked the turning point of the changes in life of people with learning disabilities. The government of UK in this time implemented this policy to wean the people with such disabilities from prolonged hospitalization to home based therapy. Concurrently, the lifestyle and entirety of this population together with their families changed together with the entire society as they view this people more as part of the community rather than an ill member among the group. This change brought about the shift of focus of community nurses to responds to the contemporary requisites of the people with learning disability. In 2001, the government stated that “the main objective for health is to enable people with learning disabilities to access a health service designed around their individual needs, with fast and convenient care delivered to a high standard, and with additional support where necessary” (Department of Health 2001). This vision enabled the department to allot sufficient budget for the health care delivery in this particular group. Comprehensive health checks for people with learning disabilities followed, and housing and support were built for them (Department of Health 2006). To assist in updating services and increasing life opportunities of people with learning disability, it has been encouraged by Bates and Davis (2004) that combined application of social capital and social inclusion be observed. Social capital, as a sociological investment in the care for person with learning disability, is a concept where social relations are given value as networks of relationships are developed. Conversely, social inclusion is giving value to the person with learning disability and allowing them to have opportunities to participate fully in the society. They argued that for a person with learning disability to be completely absorbed by the society, both should be conformed to at all times. Conclusion In summary of what transpired in this paper, it can be concluded that community learning disability nursing, though complex and diverse in nature, is a branch of nursing that deals with multi-disciplinary system utilizing person-centered planning to achieve its goal of providing holistic and quality health care for the person with learning disability. A community nurse acts as a key part of a team performing roles as not just a team member but as a team player. In collaboration with professionals from several health care services involved in the delivery of needed care, person with learning disability, their families and the rest of the community, the nurse utilizes open communication to make room for learning and improvement in health care. Learning disability spreads widely globally yet the attention to its needs are limited to countries that identify them and address their needs for personal development. This awareness is congruent to the attention given to community learning disability nursing where until today; it is a career path striving to build its foundation and relevance. Person with learning disability may be scrutinized as oddly different as the rest of society, yet they must be treated as individuals same as others who has feelings and needs too. Addressing to their needs required special care from people trained to handle such cases and be able to cope with situations that arise relating to the mental condition of the client. This entails a strong urge for development of more training programs to enhance both knowledge and skills of community learning disability nurses. Adeptness to person-centered planning is vital in dealing with person with learning disability to be able to provide health services based on the true needs of the person and not on the contextual concept of the carer. Continuous assessment, evaluation, re-assessment and planning must be observed in the practice in parallel to the evolving behavioral changes and perceptions of the person with learning disabilities that comes with maturity and aging. Furthermore, participation of the society in general aids in their development. Social policies implemented by the government and committees of health care system, directly influences the society’s stance towards the person with disability. Through the guidance of the concepts of social capital and social inclusion, this population was able to function within the society to the fullest of their capacity. Reference List Bate, B. & Davis, F. (2004) Social Capital, Social Inclusion and Services for People with Learning Disability. Disability and Society, 19 (3) May. Chief Nursing Office Bulletin. (2011) UK-wide Framework for Learning Disability Nursing [Internet]. Available from: Department of Health [Accessed 24 April 2012]. Clark, P. 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