Intervention for People with Learning Disability - Essay Example

? Introduction The environment for healthcare and support are constantly changing as the number of patients with multiple and complex needs increase, and clients increasingly have high expectations on what health, care, and support should deliver. As a result, healthcare professionals expected to forge new partnerships, offering and engaging with people in making choices regarding health and care. The advances in science have played a major role in ensuring that children with learning disabilities live longer, fulfilled lives compared to the previous years. Although, this is a welcome development, governments should ensure that their health and social care systems are open and ready to meet the changing health needs of individuals with learning disabilities. In the outlined case, James was diagnosed with Prader-Willi Syndrome and was referred to the learning disabilities nursing teams to get support in managing weight and his challenging behaviours. The paper highlights theory, evidence in caring for individuals with learning disabilities, barriers and challenges that they encounter when accessing the full range of health services, and practical and effective interventions seeking to enhance access to healthcare. Learning disabilities impact on the capability to learn, to communicate, and undertake everyday tasks. The determination of eligibility can be based on the level of intelligence (via the use of IQ test), the level of social functioning based on such areas such as communication, budgeting, or personal hygiene and the history of the individual. Statistics indicate that there are 1.5 million people in Britain live with learning disabilities. This figure will increase by 14% between 2001 and 2021 (Department of Health 2009, p.4). People with learning disabilities are a diverse group and differ broadly in their capabilities, influencing the support that each person needs. Learning disability represents reduced capability to understand new or complex information, to learn new skills, along with reduced capability to cope independently (demonstrated by impaired social functioning). This definition encapsulates IQ and functional aspects that render it distinct from the term “learning difficulties” that covers a broader application in education (Mitchell 2004, p.115). People with learning disabilities are twice likely to have health problems, relative to other people, yet recent reports have indicated that people with learning disabilities manifest higher levels of unmet needs and usually receive less effective treatment despite legislation demanding equal treatment. Research studies have explored five broad classes of determinants of health inequalities that a majority of people with learning disabilities, in principle, encounter possibly open to intervention: heightened risk of exposure to social determinant of health; heightened risk linked to particular genetic and biological causes of learning disabilities; communication difficulties and minimized health “literacy”; personal health risks and behaviours; and, deficiencies in access to and the quality of health provision (Silver 2005, p.4). The existing patterns of healthcare provision are inadequate, inequitable and likely to be in contravention of legal requirements as per the Disability Discrimination Acts of 1995 and 2005. Individuals with learning disabilities, especially with less learning disabilities are highly probable to be exposed to social determinants such as poor housing conditions, poverty, overt discrimination, unemployment, and social disconnectedness. Research studies have demonstrated that individuals from minority ethnic communities face even larger health inequalities, compared to people with individuals coming from major ethnic communities. The limited communication skills may also minimize their capacity to convey identified health needs effectively to others (Mitchell 2004, p.201). Individuals with learning disabilities experience a lack of knowledge and choice regarding health eating. Individuals with learning disabilities manifest health care needs analogous to those of the rest of the population and have equal rights of access to health care services. This encompasses access to health promotion, community health services, primary health care services, and specialist health services as necessitated. Nevertheless, barriers to access to healthcare services arise from two sources: the learning and communication difficulties associated with individuals with learning disabilities and the attitudes, knowledge, and beliefs of carers or managers of services. Indeed, individuals with learning disabilities have largely been invisible to mainstream health services and health professionals. Studies have revealed that people with learning disabilities manifest a heightened risk of obesity and cardiovascular morbidity. The prevalence of obesity can be considered to be higher among individuals with learning disabilities compared with the general population, contributing towards health inequalities (Goldie and Brown 2012, p.14). Individuals with learning disabilities present certain challenges for primary care professionals in terms of clinical and prevention management of obesity. The increased risk of obesity among individuals with learning disabilities can be attributed to overeating, snacking between meals, and low consumption of vegetables, fruit, and fibre. Moreover, low physical activity has also been reported among individuals with learning disabilities. Research studies on individuals with learning disabilities frequently point to erratic and confusing profiles of individuals. The mismatch between capability, expectations, and outcomes can yield to disappointments and upset, yielding to a cascade of emotions and behaviours, which can interfere with their everyday functioning at home and community (Fowler 2008, p.4). The inconsistencies and coping strategies can be frustrating to carers and parents, but can take the toll on individuals with a devastating effect on their self-esteem. The emotional battering that individuals with learning disabilities experiences when they do not satisfy their own expectation can yield to feelings of isolation. The repeated failure of success despite the efforts can yield to “learned helplessness,” whereby repeated disappointments can make individuals assume a passive role and stop believing that there is anything that they can undertake to improve their situation. Prader-Willi syndrome represents a complex genetic disorder characterised by low muscle tone, cognitive disabilities, problem behaviours, which can yield to excessive eating and life-threatening obesity. Individuals with Prader-Willi syndrome manifest a flaw within their hypothalamus, which mainly registers feelings of hunger and satiety. Individuals with Prader-Willi syndrome are not able to control their own food intake and the obesity increases when vocational programs and independent activities allow enhanced access to food. As such, regular weight measurements are essential and any marked gain within the short period necessitates re-evaluation of the amount of supervision. The patient can be admitted into a highly structured-in-patent weight loss program in the event that the health deteriorates. Children with learning disabilities can manifest challenging behaviour; indeed, dealing with the child’s challenging behaviour can be stressful. All children can behave in ways that are difficult to deal, especially with regard to children who have tantrums. In children with learning disabilities, such behaviours can be more frequent and extreme (Swain, French, Barnes, and Thomas 2007, p.4). It is advisable to avoid things that might trigger challenging behaviour and seek professional support. Individuals with Prader-Willi syndrome manifest behavioural issues such as increasing irritability, agitation, compulsive-like behaviours, rigid, argumentativeness, and perseveration indicating heightened distress that may explode into tantrums and destructive behaviour. Obesity represents a condition in which there is abnormal or excessive fat accumulation to the level that health may be impaired. The causes of obesity are multifactorial and can be genetic drug induced, neuroendocrine with the most prominent cause being emotional, environmental, and social. Obesity can be regarded as a complex challenge and is often difficult tackle in primary care (Biswas et al. 2010, p.31). A person-centred approach can avail a critical tool within the management of obese patients such as James. The nursing interventions should centre on transferring to members of the population the knowledge and skills they require to take care of themselves. To this end, nurses frequently adopt the role of educators, advocates, counsellors, researchers, and role models with obese clients. As an educator, nurse team should exercise health maintenance, nutrition and diet planning, medication management, and administration, nutrition and diet planning. The role of learning disability nurses centres on supporting people with a learning disability and their families and carers, to allow the individuals stay at home. Despite the fact that most learning disabilities manifest during childhood, they persist throughout adult life, and learning disability and learning disability work with the client and carers from all age groups. As is the case with mental health nurses, majority of learning disability nurses work within the community, which can entail working in the community and people in homes, schools, and residential care homes. The nursing team should have personal qualities that entail understanding, patience, listening skills, and compassion; learning nurses ought to acquire a good understanding of social inclusion and networking, as well a sound knowledge of physiology conditions, which may impact on their clients (Hansen 2003, p.449). Learning disability nurses should also develop skills of assertiveness as frequent to support their clients, both within the society as well as within the care team. The management of Prader-Willi syndrome necessitates a multidisciplinary approach to delivery of care given that the combination of medical, nutritional, and behavioural problems can be challenging (Hansen 2003, p.449). Weight management persist to be a challenge for families as the freedom to engage in school and community life avails increased opportunities of finding food, frequently negating parent’s efforts to limit food consumption (Camden, 2009). The recommendations for calorie restrictions should be based on linear growth and should be less than the estimated needs. The interventions for weight loss among adults with learning disabilities and obesity may hinge on a number of key approaches: focusing on dietary intake; physical approaches to increase energy expenditure, health promotion and health education, and multifaceted approaches detailing more than one of these interventions. Although, the outlined approaches manifest some effectiveness in yielding to weight loss in the short-term, long-term data relating to sustaining the approaches is lacking. The nursing priorities in the outlined scenario centres on sustaining and enhancing functioning; preventing complications; avail information on the disease process, prognosis, and treatment regimen; and support active client control or management of the condition. Effective person-centred planning, regular reviews by skilled care managers can be employed more efficiently to pick up the poor outcomes and risk of abuse. Behavioural self-control can play a critical role in maintain the structure and support of the program meant to minimize overeating (Camden, 2009). Effective multidisciplinary work tailored to the needs of individuals usually avail some benefits, especially when the intervention is planned carefully through the collaboration of practice nurse, dietician, psychiatry input, and community learning disability nurse. An optimally designed and organized program should feature three components including a focus on dietary intake, which takes into account the individual food preferences personalised physical fitness program that encompasses an assessment of risks, and health promotion and health education within the home setting (Phillips 2012, p.42). The rationale of engaging James in his treatment centres on the fact that knowledge of the disease process and expectations can foster client’s participation in the management of obesity. The nurse should reinforce treatment rationale can aid to foster understanding of regimen, medications, restrictions, and technology, which may improve cooperation with control of symptoms. It is essential to refer the client to a dietician for counselling individual needs and dietary customs help in the identification of dietary needs, especially in the presence of diabetes and obesity (Griffiths, Bernnett, and Smith 2009, p.490). Research has shown that no appetite suppressant has worked consistently for clients diagnosed with Prader-Willi syndrome. As such, the best intervention for such cases necessitates extremely low-calorie diet and should have an environment that presents limited access to food. Health checks for individuals with learning disabilities can help in the detection of unmet health needs and inform “reasonable adjustment” pertinent to tackling health inequalities. The barrier to accessing health services encompass challenges with understanding and communicating health needs, lack of support to access services, failure to make “reasonable adjustments” to services to ensure that they can be utilized easily and effectively by persons with learning disabilities (Moulster and Turnbull 2004, p.56). Individuals with learning disabilities manifest challenging behaviour. Challenging behaviour can be defined as culturally abnormal behaviour of such frequency or duration to the extent that the physical safety of the individual or others is placed in serious jeopardy, or behaviour that is likely to limit or deny access to the utilization of facilities (Emerson and Einfeld 2011, p.8). Challenging behaviour may be caused by numerous factors including environmental, social, biological, and psychological. Nurses and carers should be alive to the fact that dealing with individuals with challenging behaviour can be stressful. This arises from the fact that caring for individuals with learning disabilities exposes the nurse to persons who are prone to tantrums, kicking, hitting, or throwing things around, or even hurting people. Understanding why the client is behaving in a challenging way is very essential as such clients have difficulties in communicating their needs. All individuals enjoy having choice and control within their lives, and the absence of choice and control can be very distressing for people with learning disabilities (Bittles et al. 2002, p.47). Nurses should establish strategies regarding partnership working to avert problems, and manage problems when they manifest while instituting skilled, long term support to allow individuals to live as independently as possible within the community. Since the values base for learning disabilities nursing remains strong, it is essential that systems retain and reinforce attitudes and capabilities to foster person-centred and strength-based approaches (Lindsey 2002, p.138). As such, learning disabilities nurses ought to embrace the new movement that seeks to transform systems, and deliver efficient, high quality improvement. As such, nurses caring for individuals with learning disabilities should adopt evidence-based interventions, with measurable outcomes that enhance safety, productivity and effectiveness along with the conventional person-centred approaches (Pawlin and Carnaby 2009, p.6). Strong leadership will be pertinent in ensuring client-centred care is adopted and guarantee that the existing architecture provides a platform that the nurses’ unique contribution can be celebrated, developed, and promoted. Research has indicated a dichotomy between respecting autonomy and securing freedom of choice, and paternalism does little to do justice to the process of care. Nurses caring of individuals with learning disabilities should be aware of the fact that their clients may not be able to express discomfort in usual ways. As such, care providers must be sensitive to change in behaviour or well-being that indicates illness, pain, or unhappiness. The role of the nurse can be most beneficial when it highlight stress factors and aid James and his family to adopt constructive ways and methods directed at supporting the family find itself in crisis, and ensure that they do not try inappropriate methods of coping (Hewett et al. 2012, p.6). As is the case of James, individuals with learning disabilities may not appreciate or understand the importance of a healthy lifestyle and the significance of health screening or appreciate symptoms or signs of ill health (Moulster, Ames, and Griffiths 2012, p.20). In order to address this scenario, the nurses caring for James should ensure that James enjoys opportunities to learn about his health. Furthermore, the nurses caring for James should ensure that information is provided in ways take James’ communication difficulties into account. The nurse should develop James assessment n partnership with individuals with the client as the subject may experience communication difficulties, or manifest unappreciated levels of perceptual or cognitive dysfunction. The model of approaching nursing intervention manifests a number of strengths given that: the subject remains an active participant and remains the core focus of the intervention (Seale and Nind 2010, p.12). Furthermore, the client should be viewed as dynamic with ever-changing needs and the process of nursing judgement is rendered explicit and integrated into the assessment process (Zeedyk, Davies, Parry, and Caldwell 2009, p.186). Healthcare and social care practitioners should work out the “right and wrong” actions in their relationships with individuals with a learning disability. Concerns remain on consent sought from nurse rather than taking the time to gain consent from individuals with the learning disability. Autonomy and individual freedom are core concepts in working ethically with individuals manifesting learning disabilities (Willner 2005, p.73). Autonomy can be considered as the guiding ethical standard that underlies nursing intervention for individuals with learning disabilities. Autonomy relates to aiding individuals to self-determine their own actions and plans. Autonomy is awarded preference within the UK over alternative ethical principles and is core to the legislative framework, as well as the philosophy in learning disabilities via the values of independence, choice, rights, and inclusion. The limitations that some individuals with learning disabilities encounter in the course of decision-making are well recognized and documented. Hence, carers should be aware of the fact that the ethical frameworks are not in themselves irrefutable, and there may be alternatives to the assumption that autonomy is the most significant ethical principle. The Mental Capacity Act 2005 outlines the grounds and process of making decisions in the client’s best interests, especially for individuals who cannot do so by themselves. Hence, on matters regarding capacity, the onus is not with the individual learning disability. The entire framework can be deemed to come into effect only instances in which the carers have doubts on the subject’s capacity. Aiding individuals with learning disabilities to make their own choices can be highlighted as one of the central tenets of a value base emanating from normalization. In order to foster empowerment and effective decision making, the process should occur as close to the subject as possible and should be undertaken by individuals and those immediately around the subjects. The code of ethics outlines the ethical obligations and duties for nursing professionals based on the shared beliefs that nursing encompasses the prevention of illnesses, alleviation of suffering, promotion, protection, and restoration of health. Intrinsic in nursing practice is the respect for both cultural and human rights, the right t life and choice and the right to dignity and treatment of clients with respect. Nurses have personal responsibility and accountability for the nursing practice, and for sustaining competence by continual learning (Hooren, Widdershoven, Borne, and Curfa 2002, p.560). Nurses, as professionals, should enjoy the capability and power to work autonomously and take responsibility for their own standards of practice. Conclusion The nursing assessment, coupled with the identification of an individual’s health needs is usually a complex and multidimensional process. It is essential to give people options, instead of making demands as this can allow clients to make choices that influence their own lives and environment, which in turn, can play a big role in making a difference to the quality of life and behaviour. Individuals with learning disabilities can be regarded as one of the most vulnerable groups in society. People with learning disabilities are at risk of abuse and neglect by both institutions and individuals. Studies indicate that individuals with learning disabilities manifest greater healthcare needs, relative to the general population, and most of these needs are unmet. Majority of people with learning disabilities manifest complex needs that can include sensory and/or physical impairments, challenging behaviour, and mental health needs, which require the nurse to be capable to avail a skilled assessment, intervention and care planning References List Biswas, A. B. et al. (2010). Obesity in people with learning disabilities: possible causes and reduction interventions, Nursing Times, 106, pp.31. Bittles, A. M. et al. (2002). The influence of intellectual disability on life expectancy. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(7) pp.470-72. Camden, S. (2009). Obesity: An Emerging Concern for Patients and Nurses, OJIN: The Online Journal of Issues in Nursing,  14 (1). Department of Health (2009). Valuing People Now: A New 3 Year Strategy for People with Learning Disabilities, London, Department of Health. Pp.4. Emerson, E. & Einfeld, S. (2011). 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