General Hospital Care for People with Learning Disabilities

Lynn Hannon is currently Head of Employment Services at East Lancashire PCT, formerly Nurse Manager of the Specialist Community Nursing Service for people with a learning disability, and a Florence Nightingale Scholar. Julie Clift is Community Nurse Specialist Learning Disabilities/Acute Liaison at NHS East Lancashire Community Services and Lecturer Practitioner for the University of Cumbria.

Preface vii Acknowledgements ix

1 Understanding Learning Disability 1

Introduction 1

Definitions and causes of a learning disability 2

How to establish if your patient has a learning disability 9

Perceptions and attitudes towards people with a learning disability 10

Health needs of people with a learning disability 15

Family/carer's needs 30

Introduction to person-centred approaches 32

Conclusion 35

References 38

2 The Process of Health Care 40

Introduction 40

The patient journey 41

Pre-admission 53

Care planning and developing care pathways 68

Intervention and treatment 71

Liaison and discharge planning 78

Conclusion 80

References 83

3 Communication 85

Introduction 85

What is communication? 86

Models of communication – verbal and non-verbal 90

Developing relationships with people with a learning disability 93

Communicating with people with a learning disability 98

Tools to aid communication 109

Helping people with learning disabilities to make choices 118

Communicating with family and carers 123

Conclusion 124

References 125

Introduction 127

What do we mean when we say a person displays challenging behaviour? 128

What could different behaviours mean? 130

How hospital admission can affect individual behaviour and ways of overcoming this 135

How to respond to behaviour in health care situations 137

The use of behavioural indicators in the assessment of pain 152

Risk assessment 159

Conclusion 160

References 165

5 Consent 167

Introduction 167

What do we mean by consent? 167

Ethical decision making 169

The law on consent and capacity to consent (in England and Wales) 172

Defining capacity 177

Obtaining consent 181

Advocacy and empowerment 188

Planning for future care 189

Emergency situations 190

What to do when consent is refused 190

Record keeping 193

Conclusion 194

References 197

6 Ethical and Political Aspects of Care 198

Introduction 198

Health care ethics and professional accountability 198

Safeguarding children and vulnerable adults 208

Cost 213

Values and beliefs 214

Political issues affecting service provision in both learning disability and secondary care services 217

Interdisciplinary approaches and partnership working 224

Where do we go from here? 230

Conclusion 232

References 237

Useful Websites and Contacts 239

Index 246