Learning Disability Nurses Research Articles

Learning disability: dimensions of professional empowerment

In contemporary nursing, the term 'empowerment' has forged a firm position in the language of professionals. It is often used as a politically correct word to describe clients' outcomes and nursing practice. The inevitable link between the lifestyles of people with learning disabilities and learning disability nursing has bound the differing ideologies of empowerment to provide a central theme for learning disability nursing practice. However, with little evidence of critical analysis of nursing practice and discourses, the notion of empowerment remains controversial and nebulous. The continual search of the learning disability nursing profession to ensure its contribution fits the ethos of the day, challenges it to enter the empowerment debate. Within this debate nursing must actively clarify whether it has a reactive or proactive part to play.This paper's primary aim is to discuss professional empowerment within the context of learning disability nursing practice. A shift in power between the social and health care interface raises questions about how nursing will develop and use its power. A conceptual framework of professional empowerment is offered to enhance the understanding of learning disability nursing. It focuses on the interface and boundaries in learning disability practice and includes: (a) the micro layer- practice within an enclosed boundary; (b) the meso layer - opening the boundary; (c) the macro layer - the sociopolitical realities. This framework provides learning disability nursing with a world view of practice that is dynamic and challenges nurses to transform it further.

Learning disability nursing: reflections on history

Recently, much has been written about the present and future of learning disability nursing in the UK but its past has been relatively neglected. This paper attempts to address this by recording an aspect of the history of learning disability nursing. The paper argues that learning disability nursing needs closer attention than it has previously received from historians of nursing. Documentary sources from the 1920s and 1940s are used to examine the relationship of learning disability nursing with the rest of the nursing profession. This paper represents part of a more comprehensive postgraduate study in progress. The two decades identified and reported on have been used because they are pivotal in understanding the marginalization of learning disability nursing within the profession of nursing. The paper concludes that by understanding their past nurse practitioners may more meaningfully place their contemporary practice in the context of a continuum of constant change.

Complementary therapies in learning disabilities: examining the evidence

Demand for alternative and complementary health care is both 'patient' and 'practitioner' generated (The Times 1996). In nursing the opportunities to improve individualized patient care through the appropriate use of such therapies appears to be a motivating factor in their use. Much of the nursing literature available focuses on the use of complementary therapies in general hospital settings and clinical practice. However, there is evidence of the use of such therapies by community nurses and in particular, learning disability nurses. Therapies considered to be of benefit in the care of people with learning disabilities are those therapies that use a 'hands-on' approach such as aromatherapy, massage, and reflexology. An examination of nursing literature and research suggests a range of different therapies is being explored by nurses within their practice, and that some evaluation-seeking evidence of effectiveness is being conducted. Aromatherapy in particular has received some attention from nurse researchers, and the evidence suggests that both a therapeutic and an experimental effect can be detected. It would appear that for people with learning disabilities the combination of the factors of oils, massage (touch) and therapist-client interaction can provide a beneficial therapeutic experience.

The changing emphasis of mental health and learning disability nurse education in the UK and ideal models of its future development.

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.

Thriving enterprise.

David Coyle and Mick Fisher describe how learning disability nurses in Wales set about selling their specialty in an increasingly competitive environment

Learning disability nursing: a position paper

Learning disability nurses in the UK have received unprecedented attention over the past 5 years in response to anxieties about their role. The problem has been conceptualized as being the inability of nurses to articulate their contribution to meeting the needs of people with learning disabilities and a lack of evidence of their effectiveness. This paper proposes that, although nurses are valued for their contribution individually in services, they are working within devaluing systems which have created conceptual and strategic uncertainty about learning disabilities generally. In order to move forward, nurses need to understand the ways in which these systems exert their influence. It is proposed that if three broad aims for the profession are pursued this will help improve practice whilst simultaneously helping nurses feel more secure about their contribution in the field of learning disabilities.

Future directions for learning disability nursing.

Over the past decade learning disability nurses have had to make many changes in the way they practice. Changes in attitude towards the way in which people with learning disabilities are cared for has meant that nurses have had to adjust their practice to address different expectations in the way these services are delivered. Nursing now provides opportunities for people with learning disabilities to express themselves and become involved in decision-making that affects their lives. For nurses this is a totally new way of working with this client group. Learning disability nurses have risen to the challenge that has resulted from moving into community care and forming links with primary healthcare teams.

Addressing barriers: disabled rights and the implications for nursing of the social construct of disability.

Drawing upon the writings of disabled people, this paper explores some of the issues which nurses working with disabled people are trying to address, in particular the barriers model of disability. Traditionally disability has been regarded as a personal tragedy afflicting the individual, hence the response to disability has been via the charity, health and welfare systems. Disabled people over the past two decades have substantially challenged this view of disability and the responses it prompts, arguing that disability is created by social barriers and barriers in the built environment. This requires a different response. Nurses working with disabled people, such as learning disability nurses, have struggled to develop more appropriate responses to disability, for example by developing working alliances with people with learning difficulties in order to both promote health and address disabling barriers. The issues these nurses face and some of the lessons disabled people have taught them are relevant to the nursing profession's wider struggle to shed its medical and dependency image.

Learning disability services undervalued

Organisations that wish to attract and retain learning disability nurses and other professional groups (News February 19) need to encourage staff who want to come and want to stay.

Leadership in learning disability nursing.

The changing leadership role of nurses caring for people with learning disabilities is discussed by Phil Boulter and Helen Cook

Learning disability nurses up to challenge

Learning disability nurses up to challenge

Learning disability nursing and primary healthcare.

This article addresses the issues surrounding the role of learning disability nurses and their relationship with primary healthcare colleagues. It highlights opportunities in general practice for the learning disability nurse who has become a key player in shaping services for this client group as services swing towards primary healthcare. The NHS Executive document NHS Priorities and Planning Guidance 1997-98 is explored and the opportunities that this gives the community learning disability nurse are discussed. The article stresses the need for learning disability nurses to obtain quality research-based evidence on effective caring interventions. The importance of clinical audit and outcome measurements from interventions are highlighted. Finally, the importance of good communication and being able to respond to this client group's needs is emphasized.

The developmentof the generalist nurse within preregistration nurse education in the UK: some points for consideration

A major difference between preregistrationnurse education in the UK as distinct from most other European countries is the existence of discrete branches of nursing. The package of four specialty areas of adult nursing, children's nursing, learning disability, and mental health nursing do not exist at preregistration level in the majority of other European countries. The Republic of Ireland offers pre-registration education in general, mental health and learning disability nursing, and not children's nursing. Intergovernmental support was givento the idea of a generalist nurse in 1988. Such a change in nurse education in the UK would have major implications for patients, nurses and the nursing profession, and requires careful consideration by all nurses in education and practice. This paper presents some of the keyarguments for and against the adoption of a generalist approach to pre-registration nurse education in the UK.

Nurses 'deskilled' in transfer to homes

MORE THAN 100 learning disability nurses in Cumbria will be re-labelled as support workers when they transfer to community homes after the closure of a Scottish hospital.

Sexuality and people with learning disabilities.

Despite the excellent pioneering work of the Family Planning Association and Brook Advisory Centres, sexuality and people with learning disabilities remains a largely unexplored area (Brandon, 1990). This article highlights the need for such individuals to receive sex education alongside social education. It is proposed that learning disability nurses are the most suitable health-care professionals to be the primary educators on such issues because of their expertise and unique relationships with their clients.

Empowering consumers: the caring challenge.

This article considers current issues relating to power relationships that exist between learning disability nurses and their clients. It examines the changing role of learning disability nurses and considers their influence on enhancing the quality of life for people with learning disabilities, whose autonomy and right to decision making has been consistently challenged throughout society.

Impaired autonomy–the challenge of caring

The aim of this paper is to present an informed argument in favour of changing power relationships between learning disability nurses and their clients and to do so through an examination of the influence that they have on quality of life issues for people whose autonomy is impaired. The challenge of empowerment and enhanced autonomy is considered to be at the 'cutting edge' of the learning-disability agenda with its increasing focus on the provision of supported living opportunities for clients in the community. Features related to institutional methods of care delivery continue to exist in some services and as a result clients may still be expected to conform to the dominant themes of time, order, control and regimentation. The application of social and environmental engineering techniques to the field of learning disability care is prerequisite for the development of more positive alternatives to the mental-handicap hospital as a focus for care provision. The main requirement for persons whose autonomy is impaired will be the promotion of equal power sharing between clients and carer. This process will involve a number of transactional considerations such as advocacy, risk taking and shared action planning. The emergence of a new paradigm for nursing practice will result in the solution for shifting the balance of power in the emergent world of consumerism for clients whose autonomy is impaired.

Call to employ learning disability nurses

The government should put pressure on trusts and health authorities to employ learning disability nurses or the ‘ghetto’ will persist, a health department conference on the future of the RNMH heard last week.

CNO backs learning disability training.

Concerns that the mental handicap branch of Project 2000 could be dropped have been quashed by the Chief Nursing Officer Yvonne Moores, who last week announced her support for learning disability nurses.

A profile of learning disability nurses.

Profiling exercises provide vital data for effective and efficient deployment of resources and for monitoring the development of services. A survey, focusing solely on community nurses for people with learning disabilities in Northern Ireland, was carried out in 1992. The findings showed, among other things, a higher caseload per nurse than the UK average. While more than half the workforce had multiple qualifications there was a lack of clinical specialist training.