Case Study of Mild Learning Disability and Autism

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Formative assessment

Scenario 1

Patrick is a 28-year-old white Scottish male; he has a diagnosis of mild learning disability and Autism. Patrick has epilepsy, which is poorly controlled with Sodium Valproate (500mg twice daily), and his mood is stabilized using Citalopram (20mg daily).

Patrick lives in shared accommodation, he shares with one housemate. The housemate has only recently moved into the accommodation following placement by the local authority. The house receives visiting support each day for four hours; Patrick receives an additional 10 hours per week at a local day service provision on top of his housing support, Patrick seems to enjoy this. Patrick receives benefits to support his daily living. Patrick lives in Edinburgh and sees his parents (who moved to Newcastle to be closer to their new grandchild) on his birthday.

Patrick spends some time online, using social media pages to introduce himself to new people; it was through Facebook that he met a woman who he know refers to as his girlfriend.

Patrick eats a traditional Scottish diet, his favourite food is macaroni and cheese, and he drinks six cans of Irn Bru a day and has a lager on Fridays and Saturdays. His BMI is 27. Patrick smokes but does this outside as the house rules dictate he is unable to do so inside

Patrick has become withdrawn from his usual activities and is refusing to take his medication; as a result, he is becoming more aggressive, verbally and physically towards staff and his housemate. The staff team have been advised that they are within their rights to press charges against Patrick if they choose, as the company operates a zero-tolerance policy towards staff aggression. Support team members are beginning to refuse to work with Patrick as a result.

What are you being asked?

Explore the role of the learning disability nurse in the delivery of high-quality holistic assessment and intervention; consider the use of assessment frameworks and outcome measurement tools to support this.

What is holistic assessment?

The role of the learning disability (LD) nurse in the delivery of high-quality assessment and intervention, involves supporting people, often those with varied and complex needs. The role necessitates a good level of competency in assessment ability, communication skills, and health promotion.

Effective use of assessment is an important nursing skill which provides the foundations for both initial and ongoing patient care. A comprehensive, holistic assessment is the first step of the nursing process. The assessment is then used to inform decisions relating to diagnosis, planning, implementation, and ultimately evaluation.

A holistic assessment considers the person as a whole being, not just their illness, and is carried out in conjunction with health care professionals involved in the patient’s care. It ensures that a person’s whole condition in relation to their physical, emotional, mental, and spiritual health is considered in order to promote positive outcomes.

Why do we use this?

Holistic care increases a care provider’s understanding of the needs of a patient. By using holistic assessment, it enhances the depth of a nurse’s understanding, resulting in informed, evidence-based patient care decisions in determining needs.

It acknowledges the interrelationship of a person’s biological, social, psychological, and spiritual needs in facilitating their well-being. Holistic care includes a wide range of approaches, such as medication, health promotion, self-help, and therapies which are complementary.

What is outcome measurement?

The World Health Organization defines an outcome measure as a “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions” (Serban, 2019)

One such outcome measurement tool is The Health Equalities Framework (HEF). The HEF is an evidence-based, outcome measurement tool which is designed to capture the efficacy of any work LD nurses or other health care professionals undertake to improve the health and well-being of adults with LD. It works by monitoring the relationship and recording the impact of experiences that people with LD have to the determinants of health inequalities. It then monitors the impact and outcomes achieved by services rather than severity of symptoms or level of LD.

Determinants of health inequalities refer to the conditions in which people are born, grow, live, work and age. Positively addressing social determinants of health is important in improving health and reducing health disparities.

Why do we measure outcomes?

Measuring health outcomes helps nurses and healthcare workers make decisions about how to best care for patients. Measuring outcomes identify improvements that have been achieved after a period of intervention, and helps to identify which interventions would be most beneficial to individual patients and which patients would benefit from the support of any particular intervention.

References

Atkinson D et al (2015) HEF+: Health Equality Framework – The Complete Practitioner’s Guide.
Department of Health (2013) Government Response to the Confidential Inquiry into Premature Deaths of People with Learning Disabilities.
Kernohan J (2019) The art and science of learning disability nursing. In: Moulster G et al (eds) The Moulster and Griffiths Learning Disability Nursing Model: A Framework for Practice. London: Jessica Kingsley Publishers.
Kernohan J, Moulster G (2019) An introduction to the Moulster and Griffiths nursing model. In: Moulster G et al (eds) The Moulster and Griffiths Learning Disability Nursing Model: A Framework for Practice. London: Jessica Kingsley Publishers.
Moulster, G., Ames, S., & Griffiths, T. (2012). A new learning disability nursing framework. Learning Disability Practice, 15(6).
Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives, and Nursing Associates.
Rooney, J., Foxall, J., Parkinson, K., Harris, E., Collins, H., & Mariga, P. (2018). An evaluation of the Health Equalities Framework for people with a learning disability. Learning Disability Practice, 21(1), 32-37.
Scottish Government (2015) Strengthening the Commitment: Living the Commitment.
Duff, H. (2016). Health Equality Framework shows promise in improving service users’ well-being. Learning Disability Practice, 19(7), 30-36.
An evaluation of the Health Equality Framework in southeast Scotland. (2018). Learning Disability Practice (2014 ), 21(6), 26-32.
Moulster, G., & Iorizzo, J. (2014). Using a health equality framework to raise well-being. Independent Nurse, 26-28.
An evaluation of the Health Equality Framework in southeast Scotland. (2018). Learning Disability Practice (2014 ), 21(6), 26-32.
Duff, H. (2016). Health Equality Framework shows promise in improving service users’ well-being. Learning Disability Practice, 19(7), 30-36.
Atkinson D, Boulter P, Hebron C & Moulster G.The health equality framework (HEF): an outcomes framework based on the determinants of health inequalities. UK Learning Disability Consultant Nurse Network. 2013. Available at: http://www.ndti.org.uk/uploads/files/The_Health_Equality_Framework.pdf
Emerson E, Baines S, Allerton L & Welch V (2011). Health Inequalities and people with learning disabilities in the UK: 2011. Learning Disabilities Observatory. Available at: http://www.ndti.org.uk/uploads/files/IHAL_2011_healthinequalityguidance.pdf
Emerson E, Hatton C, Robertson J, Roberts H, Baines S, Evison F & Glover G. People with learning disabilities in England 2011. Available at: http://www.improvinghealthandlives.org.uk/publications/1063/People_with_Learning_Disabilities_in_England_2011
Department of Health (DH). Transforming care: a national response to Winterbourne View Hospital, Department of Health review: final report. DH, London. 2012. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213216/easy-read-of-final-report.pdf
Department of Health (DH). Liberating the NHS: Transparency in outcomes: framework for the NHS. DH, London. 2010. Available at: http://www.vsnw.org.uk/files/Transparency%20in%20Outcomes.pdf
Department of Health (DH). NHS patient experience framework. DH, London. 2012. Available at: https://www.gov.uk/government/publications/nhs-patient-experience-framework
Department of Health (DH) Improving outcomes and supporting transparency: public health outcomes framework factsheet. DH, London. 2012.
Scottish Government. Strengthening the commitment: The report of the UK Modernising Learning Disabilities Nursing Review. 2012. Available at: http://www.scotland.gov.uk/Resource/0039/00391946.pdf
Emerson E & Hatton C. Estimating future need for social care among adults with learning disabilities in England: an update. Learning Disabilities Observatory. 2011. Available at: http://www.improvinghealthandlives.org.uk/uploads/doc/vid_10673_IHaL2011-05FutureNeed.pdf
Emerson E and Baines S. Health inequalities and people with learning disabilities in the UK: 2010. Learning Disabilities Observatory. 2010. Available at: http://www.improvinghealthandlives.org.uk/uploads/doc/vid_7479_IHaL2010-3HealthInequality2010.pdf
HSCIC. Learning disabilities census report. 2013. Available at: http://www.hscic.gov.uk/catalogue/PUB13149
Keys to Life (2013)
Strengthening the Commitment: Living the commitment (2015)
Sustaining the Commitment (2019)
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian Journal of Palliative Care, 21(2), 214-224.
Serban, N. (2019). Healthcare System Access: Measurement, Inference, and Intervention. John Wiley & Sons.

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