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Roles and Duties Adult and Learning Disability Nursing

District nurses work within the primary health care team. They support patients at home or in residential care. They also provide a teaching role by enabling patients to care for themselves or by helping family members learn to care for their relatives. (NHS, 2011)

Nurse consultants spend at least of 50% of their time working in direct contacts with patients. They are highly trained and are responsible for developing personal practice. They are involved in research, development and teaching. (NHS, 2011)

Specialist nurses are also known as clinical nurse specialists. They specialise in a specific area of nursing, for example, patients suffering from diseases such as cancer, diabetes or viruses. . Some clinical nurse specialists also have a teaching and advisory role. They may also be involved in advising medical and nursing staff about caring for patients with particular conditions and/or in teaching nurses and other professionals. (NHS, 2011)

Practice nurses work in a GP surgery and are part of a primary healthcare team, which involves other health professionals such as doctors and dieticians. In larger practices, there may be several practice nurses sharing duties and responsibilities but in smaller ones, you’d be working on your own, taking on many roles (NHS, 2011).

Asthma is a long-term condition that can cause a cough, wheezing and breathlessness. Asthma can be well controlled in most people most of the time. When a person with asthma comes into contact with something that irritates their airways (an asthma trigger), the muscles around the walls of the airways tighten so that the airways become narrower and the lining of the airways becomes inflamed and starts to swell. Sometimes sticky mucus or phlegm builds up which can further narrow the airways (NHS, 2011). Salbutamol is a beta 2 agonist. Salbutamol works by acting on receptors in the lungs called beta 2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open. Side effects of these types of medication can include nervousness, tremor and headache. (BNF, 2011)

Angina describes the pain and chest tightness - and sometimes breathlessness or choking feeling - caused when blood flow in the arteries that supply the heart is restricted (BUPA, 2011). Glycerol Trinitrate can be helpful in reducing angina attacks, rather than reversing angina started, by supplementing blood concentrations of nitric oxide. Side effects from Glycerol Trinitrate include, headache, dizziness, and diarrhoea, feeling sick and flushing (BNF, 2011).

Congestive cardiac failure is something that happens when a heart does not have enough strength to pump blood around the body properly; this leads to fluid collecting inside the lungs and body tissue, which then leads to congestion. It tends to affect older people. It is a long term condition and can be managed with medication and changes in lifestyle. One of the treatments available for use in congestive heart failure is Furosemide, which is a diuretic. Diuretics get rid of excess fluid and salt from a patient’s body, but in turn the body produces extra urine. They reduce swelling in ankles, make breathing easier and potentially increase life expectancy.

Cerebrovascular accident is the medical term for a stroke. The World Health Organisation (WHO) states that: ‘A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.’ Aspirin is used in both the treatment and in the prevention of strokes. It works by thinning the blood, therefore reducing the risk of clots. Common side effects include stomach problems such as vomiting and pain. Long term effects can be serious and include a small risk of internal haemorrhage, which could lead to death.

Diabetes is a condition in which the body produces too much glucose as a result of a decrease in the amount of insulin that is present in the body. In a healthy individual the pancreas produces insulin which helps to regulate the amount of sugar that remains in the blood stream. In the body of someone with diabetes there is not enough insulin in the blood stream to break down glucose and create energy. There are two types of Diabetes known simply as Type 1 and Type 2. In Type 1 diabetes the body is unable to create insulin on its own and is diagnosed generally during youth mainly during the teenage years. It is very uncommon as it is an inherited trait and only 5-10% of all people who suffer from diabetes fall into the Type 1 category. With type 2 diabetes, the illness and symptoms tend to develop gradually. This is because in type 2 diabetes you still make insulin (unlike type 1 diabetes). However, you develop diabetes because: you do not make enough insulin for your body's needs, or the cells in your body do not use insulin properly. This is called 'insulin resistance'. The cells in your body become resistant to normal levels of insulin. This means that you need more insulin than you normally make to keep the blood glucose level down, or a combination of the above two reasons. Diabetes is associated with short term problems such as hypoglycaemia which can lead to death and many long term health issues which can develop as a result of the illness. The risk of these potential health problems can be reduced through lifestyle and diet management. Synthetic Insulin is used in the treatment of type 1diabetes in a carefully planned insulin therapy programme to replace the insulin that has not been produced by the pancreas. The longer a person has type 2 diabetes the greater the risk that they will have to start insulin therapy at some point throughout their lives.

Appendectomy - Removal of Appendix in cases of acute appendicitis.

Total Knee Replacement - Replacement of the whole knee joint. Used to treat severe knee pain, trauma, long term arthritis and mobility problems.

Coronary Artery Bypass Graft - A surgical procedure used to treat coronary heart disease. It diverts blood around narrowed or clogged parts of the major arteries, to improve blood flow and oxygen supply to the heart. 

Total Mastectomy - A total mastectomy is also known as a simple mastectomy. It is a procedure that removes all of the breast tissue of an affected breast. The most common form of the surgery, referred to as traditional total mastectomy, includes the removal of the areola and nipple. However, the surgery can be performed using skin and nipple sparing techniques. It also leaves the muscle under the breast left intact.

Prostatectomy - A prostatectomy is the surgical removal of all or part of the prostate gland. Blockages like tumors of the prostate can affect the normal flow of urine in the urethra. A prostatectomy can help with this.

Laparoscopy - A laparoscopy is a surgical procedure that is carried out using a laparoscope which is a small, flexible tube with a camera on it. Using a laparoscope means that a surgeon can access the inside of the abdomen and the pelvis without the procedure being invasive because large cuts are not needed; Sometimes known as keyhole surgery.

According to The department of Health (2005) MRSA stands for Meticillin Resistant Staphylococcus Aureus. It is a very contagious strain of the Staphylococcus type of bacteria. It can cause many different infections and some of these can be very serious. About 3% of the population are known carriers of MRSA and it can be transmitted by a carrier to another person or themselves through an open wound or into the blood steam. In order to reduce the risk of infection of MRSA healthcare workers can practice proper hand hygiene and they can encourage patients to wash their hands after going to the toilet. Gloves can also be used with known carriers.

The Department of Health (2007) explains that Clostridium Difficile is a bacterium which is the major cause of antibiotic-associated diarrhoea and colitis, an infection of the intestines. It most commonly affects elderly patients with other underlying diseases. It is present in a small proportion of the population but is usually kept in check by the good bacteria. When this good bacteria is not present illness develops. People who have been treated with antibiotics are most at risk. The disease can be spread by healthcare workers, therefore washing hands after contact with a patient can help prevent the spread and reducing the use of antibiotics can help reduce the harm that the bacterium can cause.

Adult nurses work with old and young adults with a variety of health problems, chronic and acute. They are involved in many roles including caring, counselling, managing and teaching to improve the quality of a patient’s life, often in challenging situations. Adult nurses can hold positions at most levels of the NHS career framework. Adult nurses work at the centre of a multi professional team that can include doctors, physiotherapists, occupational therapists, pharmacists, radiographers, healthcare assistants and others workers. They assess, plan, implement and evaluate care for individual patients. Adult nurses can work in both hospital and community settings.

Learning Disability Nursing

The World Health Organisation defines learning disabilities or LD as: “a state of arrested or incomplete development of mind”. Learning disabilities is an umbrella term encompassing a range of disorders and deficits that create problems for an individual in relation to learning. People with LD often have physical problems that go hand in hand.

Learning disabilities are often diagnosed by psychologists, through a combination of intelligence testing, academic achievement testing, classroom performance, and social interaction and aptitude. Other areas of assessment may include perception, cognition, memory, attention, and language abilities.

IQ or Intelligence Quotient is an attempt to measure intelligence using standardized tests. According to the British Institute of Learning Disabilities (2006) it is often used to classify the level of intellectual impairment in someone with learning disabilities. Below 20 would be classed as a profound learning disability; 25 to 35, Severe; 35 to 50, Moderate and 55 to 70, Mild.

Errors in fetal development. Problems during pregnancy. Toxins in the child’s environment. Tobacco, alcohol and other drug use. Genetic factors.

According to the British Institute of Learning Disabilities (2006), between 1 and 2 percent of the UK population have a learning disability.

According to Autism.org.uk, autism is a developmental disability that lasts for a lifetime. It affects how they make sense of the world around them and how they communicate and relate to other people. It is a spectrum condition so even though people with autism share difficulties, their condition will be personal to them and will affect them in different ways. People with autism sometimes experience over- or under-sensitivity to sounds, touch, tastes, smells, light or colours.

According to the NHS (2010) Epilepsy affects the brain and can cause repeated seizures, also known as fits. Epilepsy usually begins early in someone’s life, although it can potentially start at any age. The severity of the seizures can vary in different people. Some may experience a ‘trance-like’ state for a short time, while some others lose consciousness completely and have convulsions where they shake uncontrollably.

Down's syndrome is a genetic condition where a person inherits an extra copy of one chromosome. This additional genetic material can result in characteristic physical features such as a flatter than normal face and also intellectual features which can vary from moderate to severe LD.

Cerebral palsy is not a learning disability, but is common to have a LD if you also have cerebral palsy. It is a physical condition that affects the movement and control of a body. It is caused by a lack of development in part of the brain during pregnancy or childhood. The severities of problems are dependent on which part of the brain is affected (Mencap, 2010).

When talking about people with LD, dual diagnosis refers to the comorbidity of learning disabilities and mental health problems. People with LD often suffer with depression or anxiety.

It is important for nurses to be aware of the common conditions in LD because they can easily be missed if they are not actively looked for. It can be much more difficult for someone with LD to communicate a problem with their health and also, symptoms can be missed due to diagnostic overshadowing which means that secondary illnesses are missed because the symptoms are mistaken to be related to the primary disorder.

Most people with LD live at home with help from families and day care services.

Care for people with LD is often provided by family members with support from a range of healthcare workers and professionals such as nurses, psychologists, speech therapists, physiotherapists and specialist behavioral therapists; healthcare assistants and day workers.

Direct payments are made by councils to people receiving social care services, instead of the council providing the service directly (direct.gov.uk).

LD nurses work in a variety of setting which include the home, family, adult education, education for young people and community/residential settings (NHS Careers Website).

Social Role Valorisation is the name given to a concept formulated by Wolf Wolfensberger, Ph.D in 1983 which follows the principle of normalisation. Normalisation is a set of principles that underlie the idea that people with a learning disability should live in ordinary places, doing ordinary things, with ordinary people: essentially experiencing the ‘normal’ patterns of everyday life.

The five service accomplishments identified by O’Brien and Tyne (1981) were: Community presence; Relationships; Choice; Competence; Respect.

Person Cantered Planning is way of seeing and working with all people with disabilities. It helps people with disabilities plan and organise their future in a more ordinary way. Fundamentally the person is at the centre and family members and friends are made full partners in the plan. The plan should reflect what is important to the person and the capacities that they have. It should also help a person to make a valued contribution to society.

People with learning LD have been referred to as patients, clients and service users. Service user is the current term used within healthcare but the term client is still used by some and probably depends on who you are talking to.

The four principles of the 2001 white paper ‘valuing people’ are: right, independence, choice and inclusion. Right means that people with learning disabilities should have the same rights and choices as everybody else. Independence means the people with LD should be helped to live lives that are as independent as possible. Choice means that people with LD should be empowered to have choice in the treatment they receive and the lives that they lead. Inclusion means that people with LD should be included in society, have access to services and helped to gain valued social roles within society.

One of the issues with LD nursing is mental health. People with LD often also suffer with mental health problems. There is a distinct difference between a person having a mental illness and a learning disability,

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