Communicating within the Learning Disabilities | Reflection

(1) Area of Reflection :

Communication

Insight Area

Learning Disabilities

Your reflection

Communicating within the Learning disabilities area of nursing is a very complex task which encompasses multiple barriers such as blindness, selective mutisim and deafness. Moreover this can be even further complicated by culture, language barriers. Consequently it is imperative when embarking upon building a solid foundation with patients in this field communication is planned and catered to suit the patients strongest areas of communicating. I had a placement within an adult education centre with learning disabilities; I felt this placement offered me development and growth which after interacting with the service users eventually evolved in quite a progressive manner. I worked with a particular serve user called Frank – patients name has been changed for reasons of confidentiality (NMC, 2002). Frank had selective mutisim, he was either unable to or just made the choice to ignore certain conversations or people. Initially I found this very challenging as Frank was very frustrated by the lack of understanding towards him, I looked at other ways to communicate in a respectful, comfortable way that would suit Frank. Mencap (2008) Guide to Communicating with people with a learning disability. Communication is made up of 55% body language, 38% tone of voice and 7% words. After trial and error and through seeking advice from mentors I ascertained that body language was key to communicating with Frank, he used body language to deduce what was being asked of him. Furthermore I learned the basics of Makaton adequate enough to accomplish a positive relationship between Frank and I, Makaton was developed in the early 1970’s with 350 core signs (Bunning, 2004). This specific type of communication was beneficial as Frank needed to concentrate and focus on me for the reason that when using Makaton sign, a whole sentence is not signed, only key words.

Reference List

Nursing and Midwifery Council (2002) Professional Code of Conduct [online]. London. Available from:

http://www.nmc-uk.org/Documents/Archived%20Publications/NMC%20Archived%20Publications/Code%20of%20Professional

%20Conduct%20April%202002.PDF

Mencap (2008) Communicating With People With a Learning Disability [online]. London: Golden Lane. Available from:http://www.mencap.org.uk/sites/default/files/documents/Communicating with people

_updated.pdf [Accessed 20/05/2014]

Bunning, K. (2004) Implementing Values-Based Support: Let me speak – facilitating communication. In: Atherton, H & Crickmore, D Learning (ed.) Learning Disabilities Toward Inclusion 6^th ed. Philadelphia: Churschill & Livingstone, pp.91-113

(2) Area of Reflection :

Clinical Care / Service Delivery

Insight Area

Mental Health

Your reflection

Dealing with a mental health issue when you are trying to deliver care is a very challenging area when you are focussing on the medical issues at present. Often the delicacy of the individuals needs can be overlooked which can aggravate a patient suffering with their Mental Health. Centre of Mental Health (2012) claims that services will tackle physical and mental health issues supporting those with a dual diagnosis. I was attending to a particular patient who had self-harmed and was suffering with a bipolar disorder. His behaviour was erratic and hard to control, he would lash out at staff and due to his confusion he became quite angry towards staff. As a team we put measures in place to manage the patient, such as a 1-1 nurse and enlisting the psychiatric team to advise on correct procedures. Working as part of a Multidisciplinary team we put a care plan in place to understand the needs of the patient and adapt our clinical care to cater for the needs of a patient with a bipolar disorder. We found that the patient became co-operative and eventually we were able to build a rapport with the patient. The Department of Health (2012) highlights that mental health problems should be treated just as seriously as physical health problems to enable a more sufficient service delivery to patients.

As a team we learned from our psychiatric team colleagues about mental health service delivery and made the environment a safer calmer environment to the benefit of other patients and staff.

Reference List

Centre of Medical Health (2012) No Health without Mental Health: Implementation Framework [online] Available from:https://www.gov.uk/government/uploads/system/uploads/attachment_data

/file/156084/No-Health-Without-Mental-Health-Implementation-Framework-Report-accessible-version.pdf.pdf [Accessed 20/05/2014]

Department of Health (2012) Health and Social Care act 2012: Fact Sheet [online]. London: Department of Health. Available from: https://www.gov.uk/government/publications/health-and-social-care-act-2012-fact-sheets [Accessed 20/05/2014]

(3) Area of Reflection :

Safeguarding / Advocacy /

Risk Management

Insight Area

Care of The Elderly

Your reflection

In a document the Department of Health published called No Secrets (2002), the term ‘vulnerable adult’ is someone aged 18 or over who may be in need of community care by reason of mental or other disability, age or illness; who may be unable to take care of him or herself, or unable to protect him/herself from significant harm or exploitation. I have chosen to focus on a patient in this reflective piece who claimed financial abuse from her daughter. Abuse can occur in a person’s home, in hospital or care home (Age UK, 2013). ‘Martha’ had been admitted to the ward with a fractured neck of femur and early dementia. He lived alone with home help coming in three times a day. After Martha’s operation, a Multidisciplinary meeting was conducted in order to discuss discharge plans. Occupational therapists (OT) assessing Martha said she wanted to go home with carers as long as the appropriate equipment had been put in place. However, the son wanted Martha in a nursing home as he said he would not cope at home with his dementia. Walter however refused this option as he was fully compos mentis. Walter disclosed to the OT that his son wanted him in a home so he could have the house. As time went on during Walters hospital stay, nurses noticed his son would not come in to visit, but would ring in the morning to see how Walter got the night. It was clear to see that action needed to be taken to protect Walter from the financial abuse.. This has enabled me to be able to identify such indications of abuse.

Reference List

Age UK (2013) Safeguarding Older People From Abuse [online]. Available from: http://www.ageuk.org.uk/health-wellbeing/relationships-and-family/protecting-yourself/ [Accessed 20/05/2014]

Department of Health (2000) No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse [online]. London: The Stationery Office. Available from: http://www.elderabuse.org.uk/Documents/Other%20Orgs/No%20Secrets.pdf [Accessed 20/05/2014]

(4) Area of Reflection :

Organisational aspects of service provision

Insight Area

Maternity

Your reflection

It is important to treat patients as partners in their care and helping them understand the continuity of care in promoting safety long after they have give birth. The journey of pregnancy can be very daunting and can leave both mothers and fathers-to-be anxious as to what support is offered after baby is born. One particular family I was introduced to while on placement were expecting their first child. No matter whether it is your first or third, pregnancy can be a very anxious time. Dues to the fact they were first time parents, they didn’t know what services were available to them. A document published by The House of Commons (2003) highlights the various services available to parents stating that they have choices as to how and where they wish to have their baby. The Maternity Services Reform published in 2005 highlighted The Changing Childbirth report (1993) by the House of Commons recommended an increased involvement of midwives in maternity care with a development of their roles and a greater patient choice over where they wish to deliver. In conjunction with this report, it is not necessary to visit your GP when you find out your pregnant. There are community Midwives on hand in local clinics that will help you and guide you through your pregnancy. This particular couple informed their GP that the woman had fallen pregnant and therefore referred her to the community midwife within the local clinic. Overall, this broadened my knowledge into how care is co-ordinated within the community setting between GP’s, Midwives and health visitors.

Reference List

The House of Commons (2003) Provision of Maternity Services [online]. London: The Stationary Office. Available from: http://www.publications.parliament.uk/pa/cm200203/cmselect/cmhealth/464/464.pdf [Accessed: 20/05/2014]

Bosanquet, N et al. (2005) Maternity Services Reform [online]. London. Available from: http://reform.co.uk/client_files/www.reform.co.uk/files/maternity_services_in_the_nhs.pdf [Accessed: 20/05/2014]

(5) Area of Reflection :

Government Initiatives

Insight Area

Child Nursing

Your reflection

Recently, we had a young boy suffering from Diabetic Ketone Acidosis. He was non-compliant with his insulin regime. He stated to me ‘He only wished to be like every young teenager’. When treating him on an adult ward, it is important that I respected his right to confidentiality as there were many things he wished for his parents not to know. In addition, you must be especially attentive to the needs of young people (NMC, 2012) as they are very sensitive in unfamiliar settings such as hospitals. This particular young boy felt alone on the ward and therefore confided in me because I was not much older than him. During his time in hospital, it was vital to organise the appropriate community care as he suffered from various long term conditions and he said he felt he had not received enough support from the community services. Community Children’s Nursing Services published by the Department of Health (2011) highlights that to improve the experience of young people; care needs to be delivered through not only primary and secondary services but through to the transition to adult services. In addition, it was vital the various support and services were in place for discharge. His care was liaised with community diabetic specialists, cardiology specialists, social services and community matrons. Not only was personalised care on hand for him, but for his parents too so they could put being a parent first and being his carers second. These various initiatives meant this young boy could possibly live as normal a life as possible with the community support offered to him and not have to face the frequent disruption being admitted to hospital every weekend.

Reference List

Department of Health (2011) NHS at Home: Community Children’s Nursing Services [online]. London. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147415/dh_124900.pdf.pdf [Accessed: 20/05/2014]

Nursing and Midwifery Council (2012) Working With Young People [online]. NMC. Available from: http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/Advice-for-nurses-and-midwives-working-with-young-people/ [Accessed: 20/05/2014]