The main purpose of this essay is to discuss and explore what learning disability is and the experience of accessing health and social professional care. An issue regarding a case of a patient with a learning disability will be dealt with. Identification will be made to discuss the major cultural and social-economic factors that control the health and health options of service user in situation of nursing.
An analysis of the differences in meaning between health education and health promotion will be made. This essay will then demonstrate an understanding of the legislation related to the provision of health and social care and the reason why as a nurse you need to be aware of some certain inequalities in provision. An attempt will be made to describe the challenges inherent in meeting the need of service user changing abilities and social background access to health and social care.
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Finally, this essay will describe the factors that trigger accessing multi - professional health and social care service. Confidentiality will be maintained throughout this assignment in accordance with the nursing and midwifery council (NMC 2008).
LO 1: THE MAJOR SOCIAL ECONOMIC, CULTURAL FACTORS THAT INFLUENCE THE HEALTH AND HEALTH CHOICES
Kenneth is a twenty - four year old Ghanaian gentleman who suffers from cerebral palsy. He lives with both parents and a sister in Hampstead. Housing is another effect that Kenneth family will be facing with regards to poor housing and health related problems like overcrowding in the house. If they live in one bed room flat then there will automatically be no space for Kenneth's equipment to be used, if it has been delivered for his service.
His parents are his main carers and they have a small cleaning company which was given to them by a family member. He has been admitted to hospital at the Sugary ward with loss of control of his posture and balance.
Kenneth has limited communication and breathing impairment mostly in the middle of the night. His family are very much involved with his care as they sometimes respond to familiar faces that come in to deliver care for him. Both of his parents cannot speak fluent English language.
Cerebral palsy is caused by lack of oxygen during labour, an extreme premature injury of infections (scouts, 2008). People with cerebral palsy normally have difficulties in controlling their movement and facial expressions (WHO, 2004).
Culture is the totality of a society's distinctive ideas, beliefs, values and knowledge (DH, 2001). In Ghana where they migrated from, there are 50 languages spoken, so when Kenneth parent came to London they have been depending on translators since English language is not their first language to explain the processes in accessing care for their son and to assist them in attending hospital or GP. If Kenneth's family live in a place where there is no black African background the doctors or nurses will stereotyped against them regarding accessed to treatment. Valuing people shows the entitlement of the basic concern of treatment which Kenneth's family should undertake.
Their lack of understanding to the English language could affect the type and nature of care their son needs without the help of these translators, for instance wrong treatment, medication, wrong diagnosis etc In some cases if the parent does not get the right translator, they might not be able to understand the jargon / health related discussion which will be made during their visit to the hospital or GP. Cultural differences may affect Kenneth parents in a way of them having the wrong treatment, medication, wrong diagnosis due to their lack of understanding and ability to explain their needs.
Valuing people (2001) discriminates against lack of proper health care service for service users. In our society today every individual has their own beliefs, religion and cultural differences. Moreover, Stone (2005) cited that people without any culture normally get stereotyped or prejudged in receiving treatment of care from health care professionals within their own communities.
The NMC (2008) code fight against discrimination based on people believe and preferences in receiving of care. It also states that observation and respect of patient rights should be delivered in all sector of health care. WHO (2009) empowered service users to exercise an increased control over their health and also make healthy choices in order to improve their health.
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Due to Kenneth's illness both parent have given up their work to look after their son which has resulted financial difficulties leading to their inability to provide basic amenities like food, shelter and the ability to participate in society activities (Benz Val et al 1995). Russell (1999) stated that some of the socio-economic factors in life are loss, marital, social isolation, financial problems, joblessness and environmental housing problems. As a result of their financial situation Kenneth's parent could not afford a bigger house for Kenneth and his sister, so there has been dampness and lack of heating during the winter periods, and also overcrowding which has had effect on Kenneth`s health. The lack of space means that they find it difficult o keep their equipments which are meant for health service delivery.
The hospital and the GP they normally visit could seek an NHS interpreter or could use non - verbal communication such as pictures to talk to the family. The family should know the consequences of the flare up emotion and also the choices about where, when and how Kenneth wishes to communicate. The communication should be an approachable level which is respectful of Kenneth's abilities and level of understanding.
Poverty is another effect that has high level on the development on depression and mood disorders. There are a lot of challenges which Kenneth's parent are facing due to his illness, because of the health issues they might not be able to provide the basics necessities such as food, shelter and the ability to participate in society activities . Due to their job loss they might find it difficult to afford a descent house. Benz Val et al (1995).
L0 2: THE DIFFERENCE BETWEEN HEALTH EDUCATION AND HEALTH PROMOTION
According to The World Health Organisation (2001) health is the state of being complete mentally, emotionally, socially, physically, psychologically fit and not just a mere absence of sickness as compared to the case of Kenneth. . The WHO (1986) state that health promotion is the process of enabling people to increase control over their health issues and improving their healthy lifestyle, while Tones et al (2001) cited that health promotion is a seeking intervention that improves health or to prevent disease by the use of the four main concepts which are individual behaviour, lifestyle, social and environmental determinants.
However, it is very important to maintain a good state of well-being in our health condition and people making the right choices in life. In some cases lack of health education and health promotion affect service user with learning disabilities with their decision-making when it comes to their health. The family in this case study would have just arrived in the United Kingdom and automatically feel sick, they might not know where to get access to health care if they do not know anyone in the community.
Guilford et al (2001) developed a model which illustrates the interaction between health care professional and service user with regard to how service user finds it difficult to identify the signs and symptoms requiring medical attention, forcing them to rely on family like Kenneth. This model provides the conceptual framework for literature review.
Due to the level of Kenneth's parent`s educational background, makes it difficult for them to know what benefits available for them, and even how to access them. There are a lot of charities who deal with learning disabilities and even pressure groups where they can go and meet people with similar conditions. Under valuing people (2001) the government stated that service user with learning disabilities should be enabled to get access to a health service designed around their individual needs. This is important for all nurses to know as we can signpost such families in the right direction.
Health Promotion is a joint effort in order to prevent ill-health through risk reduction or to prevent disease from re-occurring and to manifest itself in our society. Health education helps to educate and give information on issues regarding health whiles health education designs risk awareness to prevent disease. Coote (2004) cited that health promotion aims at preventing illness by implementing and monitoring check as well as early intervention to minimise effect.
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Health promotion and health education has a link together thus extremely essential to the sufferer or the service user in having a good level of understanding on skills regarding coping mechanism. Baggott (2004) implicated that as the major cause of death, stress, smoking is behaviourally uncontrolled due to lack of health education.
The other aim of health education will be a preventive goal to improve community health status by increasing a behaviour change. They should educate the health care professionals who will be working with Kenneth about the procedures and process of delivering care. Walsh et al (2005) also concluded that health promotion is the use of different approaches such as medical, behavioural, societal and person-centred approach with people's decision concerning their health.
The WHO (2004) cited that health education is concerned with maximising service user and community potential in terms of their physical, mental and social contribution. Also there are difficulties in determining the nature of such potential except in terms of normative.
Health education is an empowerment access and it therefore combined with public health policies which bring about the promotion of health to individuals. Brown et al (1992) states that health promotion and health education is a vital need for people with learning disabilities as an aim to get over the challenges in using mainstream services.
Health promotion has been divided into three levels thus primary, secondary and tertiary whose specific aims and objectives are in relation to the progress of all ill-health. Primary health care is working with health care workers, GP's and primary nurses for the treatment of illness such as eye examination, dental and ear treatment. Secondary is the early identification of illness, for example when Kenneth visits a GP they might detect infections of all the three illnesses mentioned above. Tertiary is the long-term care and education with a provision of health promotion of those illness that may affect Kenneth. Health care workers should be educated on how to implement or give medications to Kenneth when caring for him.
Ewles (1992) stated that there are five approaches which deliver health promotion thus medical, behavioural, educational empowerment and social change.
LO 3: THE LEGISLATION RELATED TO THE PROVISION OF CARE
A number of legislations have been set up by the government in order to help protect people with learning disability regarding their careers and the service they get from service providers such as nurses, social workers, etc. These legislations are kind of tools set up as guidelines for service providers to follow when it comes to the time of providing care. The legislations are very important and helpful because they help protect and provide care, support, equality and diversity for people in need like Kenneth.
One of such legislations that have been set up by the government to help protect people with learning disability is the Disability Discrimination Act of 1995. The Act aims to protect disabled people and prevent disability discrimination. It first came into force in 1996 as an effort to put a stop to discrimination against disabled people and continued to evolve.
It is an Act that prohibits discrimination against disabled people in a range of circumstances, covering employment and occupation, transport, the provision of goods, facilities and services or the disposal or management of premises, the exercise of public functions and education. It also provides disabled people with legal rights and protection in the areas of buying or renting land or property by making it easier for disabled people to buy or rent a property and for tenants to make disability related adaptation (DOH 2010).
The Act also provides rights for people not to be directly discriminated against or harassed because they have an association with a disabled person. This can apply to a caretaker or parent of a disabled person. In addition, people must not be directly discriminated against or harassed because they are wrongly perceived to be disabled (DOH 2010).
Thanks to this Act because it helps protect people with learning disability when they are receiving care and therefore should not be treated any different from others because of their disability. They should not be discriminated against and should be given the appropriate care needed for their needs. Nurses are therefore required to provide equality of opportunity for their patients and by doing otherwise will be breaking the law and the NMC (2008) code of conduct. This Act is therefore there to enable Kenneth receive care, treatment and support he needs without being discriminated against.
Another legislation that has been set up by the government to help protect people with learning disability is the National Health Service and Community Care Act (1990). It is a piece of legislation which governs health care and social care. It sets out how the National Health Service should assess and provide for patients based on their needs, requirements and circumstances. It also sought to improve services of care in the community.
Enacted on 29 June 1990 the National Health Service and Community Care Act put on a statutory basis two sets of measures: first, many of the provisions of the Working for Patients White Paper, relating mainly to the hospital service and including the legislative framework for NHS trusts and for fund-holding general practices; second, and the theme for this paper, it contained many of the proposals of the Caring for People White Paper about how community care provisions should be restructured for the 1990s (DOH 2010).
In essence the NHS and Community Care act requires local social service and health authorities jointly to agree community care plans which clearly indicate the local implementation of needs-based individual care plans for long-term, severe and vulnerable psychiatric patients.
The provisions of the 1990 National Health Service and Community Care Act aim to fulfil a number of important principles. The key objectives are: to promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible; to ensure that service providers make practical support for carers a high priority; to make proper assessment of need and good case management the cornerstone of high quality care; to promote the development of a flourishing independent sector alongside good quality public services; to clarify the responsibilities of agencies and so make it easier to hold them to account for their performance; and to secure better value for taxpayers' money by introducing a new funding structure for social care (DOH 2010).
Therefore this Act provides a disabled person like Kenneth and other people in the community the right to receive services in their own homes. Nurses are required to be aware of this legislation as it can be used as a guideline to provision of care and a way of individual advocacy and empowerment.
A lack of mental capacity could be due to a learning disability. The Mental Capacity Act 2005 is another legislation made to protect people with learning disability. It is an Act to make new provision relating to people who lack capacity and that means that it is designed to protect and restore power to those vulnerable people who lack capacity.
The Mental Capacity Act 2005 has been in force since 2007 and applies to England and Wales only. It is an Act made to ensure that decisions made on a person's behalf are in their best interests. A prison sentence of a maximum of five years is given to people who wilfully neglect or ill-treat patients who are unable to make a decision for themselves (DOH 2010).
As it is already mentioned, this Act is designed to protect people like Kenneth who is incapable of making his own decisions. It also gives the medical team the rights in some areas of consenting since someone with cerebral palsy lacks the ability to make valuable or important decisions for himself.
LO 4: A LEARNING DISABILITY
Safeguard for Children (2006) refers to learning disability as a general lack of ability of an individual to remember, understand, organise, interpret and use language as well as to learn and process new information skills which is due to deficits in cognitive processes. Also the Department of health (2001) cited that it is a significant reduction in ability to understand new or complex information, thus to learn new things (impaired intelligence) with a reduction to cope independently (Impaired social functioning).
There are three types of learning disability, which are mild, moderate and severe (Edwards, 2007). People with learning disabilities are entitled to all levels of health care needs as an individual regardless of whether they have a learning disability or no learning disability it can be a life long condition affecting many aspects of life including education and employment, family life and daily routines.
Mencap cited that it will give NHS London health professionals a practical guidance to spell out the adjustment needed to make working with learning disability a fair and equal health care. Kenneth's family sought medical advice and treatment at the hospital and GP.
Department of health (1992) stated that a service user with learning disabilities should be respected and also reinforces the important of advocacy in the delivery of care. People with learning disability are frequently content with a lifetime of adversity, inadequate social support and poor coping skills. All these Factors contribute to increase vulnerability to stressful life events which normally trigger anxiety disorders.
LO 5: THE CHALLENGES INHERENT IN MEETING THE NEEDS OF PEOPLE OF VARYING ABILITIES AND SOCIAL BACKGROUNDS, WHEN ACCESSING HEALTH AND SOCIAL CARE
There are a lot of issues with regards to children or adults with cerebral palsy. Because of this illness, they normally have a bad facial expression and a loss of control in their movement. This develops into a routine of visiting the hospital or GP all the time, and can be a great challenge to Kenneth's parents if they are not used to going to the hospital, if they do not have a car or disabled car which is provided by the community then they need to go by bus, Ewles (1992).
Valuing people (2001) set up strategy points to making significant improvements in giving adults with learning disability have much more choice and control over their lives through Person Centred Planning, advocacy and personalisation. Commutations and misunderstanding could lead to health needs not being addressed or diagnostic overshadowing. Sometimes learning disability service user does not get access in obtaining appointment, providing escort, transport and even facilitating communication with health professionals, because they live in a small village, Department of health (2009).
Also, it is good for the service user to access a regular health screening and surveillance to ensure appropriate associated risks of certain illnesses. Service users living in the community normally do not get access to mainstream health service and there are always barriers of effectiveness of initiative which overcome them. , BILD publication (2004).
The NHS (2009) stated that there will be rules and regulation, treatment plan which will fit into the socio-culture background with learning disabilities. Also, the Department of Health (2010) cited that treatment plan will meet the cultural and social needs of service user with learning disabilities, such as food, shelter and finance. Due to the condition of Kenneth's parent, they can`t afford the food which will be provided in the treatment plan and there will be a lot of changes in them accessing health care. There should be a treatment plan to meet Kenneth's cultural social needs such as food which has a combination of fat and sugar. Because of their financial situation they might not be able to provide a supplement diet; therefore the local services should provide the necessary food and equipment which Kenneth might need.
L0 6: THE FACTORS THAT TRIGGER THE ACCESSING OF MULTI-PROFESSIONAL HEALTH AND SOCIAL SERVICE
Service users' accessing a multi-professional is a very good practice and therefore have great benefits to both the patient and care professionals. These are some of the factors that can lead Kenneth to access a multi-professional care; these are physical, emotional and social needs. People from ethnic minority are highly placed in disadvantaged groups. These people normally suffer from low-paid jobs, poverty and unemployment. This relates to ill health within the population.
Language barriers might inhibit communication and understanding, so Kenneth's parents should require additional teaching from health care professionals. A multi-disciplinary meeting should be held to discuss how Kenneth would continue his treatment at home and the kind of service which will be close to his house. The team leader would then contact the community nurse who can work with Kenneth. The occupational therapist will then make an assessment on Kenneth environment and look for the one which will be suitable for him and his family.
Foundation for people with learning disability (2001) states that regular health screening and surveillance is important to ensure appropriate access to both primary and secondary health care for this group, particularly where their disability carries associated risks of certain illnesses. A lack of interpersonal skills in working with people with learning disabilities among mainstream health care staff also affects the willingness to seek help. People with learning disabilities may think that their complaints are not taken seriously or that staff are judgemental about their capabilities. Some parents feel that their concerns about their child's health are not taken seriously when health professionals attribute symptoms to learning disability rather than a medical condition (overshadowing).
A learning disability is a major problem that many people are faced with around the world today. Because of its nature a lot of care and attention need to be given to it. Also, it is a field that is constantly changing. In this assignment, a case study is discussed to show the kind of problems and difficulties a person with a typical learning disability is facing. As future nurses we need to be aware of this illness, because of the attention, treatment and care that needs to be provided. It is therefore our duty as future nurses to learn more about learning disability.
Though there are much legislation that are there to help and protect people with learning disability the government needs to do more to improve upon their lives. This could be done by setting up more strict and tougher laws for the protection of people with learning disabilities. Nurses however, need to be familiar with these legislations since they form the bases of discharging their health care.
Individuals with learning disabilities have different and divergent needs coupled with diverse religious beliefs, educational and cultural backgrounds which ought to be taken in to consideration in discharging and providing them with health care service.