Learning Disability

The assignment will focus on a 45 year old lady of Asian origin who has a mild learning disability. She also suffers from type 2 Diabetes and Bipolar affective disorder.

The assignment will explain the nature of her learning disability and explore how Bio-Psycho-Social factors have influenced her life. The role of her learning disability nurse in supporting her needs through a person-centred planning approach will also be analysed.The assignment will also discuss with reference to the four key principals in valuing people (DOH, 2001) some of the challenges faced in supporting people with learning disability. Service users’ information should be kept confidential, therefore for the purpose of the assignment, pseudonym will be used and the service user will be referred to as Lilly NMC, (2008) Lilly suffers from a mild learning disability which was discovered at the age of six in school.

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She showed a developmental delay as she could not read or understand what was being taught.Learning Disability can be defined as ‘A significantly reduced ability to understand new or complex information, to learn new skills (Impaired Intelligence), a reduced ability to cope independently (impaired social functioning) and which started before adulthood, with a lasting effect on development DOH, (2001) There are about 1. 2 million people with mild to moderate learning disabilities: they also tend to have higher rates of physical and mental health conditions and lower levels of provision of healthcare DOH,( 2007). Lilly’s nature of learning disability is known to be intellectual developmental delay.This is usually observed between the ages of 6 to 8. During this period of growth, children develop the ability to understand perspectives or wishes of others and are able to think in rational ways. They understand that others may hold opinions and have feelings that differ from their own.

Academically children around the age of six are ready to begin more complex tasks like reading, writing and performing mathematics. As they progress from six to eight years old, they are able to take on more demanding tasks in school (Piaget’s Stage, 3).Lilly could not retain any new information and she kept on forgetting. This meant that she had to be reminded all the time. According to Gates, (1997) Learning Disability is used to describe a group of people with significant developmental delay that results in arrested or incomplete achievement of the “normal milestones” of human development. Lilly could not interact well with children her age because her speech was minimal. She used single words and repeated short sentences. She could not read or write complex words compared to other children.

Some of these limitations in learning disabilities are seen as difficulties and therefore affect schoolwork. During her time in school, Lilly had no professional support and her mother decided to take her out of school so she could support her at home. Lilly lived with her mum and two other children in a two bedroom flat, which meant she had to share her bedroom with her siblings.

People with learning disabilities are most likely to live in areas with high levels of social deprivation and experience social hardship. Low social status and poor social networks are probably the most risk factors for poor health DOH,( 2009).This had an impact on Lilly both socially and psychologically. She was lonely and could not go out and play like her other siblings, she became withdrawn, at times not talking or engaging with others.

During these times, Lilly gained a lot of weight because of poor eating habits. Less than 10% of adults with learning disabilities eat a balanced diet, with an insufficient intake of fruit and vegetables and a lack of knowledge and choice about healthy eating Robertson et al, 2000; Rodgers,( 1998). Lilly’s physical health deteriorated as she did not engage in any physical activity.Over 80% of adults with learning disabilities engage in levels of physical activity below the minimum recommended by the Department of Health, a much lower level (53%-64%) level than the general population Messent et al, (1998).

Her mother was very frustrated and found Lilly’s behaviour very challenging. The whole family was socially isolated, emotionally distraught and they could not cope with Lilly’s challenging behaviour. Lilly was sixteen when her family re-located to their country of origin and left her to be supported by care workers.Lilly was taken to sheltered accommodation. She became more withdrawn, was sad and very tearful. And the age of seventeen, she was diagnosed with Diabetes and Bipolar Affective Disorder by the GP after her support worker became more concerned of Lilly’s challenges like refusing to go out. Gates,( 2007) reports that people with learning disability are known to suffer various complications like obesity, visual impairment, diabetes and sometimes speech impairment which makes communication difficult. The key biological factor affecting Lilly is that she suffers from Type 2 Diabetes.

Type 2 diabetes is non-insulin dependent which occurs when the body is not making enough insulin or when the insulin that is made is not used properly. Some of the factors of developing type 2 diabetes are obesity and living a sedentary lifestyle. The main symptoms are extreme hunger and thirst; feeling tired constantly, blurred vision and sudden weight change. In UK, there are about 2. 6 million people who have been diagnosed with diabetes Diabetes UK, (2009). In the UK there are 9 million people with learning disabilities and it is estimated that 270,000 people from this group have type 2 diabetes.The prevalence of type 2 may be twice as high among people of Asian and afro Caribbean than European origin Diabetes UK, (2011).

This has an impact on Lilly due to poor living conditions and lifestyle. People with learning disabilities are more prone to obesity and developing diabetes than people without (Chapman et al, 2008). Lilly could have developed diabetes after gaining a lot of weight due to lack of physical activity. This made her more depressed and withdrawn which could be the cause of her bipolar affective disorder. Lilly’s diabetes is diet controlled.

Psychologically, this affects her as she cannot fully understand why she cannot choose what and when to eat. Due to her intellectual impairment, Lilly cannot communicate how she feels which makes her behaviour more erratic and changes in mood. According to Diabetes UK, People with mental health issues are less likely to attend local physical facilities, for fear of being discriminated against. Therefore Lilly feels socially excluded for fear of being laughed at by the people in the community.

Bipolar affective disorder is also known as manic depression or bipolar depression Royal College of Psychiatric ( 2011).It is also a mood disorder. People suffer experiences of extreme marked mood swings, which are beyond what most people experience. These extremes of mood may include the lows of depression as well as the highs of a very elated mood (known as mania). The number and frequency of these periods of depression and mania vary from person to person. Some symptoms of Bipolar disorder include; Low energy and increased fatigue, loss of interest in activities, persistent sadness, memory problems and indecisiveness and sudden weight changes. In Lilly’s case, she was overweight which caused her to have diabetes.It is estimated that about 1 per cent of the population suffer from bipolar affective disorder at some point in their lives.

Some people will experience just one or two episodes, whereas others will have many episodes of depression or mania. It occurs in both sexes, and often first appears in the age group 18 to 24 years ( Royal College of Psychiatrists). It is a serious condition but can be helped with the right treatment. It is increasingly higher in learning disability service users than the general population Lund, (1985) reported a prevalence rate of 1.7% compared to 1%. Lilly’s abandonment by her family proves to have had an impact on her psychologically and socially.

One of the factors which attribute to high incidences of mental health issues is the likelihood of encountering traumatic events throughout a person’s lifetime. This could be abandonment by loved ones, abuse, bullying and harassment. Lilly’s abandonment could have had an impact on her. Socially, this affected her because of the new environment and she found it hard to adapt to new changes.She could not cope independently and preferred her own company. Because of her intellectual impairment, Lilly could not communicate her feelings in a manner that could be understood. The high and low phases of bipolar depression are often so extreme they interfere with day to day activities. World Health Organization Geneva,( 1992), states that “for a definite diagnosis of mental retardation, there should be reduced level of intellectual functioning resulting in diminished ability to adapt to the daily demands of normal social environments.

” (pg 1) Socially, Lilly was excluded from the society in that she could not do the normal daily activities like everyone else. Long term effects of mental health problems can impair one’s ability to carry out day to day activities hence leading to disability (Collishaw et al, 2004) This part of the assignment will discuss the role of the nurse in supporting Lilly by adopting a person centred planning approach. A health facilitator should support the provision of excellent physical health care and mental care of people with learning disability. They should work in a person centred way with an aim of social inclusion.They should be able to respond to the needs of people with learning disability and their families while recognising the contribution of parents and carers.

They should ensure people with learning disabilities gain access to health care, advocate and empower them DOH,( 2007), (Turnbull and Chapman, 2010) suggest that learning disability nurses are most suitable as health facilitators because they have the skills and specialist knowledge. However, person centred planning requires that the person at the centre of the plan nominates the people they want involved.The role of Lilly’s learning disability nurse is to support her live her life fully and independently while respecting her rights and dignity. This is done by assessing; planning, facilitating and supporting Lilly with all her health needs through a person centred planning approach. It is also her responsibility to assist and enable Lilly to access services that she is entitled to. Valuing People DoH,( 2001) explained that “A person-centred approach to planning means that planning should start with the individual (not with services), and take account of their wishes and aspiration.This is to be done by involving Lilly and her circle of support in planning and setting out goals making choices that will help her live independently.

The nurse supports Lilly in arranging and coordinating her needs with other professionals during assessment. To overcome Lilly’s inability to communicate effectively, the nurse uses different methods of communications (pictures, drawings or diagrams) or uses objects related to an activity. The nurse also involves a speech and language therapist to support Lilly improve on her communication (speech).The nurse involves an inter-professional team and Lilly’s carers to assess her mental health and learning disability by observing and documenting any mood changes and if possible what causes them. Her mental status should also be monitored and recorded to determine when her mood swings are manic or in a depressive state. The documented information will help her team predict or know how to take supportive actions. Her sleeping patterns are also monitored and recorded and can be used to assess Lilly’s progression.

She also ensures Lilly’s medication is given at the prescribed dosage and on time.In order to meet Lilly’s health needs, the nurse will discuss and explore on how diabetes is affecting Lilly’s daily activities using pictures with facial gestures. This will help her and Lilly in planning activities which are more likely to improve her health. An example will be walking outdoors, giving Lilly a good feeling of inclusion in the community and having to make a choice of when to go out. The nurse also encourages Lilly to develop skills and try new opportunities.

“Self determination and opportunities are essential to personal development and are a basic human right” Baldwin and Thickettle,( 1999).By doing this, the nurse is trying to promote Lilly’s independence. Lilly was enrolled in a day centre five days a week where she interacts with other service users in daily activities like making art and craft, drawing and engage in fun activities like singing and dancing. This enables the nurse to observe and document how Lilly is progressing. The documented information can be used by the professional team to plan and evaluate the risks associated with Lilly’s disability. She has introduced her to the local fun and fitness centre where Lilly interacts with the wider community and enjoys some physical activities.This in effect helps Lilly achieve a good level of physical fitness and a sense of social inclusion. To cater for Lilly’s health and well being, the nurse has set up guidelines for a healthy diet.

She works together with Lilly and the support staff set up a healthy meal plan. This helps Lilly to control her weight issues which in effect helps to control her diabetes. Evidence indicates that structured approaches to weight management are effective in improving the health of people with learning disabilities and mental health problems (DRC, pg 45) The nurse has a duty to promote equality for all regardless of their disability.In this case, the nurse supports Lilly by making appointments to see her on a one to one basis to assess how she is progressing. The nurse supports Lilly access a health service designed with individual needs which also offers additional support for her impairment. For example, there is evidence that people from black and minority ethnic groups may have increased difficulty in accessing appropriate services (DH 2001b).

Learning disability nurses and other specialist workers have an important role in linking with local communities and ensuring that services can adapt to their needs.Supporting people with learning disability has its own challenges. In accordance with the four key principles underpinning ‘Valuing People/Valuing People Now’ DOH( 2001) & (2009), some of the challenges are outlined below. In 2001, the department of health published a white paper ‘Valuing people’ whose commitment was to ensure that people in England with a learning disability receive equal access to services, such as health, education, employment and leisure (pg 9).

In 2009, ‘Valuing People Now’ was published as a follow up to the 2001 paper.It was based on the concept of Social Role Valorization whose main roles are Rights, Choice, Control and Inclusion. Social Role Valorization is the “Use of culturally normative means (familiar valued techniques, tools and methods) in order to enable people’s life conditions (income, housing conditions and health service) to be at least as good as average citizens and to as much as possible enhance and support behaviours (competencies, skills, appearances, experiences, status and reputation”Wolfensberger (1983).

Valuing People Now DOH,( 2009), states that “Independent living does not mean living on your own or having to do everything yourself.Mild to moderate people with learning disability will usually be able to live independently with support. All disabled people should have greater choice and control over the support they need to go about their daily lives; greater access to housing, education, employment, leisure and transport opportunities and to participation in family and community life” (p.

30). One of the challenges in supporting Lilly to be independent is her mental instability. Lilly needs twenty four hour support to monitor her physical and mental health. Therefore, her right to independent living are undermined.People with learning disability have little choice or control over many aspects of their lives for example, limited housing choice. ‘Valuing People Now’ 2009 however, gives people with learning disability more choice and control over the services they receive through advocacy and a person centred planning.

Advocacy has been defined as ‘a way to defend the interest of a person, and to make sure their needs are met, especially someone who already feels disempowered’ (Atkinson 1999, p. 16). Valuing people also introduced the concepts of health action plans and health facilitation (p19).

This is designed by the service user together with their health facilitator to link the service user with the services and support they need. Lilly has a choice of those she likes to support her, and therefore a rota has been designed with carers supporting her round the clock. She also has a choice of what and when to eat.

Because she is on a controlled diet, one of the challenges is to make her understand why she cannot have certain foods or drinks. To overcome this, the support worker presents her with a menu which has a variety of healthy food.Valuing People Now (2009) states that “Inclusion means being able to participate in all the aspects of community- to work, learn, get about and meet people, be part of social networks and access goods and service – and to have the support to do so” (p. 30).

Therefore, to include Lilly in the community, the nurse and her support team encourage Lilly to socialise by taking part in activities that she enjoys with other service users at the day centre. For example, she enjoys making greeting cards with drawings and she enjoys community access as well. They also encourage her to use public transport while visiting her GP or going shopping.One of the challenges is lack of staff. Lilly needs one to one support while out in the community.

Sometimes this is not possible if there is a shortage of staff. This means Lilly cannot go out and she feels socially excluded. In conclusion, Lilly’s nature of learning disability proves to have affected her both psychologically and socially. However, ‘Valuing People 2001’ and ‘Valuing People Now, 2009 publication and implementation have and continues to improve the lives of people with learning disability. Child Development Institute Piaget’s Stages WWW.

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