Learning disabled patients
People with learning disabilities have increased needs, both health and social, which inevitably require more time, patience and imagination from staff caring for them. Often this additional input is willingly provided by the patient’s carers and staff can actively support this through warm, appreciative communication with relatives – and cups of tea and a listening ear are always welcome!
Additional or distinctive needs that learning disabled patients may have include:
- Exceptional closeness to and reliance on family.
- Higher rates of mental and physical illnesses (eg heart conditions, epilepsy) and of sensory impairment
- Impaired understanding and communication – and ‘inconsistency’ or unevenness – eg someone may have language and social skills which suggest the person understands much more/less than they do
- Limited or no literacy, including an inability to tell the time or use a diary.
- Poor coping mechanisms. Cognitive deficits might make it more difficult for people to plan ahead or consider the consequences of their actions.
- Frequent experience of loss and change and a lack of control/autonomy
- Sense of being different, inferior
- Lack of life experience combined with suggestibility and limited skills makes people very vulnerable and many have experience of harassment and abuse
- Problems with manual dexterity
- Difficulties with eating and swallowing.
There are some excellent resources with examples and techniques to help hospital staff support people with learning disabilities and their families. Things like:
- Right up at the top – it’s impossible to overstate the importance of supporting carers who are the best placed people to help their loved one receive and cope with the medical treatment they need. Relatives of people with learning disabilities usually have a devotion to their cherished loved one and a determination for them to be protected and have the best possible care. Carers will know their loved one’s preferences with communication, keeping calm, daily routines, self-care etc. The Triangle of Care is full of practical ideas for involving and supporting carers.
- Close involvement of the hospital Learning Disability Liaison Nurse, and/or the local Community Learning Disability Team.
- Learning disabled patients may have a Hospital Passport or equivalent, containing invaluable information about the individual’s needs and preferences.
- It’s a hard, often unrealistic ask, but wherever possible consistency of staffing means a smaller group of staff get to know the person well, and the patient builds up trust
- Reassurance and lots of flexibility
- Medication – careful explanations, repeated as often as necessary. A choice of drinks or ways in which medication is delivered (eg syrup rather than pill).
Given the problems with literacy and spoken communication that people with learning disabilities experience, the following (in addition to the other communication tips in Brief Encounters) really help:
- Speed – or rather slowness. It takes people with learning disabilities longer to process what’s being said, so it’s crucial to take a bit (sometimes a lot!) longer with explanations, repeating important parts, and checking back with the patient (and/or their carer) to see if they’ve understood. Patients might have a limited attention span so several conversations may work better than cramming it all into one.
- Using short sentences with just one main point. (For example, “Hello Fred. Would you like your bath now and how is your leg feeling?” is better separated into two sentences, with the patient answering each in turn.)
- Obviously medical jargon is unlikely to be helpful! Even commonly understood terms, including body parts, might be a mystery to the patient so showing a picture or pointing to the area you’re talking about can make things clearer. Objects can be shown (eg a stethoscope) and even touched by the patient if that helps reduce anxiety.
- Similarly, abstract language can be very difficult to grasp – even concepts like the future or the past won’t be understood by people with a severe learning disability. If you can’t easily draw it or point to it, the ‘it’ is likely to be abstract!
Finally, a quick note on caring for autistic patients. In addition to the additional needs (highly!) summarised above, people with autism can have particular difficulties with:
- Interacting with people, from avoiding eye contact to avoiding all contact.
- Sensory stimulation, resulting in sensory and emotional overload
- Change, even apparently tiny changes in routine.
- Taking things very literally – a bird in the hand becoming not a proverb but a scary prospect
- Special interests – a fascination with one thing, whether it’s a cherished toy or train-spotting.
- Mentalising. The under-pinning theme of Brief Encounters is an area of extreme challenge for people on the autistic spectrum, making it very difficult for individuals to understand that let alone what another person is independently thinking.
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