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Jess Ball knew she wanted to work in learning disability nursing from the get-go.

“I got my passion for learning disabilities care early, and realised it was definitely the career path for me,” says Jess, who is in her final year at Kingston University.

Having previously worked in a special educational needs school providing support for children and young people from 2-19 years old, Jess felt ready to immerse herself in her learning disability nursing degree, and grasp as many development opportunities as she could.

I was a bit of a guinea pig, but actually it proved to be the best placement I could have ever been on

With a passion for highlighting the diversity of learning disability needs to peers and colleagues, Jess was excited to be the first student at her university to trial a joint-partnership placement at Epsom and St Helier University Hospitals NHS Foundation Trust. 

“I was a bit of a guinea pig, but actually it proved to be the best placement I could have ever been on,” says Jess, who found herself working in acute learning disability liaison and safeguarding across two different hospitals.

“The role of an acute learning disability liaison nurse is so important because they’re the on-call specialist, and they provide a lot of education to other professionals about how to support someone with a learning disability,” she adds.

During her placement, Jess noticed what other health professionals might need to know more about for their patients with learning disabilities.  

Student nurse Jess Ball at laptop

Jess at university

“By law, we have to offer reasonable adjustments, which is something staff need to be thinking about,” she says. “You need to be looking at things like hospital passports, with information about the care of people with learning disabilities and support they need, as well as their communication style and day-to-day health information.”

Jess decided to create a booklet and poster to lay out the things all health professionals need to consider when supporting someone with a learning disability – no matter which nursing specialty they’re in.

Everyone wants a good experience in hospital

“It’s been really cool,” Jess explains. “It’s important to give out that key information quickly and efficiently, so staff can support that person properly. Everyone wants a good experience in hospital, and these simple resources can be very useful.”

The booklet explains the difference between a learning disability and a learning difficulty and demonstrates what hospital passports look like.

It explores the different communication styles patients may have, and what reasonable adjustments can be offered to them, such as extended or double appointments and a choice of appointment time. For example, first or last appointments may suit anxious patients or those who find sitting in busy waiting areas difficult.

“People have found it really helpful, and it’s made them think about mandatory learning disability awareness training,” says Jess. 

“To implement and roll that out would be a challenge, but in the meantime this booklet and poster could help in some way – especially for those struggling to access or waiting for training.”

Jess also felt it was important to discuss mental capacity (see below). The leaflet advises staff to assume a person has the capacity to make a decision themselves, unless it's proved otherwise, and not to treat a person as lacking the capacity just because they make an unwise decision.

Making assumptions

“A lot of the time people just assume that someone with a learning disability doesn’t have the mental capacity to make decisions, but actually that’s not always true," says Jess.

“Sometimes it is obvious if someone doesn’t have capacity, however, it must always be formally assessed and documented.”

Jess’s resources have since been rolled out across both Epsom and St Helier hospitals, with several departments contacting her to ask for them. 

The Mental Capacity Act

Regarding the Mental Capacity Act and assessing capacity, Jess’ information booklet says:

  • Assume a person has the capacity to make a decision themselves, unless it's proved otherwise.
  • Wherever possible, help people to make their own decisions.
  • Do not treat a person as lacking the capacity to make a decision, just because they make an unwise decision.
  • If you make a decision for someone who does not have capacity, it must be in their best interests.
  • Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms.

What to consider:

  • Does the person have mental capacity to make informed decisions about their medical interventions, treatment and so on?
  • Define who deems someone to have or lack capacity.
  • Assess their capacity at that time, do not go by previous mental capacity assessments.
  • Has someone been given the information in an accessible way for them to make informed decisions?
  • Assessing capacity is everyone’s responsibility. 

Pandemic practicalities

Like many current nursing students, most of Jess’s studies have taken place online as a result of the pandemic. “Obviously, we’ve had a very different experience from the nursing students who preceded us,” she says.

“I was on my first placement in first year when COVID-19 began to surface, but once the pandemic hit, everything went online.”

Without in-person teaching and contact with her peers, Jess explains this made time on placement all the more impactful.

“It’s great to be studying, but it feels even better to be able to put that into practice and apply your skills,” she enthuses. “That’s been the most enjoyable thing for me. There’s always so much to learn – the learning never stops.”

More information

The RCN Learning Disability Nursing Forum champions the health and social care needs of adults and children with a learning disability or autism. There are resources, events and latest news available on their page. 

Man with learning disability laughing with carer

Stock image

Jonathan Beebee, RCN Professional Lead in Learning Disabilities, says: “A key role of learning disability nursing is enabling better care. 

“Whether this is about enabling people with learning disabilities to be as independent as possible, or enabling other professionals to be empowered to apply their skills when meeting the needs of people with learning disabilities.

“People with learning disabilities should be able to access all health and social care settings so it is important that we are all prepared to meet their needs.

"It is also really useful to know what learning disability nursing support is available at your place of work so you can call on additional support if it is needed.”

The RCN Connecting for Change: for the future of learning disability nursing report explores contemporary issues concerning the field of learning disability nursing and sets out a series of recommendations and priorities that the UK government and devolved administrations need to address. 

Words by Becky Gilroy. Images of Jess by Rob Anderman.

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