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Understanding the basic assessment and treatment of lower urinary tract symptoms in older women
Lower urinary tract symptoms (LUTS) are prevalent in older women. These symptoms are often under-reported due to the potentially embarrassing nature of the symptoms and a belief that they are an inevitable consequence of ageing. LUTS such as urinary incontinence have a significant negative effect on people’s quality of life; however, with the appropriate assessment and management, improvements can be achieved. This article reviews the different types of LUTS and their causes, assessment and treatment, focusing on older women. It aims to provide nurses with an understanding of LUTS so that they can identify appropriate interventions.
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Understanding status epilepticus and its treatment in the community
Status epilepticus (SE) is a complication of epilepsy characterised by prolonged or repeated seizures. It is a life-threatening condition that requires the immediate administration of a rescue medicine. If given promptly, rescue medicines can reduce the duration of seizures and support SE cessation. Buccal midazolam is the recommended first-line treatment for SE in the community in people who have had a previous episode of prolonged or serial convulsive seizures. Therefore, it is crucial that all those who care for people with learning disabilities who have epilepsy in the community – including family members, friends and professional carers – receive support, training and guidance in the administration of buccal midazolam. This article provides an overview of the treatment of SE in the community, including the administration of buccal midazolam.
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How to give an intramuscular injection to an adult with an intellectual disability
People with intellectual disabilities can have various healthcare needs across their lifespan, which may be closely linked to genetic, biological and/or psychosocial factors. As a result, they may require medicines – some of which may be administered intramuscularly – for various clinical reasons, including as part of the treatment of a range of comorbid physical and mental health conditions. Additionally, this population may not fully understand why certain medicines are administered via the intramuscular (IM) route, nor the potential risks that are involved. Some people with intellectual disabilities may find it distressing to receive medicines via this route, and they may depend on others when making decisions in relation to IM injections. Therefore, it is important for nurses to establish a rapport with patients with intellectual disabilities and gain their consent for the procedure. Nurses also require knowledge of the preparation and administration of IM injections to ensure positive health outcomes.This article aims to enhance intellectual disability nurses’ knowledge of this procedure, and to explain how they can mitigate the potential physical and psychological effects that IM injections may have for people with intellectual disabilities.
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Supporting people with learning disabilities to receive subcutaneous injections
The average life expectancy of people with learning disabilities has increased and many of these individuals will experience long-term and potentially life-limiting conditions such as diabetes mellitus, cancer or arthritis. To manage these conditions and any associated complications medicine injections may be required, and many of these will be administered via the subcutaneous route.Learning disability nurses may sometimes need to administer subcutaneous injections as part of the care they provide and should therefore have the knowledge and skills required to undertake this procedure safely and effectively. In addition, learning disability nurses need to understand the principles of safe medicines administration, the equipment required for subcutaneous injections and the potential complications associated with the procedure.This article outlines the best practice for administering subcutaneous injections in people with learning disabilities and explains how nurses can support these individuals before, during and after this procedure.
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Oral health and supporting people with intellectual disabilities to get access to dental treatment
Oral health is an important aspect of a person’s overall health and well-being. People with intellectual disabilities have poorer oral health than the general population, so it is essential that service users and their carers are supported to address this. This article provides information for nurses and other healthcare professionals on how to provide evidence-based practice that supports people with intellectual disabilities with their oral healthcare and assists them to access dental services. The authors examine the latest evidence about optimal practice in oral healthcare for people with intellectual disabilities, emphasising the importance of a person-centred approach. The article also discusses the barriers that people with intellectual disabilities experience when accessing dental services and how these barriers can be addressed.
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Management of oxygen therapy for people with intellectual disabilities
People with intellectual disabilities may require oxygen therapy across the lifespan for various reasons. Some of them will require oxygen therapy frequently, such as those who experience recurrent respiratory conditions, while others may require oxygen therapy at times when they become acutely ill or, in certain circumstances, at the end of life. Healthcare professionals and family carers supporting people with intellectual disabilities who require this treatment must have the knowledge, skills and competence to administer it safely and effectively. Oxygen therapy may be administered at times when the individual is distressed and vulnerable, so a person-centred and respectful approach is essential. This article explores the rationale for administering oxygen therapy, outlines the types and equipment that can be used, and explains the measures that nurses can take to support people with intellectual disabilities who are receiving this treatment.
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Reducing the use of restrictive practices by applying a human rights-based approach
In 2021 the Welsh Government launched a new framework for reducing the use of restrictive practices in childcare, education, health and social care settings. A series of reports and guidelines have stressed the importance of ensuring that restrictive practices, if used at all, respect people’s human rights. Human rights that are particularly relevant in this context include the right to not be subjected to inhuman or degrading treatment, the right to have one’s autonomy and physical and psychological integrity respected, and the right to not be discriminated against in the application of the Human Rights Act 1998. This article explores how applying a human rights-based approach can support learning disability nurses to consider the legal and ethical aspects of restrictive practices, use a person-centred approach that respects service users’ dignity and autonomy, and recognise their role in reducing the use of restrictive practices.
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Exploring mental health issues in people with an intellectual disability
Mental health concerns are prevalent in regard to those with intellectual disability. There are many reasons for this, some of which may relate to the causation of the person’s intellectual impairment. Other extraneous factors, such as the number of significant life events, may also result in compromised mental health. For many people, however, mental health problems may go untreated, which may relate to difficulties in diagnosis or in ascribing the signs and symptoms to other causes. With increasing numbers of people with an intellectual disability making use of regular community health services, and the reported unfavourable nature of such services, mental health problems may not be addressed. Registered intellectual disability nurses have a crucial role to play in ensuring that the mental health concerns of people with an intellectual disability are identified and addressed in an expeditious manner to achieve maximum well-being. Mental health concerns in people with intellectual disabilities can be difficult to identify due to various factors, including the person’s physical health, behaviour and cognition, and formal and informal carers’ skill deficits and attitudes. Knowledgeable and skilled health professionals must be present in the daily lives of people with an intellectual disability to identify and explore emerging mental health issues, make referrals, implement interventions and monitor outcomes. Registered intellectual disability nurses play a vital role in ensuring that the mental health of people with an intellectual disability is addressed and maximised. This article explores such mental health concerns and, drawing on a brief case study, describes the role of nurses.
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Management of indwelling urinary catheters for people with learning disabilities
The insertion of an indwelling urethral catheter is a considered, invasive intervention that places the patient in a position of increased vulnerability. It requires the nurse to have the knowledge, skills and understanding to prepare and perform the procedure while supporting the patient. Such a procedure may evoke a range of emotions and responses in a person with a learning disability. It is important that nurses address the needs of the individual and tailor the care to their needs in a sensitive and respectful manner.
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Percutaneous endoscopic gastrostomy feeding: clinical knowledge and skills for learning disability nurses
People with learning disabilities may require percutaneous endoscopic gastrostomy (PEG) tube feeding to maintain their nutritional status when they have a congenital deformity or severe infection that makes eating and drinking difficult. In addition, people with learning disabilities may have severe dysphagia or medical or surgical conditions throughout their life that make it difficult for them to eat and drink and put them at risk of aspiration and choking. To manage this increasingly common clinical situation learning disability nurses must have the knowledge and skills required to manage patients with a PEG tube safely and effectively.
