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Symptom management at the end of life for people with intellectual disabilities
People with intellectual disabilities are living longer while experiencing significant health conditions often resulting in a prolonged period of dying. Symptom management may be complex at end of life and the unique needs of each individual necessitates a person-centred approach.This article discusses several symptoms at end of life including pain, anxiety, agitation, breathlessness and epilepsy, as well as their management strategies, focusing on the last days of life. Healthcare professionals may support people with intellectual disabilities at end of life in a variety of hospital or community settings. Therefore, they need to have the knowledge and skills to provide evidence-based care safely and effectively.Contemporary approaches to ensuring that people with an intellectual disability can self-determine the management of their symptoms and that their circle of support is involved in a meaningful way will be explored, including advanced care planning and shared decision-making. This article presents a biopsychological perspective to end of life care and symptom management, which speaks to a holistic and respectful approach.
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Biological basis of child health 5: development of the respiratory system and elements of respiratory assessment
This article is the fifth in a series on the biological basis of child health. It describes the development of the respiratory system, which starts relatively late in the embryo and continues after birth until the age of seven to eight years. It explains what the developing anatomy of the respiratory system in infants and children means in terms of the conditions that may occur and the precautions required when assessing them. The article provides an overview of the elements of respiratory assessment in infants and children and describes some respiratory conditions seen in these patient groups. It also discusses some of the changes in the care of children with respiratory conditions, which has increasingly moved from hospital into the community and become nurse-led, multidisciplinary and holistic.
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How learning disability nurses can support self-management for people with asthma
Asthma is a long-term condition that requires patient education, support and close monitoring. It is important that individuals are empowered and educated about their asthma and supported to self-manage as appropriate. Self-management is a goal that is recommended as an established and effective approach. However, it can be challenging for many individuals, including those with learning disabilities. Learning disability nurses can support individuals diagnosed with asthma to self-manage the condition and should have the knowledge, skills and competence to do so.
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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.
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Biological basis of child health 10: function and formation of blood and common blood disorders in children
This article, the tenth in a series on the biological basis of child health, focuses on blood. Blood has a crucial role in the transport of substances such as respiratory gases, nutrients and antibodies, as well as in acid-base balance, fluid balance, blood clotting and the immune system.This article describes the composition, formation and function of blood, outlines normal blood count values and explains the effects of low blood cell counts in children. It also provides an overview of the blood disorders that are commonly seen in children, including anaemia, sickle cell disease, clotting disorders and blood cancers. It is essential for children’s nurses to have knowledge and an understanding of blood, including its physiology and pathophysiology, to provide optimal care and support to children and young people and their families.
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Insertion and care of nasogastric tubes in adults with intellectual disabilities
Many adults with intellectual disabilities require nutritional support as feeding problems are prevalent in this population. While many types of nutritional support are available, enteral feeding tubes, such as nasogastric (NG) tubes, are considered safe and effective. NG tube feeding is a common clinical procedure carried out to maintain patients’ nutritional needs when they have swallowing difficulties or cannot tolerate oral feeding. Insertion of an NG tube provides adequate nutrition and improves positive health outcomes and quality of life, but being fed through an NG tube may alter patients’ perceptions of feeding and mealtimes.Healthcare professionals, including intellectual disability nurses, should not underestimate the social aspect of mealtimes or the physical and psychological effects of NG tube feeding in patients with intellectual disabilities. Demonstrating competence and compassion with regard to insertion and care of an NG tube and applying best practice to ensure patient safety and well-being are critical to supporting patients with intellectual disabilities.
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Improving safety by developing trust with a just culture
This article presents a simple conceptual road map for implementing a just culture in healthcare settings. The concept of just culture was developed as one of five fundamental elements of a safety culture by psychology professor James Reason in 1997. A just culture requires an unbiased method of judging human error and is designed to develop organisational trust so that adverse medical events (errors) are reported and corrected before they combine with other errors to cause injury or death. To implement a just culture properly so as to increase organisational safety, practitioners must understand its role in enabling the error reporting needed to develop a safety culture. This article reviews these foundational concepts and explores the human causes of errors that a just culture addresses, the psychological importance of a just culture in enabling error reporting and how to implement a just culture in organisations.
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Inhaler and nebuliser technique for people with a learning disability
Healthcare professionals who support people who require an inhaler or nebuliser need to know how to use the devices, monitor and assess patients’ inhaler techniques effectively. Often, people have inadequate inhaler techniques, which can lead to poor management of their respiratory condition, increased signs and symptoms, reduced quality of life and increased use of primary/secondary care services and treatment costs. This article explains how to use inhalers and nebulisers appropriately and considers some of the challenges for children and adults with a learning disability. It also describes some devices and assessment tools, and explores assessment/review methods to help ensure people use their inhalers/nebulisers successfully.
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Using coaching and action learning to support staff leadership development
During the coronavirus disease 2019 pandemic, nurse leaders and managers have been compelled to prioritise immediate issues in their clinical areas and put aside the professional development of staff. However, leadership development for individuals and teams is essential to ensure nurses feel valued and develop the skills required for team cohesion, problem-solving, decision-making and innovation. Simple and effective approaches to staff leadership development are needed. Two such approaches are coaching and action learning.This article provides an introduction to coaching and action learning as approaches nurse leaders and managers can use to promote leadership development among individual team members and within the team. It describes how coaching and action learning work and their potential benefits and challenges. It explains how the two approaches can be used to underpin effective problem-solving and goal setting, and support nurses in their professional development, the ultimate aim being to deliver safe and effective patient care.
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Implementing cultural safety to enhance the care of mental health service users
Culture plays an important role at every level of healthcare and in every healthcare encounter. Cultural factors significantly affect the interactions between mental health nurses and service users, the experience of mental health service users and ultimately their health-related outcomes. The concept of cultural safety originates from the work of Maori nurse leaders in New Zealand. It builds on concepts such as transcultural nursing, intercultural competence, cultural congruence and cultural competence, enabling a deeper exploration of the underlying issues of inequality affecting people from minority groups. Implementing cultural safety in mental health nursing practice can enhance the quality of care by promoting culturally sensitive communication and prompting nurses to better accommodate the needs of service users.This article discusses the concept and benefits of cultural safety in the context of mental health nursing and explains how mental health nurses can use cultural safety to enhance the experience and health-related outcomes of service users with diverse cultural backgrounds.
