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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. [ABSTRACT FROM AUTHOR]

This article describes a public engagement project on bereavement involving people with intellectual disabilities. The project was a practical application of research findings related to discussing death, dying and bereavement with people with intellectual disabilities. The project involved working with people with intellectual disabilities, staff from organisations that support them, and nursing and design students to make artificial lilies that could be illuminated for an interactive art installation. The site for the art installation was the Grassmarket area of Edinburgh, Scotland, where lilies were provided to members of the general public. The public participated in the installation by writing a message to someone who had died, then planting the lily in the garden as a means of remembrance. Through the development and implementation of the project, the authors identified that there was a desire among people with intellectual disabilities to discuss issues of loss and grief. This project also enabled people with intellectual disabilities to be part of a community of remembrance. [ABSTRACT FROM AUTHOR]

The population of people with intellectual disabilities -- this is the international term used to describe a learning disability -- is increasing and ageing, and many require frequent access to healthcare services for assessment, treatment and care. The European Disability Strategy 2010-2020 identifies the need to reduce the barriers to healthcare for people with disabilities, to improve their quality of life and reduce preventable mortality. Part of this policy focuses on the education and preparation of future practitioners. The European Union (EU) Erasmus Plus programme is an opportunity to bring together educators and students, to share learning and develop an understanding of the needs of people with intellectual disabilities. This article gives an overview of the programme, policies and practices relating to care of people with intellectual disabilities in four EU member states -- Scotland, England, Norway and Romania. It also identifies ways in which access to services for this population can be improved through education, workforce and services in an EU context. [ABSTRACT FROM AUTHOR]

Constipation is a common condition that can have significant adverse effects on people's psychological well-being and quality of life. Chronic constipation is associated with various burdensome symptoms and may lead to serious health issues, such as faecal impaction and bowel obstruction. People with intellectual disabilities may be at increased risk of constipation for several reasons, including side effects of medicines, suboptimal diet and limited mobility. This article outlines the causes and risk factors that can lead to constipation in people with intellectual disabilities. It discusses the prevention, assessment and management of this condition, emphasising the need for a holistic, integrated and person-centred approach. The article also uses a fictional case study to illustrate how such an approach could be applied in practice and to demonstrate the role of nurses in addressing constipation in people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware of secondary analysis of data from waves 1 and 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) • To appreciate that dementia is highly prevalent in older adults with intellectual disabilities, particularly in those with Down's syndrome • To recognise the need for routine assessment of cognition and adaptive functioning in older adults with intellectual disabilities to increase recognition, identify early symptoms of dementia and plan care accordingly Background: Diagnosing dementia in people with intellectual disabilities can be challenging due to pre-existing cognitive impairment. In this population, functional loss could be an early indicator of dementia, but the relationship between functional loss and dementia is not well understood. This means there is a risk of delayed diagnosis and therefore a delay in care planning. Aim: To identify and compare the prevalence and age distribution of dementia in people with intellectual disabilities, differentiating between those with Down's syndrome and those with an intellectual disability not attributable to Down's syndrome, and to identify and compare functional loss in people with intellectual disabilities who have developed dementia, differentiating between those with Down's syndrome and those with an intellectual disability not attributable to Down's syndrome. Method: This was a secondary analysis of data from waves 1 and 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative study in Ireland of older adults with intellectual disabilities as they age. Functional loss was determined by participants' level of difficulty with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results: The prevalence of dementia was higher among participants with Down's syndrome than among those with an intellectual disability not attributable to Down's syndrome, and the age distribution of dementia differed markedly between the two groups. Both groups experienced similar patterns of difficulty with ADLs and IADLs. IADLs posed more difficulty than ADLs, and among ADLs self-care activities posed the most difficulty. Conclusion: It is important to continue to investigate functional loss in older adults with intellectual disability who have developed dementia, as this should lead to earlier assessment and care planning. [ABSTRACT FROM AUTHOR]

Young people with intellectual disabilities are at greater risk of developing mental health issues. However, their mental health needs are often not recognised and therefore remain untreated. This article discusses a case study concerning a young man with a mild intellectual disability and co-existing obsessive-compulsive disorder, which was first identified in adolescence. It describes his experience of accessing appropriate services and interventions, and details the care and support that he received from community-based services, which enabled him to continue living with his family. The case study reveals various issues that are relevant to other young people in similar situations, as well as for service providers and professionals, including intellectual disability nurses. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities have greater health needs than the general population, however they also experience greater inequality in accessing healthcare. Registered intellectual disability nurses (RNIDs) have a primary role in supporting these patients to access adequate healthcare and experience optimal health. Asthma affects many people with intellectual disabilities. This article gives an overview of the condition and discusses RNIDs' role in supporting people to manage their own condition. [ABSTRACT FROM AUTHOR]

Cognitive behavioural therapy (CBT) has become established as a method for treating psychological disorders experienced by the general population, with considerable evidence available to support its efficacy. However, little research has been conducted into its effectiveness in treating psychological disorders experienced by people with intellectual disabilities. This article explores the various factors involved in the use of CBT for people with intellectual disabilities and how healthcare professionals and the multidisciplinary team have an important role in the CBT process. The input of learning disability nurses is also explored, particularly their vital role in supporting CBT and providing information that is concurrent with an individual's level of understanding. Challenges in the provision of CBT for this population are also examined, for example the prevalence of diagnostic overshadowing, which can make it difficult to distinguish between cognitive impairment and mental health issues in people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

People with an intellectual disability who aspire to further education, and who seek employment on their transition to adulthood, need access to a range of supports, for independence, personal and educational development, and collaborative transitioning. This article discusses the importance of family care, service provision, employment, influential past policies and future strategic developments within an Irish context, and how collaboration between all key stakeholders is essential for effective transitioning for people with an intellectual disability. [ABSTRACT FROM AUTHOR]

A growing body of literature documents multiple morbidities and multiple medication use among older people with intellectual disabilities. In Ireland in 2012,8.6% of all medication-related adverse events were reported from the disability sector. To determine the level of medication use in a long term care centre that was home to 129 older people, the on-site pharmacist performed a base line audit. Results showed that 31,614 oral solid form medications (tablets/capsules) were administered in 28 days with an average of 1,129 administered per day. There was also widespread use of other medication forms, such as liquids, patches and eye drops. Although medication administration may seem to be a 'simple' nursing task, the combination of multiple medication use and medical complexity in this population means that it is often more complicated than fully realised by the staff involved in the process. Pharmacists who serve older people who have intellectual disabilities need to be aware of, and sensitive to, the unique medication needs and vulnerabilities of this population. Medication use is a major therapeutic intervention in this population and it is important that all nursing, medical and pharmacy personnel, service provider management and policy makers are aware of the complexity of the medication use process. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that the prevalence of traumatic or adverse life events is high among people with intellectual disabilities • To understand that trauma-informed care is based on the rationale that in healthcare services there is the potential for traumatisation or retraumatisation in people who have been exposed to traumatic events • To recognise what trauma-informed care looks like in intellectual disability services, including the barriers to and enablers of implementation Traumatic events are associated with actual or threatened risk to life, serious injury or sexual violence. The prevalence of traumatic events is particularly high among people with intellectual disability. Trauma-informed care is an important yet unresearched area in intellectual disability services. This article outlines the principles of trauma-informed care and considers how these can be applied in practice to people with an intellectual disability. The authors discuss the limited literature on the implementation of trauma-informed care in intellectual disability services, which is primarily drawn from case studies or non-empirical research. The article includes two examples of trauma-informed care implemented in intellectual disability settings and outlines areas for future research. [ABSTRACT FROM AUTHOR]

The article emphasizes the relevance of independence to people with intellectual disabilities. It presents a person-centered assessment of independence, along with ways to promote independence and how deal with the barriers. The author concludes that independence is an important part of becoming a person, particularly to people with intellectual disabilities.

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. [ABSTRACT FROM AUTHOR]

People with intellectual disability, until recently, had notably earlier mortality rates than the general population, but many are now living into their fifties, sixties and beyond. Many older people with intellectual disabilities lose the ability to perform activities of daily living, which is termed 'mobility decline', and this has implications for service planners and intellectual disability nurses (RNIDs), who must provide appropriately designed services, and ensure they are equipped to meet the needs of this ageing population. This article highlights the importance of the role of RNIDs in assessing mobility, as part of the holistic assessment of older adults with intellectual disability, and describes a variety of resources practitioners can use. [ABSTRACT FROM AUTHOR]

Sleep is an essential activity of daily living that is often overlooked in approaches to caring for people with intellectual disabilities (IDs). Poor sleep, insomnia or disrupted sleep can have wide-ranging effects on the health and well-being of people with ID resulting in many adverse consequences. This article outlines the main challenges that people with ID may have initiating and sustaining sleep, explains the nature, prevalence and causes of sleeping problems they experience and discusses a variety of assessments of sleeping issues. It also examines sleep maintenance, management and sleep hygiene approaches to support this cohort using a person-centred nursing care plan and concludes with some suggestions for sleep maintenance and hygiene. Good sleep hygiene should form a central element of caring for people with ID and this article offers suggestions about care planning approaches to enable good quality sleep experiences for people with ID. [ABSTRACT FROM AUTHOR]

It's a chilling scenario: a young man with autism is in prison. He is approached by another inmate and asked to keep some drugs for him. The other inmate tells him that the prison officers are happy for him to take drugs, but that he prefers someone else to look after them. The young man with autism takes this request at face value – he's happy to help, but then the drugs are found in his cell... [ABSTRACT FROM AUTHOR]

This article presents a literature review that was undertaken to explore the challenges experienced by paid carers when providing palliative care to adults with intellectual disabilities. The outcomes show that providing palliative care to people with intellectual disabilities is fraught with difficulties. Professionals, whether they work in palliative care services or in intellectual disability services, face an array of challenges that limit their ability to provide high-quality care. These challenges include limited experience, difficulties in identifying and managing symptoms, such as pain and distress – partly because of diagnostic overshadowing – and suboptimal coordination of care, collaboration between services and communication with patients. This article outlines some recommendations arising from the literature that may improve the provision of palliative care for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the clinical aspects of venesection • To increase your awareness of how to make venesection a positive experience for service users • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) People with learning disabilities face challenges in accessing healthcare services, particularly testing, screening and monitoring, which means that common conditions are often missed. Like anyone, people with learning disabilities develop conditions that require diagnosis, assessment and monitoring through the laboratory analysis of blood samples, so learning disability nurses need to be skilled at performing venesection. Obtaining informed consent and preparing the person psychologically and emotionally for the procedure is as important to its success as getting the clinical aspects right. This article discusses venesection in people with learning disabilities, explaining how nurses can support them before, during and after the procedure and describing a step-by-step approach to performing venesection in a person with a learning disability. [ABSTRACT FROM AUTHOR]

Increased life expectancy allied to increasing numbers of people with learning disabilities living in the community means that more people with learning disabilities are having their health needs met in acute general medical services. In the context of a person-centred approach, this article examines the potential problems that may arise in all healthcare settings which pose barriers to effective healthcare delivery. These include perceptions and attitudes of healthcare staff, issues of consent and communication. It proceeds to outline solutions that enable these barriers to be overcome. Such solutions centre around addressing communication difficulties and issues of consent as well as developing the education of healthcare professionals. It concludes with a case study that explains how the theoretical principles may be applied sensitively in a practice situation. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the discrimination experienced by people with a learning disability who cross-dress • To learn techniques to support people with learning disabilities who want to cross-dress • To familiarise yourself with gender issues in the context of people with learning disabilities People with a learning disability who identify as lesbian, gay, bisexual, transgender, queer or as a cross-dresser can experience multiple layers of discrimination and experience numerous challenges in having their needs met. This article describes a group that was set up to support five men with learning disabilities who wanted to cross-dress. The aim of the group – called Being Me – was to offer the men support, education and empowerment. The article includes case studies to illustrate the men's experiences of being part of the support group. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that people with learning disabilities and a long-term health condition are at risk of avoidable and premature death • To identify how a combination of reflective practice and the introduction of a virtual nurse-led clinic improved health outcomes for a patient with a learning disability and uncontrolled epilepsy • To understand how reflection can enhance your practice This article presents a reflection on a case study by a hospital liaison nurse for patients with learning disabilities. The case study details the care of a patient with a learning disability and uncontrolled epilepsy who was at risk of premature and avoidable death. Following frequent hospital episodes, reasonable adjustments to the patient's care and support needs were essential. An integrated approach was adopted through the setting up of a nurse-led virtual clinic to monitor and coordinate care for patients with learning disabilities and long-term conditions. The clinic was instrumental in improving patient safety and optimising health outcomes. [ABSTRACT FROM AUTHOR]

Aim People with an intellectual disability generally have poorer emotion recognition than their typically developing peers, but there is limited research on how this might be influenced by processing style. This study aimed to explore this. Methods Children with an intellectual disability (n=45) and without (n=57) an intellectual disability completed an emotion recognition naming task and a processing style task. A path mediation model was used to evaluate whether having an intellectual disability predicted poorer emotion recognition and if this was mediated by a local processing style. Results While children with an intellectual disability were significantly less accurate at emotion recognition, having a local processing preference was not a significant factor. Conclusion The findings may help nurses involved in developing, delivering and evaluating interventions to improve the emotion recognition of people with an intellectual disability. [ABSTRACT FROM AUTHOR]

There is evidence that people with learning disabilities, particularly those with behaviour that challenges, are prescribed psychotropics even when they do not have a mental health condition. The STOMP programme was launched in 2016 in England and Wales with the aim of reducing the use of psychotropics in adults with learning disabilities and/or autism. This article describes how the STOMP programme was implemented in a community learning disability service for adults at Cheshire and Wirral Partnership NHS Foundation Trust. The article briefly discusses the overuse of psychotropics in people with learning disabilities and describes the local service's strategy to reduce its clients' use of psychotropics, highlighting some of the beneficial effects this had on clients' quality of life. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the need to reduce the use of restrictive practices • To increase your knowledge of applying a human rights-based approach to the use of restrictive practices • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study offers evidence that co-production and the delivery of person-centred care are good for staff. The researchers surveyed 466 professionals who care for people with profound learning disabilities in residential and day settings. [ABSTRACT FROM AUTHOR]

Aim To investigate the views of people with a learning disability on their experiences of the community team for people with a learning disability (CTPLD ) that is designed to meet their health and social care needs. Method Two focus groups were held with people who have learning disabilities. A flip chart with photographs of the CTPLD members, pictures and vignettes about how people use the team's services and a semi-structured interview schedule were used to ask participants about which healthcare professionals they had seen, what they had found helpful about the CTPLD and ideas for changes to the service. Findings Participants identified positive areas of practice as well as areas for improvement. Participants reflected on their relationship with the team as well as individual professionals. Conclusion The involvement of people with learning disabilities in the planning and development of the services that they receive should be an important focus for organisations. Participants' suggestions enable the team members to improve the services they provide to people with a learning disability. [ABSTRACT FROM AUTHOR]

Background Behaviours of concern restrict opportunities and choices for some people with learning disabilities and autism spectrum conditions and often lead to potentially harmful, restrictive and costly interventions. Immediate interventions, for example de-escalation, to manage behaviours of concern are required to complement behaviour support plans which may take some time to be effective. Low arousal is one de-escalation approach, which is attuned to the needs of people with learning disabilities. A low arousal approach relies on a change in the beliefs, emotional responses, opinions about the cause of the behaviour and practices of direct support staff. Aim To explore the internal consistency and concurrent validity of the Staff Perceptions of Challenging Behaviour Questionnaire (SPCBQ) -- a measure of low arousal. Method A cross-sectional survey of direct support staff included measures of mindfulness, the belief that people can control behaviours of concern (attribution of controllability), self-efficacy and a measure of physical and non-physical interventions used to manage behaviours of concern. Results Staff attitudes to low arousal approaches were associated positively with mindfulness and associated negatively with attribution of controllability. Staff perceptions were not associated with self-efficacy. One form of restrictive intervention was used less by staff who showed more positive attitudes to low arousal approaches. The staff perceptions measure showed weak internal consistency. Conclusion Further development of the SPCBQ, as a measure of low arousal approaches, has the potential to support interventions and understanding of staff practice that limit the use of restrictive approaches. [ABSTRACT FROM AUTHOR]

Keratoconus is a potentially sight-threatening condition in which the cornea distorts and becomes fragile, and without treatment can lead to severe visual impairment. The condition is much more common in people with Down's syndrome and likely to be more common in people with other types of learning disability. Since the advent of a new treatment, corneal cross-linkage, which is only applicable in the early stages of the condition, early diagnosis has become imperative. However, people with learning disabilities are less likely to complain of poor vision and more likely to have poor vision and astigmatism which can mask early changes, so keratoconus can be missed. It is essential that those caring for and supporting people with a learning disability appreciate the risk of keratoconus and ensure that clients have regular and appropriate eye examinations from the age of ten years. When keratoconus is diagnosed it is important to discuss treatment options and for carers to understand the effects of the condition to minimise sight loss and maximise quality of life. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the vulnerability of people with learning disabilities to coronavirus disease 2019 (COVID-19) • To find out about COVID-19-related deaths in patients with learning disabilities at one hospital • To enhance your awareness of the need to obtain more clinical awareness of the needs of the learning disability population There is evidence that people with learning disabilities are more vulnerable to coronavirus disease 2019 (COVID-19) than the general population, but there is a need to understand better how COVID-19 has affected that patient group. This article details a retrospective comparison study exploring the response of one acute hospital to COVID-19 in the learning disability population. A wide range of data were collected for the period between March 2020 and March 2021 about patients with learning disabilities, including admissions and deaths, do not attempt cardiopulmonary resuscitation (DNACPR) orders, ceilings of care and input from the learning disabilities acute liaison team. Data from the five years preceding the study were also collected. These data were compared with data about the general population, in the hospital and nationally. The data show that there had been no significant increase in the number of deaths of people with learning disabilities at the hospital during the first 13 months of the pandemic. However, this could be because fewer people attended hospital and more died in the community. Wider and more in-depth investigation is needed to understand the factors that may increase the risk of COVID-19-related death for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that transitions from child to adult services are often challenging • To identify the importance of early transition planning for successful outcomes • To recognise that young people's views, preferences and wishes should be reflected in transition plans Transition to adult services for young people with learning disabilities and complex needs should be a purposeful and planned process that begins at the age of 14. However, it is often fraught with challenges. This article explores the story of a young person's transition from child to adult services. It shares the lessons learned and how a collaborative, person-centred approach can result in positive outcomes for young people with autism, learning disabilities and complex needs. Recommendations are made for good practice in person-centred transition planning. Although the article explores one family's experiences, the recommendations are applicable to learning disability practice in developing improved pathways for transition for young people with complex needs. [ABSTRACT FROM AUTHOR]

Strengthening the Commitment, the Modernising Learning Disabilities Nursing Review, highlighted the importance of learning disability nurses providing support across the lifespan. This article describes an activity undertaken at the Living the Commitment Conference in Cardiff in November 2016, at which delegates were asked to identify the roles of learning disability nurses at different lifespan stages. The article examines the responses, which were thematically analysed, and highlights a range of support, some of which is provided across all lifespan stages, and some at specific periods. Responses also identified new and emerging roles across a range of settings, and the importance of influencing policy and commissioning of services. It is not possible to determine whether these roles are fulfilled across the UK, and the article recommends scoping these roles, and using the findings to inform development of learning disability nursing practice, education and research. [ABSTRACT FROM AUTHOR]

Three years ago, following surgery to remove all her teeth, a Worcestershire nursing home resident died at the age of 49. Rachel Johnston, who had 'significant learning disabilities', struggled to breathe after discharge back to her home after the procedure in 2018, but staff failed to carry out vital observations or seek emergency assistance. An inquest later concluded that neglect by nursing home staff had contributed to Ms Johnston's death. [ABSTRACT FROM AUTHOR]

The role of the registered nurse in intellectual disability (RNID) includes networking, which is an important aspect of supporting people with an intellectual disability with their health and social care needs. Networking involves RNIDs communicating with various people in intellectual disability services, mainstream health services and local communities. The advent of coronavirus disease 2019 (COVID-19) resulted in RNIDs having to use their networking competences to support clients and their families, particularly in accessing the services they needed to maintain their health during the pandemic. This article examines this networking role and discusses the developments required for RNIDs to support people with an intellectual disability effectively during a pandemic. The article also calls for further research and clarification of the networking aspect of the RNID role. This will provide knowledge that can underpin intellectual disability nursing education and practice. [ABSTRACT FROM AUTHOR]

Over the past two decades person-centred planning has been used to support people with learning disabilities to fulfil their personal aspirations. This has been backed up by national policies that have adopted the principles of person-centredness. However, widespread barriers to the implementation of person-centred planning for people with learning disabilities have been reported and the literature suggests that implementing person-centred planning is particularly challenging for people with more complex needs. This article discusses the findings of a literature review that explored the barriers and facilitators to the implementation of person-centred planning for people with learning disabilities and complex needs and their carers. The article identifies barriers such as limited funding and resources, challenges in accessing services and communication difficulties. It also describes initiatives that appear to have successfully engaged service users and their carers in person-centred planning. Further research is needed into the long-term effects of person-centred planning for people with learning disabilities and complex needs, notably to measure its effectiveness in enhancing their quality of life, while strategies to enable them to engage in person-centred planning need to be developed. [ABSTRACT FROM AUTHOR]

Research indicates that aspirate pneumonia as a result of dysphagia can be one of the leading causes for episodes of hospitalisation among people with intellectual disabilities (Glover and Evison 2013). Likewise, numerous studies have identified the risk factors for individuals and ascertained the strategies required to manage swallowing disorders and minimise the risks (Wright and Howseman 2013). Yet, several types of medication have been identified in the British National Formulary as having a high-risk effect on the process of swallowing, which may often be overlooked. Furthermore, the problems associated with polypharmacy indicate that adverse drug reactions can be implicated and linked to unplanned hospital admissions (Payne et al 2014). This article highlights the need for health professionals and care providers to reduce the potential risks and side effects that prescription medications can have in relation to swallowing dysfunction in people with intellectual disabilities and who are diagnosed with long-term conditions. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand how physical health deterioration in people with learning disabilities is often missed • To improve your knowledge of the challenges involved in detecting deterioration in adults with learning disabilities • To familiarise yourself with the need for a personalised tool that detects physical deterioration Opportunities to detect physical health deterioration early in people with learning disabilities are often missed, which can lead to suboptimal health outcomes including death. There are several challenges involved in detecting deterioration in adults with learning disabilities. One challenge is that tools such as the National Early Warning Score 2 (NEWS2) may not be suitable for this population. Another challenge is that those people who care for adults with learning disabilities in the community often do not have the skills, training, equipment and confidence to undertake physical observations and escalate any concerns to healthcare professionals in a timely manner. There is therefore a need for a personalised tool to detect and report physical deterioration in adults with learning disabilities in community settings. This article describes a project undertaken by a learning disability nursing student to develop such a tool. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the barriers that pregnant women with learning disabilities may experience in accessing maternity care • To identify reasonable adjustments that can be made to improve the care of pregnant women with learning disabilities • To learn about a service improvement initiative designed to raise healthcare professionals' awareness of the needs of women with learning disabilities during pregnancy An increasing number of women with learning disabilities are forming relationships and having children. These women are likely to have additional needs during pregnancy and to experience barriers in their access to maternity services. This article details a literature review on maternity care for women with learning disabilities during pregnancy and explains how the findings were used to inform the planning of a service improvement initiative. The literature review identified that this patient population is inconsistently and ineffectively supported by maternity services. Based on these findings, a service improvement initiative was designed to raise awareness of the needs of women with learning disabilities during pregnancy among healthcare professionals working in maternity services in Devon, England. It was decided that a one-day conference be held for up to 120 delegates in the summer of 2021. Its outcomes will be used to advance the service improvement initiative, create learning disability champions and provide practical suggestions on how reasonable adjustments can be made for women with learning disabilities during pregnancy. [ABSTRACT FROM AUTHOR]

Background The Research Active Programme (RAP) was an eight-week group-based research training programme designed to promote disability rights in research by providing opportunities for people with intellectual disabilities to become co-researchers. This article presents an evaluation of the effectiveness of the RAP from the perspectives of 14 students. Methods Data collection involved individual pre- and post-programme interviews and weekly post-session group feedback with all 14 RAP students. Interviews were transcribed and analysed. Results Students' interests, abilities and learning styles were identified and used alongside continual feedback to guide the curriculum design. Students' perspectives are presented under four domains: foundations to learning, responsive curriculum development, content learning and complementary learning. Conclusions From the students' perspectives, the RAP was a worthwhile investment for them. Participating in the programme provided access to a wider social network in a third-level educational environment and created opportunities for lifelong learners interested in becoming co-researchers. [ABSTRACT FROM AUTHOR]

This article explores the lived experiences of five nursing students who participated in the Erasmus+ programme, an initiative -- funded by the European Union -- which aims to support projects that enhance, modernise and innovate education and training in Europe. The project discussed here focused on meeting the needs of children and young people with complex intellectual and developmental disabilities. The students, from across Europe, were from a variety of disciplines, including nursing, education and social education. [ABSTRACT FROM AUTHOR]

Physical intervention techniques must continue to be refined and developed to ensure they are safe and fit for purpose. However, it could be argued that innovation in this area has plateaued, partly because training providers build their business around fixed techniques, which leads to stasis. Further, the drive to eliminate restrictive practices has placed a focus on prevention of physical restraint and physical intervention, rather than evolution of the techniques. This article considers martial arts, the origin of most physical restraint techniques, and examines how they have been modernised, using Christensen's failure framework, to instigate critical debate about how physical intervention techniques need to improve. [ABSTRACT FROM AUTHOR]

Sleep problems in children with learning disabilities are common and affect their health and learning, and the health and well-being of their parents and carers. The use of melatonin in this population is growing, but research on its efficacy and safety is conflicting. This article discusses the role of learning disability nurses in supporting children with learning disabilities wit h sleep problems, describes the prevalence and relevance of sleep issues, introduces some behavioural interventions and gives an overview of the use of melatonin. [ABSTRACT FROM AUTHOR]

Visual impairments are common in people with learning disabilities, but identification, treatment and care can be difficult. Learning disabilities health professionals who have been trained as vision champions can ensure that the vision needs of their clients are being supported and met. This service evaluation aimed to learn about post-training outcomes for vision champions in their work teams and for their clients with learning disabilities. Vision champion training was delivered to ten community learning disabilities healthcare professionals and, three months later, training outcomes were evaluated with qualitative interviews. Vision champion training increased the professionals' confidence and efficacy in their abilities to assess and meet the vision needs of their clients with learning disabilities. The training enabled the professionals to create more vision-friendly environments for their clients. The champion role can be effective in meeting the health needs of clients. Further development of the champion role and its evaluation are recommended. [ABSTRACT FROM AUTHOR]

'It's never too late to start over in life, because I didn't come into learning disability nursing until I was nearly 40. Our first son was born with Down syndrome in 2000 and at the time I was working as a research scientist in the pharmaceutical industry. [ABSTRACT FROM AUTHOR]

Positive behaviour support (PBS) is considered an effective and ethical approach to supporting people with learning disabilities who are at risk of behaviour that challenges. Many people with learning disabilities are supported in the community by staff with varying levels of PBS skills and practice, and training is important to ensure PBS is used consistently. In 2019, a community learning disability team in Staffordshire, England, developed a PBS skills training programme and delivered it to 57 senior staff from 16 local community services. In an evaluation of the training programme, participants reported some improvements in their PBS knowledge and practice, as well as some benefits for service users, after the training. However, no follow-up data could be obtained from participants six months after the training. This article describes the training programme, reports the findings of its evaluation and discusses how the findings will inform a future PBS skills development project. [ABSTRACT FROM AUTHOR]

Bowel or colorectal cancer is the third most common cancer and the second most common cause of death from cancer in Scotland. People with learning disabilities have higher rates of mortality associated with cancer of the colon and the rectum than the general population. Data for 2016 suggest that in the NHS Highland health board area less than half of all people known to specialist learning disability services, who were eligible for bowel screening, participated in the Scottish national bowel screening programme. To address the low uptake of bowel screening among people with learning disabilities, a peer-led educational intervention was developed and delivered to 109 adults with learning disabilities in the health board area. Its aims were to increase participants' knowledge of bowel health and bowel screening and reduce the barriers to their participation in the bowel screening programme. This article describes the intervention and discusses the findings from its evaluation. The intervention appears to have increased participants' knowledge of bowel health [ABSTRACT FROM AUTHOR]

In May 2011 BBC Panorama aired its exposé of poor care at the Winterbourne View hospital near Bristol. The undercover filming at the inpatient unit sent shockwaves across the sector and wider society. It revealed a regime of physical and psychological abuse, neglect, and mistreatment, prompting prosecutions of the staff involved. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In May 2019 a scandal about the care of people with learning disabilities emerged when the BBC broadcast secret footage of abuse perpetrated at Whorlton Hall, a specialist unit for vulnerable adults. This was another case in a list of abuse in care settings for people with learning disabilities, including systematic abuse uncovered at Ely Hospital in 1967 and Winterbourne View in 2011. This article reflects on the parallels that can be drawn between the cases at Ely Hospital, Winterbourne View and Whorlton Hall, suggests explanations for these recurrent patterns of abuse and makes recommendations for how to address them. [ABSTRACT FROM AUTHOR]

The Transforming Care programme was devised by NHS England in 2015 with the aim of supporting people with a learning disability and/or autism who exhibit behaviour that challenges, including those with a mental health condition, to move out of long-stay hospitals and live in the community. The driving factor behind the programme was abuse and neglect experienced by people in long-stay settings, including those living at Winterbourne View, a private hospital near Bristol that was closed in 2011 after revelations that patients had been ill-treated. By March 2019, when the programme ended, the target to reduce inpatient bed capacity by 50% had not been met. This article discusses the author's experience as a dual-qualified social worker and mental health nurse employed by a Transforming Care Partnership. In this role, the author coordinated the discharge process for five people with learning disabilities and/or autism, often with co-morbid mental health issues, who had lived in hospital for 7-21 years. The complex multiagency work that enabled these successful discharges is explored and the article considers how this work can be built on in future to ensure more people with learning disabilities are able to live in their own homes. [ABSTRACT FROM AUTHOR]