The term learning disability is a broad term which covers a multitude of overlapping and interrelated clinical entities all with different aetiologies and degrees of severity. Although in this essay we are considering the topic in specific relation to cerebral palsy, we should acknowledge the wide scope and application of the term.
We can cite evidence (Xenitidis K et al 2000) to show that the incidence of learning disability in the population is steadily increasing and currently stands at about 2%. The cause for this rise is unclear and is certainly multifactorial. One of the prime causes is said to be increased sophistication in diagnosis
(Meehan S et al. 1995). Aspray TJ (et al. 1999) points to the fact that there is now a greater survival chance in pre-term babies who would otherwise have perished and both cerebral palsy and learning disability are more highly represented in this group.
The recent paper by Colvin (et al.2004) is an excellent tour de force on the subject and cites evidence to suggest that the outcomes for babies born after 32 weeks gestation are generally the same as for the general population in terms of academic attainment. The problem group is the 20 -32 week gestation babies who have a significantly higher risk of both cerebral palsy and eventual learning disability. This appears to be primarily due to the phase of rapid brain growth that occurs at this stage of development. Problems with illness, undernutrition and infection can result in:
– serious neuromotor problems (principally cerebral palsy), visual and hearing impairments, learning difficulties, and psychological, behavioural, and social problems.
In the context of this essay we should note that although the seriously pre-term infant has the greatest statistical risk (as a group) of developing cerebral palsy and learning disability, in absolute numbers the majority of cerebral palsy sufferers are not born pre-term. (Bhutta AT et al 2002)
Describe one appropriate Clinical Skill to be used when caring for a patient with such a Learning Disability,
As we have already discussed, there are a great many potential problems that can befall a patient in this particular category including intellectual impairment and hearing or visual impairment to name but a few, all of which require specific clinical skills in the healthcare professionals who treat such patients. In this essay we are going to take a more pragmatic overview and consider the role that the nurse can play in the inability of the learning disability patient to access medical care generally. This is the role of the patient’s advocate which is a skill in itself. (Mason & Whitehead 2003)
Patients with cerebral palsy specifically and with learning disabilities in general, have a greater morbidity and mortality than the general population. Cooper A et al 2004). Aspray TJ (et al. 1999) cites a greater tendency than the rest of the population to:
chronic health problems, including epilepsy, dementia, hepatitis, peptic ulcer, dysphagia, and problems related to sensory impairment. Age related diseases such as stroke, cardiovascular disease, and malignancy will also be of growing concern as life expectancy increases.
The problem is that this group are largely failed by the healthcare professionals as a group, because they may not appreciate the need to take regular medication, the need for screening or the implications of not receiving regular medical attention for these complaints. As a result, their contact with medical facilities is reduced, as is their overall health care.
Describe how this Clinical Skill can be used to meet the relevant physical care need(s) of a patient with Cerebral Palsy.
The community nurse is ideally placed to provide a liaison between this group and the healthcare professionals who may be in a position to help. A number of papers have appeared in the medical journals recently which have cited examples such as a very poor take up of cervical cytology screening (Hall et al 1999) and mamography (Piachaud J et al 1998) for women with cerebral palsy and learning disability.
There are the practical difficulties associated with getting registered with a General Practice and many general practitioners do not have the skills and specific training necessary to deal with this particular sub group. The community nurse can therefore make a great difference with a professional attitude, a caring and empathetic manner and the knowledge and determination to make a difference for these patients.
In addition, we must not overlook the fact that for every cerebral palsy sufferer there is usually a group of carers who may be parents or relatives, who will also need a degree of support. The nurses’ skills as advocate are equally important in this group, as the nurse is often the prime point of contact between carers and healthcare professionals. (Gilbert T 1995)
References
Aspray TJ, Francis RM, Tyrer SP, and Quilliam SJ 1999
Patients with learning disability in the community
BMJ, Feb 1999; 318: 476 – 477
Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. 2002
Cognitive and behavioural outcomes of school-aged children who were born preterm: a meta-analysis.
JAMA 2002;288: 728-37
Colvin M, William McGuire, and Peter W Fowlie 2004
Neurodevelopmental outcomes after preterm birth
BMJ, Dec 2004; 329: 1390 – 1393 ;
Cooper A-A, Melville C, Morrison J. 2004
People with intellectual disabilities. Their health needs differ and need to be recognised and met.
BMJ 2004;329:414-5.
Gilbert T 1995
Nursing : Empowerment and the problem of power
Journal of Advanced Nursing 21 (5) : 865-871
Hall P, Ward E, Djuretic T, Whitmore J, et al. 1999
Cervical screening for women with learning disability.
BMJ 1999; 318: 536-537
Mason T and Whitehead E (2003)
Thinking Nursing.
Open University. Maidenhead.
Meehan S, Moore G, Barr O. 1995
Specialist services for people with learning disabilities.
Nursing Times 1995;91(19): 32-4.
Piachaud J, Rohde J. 1998
Screening for breast cancer is necessary in patients with learning disability. BMJ 1998; 316: 1979-1980
Xenitidis K. Thornicroft G. Leese M. Slade M. Fotiadou M. Philp H. Sayer J. Harris E. McGee D. Murphy DG. 2000
Reliability and validity of the CANDID-a needs assessment instrument for adults with learning disabilities and mental health problems.
British Journal of Psychiatry. 176:473-8, 2000 May