Learning Disability Experience 

The aim of this essay is to reflect on my practice placement with adults who have both physical and mental disabilities focusing on risk. It was on my first-year study of Adult Nursing, I was allocated for a month in a residential home for adults with learning disabilities. Ellis (2013) stated that the main purpose for reflecting on previous experiences is to develop future practice when working with people with several needs. Reflection contributes to developing evidence-based practice in nursing, making it valuable process for me when I become qualified. Initially, I am going to talk about Ana (not the real name), (for confidentiality reasons (NMC,2002), An elderly lady with complex learning disabilities who does not communicate, is wheelchair bound with dementia, neck injury, seizure problems and with a nasogastric tube in place. Secondly, I will discuss the risks Ana is vulnerable if the staff are not trained or have no knowledge about feeding patients with swallowing problems as she has a high risk of choking and falling. Lastly, I will talk about the importance of risk assessments and government guidelines associated with Ana ‘s management and prevent chances of incidents like falls. I will be using Gibbs’1988 model of reflection it was developed to help students engage in meaningful reflection, and it is frequently used in nurse education settings and I find it useful in identifying my learning and deals with developing feelings about the incident.

This reflective framework comprises of six stages which are: Description, Feelings, Evaluation, Analysis, conclusion and Action plan. Confidentiality will be maintained over this reflection by not stating actual names of any person or organisation (NMC,2015). Throughout my four weeks of experience in a residential home for residents with learning incapacities, I have seen choking of one of the residents. The incident happened whilst I was looking after a resident who suffered from dementia and epilepsy named Ana. Ana is unable to communicate, wheelchair bound, and she needs to be hoisted for transferring from bed to chair and vice versa. She has a nasogastric tube in place because she is unable to swallow due to her disease. During mealtime, the care assistant continuously and carelessly was feeding Ana orally with a dry sandwich cut into small pieces while talking to the other staff and Ana started coughing. Instead of asking the team leader to give Ana a drink to give via the tube, the carer just shouted at Ana to swallow and to stop coughing. I went and reassured Ana and offered myself to feed Ana and informed the Team leader that Ana was coughing badly. I stayed with Ana and the carer who fed Ana went to another patient. I realised that Ana was choking, and the team leader quickly gave Ana a flush through the enteral route. At the time of the incident, it was only my third day on the learning disability placement. I did not feel confident enough to deal with these circumstances. I felt very bad initially and the level of my anxiety increased, and I was scared to intervene in the situation.

Moreover, I could have helped feeding Ana sooner as I knew that she had a Nasogastric tube and have better knowledge of Anatomy and physiology. Instead of relying on the carer to feed Ana who did seem not care and had limited knowledge of what was happening in Ana’s response to choking by coughing. I felt that I was responsible to ensure the safety of Ana as she was vulnerable due to her complex needs and did not have the capacity to communicate her feelings. Thereafter the shift leader asked the carer who fed Ana to fill out an incident report. Then I documented it in the patient’s notes countersigned by my mentor highlighting the need to be careful in feeding Ana. Furthermore, they mentioned every handover what happened to Ana and how they can avoid, her from choking. NICE (2015) guidelines endorses that everybody who is connected in service users’ care with learning disabilities must be aware of the risk involved and constantly document issues that may increase the risk. My mentor showed me Ana’s record of past choking incidents for the last year, and a care plan that was put in place. A referral to Speech and Language Therapy Team was done long time ago. Ana’s care plan had a multifactorial assessment and treatment plan intended to meet specific needs and some precautions that could help her to swallow more safely and manage her recurrent choking. Various precautions include: sitting the patient straight when eating and drinking, taking small bites, taking time and making sure that food from the patient’s mouth is cleared. According to PHE (2018) Guidance Dysphagia (Swallowing Disorder), individuals with learning disabilities are more probable to have dysphagia than other people. National Patient Safety Agency (NPSA) (2004) highlighted choking as a significant health risk for people with learning disabilities. Dysphagia can result in choking and may lead to death. Ana is an elderly with a swallowing problem, seizure problem and dementia, which has a high risk of choking because of her disease. She is on regular pain relief like ibuprofen liquid, which makes her nauseous and Carbamazepine, anticonvulsant drug which has a side effects of sleepiness, fatigue.

These are administered via nasogastric tube (BNF,2017). Ana has had a falls assessment done as well, as she has seizure problem and immobility. I have observed during my placement that staff members apply some restrictions or limits on Ana, as she had her seat belt in the wheelchair, but I know that it is for her best interest to ensure her safety. According to Mental Capacity Act 2015, Deprivation of Liberty safeguards (DoLS) is an act that is a precise method that has a list of orders intended to safeguard the adult who is deprived of right is secured and the course of action is equally suitable and, in the patient’s, best interest (Alzheimer’s Society,2016). The Department of Health’s (2015) guidance on DoLS argues that local authorities, care providers and psychiatric consultant in learning disabilities can make the verdict to make an application for DoLS or not. Ana requires, to prevent her from falling from her chair, due to risk of falls and immobility, justifies the use of a seat belt. After the incident the shift leader questioned me what had happened, and I explained. I felt guilty that Ana was carelessly fed by the carer and I should have recognised more quickly the signs of choking.

The shift leader was very supportive and explained to me that incidents happen at any time and she thanked me for staying and giving reassurance to Ana. The shift leader told me as well that, I act and responded well to the incident and they also believed that they felt I did all possible within this situation. This experience was good because I have learned from this incident, as it has taught me the importance of acting quickly for any emergency situation, in order to protect patients’ safety. The downfall of this experience is that, the staff did not seem to follow the assessment done by the Speech and Language Therapy Team by giving extra care to Ana when feeding. This relates to a risk as Ana has a swallowing problem and she a nasogastric tube. According to Department of Health (2007), The importance of adult Speech and Language Therapy (SALT) referral is important because, people who use health and social care, carers, families, practitioners or organisations see risk in a different way and as part of the risk assessment, it is vital to recognise possible risks involved concerning patients’ care and a person-centred care plan should be considered. To support the individual and to establish a critical understanding of the ways of working with individual colleagues to encourage risk assessment and exercise to recognise and examine possible measures that may cause harmful effect on service users with learning disabilities in the community and to comply with the statutory duty under the Health and Safety at Work it is important to document the risks factors, proper handover and recognising person-centred care plans considered to lessen risks. Scarborough and Broussine,2012) stated that health and social care staff need better training in how to support individuals with learning incapacities. During the period of the incident I possibly will have deferred my response and tried to keep and handle the circumstances personally. But I strongly felt that rather more serious was happening and I required help. I may perhaps ignored Ana and left but for her best wellbeing interest I thought Ana would not want to be left alone. When the shift leader arrived, I could have walked back from her as other more experienced staff were present, but because Ana was my patient I felt I had a part to play in her effective recovery. My four weeks of placement in learning disability contributes evidence and a chance to get a concise understanding of different field of practice. I have gained basic knowledge through this experience and have learned about policies and procedures, such as DoLS in place to protect the vulnerable adults and lessen the risk executed by them, and also recognise about the local and national rules obtainable online for entire staff to access for similar incident management as well. After knowing the local and national rules and management procedures I have now attain how to respond professionally once an incident arises. I now understand that I have learnt: the value of recording the risk factors, communicating with the team about the incident and the residents own care plans intended to reduce dangers.

Overall, I did well for my first experience seeing a resident choking and responding quickly to the incident, and I now feel having critically reflected and confident, be more improved with the situation that might happen in my future nursing career. I will keep all the knowledge I have gained during my placement such as safeguarding adults, risk assessment and management, on how to manage incidents, the importance of communication, record keeping and team working (Barnes and Jenkins, 2015). Any incidents should be reported and escalated with the team. Any observed exploitation or abuse must be conveyed to the safeguarding team and proper documentation is vital as required by law as relevant information about patients’ condition is important. To conclude, this reflection has described the difficulty in dealing with individuals who has learning difficulties. I have discussed the high risk; vulnerable people are both to themselves and others due to their unsafe behaviour. Several safeguarding and risk management policies and procedures are available online for all staff, have been evaluated in this essay to decrease, be able to and avoid the recurrence of incidents.

The importance of effective communication within the team and appropriate documentation is vital were mentioned (Fisher and Scott, 2013). If similar circumstances occur I would decide to act fast informing the nurse in charge or shift leader and by pulling the emergency alarm as alerting the resuscitation team. I would do first aid treatment, if competent, I would also be more prepared to give oxygen, check patient’s observation and monitor oxygen saturation. By means of reflection as part of an action plan to give an impact for my upcoming practice has assisted me to obtain and to analyse my personal nursing skills. This reflection has empowered me to look for what I did in the incident’ and validate my actions to determine if I competently be able to manage incidents and what influenced me to respond in the way that I did. In my future nursing practice, I will use this experience to deliver the best care for my patients, by ensuring that I am more aware about the signs and symptoms for patients who need urgent care. I will apply all the information I have learned over this placement and use it in my upcoming nursing career with further confidence in protecting patients keeping and maintaining good ethics and principles of the NMC (2015).

Works Cited

1. Alzheimer's Society. (2016). Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS): Guidance for people living with dementia.
2. Barnes, D., & Jenkins, P. (2015). Developing reflective practice in health and social care. Sage.
3. Department of Health. (2007). Transforming nursing practice through reflective practice.
4. Department of Health. (2015). Mental Capacity Act 2005: Deprivation of Liberty Safeguards Code of Practice. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/389643/MCA_Code_of_Practice_accessible.pdf
5. Ellis, P. (2013). Understanding and developing the value of reflection in nursing practice. British Journal of Nursing, 22(13), 738-743.
6. Fisher, R., & Scott, N. (2013). Interprofessional education and collaborative practice: Creating a blueprint for nurse educators. Nurse Education in Practice, 13(6), 489-493.
7. Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit.
8. National Patient Safety Agency. (2004). Reducing the risk of choking: The care of people with learning disabilities. Retrieved from https://www.safetyactionservices.com/userfiles/file/reducing_risk_of_choking.pdf
9. NMC. (2002). Confidentiality: Good practice in handling patient information. Retrieved from https://www.nmc.org.uk/standards/guidance/confidentiality/
10. NMC. (2015). The code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates.