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The scenario I have chosen is James. James is 55 years old and has downs syndrome. Betty, his 78 year old mother is his primary carer alongside the support of Alice, (James’ learning disability nurse) whom he has worked with for a number of years. Betty has had a fall and is in hospital. Is it is clear in the given situation that James may need additional support. A social service review suggests James is moved to a residential home whilst his mother is in hospital.

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This essay explores factors such as how best to communicate with James and the interpersonal skills I need as a nurse to be able to communicate effectively. I will look at the key professional values and beliefs that underpin safe, person centred and evidence based nursing practice and holistic care. I will look at ways to promote the health of both Betty as my patient and James to make sure both care needs are taken in to consideration. It is important also that I take lead for the care of my patient within the multi-disciplinary team. This is because there are a variety of professionals with differing prospective about this scenario. With self-review and the skills I have learnt, I should be able to successfully promote both patients health allowing an easy transaction in to the future care plan.

Professional values:

As a nurse, patient centred around the clock care for patients and their families would be my priority by implementing the use of the NMC code of standards. It is my job to promote professionalism at all times. In this scenario, patients with a specific learning disability can be quite challenging to look after, but I feel it is crucial to identify and meet their needs, both in terms of safety and health. The Nursing and Midwifery Council (2008) states that nurses have a duty of care to act in the best interests of their patients and work with other’s to protect and promote health and wellbeing to those in care, their families and the wider community.

It is important to ensure that James is kept safe and his health care needs are met too as well as Betty’s. Betty is concerned about her son so it is important that she is reassured about his safety and wellbeing in order to help aid her own recovery. James’ rights and entitlement to be involved may be overlooked in the need to reassure Betty. As a nurse I would be expected to act with integrity at all times and have clear professional boundaries for those in my care. One for the 6 C’s of care (NHS England) is competence, so it is important to show understanding of both Betty’s and James’ need. This could lead to a view that it would be in James’ best interest to go into care until his mother is better and able to care for him or stay at home with help and support. James has a right to decide where he wants to live. The DH (2009 np) states that: “People with a learning disability and their family should get a say about what support and care they need”.

Communication and Personal Skills:

Communication and compassion are again part of the six C’s of Care. This fits in really well with this scenario. With the learning difficulty, I need to understand a way to communicate best and most effectively with James, whilst showing my compassion. I feel that interpersonal skills as a nurse is important because as in this scenario, each patient needs to be communicated with in a way they feel most comfortable and on a level they fully understand. The Department of Health states that ‘a learning disability may significantly reduce the ability to understand new or complex information’. This would be when I can include the help from someone like Alice, who James has a good long standing relationship with to help explain the situation rather than upsetting James. This will help with James’ Holistic care and be more therapeutic and appropriate for the situation.

It is not just verbal communication I need to be wary of. As well as my tone of voice to James, I also need to be aware of my body language and stature. This makes up over 55% of the way communicate according to MENCAP (2008). By talking to Betty, I can also find ways how communication usually takes place with James to stop him from feeling Isolated. I could include things like sign language and pictures from contacts within the multi-disciplinary team, which would give both patients choice. Part of my communication as a nurse will be helping to patient to feel at ease with me and trust my professional judgement of any given situation.

Leadership skills:

Another two of the 6 C’s of care are commitment and courage. Taking control of patience care I can access the pros and cons of James going into residential care while his mother Betty is in hospital and involve the multi-discipline team. I have the courage to stand up for both patients to ensure the utmost excellence in their care. It is important to have a clear concise path of care whilst in hospital and out for both James and Betty. I should have courage to stand up for the patients beliefs and fight for what is the right path of care for both James and his mother. My leadership may be as simple as passing on a detailed care plan to fellow colleagues after collaborating details from the team.

As a nurse it is important I make both Betty and James aware of the good and bad points to residential care homes. The other side is if James is left at home whilst Betty is in hospital there in an increased risk of him injuring himself which is why it has been suggested by part of the multi-disciplinary team that James is moved to care. The British Journal of Nursing (2012) states that nurses have a duty of care to act in the best interests of their patients at all times and must therefore ensure they are fully aware of the health care needs of those with intellectual disabilities and provide reasonable services. The Guardian (2012) explains that half residential care homes for people with learning disabilities failed to meet the Care and Welfare Standards. Care homes can however be exceptionally good places for people with learning difficulties as James will be with others he may relate to and have 24hour care. As a nurse I need to make sure whatever is decided it is helping to promote both James and Betty’s health.

Promoting Health:

Exploring the option of James staying in own home with support is an option in this scenario. The Nice (2012) states that ‘carers find it hard to care for their family when they are ill or their own wellbeing is not what it should be’ This could result in James living in isolation and poverty and cause long term effects on his ability to care for them self. The support of just Alice is not enough and there won’t be the 24 hour care that is required should an issue arise. I feel that should James seek residence in the care home he will have the facilities available for a range of support from people who are used to caring for others with more complex needs and challenging behaviours. Within the residential home setting James will be supported in promoting his independence that he had with his mother. I feel the care would aid Betty’s recovery as the worry may affect her mental health. The holistic care would then be promoted for both.

People with learning disabilities want to make their own choices and decisions about the things that affect their lives, so it’s important to include James’ as when dignity is present people feel in control, valued, confident, comfortable and able to make decisions for themselves. Dignity applies equally to those who have capacity and those who lack it. Everyone has equal worth as a human being and must be treated as if they are able to feel, think and behave in relation to their own worth or value. The nursing team should therefore treat all people in all settings and of any health status with dignity, and dignified care should continue after death (RCN,2008).

Professional reflection:

This scenario has considered the needs of an elderly patient and her son with learning difficulties. To me it is my professional opinion that James should stay in the residential care home. It is clear the whole family need guidance and support at this time. I have looked at the needs of my patient and her son and involved the family in the decision-making process which I have lead as a nurse. I feel I have reviewed all the factors that may have an effect on James, i.e. his age and I feel I would have promoted his health by making the transition smooth and easy to prevent any upset or confusion to James and his family. I feel in my professional opinion, that James will be well cared for, have 24hour support and be with people similar to him. The quality of care will be more focused and it means than Alice may still be a continuing part of his care. It can be a short term solution that will aid the recovery of Betty as well as letting James keep his independence but also promote his health. Once Betty has fully recovered the situation could then be reviewed and a different care path may be more suited.

I have also learnt that the NHS Leadership Academy (2012) created a framework, which staff can use to work on skills involving the nine dimensions of leadership behaviour. It states that these nine dimensions provide an important role in meeting the needs of the individual’s holistic care. This would be good to use for my professional development and ensuring I am up to date with my competencies.


It is clear to me as a nurse I have a duty of care and I am bound by the code of nursing and midwifery council. I can see how I fit into a multi-disciplinary team and how important it is to have the courage to stand up for all aspect of patient care. Through this process I have made some clear reflection for future practise which will improve my confidence from a student to a competent registered nurse.

The 6 C’s of care are important and need to be used in day to day practise. I need to have mutual respect and trust for both patients and members of the multi- disciplinary team. Holistic care needs to be promoted in every situation for both patients and their families. I feel I have covered the four learning outcomes and applied them to this learning disability scenario. I feel as nurse I should be able to put into action what I have learnt for best practice for working with patients with learning disabilities in clinical settings; to encourage the transfer of skills to other relevant contexts and to stimulate the wider dissemination of best practice.

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