Safeguarding vulnerable adults

We constantly work to create products and services to meet the changing needs of evolving dynamic health and social care service. We offer an interactive workshop incorporating expert Learning Disability role players to challenge assumptions and create a live learning simulation.

A Live Simulation Workshop - exploring ‘reasonable adjustments’ and how you can make a difference

Marie O’Boyle-Duggan

‘The health and strength of a society can be measured by how well it cares for its most vulnerable members’ (Michael 2008).

Clinical Issues

Death by Indifference (Mencap 2007) and later Valuing People Now (2010) highlight how individuals with learning disabilities receive discrimination and neglect in mainstream healthcare and furthermore findings from Healthcare for All (2008) a report of the independent inquiry into access to healthcare for people with learning disabilities; shows that health services are giving insufficient attention to making reasonable adjustments, as required by the Disability Discrimination Act, further suggesting a breach of legal requirements set out in the Equality Act (2010).

A recent study conducted regarding the reported hospital experiences of people with learning disabilities and their carers (Densmore 2011) concludes that people with learning disabilities continue to struggle with poor experiences in hospital settings due to health staff not understanding individuals’ needs and more importantly the attitude of health staff towards those individuals with learning disabilities is still very negative.

The National Patient Safety Agency in 2004 expressed concern that consent is being sought from carers rather than taking the time to gain consent from the person with the learning disability, with gaps in knowledge and training regarding consent highlighted in emergency health workers (Evans et al 2007) and health staff and social workers (Willner et al (2011). Emerson et al (2011 p 19) suggests that “organisational barriers still exist for people with learning disabilities in terms of accessing mainstream healthcare”, highlighting a continued failure to make “reasonable adjustments” in light of the literacy and communication difficulties experienced by people with learning disabilities”.

Live Simulation

Simulation is not a new concept in terms of nurse education in fact it is becoming very popular (Jeffries 2009), and includes issues around safety and therapeutic communication (Henneman, Cunnungham (2005). A recent study conducted at Birmingham City University by Marie O’Boyle Duggan and other colleagues from child nursing and operating department practitioner department investigated the use of simulation using standardised patients/simulated patients (SPs which are expert role players portraying individuals with learning disabilities) with health students and more importantly investigated the students self-reported reflections regarding clinical impact when caring for patients with learning disabilities. We did this by measuring student self-confidence and satisfaction with the simulation using a questionnaire and student reflections; and at a later date following clinical placement, focus groups examined the impact on clinical care of patients with learning disabilities. The sample consisted of child and adult branch nursing students and operating department practitioner students, 173 students taking part overall with sixty taking part in three focus groups.

We ran these simulation activities using Jeffries simulation framework (2007); with students worked in groups of three; each students took part in at least one patient simulation interaction with a simulated patient (at times the role players would show signs of emotional distress and/or challenging behaviour), whilst the facilitator and other students in the group provided peer reflections using Pendletons Rules (2007). Students were given a specific task to complete with the patient simulator; for example, taking a blood pressure reading.

The results of this study indicate overwhelmingly that students highly value the simulation and importantly following clinical placement, reported that this experience impacted positively when providing direct care to patients with learning disabilities. A recent similar study by Storr (2010 p39) describes how students claimed that simulation activity “stays with them and assists them in remembering the person when the student is confronted with increased complexity of care.

The recent focus on human factors affecting critical decision making and clinical actions (Patient Safety First 2011) means that providing live simulation workshops using simulated patients to explore with health staff important issues around patient safety, reasonable adjustments and therapeutic communication is an attempt to bridge this gap.

This overall aim of the workshop is to enable clinical staff to explore their understanding and knowledge in terms of clinical impact when caring for patients with learning disability, where reasonable adjustments will become easily understood and applied as part of the role of an inclusive health practitioner.