The experiences of orthopaedic and trauma nurses who have cared for adults with a learning disability

Abstract

There was evidence of good practices within orthopaedic and trauma settings such as the active involvement of family or a paid carer who is known to thepatient and the modification of care and interventions along with specialist advice and support from the Acute Liaison Learning Disability Nurse. There were areas of concern such as the lack of use of Hospital Passports and the inconsistent implementation of reasonable and achievable adjustments. It is unknown if the care for patients with a learning disability is adequate. However, the themes that have emerged accord with the key domains in 'A competency framework for orthopaedic and trauma practitioners' (Royal College of Nursing 2012a, 2012b) and therefore could be considered for inclusion in future orthopaedic and trauma competencies to enable sharing of best practices.

The use of patient reported outcome measures (PROMs) in clinical assessment

“…All hospitals in the UK have a legal responsibility to provide reasonable adjustments for people with an intellectual disability (Equality Act, 2010) and this encompasses changes to communication methods, provision of easier to read information, use of hospital/communication passports and reasonably adjusted procedures (Drozd and Clinch, 2016), for example the completion of PROMS questionnaires that are tailored to meet the individual needs of patients with intellectual disabilities, communication difficulties and/or cognitive impairments. Good health care services are individualised and person-centred with a focus on the quality of the relationship with staff and the person with an intellectual disability (Mansell, 2010) which is the same requirement as for a patient without an intellectual disability, communication difficulty or cognitive impairment.…”

Hospital passports, patient safety and person‐centred care: A review of documents currently used for people with intellectual disabilities in theUK

“…Whilst research in this area is limited, similar findings have, however, been reported elsewhere. Drozd and Clinch () undertook a survey with a convenience sample of 13 nurses attending an international trauma and orthopaedic nursing conference and found that only two (15%) had seen a hospital passport used to support people with intellectual disabilities in orthopaedic or trauma settings. This study only surveyed a small sample (and cannot therefore be generalised); nonetheless, it does give rise to concerns given that admissions to such clinical settings are likely to occur as an emergency, that treatment is likely to be required quickly and that communication may be a particular challenge.…”

“…Drozd and Clinch () argue that further research is needed to determine why hospital passports are not being used as intended by healthcare staff to support the care of people with intellectual disabilities in hospital settings. The factors contributing to this situation are likely to be complex and relate to both the content of such documents (Tuffrey‐Wijne et al., ) and organisational issues (Bell, ).…”

“…Whilst research in this area is limited, similar findings have, however, been reported elsewhere. Drozd and Clinch (2016) undertook a survey with a convenience sample of 13 nurses attending an international trauma and orthopaedic nursing conference and found that only two (15%) had seen a hospital passport used to support people with intellectual disabilities in orthopaedic or trauma settings.…”

“…Tuffrey-Wijne et al (2013) concluded that knowledge and implementation of hospital passports in their study settings were not consistent and hence that evidence to support their contribution to patient safety was limited in their study. Drozd and Clinch (2016) argue that further research is needed to determine why hospital passports are not being used as intended by healthcare staff to support the care of people with intellectual disabilities in hospital settings. The factors contributing to this situation are likely to be complex and relate to both the content of such documents (Tuffrey-Wijne et al, 2013) and organisational issues (Bell, 2012).…”