Another feature is the comprehensive nursing assessment, which is a key part of building a relationship with the person. The model offers several care plan formats, all with person-centred components. An easy-read format can be given to service users, their relatives and carers, with whom close relations are fostered from the start. Setting up a care plan requires considering and documenting the evidence that underpins it.
People with learning disabilities often have complex histories and needs, so an approach that is right for an individual may not have a clear validated evidence base. Using knowledge of the person supports person-centredness, but interventions must be ethical and based on evidence of good practice. Finding effective ways of working with a person can also help to build a new evidence base, which can be validated and shared.
The model is designed to prompt nurses to think about outcomes right from the start. They are encouraged to measure outcomes and can use any appropriate tool to do so.
The HEF enables nurses to measure the impact of social determinants of health inequalities on a person with learning disabilities and how nursing interventions may reduce that impact Atkinson et al, The evaluation process captures a HEF score, but it also looks at factors such as whether the person-centred goals were met, how nurses helped the person achieve these goals, and how the intervention achieved desired health outcomes.
The model encourages nurses to reflect on their interventions at every stage. It includes several tools they can use to reflect on their practice, improve the care they provide and gather evidence for revalidation. Nurses use the assessment, alongside the screening tool and HEF, to inform the care plan and their proposed interventions, and reflect on the priorities and delivery of care. In the care plan, they consider desired health outcomes and how people can achieve person-centred goals, backing up their interventions with documented evidence of best practice and research findings.
HEF scores provide a measure of outcomes, and care plans are continuously evaluated and updated to reflect changing needs. Throughout the process, nurses can use tools to evaluate and reflect on their practice. The model is not prescriptive. Nurses can choose which resources and tools to use and adapt them to, for example, design their own assessment format or outcome measure. Box 1 features a case study showing how it can be used in practice. As a child, Ms Brown was monitored by social services due to unstable housing; she is currently living in a council house with her aunt.
Assessment The learning disability nurse assessed Ms Brown with her aunt present; she was initially reluctant to speak for herself, but gradually opened up and showed herself to be personable and capable of speaking her own mind. The nurse established the things that were important to Ms Brown: from a mixed African-European background, she enjoyed the culture, music and food from her African heritage and, although her family was important to her, she lacked a social circle outside of it.
Ms Brown was happy to be single but had unprotected sex with men and was unaware of safe sex and contraception. Despite being sexually active, she had never had cervical screening or a health check with her GP. She had epilepsy but her seizures were reasonably well controlled with medication.
She was obese, took little exercise and was unaware of healthy eating, which put her at risk of diabetes. She was self-conscious about her weight and had low self-esteem, which, combined with her social isolation and disruption in the family environment, left her vulnerable to depression.
Her aunt, who was a little guarded at first, recognised her niece had an unhealthy lifestyle and engaged in risky behaviours, and wanted support to help keep her safe. Care plan The nurse helped Ms Brown to create an easy-read care plan based on her aspirations, which were to:. Outcomes Ms Brown attended six sexual health education sessions and a joint session with her nurse and social worker. Her sexual knowledge score improved and she was able to identify to whom she should talk about any experiences that were uncomfortable or worrying.
The GP referred Ms Brown to a health and fitness club. Her aunt and sister attended the first sessions with her and encouraged her to continue attending. In the first six weeks, Ms Brown lost 3. She continued to attend and also expressed a desire to join a cookery club. She started to take more interest in her personal care and hygiene, and gained enough confidence to try on a dress for the first time. However, she still had a poor understanding of her epilepsy or when to go to the GP and did not want to carry a health passport.
To help address any unmet health needs, the nurse proposed extra support with attending health appointments, including annual health checks. The Moulster and Griffiths model has been adopted by a number of services — including inpatient services, respite services and community learning disability teams — in a range of settings in the UK.
Experience shows that it provides a flexible framework that can meet the needs of people with learning disabilities as well as learning disability nurses, and is capable of responding to the rapid pace of change in learning disability nursing. Sign in or Register a new account to join the discussion. You are here: Learning disability nurses. A flexible model to support person-centred learning disability nursing.
Abstract Learning disability nurses play a crucial role in improving health outcomes for people with learning disabilities, but the specialty has been held back by the lack of a bespoke care model.
This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF here if the PDF fails to fully download please try again using a different browser. Box 1. Care plan The nurse helped Ms Brown to create an easy-read care plan based on her aspirations, which were to: Have more confidence in herself and her body so she could feel more feminine and wear the clothes she liked Join a fitness club and find out about healthy eating Continue to live with her aunt and spend time with her brothers, nieces and nephews.
Key points Learning disability nurses play a key role in improving health outcomes and reducing health inequalities Learning disability nursing requires expertise in assessment, communication, health promotion, education and empowerment The Moulster and Griffiths model of learning disability nursing is person centred, evidence based, outcomes focused and reflective It clarifies the role of learning disability nurses and ensures all people receive the same high standards of care.
Aldridge J Learning disability nursing: a model for practice. Oxford: Blackwell Science. Amey P et al Person-centred planning: a team approach. Learning Disability Practice ; , Barrett D How models help staff to plan care. Nursing Times ; 24, Kernohan J The art and science of learning disability nursing. The report also set out comprehensive risk-management systems, learning lessons from industry and its management of risk.
In our trust, nursing documentation consisted of a page series of checklists, known as the nursing assessment proforma NAP , which was designed by senior nurses, specialist nurses and a nurse consultant.
The analysis also found that completion of this tool had not affected outcomes of care. In view of this, we agreed this current practice could not continue as it did not meet service need and posed a potential risk to patient safety. Developing the tool As a result of these findings, we decided to investigate whether introducing a hospital-based risk-assessment tool would improve safety. A small working party was set up to investigate how improvements to patient assessment could be made.
Until this point, nursing assessment had been influenced by using a reactive, problem-solving framework rather than taking a proactive approach. Having identified an absence of patient assessments within nursing documentation, it became clear there were further issues:. The final agreed format for the tool consists of 10 risk assessments. Three examples are shown in Table 1.
This risk tool was developed for use in a range of settings in the acute sector. Lean thinking involves five basic principles that characterise a lean enterprise Womack and Jones, Each risk category generates a score that has been carefully correlated to give parity across the risks, so all scores range from zero to six.
We invited three wards - a medical ward, a surgical vascular ward and an elderly care ward - to take part in a pilot. Each had motivated ward managers with a good track record for change projects. Qualified nurses on the wards were asked to complete the risk assessment for each patient on admission and then weekly thereafter. Risk-based care plans have been produced to accompany each category. The care is divided into triggers that are classified as low, medium and high risk, depending on each patient score generated.
All patients in the pilot had an individual holistic assessment that was reviewed weekly with measurable outcomes. Increased emphasis was placed on collaborative working between nurse specialists and ward staff.
The information gained proved invaluable and has enabled us to tailor the care we offer to patients. We found the tool could be used to identify patients ready for discharge home. Those with the lowest risk scores were usually the fittest and required the least nursing care - as such the tool allowed discharge teams to highlight these patients as ready to go home.
Conversely, those patients with the highest scores were generally the most unwell and the tool could be used in the allocation of nursing staff. In this way it worked as a type of dependency tool and ensured those patients who were most ill were cared for by the staff who were most skilled. Identifying those most at risk also meant they could be placed in the most appropriate sections of the clinical area. Feedback from those who have been using the tool has also been positive, with staff commenting it is user friendly, less time-consuming than the original page assessment document and could be completed following simple direction.
Nurses felt they were able to make a good assessment of patients based on risk factors. The tool initially takes approximately minutes to complete, but is quicker after the first assessment.
This means it releases nurses back to direct care and reduces unnecessary and burdensome paperwork. However, the tool does have disadvantages. This was the second major redesign of nursing documentation in two years and it requires investment of time and activity from senior nursing staff to train and embed it in practice, while being led and monitored by the matron.
It was envisaged that the tool would enable nursing staff to make proactive referrals to nurse specialists, but this does not happen currently.
For example, patients are only referred to the pain nurse specialist when they are identified with pain, as the current system does not allow proactive identification of those who may experience pain or any of the other risks.
Another example is the bowel nurse specialist, who could become involved with high-risk patients, but does not do so currently as no system has been available to highlight such patients. This tool offers the opportunity to refer patients with high risk scores to the appropriate nurse specialist before a problem develops, and this is one aspect of the tool that needs developing before this system can be described as fully integrated.
The tool has proved more effective than ever expected. Compliance has continued following completion of the pilot and adoption of the tool across the planned care directorate.
This is in no small part due to the fact the ward staff liked the tool immediately and found it easy to complete.
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