E-learning: a virtual challenge for educators

This article examines e-learning in nurse education, specifically in learning disability nurse education, exploring its anticipated impact and discussing the importance of managing its implementation. Ways of utilising new technologies for the benefit of nursing students are analysed. The article also looks at how nurses' use of e-learning can help people with learning disabilities and cautions against relying on an overly technological approach in the humanistic fields of education and nursing.     

A qualitative analysis of the 'management of schizophrenia' within a medium-secure service for men with learning disabilities

Within secure psychiatric services, nurses trained to work with people with learning disabilities are often called upon to deal with those experiencing psychosis; a role that they are not routinely prepared for in generic learning disability nurse training. Psycho-social interventions (PSI) are recommended as an adjunct to routine pharmacological treatment for people experiencing psychosis. There is a small literature that suggests that PSI has utility with people with learning disabilities. As part of a wider evaluation of the introduction of a PSI framework to a 10-bedded medium-secure unit for men with learning disabilities and mental health problems, 13 members of nursing staff completed the 'Management of Schizophrenic Patients Checklist'. The responses were analysed using a grounded theory approach. Principle themes identified are described. The therapy vs. security quandary frequently reported in forensic psychiatry was evident in responses. The findings are guiding a programme of training and ongoing supervision within the service and are discussed in the context of wider therapeutic issues and institutional environment.     

The specialist learning disability nurse in Wales

Fisher M. International Journal of Nursing Practice 1997; 3: 188–190
The specialist learning disability nurse in Wales
This paper reflects on the development of services for people with learning disabilities within the United Kingdom and focuses on the role of the specialist nurse. The nurse's contribution to the care of this client group has been the subject of debate and controversy for a number of years. Developments within the learning disability field in Wales in particular are explored, with the All Wales Strategy for People with Learning Disabilities providing the background and context for these developments. An example of how specialist nurses from around Wales came together in order to share good and best practice is discussed. The conclusion is that the specialist learning disability nurse has a great deal to offer, but must be prepared to work together with other professionals as well as service users and their families.     

Quality of life as a concept for developing learning disability nursing practice?

This paper offers a critical examination of how the concept of Quality of Life might be used to enhance learning disability nursing practice. Quality of Life will increasingly influence the provision and evaluation of services and practice in the field of learning disability. Attempting to define and assess Quality of Life is, however, problematic because of the complexity and multidimensional nature of the concept. The use of domains to measure Quality of Life is advocated by many researchers for both objective and subjective measures and use of Quality of Life as an evaluation tool is seen as a way of improving the life quality of people with learning disabilities. However, there are concerns that the use of such an approach could perpetuate professional agendas rather than empower people with learning disabilities themselves. To date, Quality of Life approaches have not had a major impact on learning disability nursing. However, it is suggested that they can be helpful as sensitizing concepts, a basis for collaborative care planning and a framework for evaluation. Recommendations are made for education, practice and research.     

Raising awareness of learning disability needs in acute sector care: A reflective account of a workshop from the guest facilitator perspective

Nurse education has an essential role to play in reducing health inequality for people with learning disability [Michael, J., 2008. Healthcare for All: Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Aldridge Press, London]. Many nurse education providers will need to use guest facilitators in order to raise awareness of best practice in caring for this client group for non learning disability branch students and their experiences as nurse educators will be of growing interest. This article critically reflects on an educational session for pre-registration adult branch nursing students which used a variety of teaching methods to facilitate a reflective, student centred, experiential learning approach. Self assessment based on the change between two self rating scales was used to assess learning, the session itself was evaluated by students using a feedback form and through the formal assessment of teaching by a nurse tutor. This article critically evaluates the preparation, delivery and evaluation of the session, emphasising the perspective of the guest facilitator – a practicing community learning disability nurse. The conclusion reflects on key learning from the teaching experience.     

Primary health care provision for adults with a learning disability

BACKGROUND: During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability. RESEARCH AIM: To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities. RESEARCH METHOD: A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate. RESULTS: Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team. CONCLUSION: This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.     

Effective health care for people with learning disabilities: a formal carers' perspective

This paper explores the perceptions and experiences of formal carers, working in three different geographical locations in the south of England, in accessing primary health care for people with learning disabilities. The sample included six multidisciplinary, community learning disability teams and 11 managers of small homes for residents who had learning disabilities. Data were collected through focus group and individual semistructured interviews. Levels of collaboration between primary health care groups and the community learning disability teams and the managers of small homes were assessed. Questions were focused upon the importance of primary health care and the key care provider within the community setting. Although some good experiences were recorded, the overall levels of collaboration were poor. Health care was perceived as very important by all of the respondents. The general practitioner (GP) as the coordinator of health care was perceived as the normal model within our health care system but the majority of respondents questioned the effectiveness in relation to their own experiences of accessing health care for people with learning disabilities. The relocation of this role to the learning disability nurse was perceived as a possible solution.     

An Investigation of Nursing Staff Attitudes and Emotional Reactions Towards Patients with Intellectual Disability in a General Hospital Setting

Background It has been suggested that inequalities in health care for people with intellectual disabilities may be partly explained by negative attitudes of health professionals. This study aimed to investigate the attitudes and emotional reactions reported by nursing staff working in general hospitals towards caring for patients with intellectual disabilities. Method Attitudes and emotional reactions were measured using a self‐report, vignette style questionnaire, tested for validity and reliability. Attitudes towards patients with physical disabilities were also assessed to act as a comparison. Results Nursing staff reported less positive attitudes, more negative emotions and fewer positive emotions, in response to caring for a patient with an intellectual disability compared to a patient with a physical disability. Occupational status (registered general nurse, student nurse, nursing assistant) had no effect upon respondents reported attitudes or emotions. Finally, attitudinal and emotional variables were significantly correlated, with positive emotions being associated with more favourable attitudes. Conclusions Although caution needs to be exercised when inferring actual behaviour from attitudes expressed, it is suggested that the presence of less positive attitudes and feelings amongst nursing staff towards patients with intellectual disabilities may affect the quality of care. Recommendations for future research and service development includes: the need to focus upon improving attitudes of nursing staff through training, and increased joint working between acute care services and Community Intellectual Disability Teams.     

How inclusive are we,really?

Research has revealed that nurses and nursing students with disabilities experience discrimination. There are relatively few nurses with obvious physical disabilities working in clinical settings. Misconceptions abound regarding what a nurse with a disability can do. The focus tends to be on disability rather than ability. Similarly, prospective nursing students with disabilities are viewed with apprehension and caution. The overriding concern regarding nurses and nursing students with disabilities is that they will jeopardize patient safety. Nurse educators worry that students will not be able to complete the required skills and often confuse essential functions of nursing work with the academic standards required to graduate successfully. This article proposes that based on the research, we are not truly inclusive of nurses or nursing students with disabilities.     

Priorities for mental health and learning disability nurse education in the UK: a case study

? The closure of psychiatric and mental handicap hospitals, the emphasis on community rather than hospital care and the distinction between health and social care for people in the community, with its funding implications, have demanded that mental health and learning disability nurses face the challenges of developing new skills and new ways of working. ? In this paper the findings of a study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB) are reported. This study explored the impact of these reforms on nurses and their practice, and identified the educational needs of mental health and learning disability nurses that have changed as a result. ? The study took a multiple-case study approach and involved interviews with 22 `key informants' and 88 mental health and 59 learning disability stakeholders in six sites, three in each nursing specialty. ? Inductive analysis of the interview data revealed 20 categories which summarize the major issues facing the two nursing specialties. ? These categories are discussed under seven themes and issues for nurse education are raised.     

Conceptualizing disability in nursing: some evidence from students and their teachers

This paper reports on part of a larger study which examined the nature and influence of a pre-registration nursing curriculum on the preparation of student nurses to work with disabled people. Following case study methodology it focuses on how 'disability' is conceptualized by teachers and adult branch students involved in a particular curriculum. Definitions and working assumptions concerning disability held by nurses are likely to influence ways in which disabled people are cared for. The experiences of disabled people suggest that their contact with nurses is demeaning and disempowering. Some disabled people support a reconceptualization of 'disability', from a largely medical perspective to one which embraces its social dimensions. The results of thematic analysis of data from 16 semi-structured interviews are reported; these support the need for the social dimensions of disability to be given greater emphasis within nursing. Disability was found to be conceptualized as a form of deviation, a condition of dependency or a notion which defies definition. Language associated with disability was also highlighted as an area of concern. Implications for practice and education are alluded to in the light of increasing recognition of disability as an equality opportunity issue.     

Cultural competence revisited: nursing students with disabilities

The demographic profile of students in nursing schools is changing in relation to many different cultural backgrounds. Despite the potential for students with disabilities to enrich the nursing profession, nurse educators may be perpetuating historical attitudes, values, and practices that exclude students with disabilities from gaining admission or identifying themselves as people with disabilities. Educators in nursing schools continue to ask whether people with disabilities have a place in the nursing profession, while the more salient question is, "When will people with disabilities have a place in the nursing profession?" More important, as we create environments that welcome students with disabilities into the nursing profession, how does the quality of nursing care improve and become more appropriate for people with different cultural experiences? The purpose of this article is to present the value of recruiting students with disabilities into nursing schools in, order to enhance culturally competent nursing care.     

Nursing student perceptions of disability and preparation to care for people with intellectual disabilities

As people with intellectual disabilities live longer and develop more chronic illnesses, nurses will have increasing contact with them. Therefore, nurses must have both an accurate understanding of and a positive attitude toward this population to ensure optimal nursing care is received. A cross-sectional survey of second-year and fourth-year nursing students measured their perceptions of disability, their contact with people with intellectual disabilities, and their perceptions of education to prepare them to care for people with intellectual disabilities. Students most often identified disability as physical, using a wheelchair to represent that perception. Students were confident in their ability to transfer many of the skills they learned to care for people with intellectual disabilities but identified a need for more education about providing that care. Curricular changes to enhance nursing students' awareness and understanding of people with intellectual disabilities are recommended.     

Nurses with Sensory Disabilities: Their Perceptions and Characteristics

A survey design was used to explore the perceptions and characteristics of registered nurses (RNs) with sensory disabilities and their risk for leaving their jobs. An earlier study found that nurses with disabilities are leaving nursing and that employers do not appear to support these nurses. Work instability and the mismatch between a nurse's perceptions of his or her ability and the demands of their work increase risk for job retention problems. This study's convenience sample of U.S. RNs had hearing, vision, or communication disabilities. Participants completed a demographic form, three U.S. Census questions, and the Nurse‐Work Instability Survey. Hospital nurses were three times more likely to be at risk for retention problems. Nurses with hearing disabilities were frustrated at work. Hearing difficulties increased with years spent working as a nurse. Many nurses with sensory disabilities have left nursing. Early intervention may prevent work instability and increase retention, and rehabilitation nurses are ideally positioned to lead early intervention programs.     

The way forward for learning disability nursing

This article looks at a possible future or direction for learning disability nursing. Taking into account the physical, emotional, spiritual, social, medical, dental and mental health needs of people with learning disabilities, and reports from Mencap, this article outlines the need for flexibility and innovation from within the nursing profession. One forward-thinking residential home is identified who employ their own learning disability nurse to to support the residents in achieving good health and encourage communication skills between staff and residents and to promote individual rights, choice, privacy and dignity.     

Nursing students with learning disabilities

Children with learning disabilities grow up to be adults with learning disabilities, who may go to nursing school. Nurse educators currently are faced with the same challenges as primary and secondary school teachers in meeting the education needs of individuals with learning disabilities. It is essential for nurse educators to be knowledgeable about learning disabilities, to understand the issues involved, and to use appropriate interventions to help these students succeed.     

Review of Pain Content in Three-Year Preregistration Pediatric Nursing Courses in the United Kingdom

The results of several studies suggest that gaps remain in nurses' knowledge about pain in children, and particularly regarding pain assessment, analgesic drugs, and nondrug methods, suggesting a need to explore the pain content of preregistration nursing curricula. Over the past decade, the way nurse education is delivered has changed with the advent of the internet and the use of virtual learning environments. This study, therefore, explored the depth and breadth of pain content in 3-year preregistration pediatric nursing courses across the U.K. as well as ascertaining how this content is delivered. The leads for pediatric nursing at all 56 U.K. higher education institutions running the 3-year preregistration pediatric nursing course were e-mailed a questionnaire. Participants were asked to indicate whether topics are covered in the program, and if so how it was delivered. Results suggest that preregistration pediatric nursing courses in the U.K. do not always equip students to manage pain effectively in clinical practice. There appears to be limited content on pain in nursing curricula, with several institutions not covering key topics. Most teaching is delivered face to face with limited workbooks and virtual learning activities. Further research is needed in this area to ascertain the impact of this on the quality of care provided.     

Accommodating and supporting students with disability in the context of nursing clinical placements: A collaborative action research

Aim/objectiveTo examine issues and challenges encountered by university and clinical milieus in addressing the needs of students with disability during their clinical placements; and to identify existing or potential accommodation and support measures to address the challenges encountered.BackgroundThe influx of students with learning disabilities, attention deficit disorder [with or without hyperactivity], mental health disorders or on the autism spectrum has caused an increase in the number of students with disabilities of more than 900% in universities in the past decade. This increase is causing added pressures to both the academic services providing student assistance and the personnel responsible for these students’ clinical placements. While several studies have focused on measures designed to accommodate students with disabilities during their theoretical courses, only a small number worldwide have focused on student accommodation and support in the context of clinical placements. In the current paper, strategies highlighted in these studies were grouped under three categories: prior, during and post clinical placements.DesignCollaborative action research conducted amidst three learning communities.MethodsThe larger study included learning communities from three disciplines: education, social work and nursing. Three tools helped guide the discussions: 1) brainstorming and classification tool; 2) contribution and feasibility tool; and 3) carrousel tool. The current study focusses solely on the findings from the five meetings of the nursing learning community (n = 14 participants).ResultsSix categories of challenges were documented: 1) Poor writing skills; 2) Difficulty adapting to clinical milieus; 3) Difficulty linking theory with practice and setting priorities; 4) Difficulty managing specific and situational needs; 5) Issues with interpersonal skills and overall attitude; and 6) Challenges pertaining to students’ professional responsibility to disclose their condition. Several accommodation and support measures were identified for each set of challenges and were also grouped under three categories: prior, during and post clinical placements.ConclusionsOur study revealed that the issues identified could in fact be faced by any students, albeit their impact and complexity increased considerably when dealing with students with disability. It brought to light that the implementation of some of the measures identified will require changes to the structure of nursing programs. It also highlighted the ever-growing complexity of the clinical instructor role and the fact that clinical instructors do not always feel adequately prepared to support students with disability.     

Nurse Education Tomorrow Conference 1990. How nurses learn and how to improve the learning environment

This paper considers some of the evidence that can help nurse teachers more effectively prepare nurses for practice. In particular it is concerned with how students learn and how teachers can improve the learning environment. There are four main sections to the paper. The first looks at learning styles and considers the importance of matching teaching style to the learning style of the student. The second section considers the research into the process of integrating theory and practice in nursing education and the relationship between theory, the classroom and the clinical area. The next section of the paper looks at factors influencing the process of becoming a nurse. Socialising agents such as people and techniques are reviewed in the light of research evidence from nursing and similar professions. Finally the paper represents a series of ways in which it is possible to assess and improve the learning environment for the student nurse, including human aspects, equipment and information.