It is the responsibility of clinicians/nursing staff to follow guidelines for effective communication; it is the responsibility of the learning disability liaison nurse in conjunction with other appropriate trust staff to ensure that staff have received necessary training in effective communication with people who have learning disability.
Clinicians and nursing staff need to be aware that the first point of contact is with the learning disability liaison nurse.
Many barriers to healthcare can be overcome by effective communication. Heath staff will need to communicate effectively not only with the person with learning disability but with paid carers, family members, advocates, carer managers and learning disability team staff, and they must always refer to the learning disability liaison nurse on admission.
Many people with learning disabilities have difficulties with communication. This may include problems with expression, articulation, comprehension, and coping with social situations. People with learning disabilities have difficulty understanding complex sentences and abstract concepts with time being a particularly difficulty concept of comprehend. This should be considered when discussing appointments or future treatments. It can be helpful to relate appointments to events in the person’s life. They may also have difficulty understanding written communication and this should be taken into consideration when arranging appointments, particularly if pre-appointment instructions are included.
It is important to communicate slowly and allow time to repeat information with awareness that it may take a person with learning disability up to 5 seconds to process new information.
Many are unable to communicate verbally and rely on other methods such as Makaton (specific sign language for people with a learning disability) gesture, pointing or facial expression to communicate their needs. Problems with communication can often be linked to difficult or challenging behaviour which can then present a barrier to accessing appropriate health care.
An individual’s capacity to understand and communicate can be affected by a number of factors, including anxiety, pain and distress, unfamiliar people and environments. People with learning disabilities may also be unable to describe adequately their symptoms, degree and site of discomfort and may inform staff they feel fine even when clearly unwell.
There are a number of strategies which can assist in ensuring more effective communication when meeting a person with learning disabilities for the first time.
Easy read accessible information is available on many subjects for example endoscopy. Each ward should have a ‘communication book’ with pictures of some basic procedures, food and drink choices, and parts of the body. The learning disability liaison nurse can advise on other resources available.
The Hospital Care Passport is a document which provides clear and concise information in an easy to understand format regarding the individual with a learning disability in relation to their health and support needs. The passport belongs to the service user and should accompany the person for all hospital appointments and admissions. It should be completed by the individual with help of carers and advocates. If an individual comes into hospital without a passport then it is the responsibility of nursing staff to contact carers in order to request the passport or to gain information to complete the passport, the liaison nurse can also support nursing staff in this instance.
The passport should be reviewed and updated regularly to provide a record of the individual’s health management. Passports should be available on each ward or can be downloaded from Surrey Health action website, and on the intranet.