Self-assessment Cases

Chapter 38 Care for people with learning disabilities

A 60-year-old lady with intellectual disability was admitted to a hospice from a residential care setting where she had lived for 20 years. She had a late diagnosis of advanced gastric cancer. The nursing staff in the hospice involved the nurse from the residential care home setting who was trained in intellectual disability nursing. Some joint working took place, which meant that the lady with intellectual disability had someone around who was familiar to her and with her. The lady had limited speech, but indicated pain through crying and the use of pictures, which the nurse from the residential care setting was aware of through her prior knowledge of the person. This lady’s palliative care needs were thought to have been met through joint assessment and working with the hospice staff and the nurse from the residential care home setting, who was involved in discussions about care and was able to explain the use of the syringe driver in a way that the lady could understand. The hospice staff felt more empowered and confident in caring for the lady, who was enabled to die peacefully in the hospice setting.

• 1. Why might this lady have been diagnosed late with gastric cancer?

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  Correct answer:
  People with intellectual disability may sometimes not be able to recognise or tell someone that they are unwell or that they have symptoms that may need to be investigated. Formal and informal carers may also put changes in the person or in their behaviour down to the Intellectual Disability rather than an underlying illness.

• 2. Why would it have been difficult for this lady to have been admitted to a Hospice setting?

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  Correct answer:
  The lady had lived in a residential setting for 20 years. This was her home where she had people around familiar to her and with her.

• 3.What challenges would there be for hospice staff in caring for this lady?

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  Correct answer:
  People with intellectual disability are seldom referred to hospice settings. This means that hospice staff have limited experience in caring for this group of people and can feel a lack of confidence and competence in assessing and meeting their palliative care needs.

• 4. How does a nurse need to adapt his/her care in assessing the needs of someone with an intellectual disability?

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  Correct answer:
  This involves the nurse giving time for the person with an intellectual disability to process information. The nurse also needs to use straightforward language and accessible information and involve those who know the person to assist in helping with communication to and from the person.

• 5. Reflecting on this case scenario, can you see benefits in partnership working between Intellectual Disability and palliative care services? Name some of the benefits.

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  Correct answer:
  Some of the benefits are that the skills and knowledge of intellectual disability and palliative care services are combined in providing care to the person. This lady with an intellectual disability had people around who were familiar to her and with her in the hospice setting. Thus, assessment and care provision were more effective, the hospice staff were empowered and the lady was able to settle and die peacefully.