A Historical Perspective On The Role Of Learning Disability Nursing And Its Evolution Today

The Role of LD Nurses

Learning disability (LD) nurses have the role of supporting and caring for people with learning disability to help them live a fulfilling life. People with learning disability have complex needs and nurses help such person in increasing their independence, identifying unmet health needs and developing their skills to live happy and healthier lives (Genders and Brown 2014). Learning disability was not a specialty in the nursing profession previously, however it became a part of the nursing profession after mental deficiencies posed significant problem to the society. Currently, LD nursing profession is not the same as it was in the 1980s. Today, it has become a profession much in demand in mental health nursing field. The main purpose of this essay is to discuss about the historical context of learning disability nursing role and discuss changes in the role of learning disability nurse today and back in 1980s. It mainly seeks to give clear arguments regarding why the role of LD has changed with time.

Learning disability (LD) is a neurological disorder that affects people’s ability to interpret things and process different information in the brain. This kind of disability affects people’s basic learning skills like reading and writing. This is a life time condition that may have an impact on many parts of a person’s life (Cortiella and Horowitz 2014). For instance, apart from academics, it may affect relationship work and social life too. LD nursing is the profession that has emerged to support LD people to lead a good quality life. LD nurses are involved in supporting such people to lead a more independent healthy life by maintaining their physical and mental health and reducing barriers to independent living. They also work to address problem of social inclusion in people with LD (Northway et al. 2017). To work effectively with such patients, LD nurses must also possess certain personal attributes like looking deeper, achieving balance and connecting with client to build effective relationship with patient (Lovell and Bailey 2017).

When looking at historical aspects of learning disability nurse role, it can be said that LD nursing held an anomalous position within the nursing profession. The foundation of the discipline in early phase of twentieth century was associated with many challenges and loose definitions about the role of LD nurse. There was no clear service provision and the departments for mental deficiency within psychiatry was also emerging (Mitchell 1998).  The history of mental health nursing has similarities with LD nursing. Back in the 1980s, both LD nurse and mental nurses were recruited from working class and it mainly comprised men. In addition, the value for both form of nursing was unionization instead of professionalism and they also worked with similar types of client (Mitchell 2002). This practice has wide difference from the professional expectation and standards expected now from LD nurses. There is strict provision for professionalism and maintaining professional boundaries in learning disability nursing care currently (Bowler and Nash 2014).  

Evolution of the Nursing Profession

The review of historical perspective on the LD nursing profession has also revealed that LD nursing was not regarded as proper nursing throughout 20^th century. There was no distinction between people with mental illness and those with learning disabilities. Hence, nurses working as LD nurse in those times had the perception that it is similar to mental health needs. The Idiots Act 1886 existed at that time for fulfilling the needs and care of people with signs of mental deficiency and learning disability people has no distinction from that of people with mental illness  (Mitchell 2002). Hence, back in those times, LD nurses provided care to all kinds of people working in asylums, workhouses and prisons. It was the Mental Deficiency Act 1913 that clearly distinguished between people with mental illness and learning disability. After this, gradual improvements were seen in service provision (Clapham 2014). For example, General Nursing Council was involved in developing dedicated sections with nursing profession for people with LD.

The review of past history of LD nursing also gives evidence of marginalization within nursing profession. There was no framework or professional framework which LD nurses could use to understand the challenges of people with LD. People also had vague idea about the position of LD nurses within nursing profession. Due to this limitation, LD nurses working with LD people were stigmatized. Besides this, suspicious and ambivalent attitude was also common because LD nursing lacked control over its other branches (Mitchell 2002). Hence, it can be said that LD nursing is a historical accident within nursing profession.

In the past, people with LD were segregated from society. In addition, as the role of nurse was very ambiguous throughout twentieth century, they also became part of the oppressive group and started discriminating people with LD. In contrast, the profession of LD nurses became a valuable addition to the nursing profession as they were responsible for bringing positivity’s in the life of people with LD. They worked with people of all ages and supported people with challenging behavior. Apart from specialist role in epilepsy and forensic services, LD nurses were expected to provide security to vulnerable people with LD. If LD nurses are trained regarding the true values and attitude they need to have in the profession, they can help to address various challenges in life of LD people (Gates 2002). For instance, they can make their contacts with various advocacy and social groups that can serve the best interest of these people. It is a profession which requires specialized skills and for this reason, two years of the course is spent on specializing in learning disabilities. The knowledge and skills that they acquire in these two years help them to engage in true partnership with LD, their families and cares.

The Current Expectations of Public Health Departments from LD Nurses

The role and responsibilities of LD nurses has evolved greatly compared to what it was in the 1980s. Previously, the nurses working in those sectors had no specific model to review so that they could provide appropriate care to people with LD. Currently, the profession is underpinned by values and principle of quality, accountability, equality and partnership. These principles have vital implications for those nurses who are willing to enter the LD nursing profession. The principle of quality revolves around the values of safety, dignity and efficiency. According to this principle, LD nurse are now required to possess core working knowledge regarding basic care need of LD people. They also need incorporate evidence-based approach in their practice (Clapham 2014). The principle of accountability involves the component of transparency, trust, leadership and responsibility. This means staffs coming in the LD nursing profession must be informed and work on the basis of SMART goals (Lovell et al. 2014). The principle of equality has been specially emphasized in this profession because learning disability patient are often discriminated and not supported equally by people because of their deficiency. Hence, newly placed registered nurse may face challenges in this profession if they do not implement patient-centered care and maintain equity of care for people with LD (MacArthur et al. 2015). Specialist care needs of people with LD is a major priority for LD nursing practice. Last, but not the least, proper collaboration and negotiation with different discipline is also required by registered nurse LD so that health care team can work proactively to meet the needs of LD people (Clapham 2014).

Critical discussion on difference between the current and past aspects of LD nurse role

The above discussion gave an insight into the historical context of LD nursing, how the profession was established and perceived by people in the twentieth century. Currently, the profession has evolved and such specialized role is also desired by health consumers. High accountability and professionalism in the field is seen today and it is the most sought after profession because of the prevalence of large number of people with LD today. For instance, the LD statistics for England in 2015 has revealed that about 1, 087, 100 people in England suffer from LD (Public Health England 2015). This data has been given by government departments based on the presence of LD clients using services. People with LD have been found to die younger than other population group. The affected individuals have poor statistics in the area of employment, health and education. Hence, to address all this issue, the action and performance of community LD nurse is very important today. The current expectation that public health departments has from LD nurse is to solve the problem of poor access to public health services among the group and contribute to the implementation of public health policies for them (Mafuba and Gates 2015). 

The difference in the role of LD nurse today compared to the 1980s is seen in the following areas: 

While scrutinizing the LD nursing profession today, it can be said that now nurses working in this sector have better clarity about their role and they are working across various sectors too. For instance, they are working not only in hospital setting, but also involved in health surveillance, health prevention, health promotion and education and other activities. LD nurses are present both in in-patient setting as well as community settings now working with multi-professional team. LD nurses today are taking the role of health facilitator because of poor experience of LD people with primary care team (Department of health 2017). Primary care team does not have the skills to understand needs of LD people and so many LD people have reported interaction with them as frustrating and difficult (Perry et al. 2014). The LD nurses have the potential to overcome these barriers and taken on the role of health facilitators to make patients aware about different NHS and primary care services that they can access. In this area, LD nurses are playing a vital role in help LD people navigate through relevant health services available for them ((Department of health 2017). Hence, on the basis of this diverse role, it can be said LD nurse make vital contribution to well-being of people with learning problems and their role of has evolved in the past 15 years with greater participation in public health. There is also high possibility of the demand of leadership role among LD nurses so that they can work collaboratively with different services to address barrier in care of LD people.

In contrast to the above discussion, the review of the role of LD nurses in the 1980s shows lot of ambiguity. LD nurses lacked clarity about their role and they lacked the opportunity to work in public health sector. The profession was highly neglected and many staffs had the question whether LD nursing is a part of nursing practice in reality. The past history is filled with many examples where the position of LD nursing within nursing has been questioned. The main reason for marginalization of the profession is that the role of LD nurse did not correspond with nursing image of sickness based profession (Mitchell 2002). LD nursing was never accepted within nursing image that time and hence little was done to improve the skills of LD nurses to enable them to work in diverse sectors of health.

Back in the 1980s, LD nurses lacked clarity about their role and had no nursing care models as guide to provide ideal to people with LD. Due to this shortcoming, LD nurses lacked awareness about the values to promote inclusive practice and they also got involved in oppressing people suffering from learning issues (Gates 2002). Hence, in the 1980s, stigmatizing attitudes existed both among nurses as well as common people regarding the profession. However, the scenario is very different today. LD nurses today are now aware that their primary role is to support well-being and social inclusion of people with learning problem. As per the ‘Valuing People’ initiative, a new strategy for learning disability for the 21^st century, the UK government proposal is to improve lives of people with LD by recognizing their rights and supporting social inclusion in local communities and in their daily life choices (Department of health 2017). The Disability Rights Commission and Mencap has also recognized the need to tackle health inequalities for such client. In accordance with the ‘Valuing people’ initiative, LD nurses are now doing innovative work to engage LD people in health care decision making and life choices. They possess the true value to fully support these people and reduce negative experiences in their life. Apart from social inclusion values, they also possess range of skills now to fulfill complex needs of people with LD (Lovell et al. 2014).  

Compared to 1980s, LD nurses have more pressure today because they need to be updated with current knowledge of the profession and have familiarity in utilizing different technology today. Even if they have not used certain tools and technologies before their placement, they have the obligation to learn about using those equipments to align with current method of health care delivery. Such diverse variety of options in the area of technology and tools was not available for nurses in the 1980s. Although implementation of certain new technologies have posed challenges for LD nurse in the beginning, however once they are given adequate training to use them in practice, they become a boon for them. Currently, the availability of smart phones and social networking sites is an opportunity for LD nurses to form deeper relationship with clients (Marsden et al. 2012).

In the 1980s, LD nurses were trained using the syllabus of Medico-Psychological Association (MPA) and very few learning disability institution existed to provide certification to students (Gates 2002). In contrast, LD nurses today need to take pre-registration degrees in LD. Integrated curriculum exist today where registered nurse gets to study about learning disabilities as well as generic social work skills. The uniqueness of today’s LD curriculum compared to what it was in the 1980s is that it pays special emphasis on empowerment of people with LD and developing the skills to promote independence of such people in community. LD nurses can now explore both theoretical perspectives like human grow and development knowledge and practical perspective like application of legal, ethical and moral framework in LD nursing practice (Trollor et al. 2016).

Conclusion:

The essay gave an insight into the difference in the role of LD nurse today and in the 1980s. The exploration of the historical context of LD nursing gave idea about anomaly in the profession due to lack of clarity of nurse’s role, poor acceptance of the profession, stigmatization of the profession and poor emphasis on developing specific health care model and curriculum for nurses. In addition, the discussion on the role of LD nurses today has shown that how the LD nursing profession has evolved with time and how LD nurses are now playing a major role in health promotion and health education related activities. The presence of technology and professional framework for LD nursing has enables aspirants to acquire the skills needed to confidently handle clients with LD issues. 

Reference

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