Y khoa, y dược - Chapter 14: Preconceptions and the reality of learning disabilities

Chapter 14Preconceptions and the reality of learning disabilities IntroductionPeople labelled with learning disability suffer a disproportionately higher level of ill health when compared with the rest of the populationRespiratory disease is the highest cause of death, other conditions such as epilepsy, obesity, diabetes, endocrine disorders, mental health problems, sensory impairments and gastrointestinal cancers are also prevalent.Nurses will be in frequent and regular contact with individuals from this particular social grouping over the course of their professional careers. Caring for someone identified as having a learning disability requires all the care and attention as a patient with a physical illness.It is also a matter of legislation and policy initiatives. Philosophical & Theoretical issues Below is an account of what happened when a patient, J had to go into hospital for a routine procedure:‘It said I had a learning disability on the case notes. They [the nurses] talk down to you. They explained it [the procedure] to my carer, not to me. I felt upset and kept it all bottled up'.J is a grown woman who can articulate perfectly well but the people who were supposed to be looking after her couldn't see past the label and ended up treating her badly. When communicating with someone who is identified as having a 'learning disability' remember, it's the person who is sick, not his or her label.      Do Learning Disabilities Exist?Some would suggest that there's no such thing as 'learning disability', however, what about people who have 'learning disabilities'. An example of which could be patients you’ve cared for who have Down syndrome or cerebral palsy. Some believe that these people have impairments and that's not quite the same as disability. This distinction is important, especially to anyone who wants to make a serious go of a career in health and social care. The Social Model of Disability: architecture & attitudes Disability is a concept or social construction which provokes an 'attitude', or way of behaving in those who are confronted by persons assumed to have a 'disability'. This attitude is most frequently expressed in language or by access points in the built environment. Attitudes to limited intellectual capacity also limit social activity Some people have said that that under such conditions the concept of disability is more than merely descriptive but actually presents an example of socially oppressive practices, which harm human rights. Basic Facts & Figures Definitions are easy to find, understanding though, is harder to come by. 'Learning disability' is characterised by three main components: Intelligence (as defined by measurement arrived at via an I.Q. test), Adaptive behaviour (as assessed by psychologists) The third diagnostic criterion is that onset should be before age eighteen and relates to maturity of the brain and 'normal' development. There are approximately one and a half million individuals in England who are currently described as living with some degree of 'learning disability'. Causes & Conditions‘Biological, environmental and social factors are all involved in causing learning disabilities.A simple framework of causes can be seen by looking at the timing of the event that results in the diagnosis of 'learning disability' being made. This applies particularly to 'biological' causes.Social and environmental factors are harder to pinpoint. There are three key times to consider: pre-conceptualperinatal postnatalCauses & ConditionsIn the case of pre-conceptual diagnoses causes are heredity. At this stage the immediate social conditions (drug misuse, extreme poverty) or the more global environment (radiation, pollution) may also contribute damage to the mother's womb resulting in brain damage in the foetus At the peri-natal stage a typical example is cerebral palsy (CP) caused by poor oxygenation.Postnatal causes include infection (e.g. rubella), direct trauma (e.g. head injury) and a mix of social and/or environmental conditions. History, Ethics, Eugenics & Euthanasia The Abortion Act (1967) was a social landmark. Its repercussions remain, particularly in light of the changes brought about by the 1991 Human Fertilisation and Embryology Act which;lowered the upper limit for abortion to 24 weeks overruled the foetal viability clause - permits abortion for foetal handicap right up until birth This debate gets to the very core of euthanasia, eugenics and disability ethics. The implicit assumption appears to be that some lives are inherently worth more than others, with the implication that a life lived with some degree of impairment will be of less value. The Nuffield Council on Bioethics (2006), recommended that doctors do not intervene with babies born prior to 22 weeks. What are your views on this? Cerebral Palsy This results in distorted postures and rigid muscle tone and can been diagnosed in newborns affected with the condition.The causes include; asphyxia at birthpremature birthdirect mechanical injuryCerebral palsy (CP) comes from cerebral = concerning the brain, and palsy = paralysis. This is not a single particular disease or illness. The term covers a range of physical conditions, which affect movement, as a result of an injury to the brain. Defined Cerebral palsy is the commonly used name for a group of conditions characterised by motor dysfunction due to non-progressive brain damage early in lifeThe range of severity may be from total dependency and immobility to abilities of talking, independent self-care and walking, running and other skills, although with some clumsy actions. Mobility is a big issue, and the input of physiotherapists and occupational therapists, should not be underestimated as they form the core of any treatment regime.The classification of CP can be addressed in two main ways: by affected limb(s) or by the origin. Consent: The Bournewood Case It is common for a doctor or a dentist to ask carers to sign a consent form for an adult with learning disabilities.This is not legally acceptable and has no basis in law. The European Court of Human Rights had to review the case of HL v United Kingdom - known as the “Bournewood” case from the institution where Mr L, a 49- year-old man with autism, was an in-patient. This case led to a change to the 2005 Mental Capacity Act. Anyone in Mr L's position now needs to have an Independent Mental Capacity Advocate to represent them during the assessment/treatment process. Conclusions People labelled with 'learning disability' have the same rights as the rest of the population, including access to health and social care services. They have higher levels of ill health, including epilepsy and mental health problems, and many have communication difficulties. They have lower income, less secure tenure, poorer education and reduced social prospects. Very few have a proper job, and intimate personal relationships are rare. Many live in accommodation not of their choosing, and are subject to ridicule and harassment in their own local communities. Some are subject to physical, financial and sexual abuse from the people employed to provide their care.