Marsden Daniel, Giles Rachel
Learning disabilities, East Kent Hospitals University NHS Foundation Trust, Ashford, England.
East Kent Hospitals University NHS Foundation Trust, Ashford, England.
Nurs Stand. 2017 Jan 18;31(21):45-53. doi: 10.7748/ns.2017.e10152.
Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of the 4C framework may enhance the care of people with learning disabilities in hospital, by enabling reasonable adjustments to be made in these settings.
学习障碍患者在获得医疗保健方面面临显著的不平等。法律框架，如2010年《平等法》，旨在减少护理方面的此类差距，并要求组织为包括学习障碍患者在内的残疾人做出“合理调整”。然而，合理调整在临床实践中往往没有得到明确界定或充分实施。目的：研究并综合照顾学习障碍患者所面临的挑战，以制定一个在医院为学习障碍患者进行合理调整的框架。该框架将帮助病房工作人员识别和管理在此环境中为学习障碍患者提供以人为本、安全有效的医疗保健所面临的挑战。方法：采用第四代评估、协作主题分析、反思和二次分析来制定医院环境中合理调整的框架。作者参加病房经理和护士长小组会议，收集他们的主张、关切和问题，然后与小组成员进行协作主题分析，以确定主要主题。结果：从病房经理和护士长小组会议中确定了四个主要主题：沟通、决策、协作和协调。这些主题被用于制定医院中为学习障碍患者进行合理调整的4C框架。讨论：4C框架为为学习障碍患者提供以人为本的护理提供了基础。它已被用于指导培训需求分析、开发审核工具以审查针对个体患者进行适当调整的护理提供情况；并培养学习障碍倡导者的能力。4C框架最显著的好处在于帮助评估和解决基于实践的情况。结论：使用4C框架可能会通过在这些环境中进行合理调整来加强医院中学习障碍患者的护理。
