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03
NURSING SUPPORT FOR THOSE WITH PROFOUND AND MULTIPLE LEARNING DISABILITIES
AIMS AND LEARNING OUTCOMES:
The aims of this chapter are:
To explore what profound and multiple learning disability (PMLD) is
To highlight the areas of care that a person who has a PMLD is likely to express, experience and need meeting.
By the end of this chapter, the reader will be able to:
Understand and discuss what PMLD is
Have a basic understanding of the ‘twelve activities of daily living’ model of care
Have a basic understanding of how these twelve activities of daily living could be applied when working with a person who has a PMLD.
INTRODUCTION
Chapter 2 highlighted a number of possible definitions and meanings of learning disability and suggested that the various meanings of learning disability are intimately bound up with the use of language and that as language changes, so does our understanding of those with a learning disability. It was suggested also that learning disability is a spectrum of conditions ranging from ‘borderline’ to ‘profound’.
This chapter will highlight the needs and care of Thomas, a 65-year-old gentleman with a profound and multiple learning disability (PMLD) who has recently had a heart attack. Although Thomas lives in a small care home, he was admitted to an intensive care ward and then transferred to a medical ward of his local general hospital. Whilst set against the backdrop of a busy medical ward, the contents of this chapter will have value for those working in other hospital-based clinical areas, community services and care and nursing homes, as those with a PMLD are also likely to access these services or clinical areas.
This chapter will provide a simple ‘definition’ of what PMLD is, briefly explain one model of holistic care and then explore how this model of care can be applied to those with a PMLD.
SCENARIO 3.1
Thomas is a 65-year-old gentleman who lives within a social care home and has a profound and multiple learning disability (PMLD) with additional needs in the following areas:
Severe mobility problems; is unable to sit without assistance and mobilise without the use of a wheelchair
Pre-verbal communication skills; needs assistance to communicate
Inability to digest food and drinks due to dysphagia; requires assistance to eat and drink
Arthritis
Epilepsy
Pain management
Taking and monitoring medication and their side-effects
Doubly incontinent
Personal hygiene; needs help with washing and bathing.
Thomas has suffered a heart attack and has been admitted to the ward on which Sally, the senior staff nurse introduced in Chapter 1, works.
WHAT IS PMLD?
What does profound and multiple learning disability (PMLD) mean? That is a fair question; after all, for some HCAs, student nurses and staff nurses, the whole idea of having a learning disability may be difficult to comprehend, let alone its various components or manifestations.
It is notoriously difficult to estimate with any precision the number of those with a PMLD in the UK. However, it is estimated that there are between 250 000 and 350 000 people in the UK who have a PMLD (Foundation for People with Learning Disabilities, 2005). Those with a PMLD, as well as having a profound learning disability (as indicated by an IQ of less than 40), are likely to have more than one disability which could include:
Neurological issues such as epilepsy
Physical disabilities such as cerebral palsy which will impact on the person’s mobility
Significant communication, eating and drinking problems
Respiratory and cardiovascular problems, sensory impairments, mental health issues, ‘classic autism’
Increased health problems that could be associated with any or all of the above.
Those with a PMLD are thus very likely to need significant additional support in order to maintain an optimum level of health and to engage within society.
TWELVE ACTIVITIES OF DAILY LIVING
In the past, as they are today, student nurses in all four pre-registration fields of practice were taught the vital importance of assessing the holistic needs of the patient or service user and then planning, implementing and evaluating a therapeutic and supportive care plan that met these assessed needs. This process of assessing, planning, implementing and evaluating care intervention was known as the ‘nursing process’. This nursing process utilised the work of three nursing theorists (Nancy Roper, Winifred Logan and Alison Tierney): this work being the ‘twelve activities of daily living’ (ADLs) (Roper, Logan and Tierney, 1980; 2000).
The twelve activities of daily living are:
Maintaining a safe environment
Communication
