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string(321) ‘ to consider the demands of people with learning afflictions and that conquering this way to obtain inequality was the most important concern for the NHS to cope with for this affected person BOX a couple of Terminology and facts relevant to learning disabilities ‘Mental handicap’ was a term used to describe people with learning disabilities\. ‘

learning area CONTINUING SPECIALIST DEVELOPMENT Page 58 Enhancing communication for people with learning disabilities Page 66 Learning disabilities multiple choice questionnaire Web page 67 Read Annette Martyn’s practice profile on diabetes mellitus type 2 Page 68 Guidelines on how to write a practice profile Improving communication for people with learning disabilities NS336 Godsell M, Scarborough K (2006) Improving conversation for people with learning disabilities. Nursing Standard. 20, 30, 58-65.

Date of acceptance: February 6 2006. Summary Individuals with learning disabilities have higher health care risks compared to the general populace.

Similar essay: Collate Info on an Individual’s Interaction and the Support Provided

Medical researchers need to develop skills that enable these to communicate efficiently with this kind of patient group. Identifying boundaries to connection is the first step to minimizing or eliminating them. Suggested strategies to boost healthcare gain access to for sufferers with learning disabilities incorporate: developing individualised health actions plans, streamline communication models and featuring accessible features and customized resources. learning activities you ought to be able to: Be familiar with impact of communication on interaction among healthcare services and individuals with learning disabilities.

Illustrate the relationship between communication plus the health inequalities experienced simply by people with learning disabilities. Determine strategies to boost communication among health providers and people with learning disabilities. Creators Matthew Godsell and Betty Scarborough are senior academics, Faculty of Health and Social Care, University or college of the Western world of Great britain, Bristol. Email: Matthew. [email, protected] air conditioning unit. uk Launch Learning handicap is not really a diagnosis but a expression used to describe individuals with a wide range of talents and needs.

80 per cent of kids and 60 per cent of adults with learning disabilities live with their own families (Gravestock and Bouras 1997), and many individuals with learning problems exceed the expectations of families and professionals within their capacity to find out new skills and develop all their talents (NHS Executive 1999). The term ‘learning disability’ says little regarding an individual’s strong points and needs however it does combine three elements that come in most meanings (Box 1). Emerson et al (2001) state that the amount of people with learning disabilities in the UK has not been established.

They calculate that in the UK there could be as much as 350, 000 people with severe learning problems (intelligence zone (IQ) 50). This means that two per cent of patients will likely have a learning handicap (NHS Exec 1999). The ways in which people with learning disabilities are referred to have changed. Terminology and related facts are listed in Package 2 . NURSING JOBS STANDARD Keywords Communication, Learning disabilities nursing: attitudes These types of keywords are based on the subject titles from the English Nursing Index. This article have been subject to double-blind review.

Intended for related content and writer guidelines visit our on-line archive at www. nursing-standard. co. uk and search using the keywords. Aims and intended learning outcomes The purpose of this article is to explore the impact of communication upon health care for those who have learning afflictions. The article discusses how expérience and communication influence interactions between health care providers and patients. Additionally, it examines just how poor connection can contribute to health inequalities that separate people with learning disabilities from the rest of the human population.

The article explores communication strategies that can overcome or lessen barriers to effective medical. After scanning this article and completing the 58 apr 5: vol 20 simply no 30: 06\ Time out you Based on a figure of two per cent of patients having learning disabilities, it is likely that 45 per a couple of, 000 patients registered with GP providers are likely to include learning problems. How various patients with learning disabilities are you aware of in the practice location? List a number of the reasons that may prevent people with learning problems from interacting with local well being services. Wellness inequalities

However with learning disabilities are living longer, the gap that separates the status of folks with learning disabilities plus the general human population has increased. Cohen (2001) true that major inequalities in health will be politically, socially and economically unacceptable. An investigation into well being inequalities by the Disability Privileges Commission (Nocon 2004) discovered that people with learning afflictions have: A greater risk of early death in comparison with the rest of the population, mortality costs are particularly large for those with additional severe impairments.

A greater number of healthcare requirements. Many demands that are not achieved. High rates of unrecognised or terribly managed health conditions including: hypertonie, obesity, cardiovascular disease, abdominal soreness, respiratory disease, cancer, gastrointestinal disorders, diabetes, chronic urinary tract infections, oral disease, musculoskeletal conditions, osteoporosis, thyroid gland disease, and visual and hearing impairments.

A conjonction paper manufactured by the NHS Service Delivery and Business (SDO) R and d Programme (NHS SDO 2004) identified obstacles to appropriate and regular BOX you Definition of a learning handicap A person with learning disabilities offers: Significant decrease in the ability to figure out new or complex data. Reduced capability to cope individually. Impairment starting in years as a child that will have a lasting impact on development. (DH 2001) access to health care within and outside solutions.

Many people with learning afflictions find that figuring out their healthcare needs can be described as major concern. Proactive strategies are required to motivate people to access the full range of services that are offered. Some people with learning disabilities have said that negative and unhelpful thinking from health-related workers have prevented these people from looking for medical support (Bristol and District People First 2003). Support and encouragement are essential by carers, allies and friends ahead of people with these kinds of concerns will be ready to engage with companies again.

Folks are more likely to trust service providers if they are convinced that services and practitioners possess responded to their demands by enhancing communication skills and generating information within an accessible formatting. People with learning disabilities have similar right to access mainstream solutions as all of those other population (Department of Well being (DH) 2001). However , mainstream services have already been slow to formulate the capacity and skills in order to meet their needs.

In the document Valuing People (DH 2001) it had been acknowledged the wider NHS had failed to consider the needs of people with learning disabilities and that overcoming this kind of source of inequality was the most important issue pertaining to the NHS to address for this patient CONTAINER 2 Terminology and details related to learning disabilities ‘Mental handicap’ was a term used to spell out people with learning disabilities.

You read ‘Improving Communication for People with Learning Disabilitie’ in category ‘Essay examples’ It is no more used in the UK. ‘Mental retardation’ is a term used internationally, nevertheless , it is not an accepted term in the UK and some might find this term offensive. Learning difficulty’ is the term used in education to define individuals who have specific learning needs, for instance , dyslexia. Some people who happen to be identified as having learning difficulty by education companies may also be considered to have a learning incapacity, but this is not necessarily the situation. ‘Mild’, ‘moderate’, ‘severe’ and ‘profound’ happen to be terms to describe different examples of disability (Figure 1). A person with mild learning disabilities may possibly communicate properly, learn, live and work with small support.

Yet , a person with serious learning disabilities will require support with activities of daily living, for example , conversation, dressing, feeding, washing and mobility. An analysis of ‘mental illness’ is usually not the same as using a learning disability, but people with learning afflictions may include mental health problems as well. Not everyone with learning afflictions requires a social worker or possibly a community nurse. People with learning disabilities may well have multiple diagnoses resulting in complex well being needs. People who have the most outstanding physical or perhaps sensory impairments do not have always the most outstanding cognitive impairments.

NURSING STANDARD april five: vol 20 no 40: 2006 59 learning region nursing behaviour group. The briefing newspaper produced by the NHS SDO (2004) presented key action points to get removing boundaries and improving access to healthcare, which included: Employing specialist learning disability groups to aid variation of popular services in order to meet the demands of people with learning disabilities. Producing strategies for well being education and health investigations for people with learning disabilities that promote regular access to medical.

Families and paid carers have an natural part in helping individuals with learning afflictions to access medical care. Some people will require assistance to recognise mental health issues and to recognize gradual within health. Time out 2 Have a list of the ways that you communicate with patients of their health, for example , through appointments and telephone calls. Take three examples from your list and consider main reasons why communication with a person with learning problems might be tough.

Give a good example of effective interaction between a practitioner and a person with learning disabilities. Guidelines should talk about the use of technology to support conversation, and the development and dissemination of accessible information. Smith (2003) shows that managers and commissioners of services will need to liaise with health, interpersonal care and education firms to ensure persistence in connection policies through the lives of folks with learning disabilities. Communication can be extensively defined as the exchange of information between a sender and a receiver (Figure 2).

Where a person has learning disabilities they could be communicating with a great intention to draw a conversation partner and initiate a two-way dialogue. Yet , for some people with profound learning disabilities mailing a message could be a response with their body and feelings. Their level of expérience might be so that they are unacquainted with possible connection partners associated with how to take those communication further. This is called pre-intentional conversation, in which the individual says or does issues without planning to affect individuals around them.

It is necessary to remember that everyone convey and that the role of communicator and communication partner swaps from one person to the additional so that a conversation can develop. The challenge pertaining to health professionals is always to develop abilities that permit them to interpret the messages they acquire and associated with messages that they send understandable. Communication is not only about verbal communication, it is additionally about non-verbal communication, for example , the use of gestures, words and pictures. Communication

Recommendations have been made to improve communication and use of health services for people with learning disabilities. Roberts (2003) says that providers supporting people from beginning to old age should certainly develop connection policies. PHYSIQUE 1 Estimated percentage of people with learning disabilities according to amount of severity Slight Moderate 12% Severe Serious 80% 7% 1% Augmentative and substitute communication systems Systems of communication, including sign dialect, symbols and eye pointing, are referred to as augmentative and alternative conversation systems (AACs).

AACs may be used to enhance or replace traditional pathways, including speech or perhaps writing. The utilization of photographs every day objects, photo boards, range drawing and real objects are good ways to enhance connection with people with learning problems (American Speech-Language-Hearing Association (ASHA) 2005). You no longer need to attend expert training to use AACs such as these. Even more formal AACs, such as Makaton (a sort of sign vocabulary for people who have learning afflictions that uses keywords to boost understanding), need preparation although learning a vocabulary will not require intensive training.

Expérience and conversation (Winterhalder 1997) Understanding complex information Individuals with learning afflictions have a reduced ability to MEDICAL STANDARD 60 april five: vol 20 no 35: 2006 appreciate new or complex details (DH 2001), and those whom experience troubles when digesting information might find it hard to learn new skills. Brains can be quantified as a determine related to could be IQ. Nevertheless , it might be even more useful to consider intelligence in relation to cognitive techniques.

Smith and Mackie (2000) describe cognitive processes while: ‘¦the method by which our thoughts, perceptions, thoughts, emotions and motives information our comprehension of the world and our activities. ‘ Intelligence exerts an effective influence over the ability to method information, the capability to learn additional skills and to adapt knowledge to different situations. Intellect is a great attribute that could guide the understanding of the world, but it is not fixed or static. Teaching and learning tactics can be used to induce cognitive processes so that persons can procedure information, or potentially confusing situations, with additional confidence.

In the same way, complicated responsibilities and information can be broken down into small , and simple steps in order that people may approach these people in levels. Attempting to appreciate another person’s cognitive processes can help practitioners to build up a more understanding and person-centred approach to proper care, and can provide an incentive to build up the educating and learning strategies which might be best suited for the individual needs of patients. Dealing independently People who have learning disabilities may include a reduced ability to cope separately (DH 2001). Independence is defined relating to degrees of social operating.

Assessment of the patient’s advantages and needs in social operating is a primary stage in developing designed care that may be familiar to practitioners coming from all twigs of medical. Making an exact assessment of social operating provides valuable information about the array of activities that the person can easily undertake in the or her own and those activities where a person requires support. Some people with learning problems may require help with tasks including washing and dressing, and lots of need help to acquire their method of conversation understood.

Learning disability and development Learning disability begins before adult life, affects many people coming from all ages and has a enduring effect on creation (DH 2001). A majority of younger people with learning disabilities reside in the community with the parents or carers. Older people with learning disabilities likewise live in the city but they may have periods of institutional care. Some individuals will have recurrent contact with wellness services and more have unusual contact. Individuals with learning problems are not a homogeneous group. Their awareness of nursing staff, NURSING COMMON

FIGURE 2 A model pertaining to communication Person communicating: we take turns through this role of sender of information. Depending on the individual’s cognitive potential, this may be deliberate or pre-intentional communication Connection barriers: could be present in environmental surroundings as well as staying caused by the communicator and communication spouse Communication partner: we take becomes in this position of the person who receives the information sent, makes sense of it and responds properly doctors, health centres, clinics and clinics will have recently been shaped by way of a formative encounters with personnel and companies.

Providing confidence for people with learning disabilities to attend health bank checks and to make use of healthcare solutions can involve changing their particular perceptions of health professionals. A lot of people with learning disabilities have not received the therapy they need because they are reluctant to engage with solutions where they have had poor experiences before. To inspire people with learning disabilities for making effective utilization of healthcare solutions throughout their particular lives, experts need to use their conversation skills to initiate and keep positive associations. Time out three or more

Think about the previous time you communicated having a person with learning disabilities, or an agent who has communication problems. Refer to checklist you produced in Time out a couple of about the communication devices you use in your workplace. Exactly what the main barriers to communicating about health with a individual who has learning disabilities? How can you remove or reduce obstacles to connection? Which environmental factors obstruct communication? Discover any boundaries that you had certainly not previously considered. april five: vol twenty no 30: 2006 61 learning sector nursing behaviour Barriers to communication

You will find barriers to communication that can be identified pertaining to the person with learning disabilities, the health specialist and the environment (Box 3). When boundaries have been discovered, health professionals can begin to think about means of reducing or perhaps removing all of them. Health professionals exchange information by using terminology that reflects their very own specialised know-how. Patients and other people who are not really involved in the daily delivery of health care CONTAINER 3 Barriers to interaction The person with learning problems may: Possess limited understanding.

Have limited vocabulary or perhaps difficulty speaking. Have physical impairments that limit ability to hear requests or perhaps instructions. Include poor knowledge of health and diet and weight loss. Be scared of individuals in uniforms. Be burdened because of disease. Not like fresh places. Have a problem waiting and may not be familiar with concept of period or queuing. Have limited literacy and numeracy skills to read wellness advice and information, for instance , instructions, characters, dosages. Anticipate contact with nurses to be distressing because of prior experiences. The nurse might: Be rushed because of large workload.

Have biases and assumptions about people with learning disabilities. Have poor being attentive and attending skills. Be unable to understand augmentative and substitute communication devices. Have limited knowledge of the individual. Have too little time to produce a good romance with the individual or carer. Not work with visual assists to support understanding. Use technological jargon and/or long terms. Provide written information not having thought of the patient’s ability to read it. Give information about the up coming appointment in a way the patient will not likely understand or perhaps remember.

The environment may: Become crowded. Occupied. Uncomfortable. Have got strange smells and tones. Bring back negative memories. Have got limited physical access, for instance , no hoists. Include unhelpful people. Have poor signs, relying on literacy skills and good sensory abilities. Have zero area to sit silently with limited sensory activation while waiting around. Be stuffed with machines and instruments that a person with learning disabilities may not understand. may find it difficult to comprehend the terms and ideas they encounter in healthcare configurations. They can find it hard to follow along with advice or perhaps instructions.

This can result in individuals making incorrect decisions or perhaps exposing themselves to needless risks. For example , patients with learning afflictions who consider their own medicine may be in danger of overdosing or perhaps taking an ineffectual dosage, particularly if the road and medication dosage of a newly prescribed medicine has not been described clearly and/or recorded within an accessible formatting. Time out some Consider the list of potential barriers to communication and categorise all of them according to: Barriers which have been addressed to get patients with learning afflictions using the companies you work in.

Barriers that could be remedied quickly. Barriers that require planning to become reduced or removed. Boundaries that require economical investment to become reduced or perhaps overcome. Go over this list with your acquaintances. Identify techniques for removing obstacles and bettering communication. Wise practice in conversation In Southern region Warwickshire, well being passports had been developed for people with learning disabilities (Leamington Health spa Today 2005). These provide detailed information regarding an individual’s overall health, strengths and desires so that practitioners can provide patient-centred care.

They can be used to boost communication across a range of healthcare providers. Having an alert system included into individual notes which provides individual connection needs could possibly be beneficial, especially where staff do not know person patients. Health practitioners may use and become involved in developing health actions plans. These are generally plans particular to individuals and they are developed to fulfill their get needs. Overall health action ideas are a way of overcoming some of the barriers to high quality health care (DH 2001).

Plans are produced by someone including the affected person. They inspire the development of a shared understanding about a person’s health needs. Where trained in health actions planning has been provided for GP surgeries, advancements have been shown in the well being of patients with learning disabilities (Smith et approach 2004). You will find benefits to using a lead person to handle learning incapacity issues. In primary health care services, a lead person takes a in learning handicap issues, collates information, MEDICAL STANDARD 62 april 5: vol 20 no 31: 2006 ives support and advice to health personnel and grows links with professional services for those who have learning problems and other organizations (NHS Exec 1999). Time out 5 Does your organisation include a business lead person who is definitely involved in projects such as joint communication guidelines and the creation and writing of attainable health information? If yes, find out how she or he is supporting the team to build up skills in communicating with those who have learning problems. If zero, how might producing this function benefit your team and improve use of health care to get patients with learning afflictions?

To improve interaction with people with learning afflictions, more time should be allocated to visits so that there may be more time for them to express themselves and understand any information they have received (DH 1999). This is particularly the case in the event that AACs are utilized. Reception staff are often aware of people who have difficulties using services. Supporting these key staff to develop effective communication expertise and flexibility can improve usage of health companies (NHS Exec 1999).

For instance , if personnel in reception are aware that someone finds it difficult to wait in a for a, they may provide that person the first scheduled appointment. Several methods have been manufactured by trusts to boost communication. Some examples of these incorporate: Hambleton and Richmondshire Major Care Trust (PCT), together with Mencap, has evolved an available ‘Choose and Book’ guidebook for hospital appointments that uses a combination of pictures and words to clarify how sufferers can make selections about hospitals and meetings.

Bristol The west PCT, as part of its ‘Expert Patient Programme’, has developed programs that support prepare people with learning disabilities for a trip to the doctor. The Health Facilitation Group at Gloucestershire Partnership NHS Trust (2004) has produced a ‘traffic light assessment’ that provides information about people on entrance to medical center. This makes sure that important information is definitely clearly conveyed to health care professionals. Camden PCT (2005) is using this function to develop a web resource. However may seem to have limited communication skills, they should certainly not be ignored.

These people should be tackled directly and NURSING COMMON the information they will receive ought to be provided in a simple way without being patronising. Effective communication often depends upon how the information is sent. Practitioners may have to talk to carers, but they probably should not forget to talk about the person with learning disabilities. Practitioners ought to examine all their beliefs about people with learning disabilities and avoid making presumptions about an individual’s strengths and desires. This will help to generate health checks more accurate (DH 1999).

It can be useful to ask a speaker with learning disabilities to talk to healthcare staff about living with a learning disability fantastic or her experiences of accessing overall health services. Periods 6 What beliefs and values do you think society keeps about people who have learning afflictions? Some examples of negative beliefs and values are that people with learning disabilities: Have got a poor standard of living. Have larger pain thresholds. Are risky and promiscuous. Will not understand anything. Must not get married or have children. Cannot care for youngsters. Need institutional care. Simply cannot work.

Are just like children not really adults. Are these the best feelings regarding these statements? So how does15404 the presence of any of these beliefs influence the care provided to a person with learning disabilities? People with learning disabilities can have got additional physical or physical impairments which should be considered. They are also more likely to convey more mental overall health needs than the general population (DH 2001). Where a sufferer has further impairments or health issues these need to be regarded as during interaction. The healthcare environment must be adapted to allow for people with physical or sensory impairments.

Break 7 In your work place: Are there a private region to talk to a person who has a large wheelchair? Do you possess rooms where glare is definitely controlled plus the environment is suitable for people with limited vision? Will you consider the needs of interpreters/ carers and ensure they will fully understand information before they will pass it on? apr 5: volume 20 zero 30: 2006 63 learning zone nursing attitudes Accessible information Attainable information comes in many varieties, such as video clips, CDs, Digital video disks and audiotapes. Pamphlets may be produced with accessible advice about the services provided.

Written data needs to be in plain dialect, with short sentences and one subject matter per sentence in your essay. Photographs, sketches, symbols and other visual data can be used to support written data. It is important to keep pages clean on ordinary backgrounds to ensure that text would not detract via graphics. Albhabets should be large, 16-18 stage type size, and fonts that do not need serifs, just like Arial and Comic Without, should be used. Graphic textual content, underlining and italics must be kept to a minimum because they will impede legibility. Many société are now making resources to improve accessibility.

Many of these include: The United Bristol Healthcare NHS Trust offers produced a leaflet named ‘You happen to be coming to the Bristol Royal Infirmary with regards to your heart’, STAND 1 Employing terminology that is certainly easy to understand Ailment Common words and phrases that are used Epilepsy Investigations EEG (electroencephalogram) Strategies or terms that increase understanding Discover more about This phrase would have to be applied, but a photograph of someone having an ELEKTROENZEPHALOGRAFIE may help understanding Medicine tablets to help control your epilepsy Having two or more seizures direct after the other person or no matter what describes position for the Taking your medicine as we have agreed Things which may make you have got a seizure Not being able to experience a poo for three days Things you feel in your mind and human body that make you imagine you will have a seizure Having a fit or change, whichever word the person uses which uses pictures and words to introduce a number of the staff and explain what goes on when individuals are confessed to the cardiology department.

The training Disability Partnership Board in Surrey has developed ‘The Medical center Communication Book’ that combines words, images, signs and symbols. Trafford North and South PCTs have created a tool set for people with learning disabilities referred to as ‘Cancer and You’ (Provan 2004). Contact your local Community Learning Disability Group or People First enterprise for information about local resources. Simplifying conversation When conversing with people with learning disabilities, employ approaches a lot like those used for written text message. Plain language, the use of keywords, short sentences and one subject every sentence should be used. Give people a chance to process precisely what is being stated and to come up with a reply.

Work with openended inquiries to assess an individual’s understanding and rephrase problem if necessary, while repeating the same question rarely improves understanding. When info is offered during a assessment it is important to check on that the person with learning disabilities has understood this. If there is insufficient time throughout the initial discussion, it may be important to make an additional appointment to evaluate what the person has realized and maintained. For somebody who processes information slowly this might be essential to ensure an exact assessment as well as the effective setup of a plan for treatment. Examples of conditions that are easier to understand are presented in Table 1 .

Such terms are only effective if the person understands all of them so , for instance , ‘constipation’ is ‘not having a poo’, but the health practitioner needs to know whether the person uses this term to explain defecation. Anti-epileptic drugs Status epilepticus Medicine compliance Activates Constipation Environment Time out eight Think of several common health issues that are very likely to make a person visit your services. Write those inside the first column of a table (see Table 1). Identify the chinese language you use when ever discussing these types of illnesses and record these words or phrases in column two. These may be medical terms, health conditions or lengthy words. At this point spend some time figuring out words that are easier to understand and record them inside the third column. NURSING COMMON Seizure 64 april a few: vol 20 no 30: 2006 Realization

People with learning disabilities may have communication difficulties which may have restricted their access to health care and averted them from receiving the info required to keep their well being. In addition to learning impairment, they are more likely to have complicated healthcare needs leading to multiple diagnoses. Measures towards better health for those who have learning disabilities can be of providing encouragement and support to attend regular health verification and testimonials, and by developing a range of ways of improve conversation between practitioners and individuals with learning afflictions NS SUGGESTED RESOURCES British Institute of Learning Afflictions (2001) Factsheet No . 005 Communication. www. bild. org. uk/pdf/factsheets/communication. pdf format (Last reached: March 12 2006. United kingdom Institute of Learning Problems (2005) The Good Health (a set of 12 illustrated booklets). www. bild. org. uk/publications/your_very_good_health_details. htm (Last accessed: Mar 10 2006. ) Connection Matters (updates 2005) What is AAC? www. communicationmatters. org. uk (Last accessed: Drive 10 06\. ) Interaction Matters (updated 2005) How you can be a good listener. www. communicationmatters. org. uk (Last accessed: 03 10 2006. ) Division of Health. www. dh. gov. uk (Last seen: March twelve 2006. ) Foundation for People with Learning Problems (2004) Interaction and people with learning afflictions. www. learningdisabilities. org. uk/page. cfm? agecode=ISSICMMT (Last accessed: March 12 2006. ) Foundation for those who have Learning Problems (2005) People with learning disabilities in South Warwickshire have been given a new kind of passport to help with their medical appointments. www. learningdisabilities. org. uk/profilenews. cfm? pagecode=ISSICOLN, are acode=ld_communication_news, id=7231 (Last utilized: March 10 2006. ) MENCAP (2003) You and your quality of life: a basic guide to being healthy. www. mencap. org. uk/download/you_and_your_health. pdf (Last accessed: Drive 10 2006. ) Plymouth Hospitals NHS Trust (2005) Living with tumor. www. learningdisabilitycancer. nhs. uk/ (Last utilized: March twelve 2006. ) Time out on the lookout for

Complete a SWOT analysis (strengths, weaknesses, opportunities and threats) of your abilities and understanding when conntacting and promoting access to healthcare for people with learning disabilities. Time out 10 Now that you’ve got completed this article, you might like to consider writing a practice account. Guidelines are recorded page 68. References American Speech-LanguageHearing Association (2005) Introduction to Augmentative and Alternative Communication. www. asha. org/public/ speech/disorders/acc_primer. htm (Last accessed: March 9 2006. ) Bristol and Section People First (2003) Were People Initial. (Film) Persons First, Bristol. Camden PCT (2005) How it all started About Me in Medical center. www. camden. gov. k/ (Last utilized: March 17 2006. ) Cohen M (2001) Countries’ health overall performance. The Lancet. 358, 9285, 929. Office of Overall health (1999) Facing the Facts: Services for People with Learning Disabilities: An insurance policy Impact Examine of Social Care and Health Providers. The Stationery Office, Greater london. Department of Health (2001) Valuing Persons: A New Technique for Learning Handicap for the 21st Century. The Stationery Workplace, London. Emerson E, Hatton C, Felce D, Murphy G (2001) Learning Problems: The Fundamental Facts. Foundation for People with Learning Problems, London. Gloucestershire Partnership NHS Trust (2004) Traffic mild assessment. Unpublished document.

Gloucestershire Partnership NHS Trust, Gloucester. Gravestock S i9000, Bouras D (1997) Emotional disorders. In Holt G, Bouras D (Eds) Mental Health in Learning Disabilities: A Training Pack pertaining to Staff Working together with People who have a Dual Associated with Mental Well being Needs and Learning Disabilities. Second model. Pavilion Submitting, Brighton, 17-26. Jones L (2003) The Communication Difference. www. learningdisabilities. org. uk /page. cfm? pagecode= FBFMCHTP04 (Last seen: March 12 2006. ) Leamington Day spa Today (2005) Patients with learning problems in South Warwickshire had been given a fresh type of passport to help using their medical sessions. Leamington Spa Today. January 19, 2005.

NHS Exec (1999) Once a Day One or More Individuals with Learning Afflictions are Likely to be in touch with Your Primary Health-related Team. How could you Help Them? Office of Health, Leeds. NHS Service Delivery and Enterprise (SDO) Research and Development Programme (2004) Access to Healthcare for People with Learning Disabilities. Conjonction paper. NHS SDO, Birmingham. Nocon A (2004) Qualifications Evidence pertaining to the DRC’s Formal Exploration into Health Inequalities Experienced by Individuals with Learning Disabilities or Mental Health Problems. Incapacity Rights Commission rate, Stratford after Avon. Provan K (2004) Cancer therefore you: Toolkit pertaining to Working with People who have Learning Disabilities. www. cancerandyou. info/docs/ FullToolkitNov04. pdf (Last accessed: Drive 9 06\. Smith SER, Mackie DM (2000) Social Psychology. Second edition. Mindset Press, Hove. Smith C, Giraud-Saunders A, McIntosh B (2004) Healthy and balanced Lives: Well being Action Preparing in a Person Centred Way, Including Health in Person Centered Planning. www. valuingpeople. gov. uk/ HealthHealthyLives. htm (Last accessed Drive 10 06\. ) Winterhalder R (1997) An overview of learning problems. In Holt G, Bouras N (Eds) Mental Well being in Learning Afflictions: A Training Load up for Staff Working with Those who a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Stand Publishing, Brighton, 1-6. NURSING JOBS STANDARD apr 5: volume 20 no 30: 06\ 65

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