Promoting health, safety and welfare of adults with a learning disability in acute health care
Citation: Bradbury-Jones C, Rattray J, Jones M, et al. Promoting the health, safety and welfare of adults with learning disabilities in acute care settings: a structured literature review. Journal of Clinical Nursing. 2013;22:1497–509.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: NHS Tayside (Scotland).
What is this? People with a learning disability have greater health needs than the general population and identifying ways to ensure that their health care is effective is important for resilient health systems.
In this review, the authors searched for studies that investigated factors that influence the health, safety and welfare of adults with a learning disability in acute care settings. They restricted their searches to articles published between 2000 and 2011 and did the search in March 2011. They included 6 qualitative studies and 1 mixed-methods study, which were conducted in Australia (2 studies) and the UK (5).
What was found: Six areas influencing the health, safety and welfare of adults with a learning disability were identified: care provision, communication, staff attitudes, staff knowledge, supporters and carers, and physical environment.
Issues with care provision included lack of access to food and fluids, toileting needs, and mobility assistance and medical treatment. Strategies to address these challenges included implementing special equipment, central storage of this equipment, and developing and using assessment tools for, for example, pain and distress.
Challenges in communication included difficulty expressing needs, understanding healthcare professionals, and non-verbal communication. Strategies to address these challenges included information videos and booklets, communication passports, augmentative and alternative communication methods and carers conveying special needs/circumstances to staff.
Staff attitudes and knowledge show that negative comments and problematic attitudes by hospital staff are rooted in fear, vulnerability and lack of knowledge. Ways to address these issues include education, training and mentoring of healthcare workers and emphasizing liaison services to improve care and staff awareness.
Supporters and carers play an important role in the care of people with a learning disability in hospitals, staying with them for long periods of time and assisting with communication. Conflict can arise if carers feel that they are being taken for granted and not getting adequate breaks. This can be improved if their opinions are valued and listened to, and they are given support and breaks.
Challenges with the physical hospital environment include inadequate care due to business, fear of getting lost and preferences for single rooms over wards. Strategies to address these issues include preliminary hospital visits to improve the admission experience and using symbols or pictures to enhance safety and experience.
Implications: The authors of the review concluded that the influences on the health, safety and welfare of people with learning disabilities in acute care settings are multi-layered and that improvement strategies should consider multiple interventions. Specifically, the authors mentioned investment in education and training, and support/liaison services. They also stated that promoting decision-making autonomy and involving people with a learning disability in policy development, education and research is important to improve decision-making and show commitment to improving their well-being.
Other considerations: The authors of the review discussed their findings in the context of disability.
This summary was prepared by Catherine Haynes, checked by Cristián Mansilla and Jawaria Karim, and finalized by Mike Clarke.
Evidence Gaps: This review identified two main gaps:
| Evidence gap | Classification | Population/setting identified | Study type |
| ‘’We found no quantitative studies that met the inclusion criteria, yet such studies may have contributed significantly to answering our research questions. We suggest this as a focus for future research.’’ | More research is needed | Adults with learning disabilities in acute care settings | Quantitative studies |
| ‘’We found limited evidence regarding the physical safety of adults with learning disabilities in acute care settings. As reported, most studies are concerned with matters of patient experience and welfare. Again, this has highlighted an important area for research development’’ | More research is needed | Adults with learning disabilities in acute care settings | N/A |
These gaps were identified up to March 2011, with no geographical restrictions. An updated search was conducted on 28/9/2023 to check if new studies have filled this gap, finding:
- No more recent systematic review addressing the same or a broader question.
- No primary study that could contribute to fill the gap.
This evidence gap was identified, extracted, and classified by Ana Beatriz Pizarro and Jawaria Karim. Updated searches were carried out by Jane McHugh. Ana Beatriz Pizarro assessed the search results to address the gaps, and the findings were checked and finalized by Cristián Mansilla. The methodology we used to assess each gap can be found here.