Syndrome and diabetes

The purpose of this essay is to use a systematic approach and write a holistic and analytical account concerning one aspect of care in a chosen individual who has complex needs. Before choosing a client it is important to understand what complex needs are. There is no commonly agreed definition, however both of the definitions below illustrate clearly what complex needs are. Stalker, et al (2003:1) suggest complex needs include “those with acute and chronic medical conditions, multiple and profound impairment and learning disabilities.

” Another definition provided by Tait and Genders (2002: xi) suggests that, “People with by virtue of their disability and additional physical, emotional or behaviour problems require a co-ordinated approach that meets their everyday needs. ” Therefore, with these definitions in mind I have chosen to focus upon the challenging behaviour(s) of a forty-five year old man who has a moderate learning difficulty and Down’s syndrome.

With due consideration of protecting the individual’s identity in accordance with the NMC ‘Code of Professional Conduct’ (2002) the name ‘Henry’ will be applied throughout this essay. Henry lives in a six bedded private home for adults with moderate learning disabilities. Previous to this Henry lived at home with his parents until his father died three years ago. After this Henry received counselling through his community nurse in order to help him go through the bereavement process.

No signs of grief have been identified since the counselling sessions finished two years ago. The manager of the home contacted Henry’s community nurse as she was unsure of the causes of Henry’s behaviour and how staff could manage it. Before considering the behaviour(s) Henry is displaying, it is useful to consider the importance of forming a therapeutic relationship in order to help Henry. A therapeutic relationship between a nurse and client compromises of intimacy, partnership, reciprocity, trust and respect.

The most important skill in this relationship is communication and this requires the nurse to overcome any barriers, which may stand in the way. Without it, it is virtually impossible to form a relationship with another person and gain the information required (Turnbull, 2004). Therefore, the initial interviews and one-to-one sessions for assessment purposes were carried out a few weeks after meeting Henry in order to develop a therapeutic relationship, such as the one that had developed with his Community Nurse. In order to identify his needs permission was sought from Henry.

Henry said he understood what we would be doing and said he had no problem with us talking to him and others involved in his care. The initial assessment using an unpublished assessment tool was then carried out by his Community Nurse (See appendix one). This assessment showed several behaviours that Henry was displaying on a daily basis such as hoarding, aggression, and self-exclusion. Huxley, et al, (2005) found that people with learning disabilities often present with a variety of behaviours considered to be challenging and rarely display one type of behaviour in isolation.

Emerson (2001:1) identified challenging behaviour as “Culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is likely to be put in jeopardy, or behaviour which is likely to limit the use of, or result in the person being denied access to ordinary community facilities. ” Furthermore, McGill (2001:1) suggests that some challenging behaviour are “behaviours which do not have serious consequences but are disruptive, stressful or upsetting and has an impact on the person’s or other people’s quality of life,” such as the behaviours identified by Henry’s carers.

Before using further assessment tools it was suggested by the community nurse that Henry received a health check to eliminate any possible contributions to his behaviour. This was supported by Cohen, et al, (2002) who suggests that when evaluating behavioural concerns in Down’s syndrome, it is important to determine whether there are acute or chronic health problems impacting on the behaviour. Also when evaluating compliance issues, it is important that speech and language ability, hearing, vision and general cognitive development are assessed.

If health issues are not picked up such as a hearing loss then the interventions put in place to help Henry may not be successful as he wouldn’t understand staff are saying to him. The G. P. found no health concerns that could be impacting Henry’s behaviour and so mental health issues also were considered. This was because Henry was now in his stage of life where Alzheimer’s has been found to be more common in people with Down’s syndrome than the general population (Davidson, et al, 2003 & Bouras, et al, 2000:44).

Behaviours such as losing his temper and obsessional behaviour may be indicators of the onset of this condition (McKenzie, et al, 2002 & Huxley, et al 2005). However, following an assessment from the consultant it was found that we could dismiss this as an explanation for Henry’s behaviours as the consultant found that these behaviours were not related to Alzheimer’s. A major concern was that the hoarding Henry was carrying out showed strong traits, which were comparable with obsessive-compulsive disorder (O. C. D). O. C. D behaviours are often reported in adults with Down’s syndrome (Cohen, et al, 2002).

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