مقياس صعوبات التعلم
- LEARNING
DISABILITY DEPENDENCY ASSESSMENT SCALE
Background
The Lothian Learning Disability
Dependency Assessment Scale has been developed to assist nurses in the acute
hospital and community teams to identify the specific care needs that may be
present when caring for a patient with a learning disability. It is important to recognise that the
Assessment Scale is designed to enhance and complement the nurse’s existing
skills of observation, communication and assessment. The additional information obtained from the
assessment made using the Dependency Assessment Scale should be used to assist
with the development of a comprehensive patient care plan.
Guidance on
completion
The nurses should use their
interpersonal and communication skills to assess the care needs in a sensitive
manner. Some patients or carers may find
certain aspects of the assessment awkward, such as those contained in the
section on Mental Health Needs, and as such, care and sensitivity should be
exercised when completing this section.
Pre-admission contact may be made with
the main carer/CLDT when a patient needs to attend Out Patients or to be
admitted to the Acute
Hospital. Where appropriate, the Dependency Assessment
should be completed and the outcome discussed with the acute care nurse.
It should be considered good practice
to obtain information that may assist with the assessment of the patient’s care
needs prior to admission to the acute hospital including completion of LDDAS
and use of HHA. It is acknowledged that
this is not possible in all cases. It
could be that the patient is unable to provide the nurse with all the details
required during assessment. If this is
the case, the nurse should consider additional sources of information, having
first obtained the patient’s agreement.
These sources could include:
·
The main carer
·
Relatives
·
Residential care staff
·
Community Learning Disability Team
·
Primary Care Staff
Method
The
nurse should systematically assess the patient in relation to each category,
identifying their current level of dependency according to each assistance
level. The four assessment categories
are:
·
Self Care/Nursing Support
·
Communication and Safety
·
Mental Health Needs
·
Nursing Procedures
It is important to recognise that the
overall Assistance Level Score cannot itself determine the need for
additional nursing support. It is the
balance of the scores across which will give guidance to nursing staff of the
patient specific care requirements and offer an indication of the most
appropriate nursing resource required to meet the care needs.
In appropriate circumstances the role
of the main carer should be taken into account when completing the Dependency
Assessment Scale and his/her availability and desire to participate in direct
care. This factor could have a direct
influence on the nursing resource required.
It is the responsibility of the
assessing nurse and nurse-in-charge of the clinical area to identify the level
of nursing resource required. They
should consider the following recommendations:
A - Self
Care / Nursing Support
A
high score in this category only would indicate the possible need for
additional support from a Health Care Assistant/Auxillary.
B -
Communications & Safety
A high score in this category only
would indicate the need for specific supervision and observation. This may be required on a continuous or
intermittent basis and should be judged in relation to the assessment of the
patient in Categories A, C & D.
C - Mental
Health Needs
-
If the patient is assessed at Assistance
Level 2 across one or more categories then consider whether support from a
Health Care Assistant would be appropriate. -
If the patient were assessed at
Assistance Level 3 or 4 in one or more categories it would suggest the
need for support from an appropriately trained nurse. -
If the patient is assessed at
Assistance Level 4 in one or more categories then consider whether a
trained nurse with additional skills e.g. RNLD/RMN is required to provide
the support needed.
D - Nursing Procedures
·
If the patient
is assessed at Assistance Level 1 or 2 across one or more categories then
consider whether support can be met within existing trained nursing resources.
·
If the patient is
assessed at Assistance Level 3 or 4 across one or more categories then consider
whether a dedicated trained nurse resource may be required.
·
If the patient is
assessed at Assistance Level 3 or 4 plus has care needs identified in
categories A, B & C then a dedicated trained nurse resource may be
required.
It is possible that the patient will be
assessed as having care needs across all categories. Where this is the case it is important to
look at the balance across the categories and make an informed professional
judgement about the nursing resource that may be required.
The
nurse-in-charge/Charge Nurse should assess the patient using the Dependency
Assessment Scale to determine the possibility of meeting any additional care
needs. Where possible these care needs
should be met from existing resources prior to requesting additional
nursing support from the Clinical Manager, who may in turn contact the relevant
Nurse Bank.
Frequency of Assessment
The
Learning Disability Dependency Assessment Scale should be completed initially
at the time of admission and subsequent reassessment should be completed as
required in response to the changing needs of the patient. Examples include:
·
Pre-surgery/procedures
(where the patient may present with needs not initially identified)
·
Post-surgery/
procedures (where the patient’s support and supervision needs are increased)
·
Where the
anxiety/stress associated with hospitalisation is seen to be impacting on the
patient’s ability to cope with the situation.
·
Any other
circumstances felt to be significant.
This
information is summarised in the form of a flow chart in Appendix 2.
