LEARNING DISABILITY PRACTICEApril 2009 | Volume 12 | Number 328
Feature
aggression, tom should be accommodated in a side
room away from the main day ward. the plan agreed
by the care team was that if tom became agitated
or aggressive, then everyone would leave the room
except me because i had experience of de-escalating
and managing his behaviour.
to keep tom's anxiety levels at a minimum all
medical equipment was removed. this left a bed, a
television and tom's favourite music playing softly.
On his bed the nurse had ensured that there was a
selection of his favourite magazines.
solution-focused work relies on client and
practitioner being centred in the present with an
orientation towards the future (Macdonald 2007). this
perspective enables both to remain focused on the
now and so reduces anxiety, yet with an awareness
of the positive future goal to be achieved. A sense of
playfulness and humour, if appropriate, can reduce
stress and tom responded well to my banter. At one
stage tom noticed the cardboard `sick bowls', which
heightened his anxiety. i responded by placing one on
my head and making out it was a hat. tom laughed
and commented that i was `silly', saying: `stop it, you'll
get us thrown out of here!'
A main tool of solution-focused work is the use
of compliments and questions (de shazer et al 2007).
tom's nurse and i used compliments to encourage his
co-operation with measuring his blood pressure and
placing his name band on his wrist. Questions were
asked of tom in a calm, respectful manner and these
empowered him to make choices and feel in control.
Examples included: `tom, it feels a bit hot in here.
shall we take our coats off?'; `What magazine shall we
look at?' and `tom, can i take your blood pressure?'
the clinical staff had experience of similar
situations and they displayed considerable respect
and compassion for tom. the anaesthetist
introduced himself as the `doctor' and said he
would give tom a medicine to relax him. this he did
while i distracted tom with one of his magazines.
shortly afterwards, Michele and i were following
tom down the corridor as he was wheeled towards
the operating theatre. However, the sense of relief we
felt as tom disappeared behind the operating-room
doors was short-lived: tom began screaming. i found
the anaesthetist trying to cannulate, but tom had
panicked at the sight of the needle. i cradled tom's
head so that he was facing away from what they
were doing and, looking into his eyes, reassured him
that he was safe and that he was about to drift into a
relaxing sleep. tom calmed and fell asleep.
He emerged from the operating theatre, minus his
teeth, half an hour later. His recovery nurse attended
to him with kindness and reassurance, which tom
soaked up in abundance.
Later i was able to speak to this nurse
who commented on how positive, skilful and
compassionate this patient's journey had been.
she told me that before Michele's arrival, patients
with learning disabilities had often been held down
to anaesthetise them or procedures had been
abandoned. she recounted that the violence she had
witnessed on such occasions would leave her very
upset and traumatised.
it was a privilege to experience the dedicated
work and clinical skills of Michele and the day
surgery team. they had made tom's journey positive,
supportive and ultimately successful. for me, the
role of a learning disability liaison nurse was pivotal
in ensuring equitable access and in making sure that
the clinical team made the necessary person-centred
adjustments that resulted in a high-quality patient
experience. this is of paramount importance, as was
highlighted in the recent Michael report (2008). tom
was very pleased with the outcome. He now has false
teeth and a beaming smile.
in being person-centred and really listening to
what tom was telling us, we found a solution to his
dilemma. in tom's case solution-focused was an
appropriate response. What tom gave me was not
ideas about what should be happening, but trust in
the client's own wisdom to help find a solution.
finally, working with tom reminded me why i
became a learning disability nurse and therapist. the
challenge, learning, curiosity, and relating at depth
involved in working with people like tom never
cease to amaze me. People like tom have a habit of
showing us professionals the way to be.
References
British Dental Health Foundation (2009) Brush for Health: Healthy
Mouth, Healthy Body www.dentalhealth.org.uk/faqs/leafletdetail.
php?LeafletiD=61 (Last accessed: March 12 2009.)
de Shazer S, Donlan Y, Korman H et al (2007) More Than Miracles: The
State of the Art of Solution-Focused Brief Therapy. the Haworth Press,
New york.
Macdonald A (2007) Solution-Focused Therapy: Theory, Research and
Practice. sage Publications, London.
Michael J (2008) Health Care for All: Report of the Independent Inquiry into
Access to Healthcare for People with Learning Disabilities. London
O'Hanlon B (1999) Do One Thing Different. Quill, New york.
Royal College of Psychiatrists, British Psychological Society and Royal
College of Speech and Language Therapists (2007) Challenging Behaviour:
A Unified Approach. Clinical and Service Guidelines for Supporting People
with Learning Disability who are Risk of Receiving Abusive or Restrictive
Practices. College report Cr14. rCP, London.
Rob Mirow is acting lead
community nurse, and
specialist practitioner,
counsellor and psychotherapist
with the community learning
disabilities team, Trafford
Primary Care Trust
For author guidelines
visit the Learning
Disability Practice
home page at www.
learningdisabilitypractice.
co.uk For related articles
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This article has been
subject to double-blind
review
Tom was very pleased with the
outcome. He now has false teeth
and a beaming smile

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