Obrazovni program medicinskih sestara za rad s osobama s poteškaćama u učenju: perspektiva edukacije u Ujedinjenom Kraljestvu naspram zdravstvenih i socijalnih potreba osoba s poteškoćama u učenju

Eric Broussine

Senior lecturer Learning disabilities

Faculty of Health and Social Care

University of the West of England, Bristol

Rad prenosimo u izvornom obliku na engleskom jeziku. Prijevod na hrvatski jezik je u tijeku te će biti po završetku i recenziji objavljen.

Learning Disabilities nursing programme: a U.K. perspective of nurse education to meet the health & social needs of people with learning disabilities.

Introduction:

Normally every 5 years in the UK nursing curricula have to undergo critical review and re-validation with the Nursing & Midwifery Councils' approval (NMC, formally known as the UKCC) so that Higher Education Institutions (HEIs) can demonstrate and apply a relevant and contemporary programme that meets the needs of children and adults with learning disabilities and their carers within a range of service settings. 

In May 2004 the Bsc(Hons)/Bsc/Diploma in Higher Education Learning Disabilities Nursing had a successful validation and the 3 year programme commenced in September '04 with a cohort of 20 student nurses.                                                    

The programme reflects the Governments' modernising agenda whereby it is committed to strengthening education and training in the National Health Service (NHS) and developing a structured career framework. It has also adopted the recommendations of the NMCs' Fitness to Practice (1999). These are: applying a 1 year common foundation programme for all 4 branches of nursing, longer practice placements and flexible programmes for students who have varied academic profiles. The Government also published ‘Valuing People: A New Strategy for people with learning disabilities' (DOH 2001) and the nursing curriculum integrated the themes of the white paper into the programmes philosophy. Additionally, parents, carers and clients themselves became involved in the design and planning of learning disabilities nurse education.

This paper will contextualise the learning disability nursing programme by briefly examining the aims, knowledge, skills and attitudes of the learning disability nurse. The study will also outline the philosophy; describe the educational design of the curriculum, how practice is organised and implemented and the teaching, learning and assessment strategies. A learning unit (a module) relevant to working with children and adolescents will be explored to illustrate how students are prepared academically to work with families and children's services. To conclude a critique of the curriculum will be investigated.  

Learning Disability Nursing:

The learning disability nursing profession makes a respected and necessary contribution to the complex needs of people with learning disabilities, their families and carers in an ever-diverse range of community environments (Kay et al 1995, Moulster & Turnbull 2004). Learning disability nurses make valued contributions to enhancing the quality and standards of care within services and meeting needs of people with learning disabilities. For example, nurses enable people to become more independent, to integrate more effectively in the community, to ensure that their health is optimised, increase their feelings of self-esteem & competence, combats the negative effects of stigma, marginalisation and prejudice and increases their autonomy by promoting their rights.

On the successful completion of the programme the student qualifies as a registered learning disability nurse (RNLD) and should have the necessary knowledge, skills and attitudes to work in the complex milieu of community care. Consequently, nurses may have different roles and responsibilities depending on where they work. Some of the knowledge and skills are an ability to assess need, plan interventions, implement them within a multi-professional context and evaluate the care, all conducted with the individual central to the decision making process wherever possible.

Other aims of learning disability nursing are the surveillance and promotion of health, healthy choices and lifestyles, developing trusting and therapeutic relationships and enhancing opportunities for people with learning disabilities to express themselves. A final yet equally important role that learning disability nurses fulfil is managing and leading teams primarily within residential settings.

The limited research that has been conducted into the nature of learning disability nursing suggests that these knowledge, skills and attitudes are not unique or solely characteristic to the RNLD (Alaszewski et al 2001) but that they do safeguard quality and have an ‘added value' dimension to service provision (Raynes et al 1994). Richardson (1997) points out that the nature of learning disability nursing should include reciprocal relationships and mutuality, whereby the nurse and the client learn from each other and both should be changed by the experience of caring. Mutuality is regarded as a process where both parties share a common experience. These two characteristics imply that nurse and client are on a personal journey together, learning to move from being controlled and devalued to becoming autonomous and expressing their rights. Mitchell (2000) asserts that learning disability nurses have suffered with low self esteem and marginalisation which has paralleled the lives and experiences of people with learning disabilities themselves. One of the reasons for this, he continues is due to the publics' and some other professionals misunderstanding and ignorance of what a learning disability is. This alleged ignorance means that people will not know what care or support people with learning disabilities will need. Generalisations and stereotypes still abound about the word ‘nurse' and there are assumptions that people with learning disabilities only require medical care.

Programme philosophy:

The concepts and principles that underpin the programme are shaped by O'Briens' (1987) 5 service accomplishments, the ideas of advocacy and empowerment (McNally 2003, Goodley & Ramcharan 2005) and Valuing People (2001).

The 5 service accomplishments recognise that people with learning disabilities should:-

Share Ordinary places - they should wherever possible be encouraged to take part in activities in an integrated community learning environment.

Make Choices - Giving people the opportunity to make informed choices.

Develop Abilities - People have abilities which should be developed and encouraged so that they are able to reach their full potential.

Be treated with respect and having a valued social role - People with a learning disability have a part to play as a valued member of society and should be empowered to do this.

Grow in relationships - People with learning disabilities have the right to friendships and relationships. It should be remembered that this is sometimes difficult from them to achieve this.

The ethics of advocacy and empowerment are promoted both within the student group and transferred to the lives of people with learning disabilities. The 2 ideas are closely linked with autonomy, rights and actively making choices. They function at different levels, in different contexts and on an individual as well as on a group level. The aim of advocacy and empowerment is to promote self-esteem, self-determination, self-expression and having more control over one's life (McNally 2003). The social context of these beliefs was born from the European Convention on Human Rights (Human Rights Act 1998) with the advantage that challenges on the grounds of discrimination can now be made within the UK courts.   

Closely linked with advocacy and empowerment are the themes of the Valuing People (2001) White Paper, namely, Rights, Choice, Independence & Inclusion. These themes are integrated throughout the aims of the programme and within each theory and practice module. The White paper further supports the principles of person centred planning (PCP) (Sanderson 2000) which is defined as,

"...a process for continual listening and learning, focusing on what is important to someone now and in the future and acting upon this in alliance with their family and friends"  (DOH 2001:12)

Students are actively encouraged to become involved with families and carers and to participate, initiate and manage PCPs in partnership with other agencies and services where appropriate. Additionally, the student nurses are taught these principles explicitly throughout the programme. The development of these main beliefs are monitored and assessed both formatively and summatively, under supervision of a qualified practitioner. They are encouraged to question service providers when these ideologies are badly implemented, sporadic or absent and are further required to research these philosophies/theories that underpin their practice. Finally, the students are expected to implement evidence-based care, that is ensure that there are sound, contemporary rationales that support their work with people with learning disabilities.

Educational design of the curriculum:

Rule 18a of the NMC (2002) articulates that nursing programmes delivered in HEIs must meet the required 4600 hours over 3 years full time or up to 5 years part time. These hours are divided into 2300 hours of theory and 2300 hours of practice thus acknowledging the equal emphasis of student learning in an academic environment as well as in practice and that the two are not inseparable. The programme offers a balance of theory and practice modules over 40 weeks per academic year in an incremental and staggered manner so that student progression can be monitored. The programme has adapted Benners' Novice to Expert (1984) model. This model represents theoretical and practical development over three phases - Participation, Initiation & Management with the additional theme of the reflective learning cycle which demonstrates a commitment to the integration of theory to practice.

Briefly, phase one (participation) enables the students to be introduced to working in community settings and with people with profound and multiple learning disabilities. The transferable nature of skills is explored and there is a sharing of skills with other branches of nursing and other professional groups within Faculty. The principles of accountability and responsibility are introduced through the theory modules and portfolio development - a system of assessing practice competencies. The ideas of pedagogic lifelong learning, self management and enquiry based learning are also examined. Students following the 3 year diploma and degree programme undertake the same modules in the 1^st year. 

Phase two (initiation) is also shared with diploma and degree students. The student builds upon the 1^st year and begins to initiate care, that is undertake more complex assessment with appropriate assessment tools within the context of community nursing teams, formal and informal agencies and organisations and working with children/adults with learning disabilities within their own families. Disability issues, the nature of anti-discriminatory practice, equal opportunities and the concepts of power within care relationships are explored with children's student nurses. Skills of communicating with people, negotiating and sharing care, offering a holistic approach to identification of need and care planning are further developed. There is an expectation that the student will also begin to take more responsibility for their learning. The research process and evidence is investigated to provide rationales for learning disabilities nursing care.

Phase three (management) of the model builds on the previous two stages by focusing on the management of self, teams and service provision. Leadership skills, critical thinking, health & public policy and collaborative working practices are themes that are incorporated into theory and practice modules. Additionally, students will extend their skills of analysis and evaluation and build on their literature searching and IT skills. Practice concentrates on people with learning disabilities who challenge services, to work on their management skills and to partake in a national or international elective opportunity. At this point in the programme the diploma and degree pathways become more distinctive with diploma students undertaking modules at different academic levels to the degree students. The 3^rd year of the programme allows students to review their own progress, prepares them for registration, and helps them to formulate goals for development as a registered learning disability nurse.      

Work based learning days:

The integration of theory with practice is regarded as fundamental to the success of the programme and for the achievement of professional competence. To facilitate the delivery of the curriculum in practice work based learning days have been designed with the aims of expanding opportunities for the students' to develop independence, autonomy, flexibility and reflective practice (Ashcroft & James 1999). The days create opportunities for the exploration of a range of evidence to support nursing practice as it is delivered. Involving practitioners is regarded as good practice, which recognises their valued contribution and expertise in delivering the curriculum. Learning activities are student-centred, for example, student-led discussions, structured reflections, problem-solving activities and examining student portfolios. All strategies must reflect the learning outcomes of the module and the nature of practice experiences. There is a work based learning day every 2 weeks whilst the student undertakes a practice module. Attendance is compulsory and the student is released from practice for the day.   

Programme structure:

All theoretical and practice modules are compulsory and have a set number of academic credits attached to them. Moreover, there are three types of module:

1. professional pathway modules - these modules focus on learning disabilities nursing, both theory and practice.
2. inter-professional modules - these are modules where the student, together with other health & social care professional groups will be introduced and assisted to develop knowledge, skills and attitudes that actively promote inter-professional and inter-agency working.
3. shared learning modules - these are modules where the student shares the same knowledge base as other branches of nursing and therefore learn together.

As previously mentioned all modules for the 1^st 2 years are undertaken by diploma and degree students. In year one, students accumulate a total of 120 credits at level 1 (certificate level), in year two 120 credits at level 2 (diploma level) but in the 3^rd year diploma students accumulate a further 100 credits at level 2 and 20 credits at level 3 (degree level). On the successful completion of the programme diploma students will graduate with a Diploma in Higher Education and the nursing registration. The degree students have to achieve 120 level 3 credits to graduate with a Bsc (Hons) and the learning disabilities nursing registration.

The following narrative outlines the modules within the programme. The letters (P), (I) and (S) after the name of the module denotes whether the module is a Professional pathway, Inter-professional or Shared module.

Year one, level one:

Foundations of Health (S) - a module that examines the biological, sociological and psychological sciences in nursing and health concepts including health promotion. (20 credits)

Inter-professional module One (I) - an examination of cross boundary health care provision and services and the nature of inter-professional collaboration necessary for the high quality delivery of health & social care. (20 credits)

Participating in community services (P) - an introduction to community service provision for people with learning disabilities. (20 credits)

Support of people with profound & multiple learning disabilities and multi-sensory impairments (P) - an introduction to the nursing care of people with more complex physical health needs and limited communication. (20 credits)

Learning Disabilities Nursing Practice 1 (P) - 24 weeks of practice that supplements the theoretical modules, working in community settings under the direct supervision of a qualified learning disability nurse. (40 credits)

Year two, level two:

Inter-professional module two (I) - a module that builds on the 1^st year and further develops students reflective thinking and problem-solving skills. (20 credits)

Supporting children, families & adults in the context of community care (P & S) - further develops the students' ability to work in a community setting, promoting partnership working with families, special schools and the diverse range of agencies/services available to meet the needs of people with learning disabilities. Taught together with childrens student nurses (40 credits)

Working collaboratively in family & community settings (P) - facilitates the learning of social, political, cultural and historical contexts of services for children, adolescents and adults (20 credits)

Learning Disabilities Nursing Practice 2 (P) - 24 weeks of practice that supplements the theoretical modules. Students work in networks, community teams & families (40 credits)

Year Three (Diploma students):

Inter-professional module three (I) - this module builds on the previous two modules with an emphasis on the students critically evaluating their own & others contributions to inter-professional practice (20 credits).

Managing Teaching & Learning for Personal development (P) - explores teaching & learning theories, evidence based interventions and how they are applied for people who have challenging behaviours. Also examines management and leadership issues (40 credits)

Utilising Evidence Base care (S) - this module provides opportunities for students to review sources of knowledge and evidence that informs professional practice. The research process is critical evaluated (20 credits).

Learning Disabilities Nursing Practice 3 (P) - This 24 week practice placement enables the students to experience working with those people who challenge and to gain some management experience. There is also the opportunity to have a national or international elective (40 credits).

Year Three (Degree students):

Inter-professional module three (I) - this module builds on the previous two modules with an emphasis on the students critically evaluating their own & others contributions to inter-professional practice (20 credits).

Managing Teaching & Learning for Personal development (P) - explores teaching & learning theories, evidence based interventions and how they are applied for people who have challenging behaviours. Also examines management and leadership issues (20 credits)

Dissertation (S) - an extended independent study based around a literature review. Students will research and critically evaluate current issues in a selected area of learning disabilities practice (40 credits).

Learning Disabilities Nursing Practice 3 (P) - This 24 week practice placement enables the students to experience working with those people who challenge and to gain some management experience. There is also the opportunity to have a national or international elective (40 credits).

Diploma students graduate with 120 level 1 credits, 200 level 2 credits and 20 level 3 credits.

Degree students graduate with 120 credits at level 1, 2 & 3, total: 360 credits.

Teaching, Learning & assessment strategies:

The Faculty recognises the importance of lifelong learning of nurses and that they will be working in ever increasing complex and diverse health & social care settings. Therefore the following principles strengthen the learning disabilities nursing programme:

• Students are equal partners in the education process and are empowered to accept responsibility for and to negotiate their own learning via contracts and portfolio development.
• Reflection is important to professional growth and in managing change
• Students are valued as adults and encouraged to accept increasing accountability for their practice
• The programme develops knowledge, skills and attitudes in relation to the 4 domains identified by the NMC (2002) - professional/ethical practice, care delivery, care management & personal/professional development
• The co-dependence of nursing theory to practice is recognised and an integrated approach is designed in the programme structure and in the assessment strategies.
• Those involved in the education of student nurses act as catalysts and facilitators of learning, promoting student centred teaching approaches.

Within the programme students experience a wide range of teaching and learning techniques.  These included working in seminar groups, working in inter-professional groups; evidence based learning, using web-based resources, lectures, learning contracts and supervision in practice. These teaching and learning strategies are encountered in uni-professional and inter-professional groups. No single teaching method is likely to appeal to all of them. However, the nature of adult learning would suggest that students prefer a variety of teaching and learning approaches and by designing individual learning contracts in certain modules can follow their own particular interests within the constraints of the module specifications. With support and guidance from the module leader and personal tutor, students do learn successfully and consequently the team has chosen to maintain an eclectic approach to learning.

As student learning is seen as progressive and increasing in complexity, the assessment strategy aims to reflect the learning undertaken at specific stages and identifies students' strengths and weaknesses and their learning needs at any stage of the programme. The students are encouraged to integrate theory with practice and ‘make sense' of situations in which they work. Moreover, students search for, use and critique evidence so that they can develop critical and analytical skills with the aim of improving practice.

Assessment of practice is undertaken using formative and summative methods. A continuous assessment of practice profile aims at achieving the required learning outcomes for the professional practice modules and achievement of practice competencies at the end of the 1^st and 3^rd years. Qualified nurses will undertake the supervision and assessment of students practice and they will be graded using pass/fail criteria against the appropriate competency outcomes. Students are expected to collect evidence of how they are achieving their outcomes and express their understanding and application of each competency to satisfy their assessor. This supports student self assessment and a recognition of the student responsibility in engaging in lifelong learning. It further requires a process of collaboration between faculty and practice to support the student which the work based learning days help to facilitate.  

There are a variety of assessments for the theoretical modules. These range from short examinations, seminar and poster presentations to 2000, 3000, 4000 & 8000 word essays and an 8000-10000 word dissertation for the degree students. Most assignments must demonstrate reflective practice, personal development and identification of further learning in line with the Faculty teaching, learning & assessment strategy. There exist very clear and strict guidelines for the assessment of modules within the university. The requirements of The Special Educational Needs and Disability Act (2001 SENDA) have also helped to inform the assessment approaches within the programme. The Act introduces the right for disabled students not to be discriminated against in education, training and any services provided wholly or mainly for students and for those enrolled on courses provided by further and higher education institutions and sixth form colleges. In effect this means that allowances must be made for disabled students, for example extra time in examinations, presenting a portfolio of learning via oral presentation, video or audio-tape, adding photographs, drawings and so on.

Supporting children, families & adults in the context of community care:

This is a 40 credit, level 2 module which prepares students to work with children, adults and families before they start their Nursing Practice 2 (year 2). The content explores, for example the mental health needs of disabled children, the health & welfare needs of children and adolescents, understand the ethical implications to pre-natal testing, screening, genetic counselling and decision making for families. It further examines the impact of loss for families of children with special needs, chronic illness or mental health problems. Finally, the module enables students to develop effective therapeutic communication skills and learn how to work in partnership, recognising the rights of children and families, risk management, protection, power and authority in their work. In effect, the module emphasises the ethics of working in peoples' own homes and working with vulnerable children and adolescents.

Learning disability student nurses will have the opportunity to visit families and participate in family routines where there is someone with a learning disability. The student will be able to liaise with networks that the family accesses including special schools, after school clubs, befriending services, respite care, clubs and activity centres, health centres and hospital when necessary. The approach students are encouraged to adopt is based on family centredness (Guillett 2002) which promotes positive attitudes. This approach requires that students appreciate and respect that the family are the experts when it comes to knowing their child's' disability better than the professional. By acknowledging that the student is a guest in their home, they can learn to collaborate with the family's ways of managing, integrating and working around the child's condition. This empowers the family and helps build their skills and esteem when caring for their child. Additionally, the student needs to learn to be child-centred, that is, relating to the child first and not seeing the disability only. A social model of disability (Oliver 1990, Oliver 1996, Dowling & Dolan 2001) recognises that a disability is a result of the individuals' interaction with their environment and thus located outside the person. It is the environment which fails the child and not the child having to adapt to a ‘normal' environment. There are clear distinctions between impairment and disability, with the latter regarded as barriers to social, educational, material and cultural aspects of society and therefore excludes and marginalises children and adults with disabilities. Students are taught to focus on the strengths of the child and to look towards interventions that improve the relationship between the child and his/her environment.    

The aims of a family placement are:

• To begin to appreciate the diverse needs of families who care for someone with a learning disability.
• To understand the joys and stress of caring and the structures and functions of their support networks.
• To raise awareness of how you can work more collaboratively and in partnership with families.
• To develop a relationship with a family and someone with a learning disability within the family environment.

There are many other factors and issues for the students to research whilst working with families, for example family dynamics, stress-coping models, the idea of resilience, the role of extended family members and sharing responsibilities (Grant 2005). As this is a new experience, it is not possible to evaluate the effectiveness of the placement with students until the summer of 2006 when the students complete their 24 weeks practice.  

The family placement is further supplemented with a 12 week placement with community learning disability nurses who work with children and adults in the community. In these settings students learn the nature of community nursing, that is, assessing, planning, designing interventions and evaluating packages of care for people with learning disabilities within their own homes. It also involves physical and mental health education & promotion, educating other professional groups about learning disabilities, managing case loads and developing therapeutic relationships. The aims of the community nursing placement are based around the student becoming more aware of inter-professional and inter-agency working, developing their networking skills, working with models of assessment and care, developing personal competence and learning about specialist and primary health services.

Strengths & weaknesses of the curriculum:

Every curriculum should be innovative, creative and organic. It should promote good practice in learning disability services, encourage positive change in working practices, facilitate research opportunities and support the Higher Education Institution to communicate with external agencies which help meet the Faculty's' mission statement (http://hsc.uwe.ac.uk/ ) The following strengths and weaknesses are a snap-shot' of the 2004 curriculum, which is only 1 year old. They are not exhaustive and not in any particular order. I have summarised 4 strengths and 4 weaknesses for the sake of brevity only. There are many more but are beyond the scope of this paper.

Strengths:

One of the major areas that the academic team are proud of is the inclusion of people with learning disabilities, their families and other professional groups who have contributed to the design, management and teaching of the programme. User involvement in curricula design is encouraged and is in keeping with Valuing People (2001). The team have had to review information ensuring that it is accessible and easy to read. Therefore, we have had to write minutes and other information from the university in a larger font and with photo symbols (Worth a 1000 words Ltd 2004). The team always welcome feedback on how to improve communication with outside agencies, how to reduce jargon and technical words and how to ensure that people with learning disabilities are fully included and able to participate in university activities.

Many people coming to university for the first time find the experience daunting and intimidating both personally and professionally. The demands of the programme over 3 years means that they are working at a high and intense pace for 40 weeks of the year. Therefore they may need access to the matrix of student support both in Faculty and in practice. Students are encouraged to access the full range of Faculty services to meet diverse needs. The Faculty recognises that providing academic guidance, ensuring that students are well informed have opportunities to evaluate and feedback to the team are integral to a positive student experience.

Having longer practice placements is regarded by students, academic staff, practice staff, clients and families as being an advantage. The student may not have breadth of experience but with each placement being 12 weeks long they do have opportunities for a depth of experience with the value-added benefit of more meaningful learning. More able students will take advantage of the resources and learning opportunities available and will be able to demonstrate their learning in a wider health & social context.

The learning disability team can profit from being small. There are 6 senior lecturers and consequently communication between and commitment to the student group is of a high standard. Furthermore, there is only 1 intake per year of 20-25 students and the team get to know each student and his/her learning needs quite well. Relationships with the student group are good and that shared commitment results in ‘learning together', a sense of belonging, a positive dynamic that has a similar value base and facilitates excellent role modelling from the teaching staff.

Weaknesses:

Although the curriculum highly values reflective practise both in theory and practice environments, the method of teaching the skills of reflection is neither consistent nor reliable. The modular scheme negates full and joined-up thinking as weaker students may see each module as a separate unit of learning and each module leader will teach reflection in their own way or not at all. Consequently, students are exposed to contradictory approaches which confuse them further. Burrows (1995) clearly articulates that the skills of reflection include self-awareness, description, critical analysis, synthesis and evaluation. These are highly developed skills and for the novice or weaker student may be beyond their cognitive capabilities. Reflective thinking, discussion and writing needs to be developed in students otherwise the process remains immature, ad-hoc and informal. The lecturer needs to role-model the skills of reflection and introduce a range of strategies that are available over and above writing a journal or log (Taylor 2000). Additionally some students regard the practice portfolio as a chore and do not appreciate the true value of how reflection can benefit their learning. Admittedly, the portfolio is not summatively assessed and therefore some students will have the attitude of ‘why bother'? This problem needs to be addressed by all the academic teams across nursing.

Another concern that is acknowledged by the team is the relationship with practice and assessors. The curriculum is founded on an even split between Faculty and practice, yet many practitioners regard student learning as a university responsibility. Despite formal training and development of teaching & assessing, some assessors maintain that it falls upon the university to pass or refer/fail a student. The team emphasise the importance of learning in practice and the vital role assessors have but still there are challenges and obstacles that they will express. This needs to be addressed and open discussions take place with assessors and other practitioners and their managers with the academic team 4 times per year. There is also an individual who liaises with practice - a Practice Education Facilitator who promotes open communication between Faculty and placements. This role is beginning to ameliorate relationships and the idea of shared responsibility of learning is being acknowledged.

As alluded to above, the modular system of learning disabilities nurse education creates difficulties. As the programme manager it is my responsibility to monitor and enhance the quality of the programme but there is a tendency for some module leaders to work in isolation or not appreciate the relationship between one module and another. Consequently, there is a risk that teaching could be repeated, missed out or that learning outcomes do not relate to the overall aims of the programme. It is my role to pull module reports together so that a coherent and comprehensive programme is delivered to the students.

Finally, despite the network of support mechanisms available to students within and out with the university, there remains a fairly high attrition rate. For example, the rate for the September '04 cohort currently runs at 20%. Students leaving university do so for a variety of reasons, one being the nature of the programme having a practice as well as a theoretical component attached to it which may cause additional stress. The Faculty is aware of attrition throughout the student professional groups and there are steps to look at ways of reducing it. Student drop out does affect morale of students and staff and ultimately affects the number of people qualifying and starting a career in learning disability practice.

Summary:

This paper has provided a succinct resume of a complex programme - Bsc(Hons)/Diploma in Higher Education Learning Disabilities nursing that is delivered in a university in the West of England. In order to understand the educational context of the programme, the knowledge, skills, attitudes and roles of the learning disability nurse have been examined with the potential benefits to people with learning disabilities outlined. The philosophy of the programme has been articulated whereby emphasis has been put on O'Briens' (1987) 5 service accomplishments and the ethics of advocacy, empowerment, rights, choice, independence and inclusion. Person centred approaches are taught throughout the programme with the aim of students enhancing their caring, empathic and sensitive attitude of working in partnership with people with learning disabilities, their families and other carers. The design of the programme has been summarised with the main points of the programme being 50% - 50% split between theory and practice, the linear progression of the curriculum, a brief explanation of the modules, the importance of reflective thinking, writing and discussion and an introduction to the variety of teaching, learning and assessment strategies. The academic team are looking towards designing more innovative and creative assessments, by involving people with learning disabilities and their families in making valid and reliable contributions.

A specific module: Supporting children, families & adults in the context of community care illustrates how students are initially prepared for a particular practice experience, that of working within the family unit. This is the first time that families have been directly involved in student nurse education and the team will evaluate the quality and value next summer with a view of researching further the experiences of families and students working and learning together.

A critique of the curriculum has been offered by examining 4 strengths and 4 weaknesses/difficulties. As the programme is only 1 year old it remains premature to suggest that these are major strengths or weaknesses. If the curriculum is to be truly dynamic then positive and negative aspects will also change, evolve and what was once a strength could become a new challenge and vice versa. Curriculum design is a complicated process, has to involve many stake-holders and internal as well as external agencies, student evaluations, NMC conditions and Government initiatives. However, one would expect a degree of challenge and problem-solving in such a complex organisation and the academic team are, because of their own expertise and experience, prepared to be tested.

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Worth a 1000 words Ltd (2004) Photo symbols, Bristol.

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Broussine E. Obrazovni program medicinskih sestara za rad s osobama s poteškaćama u učenju: perspektiva edukacije u Ujedinjenom Kraljestvu naspram zdravstvenih i socijalnih potreba osoba s poteškoćama u učenju. Sestrinski edukacijski magazin 2006:3(2)