• Caring for a child with a learning disability born into the family unit: Women's recollections over time

      Lovell, Andy; Mason, Tom; University of Chester (Taylor & Francis, 2011-08-01)
      Caring over time for a child/young adult with a learning disability requires that the family, and in particular the mother, negotiate their needs with services and professionals, and these negotiations are complicated further by significant behavioural issues in the children. This study reports on a series of interviews undertaken with mothers of children and young adults with learning disabilities and a history of challenging behaviours. The interviews were supplemented by documentary data from clinical and other notes in order to provide a more detailed view of the issues arising from caring over time. Detailed thematic analysis revealed five key themes demonstrating the cumulative effect of caring for someone with such complex needs, the centrality of that individual’s needs to the lives of those interviewed and the ongoing negotiation between family and professionals required in order for the former to work out how to continue caring both effectively and on their own terms. All the names of mothers and children are psuedonyms.
    • Cultural change in a learning disability secure service: The role of the ‘toggle’ group

      Astbury, Geoff; Lovell, Andy; Mason, Tom; Froom, Katy; University of Chester ; University of Chester ; University of Chester ; 5 Boroughs Partnership NHS Foundation Trust, Warrington (2011-04-01)
      This paper reports the findings of a study into the management of change within a learning disability service in transition from medium to low security status. The relationship between the service culture and resistance to change was a key consideration. A focus group approach was utilized with eight professionals from a range of disciplines meeting on six separate occasions, and the data was subsequently subject to thematic analysis. The study findings revealed markedly different perceptions of the response of the staff team to the implementation of change, with three groups adopting markedly different identities and allegiances. A dynamic group, embracing change and showing initiative, a strategically resistant group, and a third group, the ‘toggle’, swaying towards one of the other two groups according to changing circumstances. The paper concludes that the toggle group were extremely influential with regard to the implementation of change, and may be of significance in analysis of strategies of resistance.
    • De-escalation of Violence in the Context of Learning Disability: Working with complexity

      Lovell, Andy; University of Chester (Oud Consultancy, 2017-10-26)
      The use of physical interventions as a response to violence has come under increasing critique over recent years, particularly when the service user group is perceived as vulnerable, such as with elderly populations and those with intellectual disabilities. A 2-day educational workshop was devised for a whole population of qualified nurses and support workers currently working with people with intellectual disabilities detained under conditions of security in the north of England. The workshops were delivered between October 2016 and March 2017, and evaluated on an ongoing basis to ensure immediate feedback to service management. The basis of the workshop was a model of understanding the de-escalation of violence derived from several inter-linked components. Firstly, the process of violence is analysed in relation to how a situation becomes enflamed and violent behaviour results. The concept of de-escalation is then deconstructed so that the various components can be considered in relation to each other. Finally, the concept of complexity is unpicked, specifically around intellectual disability, and this constitutes the final element of the model. The three elements are subsequently developed in relation to each other to constitute a better way of understanding the process of de-escalating violence. The workshop, in effect, demands that participants reflect on their own work, and the therapeutic relationships developed over time with service users. The relationship between knowledge and practice is explored in some detail. The emphasis is placed on how the successful de-escalation of potentially violent situations directly relates to the effective translation of this knowledge, in all its diversity, into practice; and, perhaps, this is less understood than might immediately appear.
    • Gaining employment: The experience of students at a further education college for individuals with learning disabilities

      Skellern, Joanne; Astbury, Geoff; University of Chester (Wiley, 2012-01-02)
      Employment is widely acknowledged as a key factor to social inclusion, but it is estimated that <7% of people with learning disabilities are in paid employment. It was the aim of the research study to critically examine the experience of gaining employment from the perspectives of students with learning disabilities, parents, education staff and employers. All participants were recruited from one collaborating UK organisation, a college offering further education for young people with learning disabilities. Twenty-three interviews were conducted. Analysis of the data identified three themes surrounding the perceived roles of: Protector, Rescuer and Worker. Recommendations are discussed to improve collaborative working between student, parent, education staff and employer to overcome some of the difficulties influencing employment rates and contribute to the empowerment and inclusion of people with learning disabilities in society.
    • Guest editorial

      Skellern, Joanne; University of Chester (Emerald, 2016-06-13)
      This is the editorial for a special edition entitled 'Intellectual Disabilities: Nursing' of the Journal of Intellectual Disabilities and Offending Behaviour.
    • Nurses’ perceptions of personal attributes required when working with people with a learning disability and an offending background: a qualitative study

      Lovell, Andy; Bailey, Jan; University of Chester (2016-07-21)
      Abstract Aim: To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background: This paper was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design: A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods: A semi-structured interview schedule was devised and constructed, and thirty-nine individual interviews subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1-year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings: The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion: Nursing of those with a learning disability and an offending background continues to develop. The interplay between personal history, additional background factors, nurses’ personal attributes and learning disability is critical for effective relationship building.
    • ‘Tolerating violence’: A qualitative study into the experience of professionals working in one UK learning disability service

      Lovell, Andy; Skellern, Joanne; University of Chester (Wiley-Blackwell, 2013-05-06)
      This article reports on a qualitative follow-up study to a whole-population survey investigating the underreporting of violence within one learning disability service. The survey had identified a pronounced level of under-reporting but suggested an unexpected degree of complexity around the issue, which warranted further study. Design. A qualitative research design was employed. Semi-structured interviews were conducted with 22 professionals working in learning disability services; data were subsequently transcribed verbatim and subject to stringent thematic analysis. The findings confirmed that the decision to report an incident or not was complicated by professional interpretation of violence. Three themes were produced by the analysis: the reality of violence, change over time and (zero) tolerance. Conclusion. The study indicates that both experience of violence and ways of understanding it in relation to learning disability are shared across professional groups, although nurses are both more inured and generally more accepting of it. The study suggests that the relationship between learning disability nurses and service users with a propensity for violence is complicated by issues of professional background and concerns about the pertinence of zero tolerance. The availability of effective protocols and procedures is important, but services need also to acknowledge the more ambiguous aspects of the therapeutic relationship to fully understand under-reporting of service user violence in the context of learning disability.
    • Understanding and working with challenging behaviour

      Ingram, Charles; Lovell, Andy; University of Chester (RCN Publishers, 2011-03)
      This article examines the theoretical approaches to understanding and managing individuals with a learning disability who display behaviours that challenge. The authors explain how drawing on these approaches can help professionals from different disciplines to provide effective, patient-centred care.
    • Understanding and working with people with learning disabilities who self-injure

      Heslop, Pauline; Lovell, Andy; University of Bristol ; University of Chester (Jessica Kingsley, 2012-11-15)
      Adopting a predominantly psychological approach, this book provides carers with up-to-date information and resources to provide appropriately individualised care to people with learning disabilities who self-injure. Understanding and Working with People with Learning Disabilities who Self-Injure synthesises traditional (behavioural) and newer (psychological) approaches to understanding self-injury, drawing on psychoanalytic and social theory to provide practical guidelines for more sustained and effective support. It suggests that motivations for self-injury may be similar for people with and without learning disabilities, and draws on case work examples to suggest person-centred techniques that encourage communication particularly important with people who do not use verbal communication - and recovery. The book covers a range of specific needs, including people with autism who self-injure, and emphasises the views of people with learning disabilities themselves and their families about what has worked best, and why. At the end of each chapter, a variety of practical implications for the provision of support are given. This book is for those supporting people with learning disabilities who self-injure and will be a useful resource for social workers, psychologists, counsellors, learning support workers, nurses and social and health care students.
    • Violence and under-reporting: Learning disability nursing and the impact of environment, experience and banding

      Lovell, Andy; Skellern, Joanne; Mason, Tom; University of Chester (Wiley-Blackwell, 2011-11-23)
      The study explores the implications of a survey into the discrepancy between actual and reported incidents of violence, perpetrated by service users, within the learning disability division of one mental health NHS Trust. Violence within the NHS continues to constitute a significant issue, especially within mental health and learning disability services where incidence remains disproportionately high despite the context of zero tolerance. A whole-population survey of 411 nurses working within a variety of settings within the learning disability division of one mental health NHS Trust. A questionnaire was administered to learning disability nursing staff working in community, respite, residential, assessment and treatment and medium secure settings, yielding a response rate of approximately 40%. There were distinct differences in the levels of violence reported within specific specialist services along with variation between these areas according to clinical environment, years of experience and nursing band. The study does not support previous findings whereby unqualified nurses experienced more incidents of violence than qualified nurses. The situation was less clear, complicated by the interrelationship between years of nursing experience, nursing band and clinical environment. The conclusions suggest that the increased emphasis on reducing violent incidents has been fairly successful with staff reporting adequate preparation for responding to specific incidents and being well supported by colleagues, managers and the organisation. The differences between specific clinical environments, however, constituted a worrying finding with implications for skill mix and staff education. The study raises questions about the relationship between the qualified nurse and the individual with a learning disability in the context of violence and according to specific circumstances of care delivery. The relationship is clearly not a simple one, and this group of nurses’ understanding and expectations of tolerance requires further research; violence is clearly never acceptable, but these nurses appear reluctant to condemn and attribute culpability.