Case studies
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Case studies
Managing pain in someone with a learning disability requires meticulous attention to detail in the assessment process. This is demonstrated in the following case studies and described using the word ‘CARE’.
- C: Compassion, communication, collaboration.
- A: Assessment of individual needs/use of tool.
- R: Reflective practice and learning.
- E: Effective systems – whole system approach/excellent leadership
Case study one: Learning disability and community care
A stoma community nurse specialist has had a patient referred to her by the district nurse with painful skin around her new colostomy. The colostomy had been formed due to ongoing major complications related to constipation.
Patient
Lilly is a 24-year-old woman with severe learning disability and is non-verbal. She lives at home with both parents, who share the responsibility of her care. They do not usually allow other health care professionals in the house due to their trust issues with anyone else caring for their daughter.
Assessment
On entering the home, the stoma nurse observed Lilly sitting in a special recliner chair, but she was rocking furiously and moaning. Her mum informed her that it was due to her being on her period. Mum and dad gently moved her to the sofa so the stoma nurse could remove the stoma pouch and examine the skin underneath.
On examination, the surrounding skin was raw. The care provided included the careful application of the appropriate skin products and a new two-piece appliance that would reduce the number of times the skin would be touched.
Reflective questions and lessons learnt
It is important to consider the appropriate use of pain relief before, during and after an assessment.
- What are the challenges based in the scenario?
- What would you have done differently?
- What will you take back to your practice?
Case study two: UTI and secondary care
Patient
A 16-year-old girl named Cara is admitted to the urology adult ward with a urinary tract infection (UTI). Cara has a urostomy is place and has been diagnosed with a learning disability and spina bifida.
Assessment
When the stoma care nurse arrives to assess and review Cara, she is clearly upset as the staff nurse took blood but did not use the “magic cream” as Cara described it. This was Cara’s first experience in an adult ward, and she is frightened. The stoma nurse recommends she have topical lidocaine in any future venepuncture procedures, and a different, more empathic approach is adopted to her care.
Reflective question and lessons learnt
- What are the challenges based in the scenario?
- What would you have done differently?
- What will you take back to your practice?
Case study three: Learning disability and outpatient clinic
Patient
Emily, a 24-year-old woman with a mild-to-moderate learning disability. Emily has recently been diagnosed with Hodgkin’s lymphoma and is attending an outpatient clinic for a bone marrow biopsy as part of staging investigations.
On her last appointment, there is a note in her records to say she was very anxious about having a blood test due to needle phobia and feared it would be painful.
Emily uses some verbal language but struggles to describe sensations and emotions. She relies heavily on familiar routines and known staff for reassurance. Her mother is with her today, and she is her main carer.
Assessment
They arrive in the department for their appointment, but there is a delay in starting the procedure; no one has informed Emily and her mum of this.
They are left in the waiting room and Emily is becoming more anxious. They are eventually called into the procedure room, where the staff performing the procedure ask Emily's mum to wait in the waiting area while they prepare her for the procedure.
Emily is very scared as she does not know the staff. They ask her to change into a gown, but she refuses to do so and becomes very upset. The staff asks Emily's mom to help her change into a gown and prepare for the procedure.
Emily's mum is starting to become upset seeing her daughter distressed. They start the procedure by injecting a local anesthetic into Emily's back. They do not give her any warning about this, and Emily becomes more distressed.
Emily is tearful throughout the procedure and pulls away at certain points. After a short period of observation, Emily is calmer and asks to go home. She is grimacing when moving but does not wish to speak with the staff.
Reflective questions and lessons learnt
Pain related to procedures can be very distressing. Pain assessment and management should happen throughout the procedure to reduce unnecessary distress.
- What are the challenges based in the scenario?
- What would you have done differently?
- What will you take back to your practice?
Resource lead(s)
The resource lead(s) is responsible for
