This weeks’ blog is by Helen Needham, Senior Lecturer and Practice lead for Learning disability nursing, Birmingham City University (helen.needham@bcu.ac.uk)

I am currently conducting research focusing upon the use of simulated patients in the education of nurses around the healthcare needs of people with a cognitive impairment and breaking bad news to people with a learning disability ¹. The interchangeable terms of simulated, or standardised patient, are that of a well person enacting the scenario of a patient for learning ². The use of simulation in nurse education, replicating real patient scenarios in a safe, authentic environment to prepare students for clinical practise, is well evidenced ². Engagement in well-designed, real-life scenarios can support nurses to address the health care needs of people with learning disabilities, and in reducing health inequalities experienced by this population. This is achieved by challenging attitudes and perceptions, increasing confidence, and improving understanding of how to implement reasonable adjustments ³.

So how can we incorporate peoples’ lived experiences into simulation and involve the person with the learning disability? In my current research, which focusses upon the education of nurses around the healthcare needs of people with a cognitive impairment and of breaking bad news to people with a learning disability, I address this in the use of simulated patients.  Simulated patients are usually ‘actors’, people who know or have worked with people with learning disabilities, and who can thus achieve both sensitivity and authenticity⁴. Their experience of knowing people with learning disabilities allows them to give a true representation of a scenario which could be potentially distressing such as breaking of bad news.  The type of bad news could be that they or a family member is ill, or has died, or that there are changes to their living or care arrangements.  As these scenarios are potentially difficult and distressing³ simulated patients are used.

Ensuring the involvement of people with learning disabilities as collaborators in training, and alongside others as simulated patients is much needed. However, collaborating with people with learning disabilities within the academic arena brings challenges in relation to access, renumeration and support. This can be addressed by good preparation and debrief, the use of accessible information, the appropriate employment and inclusion of chaperones or support workers who know the person as well as programme content. Having a strict criterion for choosing the more experienced ‘actors’ work to alongside people with disabilities can help bridge that gap. This can facilitate training that is an appropriate reflection of their lived experiences, whilst ensuring that they are not exposed situations that may be upsetting or even traumatic for them³.

People with learning disabilities experience extensive health inequalities which impacts on mortality and quality of life⁵. The quality of care received can lead to poorer outcomes that are often avoidable.  Using Simulated Patients offers an appropriate approach to impart information in a format to students that allows for deeper understanding. It provides a safe learning environment for students to practice/ rehearse their skills. This offers the potential for better health outcomes and, harnessing the knowledge of experts by experience is key to getting this training right.

References

1. NEEDHAM, H. & FEREDAY, K. (2021) P-40 Online simulation to educate the workforce in breaking bad news to people with learning disabilities.BMJ supportive & palliative care. 11 (Suppl 2), A24–A24. Available at: P-40 Online simulation to educate the workforce in breaking bad news to people with learning disabilities | Semantic Scholar
2. MACLEAN et al. (2017) Use of Simulated patients to Develop Communication Skills in Nursing Education: An Integrative Review. Nurse Education Today, 48, pp.
   90-98.
3. BROUGHTON, E. et al. (2019) 43 Actors with learning disabilities co-delivering paediatric simulation.Archives of disease in childhood. 104 (Suppl 4), A18. Available at: 43 Actors with learning disabilities co-delivering paediatric simulation | Archives of Disease in Childhood (bmj.com)
4. GILLETT, R. (2014) Role of live simulations in learning disability nursing: Rebecca Gillett outlines a collaborative project in which students from different professions practised communication skills with actors portraying service users.Learning disability practice. 17 (2), 26–28. Available at; Role of live simulations in learning disability nursing (rcni.com)
5. NATIONAL INSTITUTE FOR HEALTH RESEARCH (2020) Better health and care for all: Health and care services for people with learning disabilities. NIHR Dissemination Centre doi 10.3310/themedreview-04326