TheEquality Act (2010) obligates service providers to make ‘reasonableadjustments’ to ensure equal access to services. Reasonableadjustments can be defined as the requirement of public sectororganisations to adapt their provision or approach to facilitateequal access to services for people with learning disabilities(Public Health England, 2017). Some therapists acknowledge that theyneed to be prepared to make appropriate reasonable adjustments forpeople with learning disabilities in order to compensate for thedeficits in cognitive functioning (Jahoda et al., 2017). AsSamara has not had input from the multi-disciplinary team, she maylack some of the prerequisite skills for CBT. Researchers argue thatpre-therapy structured training can lead to significant improvementin people with learning disabilities ability to link thoughts andfeelings (Bruce et al., 2010).
Therefore, Samara may benefit frompreparatory training to gain an understanding of the concept of CBT(Bruce et al., 2010). Also, as CBT treatment effects are argued to beshort-lived, another reasonable adjustment for Samara may includebooster sessions to sustain the positive impact of treatment (Unwinet al., 2016). Moreover, considering some people with learningdisabilities have communication difficulties, provision ofinformation in an accessible format tailored to the individual may bemore meaningful (Mander, 2016).
It appears that Samara prefers easyread and pictorials, thus the learning disabilities nurse couldconsider supporting and involving Samara by providing information torefer to in Samaras preferred format.Ultimately,research showing the positive impact of CBT in preventing andtreating depression is well established (van Zoonen et al. 2014;Cuijpers et al.
,2013), however, studies outline the concern regardingshort-term effects of CBT for people with learning disabilities.Therefore, for Samara to experience long-term effects of CBT thelearning disabilities nurse can support Samara’s carers by trainingand involving them through the intervention. This would supportsustaining the techniques learnt, transferring these skills to homelife, and supporting Samara with the homework component (Unwin etal., 2016). Furthermore, putting in place reasonable adjustments isessential as researchers outline the significant improvement in CBTwhen reasonable adjustments such as pre-therapy, adapting the methodsand materials to make it accessible and booster sessions are put inplace (Jahoda et al., 2017; Bruce et al.
, 2010). Considering studiesshow that CBT can have positive effects amongst people with mild tomoderate learning disabilities, CBT may be an appropriate therapeuticintervention in supporting Samara with her mental health (Darbyshireand Kroese, 2012).Anursing assessment is a critical part of the nurse’s role in order togather information to identify the patient’s needs and establishfuture interventions (Dougherty et al., 2015). Incorporating Samara’sviews and opinions in the nursing assessment, regardless of capacitydemonstrate good practice, as this can be seen as beingperson-centred (McCormack and McCance, 2016). Additionally,communicating interest in Samara’s dreams and wishes shows adherenceto the person-centred approach as well as aiding the development of arapport, which assists the therapeutic relationship (Lay and Kirk,2012). It can be argued that good practice was shown, however, thereare many significant components of care lacking from the nursingassessment which are fundamental for Samara’s care. For example riskassessments, integration of the multi-disciplinary team, a healthaction plan, a hospital passport, urinalysis, blood test and a healthcheck, all are significant aspects of care required for people withlearning disabilities.