personal communication plan for service improvement

Introduction It has been well established that people with learning disabilities (PWLD) are more likely to experience some challenges in communication, social exclusion, socioeconomic deprivation, and reduced social communication networks (Nind & Hewett, 2012; Kyle et al., 2010). This is because learning disability in some cases impact on how these persons communicate or process information (Baig, 2013). Consequently, PWLD tend to have challenges with speech, language, and other sensory impairment that has broader implications on their ability to access health services (Ali et al., 2013). This is often more difficult where there is the necessity for them to provide information about their medical history, symptoms, medications and other ailments. Without such vital communication, health needs are more likely to be poorly assessed, overlooked and most often, avoidable errors made, which could lead to common diseases and conditions not properly treated (Ali et al., 2013). Also, barriers to communication has led the behaviours of some PWLD to be seen as ‘challenging’ whereas it is an expression of pain or has simply been ascribed to the patient’s learning disability and as such go untreated (Iacono et al., 2014). These challenges have led to innovations in communication where the needs of individuals have been taken into consideration and plans have been put in place to enable effective communication such as for example, through the use of gestures, Makaton, symbols, objects of reference and easy read (Mathews, 2013). With such innovative forms of communications, health professionals are able to minimise challenges that inhibit information sharing and provide reasonable adjustments where such needs arise. Special Needs schools cater for the needs of children with communication difficulties, including those with learning disabilities. Many communities in the United Kingdom (UK) are seeing an increase in the cultural and linguistic diversity of the population (Holliday, 2018). Reasonable adjustments are made within the National Health Service (NHS) Trusts to provide interpreters in cases where there is a language barrier (Castles et al., 2014). There, however, remains a question of whether such adjustments are robust enough to accommodate PWLD who are non-native English speakers. That will be the focus of this research. Aim/Objective The aim of this study is to explore the need for communication plans that can be suited to non-native English speakers with learning disability. The objective is to propose a service improvement plan for overcoming the communication barriers that PWLD, whose first language is not English face, when accessing health services. Research Question The aims and objectives of this study will be achieved by answering the question: Do non-native English speaking PWLD have additional communication challenges and can a personalised plan for them increase access to services? JustificationThe Migration Observatory (2019) indicates that an estimated 14% of the UK’s population consisting of 9.3 million people, migrated from other countries. This number represents an increase from 5.3 million in 2004. While the highest number of non-native English speakers in this general population were Polish, a great number came from other European Union Countries, Asia and Africa. While there are no statistics for the percentage of PWLD within this population, Public Health England PHE (2019) indicates that close to 2 million people in the UK have a learning disability. This points to the possibility that a substantial number of PWLD are non-native English Speakers, who are not routinely considered when improvements in communication strategies are put in place. Furthermore, issues such as cultural difference and a range of challenges faced by newly arrived migrants, compound the communication challenges they face. This study is therefore important as it seeks to propose a service improvement for people who generally would face communication difficulties because of language barriers, a situation compounded by their learning disabilities. Review and appraisal of the literatureThe main articles for this research have been sourced from the University of Wolverhampton online databases. Focus has been on CINAHL, Medline and Psycinfo. Inclusion criteria included articles published within the last 10 years, in English and with abstract. The articles were critically appraised using the CASP framework. Review of the literature is going to focus on themes such as: definition and importance of communication (Koski & Launonen, 2012); Alternative Communication (Cummings et al., 2012; Bracken & Rohrer, 2014); Communication and Social exclusion/inclusion (Simplican et al., 2015); and Communication by proxy (Kyle et al., 2010) which represents the recent shift away from the development of communication strategies for PWLD to communication intervention programmes targeted at paid carers and family members. Methodology Research is defined by Hockey (1984 p. 4, cited in Kumar, 2016) as a systematic scientific enquiry that explores “a body of knowledge” with the objective of discovering relationships between existing facts or finding new evidences. The two most popular research methods are qualitative and quantitative researches (Gerrish & Lacey, 2010). Quantitative research positivistic in nature while qualitative research is phenomenological in its approach (Holloway & Galvin, 2016). As such, quantitative research strives for the measurement of the magnitude of a problem, while the objective of qualitative research is the provision of a description of a phenomenon and the acquisition of new insight into specific practice through the exploration or interpretation of participant experience, perceptions and attitudes in relation to the issue under investigation (Creswell and Creswell, 2017). As this study is concerned with the improvement of practice through an interpretation of experience, it will be making use of the qualitative method. Secondary data sources will be critically analysed to acquire new insight into how communication for non-English speaking PWLD can be improved. A thematic approach to data analysis will therefore be employed to find correlations between existing themes. Ethical considerations Wellington (2000 p. 3) makes the case that “ethical concerns should be at the centre of any research project and should continue through to the write-up and dissemination stages”. This is supported by the principles set out in the UK policy framework for health and social care research (NHS HRA, 2017). This study will therefore adhere to strict ethical principles ensuring confidentiality, anonymity and gaining informed consent where necessary. As this is a nursing research, respect for the autonomy of every person, maintaining confidentiality (NMC, 2018), and having a duty of care to all service users (Yoost & Crawford, 2015), will be at the centre of this study. It is however, believed the need for some of these might not arise, given that this study will be making use of existing literature, with a focus on those that have a statement of ethics. Dissemination and outputs Dissemination is at the heart of nurse-led research and knowledge translation (Gerrish, 2015). In order therefore, for research findings to translate from theory to practice, its findings must be disseminated through different media such as presentations at professional fora and/or publications in a peer‐reviewed journals (Brownson et al., 2018). Other forms of dissemination are poster presentations and public research reports (Gerrish, 2015). In a study such as this whereby the recommendations will be made on how the research findings could improve service delivery, appropriate dissemination remains one of the most essential elements of ensuring that the objectives of the study are met (Brownson et al., 2018).