The purpose of this assignment is to critically explore the impact of a person with learning disabilities arriving in the UK and accessing Initial Assessment under the support of a community nurse. Moreover, identify a Package of Care to meet the holistic needs of a person with a learning disability from a different country, examination of a suitable service provision for a person with a learning disability, examination of the individual’s cultural needs and an examination of the influence of their religious culture on service provision. To avoid a breach of confidentiality service user will be referred to as “Danielle”, a pseudonym (Griffith, 2015). According to The Nursing and Midwifery council, (NMC, 2018) it is patient’s right to be autonomous for their private and health information that what and how much information should be shared to others. Danielle is 19 years old white young woman with mild learning disability and associated behavioural difficulties. Danielle is wheelchair’s user and has diabetes. Danielle lives with her mother and father and two siblings who are originally from Italy. Danielle and her family moved to the UK one year ago, the family does not speak English fluently. The referral has been sent to the community learning disability because of Danielle challenging behaviour and others health needs.Italy is among the most visited countries in world renowned for its art and design, architecture and engineering, culture, food, and la dolce vita (the sweet life). (Giangreco & Doyle, 2012). What is less known to the general public outside of Italy is that for approximately four decades this popular Mediterranean country has reported including among the highest proportion of its students with disabilities in general education classes and among the smallest use of special classes and special schools in the world. Therefore, Italian policies and practices have been, and continue to be, of interest to the international community involved in extending inclusive educational opportunities for children and youth with disabilities and other special educational needs (Giangreco & Doyle 2012). In Italy, Pupils with disabilities have the right to attend mainstream classes with appropriate teaching support. They have the right to full participation in school life, such as summer camps, study visits (by the support of special staffs). Also, the local authorities provide assistants to children according to their disability. Moreover, they have the right to an individual education plan, provided by family and schools; to a social activity (put in place by social assistants and experts from the local health board); to a reintegration programme personalized to their individual needs and to professional supervision.In Italy, the law 118/1971, approved all people the right to be educated in common classes, and with Law 517/1977, which eradicated special schools. In addition, Law 104/1992 is the main framework for all disability issues: its assurances specific rights for people with disabilities and their families, helps, requires full integration and the adoption of measures for prevention and functional recovery, and also ensures social, economic and legal protection (Anastasiou, et al., 2015). The Italian model, which promotes scholastic inclusion for individuals with disabilities (law 118/1971 and 517/1977), boasts over 30 years of ground-breaking experimental work both theoretical and applied. Drawing on pioneering pedagogical values that are now internationally recognized, Italy has been one of the first countries in the world to promote the inclusion of students with disability into mainstream educational provisions (Agnelli Foundation et al., 2011). In the mainstream education, Italy is so far the only European country which has reached 99.6% inclusion of learners with disabilities. Moreover, there are no special schools or classes in the Italian school system as they were abolished by law in 1977. Therefore, 0.4% of pupils with disabilities attend rehabilitation centres financed by the local health services. The rationale behind the closing of special schools and classes, and the rejection of proposals for their re-introduction was that: separate special education is discriminatory, and it is difficult to draw a line between degrees of severity (Anastasiou, et al., 2015).After considered the inclusion of people with learning disabilities in Italy, the student will now focus on the impact of Danielle and her family arriving in the UK and have to face new culture (diet and life style, language barrier and communication). Danielle and her family are from Italy, arriving in the Uk and with English as their second language, they might face difficulties to interact with other people because of language barrier and culture shock. Therefore, this might lead to social isolation, depression and might increase Danielle’s challenging behaviour. According to Irwin, (2007), depression, isolation and mental or physical distress experienced in a foreign location could be symptoms of culture shock, and this occur when communicating with others is difficult. Moreover, language barriers, in any country, can negatively affect nurses’ capability to communicate successfully with their patients and consequently have a negative impact on the provision of Suitable, timely, safe and effective care to meet patient’s needs. (Ali & Watson, 2018). In addition, language is central to communicate as it is helping nurses to build a therapeutic relationship with the client in order to deliver the high quality of care. Also, people with minority ethnic communities face health inequalities because of language barriers (Hull, 2015). Although, health care professionals are responsible to provide care to patients regardless of their culture, religion, linguistic ability and ethnic background, language barriers impede their ability to provide culturally competent and patient centred care to their patients (Bischoff & Denhaerynck, 2010). For example, Evidence suggests that language barriers can endanger patient safety by increasing the risk of adverse events including medication errors (Wasserman et al. 2014). Moreover, Richardson et al. (2006) suggest that language barriers are negatively related with treatment compliance, follow up, for chronic illnesses, understanding of diagnosis and treatment, ability to find appropriate health information (Pippins et al. 2007) and medical complications (Jacobs et al. 2007).Moreover, in English’s culture, people enjoying eating in the pub, enjoying eating take away, every Friday, usually they have their traditional fish and chips, nevertheless, in the Italian culture, food isn’t just nutrition, it is life. family assemblies are frequent and often cantered around food and the extended networks of families, therefore is very important for Italian family to seat together during meal time, as it is part of Italian culture. Therefore, Danielle and her family might face this new challenge as they used to spend time around the table at home during the meal time. Also, Danielle and her family are from the centre of Italy, they have spaghetti and pizza as the main dominant dishes, and they eat spaghetti almost every day of the week. Therefore, because of Danielle and family habits of eating spaghetti and pizza all the time and, they are enjoying being altogether as a family everyday while eating, UK tradition and culture will a big chock for them as they are not used to it. This might lead to nostalgia and preoccupation with health for Danielle (Irwin, 2007). Even though Danielle is from Italy, she will have the same rights, the same opportunities and the same treatment as everybody. As The Equality Act 2010 (Disability Discrimination) protects the rights of individuals and advance equality of opportunity for all. Also, the Act provide Britain with a new discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society. Also, The Human Rights Act 1998, became law in Britain in October 2000, The Rights have aimed to improve the lives of people with learning disabilities through improved support, services and advocacy. Therefore, the White paper “Valuing People” and its descendant “Valuing people now are two such examples of this”. In addition, The Rights are at the very fundamental of Person-Centred Planning, which aims to give people with learning disabilities the right to be treated and live life with the same rights, choices and opportunities as everybody else.The nurse will now focus on the initial assessment in order to identify Danielle’s health needs. Nurses are required to obtain valid consent from patient before any treatment and People with learning disability should not be assumed to not have capacity to understand information. The Mental Capacity Act 2005 requires that every adult has the right to make decisions concerning their care and treatment, everyone must be assumed to have capacity and provide consent unless determined otherwise (MCA, 2005). Therefore, the nurse will obtain valid consent from Danielle and her family before any intervention. Moreover, to identify Danielle’s need, the nurse will arrange a home visit to see Danielle and her family in order to assess all her health needs, the nurse to ensure the interpreter is present during the visit in order to avoid a misunderstanding as the family does not speak very well English. During the initial assessment, the nurse will assess Danielle’s capacity and her physical and mental health needs. The nurse to assume Danielle has capacity, as Mental Capacity Act states that everyone must be assumed to have capacity and provide consent unless determined otherwise. (MCA, 2005), Also, the nurse to obtain valid consent from Danielle before allowing her family member to attend the initial interview. Moreover, the nurse will assess Danielle’s routine back home (Italy) in term of care, support and services in order to adapt it to the one in the UK. This is to avoid culture shock. For example, if in Italy, Danielle used to attend a catholic church every Sunday, the nurse to ensure this will happen in the UK, in order to minimise culture shock, because culture shock might lead to distress or challenging behaviour (Irwin, 2007).Moreover, the nurse will assess Danielle communication needs, whether she can communicate verbally or not, the nurse will also assess the language spoken and Makaton used, or interpreter needed. As Danielle does not speak very well English, the nurse to ensure reasonable adjustments are in place to facilitate Danielle and her family communication and level of understanding. Therefore, every time when Danielle has appointment, the nurse to ensure the interpreter is present to enhance their communication. According to The NHs constitution in the UK requires all NHS institutes to deliver high quality inclusive services, based on clinical need, which do not differentiate between patients. (Walker et al., 2016). Therefore, the Disability Rights Commission in 2006 suggested the introduction in England and Wales of reasonable adjustment in primary healthcare services for people with learning disability, such as annual health check (Disability Rights Commission, 2006). Moreover, reasonable adjustments mention to the legal duty of public sector services to make their services as available and effective as they would be for individuals without disabilities (Hatton et al., 2011).After assessing Danielle’s communication need, the nurse will now focus on Danielle’s health needs: physical and mental health. According to the case study, Danielle’s current health status is mild learning disability. For her mental health, Danielle has behaviour difficulties, and for a physical health, Danielle has type 2 diabetes and she is wheelchair user. When assessing Danielle’s health needs, the nurse to find out from the family if Danielle has been admitted in the hospital in the past few years because of her mental state, or she has been detained under Mental Health Act. Also, the nurse to find out if Danielle has any forensic history. As Danielle has behaviour difficulties, the nurse to liaise with a psychiatrist. Therefore, the psychiatrist will assess Danielle mental state, medication she is on, also, understand her history, and find out the appropriate treatment suitable to treat or monitor her condition.Moreover, as Danielle is wheelchair user, the nurse to liaise with the Occupational Therapist (OT) who will assess Danielle. The OT will arrange a home visit and during the visit, the OT to find out what Danielle usually does in her day to day life and any challenges she faces. Therefore, the OT to help Danielle find ways to overcome these challenges as she is on the wheelchair. For example, providing specialist equipment to help with mobility, supporting Danielle and family to adapt their home to make it more accessible with her wheelchair. In addition, Danielle has diabetes and her nutrition needs are based on her personal and cultural preferences (spaghetti, pizza). According to Italian culture, pizza, lasagne, cheese, pasta and spaghetti are the main dishes eaten in Italy. Therefore, the nurse to educate Danielle about healthy choices and healthy eating without restrictive, as any change of her diet might affect her mental state. The nurse to encourage Danielle to mix her diet with fruits and vegetable in order to monitor her diabetes. According to Evert, et al., (2014), for many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat. Therefore, healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. Also, the nurse to liaise with the dietitian as everyone with diabetes should receive individual, ongoing nutritional advice from a dietitian in order to prevent and manage their diabetes (Dyson, et al., 2011). Furthermore, the nurse to liaise with the General Practitioner (GP), as the GP will assess Danielle’s diabetes and find out the appropriate treatment to monitor it. Also, the nurse to ensure an annual health check will be done by the GP in order to monitor Danielle’s health condition as the Disability Rights Commission, (2006), suggested that all people with learning disability should have an annual health check.After the initial is completed and all Danielle’s health needs are identified, a package of care will be provided by the social worker in order to determine exactly what Danielle needs in the way of care, services or equipment to live her life in a dignified and comfortable manner in the UK. For example, a package of care could include, day centre to give Danielle or her family who care for her a rest from care, Disability equipment and adaptations to the home. Day care for Danielle to give her social interaction.