The 4C framework for making reasonable adjustments for people with learning disabilities
Evidence & Practice    

The 4C framework for making reasonable adjustments for people with learning disabilities

Daniel Marsden Practice development nurse, Learning disabilities, East Kent Hospitals University NHS Foundation Trust, Ashford, England
Rachel Giles Ward sister, East Kent Hospitals University NHS Foundation Trust, Ashford, England
Background

People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make ‘reasonable adjustments’ for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice.

Aim

To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting.

Method

Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes.

Findings

Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital.

Discussion

The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios.

Conclusion

Use of the 4C framework may enhance the care of people with learning disabilities in hospital, by enabling reasonable adjustments to be made in these settings.

Nursing Standard. doi: 10.7748/ns.2017.e10152

Correspondence

Daniel.marsden@nhs.net

Peer review

This article had been subject to external double-blind peer review and checked for plagiarism using automated software

Received: 22 May 2015

Accepted: 29 April 2016

Published online: 12 January 2017