Empowerment can raise ethical dilemmas for nurses. Stephen Rawlinson describes his experience with a client with a dental phobia

Underpinning good health education practice is the need for specialist community learning disability nurses to exploit ‘opportunistic’ learning experiences and to promote preventive healthcare strategies. This often means adopting proactive and innovative approaches to meet the ‘special needs’ of vulnerable individuals. However, this is not always straightforward and the ideology of client-centred approaches may need to be modified by other considerations. For example, the effectiveness of therapeutic nursing interventions may ultimately depend on a wider understanding of the complex dependency relationships and limitations in the client’s life, in the family home and elsewhere.