Person-centred critical care for a person with learning disability and COVID-19: case study of positive risk taking
People with learning disabilities are known to experience a wide range of health inequalities and have a lower life expectancy than the general population. During the COVID-19 pandemic this extended to higher mortality rates following infection with the novel coronavirus. This case study presents an example of a positive outcome for Jade, a 21-year-old woman with learning disabilities and autism who required a long period in intensive care following COVID-19 infection. It demonstrates the impact of effective multidisciplinary collaboration involving the acute hospital learning disability liaison nurse and Jade's family, leading to a wide range of reasonable and achievable adjustments to her care.
This case study focuses on Jade, a 21-year old woman who contracted COVID-19 in December 2021 and was in hospital for around 4 months, including 68 days being ventilated in an intensive care unit (ICU). Jade's health needs were compounded by having learning disabilities and autism, and this case study illuminates the effective multidisciplinary collaboration between critical care staff and the acute hospital learning disability liaison nurse (AHLDLN) that led to an eventual positive outcome for Jade. It aims to illustrate the complexity of Jade's physical, social, emotional and cognitive health needs during the acute and recovery phases of her illness, and the extensive reasonable adjustments made to support her and her family's needs. It presents the perspective of both the critical care and learning disability liaison nurses and draws on their reflections from this experience.
From the initial identification of COVID-19 as a disease caused by a novel, highly contagious virus (SARS-CoV-2) presenting a global public health emergency, people with learning disabilities experienced higher rates of infection, symptom complications, and mortality (Williamson et al, 2021). During the first wave of COVID-19 in the UK, mortality rates for people with learning disabilities were six times higher than those in the general population, and at the end of 2021 (following the introduction of vaccination) they remained three times higher (Henderson et al, 2022). Furthermore, analysis undertaken by Learning from Lives and Deaths (LeDeR), a service improvement programme for people with a learning disability and autistic people at King's College London, identified that during 2021 the rate of excess deaths was more than two times higher for people with a learning disability compared with the general population (White et al, 2022).
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