HEF: Underpinning Domains of Evidence for Learning Disabilities Nursing

HEF: Underpinning Evidence for Practice: A Reflective Tool for Practitioners.

Introduction

The Health Equalities Framework (HEF) concentrates on the determinants of health inequalities by addressing the ‘cause of the causes’ and proactively focuses on the prevention and reduction of their impact, rather than reactive approaches to the symptoms of health inequalities.

Using the HEF enables the practitioner to demonstrate the impact of the known determinants of health inequalities (IHAL 2010,2011) See HEF guidance: http://www.ndti.org.uk/publications/other-publications/the-health-equality-framework-and- commissioning-guide1

Using the HEF to measure outcomes after a period of intervention, enables the practitioner to review how effective their input has been in reducing the impact of the health inequalities faced by the person. Practitioners need to be clear about the nature and evidence for the interventions they choose to use.

This supporting tool for use with the HEF, enables the practitioner to review their interventions in line with the outcome identified in relation to each of the determinants and the evidence base for best practice. It helps the practitioner identify how their work impacts on the specific indicators for health inequalities and enables an on-going record of practice interventions, evidence of individual change and the evidence that underpins their work in relation to each indicator.

It is recommended from the commencement of any practice intervention, the practitioner records the evidence they are using or that they can produce to demonstrate why, what and how they have intervened. This can be used within practice supervision to explore the practitioner’s role, the evidence underpinning it and what others can see that demonstrates their unique practice activity. It can act as a focus for professional development and within appraisal and can help a practitioner reflect on their effectiveness, knowledge and skills, either independently or with others.

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 1 Completing the evidence indicator

Complete the form below

 Identify scores from the HEF measurement before and after your intervention. Include these in ‘impact’ columns

 Read the quality domain

 Identify all your practice activities and interventions used to reduce the health inequalities related to the HEF determinant, list these in the ‘practice interventions’ column

 What evidence can you identify that demonstrates how things have changed for the person or their family? List this in the ‘evidence of change’ column

 What evidence is there to support the interventions you have made? You should include validated evidence from research but can also use local evidence gained from local evaluated studies, audit, patient experience questionnaires etc? Where there is no validated evidence, you can also include evidence of interventions believed to be effective through experience (This could help inform future studies and ultimately add to the evidence base for effective interventions in the care of people who have learning disabilities) There are some suggestions in the appendix that may be helpful.

 Make it clear what kind of evidence you are including and list this in the ‘evidence base’ column

 There is a space to add additional information and comment in the additional narrative if desired. For example where an outcome shows an increase in the impact of the health inequality, this might help shed light on why this may be. E.g. the person may have moved home or become subject to a safeguarding concern. Or they may have become unwell or experienced bereavement.

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 2 Evidence Indicator

Pract Date HEF Outcome Determinant: 1 ition Social determinants of poor health er (Poor housing, poverty, unemployment and social Servi Health Inequalities Score (before Health Inequalities disconnectedness) ce intervention) Score (after user intervention) refer ence E.g. NHS Num ber

A B Employment & meaningful C Financial E Marginalising factors Assessed impact F Safeguarding Acco activities Assessed impact Support Assessed issues Assessed mmo impact impact datio n Asse ssed impa ct

Befo After Before Before Intervention After After Before Before After re Intervention Intervention Intervention Inter venti on

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 3 Major Major Major Major Major Major

Signif Signifi Signifi Signifi Significa Signifi icant cant cant cant nt cant

Limite Limite Limite Limite Limited Limite d d d d d

Minim Minim Minim Minim Minimal Minim al al al al al

None None None None None None Pract Practice Intervention(s) to reduce health inequalities: Evidence of change for Evidence base for ice individual/family/carers intervention(s) Quali ty dom ain

1.1 Evide nce of skille d perso n centr ed asse ssme nt and interv

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 4 entio ns desig ned to impro ve healt h outco mes relate d to socia l deter mina nts of poor healt h 1.2 Evide nce of practi tioner worki ng in partn ershi p,

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 5 multi- profe ssion al and multi- agen cy worki ng to enabl e a positi ve impa ct on the socia l deter mina nts of poor er healt h

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 6 1.3 Evide nce of the practi tioner ’s know ledge , skills, qualif icatio ns or comp etenc e relate d to meeti ng healt h need s asso ciate d with the

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 7 socia l deter mina nts of poor healt h

1.4 Evide nce of risk asse ssme nt or mana geme nt strate gies, or plans desig ned to mitig ate again

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 8 st and reduc e risks asso ciate d with socia l deter mina nts of poor healt h

1.5 Evide nce of resea rch, audit, polici es, guida nce, clinic

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 9 al proto cols used to infor m interv entio ns used to impro ve healt h outco mes relate d to socia l deter mina nts of poor healt h

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 10 Additional narrative:

Pract Date HEF Outcome Determinant: 2 ition Biological determinants of physical and mental ill health er related to learning disabilities (genetic, causative factors for Servi Health Inequalities Score (before Health Inequalities LD leading to physical/mental ill health) ce intervention) Score (after user intervention) refer ence E.g. NHS Num ber

A B Long Term Condition pathways & C Care Planning & E Medication F Specialist Asses planned reviews of need Health Action provision smen Planning t of physi Assessed impact cal & Assessed impact Assessed impact ment Assessed impact al healt h needs and healt h

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 12 check s

Asses sed impac t

Befo After Before Before Intervention After After Before Before After re Intervention Intervention Intervention Inter venti on Major Major Major Major Major Major

Signif Signifi Signifi Signifi Significa Signifi icant cant cant cant nt cant Limite Limite Limite Limite Limited Limite d d d d d Minim Minim Minim Minim Minimal Minim al al al al al None None None None None None

Pract Practice Intervention(s) to reduce health inequalities: Evidence of change for Evidence base for ice individual/family/carers intervention(s) Quali ty dom ain

2.1 Evide nce of skille

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 13 d perso n centr ed asse ssme nt and interv entio ns desig ned to impro ve healt h outco mes relate d to biolo gical deter mina nts of poor healt h

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 14 2.2 Evide nce of practi tioner worki ng in partn ershi p, multi- profe ssion al and multi- agen cy worki ng to enabl e a positi ve impa ct on the biolo gical

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 15 deter mina nts of poor er healt h

2.3 Evide nce of the practi tioner ’s know ledge , skills, qualif icatio ns or comp etenc e relate d to meeti

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 16 ng healt h need s asso ciate d with the biolo gical deter mina nts of poor healt h

2.4 Evide nce of risk asse ssme nt or mana geme nt

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 17 strate gies, or plans desig ned to mitig ate again st and reduc e risks asso ciate d with biolo gical deter mina nts of poor healt h

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 18 2.5 Evide nce of resea rch, audit, polici es, guida nce, clinic al proto cols used to infor m interv entio ns used to impro ve healt h outco mes

26/04/2018 16:47:34 Nursing evidence indicator /HEF version 5/GM 19 relate d to biolo gical deter mina nts of poor healt h

Additional narrative:

Pract Date HEF Outcome Determinant: 3 ition Communication Difficulties and reduced health literacy er

Servi Health Inequalities Score (before Health Inequalities ce intervention) Score (after user intervention) refer ence E.g. NHS Num ber

A B Communicating health needs to C Ability of those E Understanding Health Information and Poor others providing support Making Choices bodil to recognise y expressions of awar need and / or pain enes s, Assessed impact pain Assessed impact resp Assessed impact onse s and com muni catio

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 21 n supp ort

Asses sed impac t

Befo After Before Before Intervention After After Before re Intervention Intervention Inter venti on Major Major Major Major Major Signif Signifi Signifi Signifi Significa icant cant cant cant nt Limite Limite Limite Limite Limited d d d d Minim Minim Minim Minim Minimal al al al al None None None None None

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 22 3.1 Evide nce of skille d perso n centr ed asse ssme nt and interv entio ns desig ned to impro ve healt h outco mes relate d to com muni catio n diffic ulties

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 23 and reduc ed healt h litera cy

3.2 Evide nce of practi tioner worki ng in partn ershi p, multi- profe ssion al and multi- agen cy worki ng to enabl

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 24 e a positi ve impa ct on com muni catio n diffic ulties and reduc ed healt h litera cy

3.3 Evide nce of the practi tioner ’s know ledge , skills,

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 25 qualif icatio ns or comp etenc e relate d to meeti ng healt h need s asso ciate d with com muni catio n diffic ulties and reduc ed healt h litera

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 26 cy

3.4 Evide nce of risk asse ssme nt or mana geme nt strate gies, or plans desig ned to mitig ate again st and reduc e risks asso

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 27 ciate d with com muni catio n diffic ulties and reduc ed healt h litera cy

3.5 Evide nce of resea rch, audit, polici es, guida nce, clinic al

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 28 proto cols used to infor m interv entio ns used to impro ve healt h outco mes relate d to com muni catio n diffic ulties and reduc ed healt h

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 29 litera cy

Pract Date HEF Outcome Determinant: 4 ition Personal health behaviour and lifestyle risks such as diet, er sexual health and exercise Servi Health Inequalities Score (before Health Inequalities ce intervention) Score (before user intervention) refer ence E.g. NHS Num ber

A B Exercise C Weight E Sexual Health F Risky behaviour Diet and routines and Hydra tion Assessed impact Assessed impact Assessed impact Assessed impact

Asses sed impac t

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 31 Befo After Before Before Intervention After After Before Before After re Intervention Intervention Intervention Inter venti on Major Major Major Major Major Major

Signif Signifi Signifi Signifi Significa Signifi icant cant cant cant nt cant Limite Limite Limite Limite Limited Limite d d d d d Minim Minim Minim Minim Minimal Minim al al al al al None None None None None None

4.1 Evide nce of skille d perso n centr ed asse ssme nt

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 32 and interv entio ns desig ned to impro ve healt h outco mes relate d to perso nal beha viour and lifest yle risks 4.2 Evide nce of practi tioner worki ng in partn ershi

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 33 p, multi- profe ssion al and multi- agen cy worki ng to enabl e a positi ve impa ct on perso nal beha viour and lifest yle risks

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 34 4.3 Evide nce of the practi tioner ’s know ledge , skills, qualif icatio ns or comp etenc e relate d to meeti ng healt h need s asso ciate d with perso

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 35 nal beha viour and lifest yle risks

4.4 Evide nce of risk asse ssme nt or mana geme nt strate gies, or plans desig ned to mitig ate

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 36 again st and reduc e risks asso ciate d with perso nal beha viour and lifest yle

4.5 Evide nce of resea rch, audit, polici es, guida nce, clinic

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 37 al proto cols used to infor m interv entio ns used to impro ve healt h outco mes relate d to perso nal beha viour and lifest yle risks

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 38 Additional narrative:

Evidence Indicator

Pract Date HEF Outcome Determinant: 5 ition Deficiencies in access to and the quality of healthcare and er other service provision Servi Health Inequalities Score (before Health Inequalities ce intervention) Score (after user intervention) refer ence E.g. NHS Num ber

A B Consent C Transitions between E Access to and quality of primary/secondary F Access to and Organ services care quality of non-health isatio services nal Assessed impact barrie rs Assessed impact Assessed impact

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 39 Assessed impact

Asses sed impac t

Befo After Before Before Intervention After After Before Before After re Intervention Intervention Intervention Inter venti on Major Major Major Major Major Major

Signif Signifi Signifi Signifi Significa Signifi icant cant cant cant nt cant Limite Limite Limite Limite Limited Limite d d d d d Minim Minim Minim Minim Minimal Minim al al al al al

None None None None None None

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 40 5.1 Evide nce of skille d perso n centr ed asse ssme nt and interv entio ns desig ned to impro ve healt h outco mes relate d to defici encie s in acce ss and

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 41 qualit y of healt hcare and other servi ces 5.2 Evide nce of practi tioner worki ng in partn ershi p, multi- profe ssion al and multi- agen cy worki ng to enabl

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 42 e a positi ve impa ct on defici encie s in acce ss and qualit y of healt hcare and other servi ces

5.3 Evide nce of the practi tioner ’s know ledge ,

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 43 skills, qualif icatio ns or comp etenc e relate d to meeti ng healt h need s asso ciate d with defici encie s in acce ss and qualit y of healt hcare and

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 44 other servi ces

5.4 Evide nce of risk asse ssme nt or mana geme nt strate gies, or plans desig ned to mitig ate again st and

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 45 reduc e risks asso ciate d with defici encie s in acce ss and qualit y of healt hcare and other servi ces

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 46 5.5 Evide nce of resea rch, audit, polici es, guida nce, clinic al proto cols used to infor m interv entio ns used to impro ve healt h outco mes

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 47 relate d to perso nal beha viour and lifest yle risks

Appendix

Practitioner Input

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 48 Notes to support the nurse in considering what to include (please note this is not a definitive list and is included here as an aid to completion

Examples of nursing interventions Some examples of evidence and other supporting information (e.g. policy, guidelines) Health education and teaching:  Individual  Joint Strategic Needs Assessment (JSNA)  Group  Self-assessment framework  Carers  Health and Wellbeing Strategy  Population  Public Health strategy  Other professionals  Partnership Board strategy, plans and minutes Health promotion  Autism Strategy  Individual  Health Action Plans  Group  Person Centred Plans  Carers  Hospital Passports  Population  Communication passports  Other professionals  Accessible care plans Health surveillance and monitoring  Pain profiles  Awareness raising and preventative interventions  Accessible information (improving health literacy)  Health Action planning  End of life plans  Health facilitation and coordination  Social stories  Safeguarding  Risk assessments and management plans  Carer support  Safeguarding processes Health access  Service user and carer feedback  Education and teaching generic health staff  NHS Self- Assessment Framework  Multidisciplinary planning and intervention  Periodic service reviews  Reasonable adjustments  Service user experience reports – dignity, respect etc. - Social stories  PROMs (patient reported outcome measures) -Easy read information  Family carer experience reports – involvement - Effective communication  Compassion scales - Reducing anxiety and fear,  Reasonable adjustments - Desensitization

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 49 - Person centred approaches  e.g. Promoting & recording reasonable adjustments (and  Carer support and advice outcomes) Physical health care and interventions  NICE Guidance  Basic nursing care and support  National and local policies & protocols  Nurse prescribing  Sign up to Getting it Right  Epilepsy management  Reports to NHS Trust Boards  Continence advice and management interventions  Clinical audit , clinical evaluation and clinical research reports  Clinical assessment and findings  Swallowing assessment and Dysphagia management  Other outcome measures: e.g. HoNOS, Tissue viability  Pain management  Nursing e.g. Strengthening the Commitment (Scottish  Clinical interventions for specific conditions e.g. Government), 6Cs (DH), Good Practice in Learning Disability - Constipation Nursing (DH). UK consultant nurse vision document, Meeting - Enteral feeding the health needs of people with learning disabilities (RCN) - Diabetes  Courses attended & Qualifications: Certificates, Portfolio, - Cardiovascular disease reflective accounts - Eczema and other skin conditions - Conditions dependant on medical technology - Tissue viability - Infection control - Obesity and other nutritional needs - Terminal illness and long term conditions  Carer support and advice Mobility and postural care interventions  Body shape protection  Carer support and advice  Mobilization and exercise Mental health care and interventions  Nurse prescribing  Mental state assessment  Dementia assessment  Reminiscence therapy  Therapeutic interventions e.g. -CBT

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 50 -DBT -Psychotherapeutic approaches -Counselling Risky behaviour interventions  Positive behavioural support  Risk assessment and management  Functional analysis  Person centred approaches  Carer support and advice  Sexual health assessment and interventions Co-production

26/04/2018 16:47:35 Nursing evidence indicator /HEF version 5/GM 51