Do Community Learning Disability Nurses (CNLDs) Support Adults with Learning Disabilities in Wales to Access Secondary Healthcare: an exploratory study within the social model of disability

    Student thesis: Doctoral Thesis



    Access to secondary healthcare for individuals with a learning disability has been a growing concern, with numerous reports highlighting the need to improve access to secondary care. In Wales, providers (health boards) have taken different approaches to promote improved access to healthcare for people with learning disabilities including community learning disability teams and learning disability liaison nurses. Nationally, whilst there is a growing body of evidence around the role of the learning disability liaison nurse there is no research in relation to the role of the community learning disability nurse in supporting access to secondary healthcare. This study provides an original contribution to knowledge by addressing this research gap.


    The overall research question that this sequential multiple methods study seeks to address is
    ‘Do community learning disability nurses (CNLDs) support adults with learning disabilities in Wales to access secondary healthcare?’

    The specific objectives are:

    Stage One
    - To examine the support that is provided by CNLDs for adults with learning disabilities who access secondary healthcare in Wales.
    - To identify barriers in accessing secondary healthcare and how these are overcome and removed by the CNLD.

    Stage Two
    - To explore the extent to which the activities identified during stage one interviews are carried out by CNLDs.
    - To explore the influences on the role of the CNLD in terms of their geographical location.
    - To explore the differences in the role of the CNLD depending upon salary grade.


    The study adopted a sequential multiple method approach, with stage one using semi-structured interviews based on critical incident technique with CNLDs (n=14). The data were analysed using thematic analysis. Stage one findings then informed the development of the survey used in stage two, which explored the extent to which the activities identified during stage one were undertaken by CNLDs. A total of 112 surveys were returned, with a response rate of 98% achieved. The quantitative data were entered into SPSS (version 26) and analysed using interferential statistics.


    Stage one findings indicated key themes (n=4) namely proactive/preparatory work, therapeutic relationships, co-ordination and influencing healthcare outcomes. The data from stage two surveys confirmed data from stage one. The research acknowledged that CNLDs throughout Wales complete similar activities to overcome barriers and support adults with learning disabilities access secondary healthcare. The findings also identify five areas of practice where there are geographical variations to the role of the CNLD but no association between the salary grade of the CNLD and activities undertaken.The study acknowledges the social model of disability as the underpinning ethos of CNLDs when supporting adults with learning disabilities to access secondary healthcare.


    This study identifies that even where LDLNs are in post, CNLDs play an important role in supporting access to secondary healthcare through identification, reduction, and removal of barriers.


    Thisstudy offers a significant contribution to the learning disability nursing evidence base. It provides essential insight into the role of the CNLD supporting access to secondary healthcare, and the implications for the wider learning disability nursing workforce.
    Date of Award2022
    Original languageEnglish
    SponsorsResearch Capacity Building Collaboration Wales (Welsh Government)
    SupervisorRuth Northway (Supervisor), Ruth Williams (Supervisor) & Catherine Bright (Supervisor)

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