Complex Needs Nursing Care and Support

This assignment requires students to analyze the bio-psycho-social impacts on individuals with complex needs, considering their continued health and development. Students must identify how different professionals contribute to the assessment and therapeutic interventions for these individuals. A key focus is on person-centered approaches to nursing care, promoting independence and utilizing therapeutic strategies to alleviate functional limitations and enhance capabilities.

Person Centred Approaches 2 Supporting People with Complex Needs
Assignment- Assessment for and with People who have Complex Needs
You must follow PCA2 summative guidance for completing the workbook.
Section 1:
Consent and confidentiality: (max 200 words)
A nursing assessment took place at the Lodge after a manager and a keyworker raised
some concerns about one of the patients who is unable to eat and drink properly. In this
assignment, a pseudonym will be given to hide the true identity of service user. The chosen
pseudonym is Muno where she is a 26 years old woman, diagnosed with a condition called
cerebral palsy. According to Schmolke and Amering, (2017) [p.97.] it is identified that cerebral
palsy is a lifelong condition that affects the movement and co-ordination of body and is caused
by a problem with brain that occurs either before, during or soon after the birth. The symptoms
of cerebral palsy may include difficulty in swallowing, constipation, muscle spasms and many
more (Butcher and Wagner, 2018).
As per the scenario, a discussion took place in between health care professionals, patients
and her sister (Heller and Fisher, 2015). In the given video, consent has been received from
patient as well as her accompanying family members with the best of their interest. Also, the
nurse is responsible to undertake all roles and responsibilities that are needed to be performed to
provide effective care to disabled people.
Section 2: Assessment -> plan -> intervention -> evaluation
Assessment based on Roper, Logan & Tierney’s Activities of Living Model (1980). (max
1000 words)
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Activities of Living
Identify and prioritise 4 activities of living in relation to the individual’s health need. The word
limit for this section means that you do not need to discuss all the activities of living.
Delete the activity headings that you have chosen not to discuss
In this assignment, Roper, Logan & Tierney’s Activities of Living Model (1980) will be used to make
an assessment on Muno. The four activities of living which are going to be used are communication,
eating and drinking, sleeping and mobility.
Communication
Communication is vital and through it, people share their thoughts and feelings in different
personal, formal and social situation (Holland et al 2008). Due to Muno`s complex needs, she is
unable to communicate in words which means she is able to communicate nonverbally. According to
Royal College of Nursing, (2015) “non-verbal communication which is usually done using body
language that says a lot about getting engaged with an interest of communicating”. (Schmolke,
Amering and Svettini, 2016. (pp. 97-111). During the assessment, manager and keyworker pointed
out that Muno uses pictures, objects references and facial expressions as her means of
communication.
According to NHS, (2015) people with complex needs require support in their everyday lives.
People with complex needs require support of activities in their daily living; they might find it
challenging, exchanging and passing on information using pictures and body language to support their
communication (MacArthur and Fletcher, 2015). However, there are many communication aids which
help but they do not express the individual`s emotions Kennedy and Brewer (2014). Communication
is difficult when individual has difficulty in expressing their choices and struggles to understand the
information Regnard et al. (2003).
Eating and Drinking
In the nursing assessment, it was highlighted that the main cause of concern was that Muno is
not eating well; she is only eating small amount of food, coughing, not having appetite and as a result,
she is losing weight. It is essential to maintain the body by eating a balanced diet. Brooker and Waugh
(2013) highlighted that each person is recommended to have 1500mls of fluids per day, whereas,
Muno is not drinking much which contributes to her constipation as it was mentioned in the meeting
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that Muno is taking movicol.
In the nursing assessment, it was mentioned by the key worker that Muno was given with
medication in her food. However, the nurse highlighted that this is a bad practice as Muno should be
given with some of the medications; at least 30 minutes before (Heller and Hsieh, 2014). Caroline
highlighted that some of the medicines which delay swallowing process or increase salivation might
impact on swallowing function. Theadom, Parmar and BIONIC Research Group, (2015) [pp.674-681]
stated that it is important to have medication review among people with learning disabilities and the
side effects might impact on their drinking, eating and nutritional habits that are needed to be
considered carefully at the time of prescribing medication. It was together stated by the nurse in the
given video that the patient Muno is fed by the staff who supports her to eat because she is more
comfortable in sitting onto a bean bag and faces difficultly in sitting to a moulded chair for eating.
Risk of poor posture during mealtime
Poor risk posture can become a risk for an individual while eating. This may can choke the
food and create serious issues for an individual. It can create swelling difficulties and choking are the
key areas of concern.
Sleeping
It was highlighted that Muno does not sleep much during the night; she tends to sleep more
during the day. Roper et al stated that sleep allows the body to relax from all stresses of everyday
activities and also leads to the growth and repair of cells, during the sleep Roper et al. (1999, 2000)
highlight that sleeping is vital for everyone and therefore, it is an important Activity of Living. The
keyworkers suggested that Muno might not be sleeping well because of the muscle spasm. There
could be some related issues that might be affecting Muno’s sleeping pattern such as feeling tired and
not eating well at meal times and also, it might be affecting her sleep pattern where she is also not
comfortable in her chair (Spear-Swerling, 2018). The nurse should consider helping Muno with the
issue. It can be suggested that it could be another reason for Muno for not being able to sleep at night
where her bedding and pillows must be checked properly. The room temperature is very important
and it is ideal to have it around 20 Celsius degrees. If the room is too warm or too cold, adjustments
can be considered. Also, a monitoring chart is required to record the temperature in her room. It will
give an evidence through monitoring chart in order to give a balanced assessment and referrals in the
future (Grimshaw, McGowan and McNichol, 2017) [pp.1169-1180] It was also mentioned that Muno
is happy when left to rest lying down.
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Mobilising
It was pointed that Muno uses moulded wheelchair and they also use a hoist to transfer her
they with other aids to help Muno with her needs (Schmolke, Amering and Svettini, 2016) (pp. 97-
111) stresses that problems with mobility are highly associated with people having physical
disabilities who have complex needs with an important need therapeutic positioning. Muno is relying
on others for the comfort and to ensure that the correct measures are taken to improve and maintain
her posture.
It was mentioned that Muno feels comfortable when lying in bed during the day. Therefore,
Muno will now missing out the activities she enjoyed by lying in bed during the day. It was
mentioned that when eating her food, she sits on the bean bag, whereby her posture is complicated,
and she will end up choking. Mencap (2016) pointed out that posture is about using right equipment
and positioning techniques. It was said that Muno does not like to be hoisted and she is not happy
sitting on her wheelchair (Mencap, 2016).
Negative effect of poor posture
There are various risks associated with the poor posture such as it can impede the ability of the
lungs to expand (Hartling, Milne and Newton, 2014). It has also become a risk factor for many
injuries and create swelling difficulty.
Section 3: Assessment –Diagnosis- plan -> intervention -> evaluation
Key Health Need / Nursing Diagnosis: (100 words)
One health need with rationale
Regular exercise is one of the health needs which is identified. It is because; Muno is not
performing any daily activities and she use to sleep in day time which lead to increase her health
issues.
Aetiology
The causes of her disease are too much consumption of caffeine and avoiding daytime
naps.
Muno has spastic cerebral palsy which affects all her four limbs. She is unable to stand
and she has a moulded wheelchair.
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Characteristics
According to Pawlyn and Carnaby, (2009) sleeping problems are also generally more in
people with learning disabilities. Not sleeping at night can negatively affect Muno in performing
the daily activities. Although, sleeping in daytime is also a reason behind her constipation related
issues Paterson (2014). It is essential for Muno to perform exercise and take all its food in time
so that health issues can be overcome (Barrett et al 2012).
Section 4: Assessment -> plan -> intervention -> evaluation
Care or Intervention Plan: (max 1200 words)
Care plan is a written document that is used to provide information about the person and also
defines the areas that care plan covers (Barrett et al. 2012).
Care of Intervention Plan
Intervention 1: Special teaching techniques
This intervention includes helping an individual to learn through multisensory
experience and provide feedback immediately to strengthen their ability of recognising things.
Action
Nurses need to use effective communication skills with respect to vulnerable people.
Along with this, a nurse can focus on home visits and attend some of the GP clinic
appointments with respect to monitoring and discussing progress with patients (Williams,
2017). Learning disable people not like to engage in social functions or event, therefore, nurses
can plan any activities or social events that help in supporting living setting.
Rationale
Reason for choosing this intervention program is that it will help in strengthening the
recognising ability and makes them confident.
Evidence based
NHS (2015) stated that people with a learning disability are likely to be underweight or
overweight; therefore people with multiple disabilities are often underweight because of poor
feeding and swallowing. Muno’s Care Plan must have strategies and techniques used for her
eating and drinking, her sitting position and proper chair when eating and must also considers
5

the overall environment (Moura, and Caetano 2015).
Intervention 2 Speech and Language Therapists
Action
Muno needs to be assessed by speech and language therapists due to her swallowing
action and identifies an appropriate food texture (Williams, 2015). A care plan should be used
to manage swallowing problems in people with learning disability and it should include
drinking, eating and swallowing forms during meal times
Rationale
It was mentioned when Muno drinking fluids they add thickener; therefore, thickener
might rarely meet the hydration target necessary for good health. After taking proper care,
Mumo is still facing some health issues. Therefore, it is important to provide proper diet plan to
Muno to overcome her health issues.
Evidence
The role of a nurse is to gather information and communicate with the pharmacist so
that right procedures will be followed. The National Institute for Health and Care Excellence
(NICE) (2015) stated that if there is an immediate need covert medication should only be
administered when a management plan is in place following the formal best interest meeting.
Nursing staff to attend the meeting, the prescriber, pharmacist and the person who can
communicate the views and the interests of the patient such as a family member or independent
mental capacity advocate. The role of LD nurse is to provide proper care to patients so that they
can overcome health issues and live a healthier life (Hall, 2015).
Intervention 3
Muno is losing weight and is not eating well; thus she is frequently constipated. The role
of the learning disability nurse is to take actions for her eating problems.. The nurse is to
prepare a care plan for her and educate the family and the staff. Care plan is a written document
that is used to provide information about the person, it also defines the areas the care plan
covers
Action
Where there is a problem with eating and drinking the nurse must include what the
concern is and needs to be done. The nurse must put in place how to support Muno to eat and
drink properly and minimise risk of choking. It is also her responsibility to ensure whether
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eating and drinking guidelines are followed or not and when to seek other professionals such as
speech therapists (Butcher and Wagner, 2018).
Rationale
The duty of the learning disability nurse is to enforce and enhance the use of food and
fluid charts by applying guidelines as well as following Muno`s routine. As mentioned that she
eats her meal while sitting on the bean bag
Evidence based
The Nursing and Midwifery Council (NMC) (2010) and the Care Quality Commission
(CQC) “Have raised concerns that what should be a last resort is often regarded as normal
practice carried out of the convenience of staff, rather than the best interests of patients”. The
CQC stressed that covertly of administer medication is unlawful and it is unsafe of
administration (Care Quality Commission 2012).
Intervention 4: Dysphagia interventions nursing
Action
The nurse needs to verbalize and shows the family and staff about ways to keep her
head greater that 30-degree and its significance of doing in every shift. Along with this, nurse
will provide mouth and lip care to patient every.
Rationale
Through this intervention, nurses can overcome health issues faced by Muno.
Evidence based
According to Perez et al. (2017) Dysphagia is a medical term used to describe eating or
drinking disorders. Dysphagia may have several numbers of causes such as mechanical
problems in dealing with food or drink in mouth such as difficulty in movement, difficulty with
swallowing or chewing and preparing food for swallowing (Heller and Fisher, 2015).
According to Royal College of Nursing (2016) eating and drinking are both fundamental
to life, both of these usually takes part on daily basis and both provides great opportunities for
maintaining a healthy body.
Care plan is a written document that is used to provide information about the person; it
also defines areas that care plan covers (Barrett et al. 2012). The nurse`s care plan is essential to
educate support workers and Muno’s family about her eating, drinking or swallowing issues.
According to Paterson (2013) individuals with learning disabilities experience a lot of
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health problems as compared to normal people. Dysphagia is a dangerous and distressing
condition that leads to death to some people. Thacker et al. (2008) highlighted that swallowing
and feeding impairments are the main predictors for increased mortality and morbidity in adults
with learning disabilities.
Similarly, Chadwick and Jolliffe (2009) states that dysphagia is an issue to people with
learning disabilities and those who look after them. To prevent Muno, it is important to
minimise risk of choking, a learning disability nurse should carry out risk assessment and
records of coughing and choking incidents. It is also important for the nurse to refer Muno to a
Speech and language therapy (SALT) in order to get help with her choking. According to Royal
College of Speech and Therapists (2017), their role is to provide life-changing treatment,
support and care to children and adults who have difficulties with communication, or with
eating, drinking and swallowing.
Wright and Howseman (2013) stated that the type of food texture recommended will be
based on an individual and it depends through this process all risk has removed all risk and
better effective growth and give better services. rright and Howseman (2013). However, the
nurse must put guidelines for Muno with swallowing difficulties to the support workers must
understand the implications of her conditions, and also receive training on management
strategies and must also have a written plan. (Wright & Howseman, 2013).
Furthermore, losing weight is another action for Muno. At present, she is eating
sandwiches but not eating proper meals. A dietician might also be involved and made
recommendations to improve her diet. According to Harding and Wright (2010) stated that use
of a special seating, or drinking and eating equipment is essential. A nurse should encourages
Muno to eat high calorie foods as well food with more roughage and food and fluid is to be
considered, as well as staff to follow the guidelines (Heller and Hsieh, 2014).
It was mentioned that the staff administer Muno`s medication by putting it in her food
because she has problems with swallowing. This is called covert administration of medication.
According to Griffith (2016) Covert administration of medicines is when medication is given to
a patient without their knowledge this can be in a drink or with food. The rationale of the action
is to provide a safe way of administering medications. According to Barber (2017) support
workers or nurses has dissolved medicine in water and or in food items in order to make the
proper changes and better objective. That also helpful to make Muno healthy.
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Section 5: Assessment -> plan -> intervention -> evaluation
Evaluation: (max 200 words)
Evaluating the outcomes that helps to give better way to the nurse to work in the future.
It is critically evaluated that speech and language therapists lead to provide life-improving
treatment, support and care for people with disability (Spear-Swerling, 2018). It helps in
measuring and teaching people so that they can communicate in better manner. The
intervention goal and objective for Dysphagia need to be maintain adequate nutritional intake
in the patient to increase airway protection.
The frequency of reviewing and monitoring will depend upon the service users’ needs and
progress towards meeting goals and it will be recorded in the plan. Glasper (2013) states that
nurse and midwives must keep clear and accurate records that are relevant to their undertaken
practices. It is evaluated that nurses need to keep all records that provide consistency in the
way professionals work when supporting people. Record keeping will encourage the support
workers to be consistent and to continue support Muno. A record of food and fluid chart needs
to be kept with patient’s weight. The reason behind it is to effectively resolve the identified
issues of Muno and take proper care with assistance of an effectively designed plaAs per the
case Muno needs to get proper arrangement and best effective designed plan according to set
target goals. It helps to make better approaching target goals and best impressive goals for the
treatment of better outcomes. (Hartling, Milne and Newton, 2014).
Section 6:
Involvement of other professionals: (300 words)
Muno was referred to the team of learning disability nurses for losing weight and not
being able to sleep. A referral to the dietitian would also be beneficial to Muno. Their aim is to
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promote good health and prevent disease in each person and communities (Health Carers NHS,
2017).
It was also mentioned that she is not comfortable in her chair, for that reason, she needs
to get a physiotherapist. Role of physiotherapist is to advise and assess on exercises and
activities that can help people to remain comfortable and mobile as much as possible (Fawcett,
2007).
Muno has swallowing problem and she is at risk of choking. However, a speech and
language therapist (SALT) can support her. SALT uses different techniques that can meet an
individual` s needs such as swallowing exercises. Role of SALT in Adults with Learning
Disability is to diagnose and provide intervention to assess and give advice regarding
communication impairment which is experienced by an individual with learning disabilities
(NHS, 2015).
Other members of the MDT would need to be involved,
A General practitioner would be involved in Muno`s care. According to NHS, 2017
general practitioners focus on the complete health of a person combining psychological, social
and physical aspects of care (Williams, 2017).
Multi-disciplinary working is very important; it benefits people who need support to
get the best care possible. Munro (2011) highlighted some of the benefits of multi-disciplinary
working which are sharing information, problem solving and improved trust in between
different professionals.
The members of MDT on referring to the given case of Muno will include the health
care professional, nurses, primary care physician, neurologist, social workers and speech
pathologist (Hockenberry and Wilson, 2014). Through MDT, a more accurate assessment of
needs could be made and a suitable care package can be drawn up.
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REFERENCES
Barber, C. (2017. Healthcare law and ethics, 11: restraint and surveillance within care homes
(2/2).British Journal of Healthcare Assistants, 11(3), 136 https://ww magonlinelibrary-
com.ezproxy.herts.ac.uk/doi/10.12968/bjha.2017.11.3.136
Barrett et al (2012). Care planning: A guide for nurses. (2nd ed.). London: Pearson.
Bob & Mafuba (2014). Learning disability nursing: Modern day practice, CRC Press. ProQuest
E-book Central,http;//ebookcentral.com/lib herts/detail. Action?
Brooker, C. & Waugh, A. (2013). Foundations of Nursing Practice. (2nd ed.). London: Mosby
Elsevier.
Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2018. Nursing
Interventions classification (NIC)-E-Book. Elsevier Health Sciences.
Care Quality Commission (2012) CQC fines Darlington care home £4,000 for failure to meet
medication regulations London: CQC.Retrieved from. http://bit.ly/1VRSuX7.
Care Quality Commission (2015) State of Care Report London: CQC.Retrieved from
http://bit.ly/1VTrscS
Caroline Walker Trust. (2007).Eating well children and adults with learning disabilities.CWT
Retrieved January, 1, 2018 from
https://www.cwt.org.uk/wp-content/uploads/2015/02/EWLDGuidelines.pdf
Chadwick D, Jolliffe J (2009) A descriptive investigation of dysphagia in adults with intellectual
disabilities. Journal of Intellectual Disability Research. 53, 1, 29-43.
Complex Needs [e-book] Retrieved from
https://www.dawsonera.com/abstract/9781444301533
Fawcett, A. L. (2007). Principles of Assessment and Outcome Measurement for Occupational
Therapists and Physiotherapists: Theory, Skills and Application [e-book] Retrieved from
https://www.dawsonera.com/abstract/9780470029084
Glasper, A. (2013) Improving record keeping: important lessons for nurses. British Journal of
Nursing, 20(14), 886 https://www-magonlinelibrary
com.ezproxy.herts.ac.uk/doi/10.12968/bjon.2011.20.14.886
GOV.UK. (2014). Mental Capacity Act: making decisions. GOV. UK. Retrieved December, 24,
2017 from https://www.gov.uk/government/collections/mental-capacity-act-making-
decisions
11

Griffith, R. (2016). Covert administration of medicines: a contentious issue. British Journal of
Community Nursing, 21(5), 261.doi-org.ezproxy.herts.ac.uk/10.12968/bjcn.2016.21.5.261
Grimshaw, P., McGowan, L. and McNichol, E., 2017. An extra care community's perceived
priorities for ‘whole system ‘relationships: A Q‐methodological study. Health & social
care in the community, 25(3), pp.1169-1180.
Hall, C., 2015. Introduction to Nursing Theory. Essentials of Nursing Practice, p.157.
Harding, C. & Wright, J. (2010). Dysphagia: the challenge of managing eating and drinking
difficulties in children and adults who have learning disabilities. Tizard Learning Disability
Review, 15(1), 4-13
Hartling, L., Milne, A., Tjosvold, L., Wrightson, D., Gallivan, J. and Newton, A.S., 2014. A
systematic review of interventions to support siblings of children with chronic illness or
disability. Journal of paediatrics and child health, 50(10).
Health Careers NHS. (2017). Dietitians translate the science of nutrition into everyday
information about food. Retrieved from https://www.healthcareers.nhs.uk/explore
Heller, T., Fisher, D., Marks, B. and Hsieh, K., 2014. Interventions to promote health: crossing
networks of intellectual and developmental disabilities and aging. Disability and health
journal, 7(1), pp. S24-S32.
Heller, T., Gibbons, H.M. and Fisher, D., 2015. Caregiving and family support interventions:
Crossing networks of aging and developmental disabilities. Intellectual and developmental
disabilities, 53(5), pp.329-345.
Hockenberry, M.J. and Wilson, D., 2014. Wong's nursing care of infants and Children-E-book.
Elsevier Health Sciences.
Holland et al (2008). Applying the Roper. Logan. Tierney Model in Practice (2nd ed.). London:
Churchill- Livingstone.
Holland, K, Jenkins. J, Solomon. J, and Whittam. S. 2012. Applying the Roper Logan Tierney
Model in Practice. (2nd ed.) Churchill Livingstone: Elsevier.
Kennedy, L. & Brewer, G. (2014). Creative methodologies to enhance communication:
British journal of learning disabilities. 1 (44), 35-42. doi: 10.111/bld.12107
MacArthur, J., Brown, M., McKechanie, A., Mack, S., Hayes, M. and Fletcher, J., 2015. Making
reasonable and achievable adjustments: the contributions of learning disability liaison
12

nurses in ‘Getting it right’ for people with learning disabilities receiving general hospitals
care. Journal of advanced nursing, 71(7), pp.1552-1563.
Mental Capacity Act 2005. (c.9). London: The Stationery Office.
Moura, G.N.D., Nascimento, J.C.D., Lima, M.A.D., Frota, N.M., Cristino, V.M. and Caetano,
J.A., 2015. Activities of living of disabled people according to the Roper-Logan-Tierney
model of nursing. Northeast Network Nursing Journal, 16(3).
Munro E (2011) The Munro Review of Child Protection: Final report. A child-centred system.
London: Department for Education.
NHS Health Careers. (2017). Explore roles. NHS. Retrieved December, 24, 2017 from
https://www.healthcareers.nhs.uk/explore-roles
NHS. choices (2015). Dysphagia (swallowing problems).Retrieved from
https://www.nhs.uk/conditions/swallowing-problems-dysphagia/treatment/
NHS. Midlands and East. (2016). Top Tips for supporting and meeting the needs of people with
profound and multiple learning disabilities (PMLD). NHS. Retrieved December, 24, 2017
from https://www.mencap.org.uk/sites/default/files/2016-06/NHS%20EM%20-
%20PMLD.pdf
Nursing and Midwifery Council (2015). The Code: Professional Standards of Practice and
Behaviour for Registered Nurses and Midwives. NMC, London.
Nursing Theory, (2011). Roper-Logan-Tierney model for nursing based on a model of living.
Retrieved December, 24, 2017 from<http://nursing-theory.org/theories-and-models/roper-
modelfor- nursing-based-on-a-model-of living.php>
Paterson, J.G. (2013). Dysphagia in people with learning
disabilities.https://rcni.com/sites/rcn_nspace/files/ldp2013.11.16.9.14.e1477.pdf
Paterson.J.G. (2014). Managing constipation in adults with severe learning disabilities. Retrieved
December, 23, 2017 from https://rcni.com/sites/rcn_nspace/files/ldp.17.9.16.e1582.pdf
Pawlyn, J. & Carnaby, S. (2009). Profound Intellectual and Multiple Disabilities Nursing
Perez, C.M., Wagner, A. P., Ball, S, L., White, S.R., Clare,I.C.H.,& Holland,A.J.
(2017).Prognostic models for identifying adults with intellectual disabilities and mealtime
support needs who are at greater risk of respiratory infection and emergency
hospitalisation. Journal of Intellectual Disability Research, 61(8), 737-754.
http://onlinelibrary.wiley.com/doi/10.1111/jir.12376/full
13

Regnard, C., Mathews, D., Gibson, L., & Clarke (2003). Difficulties in identifying and its cause
in people with severe communication problems, 9(4), 173-176.Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/12734454
roles/allied-health-professionals/roles-allied-health-professions/dietitian.
Roper, N., Logan, W. W., Tierney, A.J. & Tomey, A. M. (2000). The Roper Logan and Tierney
model nursing: Based on activities of living. Edinburgh: Churchill Livingstone
Royal College of Nursing. (2015). Nonverbal communication. Retrieved from
http://rcnhca.org.uk/top-page-001/communication-methods/non-verbal-communication-2/
Royal College of Nursing. (2016). Eating and driking. RCN. Retrieved December, 24, 2017 from
https://rcni.com/hosted-content/rcn/first-steps/eating-and-drinking
Royal College of Speech & Language Therapists (2017). Introducing the RCSLT.
RCSLT.Retrieved December, 28, 2017 from https://www.rcslt.org/about/introduction
Schmolke, M. and Amering, M., 2017. and Alessandro Svettini, MD. Person Centered
Psychiatry, p.97.
Schmolke, M., Amering, M. and Svettini, A., 2016. Recovery, Empowerment, and Person
Centeredness. In Person Centered Psychiatry (pp. 97-111). Springer, Cham.
Social Care Institute for Excellence. (2013). Dignity factor- Eating and nutritional care.SCIE.
Retrieved from January, 1, 2018 from
https://www.scie.org.uk/publications/guides/guide15/factors/nutrition/
Spear-Swerling, L., 2018. Off Track: When Poor Readers Become"" Learning Disabled"".
Routledge.
Thacker A, Abdelnoor A, Anderson C et al (2008) Indicators of choking risk in adults with
learning disabilities a questionnaire survey and interview study. Disability and
Rehabilitation. 30, 15, 1131-1138.
Theadom, A., Parmar, P., Jones, K., Barker-Collo, S., Starkey, N.J., McPherson, K.M.,
Ameratunga, S., Feigin, V.L. and BIONIC Research Group, 2015. Frequency and impact of
recurrent traumatic brain injury in a population-based sample. Journal of neurotrauma,
32(10), pp.674-681.
Williams, B.C., 2015. The Roper-Logan-Tierney model of nursing: A framework to complement
the nursing process. Nursing2017, 45(3), pp.24-26.
14

Williams, B.C., 2017. The Roper-Logan-Tierney model of nursing. Nursing2017 Critical Care,
12(1), pp.17-20.
Wright, D. & Howseman, T. (2013). Managing swallowing difficulties in patients with learning
disabilities. Learning disabilities. Vol 27(4), 80-82.Retrieved from
https://www.jcn.co.uk/files/downloads/articles/09-2013-learning-disabilities.pdf
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14037186 (Oxford) 5NMH1040)
Grading Criteria and Feedback Form - Level 5 Written Coursework
Module Name: PCA2 – supporting people with complex needs
Module Code: 5NMH1008 (Hatfield) 5NMH1033 (Oxford) 5NMH1040 (Hampshire) 5NMH1046
(Berkshire)
Learning Outcomes (Module Leader to add):
Knowledge and understanding:
1. Analyse the bio-psycho-social effects on the person with complex needs in the context of their
continued health and development
2. Recognise the particular contribution that other professionals can make to the assessment and
therapeutic interventions for and with people who have complex needs.
Skills and attributes:
1. Discuss person-centred approaches to the nursing care and support of people with complex needs
in living as independently as possible.
2. Use therapeutic approaches and interventions which ameliorate the bio-psycho-social functional
limitations and enhance the capabilities of persons who have complex needs.
Note to Markers: Select criteria appropriate to the assignment and mark not applicable ones accordingly. Use
yellow highlight to indicate which feedback statements are relevant to this student.
Outstanding
>80
Excellent
79-70
Very Good
69-60
Good
59-50
Satisfactory
49-40
Marginal Fail
39-30
Clear Fail
29-20
Little or
nothing of
merit
19-0
Presentatio
n and
Outstanding Excellent Very good
presentation.
Good
presentation.
Satisfactory Poor Poor
presentation.
Little or
nothing of
16

structure
10%
presentation.
Logically
structured.
Highly articulate
and fluent
writing style.
No grammatical
or spelling
errors.
presentation.
Logically
structured.
Highly
articulate and
fluent writing
style with very
few (minor)
errors.
Logically
structured.
Articulate and
fluent writing
style.
A few
grammatical
errors and
spelling
mistakes.
Logically
ordered.
Writing is
mainly clear
but some
spelling and/
or
grammatical
errors.
presentation.
Mostly logical
structure.
Not always
written clearly
and has several
grammatical
and / or spelling
errors.
presentation.
Inconsistent or
illogical
structure.
Has many
spelling and / or
grammatical
errors.
Very
inconsistent or
illogical
structure
Poorly written
and/or many
spelling and
grammatical
errors
merit.
Poorly written.
Numerous
inaccuracies in
grammar and
spelling.
Content,
Knowledge
and
understand
-ing
25%
Outstanding
exploration of
topic showing
excellent
knowledge and
understanding
Excellent level
of knowledge
and
understanding
demonstrated.
Covers all
relevant points
and issues.
Very good level
of knowledge
and
understanding
demonstrated.
Covers most
relevant points
and issues.
Good grasp of
the topic and
some of its
implications
presented.
Knowledge
and
understanding
is
demonstrated.
Minor errors /
omissions.
Satisfactory
content / level of
knowledge of the
topic.
Addresses part
of the question.
Some errors /
omissions.
Limited content /
knowledge.
Limited or
muddled
understanding of
the
topic/question.
Lacking in
knowledge.
Content
irrelevant /
inaccurate. Does
not address the
question and
therefore does
not meet the
learning
outcomes.
Little or
nothing of
merit.
Unsatisfactory
level of
knowledge
demonstrated.
Content not
appropriate to
the topic.
Breadth /
depth and
integration
of literature
20%
Outstanding
breadth and
depth of
literature
utilised.
Outstanding
integration of
literature into
work.
Excellent
breadth &
depth of
literature
utilised.
Excellent
integration of
literature into
work.
Very good
breadth & depth
of literature
utilised.
Literature
integrated very
well.
Good use of
literature.
Depth
appropriate to
topic but
moderate
breadth or vice
versa.
Literature
integrated into
the
coursework
reasonably
well.
Satisfactory use
of literature but
limited in
breadth and /or
depth.
Uncritical and
cited without
comment.
Limited breadth
and depth
Literature cited
without
comment.
Lacks breadth &
depth. Some
literature
irrelevant to
topic area.
Little or
nothing of
merit.
Literature used
irrelevant to
topic area.
Description
, discussion
and/or
reflection
20%
Outstanding
level of
description,
discussion
and/or
reflection.
Excellent level
of
description /
discussion
and/or
reflection of
issues.
Very good level
of description,
discussion
and/or
reflection but
some areas
would benefit
from further
development.
Good level of
description,
discussion
and/or
reflection but
some areas
could be
expanded on
Satisfactory
level of
description but
limited evidence
of discussion
and/or reflection.
Limited
evidence of
description,
discussion
and/or reflection.
Lacking /
inadequate level
of description,
discussion
and/or reflection.
Little or
nothing of
merit.
Unsatisfactory
level of
description /
reflection.
17

further.
Analysis
20%
Significant
evidence of
ability to think
analytically
Substantial
evidence of
ability to think
analytically
Clear and
consistent
evidence of
ability to think
analytically
Good evidence
of analytical
thinking.
Some evidence
of analytical
thinking.
Limited
evidence of
ability to think
analytically
Very little
evidence of
ability to think
analytically
No evidence of
ability to think
analytically
Presentatio
n of
references
5%
Recommended
referencing
system used
with no
inaccuracies or
inconsistencies
noted.
Recommended
referencing
system used
with very few
(minor)
inaccuracies
and/or
inconsistencie
s.
Recommended
referencing
system used with
few inaccuracies
and/or
inconsistencies.
Recommended
referencing
system used
but occasional
inaccuracies
and/or
inconsistencie
s noted.
An attempt to
use the
recommended
referencing
system but
several
inaccuracies
and/or
inconsistencies
noted.
An attempt to
use the
recommended
referencing
system but many
inaccuracies
and/or
inconsistencies
noted.
An attempt to
use the
recommended
referencing
system but
numerous errors
noted and
inconsistently
applied.
Little or no
attempt to use
the
recommended
referencing
system
Strengths
 You have considered the importance of consent and confidentiality
 You have made an attempt to identify some of the key health needs for the individual concerned
 You have demonstrated an understanding of the role of the practitioners in the MDT
Areas for development
 Please ensure that you use the university referencing guidelines to develop your ability to reference in the
text and in the reference list correctly
 You need to development your ability to critically read and critically write for this level 5 piece of work,
there is limited breadth and depth of the literature that you have used to support your thinking.
 Please ensure that you proof read your work carefully, there are times when it is difficult to understand what
you are trying to explain due to the sentence construction and grammar used.
 It is important that you demonstrate your ability to assess the bio/psycho/social needs for this assignment
and this is not evident for all of the ADL that you have explored for this individual
General feedback / additional comments
Please seek tutorial guidance/advice
Academic Skills Advice
Please remember there are lots of useful resources to support your academic skills development on the Academic
Skills Advice site.
Learning outcomes achieved: No
18

Within word count limit: Yes
Provisional weighted/overall mark (before application of penalties):
Note: All marks are provisional until the Board of Examiners has ratified them.
Marked by: Lynne stracey
Reflection on Learning
Health and social care regulatory bodies require that registrants (and aspiring registrants) actively
participate in learning activities; keep records of their learning and ensure that these activities inform and
enhance services for patients/clients. Please consider the learning you have achieved while working on
this assignment and how you have applied the feedback you have been given. For example:
Academic: what previous feedback have you been given and how have you used it to inform and
improve this assessment?
Application to your professional setting: what have you learned in this assessment that you intend to
apply to your practice and how will you demonstrate this?
You should keep your feedback and reflection in a file/portfolio as evidence of your professional
development.
19

0
20