Assessing health needs in people with severe learning disabilities: a qualitative approach.

The nursing assessment, and the contribution it makes to the identification of an individual's health needs, is often a complex and multidimensional process. This is always true when the individual concerned has a severe learning disability. The nurse should develop the assessment in partnership with individuals who may experience major communication difficulties, or have unappreciated levels of perceptual or cognitive dysfunction. They may also live with the ongoing possibility that their affective or behavioural responses may be misinterpreted as 'challenging behaviour'. This case study focuses upon one particular young man with a severe learning disability living in a community home. Drawing upon the principles of qualitative research methods, especially those of 'grounded theory', this study aims to demonstrate how these can be used to develop a uniquely person-centered assessment. A systematic process of observation, analysis and reflection produces a detailed picture of the individual and his or her particular health states. The strength of this approach is threefold. Firstly, the person is considered as an active participant and remains the central focus. Secondly, in contrast to many other forms of assessment, the person is viewed as dynamic with ever changing needs. Thirdly, the process of nursing judgement is made explicit and integrated into the assessment process.