Learning disability nursing: behaviours that challenge
NMC OSCE practice station

The task

You are a community learning disability nurse visiting a supported living house. Callum Reid, aged 24, has a mild to moderate learning disability and autism. Over the past week there have been four incidents of shouting and hitting walls. His support worker, Beverley, is present. Talk with Callum and Beverley to understand what may be behind the behaviour, and agree a plan with both of them. Record your assessment, plan and any safety concern on the form provided. Say aloud what you are doing and why.

What this station tests

• Behaviour that challenges is communication; look for pain, illness, sensory and environmental causes first.
• Do not blame the disability: diagnostic overshadowing hides treatable problems such as dental pain.
• Restrictive practices and as-required sedation must be recorded, reported and reviewed.
• Positive behaviour support: predictable routines, visual supports and consistent, calm responses.
• Support carers; they are partners and need a blame-free space to be honest.

Sources for the clinical content

• NICE NG11: Challenging behaviour and learning disabilities: prevention and interventions
• NHS England: STOMP: stopping over medication of people with a learning disability, autism or both
• Mental Capacity Act Code of Practice
• NMC: The Code

An original practice scenario with invented patients. Not an exam question.