The social factors affecting Rachel and her family include socio-economic factors (for example redundancy and not being able to work due to a caring role), the social effects of illness and disability (Tom's disability, Mark's depression and Rachel's mother's stroke are all impacting on her and her family's well-being), the role of the family (loss of support due to geographic distance and also requirement for additional support due to ageing), gender roles (for example, the assumption that Rachel will provide care for her mother), stigma (following depression Mark may find it more difficult to get another job if he discloses he has had depression).

What assumptions did the ward staff hold about Lisa before she arrived and on what did they base these assumptions?

The staff seemed to have based their view of Lisa on their (possibly sterotypical) views of someone who has Down's Syndrome/Learning Disabilities rather than on her strengths and abilities. Therefore they assume that she will be 'difficult' and that she will require additional care that they are not equipped to provide.

How might these assumptions impact on the way in which they provide nursing care for Lisa?

The staff decided that she should be nursed in a side room rather than in the main ward and if Helen (the student nurse) had not been there and spent time with Lisa getting to know her and her needs there is a danger that she may not have received appropriate care and that she may have been very isolated during her stay on the ward.

What could be done to try and prevent such situations from occurring?

It is important that all staff working in healthcare settings have disability awareness training (preferably delivered by disabled people) so that any stereotypical assumptions they hold can be identified and challenged. It is also important for staff to be supported to work directly with people with learning disabilities so that they can increase their confidence and competence especially in relation to developing and using appropriate communication skills.