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Getting the message: intuition and reflexivity in professional interpretations of non-verbal behaviours in people with profound learning disabilities



Accessible summary

People with profound and multiple learning disabilities are often unable to talk to the staff who help to care for them. They rely on non-verbal communication behaviours to communicate, for example

  •  Facial expressions.
  •  Gestures.
  •  Eye contact.

This raises particular challenges for those staff, who include nurses with learning disability nurses. This paper outlines those challenges. They include challenges raised by

  •  Person centred planning.
  •  The mental capacity act.
  •  The need to provide evidence for practice.

This paper goes on to suggest ways in which staff can meet these challenges, including the use of skills based on intuition and the use of reflective practice. This paper will help professional staff move towards understanding the NVC of people who have profound and multiple learning disabilities.


This paper describes the current challenges facing nurses and other professionals who care for people with profound and multiple intellectual disabilities. This particularly vulnerable group of service users often rely on a repertoire of non-verbal behaviours to communicate their needs and wishes. These challenges include the requirements of Person Centred Planning, the Mental Capacity Act 2005 and the evidence-based practice movement. Drawing on nursing and some other relevant professional literature, this paper explores the latter in particular and how it relates to the intuitive knowledge base that professionals use to interpret NVC behaviours in this field. It concludes with a discussion of the dangers and limitations of this knowledge and skill base and posits a professional need to discipline its deployment by reflective practice (reflexivity) within well-established therapeutic relationships. A theoretical example of reflective practice is included.