Supporting Students with Dyslexia in Clinical

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Supporting Students with
Dyslexia in Clinical
Practice
Sarah Traylor
Disability Liaison Officer
School of Nursing & Midwifery
Disability
• Under the Equality Act 2010 the protected
characteristic of disability applies to a
person who has a physical or mental
impairment that has a substantial and
long-term adverse effect on their ability to
carry out normal day-to-day activities
Dyslexia as Disability
• The extent to which students on nursing
and midwifery courses who are diagnosed
with dyslexia experience a ‘substantial
and long-term adverse effect on their
ability to carry out normal day-to-day
activities’ may vary.
• However dyslexia that produces these
adverse effects is categorised as a
disability
What is the Public Sector Equality
Duty?
• The Equality Duty is a duty on public
bodies and others carrying out public
functions. It ensures that public bodies
consider the needs of all individuals in
their day to day work – in shaping policy,
in delivering services, and in relation to
their own employees.
Equality Act 2010
Equality Duty and Disability
• The Equality Duty also explicitly recognises that
disabled people’s needs may be different from
those of non-disabled people. Public bodies
should therefore take account of disabled
people’s impairments when making decisions
about policies or services. This might mean
making reasonable adjustments or treating
disabled people better than non-disabled people
in order to meet their needs
Equality Act 2010
Support Needs
• An important part of our responsibilities under
the Equality Duty is the identification of those of
our students who are disabled and their support
needs. The Equality Act 2010 requires a
proacative / anticipatory approach to this.
• At Keele central services arrange for disabled
students to have their support needs identified
by a Needs Assessment. However this is
focussed mainly on needs associated with
academic study.
What is Discrimination?
• Treating a disabled person less favourably
than one treats or would treat a non –
disabled person for a reason that relates
to that persons disability. (Corlett 2004)
Discrimination
Can occur in two ways:
• When the HEI treats a disabled person
‘less favourably’ for a reason relating to
their disability.
• When the HEI fails to make a reasonable
adjustment placing the disabled student at
a disadvantage compared to their peers.
Reasonable Adjustments
• If a disabled student is at a substantial
disadvantage the education provider is
required to take such steps as are
reasonable to prevent this disadvantage.
This might include adjustments to course
requirements or work placements, the
provision of support strategies and
alternative ways of delivering courses.
Maintenance of Educational
Standards
• It is NOT expected that educational
standards should be lowered to
accommodate disabled students and one
of the criteria for determining whether an
adjustment is reasonable is the
maintenance of course standards both
academic and in clinical practice.
(Corlett 2004)
Defining Dyslexia
The British Dyslexic Association definition:
‘…a complex neurological condition ….The
symptoms may affect many areas of
learning and function, and may be
described as a specific difficulty in reading,
spelling and written language. One or
more of these areas may be affected.
BDA definition cont’d
• ‘ Numeracy, notational skills (music),
motor function and organisational skills
may also be involved. However it is
particularly related to mastering written
language, although oral language may be
affected to some degree.
(Crisfield 1996)
Characteristics of Dyslexia?
Dyslexia is often described in terms of deficits:
• Problems with space, time and numbers
• Difficulty in reading and recognising words
• Poor short term memory - particularly auditory or
visual sequential memory
• Difficulty differentiating between left and right
• Weak organisational skills
An individual won’t necessarily have all of these
difficulties.
(Sanderson-Mann, McCandless 2005)
Students with Dyslexia in
Nursing
• Dyslexia can effect 3 – 10% of the
population. However there is evidence that
people with dyslexia may be drawn to
people orientated professions, and to
careers such as nursing and midwifery.
(Sanderson-Mann, McCandless 2005)
Students with Dyslexia
• People react to learning that they have dyslexia
in a variety of ways. Many mature nursing
students are only diagnosed when they start
their nursing programme, while others may have
been diagnosed at school or college.
• Most students will share anxieties that when
other people know they have dyslexia they may
be treated in a negative way and their ability to
function effectively in clinical practice may be
questioned.
Students with Dyslexia
• It is important to recognise that students
diagnosed with dyslexia may have a range
of deficits that affect them to various
degrees.
• Many students have developed effective
coping strategies for managing the deficits
they have.
.
Support offered to Students with
Dyslexia in the University
• Students with dyslexia are allowed 25%
extra time in examinations. Those with
poor short term memory will also be
allowed the use of a prompt sheet. If
reading and understanding text under time
constraints is an issue they may be
allowed the services of a reader for the
exam question. The use of a computer to
type their answers or in some cases an
amanuensis may also be recommended.
Support offered to Students with
Dyslexia in the university
• A Tintavision assessment will indicate if
the use of a coloured overlay would assist
them in reading text printed on a white
background.
• Recording lectures, seminars and tutorials
assists with difficulties in note taking.
• In some cases the services of a note taker
in lectures may be recommended.
Disabled Students Allowance
Students with Dyslexia are eligible to apply
for
DSA which is divided into three sections:
• Equipment – IT hardware + software,
digital
recorder, handheld spellchecker.
• Non-medical Helpers – note taker,
dyslexia tutor
• General allowance – often used for
books, photocopying/coloured paper etc.
Support in Practice – When and How?
A decision needs to be made with the
student regarding:
• Anticipatory support – organised before
the student starts their practice placement
• Reactive support – support is only put in
place once difficulties in practice have
been identified
Anticipatory Support
For
Mentors
Against
are prepared and can Presumption that student will
anticipate difficulties
have difficulty in practice
Support in place early
Stigma affecting performance
Shared responsibility and
All problems automatically
collaboration established early associated with disability
Reduced risk of student
Students fear of discrimination
failure due to lack of
appropriate support.
Reactive Support
For
 Student goes into placement
with no preconceived expectations
from the mentor.
The risk of stigma is reduced
If no difficulties arise no support
is needed which can enhance the
students confidence and self
esteem.
Support is tailored to specific
identified difficulties.
Against
Before support is called for the
student will experience difficulties
which may damage their
confidence and self esteem.
The relationship between the
student and mentor may be
damaged by the mentors
identification of difficulties.
Collaboration between clinical
and university staff is delayed.

Anticipatory v Reactive Support
• Anticipatory support is usually well
accepted by students in theoretical
assessment and helps them to achieve
success and hopefully avoid the
experience of failure.
• Reactive support is much more common in
practice assessment but if focussed action
is taken as early as possible it can be very
effective.
The Role of the Mentor
• Students need to feel that their mentor is open
and approachable and will react to their
disclosure of dyslexia in a positive and
supportive way.
• The mentors aim is to work with the student to
help them to develop strategies that enable
them to achieve the required standard of
performance in practice. This may involve
‘reasonable adjustments’ within the practice
setting.
Support Strategies for Students
with Dyslexia – in Clinical Practice
• The use of taped handovers in many
placement areas is very helpful for
students with dyslexia as tapes can be
reviewed to check information. If taped
handovers are not used then the student
should be encouraged to take notes and
staff should be understanding of slow note
taking and the need to ask questions to
check the accuracy of notes.
Support Strategies for Students with
Dyslexia – in Clinical Practice
• Poor short term memory is a common feature of
dyslexia and students with this problem should
be encouraged to use a notebook to record
information and aid recall.
• The recording of information on a digital
recorder may also help and assist with repetition
to aid recall.
• Students will often have personal strategies that
they can use in practice and they should be
encouraged to share these with their mentor.
Advice you might give to students with
dyslexia on clinical placements.
• If in doubt ask someone to check that you
have completed work correctly.
• Write messages and instructions down if
you are worried that you may forget.
• Keep a notebook and use it to record
things you may want to look up later.
• Repeat instructions to ensure that you
have understood them.
Advice you might give to students
with dyslexia on clinical placements
• Make a list of words that you have
difficulty spelling and refer to this when
completing documentation.
• Use a handheld spellchecker if you have
one.
• Photocopy forms that you need to be
familiar with and practice filling them in. Fill
a photocopy in in rough then redo it, until
you gain confidence.
Clinical Needs Assessment
• Although generic advice can be helpful to
both students and mentors more specific
information gained through a Clinical
Needs Assessment allows support to be
focussed on the students specific needs in
placement.
What is a Clinical Needs Assessment ?
It’s a process by which:
• a students specific support needs in relation to
their clinical practice performance are identified
• strategies to support the student and/or
reasonable adjustments to the environment or to
the way in which the student performs a practice
element are discussed
• An appropriate course of action is agreed
Who is involved in the process?
• The Student and their Clinical Mentor are
the main participants. The Link Lecturer
and /or the Personal Tutor and Student
Support Lecturer can also offer useful
advice and support.
How is the process initiated?
This can happen in a number of ways for example:
• The student may find a particular element of clinical
practice challenging and may raise this with their mentor
or a member of University staff
• The mentor may have concerns about the students
performance in practice and may raise this with the
student and a member of University staff
• The student may have had a Clinical Needs Assessment
in a previous placement and the Personal Tutor /
Student Support Lecturer may recommend that a new
assessment is carried out at the start of subsequent
placements.
How to complete the Clinical Needs
Assessment form
Discussion should take place between the
mentor, student and lecturer and:
• The element of practice that the student
needs to perform competently should be
clearly defined and recorded as the clinical
need. The clinical learning outcomes
should provide the focus for this
e.g. Completion of accurate and timely care
plans for the patients in her care.
Clinical Need
Clinical need
Completion of accurate
and timely care plans for
the patients in her care.
Support Strategies
• Ways in which the student can be
supported to achieve competence should
be clearly defined and recorded as support
strategies/reasonable adjustments.
Support Strategies/Reasonable Adjustments
Clinical need
Completion of accurate and timely
care plans for the patients in her care.
Support Strategy/Reasonable
Adjustment

Keep a list of most used words /
phrases in a notebook and use this in
practice.
 Use handheld spell checker in
practice
Allow extra time for the completion of
care plans
Use green overlay to aid reading in
practice
Mentor to help with proof reading
documentation
Work with specialist tutor to develop
spelling and proof reading strategies

Who is responsible for actions?
• Details of who is responsible for actions to
ensure that the support/ reasonable
adjustments are put in place should be
identified and recorded
Actions
Support Strategy/Reasonable
Adjustment
Keep
a list of most used
words/phrases in a notebook and use
this in practice.
Use handheld spell checker in
practice

Extra time for care planning
Use green overlay to aid reading in
practice
Mentor to help with proof reading
documentation
Work with specialist tutor to develop
spelling and proof reading strategies
Actions
Student
Student/CLASS
Student/Mentor
Student
Mentor
Student/CLASS
Students name:
Cohort:
Mentors name:
Clinical need
Completion of accurate
and timely care plans for
the patients in her care.
Keele University
School of Nursing and Midwifery
Clinical Needs Assessment
Placement Area:
Date of Assessment:
Date of Evaluation:
Support Strategy/Reasonable
Adjustment
 Keep a list of most used
words/phrases in a notebook
and use this in practice.
 Use handheld spell checker in
practice
 Allow extra time for the
completion of care plans
 Use green overlay to aid
reading in practice
 Mentor to help with proof
reading documentation
 Work with specialist tutor to
develop spelling and proof
reading strategies
Actions
 Student





Student/CLASS
Student/Mentor
Student
Mentor
Student/CLASS
Take and deliver accurate
telephone messages
 Assess telephone skills with a
role play exercise
 Use notebook to record detail
of messages
 Design a message template
and use this to ensure that all
details are recorded
STUDENTS SIGNATURE……………………………………….
DATE…………………………………
MENTORS SIGNATURE………………………………………..
DATE…………………………………
LECTURER ROLE / NAME…………………………………….
SIGNATURE……………………………… DATE…………………
 Student/Lecturer
 Student
 Student /Mentor/
Lecturer
Advantages of using the Clinical Needs
Assessment
• It is student focussed and enables student
participation in the process of designing support.
• It enables individualisation of support based on
the growing amount of guidance available.
• It provides a written record of the support
agreed, evaluation of the support and details of
the individuals responsible for taking action
Competence in Practice
• Although mentors/assessors and
supervisors are responsible for meeting
students support needs in practice, the
student must ultimately be able to reach
the standard of safe and competent
practice in all outcomes. In order to do so
they may require ‘reasonable adjustments’
in practice and the Clinical Needs
Assessment can help to identify which
strategies will be most useful.
The educational dilemma
For all of us in health professions
education the dilemma is the same:
How to balance the needs and rights of
disabled students
V
The needs and rights of vulnerable service
users.
How can the Clinical Needs
Assessment help?
• It enables the documentation of an objective
support process that fully involves the student,
helps to tailor support to individual needs and
clarify areas of responsibility for making it
happen.
• The focus is on support to facilitate success with
recognition that at the point of evaluation there is
clear evidence of reasonable adjustments if the
student does not meet the standard of
performance required for safe and competent
practice.
Sources of Advice and Support
• Sarah Traylor is the Disability Liaison
Officer in the School of Nursing and
Midwifery, Keele University.
Sarah can be contacted by e mail at:
[email protected]
or by phone on 01782 679662
References
• Crisfield J (ed) 1996 The Dyslexia
Handbook. BDA Reading
• Corlett S. Special Educational Needs and
Disability Act. Skill - National Bureau for
Students with Disabilities.
http://www.skill.org.uk/news/senda.asp
Accessed on 13.10.05
References
Equality Act 2010
EHRC – Equality and Human Rights
Commission
References
• Sanderson-Mann, J. McCandless, F. 2005
Guidelines to the UK Disability
Discrimination Act 1995 and the SENDA
2001 with regard to nurse education and
dyslexia. Nurse Education Today (2005)
25, 542-549
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