Supporting students with specific
learning difficulties in clinical practice
David Morris & Patricia Turnbull
Incidence of Dyslexia
• In UK population, estimations vary between 4-10%
• 10% of UK workforce may be dyslexic
(National Institute of Adult Continuing Education, 2005).
• 41.3 % of UK disabled student population have diagnosis of
dyslexia (most common disability)
(Hartley, 2006).
UK Incidence of Dyslexia in Nursing
• Difficult to quantify – no legal requirement to disclose
disability to employer.
• No central ‘register’ of nurses who have disclosed their
disability.
• Local level – 21% of healthcare students (Nurses/
Midwives/ Social Workers / Operating Dept.
Practitioners) in our University have diagnosis of
dyslexia.
Total number of students with Specific Learning Difficulties
Year
Number newly identified
2002/03
60
2003/04
48
2004/5
66
2005/6
74
2006/7
125
2007/8
110
2008/9
107
2009/10
129
2010/11
79 to date
Clinical experiences of student
nurses with dyslexia
• In 2004 –
Dearth of literature exploring the work experiences of health care
professionals with dyslexia.
•
Morris, D. & Turnbull, P. (2006) Clinical experiences of students with
dyslexia Journal of Advanced Nursing 54(2) 238-247 ISSN 0309-2402
UK Student Nurses and Dyslexia
• In 2004, 67 dyslexic student nurses undertaking a 3 year preregistration nursing programme (Diploma / Degree) were invited via
letter to participate in a study exploring their clinical experiences.
• 18 (27%) responded and participated.
• Individual in-depth interviews and subsequent thematic analysis
identified a range of specific issues faced by these students.
Key Findings
1. Disclosure was an issue for all 18 participants…6 of these chose
not to disclose.
“ I’ve listened to nurses talking disrespectfully about others because
they are slow. If they knew I was dyslexic they would talk about
me.”
“ I’ve told my mentor so she’s completely understanding…but some
staff I would never tell….there’s no point.”
Morris, D. & Turnbull, P. (2007) The disclosure of dyslexia in clinical practice:
experiences of student nurses in the United Kingdom Nurse Education
Today 27, 35-42
Key Findings
• 2. Development of self-managing strategies included..
Voice recorders, note pads, repetitive behaviours,
checking and re-checking of , for example, drug
names or dosages, use of colour acetate overlays to
assist reading.
Occasional negative behaviours were reported…..
Task avoidance, e.g., hiding, not answering the phone.
Key Findings
• 3. Emotional aspects of being dyslexic..
“ No one knows about it – I can’t bring myself to say it. I
hated to be labelled as having it (dyslexia).”
“ My mentor told me not to write in care plans….she was
very rude to me. It’s hurtful but you get used to it.”
Key Findings
• 4. The need for more time….
Numerous examples were given of how nursing activities took
longer than normal (compared to non-dyslexic colleagues).
The need to limit distractions frequently cited.
Working in a busy ward environment posed difficulties for 6
participants.
Key Findings
5. Choice of future work setting
16 participants considered slower paced environments to
be more suitable.
Acute areas with a high turnover of patients were believed
to potentially magnitude the student’s problems
The legislation and the law
Government Equalities Office
The Disability Discrimination Act
(DOH 1995)
• The UK Disability Discrimination Act (DDA, DOH 1995)
prohibits discrimination against disabled people in
employment.
• This was extended to the educational environment in
September 2002 following amendments introduced by
the Special Educational Needs and Disability Act 2001).
The Equality Act 2010
•Came into force October 2010 with phased
introduction. Further provision April 2011
•Replaces existing anti-discrimination laws with one
single act
•Simplifies the law, removes inconsistencies and
makes it easier to understand and comply with
Defining Disability
Someone with a physical or mental
impairment which has a substantial and long
term adverse impact on their ability to carry
out normal day to day activities
(Equality Act 2010)
Nursing and Midwifery Council in UK
• The NMC (2008) requires educational
institutions and practice environments to
work in partnership to support students
with disabilities working in clinical practice.
REASONABLE ADJUSTMENT
• As part of the Disability Discrimination Act, and
subsequent Equality Act ( 2010) employers are required
to make “reasonable adjustments” to enable ‘disabled’
employees to undertake their duties effectively in the
workplace.
Changes to reasonable adjustment
Previously adjustments made where otherwise
impossible or unreasonably difficult for disabled
person to use the service
Adjustments must now be made where disabled
person experiences a substantial disadvantage
Therefore more adjustments are required than
previously
The Equality Act 2010 and previous DDA legislation imposes 5
obligations towards disabled people –
1. Not to directly discriminate on grounds of a person’s disability
2. Not to treat less favourably for a reason relating to a person’s
disability- without justification
3. To make reasonable adjustments.
4. Not to harass a disabled person
5. Not to victimise anyone.
Nursing and Midwifery Council in UK
• The NMC (2008) requires educational
institutions and practice environments to
work in partnership to support students
with disabilities working in clinical practice.
Working in partnership
• Findings of personal research = need for action
• Review of current literature (limited solutions)
• Involvement of student services and disability support
team for expertise
• NHS partner involvement for application
SKILL
WRITING / SPELLLING
Aspects of clinical
practice that may be
affected (Identify those that
may affect you)
Possible strategies to overcome
problems
(Discuss those that may be useful to
you with your facilitator & mentor)
Poor / Inaccurate
documentation
Useful to write patient
documentation immediately after
patient care.
Write notes on rough paper to be
checked by mentor before writing in
patient documentation.
Please tick
areas
identified
with
facilitator
Name of
Placement
Signature(s) of
mentor
agreeing
support
SKILL
READING
Aspects of clinical
practice that may be
affected (Identify those that may
affect you)
Possible strategies to overcome
problems
(Discuss those that may be useful to you
with your facilitator & mentor)
Patient handovers
Extra time to practise / deliver handover.
Request a patient handover sheet
(access 10 minutes prior to handover if
possible)
Please
tick
areas
identified
with
facilitator
Name of
Placement
Signature(s)
of mentor
agreeing
support
Reasonable Adjustment
• Adjustments for dyslexic people can be simple and
inexpensive.
• They may also be a benefit to other students and
employees.
•
A willingness to be flexible is the most important thing.
Reasonable Adjustment
• Students with disabilities must demonstrate their
competence in the same outcomes as other students
• For adjustments to be made, the student needs to
disclose details of their difficulties.
•
Disclosure rates amongst students have previously
been low
Raising Awareness in Clinical Practice
• Presentation of dyslexia research and support document to all
nurse lecturers and nursing staff in health care Trusts.
• Presentation of dyslexia research and support document to all
new clinical mentors undertaking mentorship programme.
• Review and evaluation of experiences of support document at
mentorship updates.
Process
• On confirmation of dyslexia
– Student issued support document by university dyslexia advisor.
– Statement of Reasonable Adjustments sent to personal tutor for
consideration in relation to university & practice settings.
– Student advised to meet and discuss support needs with
personal tutor.
– Student meets with clinical mentor to discuss specific aspects of
reasonable adjustment identified in support document.
Views of Support Document
Students perspectives via ‘in document’ evaluation (200
documents issued since Sept 09)
• Key reflections
– Very useful in identifying strategies that they had not previously
considered.
– Helpful in explaining some of the traits that the learning difficulty
presents.
– Relief that mentors are aware of support document.
– Those who use it feel well supported in practice.
Less positive aspects
– Concerns that the document ‘singles me out’
– ‘Personal tutors not always aware how to help’
– ‘Just means more work for me to do’
Views of Support Document
Mentors evaluation (via mentor update sessions)
• Useful to see that reasonable adjustments are readily available.
• Informative about aspects of learning difficulties and how they may
impact on clinical practice.
• Provides structure to the support being put in place
• Still requires students to disclose and they often don’t