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 Against Mentors are prepared and can anticipate difficulties Support in place early Shared responsibility and collaboration established early Reduced risk of student failure due to lack of appropriate support. Against Presumption that student will have difficulty in practice Stigma affecting performance All problems automatically associated with disability Students fear of discrimination

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

Support Strategy/Reasonable Adjustment 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 Mentor

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: s.e.a.traylor@nur.keele.ac.uk 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