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) % 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 YearNumber newly identified 2002/ / / / / / / / /1179 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) ISSN

UK Student Nurses and Dyslexia In 2004, 67 dyslexic student nurses undertaking a 3 year pre- registration 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)

The NMC (2008) requires educational institutions and practice environments to work in partnership to support students with disabilities working in clinical practice. Nursing and Midwifery Council in UK

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.

The NMC (2008) requires educational institutions and practice environments to work in partnership to support students with disabilities working in clinical practice. Nursing and Midwifery Council in UK

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) Please tick areas identified with facilitator Name of Placement Signature(s) of mentor agreeing support 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.

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) Please tick areas identified with facilitator Name of Placement Signature(s) of mentor agreeing support Patient handoversExtra time to practise / deliver handover. Request a patient handover sheet (access 10 minutes prior to handover if possible)

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