Figure - uploaded by Liz King
Content may be subject to copyright.
Coding frame with examples from interview data
Source publication
Background:
literature that reports the experiences of facilitating reasonable adjustments for student nurses who have a learning difficulty (LD) in clinical placement from the viewpoint of link lecturers is limited and warrants further exploration. Research aim: to explore link lecturers' views on reasonable adjustments in clinical placement and...
Context in source publication
Context 1
... were transcribed verbatim, reduced and interpreted using thematic analysis (Ellis, 2010). A deductive coding frame was developed seeking to extract data relevant to the research aim and research questions ( Table 1). Three overarching themes emerged from the codes: student engagement, clarity of the link lecturer role and external barriers. ...Similar publications
This article aims to assist nurses and nursing students to consider the presentation of delirium in older patients and the resulting assessment and nursing interventions required. It considers the three types of delirium: hyperactive, hypoactive and mixed. It also discusses potential causes of delirium. Older patients are at increased risk of delir...
Citations
... Students are generally not able to extend the time for completing documentation, handing off patients, or both (Steele, 2018), and describe this as a challenge. Many clinical instructors see the implementation of extended time as an unreasonable modification in clinical settings (Epstein et al., 2020;Ashcroft & Lutfiyya, 2013;King, 2018). Some clinical instructors, however, indicated that if the student discloses the need for more time, they were willing to provide this accommodation (Epstein et al., 2020). ...
... Support plans, sometimes called access plans or support summaries, are a list of adjustments needed for the student to learn successfully and to protect their wellbeing. The evidence also shows that when adjustments are made, they are inadequate, poorly implemented or fail because of systematic barriers 7,16 . ...
A previous article has highlighted the distinct lack of research investigating the barriers neurodivergent healthcare students face in clinical placement. The small amount of published literature, almost all exclusively investigating dyslexia, paints a shocking picture. It includes inadequate support, damaging student self- perceptions and inappropriate and harmful comments. As identified in a British Medical Association report, disabled medics and medical students face discrimination at all levels of their careers, including cases of bullying and harassment. Although research specifically investigating student radiographers is severely lacking, with only one piece of primary research looking at one type of neurodivergence, the wider body of evidence all points in one direction, providing the impetus for vital improvements in neurodivergent student support. A shift in the clinical education paradigm is needed. Therefore, rather than carrying out research to reaffirm this fact, it is more salient to examine the methods for progression and ask: “What does good support look like?”
... This is a repeated key issue that is highlighted in much of the research [25 , 26 , 23] . In King [25] , nursing link lecturers (also called clinical tutors or mentors) felt that students' choice not to disclose and engage with the disabilities process meant they were not able to reach their full potential. One lecturer commented "[they] could muddle through and just sneak a pass". ...
Being neurodivergent (i.e., autistic, dyslexic, dyspraxic, ADHD, etc) can present challenges in the neurotypical world. These challenges can be disabling and thus, in accordance with the Equality Act 2010 of the UK, reasonable adjustments should be made. However, there is little published research investigating the experiences of, and therefore support needed for, neurodivergent students on clinical placements. This is especially true in radiography research, which is pertinent considering the potential for neurodivergent disabilities to interact with the demands of the role. Worthy of note, there is no research exploring the experiences of autistic students, dyspraxic or ADHD students. Due to this, it is impossible to know what radiography-specific support is needed. This piece will review the literature from the radiography and wider healthcare field and outline the possible impact this research deflect will have on neurodivergent student radiographers.
... Despite a total absence of any evidence of a relationship between patient safety or medical errors and a nurse's disability (Marks & McCulloh 2015;Meloy & Gambescia 2014) most CI in our study labeled nursing students who seemed "slow" or "could not perform the skill" as students with disabilities and assumed they were a threat to patient safety in nursing practice (8/14). Similar findings have been reported in previous studies (Ashcroft & Lutfiyya 2013;Azzopardi et al. 2013;Evans 2014a;King 2018;McPheat 2014;Neal-Boylan & Smith 2016). ...
The current approach to clinical placement training for nurses excludes students with disabilities. The purpose of this article is to introduce a four-step model for nursing programs to identify clinical essential requirements – specific skills and competencies students must gain during placement. Engaging this four-step model will allow educators to identify how essential requirements can be achieved in a variety of ways, and thus can involve accommodations. It will also allow for the identification of which essential requirements cannot be accommodated and must be demonstrated in a prescribed manner due to impacting the nature or integrity of the task. Analyzing clinical essential requirements using this framework will create a consistent and defensible method to determine the flexibility or inflexibility of clinical tasks. The framework provided requires a collaborative process including key experts, nursing students and nurses with disabilities to comprehensively address the challenges clinical environments pose to inclusiveness.
... Health care educators' experiences of challenging student mentoring situations were related to three different areas: their own actions; mentoring aspects; and students' aspects. The current study is relevant because the proportion of students with learning challenges is increasing on a global level (Wray et al. 2013), and scholars have emphasized that professionals involved in teaching must be able to identify learning challenges to support student learning (King 2018). The continuous monitoring and evaluation of students, along with collaboration between professionals, is crucial to successfully support and guide students with learning challenges, while a positive clinical practice atmosphere, encouragement by educators, and viewing learning challenges as a unique opportunity can help students openly discuss their experiences with learning challenges (Ashcroft & Lutfiyya 2013). ...
During clinical practice, students become acquainted with the key work tasks associated with their professions. Students need more support from healthcare educators during clinical practice learning, particularly in challenging situations. This study aimed to describe healthcare educators’ experiences of challenging situations during clinical practice placements. A qualitative study design was used to collect data through interviews with ten healthcare educators from two higher education institutions. The data were analyzed with inductive content analysis. The SRQR reporting guidelines were used to improve the transparency of the study. Educator reactions commonly involved emotional, goal-oriented and pedagogical support towards their students. The interviewed educators felt that mentors – when facing a challenging situation during clinical practice – are tasked with creating an atmosphere that supports student learning. Students faced challenges that were related to self-evaluation, goal-oriented activities, and their attitudes towards feedback. The building of a safe clinical learning environment involves collaboration between students, their clinical mentors and educators.
... The scoping review included 27 studies published between 1999 and 2018 from diverse disciplines (e.g., nursing, medicine, occupational therapy, midwifery) and countries (Canada, the UK, Australia, Israel, and the USA) yet predominantly from the nursing profession and from the UK (Table 3). There was a mix of methodology designs, including phenomenology (Brown et al. 2006;Child and Langford 2011;King 2018;Luckowski 2014Luckowski , 2016Reep-Jarmin 2016;Ridley 2011;Steele 2018), qualitative discourse (Ashcroft and Lutfiyya 2013;Evans 2013Evans , 2014Sanderson-Mann and McCandless 2006), quantitative design (Millward et al. 2005;Sowers and Smith 2004), case reports (Maheady 1999;Maheady and Fleming 2005;White 2007), literature reviews (Ashcroft et al. 2008;McPheat 2014;Morris and Turnbull 2007;Neal-Boylan and Smith 2016), and anecdotal reports (Arndt 2004;Carroll 2004;Marks 2000;Marks and Mcculloh 2016;Moore 2004;McCarthy et al. 2018). Semistructured interviews and focus groups were the most prevalent data collection techniques. ...
... Instructors included part-time and full-time faculty affiliated with the school of nursing. The majority of the studies focused on invisible disabilities, including learning and mental health disabilities (Arndt 2004;Ashcroft and Lutfiyya 2013;Ashcroft et al. 2008;Child and Langford 2011;Evans 2013Evans , 2014King 2018;Luckowski 2014Luckowski , 2016Marks 2000;Marks and Mcculloh 2016;McPheat 2014; 1. 2 main themes emerging from analysis:(a) Getting the work done: emphasis on physicality, stamina and efficiency; students who fail to get the work done are viewed as problematic; students requiring support are perceived disapprovingly; getting the work done for patients takes precedence over the rights supporting a student with a disability (b) Severe dyslexic student: ...
... 1319). Similarly, White (2007) studied students (n = 7) with dyslexia in clinical practice, in which a student disclosed, "If they [faculty] think you're having a problem it gives them a In some studies (12/27; 41%) clinical instructors' experiences focused on how SWD pose a risk to patient safety (Arndt 2004;Ashcroft et al. 2008;Ashcroft and Lutfiyya 2013;Evans 2014;King 2018;Maheady 1999;Maheady and Fleming 2005;McPheat 2014;Moore 2004;Morris and Turnbull 2007;Neal-Boylan and Smith 2016;Reep-Jarmin 2016). For example, Maheady (1999) highlighted that nursing students with limited mobility can "impact patients' safety" (p. ...
The number of students with disabilities in post-secondary institutions and in nursing programs is on the rise. With limited clinical placements, nursing programs and clinical instructors are asking how to reasonably accommodate students who identify with disabilities in clinical placements. The purpose of this paper is to explore what we know about the experiences of nursing students who identify with a disability and of instructors in nursing clinical practice. Guided by Arksey and O’Malley’s (2005) scoping review methodology, a total of 27 papers published between 1999 and 2018 were selected. Three overarching themes emerged. While students who identify with a disability experienced (a) feeling labeled and excluded they responded by (b) masking their disability and accommodation (including assisted technology accommodation) during clinical placement and (c) suggesting better policy support to highlight their strengths rather than their disability. Most surprisingly to us was the limited Canadian studies. Further education and research implications will be discussed.
... The literature on this topic is also limited. For example, there is evidence on lecturers' views of supporting student nurses requiring reasonable adjustments in university but little on the link lecturer perspective of supporting these students in the clinical setting (King, 2018). The viewpoints of student nurses are also limited in the literature, which focuses mainly on experiences of disclosing their need for reasonable adjustments to nurse mentors and the lack of time nurse mentors have for supporting them with reasonable adjustments (Morris and Turnbull, 2007;Child and Langford, 2011;Ridley, 2011). ...
Background
student nurses who attend preregistration nursing programmes in the UK are assessed on their academic work and their performance in clinical placement. Some of them require reasonable adjustments to be made in order to support their learning. Although there is national guidance on making reasonable adjustments for academic work, information on this associated with clinical placement is limited. The nursing literature reports varying levels of success in facilitating reasonable adjustments in clinical placement.
Aim
to explore the experiences of student nurses who require reasonable adjustments and their link lecturers associated with the facilitation of this support in clinical placement.
Method
a descriptive phenomenological methodology was adopted. Data were collected using semistructured interviews with seven student nurses and three link lecturers from three fields of nursing (adult, child and mental health). Audiorecorded interview data were transcribed, coded and thematically analysed. Phenomena were identified and discussed, viewed through relevant educational theoretical lenses and in conjunction with nursing research literature.
Findings
three main themes emerged: defining reasonable adjustments, supporting students, and being professional.
Conclusion
all study participants could define reasonable adjustments and described a variety of experiences of these being facilitated in clinical placement. The process could be complex and depended on many factors that could promote or hinder the provision of support.
... Beliefs that accommodations are helpful, and understanding the need for accommodations, may impact attitudes toward the need for and use of accommodations in clinical settings (Bourke et al., 2000;Nelson et al., 1990;Wood and Marshall, 2010). Interviews of clinical faculty (called link lecturers in the United Kingdom) who oversee precepted clinical's described a lack of clear guidance regarding accommodations and the need for more information about reasonable adjustments (King, 2018). ...
... This may indicate that preceptors think students with learning disabilities can be successful given the appropriate accommodations. These findings lend support for the need for supportive faculty and preceptors in clinical settings for students with learning disabilities (Kolanko, 2003;White, 2007;Wood and Marshall, 2010;King, 2018). ...
The aim of this study was to describe the perceptions of nurse preceptors of nursing students and new graduate nurses with learning disabilities in clinical settings. Learning disabilities pose potential challenges in nursing education, especially in clinical settings when working with preceptors. Preceptors (N = 166) who attended a state-wide preceptor workshop responded to an electronic survey that assessed their perceptions. Four concepts were explored: preceptor perceived level of preparedness; preceptor perceived confidence in implementation of their role; preceptor beliefs regarding the potential of learners with learning disabilities; and preceptor agreement with provision of accommodations for learners with learning disabilities. Preceptors felt unprepared and lacked confidence in their ability to implement their role as preceptor for those with learning disabilities. Those who had exposure to learning disabilities reported feeling more prepared, however they had expectations for the learner to work hard, have strategies and accommodations in place, ask for help when needed, and take responsibility for their learning. Preceptors reported they are willing to precept nurses with learning disabilities, and they expect support for those with learning disabilities. Educational modules and support to increase preceptor preparedness and confidence should be incorporated into preceptor training.
... Subsequent UK Government reports and guidance called for an end to discrimination in the workplace, and legal frameworks such as the Equality Act (2010) made it unlawful to discriminate against applicants and employees on the grounds of mental illness. Under Section 15 of the Equality ACT (2010) and nursing regulator's standards (NMC, 2013), AEIs, as well as having to undertake assessment of prospective students' health and character, are also required, if they accept a student onto the mental health programme have to provide reasonable adjustments for those students who disclose their disability to support them in successfully completing their studies (King 2018). ...
There is an increasing number of students with lived experience on the preregistration mental health nursing programmes. The challenges faced by these students in managing the demands of the programme have not been fully explored. Mental health and well‐being is an integral part of providing a healthy university in which students can flourish. The purpose of the study was to explore how students with lived experience meet the demands of the nursing course. The outcomes of the study are aimed at informing inclusive teaching and learning and current student support provision. Ethics approval was given. Students from two universities in South East England who met the criterion of having a pre‐existing mental health condition when enrolling on the mental health preregistration nursing programme were invited to take part. Nine students took part in the study. Using an interpretative descriptive design, 1:1 face‐to‐face, audio‐taped, semistructured interviews were undertaken. The data were analysed using a framework approach, and this revealed four main themes: timing of disclosure; managing lived experience in learning environments; students’ coping mechanisms, and experience of support. Recommendations for practice was that approved education institutes (AEIs) should ensure they have a robust, inclusive practice by implementing strategies to develop these students’ resilience, and enhance their learning and the current support provisions. This will ensure the barriers to disclosing their mental health conditions are recognized and minimized to enable these students to fully contribute to their own learning and teaching experience.
Purpose
The number of individuals with disabilities enrolling in speech-language pathology and audiology graduate programs is increasing. While academic accommodations for classroom learning are well accepted, there is very little information regarding the feasibility of accommodations in external clinical placements. The goal of this article was to describe the current processes and the future feasibility of such accommodations.
Method
External clinical supervisors completed a Likert-type survey regarding past experiences supervising students with disabilities, the types of requested accommodations, and the feasibility of the various types of accommodations in their setting.
Results
Of the respondents ( N = 49), only nine individuals reported supervising at least one student with a disability. Most frequently, external clinical educators generally did not learn about the disability or need for accommodations until the student was already in the placement. Attendance modifications were the most frequently requested accommodation ( n = 6), followed by timing modifications ( n = 5) and load adjustments ( n = 4). External clinical educators reported coaching and support ( n = 33), the use of assistive technology ( n = 32), and timing accommodations ( n = 30) were the most feasible accommodations. Most respondents were definitely ( n = 23) or probably ( n = 21) willing to supervise a student with a disability.
Conclusions
The study's findings show that students are not disclosing the need for accommodations until after the placement begins. External clinical educators are willing to support students with disabilities and describe a variety of accommodations that could potentially be implemented into external clinical placements.
