Elsevier

Nurse Education Today

Volume 32, Issue 1, January 2012, Pages 96-100
Nurse Education Today

Screening for specific learning difficulties (SpLD): The impact upon the progression of pre-registration nursing students

https://doi.org/10.1016/j.nedt.2011.01.021Get rights and content

Summary

The study aimed to explore the impact of screening pre-registration nursing students for an SpLD at entry to an education programme, and the provision of specialist support for those identified as ‘at risk’. Progression was monitored using a multiple method approach.

242 (98%) students completed and returned the Adult Dyslexia Check List (ADCL). 69 scored 7 or above (28.5% of responses) and 36 (52%) went on for further assessment. 48% of students who scored 7+ did not go on to contact Disability Services at all.

11% of the cohort was formally identified as having a SpLD at the end of the year compared to 3.9% of students with a declared disability entering pre-registration nurse education in 2007.

54% of the students who scored 7+ successfully progressed into year two, compared with 41% of students with SpLD from a previous cohort.

Introduction

Specific learning difficulties (SpLD) are a range of learning difficulties including dyslexia, dyspraxia and dyscalculia (Skills for Access, 2010). In the US, the terms ‘neuro-diversity’ or ‘learning difference’ are preferred as more consistent with the social model of disability (The Lancet, 2009, Madriaga, 2007, Hendrickx, 2010) and between 10% and 15% of the US population has dyslexia (Dyslexia Research Institute, 2010a). Prevalence rates of SpLD in the UK vary but between 4% and 10% of the workforce is thought to be dyslexic, including nurses (NIACE National Institute of Adult Continuing Education, 2005, Sanderson-Mann and McCandless, 2006). Adults with SpLD have patterns of strengths and weaknesses that may predispose them to adopt significant patterns of occupation choice (Hartley, 2006). People with dyslexia are less likely than non-dyslexics to be involved in professions such as science, computing, management and finance, and are more attracted to people-oriented professions such as nursing (Taylor and Walter, 2003). People with SpLD tend to have excellent interpersonal skills and intuition, the ability to problem solve, and think holistically and creatively; they are typically focused, determined and hard-working (Dale and Aiken, 2007, Dyslexia Solutions, 2010, Sanderson-Mann and McCandless, 2006) and may also have high levels of compassion and empathy. This may explain why they gravitate to the caring professions (Jamieson and Morgan, 2008). Disabled nurses can be more empathetic to patients and give culturally competent care (Marks, 2007) and they can enrich the educational environment (Evans, 2005).

Nursing was found to be one of the subject areas with the highest proportion of dyslexic students in the UK (Dale and Aiken, 2007, James, 2006, White, 2007) and the US (Watson, 1995). The number of students with learning difficulties accepted into Higher Education in the UK has increased, from 9,238 in 2004 to 13,320 in 2009 (UCAS, 2010). The Higher Education Statistics Agency (HESA) reports that of all full-time students with a disability, 54% of these have dyslexia (National Audit Office, 2007). The number of disabled students entering US Higher Education Institutions (HEIs) is consistent with the extent to which the disabled are present in the general population, i.e. 9% of adults aged 18–44 have a disability, and 9% of freshmen report disabilities (Watson, 1995). These numbers may be attributed to two main factors: first, that children are being better assessed and supported at school and further education level; and second, that there has been a concerted effort by universities to increase the number of students who gain admission (Jamieson and Morgan, 2008). ‘Widening participation’ at higher education level should also widen access to the profession, leading to a more balanced and productive workforce (NHS, 2010).

Students are not required to disclose a SpLD at entry to education and may therefore choose not to do so. Students who have been identified prior to attending a HEI may have been reluctant to disclose due to concerns over their ‘fitness to practise’ (Stanley et al., 2007), they may fear discrimination or stigma (Olney and Brockelman, 2003, Pollak, 2005, Rocco, 2001) or may not consider themselves a disabled person (Macleod and Cebula, 2009). Often they have developed strategies which have enabled them to succeed academically and/or professionally and thus choose not to disclose (Jamieson and Morgan, 2008). A prospective student may not have considered a SpLD relevant in terms of their declaration of ‘good health’ (Nursing and Midwifery Council, 2004, Nursing and Midwifery Council, 2008) — a term open to interpretation (Sin and Fong, 2008).

Competence in literacy and calculation skills for clinical practice is a pre-requisite to professional registration (Elliott and Joyce, 2005) and the NMC has recently issued more detailed guidance (NMC, 2010). The potential impact of a SpLD on the accuracy of report writing and patient notes, and on drug calculations and administration has concerned the profession (Sanderson-Mann and McCandless, 2006). In the US, mistakes are mostly caused by faulty systems, processes and conditions, not individuals and no research to date has systematically documented a relationship between disability status and medical errors/patient safety (Marks, 2007). Literacy and numeracy problems are not restricted to training healthcare workers but are present in the workforce across professional groups and staff in support roles (Sabin, 2006).

In the UK, all students must meet all of the learning competencies and skills required to practise in accordance with the NMC code of professional conduct (NMC, 2004). In the US, student nurses must pass the National Council Licensure Exam — Registered Nurse (NCLEX-RN) to practice and students with SpLD are thought to be at higher risk of failure than those without a SpLD (Watson, 1995).

The NMC has made considerable progress towards more inclusive practices, and is clear to disabled students and practitioners that “good health means that a person must be capable of safe and effective practice without supervision. It does not mean the absence of any disability or health condition. Many disabled people and those with long-term health conditions are able to practise with or without adjustments to support their practice,” (NMC, 2008, p. 6). Information and guidance for students in both academic and practice settings has proliferated in the last few years (Council of Deans of Health, 2010, Crouch, 2008, Dale and Aiken, 2007, Kane and Gooding, 2009, Stainer and Ware, 2006).

In addition, there was the ‘human cost’ to students. The process of assessment took considerable time (Harrison, 2009) and students are often required to intercalate during this period and were not eligible for either disabled students allowance or access to their bursary. Newly identified students needed to adjust to their new status as ‘disabled’ and may have many reactions, including reduced self-esteem, heightened self-consciousness and doubts surrounding their abilities (Martin, 2009).

One of the key drivers for this research was that some students were identified on failing or exiting and did not progress into year 2 (Nursing Standard, 2006, Smith, 2008). An early screening programme seems an expedient way of identifying students at risk of having a SpLD at entry to the programme. It was anticipated that providing specialist teaching to ‘at risk’ students’ and before formal identification would improve retention and achievement for this group of students.

Section snippets

Method

The study aimed to explore the impact of screening and the provision of specialist support on the progression of pre-registration student nurses. A multiple method approach was used to capture data. Ethical approval to proceed with this project was given by the organisation's research ethics committee in September 2007. All students were informed that participation was voluntary.

The Adult Dyslexia Check List (ADCL) designed by Vinegrad (1994) was used for screening. The ADCL does not provide

Results

242 students (98%) in cohort A completed and returned the ADCL. 69 scored 7 or above (28.5% of responses), 30 students scored 5 or 6 (12.5%), and 143 students scored 4 or less (59%).

Diploma students comprised 75% of the total cohort (n = 181) compared with degree students at 25% (n = 61). However, 53% of diploma students scored 4 or less, compared to 75.5% of degree students. 34% of diploma students scored 7+ in the ADCL, compared to 13% of degree students. This shows an increasing trend with

Discussion

28.5% of cohort A scored 7+ on the ADCL although only 11% were formally identified as having a SpLD. Students with a declared disability entering pre-registration nurse education in 2007 was 3.9% and this confirmed anecdotal evidence that initiated the research, i.e. a significant number of students were identified with a SpLD during the first year.

Many people may not realise that they have a SpLD at school or college and as they move on to university, SpLD may become evident with higher

Conclusion

The number of students with SpLD choosing to enter the nursing profession is increasing, and screening provides an expedient way of ensuring early identification. Further research is needed to establish more reliable prevalence rates for SpLD within pre-registration education programmes as well as within the workforce. However, it is important that this is specifically linked with ensuring access to appropriate support and training in learning strategies. This will enable students to

References (58)

  • C. Dale et al.

    A review of the literature into dyslexia in nursing practice

    (2007)
  • DfES

    DSA SpLD Group: Disabled Students Allowance

  • Our mission. Web page

  • Identification. Web page

  • Dyslexia in Adults. Web page

  • B.C. Evans

    Nursing education for students with disabilities: our students, our teachers. Chapter in Strategies for Teaching, Assessment and Program Planning

  • S. Gorard et al.

    Review of Widening Participation research: addressing the barriers to participation in higher education. A report to HEFCE by the University of York, Higher Education Academy and Institute for Access Studies

  • P. Harrison

    Early intervention and support for HE students with SpLD — findings from a research study, Presentation to University of Chester Staff Conference, 22 May

  • J. Hartley

    What are UK schools of pharmacy providing for undergraduates with disabilities?

    The Pharmaceutical Journal

    (2006)
  • V. Heathcote et al.

    16–18 year old students with specific learning difficulties: transition into HE. Aim Higher, South Yorkshire

  • S. Hendrickx

    The adolescent and adult neuro-diversity handbook

    (2010)
  • A. James

    What subjects do dyslexic students study at university? Webpage. Dyslexic.com

  • C. Jamieson et al.

    Managing dyslexia at University: a resource for students, academic and support staff

    (2008)
  • A. Kane et al.

    Reasonable adjustments in nursing and midwifery: a literature review

    (2009)
  • K. Kolanko

    A collective case study of nursing students with learning disabilities

    Nursing Education Perspectives

    (2003)
  • G. Macleod et al.

    Experiences of disabled students in initial teacher education

    Cambridge Journal of Education

    (2009)
  • M. Madriaga

    Enduring disablism: students with dyslexia and their pathways into UK higher education and beyond

    Disability and Society

    (2007)
  • B. Marks

    Cultural competence revisited: nursing students with disabilities

    Journal of Nursing Education

    (2007)
  • N. Martin

    Feeling special — a grown up's guide: reflections arising from adult diagnosis to dyspraxia

    The Journal of Inclusive Practice in further and higher education

    (2009)
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