How to interpret and manage learning needs on placement
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How to interpret and manage learning needs on placement. Sarah Illingworth & Louise Goff. Specific Learning Difficulties ( SplDs ). SplDs affect the way information is learned and processed

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Specific learning difficulties splds
Specific Learning Difficulties (SplDs)

  • SplDs affect the way information is learned and processed

  • They are neurological (rather than psychological), usually hereditary and occur independently of intelligence

  • They include:

    • Dyslexia,

    • Dyspraxia or Development Co-ordination Disorder,

    • Dyscalculia,

    • Attention Deficit Disorder

  • Highly variable profile

  • Strengths and weaknesses

Information processing
Information processing

  • Difficulties with taking in information efficiently (this could be written or auditory)

  • Slow speed of information processing - a 'penny dropping' delay between hearing something and understanding and responding to it

Information processing

Memory concentration

Memory & concentration

Memory & concentration

  • Poor short term memory for facts, times, dates

  • Poor working memory -difficulty holding several pieces of information while undertaking a task e.g. taking notes as you listen.

  • Mistakes with routine information

  • Inability to hold on to information without referring to notes.

Memory concentration1

Memory & concentration

Memory & concentration

  • Weak listening skills, a limited attention span, problems maintaining focus

  • A tendency to be easily distracted, inability to remain focused

Communication skills
Communication skills

Communication skills

  • Lack of verbal fluency or precision in speech

  • Word-finding problems

  • Inability to work out what to say quickly enough

  • Misunderstandings or misinterpretations during oral exchanges

  • Over-loud speech or murmuring that cannot be clearly heard

  • Sometimes mispronunciations or a speech impediment may be evident


  • Lateness or difficulty in acquiring reading and writing skills

  • Erratic spelling, difficulty extracting the sense from written material, difficulty with unfamiliar words, an inability to scan text

  • Particular difficulty with unfamiliar types of language such as technical terminology, acronyms


Organisation time management
Organisation & time management

  • Difficulty presenting a sequence of events in a logical, structured way

  • Incorrect sequencing of number and letter strings

  • Tendency to misplace items

  • Chronic disorganisation

  • Poor time management: particular difficulties in estimating the passage of time

Organisation & time management

Direction navigation
Direction & navigation

  • Difficulty with finding the way to places or navigating the way round an unfamiliar building

Direction & navigation

Sensory sensitivity
Sensory sensitivity

Sensory sensitivity

  • A heightened sensitivity to noise and visual stimuli

  • Impaired ability to screen out background noise or movement

  • Sensations of mental overload / switching off

Visual stress1
Visual Stress

  • Some people with dyslexic difficulties may experience visual stress when reading

  • Text can appear distorted and words or letters appear to move or become blurred

  • White paper or backgrounds can appear too dazzling and make print hard to decipher

One size does not fit all
One size does NOT fit all…

  • Individuals vary greatly in their profile

  • Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties

  • Key is to develop and implement coping strategies

  • Strategies included: technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy

  • Strategies are prone to break down under stressful conditions which impinge on areas of weakness


  • People with Specific Learning Difficulties are particularly susceptible to stress, compared with the ordinary population

  • Leads to impairments becoming more pronounced

  • As a result many people with Specific Learning Difficulties have little confidence and low self-esteem

Areas of strength
Areas of Strength

  • Specific Learning Difficulties are linked to a range of skills:

    • 'big picture' thinking

    • problem-solving

    • lateral thinking abilities

    • instinctive understanding of how things work

    • originality & creativity

    • exceptional visual-spatial skills

  • Not all people with SplDs will have outstanding talents, but all will have comparative strengths and often demonstrate great perseverance and determination

Case study 1
Case Study 1

  • Undergraduate student who has disclosed that she has dyslexia

  • She was diagnosed at school and is engaged with her learning needs

  • She has had little contact with disability support whilst at university and has not discussed her learning needs with her university lecturers

Case study 11
Case study 1

  • The university disability support service has assessed that she requires the following adjustments:

    • 25% additional time for examinations

    • Examinations to be carried out in a separate room.

    • Two week extended hand-in for assessed coursework

    • Lecture notes to be available one week in advance

Case study 12
Case Study 1

  • What reasonable adjustments would you suggest for this student on their second placement ?

Case study 2
Case Study 2

  • A student is half way through C placement and isn’t progressing as well as you would expect

  • She ‘can’t quite pull it together’ and you have no idea why

  • Her pre-placement form states that she achieves an average academic performance

  • Her performance on B placement was unremarkable.

Case study 21
Case Study 2

  • During a visit by the university tutor you identify the following as areas that need improvement:

  • Lacking consistency in gathering and interpreting patient information required to perform an assessment

  • Difficultly in remembering key facts. Your concerned that the student has knowledge gaps/deficiencies

Case study 22
Case Study 2

  • The student seems very disorganised. Work is sometimes handed in late, the student is often late or in the wrong place

  • Her portfolio is poorly organised and lacks sufficient evidence demonstrating clinical and reflective skills

  • She finds recording information challenging, making many errors and this process is very time consuming

  • She is very, very stressed and anxious at times which limits her ability to perform

Case study 23
Case Study 2

  • What do you think the problem is ?

  • How are you going to manage it ?

Case study 24
Case Study 2

  • What will the university do ?

    • Arrange diagnostic tests for a possible specific learning disability

    • Work with the placement site to develop reasonable adjustments

    • Work with the student to support them

    • Facilitate stress management support at the University

    • Provide additional contact for both the student and the placement site

    • Facilitate post-placement discussions of experiences

Case study 25
Case Study 2

  • What do you have to do:

    • Facilitate and support reasonable adjustments

    • Reasonable adjustments have to be agreed by the placement site, student, university

    • Document your decisions and rationale

Reading strategies
Reading strategies

  • Allow extra time for reading.

  • Present essential reading well in advance of meetings – highlighting important parts if appropriate.

  • Provide opportunities to discuss reading.

  • Make word processed documents ‘dyslexia friendly’:

    • write in a logical sequence

    • avoid small print (use font size 12 or above)

    • use a dyslexia friendly font (arial, verdana, tahoma or lucinda sans are best)

    • use bullet points in preference to sentences where possible

    • use simple words/avoid overuse of jargon or uncommon words

    • do not justify the right hand margin – this makes the spaces between words uneven and harder to read if you are dyslexic

    • space the information so it is not cramped, use short paragraphs to break up dense text

    • where possible print documents on off white/cream paper

Writing strategies
Writing strategies

  • Allow individuals enough time to write up their notes.

  • Try not to disturb individuals when they are concentrating on their documentation.

  • Allow them to write a rough draft on scrap paper which you can check before they write it into the notes.

  • Help students to devise a checklist of key areas to include in certain types of documentation.

  • Consider devising a ‘sample’ or ‘model’ for different types of documentation to show them the level and content expected

  • Allow word processing of reports etc where possible

Memory strategies
Memory Strategies

  • Help the student to invent and use mnemonics.

  • Encourage the individual to use ‘to do’ lists rather than trying to remember.

  • Don’t give too many instructions at once.

  • Prepare printed ‘handover sheets’ covering core information – the individual can add to these but it will reduce the amount they need to write down and avoids things being missed.

  • Help a colleague to draw up a plan highlighting important tasks/ deadlines.

Memory strategies1
Memory Strategies

  • Set clear, measurable targets.

  • Allow enough time for the person to grasp key information, try not to rush them.

  • In the case of procedures allow the person a chance to practice (ideally as close as possible to when you explained it or demonstrated it).

  • Explain things more than once if required.

  • Where possible give instructions in written and verbal form (you could consider using a digital voice recorder to record sets of instructions).

Liaising with colleagues
Liaising with colleagues

  • Try to create an environment which helps colleagues to feel comfortable

    • anxiety will only make problems worse.

  • Don’t let people draw attention to mispronounced words, even inadvertently

  • Try not to use abbreviations as some people find them difficult to interpret and they may mean different things to different people

Useful resources
Useful resources


  • Dyslexia, dyspraxia and dyscalculia: a toolkit for nursing staff