Scoil Na hAtrachta, an Cnaimhseachais agus na gCoras Slainte UCD

1. Development and Evaluation of a Clinical Needs Assessment (CNA) used to Support Student Nurses and Midwives with a Disability  Dr S. O’Toole, F. Howlin & Dr P. Halligan Scoil Na hAtrachta, an Cnaimhseachais agus na gCoras Slainte UCD UCD School of Nursing, Midwifery and Health Systems Ireland TCD Nov 2012

2. Introduction & Background • Background & context • Nature of disabilities • Students with disabilities & third level education TCD Nov 2012

3. Association for Higher Education and Access Disabilities (AHEAD) (2011) TCD Nov 2012

4. Nursing & Midwifery Students Registered with a Disability *UCD/SNMHS = University College Dublin/School of Nursing, Midwifery & Health Systems • 1: 19 students • Dyslexia most common • Varied types of disabilities • More than 1 disability • UCD/SNMHS* stats: • 2010/11 = 49 • 2011/12 = 51 • 2012/13 = 46 TCD Nov 2012

5. Disability Profile UndergraduateNursing & Midwifery Students in UCD TCD Nov 2012

6. Aim Present the development and evaluation of a Clinical Needs Assessment (CNA) for Nursing and Midwifery students with a disability in clinical practice TCD Nov 2012

7. Phase 1 – Review • Review of current academic needs assessment • Discussion of core competencies: • UCD/SNMHS • Access centre disability team • Key clinical stakeholders • Experts who support and advise people with disabilities (AHEAD & SKILL) TCD Nov 2012

8. Phase 2 – Exploration • Exploration of the accommodations • Examination of five domains and standards • Identification of core competencies • Explore literature on needs assessments • Research literature • Disability support services • Refinement of the draft CNA • Competencies should not screen out individuals with a disability • Domains of Competence Source: An Bord Altranais (ABA) TCD Nov 2012

9. The Clinical Needs Assessment • Conducted by Disability Liaison Team • Individualised • Assistive Technology (AT) • Not static • Collaboration TCD Nov 2012

10. Clinical Needs Assessment Part 1 • Background Part 2 • Detailed history • Reasonable accommodations Part 3 (Clinical site) • Reasonable accommodations Part 4 (Std & Clinical site) • Review of reasonable accommodations ..\..\DSS 2012\CNA\Sample of CNA Part 3.pdf TCD Nov 2012

11. Phase 3- Evaluation • Sample (student profile) • Data collection: e-mail, Interview: (semi-structured, open ended, individual, audio taped) • Ethics – confidentiality and anonymity • Thematic Analyses • Key findings: • The Process of Disclosure • Supports • Environment • Personal Student profile • 18-21 [school leavers] • Female (mainly) • Irish • Single • Type of disability: • Dyslexia = 8 • Mental Health =1 • SOI=1 • Disclosure: 7/10 • 3 programmes: BSc G, M, P TCD Nov 2012

12. The Process of Disclosure TCD Nov 2012

13. Process of Disclosure I don’t think that the person I was placed with [preceptor], I don’t think that she knew to be honest. I mentioned it to her a few times but a lot of people say, oh I have a difficulty in writing and stuff like that. (Int 2) ...when you first go into placement there is so much to take in and you don't want to single yourself out. (Int 1) I had a different preceptor almost every day which I found really difficult because you were constantly explaining to someone about your difficulties ...(Int 3) When you are on the ward there isn’t time to be discussing things like that (disclosure) (Int3) CPC came down and explained to my preceptor that I have a learning disability and when she left, I was told by the preceptor, yes you have a learning disability but don’t become a victim about it.(Int 3) ...you didn't want to, in front of everyone say, well actually I have dyslexia, it might take me a couple of minutes to catch up. You don't want to be making an issue of it again. (Int 5) TCD Nov 2012

14. Process of Disclosure I found that the forms that we filled out were helpful so the pressure was taken off me, we didn't have to verbally disclose, I just handed the sheets and then they could ask me questions if they needed to... (Int 5) You are not explaining yourself and getting all worked up and embarrassed and psyching yourself up to disclose (Int 5) - I decided to tell them just, ... not to watch my back, ... but say if something did happen at least I would know that I have told them I have dyslexia (Int 4)

15. Supports TCD Nov 2012

16. Supports ...And the nurses were really good like they'd quiz you and you are kind of put on the spot and you feel a bit like, oh oh, when someone is throwing a question at you. You just have to get on with it and its probably better that you have to try (Int2) ...she'd [nurse] say a big long word and I'd try and keep repeating it and then someone else might say, oh can you grab this when you are in there as well (Int 4) ...I kind of felt when that [CNA] was done there was a lot of things mentioned that didn't really happen. There wasn’t much put in place if you know what I mean. (Int 3) TCD Nov 2012

17. Supports ... Definitely the CPCs coming down ... and go through things with me, different clinical issues and stuff like that that I wouldn't have been aware of before ... she would just take a bit of time if she had it to go through things. And I just wanted to say it was absolutely fantastic (Int 3) I didn't find there was any difficulties as such only when it came to reading... a handover sheet and some of the words I just hadn't a clue how to pronounce, I didn’t even know where to start pronouncing them. That would have been difficult. (Int 4) When I was on placement a few things happened that could have knocked me back, that could have made me ill again…I got upset one day in clinical placement and my CPC came to me and made me a cup of tea and calmed me down and was someone to talk to. And I found that was really, really helpful for me. (Int 5) I didn’t really have any problems as far as dyslexia (Int 2) I found the support of the other students, knowing someone else was going through the same thing...really helpful...they can understand what you are saying to them.(Int 5)

18. Environment TCD Nov 2012

19. Environment ...they are all so busy and not everyone remembers or whatever...I found in some situations the nurses just didn’t have the time to take us on, and in your first placement, you take a little more time, you know, you don’t know how to do everything when you first go to the ward. Sometimes the nurses would be like; oh I will do it, instead of taking the time to teach you or whatever. (Int 2) I had a different preceptor almost every day which I found really difficult because you were constantly explaining to someone about your difficulties and then there was no consistency about what you were learning and you were nearly starting from scratch every day …my fault was not really telling people (Int 3) But I found that interview [Occ health] really terrible, it was really stressful... a terrible experience. I came out nearly in tears, it was dreadful... he [DR]was very blunt and not sensitive to my disability. But at the same time I think what he was trying to do was to see how far he could go before I cracked, to see if I would be able for the pressure of nursing... knock my confidence and it did take me a while... I was questioning myself again was I actually able for this course, was I able for this nursing? (Int 5) TCD Nov 2012

20. Personal TCD Nov 2012

21. Personal Just don’t want to be making a big issue all the time (Int 3) ...unless you are really confident enough to go up to your preceptor and say, can I have a word with you, you are not ever going to be by yourself with her….I never actually got the opportunity to just say it to her ( Int 1) I'd bring them [list of words] on placement with me so I'd flick through them (Int 3) you know what you are able to do and what you are not able to do...(Int 1) At the start though I found the communication with the patients difficult...because when I was coming from school where you are always looking up to someone else; whereas when you go into clinical placement, they are looking up to you and they expect you to know; like the roles have completely shifted (Int 4) TCD Nov 2012

22. Conclusion • The CNA bridges the gap in provision of student support between the academic and clinical environment • The communication re student accommodations between academia and clinical areas requires further improvement • Experience of students were mixed re disclosure and supports received • Environment played a major role in the experience of disclosure and support. Consideration needs to be given to the environment and its impact on these areas. • Recognize that supports are not unilateral but interdependent between clinical, academia and the student TCD Nov 2012

23. Relevance to Clinical Practice Ongoing disability awareness training for all professionals and incorporate into all education programs. This will ensure that staff are up to date and have the necessary knowledge and skills in providing disability support Educate students with a disability re the transition to clinical practice (i.e. terminology, word pronunciation, abbreviations) Improve communications between academic and clinical areas re accommodations and support Continue to monitor the provision of supports to ensure that students needs are fully met Seek ways to conduct research into larger populations (i.e. students with different disabilities and from all professions) Disseminate findings from evaluations to all who support students with a disability TCD Nov 2012

24. Acknowledgements Thanks to, clinical partners, colleagues and students Special thanks to AHEAD and UCD Access Centre for their support Further information: Frances Howlin 00 353 1 7166563 frances.howlin@ucd.ie Phil Halligan 00 353 1 7166420 phil.halligan@ucd.ie TCD Nov 2012

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