Faculty beliefs related to admitting and educating nursing students with disabilities

A dissertationUniversity of Minnesota

By Diane Dahl, PhD, RN

Objectives

Participants will be able to: Define personal definition of disability . Contemplate belief related to admitting and

educating students with disabilities. Recognize behaviors that may contribute to

oppression that students with disabilities experience.

Background of the Study

Past personal history of educating a nursing student with physical disabilities.

Nursing Programs continue to raise questions and concerns related to admitting and educating nursing students with disabilities.

Purpose of the Study

Explore faculty beliefs related to admitting and educating nursing students with disabilities.

The issues are complex and are not well understood based on past quantitative research.

Should lead to a deeper understanding of an important area in nursing.

May encourage faculty to contemplate their own beliefs.

Encourage review and revision of admission and curricular policies for nursing students with disabilities resulting in appropriate and fair policies.

Theory and Method

Framework of Oppression

Iris Marion Young (1990)

Medical/Individual Model of Disability

Social Model of Disability

Michael Oliver (1993)

Framework of Oppression

Five Faces or Forms of Oppression

1. Exploitation – process of transfer of the results of the labor of one social group (oppressed group) to benefit another.

2. Marginalization – groups of people are excluded from useful participation in society.

3. Powerlessness – imbalance of power.

4. Cultural Imperialism – universalization of a dominant group’s experience of culture, and its establishment as the norm.

5. Violence – random and unprovoked attacks of a person physically or of their property.

“The conscious actions of many individuals daily contribute to maintaining and reproducing oppression, but those people are usually simply doing their jobs or living their lives, and do not understand themselves as agents of oppression”(Young, 1990, p.41).

Medical/Individual Model of Disability Emphasis on disability as a disease in need of

a cure. Disability viewed as a deficiency or

abnormality and considered negative. Disability resides in the individual and the

remedy is cure or normalization of the individual (Blacklock, 1995).

Social Model of Disability

The problem of disability exists; it does not reside in the individual, but within the society.

“Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society” (UPISAS, 1976. p.14).

Proponents state society needs to change, not individuals.

Methodological Framework

Discipline of Nursing Feminist Beliefs Interpretive Research

Research Method

Purposeful sample of 10 full-time nursing faculty from institutions offering baccalaureate degrees.

Four private institutions and three state institutions from the state of Minnesota.

Experience in teaching clinical and theory to undergraduate nursing students.

Minimum five years experience as a faculty member.

Data was obtained from two separate audio-taped, hour long, open-ended interviews.

Second interview was to further increase understanding and for clarification if needed.

Data Analysis

Interviews were transcribed. Completed first reading using transcript and

audio tape (first and second interview). Formulated questions for the second interview

to increase understanding and clarification if needed.

Constructed meaning units, labels, and then themes with supporting data.

Questions Posed

1. Explore personal definition of disability.

2. Describe their own experience as faculty admitting and/or educating a student with disabilities.

3. Discuss admission criteria related to functional abilities if used by their programs.

4. Relate their definition to a medical or social model framework of disability (second interview).

Findings

I. Participant’s Stories

Themes:

1. A disabled nursing student desiring multiple reassurances that she could successfully complete the nursing curriculum.

2. Pre-admission counseling for prenursing students with disabilities.

3. Ethical complexity of educating a student that may not find employment.

4. Defeatist attitude.

5. Non-disclosure/disclosure of disabilities

6. Lack of information about the disability.

Formally Counseling Prenursing Majors

Diane: How did you help her to become aware of what the nurse’s role would be or how did she learn about it?

Alice: Well, she had an aunt who was a nurse and then the prenursing course−we bring a lot of different nurses in−who talk to, tell their stories about the nurse because it’s kind of an experiential type of experience.

And she also got to follow a nurse and shadow them in the clinical setting and so I think that was a big eye-opener for her. And she, we made a special person attempt−an interpreter was with her and when she shadowed the nurse I think that’s when she really became clear, to her, kind of where that gap is.

Disclosing Disabilities

Wendy reported hearing the following statements from those who did not want to disclose their disabilities: “I wanted to be like my classmates for one time in my life,” and “I want to be like my peer group and I am not.”

Forms of Oppression: Marginalization concern about what role a disabled nursing

student could have in nursing.Cultural Imperialism shadowing an able-bodied nurse, a member of

the dominant group in nursing. students with disabilities beliefs that they will be

perceived negatively by the dominant group.

II. Personal Definition of Disability

Themes:

1. Outside of the Normal

2. Unable to Perform/Function

3. Broad-based Definitions

4. Linking Disability to Requiring an Accommodation

Outside of Normal

Marcia: Well, you know that’s a tough one because there are so many definitions of what normal is. I guess probably−a disability in my definition would include somebody who cannot complete the skills that are expected of them, whether that means communication or the physical skills or the learning, like we talked about the learning disabilities, so someone who cannot complete the expectations that are outlined within whatever program that they are in.

In the second interview, Marcia added,

I believe it truly is someone who is outside of the norm in completing skills. And I hate using that word norm−normal−but it is someone who wouldn’t be able to complete the expectations that are expected of anybody else in the program.

Vicki: I guess I think of disability as being a deficiency in some physical or mental capacity.

In the second interview, Vicki expanded on her original definition.

Well, I guess the one thing I would react to in that definition is the word deficiency because it seems like it has a negative connotation. But when I think of disability, I’m trying to think that if there’s any examples that I can think of where it’s normal

−where there isn’t something that’s lacking like vision, hearing, dexterity, so yeah, you know I’m not sure if I can come up with a different word that’s not−not negative. I guess, well alteration, alteration could be non-negative sounding−instead of a deficiency, an alteration.

All definitions supported a belief in the medical model of disability; the disability resides within the individual; the goal is normalization.

These definitions may inform nursing practice. This practice may result in the oppression of

nursing students with disabilities.

III. Admission Criteria Statements

Physical, mental, and behavioral performance requirements

Nursing admission criteria documents in 4 of the 6 schools.

Two schools had disability documents that applied to all programs.

Several participants were not aware a document existed, or were unsure of what it said or how it was used.

Examples of Use

1. Using an attribute or activities statement as a means of helping students be proactive in seeking accommodations.

2. Used as a gate-keeping tool to screen out students with disabilities.

3. Applied to progression issues if a student were to become disabled during the program.

Admission Criteria Statements…

were developed in response to admitting and educating a nursing student with disabilities.

define nursing curricula from a medical model framework.

do not encourage movement toward a barrier-free environment.

discourage students with disabilities from considering nursing as a career.

IV. Safety

Safety of patients Safety of nursing students Employment requirements of safe care Student awareness of safe employment

environments

Marcia: I think that my concern is for the client, I mean ours is two-fold really when we’re in education, we’re concerned about the student. We advocate for the student. But we also have to think about the safety of our client, and if they are in a position where they are not safe and able to care for their client, I don’t feel okay with that.

No documented studies that would support students with disabilities have more unsafe episodes or have harmed themselves at a greater percentage than do other students.

Assumption is made by nursing faculty that there is an increased safety risk.

Unconsciously contribute to the oppression nursing students with disabilities experience.

Other Themes

V. National Licensing Exam

VI. Disclosure of a disability

VII. Student self-awareness of strengths and limitations

VIII. Post-graduation employment

IV. Nursing faculty themes

Implications for Nursing

Through dissemination of this study, nursing faculty will:

take time to contemplate personal beliefs related to admitting and educating a nursing student with disabilities.

dialog about beliefs as they relate to mission and philosophy.

consider assumptions made when defining the nursing meta paradigm.

consider the implications of developing and implementing curricula using the medical model.

contemplate being participants as agents of oppression.

explore the impact of developing curricula using the social model of disability.

change admission and educational policies that are oppressive to students with disabilities.

Limitations

Always more questions to ask. Limited member checking. Faculty voice – interested participants versus

others.

Suggestions for Further Research

Repeat study interviewing an increased number of faculty from different regions.

Interview nursing students with disabilities related to their admission and educational experiences.

If programs chose to move to a social framework for admission and curricular design, it would be important to research the effects.

Questions?