C L I M I C A L RESEARC EDO CATIO N. Supporting nursing students with dyslexia in clinical practice

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1 art & science The synthesis off arj the nufse in the science is ijvedl by act JOSEPHIKE G PATERSON C L I M I C A L RESEARC EDO CATIO N Supporting nursing students with dyslexia in clinical practice White J (2007) Supporting nursing students with dyslexia in clinical practice. Nursing Standard. 21,19, Date of acceptance: October Abstract Aims To determine whether pre-registration nursing students with dyslexia experience specific problems in developing clinical competence, identify what strategies they use and how they may be supported in clinical practice. Method Qualitative case study methodology was used. Stage 1 involved semi-structured interviews with seven students, three support and eight teaching staff, postal questionnaires from nine mentors. In addition to a review of policy documentation. Stage 2 involved a two-year study of four students on their branch programme and included semi-structured interviews with seven mentors. Findings The students' difficulties in clinical practice fell into three categories: dealing with information; performing the role; and administering drugs. Specific supporting measures included: informal and formal support networks; portable information technology equipment; and personal strategies, for example, rehearsing difficult tasks such as the handover report. The students' relationships with their mentors and the type of environment they were working in were key to the successful development of clinical competence. Conclusion Nursing students who have dyslexia have specific learning difficulties in practice. Their response to these difficulties is individual and support needs to be tailored to meet their specific needs. Author Jean White is nursing officer. Office ofthe Chief Nursing Officer, Welsh Assembly Government, Cathay's Park, Cardiff. jean.white@wales.gsi.gov.uk Keywords Education: practical experience; Educational problems; Mentoring; Nursing: education These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at For related articles visit our online archive and search using the keywords. DYSLEXIA IS widely accepted as a specific learning difficulty of constitutional origin. Individuals who have dyslexia experience varying degrees of difficulty in learning to read, write and spell. The problems persist throughout a person's life and are unrelated to intellectual ability (Morgan and Klein 2000). Individuals may also have weaknesses in relation to processing information, short-term memory, sequencing and organising and prioritising activity (Ott 1997). Positive attributes often ascribed to individuals with dyslexia include the ability to process information holistically, resulting in creative and innovative problem-solving in the workplace (British Dyslexia Association 2006). Some individuals may have co-morbidities: dyscalculia, which gives rise to difficulties with numbers and remembering mathematical facts as well as performing mathematical operations; and/or dyspraxia, which is an impairment or immaturity of the organisation of movement causing individuals to appear clumsy (Department for Education and Skills (DfES) 2004). Individuals with dyslexia exhibit a spectrum of strengths and weaknesses. Their specific learning needs pose challenges to them, their lecturers and mentors during pre-registration nursing programmes, particularly in the development of clinical competences. Literature review There is ongoing debate about the nature of dyslexia. For example, in September 2005, a Channel 4 Dispatches programme. The Dyslexia Myth, postulated that the common understanding of dyslexia was not only false but also made it more difficult for some children to receive appropriate help with learning to read. The furore that followed the programme culminated in Lord Addington January 17 :: vol 21 no 19 ::

2 art & science research tabling a motion in the House of Lords in December 2005 about helping people deal with dyslexia throughout their educational and working lives (Hansard 2005). Part ofthe conclusion of this debate was the government's acceptance ofthe British Psychological Society's (1999) definition of dyslexia and recognition that dyslexia is 'a complex neurological condition and people with dyslexia need proper support to develop reading, writing and comprehension skills essential to succeeding in school, in work and in life'. The Disability Discrimination Act 1995 stipulates that organisations have a duty not to treat students with a disability less favourably, without justification, for a reason related to their disability. Dyslexia is classed as a disability under this act. It also requires organisations to make reasonable adjustments if their arrangements place people with a disability at a substantial disadvantage compared with non-disabled people. Nursing schools and their associated clinical partners are therefore required to explore the needs of students with dyslexia and put anticipatory adjustments in place to support them. The individual nature ofthe learning needs of students with dyslexia poses challenges to education and service providers. The Higher Education Statistics Agency (HESA 2006) gathers statistics on students entering higher education. Its data indicate that in the academic years 2002/03,2003/04 and 2004/05, between 2.3 and 2.6 per cent of students declared they had dyslexia. However, many individuals are not identified until adulthood and some people pass through the educational system undiagnosed. This means that the true figure is likely to be higher. Problems in practice Moody (1999) related the typical problems experienced by adults with dyslexia to potential effects on efficiency at work. In the following list, clinical nursing practice examples have been added to Moody's examples to provide appropriate context: 36 January 17 :: vol 21 no 19 :: 2007 Literacy skills - reading and writing reports. Memory - remembering information or instruction, for example, in handover, doctors' rounds and case conferences. Sequencing ability - undertaking a complex activity or procedure involving many steps. Visual orientation - confusing left and right or up and down. Hand/eye co-ordination - may result in poor presentation of written work or difficulty in undertaking some clinical skills. Speech - may talk in a disorganised way, especially at meetings or on the telephone. Organisational skills - poor time management and work environment can look disorganised. Emotional factors - may display anger, embarrassment and anxieties. Findings by researchers examining the performance of nursing students with dyslexia in clinical practice further support some of the areas listed by Moody (1999). Tumminia and Weinfield (1983) found that students had difficulty articulating instructions given to them by others. Shuler (1990) found a disparity between classroom performance and clinical performance; students were disorganised and had difficulty meeting deadlines and in following directions. Shellenbarger (1993) found students had problems following directions and got items in an incorrect order, especially if there was a list of instructions; and had difficulty carrying out procedures where lengthy lists were involved, for example, catheterisation. They also became confused about directions (up, down, left and right). In addition, care plans were completed late and deadlines were missed, and there were errors in charting and writing patient records. Kolanko (2003) noted that individuals exhibited anxiety and felt socially isolated from peers and needed time to process and complete specific activities such as report writing. Self-concept and self-esteem are important in developing a positive attitude to learning and overcoming learning difficulties (Rogers 2002). An individual who frequently experiences failure will come to anticipate failure in future endeavours (Hogg and Vaughan 2002). Riddick etal {1999) compared self-esteem and anxiety in 16 university students with dyslexia matched to 16 control participants who did not have dyslexia. Their findings showed that the group with dyslexia had significantly lower self-esteem than the control group and reported being more anxious and less competent in their written work and academic achievements. Morgan and Klein (2000) considered the external factors that influence individuals' perception of the effect of dyslexia on their lives. The most important is the stage at which dyslexia is first diagnosed and the type of support, emotional and academic, that the individual receives. Adults who are not recognised as having a specific problem as a child receive inappropriate intervention in their education and, as a result, may experience feelings of inadequacy, frustration, anger and resentment. They may have been labelled as 'lazy' or 'stupid', terms they internalised and accepted. An individual's past experiences in a learning NURSING STANDARD

3 environment and self-concept of his or her abilities and performance will affect any future education (Morgan and Klein 2000). Wright's (2000) study ofuk higher education institutions offering nursing courses showed that 24 per cent of respondents feared that individuals with dyslexia posed a safety risk in practice. There are anecdotal reports by students and qualified nurses of problems arising from negative attitudes towards their learning difficulty (Allen 2002, Shepherd 2002). Blankfield (2002) believes that the'biggest "problem" for a nurse with dyslexia is the attitude of non-dyslexic employers, placement tutors and colleagues, who tend to react either with horror or sympathy when dyslexia is disclosed. This is not appropriate or helpful. Trainee nurses with dyslexia need practical discussions about what strategies they can use in the workplace, if any, to ensure they manage any difficulties that may arise'. The review of the literature indicated that individuals diagnosed with dyslexia have specific difficulties related primarily to reading, writing and short-term memory. What was not clear was how individuals with dyslexia coped with these difficulties in developing the clinical competences to become a registered nurse. Much ofthe reported literature was anecdotal and subjective and did not consider the external environmental factors and their effect on student achievement. It was difficult to say with any certainty how education providers - school and service - should select, teach and support nursing students with dyslexia during the clinical element of the preregistration nursing course. Ai ms^^ The aims of this study were to determine the nature ofthe problems experienced by pre-registration nursing students with dyslexia in developing clinical competence, and to identify the strategies they use to achieve the clinical outcomes and establish how they may be supported in clinical practice. lyiethod A qualitative research study using a case study approach was chosen so that, in addition to the personal experiences of individual students with dyslexia, the wider context of nurse education and the health service could be considered. Yin's (1994) description ofa case study as an empirical enquiry neatly summarised the research design needed. Case study methodology investigates both a phenomenon (in this study, nursing students with dyslexia developing clinical competence) and the context in which the phenomenon is occurring (in this study, the clinical component of pre-registration programmes) and relies on multiple sources of evidence to draw conclusions (Yin 1994). The study centred on one school of nursing and the clinical areas it used for the practice element of the pre-registration nursing course. As a result of the small number of students with dyslexia available in stage one, four students from an adjacent school who shared the clinical areas were also interviewed. Two local research ethics committees and the school ethics committee ' granted ethical permission for the study. Permission to participate from students was facilitated by designated officers in the schools to ensure that students retained control over who was told about their diagnosis. In stage one, data were gathered from a number of sources to develop an understanding ofthe context and nature of the problems faced by nursing students with dyslexia. Semi-structured interviews were held with eight admissions lecturers, two from each branch of nursing, three school and university specific learning needs support officers and seven pre-registration nursing students with dyslexia studying in years two and three of the programme. Three of these students took part in a group interview. Postal questionnaires were received from nine clinical mentors who had supported nursing students with dyslexia to identify what problems they encountered and how they supported the students during the placement. University and school written policies in respect to students with disabilities were reviewed, in particular guidance or standards for selection and support. Findings from stage 1 were used as a guide to the data collected in stage 2 and influenced what was discussed with the students and clinical mentors. Stage 2 involved a longitudinal study of four nursing students with dyslexia studying the two-year branch element of the course. One adult branch student went on maternity leave halfway through and withdrew from the study. The branch allocation for the remaining students was two adult, one learning disability and one mental health. This was the total population of nursing students in that year's intake who had declared they had been diagnosed as having dyslexia. At the commencement of the branch programme, a life history in relation to each individual's specific learning difficulty was recorded. Students were interviewed after each clinical placement (five occasions), to discuss areas of difficulty and strategies that had been used to overcome the difficulties. During some of these interviews students chose to demonstrate specific activities that were either a problem or a helpful strategy. January 17 :: vol 21 no 19 ::

4 art & science research A purposive sample of seven clinical mentors was interviewed (one mentor from each year per student) to discuss the strategies they had used to support students in practice. Interviews followed students' completion of that placement. Mentors were approached only with the express permission ofthe students. Following transcription and checking for accuracy, each piece of data, for example, interview transcript, was reviewed and coded into themes and patterns. For the fine grain and intensive analysis of the large volume of data gathered in stage two, the NVivo software package was used (Gibbs 2002). The thematic review identified areas of similarity and contrast and evidence of relationships between events, environments and behaviours. Data were gathered for stage 1 between July 2003 and November 2003 and for stage 2 between September 2003 to July Findings Difficulties in clinical practice The first research question sought to identify what, if any, problems were experienced by nursing students with dyslexia in clinical practice. Evidence from both stages of the study suggested that all students had some problems in practice as a result of having dyslexia. Students in this study typically had problems with spelling, particularly everyday words such as 'there', 'they're' and 'their', and sometimes transposed letters within words. They were slow at reading and writing and had to read text a number of times to gain comprehension. Students had difficulty in reading and pronouncing unfamiliar, long or unusual words and had untidy or childlike handwriting. Poor short-term memory and concentration span were particularly troubling. These general problems led to difficulties in specific areas of practice, summarised below under the three headings; dealing with information; performing the role; and administering drugs. Dealing with information Receiving and giving handover report. Respondent A (nursing student stage 1) said: 'I find handover really hard work. I find a lot of the people go too fast and I can't keep up with what they are saying and writing down what they mean.' This inability to write down key details fast enough at handover was also reported by the nine nursing students with dyslexia in McCandless etal's (2004) study. > Completing the nursing records. 38 January 17 :: vol 21 no 19 :: 2007 Writing transfer letters and filling in forms. Highly structured forms or ones with tick box format were not problematic. Reading other people's handwriting, for example, doctors' handwriting in medical records. Performing the role Remembering to do things. Remembering detailed instructions. Respondent H (nursing student stage 2) said: 'I find it worrying when lam told to pass on a complicated message, like from the doctor to the nurse in charge about changes in the patient's care.' Managing and prioritising workload. Organising complex tasks, for example, discharge planning. Administering drugs y Reading, spelling or pronouncing drug names on charts and labels, particularly doctors' handwriting on prescription charts. Doing drug calculations - only those students who had co-morbidity of dyscalculia. Evidence from the study identified a range of factors that exacerbated the problems students experienced in practice, these included: dealing with unfamiliar names and terms; having a limited vocabulary; pressure to complete in a given time; the speed needed to do things in practice; being distracted by things going on around them; and negative or unsupportive attitudes and behaviour of others because this affected confidence and self-esteem. Disclosure Dyslexia is an 'unseen' disability. Therefore, for a student with dyslexia to gain specific or additional support in practice, disclosing diagnosis and identifying specific learning needs is an important first step. In both stages ofthe study it was clear that the students made conscious decisions about disclosing their diagnosis to others, which were influenced by a number of factors. These factors related to their previous experiences of disclosure and the context in which they were disclosing. The main factor was in relation to students' fear about potential negative consequences of disclosure and the potential challenge to their desire to become a registered nurse: 'If they think you're having a problem it gives them reason to give you even more stigma when you go back out. If you start saying "Ah well, I've got this problem" it's "what are you doing in nursing then if you've got problems doing this?"' (Respondent B, nursing student stage 1). NURSING STANDAiD

5 Fear that disclosure would result in a 'poor' response from others, with a potential for subsequent discrimination, was paramount in disclosure decisions. Social psychologists have recognised that people are guided by a 'self-enhancement motive', in other words, they are motivated to have a positive self-image and associated self-esteem (Hogg and Vaughan 2002) and will avoid circumstances that challenge this positive self-identity. The 11 students who took part generally agreed that individuals should tell others about their specific learning needs; however, most advised caution and the need to recognise that there might be consequences to disclosure. There was evidence that the students used strategies to get others to view them in a positive light, in other words there was evidence of 'impression management' (Goffman 1959). The students were careful about what they disclosed and to whom they disclosed information about their dyslexia. Being labelled as dyslexic or as someone with specific learning needs has a major effect on bow an individual perceives him or herself and therefore maintaining control over who knows about the disability is important to the individual. Disclosure is a matter of personal choice and rather than imposing on individuals a requirement to disclose, evidence from this study supports Galambos's (1998) view that it is better to put strategies in place to assist the individual in understanding the complexities and possible consequences of disclosure. Emotional aspect of diagnosis The diagnosis of dyslexia bad a negative impact on the students' self-image, particularly those diagnosed when they were adults, which in turn impinged on their feelings of self-worth and performance in practice. The emotional aspect of being a nursing student with dyslexia reflects the work of Morgan and Klein (2000). It was also evident in Morris and TurnbuU's (2006) study of 18 nursing students witb dyslexia, from which tbey observed that being in practice was 'emotionally challenging' leading some to use 'strategies of avoidance'. The students in this study also described instances where they either openly refused to carry out specific tasks or got a colleague to do an activity for them. Support in practice The study identified belpful measures undertaken by students or tbeir mentors to deal with specific difficulties students experienced in practice, which were caused by dyslexia. Equipment AW students found tbe use of laptop computers invaluable for tbeir tbeoretical work. However, the successful use of IT sucb as handheld computers and laptops in clinical practice was limited, mainly because of resistance from qualified staff to their use, fear for the safety ofthe equipment and the need for the student to learn bow to use it. Tbis suggests tbat providing IT equipment for practice may not have the same outcome for all students because using tecbnology requires interest and dedication to learn. Support network Students had access to a range of officers in tbe scbool and university who could provide additional support. Tbe students sought tbem out mainly for assistance witb tbe tbeoretical element oftbe course, access to additional equipment or personal problems. Students relied on an informal network of family and friends for belp witb course work. Students in stage 1 reported a lack of access to dedicated support staff during clinical practice, and it being awkward to return to tbe university to seek belp because of sbift patterns and travelling. One solution they proposed was the establisbment of peer support groups, wbicb could function in school and practice. It was clear from students' descriptions tbat tbe personal relationship tbe student bad with different members of staff ratber tban his or ber designated role was tbe deciding criterion in wbether to seek belp from tbat person. Tbis suggests tbat supporting the needs of students should remain a core element of most teaching roles in the school and clinical areas. It also suggests tbat staff training should include instruction on bow to support students witb specific needs. Me/?to/-sNeary (2000) identified 20 ways in wbicb the mentor could provide either belp or support to tbe mentee. Five areas were evident in stage 2 and bad a bearing on tbe specific needs of students witb dyslexia: Personal development - mentors and mentees need to develop an appropriate professional, supportive relationsbip. How effective their relationsbip was witb their mentor had a direct effect on bow successful and confident tbe student was on placement. Students valued mentors wbo were 'approacbable', 'friendly', 'relaxed' and wbo bad 'time' and 'patience' to show tbem how to do things and allowed them to ask questions. Students and mentors spoke consistently about tbe need for time togetber and tbe importance of listening to tbe needs of students. It was important for students not to feel pitied but to receive 'belp and encouragement' in a positive way and to have things explained. Challenge tbe mentee to face up to opportunities and problems and recognise personal strengtbs and weaknesses. For example, one mentor in tbe second year pushed a student to take on ber bay of patients on the ward to organise and report on care, and encouraged tbe student to give tbe handover January 17 :: vol 21 no 19 ::

6 art & science research report each day that tbey worked togetber. Althougb the student found this experience 'draining', she did have a sense of achievement from doing it. If the support and environment is overly controlled the students would not get the opportunity to learn bow to cope, wbicb would, in turn, not prepare tbem for wben they are qualified and tbis level of support is not available. Students welcomed constructive feedback on tbeir performance, particularly in respect of tbeir written work. Some mentors took the time to discuss witb students wbat should be written in the nursing records, and provided examples of what should be written. Dealing with difficulties. All tbe students bad difficulty with terminology and drug names. The mentors identified tbe importance of helping the students deal with this difficulty and many reported helping the students with tbe pronunciation of terms/drug names. Planning - helping tbe mentee plan bis or ber learning. Many of tbe mentors tbougbt carefully about activities witb wbicb the student should be involved. Tbe more successful interactions were based on discussion witb the students about their needs ratber tban setting challenges that could be daunting or by over-restricting the experience. summary oftbe coping strategies developed by the students in botb stages of tbe study: 40 January 17 :: vol 21 no 19 :: 2007 Carried a nursing and/or ordinary dictionary or spell cbecker device. Used coloured paper, overlays or tinted glasses. Asked otbers for belp or sougbt clarification from otber sources, for example, to check tbeir comprebension of information, the accuracy of reports tbey had written, spelling, pronunciation and drug calculations. Looked up terms used in the patient's records. Used a form of shorthand when taking notes, for example, # for fracture. Learned and practised saying new words and terms. Respondent H (nursing student stage 2) reported: 'Sometimes the mentor has got to say to me wbat the drug name is. So what I've done for that is, I go home and look in my BNF [British National Formulary] and write it and try to say it and learn it. And I recognise it then, if it comes up again, I know what it is.' At handover, concentrated on tbe important aspects oftbe patient's care. Rehearsed wbat would be said at bandover. Wrote things down or bad the mentor write things down for the student tbat could be carried witb bim or ber during tbe shift. Sought a quiet environment, free from distractions, wben carrying out written tasks or otber activities that required concentration. Arranged sucb tasks so there was sufficient time to complete tbem and undue pressure to perform was avoided. Ratber tban solely relying on otbers to belp them, the students also recognised tbe need to be vigilant and cautious, particularly in tasks sucb as reading drug cbarts. One student said that if in doubt she would check, letter by letter, the drug listed on tbe administration chart witb tbe name on the drug container. Many of tbese strategies would be helpful to any nursing student not just those with a specific learning need. Enabling and disabling environments During the interviews witb the students and their mentors for stage 2, themes emerged wbicb related to tbe nature of the placements. All four students consistently identified placement characteristics that they found either enabling or more cballenging in tbeir achievement of clinical competences; their preference for less acute clinical areas supports Morris and TurnbuU's (2006) findings. Tbe characteristics of a 'good' placement cited by tbe students were: Working in small, closely knit teams of staff tbat accepted and supported tbe student, for example, long-stay learning disability community home or a post-operative recovery unit. Small teams allowed tbe student to get to know the staff members well and they had no difficulty in remembering staff names. Areas that had open, friendly, relaxed atmospheres, where the students felt comfortable in asking questions, had good relationships with tbeir mentors and felt happy disclosing that they had dyslexia. Stressful environments made tbe students less able to cope witb their dyslexia. Tbis supports Kolanko's (2003) findings tbat an accepting environment where students can disclose their diagnosis is essential. Working with small numbers of patients, preferably wbere there were clear protocols for care or a structured routine; working in areas wbere patient cbangeover was infrequent so that tbe student got to know the patients well, NURSING STANDARD

7 for example, learning disability long-stay or stroke rehabilitation units; or working with one patient at a time as in the community or a post-operative recovery unit. There was a sense tbat the students could focus tbeir attention on tbe patient witbout having to worry about remembering various other tasks. Minimal report writing, preferably on standardised forms wbere little free text was required. In keeping with the preference for a relaxed work atmosphere, tbe students preferred not to be pressured to complete tbe writing tasks. One student found working on night duty easier because tbere was more time to write reports. > Areas tbat used aids for staff to assist tbem in identifying patients and giving appropriate care. One acute 30-bed hospital ward used printed handover sheets listing tbe patients to be cared for on that shift. Tbe sbeet also identified wbicb team of nurses was caring for tbem and specific instructions or conditions tbat should be noted. Tbis printout came from the computerised patient records generated on tbe ward and its use reduced the need for each nurse/student to take down individual dictated notes at handover between sbifts. Other units, particularly in areas where patients had communication difficulties, placed pictures of patients on drug cbarts to aid identification. Students preferred substantial continuous placements during tbeir course ratber than ones broken up by visits, other sbort placements, bolidays or tbeory weeks. Tbe students also preferred going to areas where they bad a clear idea of what to expect and having reading weeks before submitting assignments. Tbe clinical areas tbat were more cballenging for tbe students were those that bad: variable, unpredictable and pressured work, where students would need to remember a range of activities and had to prioritise their workload; report writing that required large volumes of unstructured free text; many unfamiliar terms, equipment, instruments and procedures, for example, operating room or intensive care; and where tbere were staff tensions resulting in an unsupportive atmosphere. Limitations Dyslexia is a 'bidden' disability and therefore only those students who bad disclosed to tbe university were eligible to be included in tbis study. It is likely that some individuals were excluded because they chose not to disclose. Students in botb stages spoke about other students who had chosen not to be assessed or disclose tbeir difficulties. NURSING STANDARD It is acknowledged tbat 11 participants witb dyslexia is a relatively small sample and that basing the case study in a particular geographical area also has implications for tbe wider generalisation of the research. Conclusion Evidence from this study demonstrates that nursing students with dyslexia have specific problems in clinical practice. However, tbe range and severity of tbese difficulties is unique to the student, requiring any support to be individually tailored to the student's needs. Tbe mentor's relationsbip with the student is key to his or her development of clinical competence (Twentyman etal 2006). None oftbe mentors in tbis study bad received instruction in supporting students with a disability and all felt unprepared for tbeir role. Therefore, mentors and otber staff involved in teaching students with specific learning difficulties need preparation and ongoing support to fulfil tbe role adequately. Mentors need to establish relationships with students that are open, non-judgemental, friendly and relaxed, and in wbich students feel able to disclose that tbey bave dyslexia and discuss tbeir learning needs witbout fear of discrimination. Students with dyslexia must be collaborative partners in determining how tbeir learning needs should be met. Mentors sbould be able to access expert advice and support from the university student support services and be able to contact designated special needs officers in tbe school to assist in the teaching, support and assessment of students in practice. Tbey should also be able to access support wben faced with difficulties in determining student competence or lack of it. This support could be from specific 'practice facilitator' officers employed to support mentors or from link lecturers or other educator roles. Students witb specific learning needs must not be perceived as a 'problem'; ratber, staff in clinical practice should work witb tbe scbool to consider ways to adjust tbe environment to accommodate students' needs while ensuring that standards of patient care remain unaffected. Education providers need to consider tbe culture in the respective organisations and the effect it has on students' disclosure decisions. All officers involved in tbe teacbing and assessment of pre-registration nursing students need to be aware of individuals wbo require additional specific support. Evidence from tbe study suggested tbat selection decisions related directly to bow admissions staff reconciled tbe tension tbey felt about upbolding the rights of students to seek nurse registration with tbe potential risk tbey tbougbt students posed to patients. Guidance and support sbould be made available to January 17 :: vol 21 no 19 ::

8 art & science research admissions staff by, for example, student support services or organisations such as SKILL: National Bureau for Students with Disabilities ( By interviewing the students after each of their six substantive clinical placements during the two-year branch programme, it was possible to develop an understanding of the types of environments with which the students either found it easier or more difficult to cope. This suggests that it may be possible to organise the students' programme to offer practice placements IMPLlCATIOiNS FORPRftejlOE Clinical staff should recognise that dysiexic individuals have difficulties in dealing with information, remembering things, organising and prioritising their work, completing complex tasks and administering drugs. Mentors and educational staff should receive preparation in how to support students who have specific learning needs. Students should be supported to develop appropriate coping strategies in clinical practice so that they can provide safe, competent nursing care. where they have the best chance of developing competences. However, ultimately, the responsibility lies with individuals to take responsibility for their learning needs, recognise where they have problems and, with support, develop actively appropriate coping strategies that will enable them to practise safely as registered nurses because levels of support are likely to diminish on qualifying. Greater attention is now being focused on the needs and rights of disabled individuals in society than at any time in the past. It is, therefore, fitting that the Nursing and Midwifery Council (NMC) has included specific instructions that mentors, practice teachers and lecturers should have preparation to work with disabled students (NMC 2006). These standards come into effect in September During 2006, the NMC has also significantly revised and enhanced its guidance in respect of disabled students and registered nurses, in light ofthe revised Disability Discrimination Act 2005 NS The views expressed in the article are those ofthe author and do not constitute National Assembly for Wales policy. References Allen L (2002) Dyslexia is not a cause for concern... ignorance is. Nursing Standard 16, 35, 30. Blankfield S (2002) Greatest problem with dyslexia is attitude. Nursing Standard. 16, 42, British Dyslexia Association (2006) What is Dyslexia? whatisdyslexia.html. (Last accessed: November ) British Psychological Society (1999) Dysiexia, Literacy and Psychoiogicai Assessment. Report by a Working Party of the Division of Educational and Child Psychology. British Psychological Society, Leicester. Channel 4 (2005) Dispatches: The Dyslexia Myth. Transmitted September com/news/microsites/d/dyslexia_ myth/ (Last accessed: November ) Department for Education and Skills (2004) Delivering SIdlls for Life: A Framework for Understanding Dysiexia. docbank/index.cfm?id=7073. (Last accessed: November ) Galamhos D (1998) To disclose or not to disclose: a question for adult learners with learning difficulties. Unpublished PhD thesis. Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education, Toronto University. Wharrad H (2004) DysPEL Dysiexia and Practice Environment Learning in Nursing. resources/methods/practicals/ Gibbs GR (2002) Quaiitative Data Anaiysis: Expiorations with NVivo. dyspelst681/ (Last accessed: December ) Open University Press, Milton Keynes. Moody S (1999) Dysiexia in the Goffman E (1959) The Presentation Workplace, of Self in Everyday Life. Anchor dyslexia.com/docs/dyslexia-inthe-workplace.pdf (Last accessed: Books, New York NY. 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Nursing Education Perspectives. 24, 5, Ott P (1997) How to Detect and Manage Dyslexia. A Reference and Resource Manual. Heinemann, Oxford. McCandless F, Sanderson-Mann J, Riddick B, Sterling C, Farmer M, Morgan S (1999) Self-esteem and anxiety in the educational histories of adult dyslexic students. Dyslexia. 5, 4, Rogers A (2002) Teaching Adults. Third edition. Open University Press, Milton Keynes. Shellenbarger T (1993) Helping the dyslexic nursing student. Nurse Educator 18, 6, Shepherd K (2002) People with dyslexia are quite capable of nursing. Nursing Standard. 16, 36, 30. Shuler SN (1990) Nursing students with learning disabilities: guidelines for fostering success. Nursing Forum. 25, 2, Tumminia PA, Weinfield AM (1983) Teaching the learningdisabled student. Nurse Educator 8, 4,12-14, 20, 26. Twentyman M, Eaton E, Henderson A (2006) Enhancing support for nursing students in tiie clinical setting. Nursing Times. 102, 14, Wright D (2000) Educational support for nursing and midwifery students with dyslexia. Nursing Standard. 14, 41, Yin RK (1994) Case Study Research: Design and Methods. Second edition. Sage, London. 42 January 17 :: vol 21 no 19 :: 2007

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