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An exploration of the concept of reasonable adjustments in pre-registration nursing education in Scotland

Craig, Anne Marie

[Thesis]. Manchester, UK: The University of Manchester; 2018.

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Abstract

As part of their statutory Public Sector Duty universities and practice learning partners need to provide reasonable adjustments to support pre-registration nursing students with disabilities. Support measures should meet students' individual needs while maintaining academic and professional standards. Anecdotal evidence highlights inconsistencies regarding the availability and type of reasonable adjustments employed within and between academic and practice settings. This study therefore explored the concept of reasonable adjustments in Scottish pre-registration nursing education. A sequential, explanatory, mixed-methods approach underpinned by pragmatism was adopted to generate and organise the data. Various non-probability sampling techniques were implemented to access the maximum number of participants. Data were collected via a telephone survey with eight respondents during phase one. Twelve academic staff; eight Practice Education Facilitators and one lecturer joint appointee (n=21) participated in phase two. Seventeen participants contributed to five focus groups and four agreed to be individually interviewed. Data analyses included descriptive statistics, descriptive and thematic analysis and documentary analysis prior to synthesising the data to augment the findings. The findings revealed considerable differences across Scottish pre-registration nursing education programmes. Processes to identify and implement reasonable adjustments varied although participants wanted to offer students support that facilitated equal opportunities. However the types of reasonable adjustments available were influenced by attitudes, disclosure, educational setting, experiences, and perceptions surrounding the law and education standards, as well as individuals' personal values and beliefs. Four interrelated themes emerged: Reasonable adjustments - a wicked problem; Influence of context - location and status; To disclose or not disclose, and Safety first. Being a wicked problem, reasonable adjustments are complex, ill-defined, multi-factorial and subjective, with no easy resolution. Participants indicated requests for reasonable adjustments were unique, with students entitled to individualised, support plans enabling them to work effectively across diverse academic and practice environments. Conversely, evidence from the findings illustrated localised processes reflecting a 'one-size-fits-all' generic approach, weighted towards academic rather than practice based reasonable adjustments, with limited evidence of individualised support. Hence, stakeholders in HEIs and practice need to work collaboratively to address adjustment issues arising in both settings to facilitate fair resolutions to support students with disabilities. Furthermore, to secure equal opportunities and flexibility for students with disabilities with the potential to be effective nurses, but unable to meet current curricular expectations, the possibility of developing bespoke education programmes to achieve registration as a nurse also requires exploration.