Scoil Na hAtrachta, an Cnaimhseachais agus na gCoras Slainte UCD
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Transcript of Scoil Na hAtrachta, an Cnaimhseachais agus na gCoras Slainte UCD
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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 agusna gCoras Slainte UCD
UCD School of Nursing, Midwifery and Health SystemsIreland
Introduction & Background
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Background & context
Nature of disabilities
Students with disabilities & third level education
Association for Higher Education and Access Disabilities (AHEAD) (2011)
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Nursing & Midwifery Students Registered with a Disability
1: 19 studentsDyslexia most common Varied types of disabilitiesMore than 1 disabilityUCD/SNMHS* stats:
2010/11 = 49 2011/12 = 51 2012/13 = 46
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*UCD/SNMHS = University College Dublin/School of Nursing, Midwifery & Health Systems
Disability Profile Undergraduate Nursing & Midwifery Students in UCD
2012/2013 – UCD/SNMHS Nursing /Midwifery
Students
Specific learning disabilities 31
Significant ongoing illness 6
Mental health 3
ADD/ADHD 3
Hearing impairment 1
Visual impairment 1
Physical disability 1
Autistic spectrum disorder 0
Other 0
Unspecified 0
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Aim
Present the development and evaluation of a Clinical Needs Assessment (CNA) for
Nursing and Midwifery studentswith a disability in clinical practice
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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)
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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
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1. Professional/
Ethical Practice
2Holistic
approaches to care
3Interpersonal relationships
4.Organization
and management of
care
5. Personal and professional development
Domains of Competence
Source: An Bord Altranais (ABA)
The Clinical Needs Assessment
Conducted by Disability Liaison Team
Individualised
Assistive Technology (AT)
Not static
Collaboration
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Clinical Needs AssessmentPart 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
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Phase 3- Evaluation
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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 profile18-21 [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
The Process of Disclosure
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Disclosure
Staff
Personality
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)
When you are on the ward there isn’t time to
be discussing things like that (disclosure)
(Int 3)
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)
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)
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...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)
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)
Supports
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Supports
Disability Awareness
Receiving support
Supports
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...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)
...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 (Int 2)
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)
I didn’t really have any problems as
far as dyslexia (Int 2)
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 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)
Environment
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Environment
Nature of the ward
Documentation
Staffing
Support
Environment
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...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)
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)
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)
Personal
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Personality
Communication
Self strategies
Personal
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I'd bring them [list of words] on placement with me so I'd flick through them (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)
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)
Just don’t want to be making a big issue all the time (Int 3)
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
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Relevance to Clinical Practice
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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
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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 [email protected]
Phil Halligan 00 353 1 7166420 [email protected]
Acknowledgements
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