CHAPTER 11. Mentoring Students with Disabilities
Chapter Aims
The purpose of this chapter is to explore your role as a mentor in supporting a student with a disability(ies). After reading this chapter you will be able to:
• Understand what the Disability Discrimination Act (1995) means for you as a mentor.
• Define what disability is and appreciate the implications of different models of disability.
• Develop the skills to respond to a student who discloses a disability.
• Understand how reasonable adjustments can be implemented for a student.
• Consider how to support and assess a disabled student in a way that is fair and transparent.
Introduction
Before we start let’s get a feel of what your thoughts are about disabled students by completing Activity 11.1.
Activity 11.1
Entry into nursing
Below is a list of common disabilities. Which of the following impairments/disabilities do you believe would not prevent someone from applying to become a student nurse? (Place a tick where you believe that the impairment would not prevent someone from being able to become a nurse within the specified field of practice.)
| Disability | Adult Nurse | Mental Health Nurse | Child Health Nurse | Learning Disability Nurse |
|---|---|---|---|---|
| Bipolar affective disorder | ||||
| Diabetes | ||||
| Dyscalculia | ||||
| Dyslexia | ||||
| Epilepsy | ||||
| Hearing impairment | ||||
| HIV | ||||
| Multiple sclerosis | ||||
| Partial limb loss (hand/arm) | ||||
| Partial limb loss (foot/leg) | ||||
| Visual impairment |
Hopefully you have ticked all of the boxes. This is because the answer is that none of these impairments would automatically prevent someone from applying to become a nurse, regardless of their branch. Disability legislation requires that a course design must aim to ensure it is accessible to students with disabilities and anticipate and remove potential barriers.
The NMC is quite clear that neither significant health impairments nor a disability would necessarily prevent someone from becoming a nurse. Each applicant who declares a disability is considered on an individual basis to identify what, if any, reasonable adjustments would be required to help them undertake the programme and achieve the competence standards required. The focus is always on whether or not a student will be able to practice safely and effectively. We will explore reasonable adjustments in more detail later as these will directly involve you as a mentor.
Models of disability
Models of disability offer different ways of looking at disability and therefore influence how you might respond to a disabled person. The two significant models of disability are the medical model and the social model.
The medical model of disability
The medical model sees a disability as the individual’s problem, with the disabled person dependent on others and either needing to be cured or cared for. In this model the focus is on the negatives: what the disabled person cannot do (walk, read text, hear, etc.).
Under the Disability Discrimination Act (DDA) (1995) a disability is ‘a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities’. A disability can be due to a whole range of impairments which can be usefully grouped under a number of headings. Box 11.1 lists those that are now used on the Universities and Colleges Admissions Service (UCAS) forms for those applying to a university.
Box 11.1
Disability categories
All applicants to a university will be asked to complete a section on the application form where they are offered the opportunity to declare whether they have a disability or impairment. The categories used are:
• No disability.
• You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder.
• You are blind or have a serious visual impairment uncorrected by glasses.
• You are deaf or have a serious hearing impairment.
• You have a long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy.
• You have a mental health condition, such as depression, schizophrenia or anxiety disorder.
• You have a specific learning difficulty such as dyslexia, dyspraxia or attention deficit hyperactivity disorder.
• You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches.
• You have a disability, impairment or medical condition that is not listed above.
• You have two or more impairments and/or disabling medical conditions.
Following an amendment to the Act in 2005 people with human immunodeficiency virus (HIV) infection, cancer or multiple sclerosis also meet the definition of having a disability.
The social model
The social model was developed by disabled people in response to the medical model which is seen as segregating disabled people from the rest of society. With the social model, disability is not an individual’s problem rather it is a social issue with the environment disabling the individual. Barriers that can prevent disabled people from participating in society include:
• attitudinal barriers
• physical barriers
• policies or procedural barriers
• communication barriers.
For example, on a busy ward, a hearing person telephone has not been designed to be adjustable for a person with a hearing impairment and so will prevent that person from answering the phone. Your attitudes to disabled students will be influenced by your culture, background, education, and ethnicity. As a nurse many of the patients you care for will have an impairment that will be viewed as a disability. It will therefore be easy to fall into the trap of seeing a disabled student as a person needing to be cared for (the medical model) and requiring them to ‘fit in’ within the existing structures and processes. If you subscribe to the social model your approach will be very different as your focus will be on removing the barriers that prevent your student from participating fully in their placement. The social model is linked to ideas of inclusivity and widening participation, looking at ways to overcome challenges and move forward.
Disability and the law
There are a number of legal requirements that you need to be aware of in relation to disabled students. The key ones are:
• The DDA (1995) which sets out a legal framework which protects disabled people from discrimination and sets out the duties that organizations have towards disabled people.
• The Special Educational Needs and Disability Act (SENDA) (2001), which amended part 4 of the DDA to prohibit discrimination in the education sector.
• The DDA (2005), which was an amendment that requires all public bodies (e.g. the NHS and education sector) to actively promote disability equality and produce a Disability Equality Scheme. It also extended the definition of disability to include cancer, HIV infection and multiple sclerosis and no longer required mental health difficulties to be ‘clinically well recognized’.
You do need to understand your responsibilities as a mentor and should have attended sessions in your workplace around equality and diversity which would include both the role of the organization and your own in relation to disability legislation. To help you the following sections summarize the main duties an organization has under the DDA which fall under the following headings:
• direct discrimination
• disability-related discrimination
• victimization
• harassment
• reasonable adjustments.
Direct discrimination
This means treating a person less favourably than another person who is not disabled, solely on the grounds of their disability. This often occurs due to stereotypical assumptions or prejudice, for example, turning down an applicant to a nursing course because they have a disability even though they have met all the admission criteria. Equally, if a hospital refused to allow students who were deaf or dyslexic, for example, to have placements with them that would also be direct discrimination.
Disability-related discrimination
In this case discrimination occurs for a disability-related reason, whereby the disabled person is treated less favourably for a reason related to their disability rather than the disability itself and it is not possible to show that that reason is justified. For example, failing a student in their practice assessment because they write slowly due to their disability would be disability-related discrimination, as there is no requirement within the competence standards for students to be able to complete patient/client documentation within a specified time-frame.
Victimization
Victimization is unlawful under the DDA and relates to someone being victimized who makes or supports an allegation of disability discrimination regardless of whether that person is themselves disabled or not.
Harassment
The harassment provision protects the disabled person from behaviour that creates an environment that the person perceives as hostile, intimidating, degrading, humiliating or offensive. This could be, for example, making jokes or derogatory remarks about their disability, blocking wheelchair access or interfering with any special support equipment they use.
Reasonable adjustments
The DDA requires reasonable adjustments to be made. There is no definitive list of what constitutes a reasonable adjustment as these will depend on the type of disability, how the individual manages it, and the nature of the work activities the disabled person is involved in. Examples particularly relevant to students are:
• making adjustments to premises
• altering a student’s hours of working or training
• assigning a student to a different placement
• allowing the student to be absent during working or training hours for rehabilitation, assessment or treatment
• giving, or arranging for, training or mentoring (whether for the disabled person or any other person)
• acquiring or modifying equipment
• modifying instructions or reference manuals
• modifying procedures for testing or assessment
• providing a reader or interpreter
• providing supervision or other support.
However, consideration will need to be given to the practicality of the adjustments, the health and safety implications for the student and others as well as the financial or other resources of the university. As a mentor you may be involved in identifying potential barriers and possible reasonable adjustments to overcome or remove those barriers for your student and will definitely be involved in the implementation of the adjustments that have been agreed as reasonable for your student.
It is important to note that the university and placement providers also have an anticipatory duty. This means that the university and placement providers should have in place systems and processes for making reasonable adjustments in anticipation of having disabled students and do not wait until a disabled student arrives.
For example, universities will have in place a policy on assessment processes that will include provisions for adjustments to examination processes; for example, students with dyslexia may require extra time to complete an examination. Activity 11.2 requires you to consider adjustments that may already be in place where you work.
Activity 11.2
Anticipatory reasonable adjustments
Take a walk round your organization and your workplace and identify what adjustments are already in place for disabled people or policies/processes/equipment that are inclusive of disabled people rather than excluding them. Also consider whether there are any you have in place specifically for students.
Adjustments/processes or equipment that you may have identified as already being in place might be:
• access ramps
• accessible toilets
• parking bays for disabled people
• loop systems for hearing aid users
• information booklets in large font or different-coloured paper
• taped handovers for people with visual impairments
• flashing phones/alarms for people with hearing impairments
• text phones
• computers.
We will come back to reasonable adjustments later in the chapter.
Disability and the NMC
The NMC’s prime function is to safeguard the public. It does this by setting the standards for education programmes, monitoring the quality of those programmes and giving guidance and advice to the professions.
The NMC do not bar anyone with a disability/ies from entering nursing programmes (this would be against the Disability Discrimination Act) but they do set the minimum entry criteria for nursing programmes which relate specifically to academic criteria. They also require both the education institution and their placement providers to ensure that they themselves meet the requirements of the Disability Discrimination Act (DDA), 1995 and Disability Discrimination Act, 2005) which means that the education institution has to undertake the necessary checks to ensure applicants have ‘the capability for safe and effective practice without supervision’ (NMC, 2008). All applicants undergo a health check and if they have disclosed a disability then the student is offered advice and support through the university’s occupational health and disability services. The university and placement providers also have a responsibility to ensure that their staff are aware of their role and responsibilities in relation to students with a disability.
Guidance for universities and placement providers are set out in the NMC’s (2008)Good Health and Good Character Guidance for Education Institutions document, which is available on the NMC website. This is a useful guide to look at as it also has some scenarios related to disabled students which can help you understand how students can be supported.
The NMC also discuss the role of the mentor in relation to students with disabilities in their Standards to Support Learning and Assessment in Practice (NMC, 2008). Although rather brief it sets out the importance of promoting equality of opportunity and treating students with fairness, respect and understanding. It also highlights the importance of the university and practice working together to prepare staff for supporting students and preparing students for their practice placements.
The implications of the DDA for the mentor
Put simply, you are legally required to comply with the DDA and professionally required to comply with the standards laid down by the NMC. However, you are not expected to find out about this by yourself; both your employer and the university have responsibilities.
Your employer should provide equality and diversity training that will encompass information on disabilities. This is usually a mandatory session that staff have to attend on a regular basis. Universities are required by the NMC to include information on supporting disabled students within its mentor preparation programmes and are also expected to work with practice partners to ensure mentors are prepared and supported for mentoring disabled students. All mentors are required by the NMC to update annually and these updates should also encompass information on mentoring disabled students.
Your responsibilities therefore are to:
• attend/complete statutory/mandatory training on equality and diversity
• ensure you update yourself as a mentor annually
• identify any gaps in your knowledge regarding you role in working with and supporting both students and colleagues who have a disability and seek to rectify those gaps
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