Legal Issues In Nursing Education and Students with Disabilities
Legal Issues Related to Students with
Disabilities In Nursing Education
Faculty should be aware of the legal issues
associated with teaching students with disabilities. The ADA protects the
rights of individuals with disabilities in the arenas of education, employment,
and environmental accessibility. Higher education institutions must guarantee
individuals with disabilities equal access to educational opportunities.
Discrimination against individuals with physical and mental disabilities is
prohibited by the ADA. However, the ADA does not guarantee that an admitted
student will achieve academic success only that the student has the opportunity
to achieve academic success. A university or college has the obligation to
maintain academic and behavioral standards for all students, disabled or not
(Meloy & Gambescia , 2014).
The full effect of the ADA on professional
education continues to be determined as more potential students with
disabilities seek admission to nursing programs. Focusing on stated program
outcomes rather than on specific skills puts faculty in a better position to
make decisions about reasonable accommodations for students who are disabled or
have other special needs.
Aaberg (2012) has recommended that essential
functions be more job-related than applied to all nurses or nursing students.
For example, not all nurses work in intensive care; Therefore not all nurses
need to hear a monitor alarm within a prescribed distance.
Failure of an
institution to make reasonable accommodations for a student who is disabled is
considered discrimination (Dupler et al., 2012), and the institution and
faculty may be sued for failing to make reasonable accommodations.
For example,
a Missouri Appeals Court ruled that a nursing program had erred in dismissing a
deaf nursing student because she needed accommodations in clinical practice
(Wells v. Lester E. Cox Medical Centers, 2012).
Implications for Nursing Education for Disabilities and Law
By law, students have the responsibility to
notify the institution regarding a disability and the need for accommodation
(Dupler et al., 2012). Although disclosure of disabilities is voluntary and not
legally required, students who have a disability and require accommodation are
encouraged to share this information with the institution’s office for students
with disabilities.
However, many students will not share information regarding
their disabilities for fear of rejection. Barriers to student success may be
related more to faculty and practice partners’ attitudes rather than to student
ability (Aaberg, 2012; Scullion, 2010).
Based on faculty interviews, Ashcroft
and Lutfiyya (2013) developed a grounded theory about nursing educators’
perceptions of working with students with disabilities. Their theory was named
“producing competent graduates” (p. 1317).
Subthemes within the theory included
“let’s work with it” (the disability); “it becomes very difficult” (to
accommodate); “what would happen if someone died ?” ( due to unsafe practice);
a wary challenge; educator attributes, which included past experience in
working with students with disabilities; and perceived student attributes, or
kind of disability. Negative faculty attitudes can change.
A study by Tee and
Cowen (2012) demonstrated that a variety of strategies can enhance the ability
of practice partners to work with students who have disabilities. Such
strategies included having students tell their stories and developing a series
of DVDs and interactive slide shows that practice partners, called mentors,
could use to understand the issues faced by students with disabilities and how
to appropriately accommodate those students.
Education for related faculty to
provide accommodations and understanding the possibilities for achievement
among students with disabilities is key for students’ academic success. When a
student makes known the presence of a disability and gives permission to share
this information with faculty, course faculty are notified about the disability
that requires accommodation.
Course faculty must keep this information
confidential and are not to share this information with other faculty, as it is
the student’s responsibility to decide when and where to disclose the presence
of a disability.
Students may choose not to disclose a disability
in some courses. Even when student consent is given to share information with
faculty, the nature of the disability is not disclosed to faculty unless the
student decides to disclose it (Meloy & Gambescia , 2014). To
receive accommodation, the student must disclose the presence of a disability
prior to engaging in the learning experience; it is not possible to retroactively
claim the need for accommodations after the student has already unsuccessfully
engaged in the experience.
Services for Persons with Disabilities
Disability In Nursing Education
Support Services provides reasonable,
appropriate, and effective academic accommodations to those with known
disabilities. This may include academic adjustments and services such as
special testing arrangements. Note-taker services are available to qualified
individuals.
Services for persons with disabilities are based on individual
needs and the University aims to offer appropriate accommodations according to
the student’s documentation of need for same.
These services are coordinated by
the Student Support Services Grant Program. It is recommended that persons with
disabilities visit Indiana State University prior to making a decision to
enroll. Courtesy Indiana State University Undergraduate Catalog, 2014–2015.
Faculty are not allowed to inquire about the
nature of the disability. In fact, decisions regarding whether accommodation is
possible must be made after the student has been admitted, unless essential
abilities are published and all students are asked before admission whether
they possess the abilities needed for academic success (Aaberg, 2012).
However,
most lists of essential abilities focus, in part, on physical abilities such as
lifting. Recent initiatives call into question such requirements (American Nurses
Association, nd). Although some schools publish essential abilities that
students must achieve, faculty need to consider if they are truly essential to
nursing practice.
Levey (2014) conducted an integrative literature review on
faculty attitudes regarding various aspects of working with nursing students
who have disabilities, and concluded that disclosure of disability status prior
to admission can be a barrier for students, especially if essential abilities
are published.
Furthermore, Levey stated that essential functions are more
related to employment, not student status. Faculty must remember, however, that
students are not required to disclose disabilities prior to admission. When
considering the admission of a student who has a disability, admission
committees in schools of nursing must consider the following questions:
- Disregarding the disability, is the individual
otherwise qualified to be admitted to the program? - What reasonable accommodations can the school
make to enable the student to be successful in the pursuit of becoming a nurse
who can deliver safe patient care?
Although institutions are not expected to lower
or alter academic or technical standards to accommodate a student with a
disability (Meloy & Gambescia , 2014), they are expected to determine what
accommodations would be reasonable for a student who is disabled.
Examples of
reasonable accommodations include altering the length of test-taking times or
methods, providing proctors to read tests or write test answers, allowing
additional time to complete the program of study, providing supplemental study
aids such as audiotapes of texts, providing note takers, or altering the method
of course delivery, such as the use of simulation for some clinical practice
(Azzopardi et al., 2014).
The same considerations must be given to students who
become disabled during their enrollment in a nursing program. Questions to be
asked include the following:
- Disregarding the disability, is the student
otherwise qualified to continue in the nursing program? - What reasonable accommodations can be made to
allow the student to continue.
Concepts of universal design can accommodate
learning styles for all students, not just students with disabilities (Meloy
& Gambescia , 2014). Marcyjanik and Zom (2011) have stated that universal
design is particularly important for courses offered at a distance.
Universal
design promotes course design that uses multiple ways of presenting course
materials and engaging students in their learning and multiple ways for
students to demonstrate course outcomes in the classroom and at a distance
(Tobin, 2013).
Most learning management systems allow faculty to use universal
design in presenting their course materials.. Instructional design specialists should be part
of the team that designs accessible distance courses.
Universal Design Strategies for Nursing Students with Disabilities
Have course materials available in audio and
video format.
1. Design uncluttered webpages that don’t rely
on color alone.
2. Provide accessible javascript .
3. Provide access to webpages that convert text
to audio and audio to text.
Faculty should consider that just because a
student has a disability, he or she is not necessarily ill, and the type of
support needed is not the type needed to cure an illness but to support health
(Evans, 2014a). Whether a person’s limitations are viewed as a disability is
defined by society rather than by the actual abilities of the person involved.
Thus the process of deciding what is an appropriate accommodation for a person
with a disability is complex and is influenced as much by faculty and practice
partner attitudes as by actual student abilities.
As the influence of the ADA,
and now ADAAA, on nursing education continues to unfold in the courts and in
the workplace, nurse educators must keep current with legal developments that
relate to the education of individuals with disabilities who are pursuing
degrees in the health professions .
Some suggestions for increasing faculty
awareness of the needs of students with disabilities include periodic
continuing education sessions related to the legal implications of educating
such students and the use of consultants who are experts in working with
students with disabilities.
Most institutions of higher education have an
office dedicated to assisting and supporting students with disabilities who are
enrolled on campus. This office can provide resources and expert advice to
faculty and students. Another source of information may be individuals with
disabilities who have successfully developed a career in nursing.
These
successful nurses can help nursing faculty understand the issues involved in
educating students with disabilities and they can serve as mentors to students
with disabilities who are pursuing a nursing education. Practicing nurses with
disabilities can serve as advocates for students as well as help nursing
programs advocate for students who graduate and then seek employment.
Nursing faculty should begin to separate the
truly essential components of nursing education from the merely traditional
nursing curricula and teaching strategies. Nursing faculty need to consider
such philosophical issues as whether nursing education might be extended to
those individuals who will never practice bedside nursing in an acute care
setting.
Such nursing jobs might include staff development, infection control,
case management, or a variety of jobs in the community settings where nursing
care is delivered. A study of admission and retention practices of California
nursing schools (Betz et al., 2012) showed that nursing faculty vary in
approaches in dealing with disabilities.
In making admission and progression
decisions for all students, faculty need to balance student rights, safety, and
abilities with issues of patient safety and university responsibility for
providing appropriate accommodations according to the ADA.
Faculty can use a
variety of clinical settings to achieve the prescribed learning outcomes.
Working with preceptors in practice not only assists students in their
educational process (Tee & Cowen, 2012) but could also demonstrate that
disabled students can be successful as graduates by providing evidence of safe
practice given by the students.