Legal Issues In Nursing Education and Students with Disabilities

Legal Issues Related to Students with Disabilities In Nursing Education, Implications for Nursing Education for Disabilities and Law, Services for Persons with Disabilities Disability In Nursing Education, Universal Design Strategies for Nursing 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.


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