Nurse Educator
Nurse Educator Vol. 39, No. 5, pp. 241-245 Copyright * 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Faculty Knowledge of the Americans With Disabilities Act Karen A. May, PhD, RN, CNE A survey was conducted to assess nursing faculty (n = 231) knowledge of the Americans With Disabilities Act requirements. Only 21% (n = 46) of the participants received a passing score of 78%. While 76% (n = 161) knew that students must provide documentation of a disability to receive accommodation, 49% (n = 104) did not recognize that an individual faculty member may be held personally liable if he/she fails to provide accommodation. Participants’ knowledge of the Act was low and could create barriers to student success. Keywords: accommodation; Americans with Disabilities Act; disability; nursing faculty; nursing students
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n the United States, 1 in 5 people live with at least 1 disability.1 In a national survey, 31% of the respondents indicated that their disability was first identified at the postsecondary level.2 Students are participating in higher education in greater numbers, and it is likely that many will require academic accommodation.3-5 Accommodation can refer to the process of making adjustments or alternative arrangements in the educational environment to ensure that a discriminatory effect does not occur because of a student’s disability.6 Without accommodation, the student’s ability to demonstrate mastery of required skills or knowledge may be hindered or impossible to assess. Fundamental knowledge of disability-related legislation is essential for faculty to be aware of what constitutes a reasonable accommodation and how to access disability resources on campus. Although institutions of higher education are required to provide reasonable accommodation to students that provide documentation of a disability, they are not required to provide training to faculty members about the implementation of the accommodation. It remains the faculty member’s responsibility to implement the accommodation. Nursing faculty have expressed concerns about providing accommodation to students with disabilities and often cite the unique nature of nursing, essential competencies, and safety as barriers to providing accommodation and exclusion of students with disabilities from the profession.7-10 The American Nurses Association, National League for Nursing, and National Organization of Author Affiliation: Assistant Professor, Division of Health Sciences, Neumann University, Aston, Pennsylvania. Correspondence: Dr May, Neumann University, One Neumann Dr, Aston, PA 19014 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www .nurseeducatoronline.com). Accepted for publication: April 19, 2014 Published ahead of print date: May 23, 2014 DOI: 10.1097/NNE.0000000000000058
Nurse Educator
Nurses With Disabilities support the recommendation to admit more people with disabilities into nursing programs.11 The responsibility of nursing faculty is to facilitate a student’s ability to demonstrate knowledge and be a safe and effective nurse. The process of creating or selecting an appropriate accommodation may be addressed by implementing best teaching practices.12 Prior research on nursing students with disabilities has focused on associate degree programs because students with disabilities believed that community college environments were more disability friendly and graduation was an attainable goal.13 However, the report on the Future of Nursing recommends that 80% of the nursing workforce be baccalaureate prepared by 2020; thus, baccalaureate nursing programs need to be perceived as disability friendly.14 Research has demonstrated that nursing students with disabilities can be successful in nursing.9 Kolanko7 chronicled the experiences of nursing students with disabilities and concluded that they need to develop strategies that address their specific learning needs to be successful. These learning strategies can be developed when students are open with faculty members about their learning needs, and faculty are open to new teaching approaches. Research has been published on how best to prepare teachers to assist students with disabilities demonstrate their knowledge of content.15,16 An essential component is to educate faculty about requirements of the Americans With Disabilities Act (ADA) law and provide development activities to acquaint them with best practices.17 Murray and colleagues18 suggested that faculty who were knowledgeable about students with disabilities and the use of accommodation created learning environments in which students felt comfortable and learning was enhanced.
Background and Purpose The topic of students with disabilities has been explored in the nursing literature from a variety of perspectives, but Volume 39 & Number 5 & September/October 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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few have required self-reflection of faculty or knowledge assessment. Maheady8 was among the first to examine the experiences of nursing students with disabilities. Maheady’s qualitative study concluded that students with disabilities fear the consequences of disclosure but have unique insights from living with a disability that could contribute to the care they provide to clients.8 Sower and Smith19 examined faculty knowledge and crafted a faculty development activity with a pretest and posttest component. Nursing faculty were able to assess their own learning needs related to students with disabilities and work toward developing best teaching practices. Morris and Turnball20 examined the clinical experience of nursing students with dyslexia and concluded that when mentors were empathetic and understanding of individual student needs, the participants’ learning was enhanced, and they were more likely to disclose their disabilities. Betz et al21 examined admission and accommodation policies for nursing students in the California Community College system. They concluded that barriers exist for students with disabilities including faculty negativity and misinformation. Marks22 noted that nursing faculty often demonstrate historical attitudes and values and exclude those with disabilities from considering nursing as a profession. Marks proposed that by expanding our view of disability, improving disability content, and actively seeking to accommodate students and nurses with disabilities, conditions for all people with disabilities will improve. She stated that nursing should recognize the needs of students with disabilities and advocate for improving the care of patients with disabilities.22 These changes cannot be made in isolation but must reflect a consistent message of the profession. Lack of faculty knowledge about disability-related laws may negatively affect students seeking accommodations and place institutions at risk for Office Civil Rights violations.23,24 The purpose of this study was to examine faculty knowledge of disability-related legislation and explore the training opportunities they had related to this subject.
Methods Participants Institutions identified as baccalaureate programs by the Pennsylvania State Board of Nursing were invited to complete an online survey. E-mail addresses of 903 nursing faculty were obtained from program Web sites. A prenotice of the survey, the initial invitation, and a 2-week reminder were sent by e-mail to potential participants. Institutional review board approval was obtained from the author’s university. Instrument Thompson et al23 designed the Assessment of Faculty Knowledge of the Americans With Disabilities Act of 1990 Policies and Guidelines (the Assessment), a 23-item survey specifically related to higher education. Survey items were derived from Sections 504 subpart E of the Rehabilitation Act of 1973 and the ADA.25 The instrument assesses knowledge of topics that include the requirements that students must meet to receive accommodations, the responsibilities of the student and institution in the provision of accommodation, and examples of specific accommodations that may be requested. Originally designed as a dichotomous scale, the instrument in the study 242
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by Thompson et al included a write in response of ‘‘I don’t know’’ to more clearly indicate participants’ responses. Researchers continued this format of yes, no, and I don’t know so that one can accurately assess the respondent’s level of knowledge. The instrument was first published in 199723 and used in several studies.26-29 A Cronbach’s ! coefficient of .96 for internal consistency was reported by Thompson et al.23 Coefficient ! documented in subsequent studies ranged from .79 to .96.26-29 The survey also collected demographic information such as academic rank, tenure status, number of years in higher education, number of students taught with disabilities, and types of disabilities encountered. Participants were asked if their institution provided training regarding students with disabilities and if training about providing accommodation or working with students with disabilities had been sought.
Data Collection and Analysis Data were cleaned, and pairwise deletions were used for missing data during statistical analysis. Data were then exported to SPSS version 20 (IBM, Inc, Armonk, New York), and descriptive analyses were conducted. Mean scores, SDs, and correlations were calculated.
Results Of the 903 eligible participants whose e-mail addresses were available from program Web sites, 231 agreed to participate in the study, yielding a 26% response rate. The sample reflected the nursing faculty population with 91% (n = 212) female. Faculty rank was reported as instructor (32%, n = 72), assistant professor (38%, n = 87), associate professor (21%, n = 47), and professor (8%, n = 18). The sample was 45% (n = 104) tenured and tenure track faculty and 50% (n = 117) nontenured faculty. Years of teaching experience ranged from 1 to 42 years (mean, 14.5 [SD, 10.67] years). Ninety percent of the respondents had worked with students with disabilities in the prior 3 years, with more than half of the sample (55%, n = 128) indicating having taught 1 to 5 nursing students with a disability in that time period. More than half (52%, n = 122) of the respondents indicated that they had not received training from their institution about the provision of academic accommodation. Respondents sought information to provide accommodation from a variety of sources. The office of disability services of the respondent’s college or university was identified by 67% (n = 156) of respondents as their source of information to improve their understanding of academic accommodation. Other faculty cited colleagues and mentors (46%, n = 107) as knowledgeable sources of information. Other resources used by respondents included knowledge acquired through journal articles and faculty development programs.
Assessment Scores The knowledge assessment was completed by 211 of the respondents. A small percentage, 21% (n = 46), of faculty respondents answered 18 or more items correctly, which was identified as the passing standard (22, 23, 25-27). Results of the analysis of responses to the assessment indicated a mean score of 14.53 (SD, 3.71). Faculty (76%, n = 177) identified correctly that students with a documented disability must be provided accommodation such as scribes, Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
readers, or use of adaptive equipment. However, less than half (n = 104) of respondents knew that individual faculty members could be held personally liable if they failed to provide accommodation (See Table, Supplemental Digital Content 1, http://links.lww.com/NE/A145). Topics addressing who is responsible for the design and delivery of accommodation may be unclear to faculty members. Only 25% (n = 53) of respondents recognized that the office of disability services or the individual faculty member is responsible for obtaining accommodation for students with disabilities. Such accommodation may include identifying a quiet room for testing, securing large-print handouts, or changing the classroom setting if the room is not wheelchair accessible. Based on this finding, it is apparent that faculty may not be aware of who is responsible for making these arrangements, which could create a significant barrier for student success. Only 32% (n = 66) of respondents identified that if a student with a disability has difficulty writing, the instructor is responsible for providing the student with an oral test. Oral testing is considered an acceptable alternative to written testing.25 Furthermore, an individual faculty member who fails to provide accommodation to a student with a disability may be held personally liable. This correct response was identified by 49% (n = 104) of respondents. Faculty members and institutions are vulnerable to litigation if employees are not aware of their potential liability.25
Discussion Participant responses to several items on the knowledge scale merit discussion. Respondents were knowledgeable about the need for students to provide documentation of their disability to the office of disability services. Findings demonstrated that respondents were aware that fundamental changes in a course are not a reasonable expectation of students with disabilities. Furthermore, the responses indicated that faculty members were aware that academic freedom is not an excuse to deny accommodation. Participants provided mixed responses when asked if the institution’s office of disability services or the individual faculty member is responsible for obtaining accommodation. Most institutions have an office of disability services that arrange for the implementation of student accommodation. However, there are some smaller institutions that have delegated this responsibility to faculty members. Faculty cannot assume that a student’s accommodation is being provided unless the institution has expressly stated who is responsible for this task. If a student with a disability has difficulty writing, the instructor is responsible for providing the student with an oral test. While it is true that NCLEX testing cannot be completed orally, the issue to address when considering an accommodation for a written test would be the role of the written question and if there is an alternative format that would allow the student to demonstrate knowledge of the content.30 Most (90%) of the participants indicated that they worked with students with disabilities who required accommodation during the past 3 years; slightly more than half (52%) did not receive training from their institutions about the provision Nurse Educator
of accommodation. Participants, however, used several resources to obtain information about students with disabilities and the use of accommodation. The office of disability services (67%) and colleagues or mentors (46%) were the most frequently cited resources. Currently, there are no state or federal regulations that mandate institutions of higher education provide professional development activities on disability-related legislation or the use of accommodation to meet the needs of students with disabilities. However, institutions should provide training and development activities to educate faculty about their role and responsibilities in the provision of accommodation. The results of this study are consistent with prior research that demonstrated a knowledge deficit of disabilityrelated law among faculty members.15,25 Burgstahler and Doe16 suggested that faculty members who are knowledgeable about academic accommodation and are able to develop creative strategies to provide accommodation are better prepared to assist students with disabilities. The findings of the current study support the need for professional development activities addressing disability-related law and the provision of accommodation for faculty working with students with disabilities. Helms et al17 suggested that the latitude given in the selection of an accommodation requires faculty to be knowledgeable about what constitutes an appropriate accommodation and how to provide appropriate modifications for students. Faculty development activities could address this knowledge deficit and include innovative teaching strategies that could be used to improve the outcomes of students with disabilities. Thompson et al23 concluded that assessment of faculty knowledge of disability law can provide valuable feedback to faculty and generate interest in learning more about their responsibilities and those of the student. Faculty members’ insights and experiences are essential components in creating and providing accommodation that are unique to academic and clinical settings. Use of accommodation is pedagogically sound, required by law, and essential to student success.2,3,6,16,17,24 Approaching the use of accommodation from a pedagogical perspective may provide an evidence-based approach that faculty members can understand and implement. Groccia and Buskist12 noted that when the evidence-based principles of learning are the basis for the development of best practices in teaching and learning, the diverse needs of all learners can be met. This could be accomplished through cooperative learning strategies used in the classroom and clinical setting. Project Opportunity and Access (POA) is a technologybased faculty development program developed at Pennsylvania State University. The program reviews disability-related legislation and the use of accommodation in the postsecondary setting. Faculty and staff are encouraged to complete the program as a way to enhance their ability to provide resources to students with disabilities. Products such as POA can be beneficial to faculty because of their convenience and easy access to information.24
Limitations There are several limitations of this study. Three of the 34 institutions eligible to participate in the study did not publish faculty e-mail addresses on their Web sites and could not be Volume 39 & Number 5 & September/October 2014
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included in the study. Those unfamiliar with online surveys may have chosen not to participate. Subjects who are not interested in disability-related issues may not have responded to the survey, resulting in a lower response rate.
Future Research Research is needed to differentiate the specific issues related to accommodation between the clinical and classroom setting. Addressing the issue of providing accommodation in the clinical setting is not new27,28; however, as a culture of safety has been the focus of the Institute of Medicine8 and the Quality and Safety Education for Nurses initiative,31 concerns about safety have resurfaced. Safety is a concern for all students, and students with disabilities do not pose greater safety risk.22 Betz et al21 noted that the lack of accommodation for clinical environments may be related to the small number of students who request them. Furthermore, the infrequent request is attributed to the possible belief of students and faculty alike that the physical demands of a nursing career are incompatible with having physical disabilities. Future research could examine the validity of technical standards to which nursing students are held and the development and testing of strategies amenable to accommodation.
Conclusion Findings of this study demonstrated a knowledge deficit related to disability-related legislation and the provision of accommodation. This could be remedied through faculty development activities that address disability-related laws and the unique challenges and opportunities of creating accommodation in the classroom and clinical setting for nursing students with disabilities. Additional research should address the concerns of faculty about accommodation that meets the needs of students with disabilities and the rigor of nursing programs. These are not mutually exclusive goals. Re-envisioning the traditional clinical evaluation without compromising rigor is possible, but the profession needs to be committed to the value and contributions of students with disabilities. Acknowledgments The author participated in the 2013 NLN Scholarly Writing Retreat, sponsored by the NLN Foundation for Nursing Education and Pocket Nurse.
References 1. 2005 Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities: Calling You to Action. US Department of Health and Human Services, Office of the Surgeon General Web site. Available at http://www.cdc.gov/ ncbddd/disabilityandhealth/pdf/whatitmeanstoyou508.pdf. Published 2005. Accessed March 1, 2014. 2. 2003 Improving educational outcomes for students with disabilities. National Council on Disability Web site. Available at http:// www.ncd.gov/publications/2003/Sept152003. Published September 2003. Accessed January 3, 2014. 3. Erickson W, Lee C, von Schrader S. Disability Statistics From the 2011 American Community Survey (ACS). Ithaca, NY: Cornell University Employment and Disability Institute (EDI); 2013. Available at www.disabilitystatistics.org. Accessed January 12, 2014.
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4. Health Resources and Services Administration. The registered nurse population: findings from the 2008 national sample survey of registered nurses. 2010. US Department of Health and Human Services. Available at http://bhpr.hrsa.gov/healthworkforce1/ rnsurveys/rnsurveyfinal.pdf. Accessed May 19, 2014. 5. 2013 Enhancing diversity in the workforce. American Association of Colleges of Nursing Web site. Available at http:// www.aacn.nche.edu/media-relations/fact-sheets/enhancing-diversity. Published January 2013. Accessed November 15, 2013. 6. PL 101:336; PL 105-107 The Americans With Disabilities Act. Available at http://www.eeoc.gov/laws/statutes/ada.cfm. Accessed December 2, 2013. 7. Kolanko K. A collective case study of nursing students with learning disabilities. Nurs Educ Perspect. 2003;24(5):251-256. 8. Maheady D. Jumping through hoops, walking on egg shells: the experiences of nursing students with disabilities. J Nurs Educ. 1999;38(4):162-170. 9. Evans BC. Nursing education for students with disabilities: our students our teachers. In: Oermann MH, Heinrich K, eds. Annual Review of Nursing Education. Vol 3. New York, NY: Springer Publishing; 2005;3-22. 10. Persaud D, Leedom C. The Americans with Disabilities Act: effect on student admission and retention practices in California nursing schools. J Nurs Educ. 2002;41(8):349-352. 11. National Organization of Nurses With Disabilities policy statement: nursing students with disabilities. Available at http://www .nond.org. Accessed January 4, 2012. 12. Groccia J, Buskist W. Need for evidence-based teaching. In: Groccia J, Buskist W, ed. New Directions for Teaching and Learning. San Francisco, CA: Jossey-Bass; 2010;128:5-11. 13. 2009 The Current State of Health Care for People With Disabilities. National Council on Disability Web site. Available at http://www .ncd.gov/policy/education. Published 2009. Accessed January 15, 2014. 14. 2010 The Future of Nursing: Leading change, Advancing Health. Institute of Medicine Web site. Available at http://www.iom.edu/ Reports/2010/the-future-of-nursing-leading-change-advancinghealth.aspx. Published 2010. 15. Vogel S, Holt J, Sligar S, Leake E. Assessment of campus climate to enhance student success. J Postsecondary Educ Disabil. 2008;21(1):15-31. 16. Burgstahler S, Doe T. Improving postsecondary outcomes for students with disabilities: designing professional development for faculty. J Postsecondary Educ Disabil. 2006;18:135-147. 17. Helms L, Jorgensen J, Anderson M. Disability law and nursing education: an update. J Prof Nurs. 2006;22(3):190-196. 18. Murray C, Flannery B, Wren C. University staff members’ attitudes and knowledge about learning disabilities and disability support services. J Postsecondary Educ Disabil. 2008;21(2): 73-90. 19. Sower J, Smith M. Nursing faculty members’ perceptions, knowledge, and concerns about students with disabilities. J Nurs Educ. 2004;43(5):213-218. 20. Morris D, Turnball P. Clinical experiences of students with dyslexia. J Adv Nurs. 2006;54(2):238-247. 21. Betz CL, Smith KB, Bui K. A survey of California nursing programs: admission and accommodation policies for students with disabilities. J Nurs Educ. 2013;51(12):676-676. 22. Marks B. Cultural competence revisited: nursing students with disabilities. J Nurs Educ. 2007;46(2):70-74. 23. Thompson A, Bethea L, Turner J. Faculty knowledge of disability laws in higher education: a survey. Rehabil Couns Bull. 1997;40(3):166-180. 24. Junco R, Slater D. Improving the campus climate for students with disabilities through the use of online training. NASPA J. 2004;41(2):263-276. Nurse Educator
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25. Rehabilitation Act of 1973, Section 504, P.L. 93-112, 229 U.S.C.A. 794. Available at http://www.dol.gov/oasam/regs/statutes/sec504.htm. Accessed January 12, 2014. 26. Dona J, Edmister J. An examination of community college faculty members’ knowledge of the Americans With Disabilities Act of 1990 at the fifteen community colleges in Mississippi. J Postsecondary Educ Disabil. 2001;14:91-103. 27. Bourque D. Factors That Influence the Attitudes and practices of Postsecondary Faculty in Providing Academic Accommodation to Students With Disabilities [dissertation]. Boston, MA: University of Massachusetts; 2004.
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28. Hammel C. Faculty Knowledge of Disability Law and Its Relationship to Attitude, Education, and Experience [dissertation]. Long Island, NY: Hofstra University; 2009. 29. Villarreal P. Faculty Knowledge of Disability Law: Implications for Higher Education Practice [thesis]. Waco, TX: Baylor University; 2002. 30. National Council of State Boards of Nursing. Available at https:// www.ncsbn.org/index.htm. Accessed March 12, 2014. 31. Cronenwett L, Sherwood J, Disch J, Johnson J, Mitchell P, Sullivan D, Warren J. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122-131.
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Nurse Educator Vol. 39, No. 5, pp. 241-245 Copyright * 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Faculty Knowledge of the Americans With Disabilities Act Karen A. May, PhD, RN, CNE A survey was conducted to assess nursing faculty (n = 231) knowledge of the Americans With Disabilities Act requirements. Only 21% (n = 46) of the participants received a passing score of 78%. While 76% (n = 161) knew that students must provide documentation of a disability to receive accommodation, 49% (n = 104) did not recognize that an individual faculty member may be held personally liable if he/she fails to provide accommodation. Participants’ knowledge of the Act was low and could create barriers to student success. Keywords: accommodation; Americans with Disabilities Act; disability; nursing faculty; nursing students
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n the United States, 1 in 5 people live with at least 1 disability.1 In a national survey, 31% of the respondents indicated that their disability was first identified at the postsecondary level.2 Students are participating in higher education in greater numbers, and it is likely that many will require academic accommodation.3-5 Accommodation can refer to the process of making adjustments or alternative arrangements in the educational environment to ensure that a discriminatory effect does not occur because of a student’s disability.6 Without accommodation, the student’s ability to demonstrate mastery of required skills or knowledge may be hindered or impossible to assess. Fundamental knowledge of disability-related legislation is essential for faculty to be aware of what constitutes a reasonable accommodation and how to access disability resources on campus. Although institutions of higher education are required to provide reasonable accommodation to students that provide documentation of a disability, they are not required to provide training to faculty members about the implementation of the accommodation. It remains the faculty member’s responsibility to implement the accommodation. Nursing faculty have expressed concerns about providing accommodation to students with disabilities and often cite the unique nature of nursing, essential competencies, and safety as barriers to providing accommodation and exclusion of students with disabilities from the profession.7-10 The American Nurses Association, National League for Nursing, and National Organization of Author Affiliation: Assistant Professor, Division of Health Sciences, Neumann University, Aston, Pennsylvania. Correspondence: Dr May, Neumann University, One Neumann Dr, Aston, PA 19014 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www .nurseeducatoronline.com). Accepted for publication: April 19, 2014 Published ahead of print date: May 23, 2014 DOI: 10.1097/NNE.0000000000000058
Nurse Educator
Nurses With Disabilities support the recommendation to admit more people with disabilities into nursing programs.11 The responsibility of nursing faculty is to facilitate a student’s ability to demonstrate knowledge and be a safe and effective nurse. The process of creating or selecting an appropriate accommodation may be addressed by implementing best teaching practices.12 Prior research on nursing students with disabilities has focused on associate degree programs because students with disabilities believed that community college environments were more disability friendly and graduation was an attainable goal.13 However, the report on the Future of Nursing recommends that 80% of the nursing workforce be baccalaureate prepared by 2020; thus, baccalaureate nursing programs need to be perceived as disability friendly.14 Research has demonstrated that nursing students with disabilities can be successful in nursing.9 Kolanko7 chronicled the experiences of nursing students with disabilities and concluded that they need to develop strategies that address their specific learning needs to be successful. These learning strategies can be developed when students are open with faculty members about their learning needs, and faculty are open to new teaching approaches. Research has been published on how best to prepare teachers to assist students with disabilities demonstrate their knowledge of content.15,16 An essential component is to educate faculty about requirements of the Americans With Disabilities Act (ADA) law and provide development activities to acquaint them with best practices.17 Murray and colleagues18 suggested that faculty who were knowledgeable about students with disabilities and the use of accommodation created learning environments in which students felt comfortable and learning was enhanced.
Background and Purpose The topic of students with disabilities has been explored in the nursing literature from a variety of perspectives, but Volume 39 & Number 5 & September/October 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
241
few have required self-reflection of faculty or knowledge assessment. Maheady8 was among the first to examine the experiences of nursing students with disabilities. Maheady’s qualitative study concluded that students with disabilities fear the consequences of disclosure but have unique insights from living with a disability that could contribute to the care they provide to clients.8 Sower and Smith19 examined faculty knowledge and crafted a faculty development activity with a pretest and posttest component. Nursing faculty were able to assess their own learning needs related to students with disabilities and work toward developing best teaching practices. Morris and Turnball20 examined the clinical experience of nursing students with dyslexia and concluded that when mentors were empathetic and understanding of individual student needs, the participants’ learning was enhanced, and they were more likely to disclose their disabilities. Betz et al21 examined admission and accommodation policies for nursing students in the California Community College system. They concluded that barriers exist for students with disabilities including faculty negativity and misinformation. Marks22 noted that nursing faculty often demonstrate historical attitudes and values and exclude those with disabilities from considering nursing as a profession. Marks proposed that by expanding our view of disability, improving disability content, and actively seeking to accommodate students and nurses with disabilities, conditions for all people with disabilities will improve. She stated that nursing should recognize the needs of students with disabilities and advocate for improving the care of patients with disabilities.22 These changes cannot be made in isolation but must reflect a consistent message of the profession. Lack of faculty knowledge about disability-related laws may negatively affect students seeking accommodations and place institutions at risk for Office Civil Rights violations.23,24 The purpose of this study was to examine faculty knowledge of disability-related legislation and explore the training opportunities they had related to this subject.
Methods Participants Institutions identified as baccalaureate programs by the Pennsylvania State Board of Nursing were invited to complete an online survey. E-mail addresses of 903 nursing faculty were obtained from program Web sites. A prenotice of the survey, the initial invitation, and a 2-week reminder were sent by e-mail to potential participants. Institutional review board approval was obtained from the author’s university. Instrument Thompson et al23 designed the Assessment of Faculty Knowledge of the Americans With Disabilities Act of 1990 Policies and Guidelines (the Assessment), a 23-item survey specifically related to higher education. Survey items were derived from Sections 504 subpart E of the Rehabilitation Act of 1973 and the ADA.25 The instrument assesses knowledge of topics that include the requirements that students must meet to receive accommodations, the responsibilities of the student and institution in the provision of accommodation, and examples of specific accommodations that may be requested. Originally designed as a dichotomous scale, the instrument in the study 242
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by Thompson et al included a write in response of ‘‘I don’t know’’ to more clearly indicate participants’ responses. Researchers continued this format of yes, no, and I don’t know so that one can accurately assess the respondent’s level of knowledge. The instrument was first published in 199723 and used in several studies.26-29 A Cronbach’s ! coefficient of .96 for internal consistency was reported by Thompson et al.23 Coefficient ! documented in subsequent studies ranged from .79 to .96.26-29 The survey also collected demographic information such as academic rank, tenure status, number of years in higher education, number of students taught with disabilities, and types of disabilities encountered. Participants were asked if their institution provided training regarding students with disabilities and if training about providing accommodation or working with students with disabilities had been sought.
Data Collection and Analysis Data were cleaned, and pairwise deletions were used for missing data during statistical analysis. Data were then exported to SPSS version 20 (IBM, Inc, Armonk, New York), and descriptive analyses were conducted. Mean scores, SDs, and correlations were calculated.
Results Of the 903 eligible participants whose e-mail addresses were available from program Web sites, 231 agreed to participate in the study, yielding a 26% response rate. The sample reflected the nursing faculty population with 91% (n = 212) female. Faculty rank was reported as instructor (32%, n = 72), assistant professor (38%, n = 87), associate professor (21%, n = 47), and professor (8%, n = 18). The sample was 45% (n = 104) tenured and tenure track faculty and 50% (n = 117) nontenured faculty. Years of teaching experience ranged from 1 to 42 years (mean, 14.5 [SD, 10.67] years). Ninety percent of the respondents had worked with students with disabilities in the prior 3 years, with more than half of the sample (55%, n = 128) indicating having taught 1 to 5 nursing students with a disability in that time period. More than half (52%, n = 122) of the respondents indicated that they had not received training from their institution about the provision of academic accommodation. Respondents sought information to provide accommodation from a variety of sources. The office of disability services of the respondent’s college or university was identified by 67% (n = 156) of respondents as their source of information to improve their understanding of academic accommodation. Other faculty cited colleagues and mentors (46%, n = 107) as knowledgeable sources of information. Other resources used by respondents included knowledge acquired through journal articles and faculty development programs.
Assessment Scores The knowledge assessment was completed by 211 of the respondents. A small percentage, 21% (n = 46), of faculty respondents answered 18 or more items correctly, which was identified as the passing standard (22, 23, 25-27). Results of the analysis of responses to the assessment indicated a mean score of 14.53 (SD, 3.71). Faculty (76%, n = 177) identified correctly that students with a documented disability must be provided accommodation such as scribes, Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
readers, or use of adaptive equipment. However, less than half (n = 104) of respondents knew that individual faculty members could be held personally liable if they failed to provide accommodation (See Table, Supplemental Digital Content 1, http://links.lww.com/NE/A145). Topics addressing who is responsible for the design and delivery of accommodation may be unclear to faculty members. Only 25% (n = 53) of respondents recognized that the office of disability services or the individual faculty member is responsible for obtaining accommodation for students with disabilities. Such accommodation may include identifying a quiet room for testing, securing large-print handouts, or changing the classroom setting if the room is not wheelchair accessible. Based on this finding, it is apparent that faculty may not be aware of who is responsible for making these arrangements, which could create a significant barrier for student success. Only 32% (n = 66) of respondents identified that if a student with a disability has difficulty writing, the instructor is responsible for providing the student with an oral test. Oral testing is considered an acceptable alternative to written testing.25 Furthermore, an individual faculty member who fails to provide accommodation to a student with a disability may be held personally liable. This correct response was identified by 49% (n = 104) of respondents. Faculty members and institutions are vulnerable to litigation if employees are not aware of their potential liability.25
Discussion Participant responses to several items on the knowledge scale merit discussion. Respondents were knowledgeable about the need for students to provide documentation of their disability to the office of disability services. Findings demonstrated that respondents were aware that fundamental changes in a course are not a reasonable expectation of students with disabilities. Furthermore, the responses indicated that faculty members were aware that academic freedom is not an excuse to deny accommodation. Participants provided mixed responses when asked if the institution’s office of disability services or the individual faculty member is responsible for obtaining accommodation. Most institutions have an office of disability services that arrange for the implementation of student accommodation. However, there are some smaller institutions that have delegated this responsibility to faculty members. Faculty cannot assume that a student’s accommodation is being provided unless the institution has expressly stated who is responsible for this task. If a student with a disability has difficulty writing, the instructor is responsible for providing the student with an oral test. While it is true that NCLEX testing cannot be completed orally, the issue to address when considering an accommodation for a written test would be the role of the written question and if there is an alternative format that would allow the student to demonstrate knowledge of the content.30 Most (90%) of the participants indicated that they worked with students with disabilities who required accommodation during the past 3 years; slightly more than half (52%) did not receive training from their institutions about the provision Nurse Educator
of accommodation. Participants, however, used several resources to obtain information about students with disabilities and the use of accommodation. The office of disability services (67%) and colleagues or mentors (46%) were the most frequently cited resources. Currently, there are no state or federal regulations that mandate institutions of higher education provide professional development activities on disability-related legislation or the use of accommodation to meet the needs of students with disabilities. However, institutions should provide training and development activities to educate faculty about their role and responsibilities in the provision of accommodation. The results of this study are consistent with prior research that demonstrated a knowledge deficit of disabilityrelated law among faculty members.15,25 Burgstahler and Doe16 suggested that faculty members who are knowledgeable about academic accommodation and are able to develop creative strategies to provide accommodation are better prepared to assist students with disabilities. The findings of the current study support the need for professional development activities addressing disability-related law and the provision of accommodation for faculty working with students with disabilities. Helms et al17 suggested that the latitude given in the selection of an accommodation requires faculty to be knowledgeable about what constitutes an appropriate accommodation and how to provide appropriate modifications for students. Faculty development activities could address this knowledge deficit and include innovative teaching strategies that could be used to improve the outcomes of students with disabilities. Thompson et al23 concluded that assessment of faculty knowledge of disability law can provide valuable feedback to faculty and generate interest in learning more about their responsibilities and those of the student. Faculty members’ insights and experiences are essential components in creating and providing accommodation that are unique to academic and clinical settings. Use of accommodation is pedagogically sound, required by law, and essential to student success.2,3,6,16,17,24 Approaching the use of accommodation from a pedagogical perspective may provide an evidence-based approach that faculty members can understand and implement. Groccia and Buskist12 noted that when the evidence-based principles of learning are the basis for the development of best practices in teaching and learning, the diverse needs of all learners can be met. This could be accomplished through cooperative learning strategies used in the classroom and clinical setting. Project Opportunity and Access (POA) is a technologybased faculty development program developed at Pennsylvania State University. The program reviews disability-related legislation and the use of accommodation in the postsecondary setting. Faculty and staff are encouraged to complete the program as a way to enhance their ability to provide resources to students with disabilities. Products such as POA can be beneficial to faculty because of their convenience and easy access to information.24
Limitations There are several limitations of this study. Three of the 34 institutions eligible to participate in the study did not publish faculty e-mail addresses on their Web sites and could not be Volume 39 & Number 5 & September/October 2014
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included in the study. Those unfamiliar with online surveys may have chosen not to participate. Subjects who are not interested in disability-related issues may not have responded to the survey, resulting in a lower response rate.
Future Research Research is needed to differentiate the specific issues related to accommodation between the clinical and classroom setting. Addressing the issue of providing accommodation in the clinical setting is not new27,28; however, as a culture of safety has been the focus of the Institute of Medicine8 and the Quality and Safety Education for Nurses initiative,31 concerns about safety have resurfaced. Safety is a concern for all students, and students with disabilities do not pose greater safety risk.22 Betz et al21 noted that the lack of accommodation for clinical environments may be related to the small number of students who request them. Furthermore, the infrequent request is attributed to the possible belief of students and faculty alike that the physical demands of a nursing career are incompatible with having physical disabilities. Future research could examine the validity of technical standards to which nursing students are held and the development and testing of strategies amenable to accommodation.
Conclusion Findings of this study demonstrated a knowledge deficit related to disability-related legislation and the provision of accommodation. This could be remedied through faculty development activities that address disability-related laws and the unique challenges and opportunities of creating accommodation in the classroom and clinical setting for nursing students with disabilities. Additional research should address the concerns of faculty about accommodation that meets the needs of students with disabilities and the rigor of nursing programs. These are not mutually exclusive goals. Re-envisioning the traditional clinical evaluation without compromising rigor is possible, but the profession needs to be committed to the value and contributions of students with disabilities. Acknowledgments The author participated in the 2013 NLN Scholarly Writing Retreat, sponsored by the NLN Foundation for Nursing Education and Pocket Nurse.
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4. Health Resources and Services Administration. The registered nurse population: findings from the 2008 national sample survey of registered nurses. 2010. US Department of Health and Human Services. Available at http://bhpr.hrsa.gov/healthworkforce1/ rnsurveys/rnsurveyfinal.pdf. Accessed May 19, 2014. 5. 2013 Enhancing diversity in the workforce. American Association of Colleges of Nursing Web site. Available at http:// www.aacn.nche.edu/media-relations/fact-sheets/enhancing-diversity. Published January 2013. Accessed November 15, 2013. 6. PL 101:336; PL 105-107 The Americans With Disabilities Act. Available at http://www.eeoc.gov/laws/statutes/ada.cfm. Accessed December 2, 2013. 7. Kolanko K. A collective case study of nursing students with learning disabilities. Nurs Educ Perspect. 2003;24(5):251-256. 8. Maheady D. Jumping through hoops, walking on egg shells: the experiences of nursing students with disabilities. J Nurs Educ. 1999;38(4):162-170. 9. Evans BC. Nursing education for students with disabilities: our students our teachers. In: Oermann MH, Heinrich K, eds. Annual Review of Nursing Education. Vol 3. New York, NY: Springer Publishing; 2005;3-22. 10. Persaud D, Leedom C. The Americans with Disabilities Act: effect on student admission and retention practices in California nursing schools. J Nurs Educ. 2002;41(8):349-352. 11. National Organization of Nurses With Disabilities policy statement: nursing students with disabilities. Available at http://www .nond.org. Accessed January 4, 2012. 12. Groccia J, Buskist W. Need for evidence-based teaching. In: Groccia J, Buskist W, ed. New Directions for Teaching and Learning. San Francisco, CA: Jossey-Bass; 2010;128:5-11. 13. 2009 The Current State of Health Care for People With Disabilities. National Council on Disability Web site. Available at http://www .ncd.gov/policy/education. Published 2009. Accessed January 15, 2014. 14. 2010 The Future of Nursing: Leading change, Advancing Health. Institute of Medicine Web site. Available at http://www.iom.edu/ Reports/2010/the-future-of-nursing-leading-change-advancinghealth.aspx. Published 2010. 15. Vogel S, Holt J, Sligar S, Leake E. Assessment of campus climate to enhance student success. J Postsecondary Educ Disabil. 2008;21(1):15-31. 16. Burgstahler S, Doe T. Improving postsecondary outcomes for students with disabilities: designing professional development for faculty. J Postsecondary Educ Disabil. 2006;18:135-147. 17. Helms L, Jorgensen J, Anderson M. Disability law and nursing education: an update. J Prof Nurs. 2006;22(3):190-196. 18. Murray C, Flannery B, Wren C. University staff members’ attitudes and knowledge about learning disabilities and disability support services. J Postsecondary Educ Disabil. 2008;21(2): 73-90. 19. Sower J, Smith M. Nursing faculty members’ perceptions, knowledge, and concerns about students with disabilities. J Nurs Educ. 2004;43(5):213-218. 20. Morris D, Turnball P. Clinical experiences of students with dyslexia. J Adv Nurs. 2006;54(2):238-247. 21. Betz CL, Smith KB, Bui K. A survey of California nursing programs: admission and accommodation policies for students with disabilities. J Nurs Educ. 2013;51(12):676-676. 22. Marks B. Cultural competence revisited: nursing students with disabilities. J Nurs Educ. 2007;46(2):70-74. 23. Thompson A, Bethea L, Turner J. Faculty knowledge of disability laws in higher education: a survey. Rehabil Couns Bull. 1997;40(3):166-180. 24. Junco R, Slater D. Improving the campus climate for students with disabilities through the use of online training. NASPA J. 2004;41(2):263-276. Nurse Educator
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25. Rehabilitation Act of 1973, Section 504, P.L. 93-112, 229 U.S.C.A. 794. Available at http://www.dol.gov/oasam/regs/statutes/sec504.htm. Accessed January 12, 2014. 26. Dona J, Edmister J. An examination of community college faculty members’ knowledge of the Americans With Disabilities Act of 1990 at the fifteen community colleges in Mississippi. J Postsecondary Educ Disabil. 2001;14:91-103. 27. Bourque D. Factors That Influence the Attitudes and practices of Postsecondary Faculty in Providing Academic Accommodation to Students With Disabilities [dissertation]. Boston, MA: University of Massachusetts; 2004.
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28. Hammel C. Faculty Knowledge of Disability Law and Its Relationship to Attitude, Education, and Experience [dissertation]. Long Island, NY: Hofstra University; 2009. 29. Villarreal P. Faculty Knowledge of Disability Law: Implications for Higher Education Practice [thesis]. Waco, TX: Baylor University; 2002. 30. National Council of State Boards of Nursing. Available at https:// www.ncsbn.org/index.htm. Accessed March 12, 2014. 31. Cronenwett L, Sherwood J, Disch J, Johnson J, Mitchell P, Sullivan D, Warren J. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122-131.
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