Reasonable Accommodations on Placement
Reasonable accommodations that can be provided by the placement and the professional course on behalf of a student are requested in a Professional Placement report. These recommended reasonable accommodations are generally agreed in consultation/agreement with the Placement Co-ordinator and the Placement Educator.
Professional Placement process outlines the process taken. For more information please download the Professional Placement Reasonable Accommodations for Students with Disabilities booklet. . Please note, this document also includes illustrative examples of scenarios where reasonable accommodations might be required. The following are examples of Reasonable Accommodations that may be required by a student on placement:
- Maintain confidentiality/do not disclose to other students, staff or clients of the service
- Disclosure of disability
- Allow student to choose placement option
- Provide accessible placement locations
- Pre-placement visit
- Allow an assistant to attend placement with student
- Flexibility of scheduling of attendance as appropriate
- Flexibility on placement deadlines as appropriate
- Allow or provide time and space for the student to take rest breaks, self-administer medication or monitor blood sugar levels as required
- Allow additional time to develop practical placement skills
- Allow student to record notes and alternative administrative management strategies on placement
- Managing Handovers - Allow extra time to prepare for handover. Receive verbal patient handover with peers and additional one to one handover to review patient notes and ask questions
- Provide daily/regular feedback on progress on placement and as requested.
- Provide relevant placement procedures and information in alternative formats or as enlarged copies if required.
- Adaptation of placement working hours and/or days
- Avoid or reduce manual/patient handling tasks
- Allow student to use assistive technology such as a digital recorder, laptop etc
- Personal Emergency Evacuation Plan
- Management of Risk for Students with Disabilities
For more information please download the Disability Service booklet titled - Professional Placement Reasonable Accommodations for Students with Disabilities by clicking on this link
The Trinity Nursing Booklet is available here.
Maintain confidentiality/do not disclose to other students, staff or clients of the service
It is important that Placement Educators are aware of an individual's disability, but highlighting it during placement may be very upsetting for a student or at the very least may cause embarrassment and so should be avoided. In addition, students have been reassured in disclosing their disability that such information is provided only to staff on placement on a need to know basis. Further disability-specific information is available on the Disability Service website
Example: Mary is on the ward and she is struggling to keep up with all the tasks she has been assigned by the Staff Nurse. Some members of staff say it to the Preceptor who is aware of Mary's disability; however the preceptor is not allowed to disclose information on Mary's disability to other staff members, even if her disability is impacting on her performance, she must be mindful of same when speaking with the other staff.
Disclosure of disability
As part of the placement planning process, students are encouraged to discuss their placement specific needs. This involves discussing whether disclosure of their disability is necessary on placement to ensure that measures and reasonable accommodations may be implemented to facilitate the student in fulfilling their placement competencies. Disability disclosure is a personal decision and ultimately a decision of the student themselves. The process can be highly sensitive for students and therefore it is imperative that disclosure is managed in a sensitive, supportive and confidential way by placement staff.
The Disability Service supports the process of disclosure and specific supports provided will depend on when a student's placement is due to start, what level of support the student needs and the level of disclosure they are comfortable with. Placement staff should adopt a positive approach to disclosure of a disability and reasonable accommodation requests, as practicable and as agreed with the student and university staff. Disclosure enables the student to avail of increased supports and provides legal protection which in turn ensures public safety in relation to any fitness to practice issues, described earlier within this document.
Students who disclose their disability on placement will have indicated the level of disclosure that they would prefer– i.e. what will be disclosed, to whom on placement, when, and how. Information disclosed by the student under the Data Protection Act is, by law, to remain confidential and be respected at all times. This information must be protected, used only for agreed purposes and should not be communicated to anyone without the student's consent. Effective disclosure management is imperative to the student feeling supported within their professional placement. Any discrimination toward a student who discloses a disability on placement is illegal; in Ireland both the Equal Status Act and the Disability Act prohibit discrimination on the grounds of disability.
Example: Barry is a 3rd Psychiatric Nursing student with a mental health difficulty. Barry successfully completed placements in 1st and 2nd year and disclosed in all placements to the level of CPC. Barry however, recently became very overwhelmed on his 3rd year placement; he struggled with multi-tasking and nursing duties. As a result he was advised to take some time off as he experienced high levels of anxiety. Barry returned to Trinity for lectures for a period of time before he repeated the placement, Barry was very anxious and worried about returning to the placement and the same scenario happening again. In consultation with his Disability Officer and Occupational therapist, Barry arranged a pre-placement meeting to disclose managing the placement. It was identified that Barry should try out new strategies to help him on the ward, such as organisational strategies, revision of nursing theory and literature, as well as practising communication skills. Barry disclosed to the CPC level again and stated that he would disclose to other members of the team if he felt it was required as the placement went on. Barry continued to use Unilink throughout the placement to support him. Barry repeated and completed his placement successfully.
Students who disclose a disability.
Students who disclose a disability to staff on placement and who are seeking guidance and support, should be informed in writing, preferably via their TCD email account, that they are advised to register with the Disability Service (DS) as soon as possible. The six steps to DS registration are provided at http://www.tcd.ie/disability/current/registration.php. You may also complete a Disability Services Referral Form , which the student should bring with them at the point of registration.
Students who disclose a disability but are reluctant to register with the Disability Service.
Students on professional courses who disclose a disability but who are not registered with the Disability Service may present a risk if they are not advised of the consequences of choosing not to disclose. This is because students who do not disclose a disability cannot avail of reasonable accommodations, and cannot claim that they have being discriminated against (on grounds of disability), if they do not disclose further. After discussion with their Tutor, students should be informed in writing, preferably via their TCD email address, that they are advised to register with DS as soon as possible. Students should also be directed to the 'Guide for Students with Disabilities on Professional Placement' which encourages all parties involved to work together to ensure that students with disabilities have a good work placement experience http://www.tcd.ie/disability/services/placement-planning.php.
More information and FAQ section see: http://www.tcd.ie/disability/teaching-info/faqs.php#help
Example: Brian has disclosed a recent diagnosis of ADHD to his placement supervisor during the course of supervision. Although Brian succeeded on this first observational placement, his supervisor noted that at times he appeared distracted and missed some information. Brian's supervisor suggested that he register with the Disability Service to complete an assessment of his needs and facilitate him to implement strategies to succeed in future placements. Brian previously did not register as he said he 'did not see himself as disabled' and was not fully aware of what types of support the Service could provide him. Upon this advice he registered with the Disability Service and he met an Occupational Therapist in Unilink who worked with him to manage concentration issues.
Disclosure of a disability to a client or patient
Another point to consider is that of disclosure of a disability to patients. As stated above, it is the student's right not to disclose. This relates to interaction with patients, as well as to any other situation. Practice-based educators may wish to discuss this matter with students, but it must be emphasized that students cannot be compelled to disclose, even if a practice-based educator believes that this would be advisable.
Example: Jack is a Social Work student who has a mental health condition, he decides to disclose to his practice-based educator. Jack feels that it would be beneficial if he discloses his condition to the clients he is working with (some of whom have a mental health condition) as a way to build rapport with clients. Jack previously volunteered with a mental health support group where he found disclosing to others beneficial in developing relationships. Through discussion with his educator they decide that on this placement it would not be appropriate to disclose to clients, as it is important maintain professional boundaries with clients who vulnerable. Instead, Jack's educator supports him to develop ways to convey his understanding and empathy of the lived experience of mental health difficulties to clients, including communication strategies e.g. Active listening. Jack's educator provided regular feedback on Jack's interactions with clients. Jack also kept a reflective journal throughout the placement to record his own emotional reactions and communication strategies with clients and shared some of these reflections with his educator in supervision.
Allow student to choose placement option
Some students may have a number of disability related reasons why they may need to select their placement venue. Some students will have difficulty travelling significant distances due to a physical or medical disability. Other students may not be ready for particular placement settings or types of settings such as a mental health placement or a physically demanding placement; such as A&E. Additionally, some students may opt to have a placement where there is additional support such as a Practice Tutor who also meets with the student regularly to support them on placement. Options can be discussed well in advance with the placement co-ordinator.Examples: Sean is training to be a teacher and has a physical disability. He is unable to use public transport and relies on taxis to get to University and placements. He has met with the Placement Co-ordinator to discuss placement options and was given support in identifying a suitable school close to where he lives.
John has a physical disability and is in his first year in OT, he has a 2 week placement, and following discussion with the practice placement coordinator was able to negotiate to get a placement closer to where he lived in Dublin.
Mary is training to be an OT and following discussion with her practice coordinator was able to request a more supportive placement environment where a Practice tutor was available weekly for additional support.
Provide accessible placement locations
Most placements will be accessible, however, there are still a few inaccessible placements and these should be avoided if at all possible. It is useful to have a list of all accessible locations available and if a pre-placement meeting is suggested this will allow for correct choice of placement sites. Students with physical, mobility or fatigue issues may find the placement environment difficulty to manage and this should be taken in to account when organising placement locations. Students will be encouraged to discuss physical needs when planning their placement with the placement co-ordinator on their course.
Examples: For a student who experiences fatigue due to a physical or mental health condition, the time taken to travel to placement may have a significant impact on their ability to maintain stamina and focus whilst on placement. This should be discussed in the planning process where the student should identify the permissible length of commute time that will not impact on them when on placement. This may also be effected by the available mode of transport e.g. if the placement is not accessible by public transport, driving may increase the student's level of fatigue. The mode of transport should also be considered in relation to the start /end time of placement e.g. being flexible regarding start /end time to facilitate times of bus/train so energy levels can be maintained. For students that have a placement further away from home (where they have to find accommodation) these issues should also be carefully considered. A pre-placement visit can be useful to assess travel arrangements and impact of this on student. The physical placement environment may also impact on the student e.g. if there are a lot of stairs in the building/no lift, this could also be identified in a pre-placement visit.
Harry is Social Work student on placement with a neurological condition. Harry's disability impacted on his resulted mobility and stamina while on placement. Placement initially was in a building with a lift that was breaking down continually. When the Harry informed the placement co-ordinator in Social Work of this difficulty, he was found an accessible placement.
Pre-placement visitStudents with disabilities are strongly advised to discuss with their Placement Co-ordinator whether a pre-placement visit would be advantageous. It is important, therefore, that Practice Educators are familiar with disability-related issues in order to be able to provide constructive guidance. The following provides suggestions as to why a pre-placement visit might be useful:
- Allows for familiarisation with the route to the placement site
- Allows for familiarisation with the local environment and identification of any potential barriers
- A discussion between the student and the practice educator can take place which allows for the identification of any specific placement accommodations
- Identification of reasonable accommodations and allows both parties to determine who is responsible for organising/implementing any reasonable accommodations; i.e. the placement provider, the University, the student, or a combination of these
Examples: Peter a student with a physical disability on a Nursing course was on placement in a location that involved three different sites in a large hospital complex that would result in significant travelling. The impact of this physical disability resulted in the student becoming fatigued and a fatigue management solution was required. The student and the Disability Officer visited the sites and discussed with the Practice Educator a number of options that would reduce the amount of travelling. For example, the supervisor arranged to meet the student at the ward where the student was based rather than the supervisor's office in another part the hospital complex.
Marie a student who has a visual impairment found it useful to travel to the placement prior to its commencement in order to familiarise herself with the elements of the journey and to orientate herself with route; e.g. identify bus stops. This reduced the stress on the first day of the placement.
Susan a student who has dyslexia was able to discuss with her Practice Educator the personal strategies that she had developed for maximising her organisational skills and time - management. She also had the opportunity to see the electronic patient notes system and to negotiate a flexible way of working and some extra time to enable her to complete her documentation in an acceptable period.
Allow an assistant to attend placement with student
Some students may require a personal assistant or an Irish Language Interpreter to attend their placement to assist them with a physical task or communication. The Placement Co-ordinator should discuss with the student what is exactly being measured in the competency developments on every placement and the role of the assistant/interpreter in achieving the goals set.
Examples: Sarah, deaf student studying to be a Social Worker uses Irish Sign Language (ISL) to communicate and requires an ISL interpreter to be present for when on placement. Sarah met with the placement co-ordinator to discuss requirements and how to work with an interpreter in sensitive situations such as client appointments. A further meeting was arranged with the placement site and manager to discuss logistics and how to manage the ISL interpreter. The Disability Service in the Trinity provided guidelines on use of interpreters http://www.tcd.ie/disability/assets/video/islinterpreters.mp4 and http://www.tcd.ie/disability/services/ and the Sarah provided continuous feedback the placement on how the ISL provision worked in practice and any issues were dealt with as they arose.
Gary has a physical disability and is on placement in a laboratory. He has limited coordination and dexterity. Following a risk assessment due to lab health and safety concerns, a personal assistant to assist Gary was recommended. The personal assistant assisted with retrieving chemicals, equipment and pouring under instruction from Gary. Gary was assessed as all other students showing their ability to perform the tasks required.
Flexibility of scheduling of attendance as appropriate
Due to the nature of a student's disability, it is possible that some hours of placement may be missed due to ill-health or medical appointments. Students who have a Placement Planning Report/LENS report have submitted medical evidence from a consultant or specialist of a disability or significant ongoing illness. While a Placement Planning Report/LENS report cannot act as an open ended medical certificate it should alert staff to the fact that regular absences may be necessary and that agreement should be sought as to what level of absence can be reasonably accommodated. This should be done on a case by case basis taking into account the placement requirements, the principle of reasonable accommodation and the nature of the student's disability. It is best to discuss attendance issues and making time up in advance to ensure the student is meeting the attendance requirements in a reasonable time line. Making up time lost as a result of disability - related absence should be treated differently to sickness or other types of absence.
Examples: Anne, a student in Nursing with an SOI who became fatigued in the later stages of the typical 13 hour requested some flexibility in shift pattern. Following a discussion with the CPC on placement Anne was allowed to shorter shifts – four shifts of 9 hours as opposed to three 13 hour shifts.
Another example where a student was hospitalised for surgery missing 2 weeks of a 9 week placement was allowed to make up the missing weeks at the end of the placement. This allowed the student to complete the placement and not have to repeat this placement.
Flexibility on placement deadlines as appropriate
Provide details of placement deadlines well in advance and in the placement handbook. Some students may have difficulty prioritising and focusing on the required elements of the placement. Providing clear specific details makes it easier for a student to complete a placement. Providing deadlines well in advance enables a student to structure their placement demands so that they divide their time appropriately between tasks required.
Examples: A student with dyslexia may find that completion of placement takes longer, so provision of deadlines well in advance enables students to pace their workload. Similarly, a blind student can effectively manage the conversion of information to alternative formats.
A student with Acquired Brain Injury may experience cognitive and memory difficulties, which may result in them experiencing difficulties with prioritising and focusing on the required elements of the placement. A supervisor could support the student to set realistic deadlines and plan and prioritise the tasks involved on placement (e.g. overall, weekly and daily goals), thus enabling the student to meet deadlines in an effective manner.
Allow or provide time and space for the student to take rest breaks, self-administer medication or monitor blood sugar levels as required
Some students require rest breaks due to fatigue associated with managing a disability or to self-administer medication or monitor blood sugar levels as required. A student that is affected by fatigue, sensory processing difficulties, Post Traumatic Stress Disorder (PTSD), insomnia or anxiety as well as many other conditions may need more frequent breaks than other students.
Examples: Sean, a student nurse with PTSD who is only sleeping 2 hours a night sought a meeting with the Course co-ordinator and was facilitated as follows:
- The student was placed in the community or in Surgery rotation, which are 9-5 days, rather than 13 hour hospital shifts. In this way, they did not need more frequent breaks, but work the same as others
- Student was allowed to use a nearby room, office or vacant ward (to themselves) to take a break away from the ward.
- Facilitated to agree their rest times with their CPC/CNM at the start of each shift.
- Made an agreement with CPC/CNM that they may take regular breaks, once senior staff member is informed (i.e. don't leave ward unannounced)
- Had a smaller caseload, which would reduce their workload, making breaks possible without disrupting patient care.
Anne is a 3rd year student in Speech Therapy and has a Mental Health Condition. Anne will need to complete 250 contact hours plus a 20 day placement. The impact of Anne's disability means that Anne may become anxious and experience fatigue. For this reason, Anne has been assigned a placement provider close to her student accommodation. In discussion with placement providers it was agreed that Anne visit the clinic prior to the placement period for orientation, at which time she can meet key staff and clarify placement requirements. At the same time, Anne can discuss opportunities to take rest breaks, and the circumstances in which use of a digital recorder to assist with assessment and session plans, might be permitted. Staff has agreed that Anne may require additional time to develop clinical skills and that regular feedback (on a daily basis) would be productive.
Avoid or minimise tasks that are not essential to core competencies but which may present the student with an additional burden
A student nurse with a physical disability developed knee pain during placement. The student attended a consultant who recommended that the type of placement be considered in future scheduling to take account of her knee pain. In addition, the Disability Service recommended flexibility in the reduction of lifting duties while on general placement. Specifically, staff was asked to encourage appropriate patient handling techniques and the use of hoists when necessary. The CPC agreed to the recommendations.
As required, modify or provide alternative methods for meeting core competencies that do not compromise professional or health and safety standards.
A student with a visual impairment studying Radiotherapy experienced difficulty in the set - up of patients for radiation treatment. The Disability Officer and the student visited the site to review tasks required to give advice on what could be modified to allow the student to be competent. The placement report recommended that the student be permitted additional time to use assistive technology – magnifier and small torch to adjust the tabletop height and distance from tattoos. Also, to allow to set the table top height and to double-check that the intersection of lasers is on tattoo with the use of a magnifier and additional light source. The accommodations worked and student passed the competencies being measured.
Allow additional time to develop practical placement skills
For any student on placement with reduced fine motor skills, processing speed difficulties or a disability which can cause pain, fatigue or reduced mobility, even the average speed may be too fast. It is not reasonable to expect everyone to work at the same speed. Where ever possible, students should be given additional time to develop alternative techniques or practice specific practical skills to reach an appropriate level of competence in the skill. Placement Educators and Course co-ordinators are encouraged to consider ways students could supplement these skills with simulated or improvised resources. Students are encouraged to take ownership of their learning and gain an understanding of how they can best work. This will be important for the workplace during and after University when they will be independently communicating what accommodations or adjustments would be appropriate.
Examples: A student with Dyspraxia/DCD may need more time to practice the organisation, sequencing and carry through of new skills. It would be reasonable to allow this student extra time to develop these skills and practice them.
A student with a mental health difficulty experienced very high levels of anxiety, difficulty concentrating during non-structured assessments and in giving feedback to clients on his observations. A reasonable accommodation was devised through collaboration between the student, supervisor and Unilink Occupational Therapist as follows:
- Student and OT devised an initial template to shape and record observations during the assessment.
- Student then developed this further, with the support of his supervisor to make it appropriate and useable within the practice setting.
- Then the student was then given time to practice using this template in graded manner, starting to use it with classmates and then with clients within the practice setting.
- After the initial times practising the format, the student discussed the results with the supervisor prior to feeding back to the client.
This reasonable accommodation proved effective in developing the student's articulation of their observations and was practiced again prior to the final assessment which involved an unseen assessment. The key to the success of the reasonable accommodation was the collaboration between student and supervisor in developing a format that worked and the student having the opportunity to practice using it.
Allow student to record notes and alternative administrative management strategies on placement
If a student is unable to take accurate notes on placement on account of their disability, students may request that they record the reminders and notes on a Dictaphone or other assistive technology devise (LiveScribe and tablet device). This request only applies to when agreed with the Placement Educator and when the deletion of material recorded is agreed with both parties. As in the case of provision of lecture notes, the student will sign a Code of Practice with the Trinity Disability Service that states that the recordings made are for their own personal use and will not be shared.
Example: Barbara has ADHD and is completing her final year internship in Nursing, taking place over 36 weeks, arranged in 4 blocks of nine weeks in a busy inner city hospital. Barbara requested a pre-placement planning meeting and has agreed to disclose to the Nursing Manager and preceptor. Barbara described the impact of her disability on placement as:
- Difficulties with memory which can be compensated for by taking notes (essential).
- Memory difficulties with long or complex information or instructions/names and client details/history.
- Difficulties maintaining concentration if interrupted or if information or processes are unclear or unknown.
- Communication: difficulty with writing concise and timely nursing notes.
- After discussion with the student and Preceptor, reasonable accommodations on placement included:
- Provide training in hospital computer systems, hospital policies, managing documentation and ward administration procedures.
- Allow student to take handover notes and use self-developed recording and time management systems (essential). Avoid placements where this is not permitted (essential).
- Provide drug administration opportunities and supervision.
- Allow extra time to prepare for handover, where possible.
- Additional time to reconcile notes with nursing records, where possible.
- Training in writing concise nursing notes and care plans.
However, Barbara's internship includes a compulsory psychiatric ward placement. Due to the vulnerability of patients and confidentiality risks, note-taking is not permitted on this ward. In consultation with the ward manager and Preceptor it was suggested that Barbara receive verbal patient handover from night staff with her peers, but that immediately afterwards Barbara has the opportunity to attend a one to one handover with night staff at which time she will be able to review patient notes and ask questions. This will allow Barbara to focus on important actions to be taken.
Managing Handovers - Allow extra time to prepare for handover. Receive verbal patient handover with peers, and additional one to one handover to review patient notes and ask questions.Clinical Handover is an integral part of clinical care, practiced in a multitude of ways, in all healthcare settings, every day. Clinical Handover is a high risk area for patients and requires significant attention and concentration. Face-to-face communication provides more opportunity to clarify information. As well as handing over information it also allows for social interaction and a better understanding of the students' needs. It allows for debriefing, clarification of information and updating knowledge which builds confidence. Some students with disabilities who have difficulties processing information verbally (the most common handover mechanism used) would benefit from a number of strategies.
- Assist in discerning key points at or before handover by going over the student's notes before or after handover.
- Consistent approach to handover sessions is encouraged as it allows the student to develop confidence in this approach.
- Allow students to used tick lists, handover sheets and takes notes if required.
- If possible, use other methods of noting information e.g. allow handover to be taped (keep on the ward and wipe clean once the student has taken action or made notes from this).
Example: Lucy is currently on her Nursing Placement on a Stroke ward. Lucy has a diagnosis of dyslexia and she experiences some difficulties reading aloud and presenting information to a group, particularly information which has been written by other members of the Multi-disciplinary team. Lucy agreed with her supervisor that prior to Handover meetings; she would have time to read aloud the Handover sheet to her supervisor. Lucy stated that this gives her the opportunity to practice and build her confidence in communicating information to her team, which in turn reduced anxiety.
Provide relevant placement procedures and information in alternative formats or as enlarged copies if required.
Some students particularly those with print disabilities (visual impairments and students with dyslexia) have difficulty accessing information and assistance should be given to allow students to be able to receive information in an alternative format either by using assistive reading technology that converts text to speech or allowing students to convert materials such as placement procedures, templates etc. This will allow the student to participate like all other students on placements and not delay information being received.
Example: Tom is a second year Social Work student with a visual impairment which limits significantly the use of his eyesight to read and take meaning from information. Tom contacted the Trinity Disability Service Assistive Technology Officer with a view to offering supports for Tom's summer social work placement in the United States. Tom's impairment limits him from:
- Reading text in a standard font size (10-14) and he has difficulty navigating a user interface due to inability to use a mouse affectively
- Colour contrast of the screen gives glare which would also impact on the amount of time he can spend looking at printed or electronic material.
- From meeting with the assistive technology officer and running through a number of training sessions, a number of technology accommodations were procured and put in place for the student for his independent working environment
- The use of Zoomtext software via USB solution which enabled Tom to change the font size of the screen automatically and the contrast to his desired view along with the addition of having a voice over aid to help him navigate the electronic information. The USB solution enabled him to install the software on a number of devices without any cost or impact to the employer. He was also familiar with the software and felt comfortable in his ability to use it when needed. This enabled Tom to interact with the customer service platform where he has to input data into in an accessible way without the need of a human support or the changing of roles or job description.
- Online support was also provided via an 'Apple facetime' solution from the assistive technology officer in TCD to the student to ensure the solution was working as planned. This gave reassurance to the student and access to expert support when needed to enable him to engage fully in his work as per his working colleagues.
Provide daily/regular feedback on progress on placementThe majority of students welcome and benefit from feedback on their placements. Students have a heightened interest in finding out specifically why they got the mark they got and how they could have done better. Students may be unaware of the standard required on placement. Placement meetings throughout the placement are a good opportunity to discuss issues arising.
For example at the first meeting with students, practice educators may find it helpful to follow a standard format. This could comprise the following:
- If a professional planning report is disclosed, review the reasonable accommodations suggested and discuss how these are working.
- Respect confidentiality and levels of disclosure agreed in this report.
- Rather than asking questions about a student's disability, focus on the practical impact of a disability on the duties that the student will be required to undertake during the placement and what support is already in place or can be implemented, to enable a student to fully participate in the placement
- Ask students what changes, if any, they would find helpful in the context of the placement
- Check with students whether any of the reasonable accommodations negotiated prior to the commencement of the placement are still relevant; e.g. pre-arranged times for any appointments, flexible working patterns, space and secure storage for assistive technology, a quiet room for feedback and carrying out documentation/administration tasks.
Examples: A student with Autistic Spectrum Disorder may not be aware of how their disability may impact them on placement and might have difficulty identifying ways to prove their competency in each competency area. This student may need more time to become aware of and integrate into a new placement environment and the routine of the placement. A reasonable accommodation in this area might be to communicate concrete examples of how the student could prove competency in this particular placement setting by citing how other students have done so previously. Another accommodation would be to give regular feedback to the student on their progress and highlighting areas where they might continue to focus and improve.
Some students, particularly those who are blind and vision impaired may have difficulty formatting submitted reports (e.g. setting margins). Provide feedback to the student on submitted work in an appropriate form, e.g. face-to-face, e-mail or large print, as appropriate.
Mary is a 2nd year Occupational Therapy student with Depression and an Eating Disorder. Mary is completing a ten week placement in this academic year. Mary disclosed her disability to her department when she went on her first placement in 1st Year and it was agreed at that time that Mary would be able to avail of placement sites that were well supported by a Practice Tutor. Her first placement went well, she did not disclose to the practice site, as she had a short placement and did not anticipate any difficulties as she felt that she was taking on an observer role, and fewer competencies needed to be met. As her 2nd year placement was a much longer placement, she decided that she wanted to disclose. This was discussed within Unilink meetings with her Occupational therapist. Mary attended a pre-placement meeting with her Disability Officer, and the practice placement coordinator to discuss reasonable accommodations in her placement. Mary had the opportunity to explore the levels of disclosure and to choose the level she was comfortable with. She also had the opportunity to discuss the areas she was concerned about prior to starting the placement.
As a result of the discussion, Mary decided that she wanted to disclose to her placement supervisor through the use of the Placement Planning report. The reasonable accommodations Mary availed of were:
- Provision of clear instructions from the supervisor to the student.
- Daily, informal feedback with more structured weekly feedback.
- Opportunity to avail of Unilink while on placement.
- Graded building of caseload with support from the supervisor.
- Mary experienced some difficulties on placement however the regular feedback and support from her supervisor as well as regular engagement with Unilink, Mary successfully completed her placement.
Adaptation of placement working hours and/or days.
Adaptation of typical placement daily working hours or days attended per week may be necessary based on a student's given disability need and to enable successful placement completion. This can be negotiated between the placement staff, University staff and the student, based on what is feasible and what the student's individual needs are.
Example: A student who experiences high levels of physical fatigue due to Chronic Fatigue Syndrome, a 5 day per week placement could be adapted to a shorter working week. The placement could be adapted to x4 days of placement per week for an extended period of 10 weeks, as opposed to the original 8 week placement block. Alternatively, or in combination depending on a student's requirements/specific course being completed, placement working daily hours could be adapted. For a placement which demands the student to work 12 hours per day for 3 days per week, this could be adapted to reduce the working hours to 9 hours per day over an extended period of 4 days. These adaptations work to reduce the occupational demands on the student.
Avoid or reduce manual/patient handling tasks
Students impacted by some disabilities such as a Significant Ongoing Illness, dwarfism, hypotonia, hypertonia and many other conditions may not be able to lift and carry/manually handle in the same way as others.
Example: A nursing student with Hemiparesis (weakness on one side of the body) was facilitated in a number of ways by being:
- paired with a health care assistant who he could direct in manual handling during patient care
- placed on a ward with limited manual handling, e.g. a ward of able bodied pre-elective surgery patients
while being assessed could indicate to supervisor what should be done
- work on split shifts so that dressing/undressing is completed while they are not on shift
- Avoid or minimise assigning tasks that are not essential to core competencies but which may present the student with an additional risk/ burden
Allow student to use assistive technology such as a digital recorder, laptop etc
Assistive Technology, whether 'high' or 'low-tech', can be immensely liberating for many disabled students, including in circumstances where other students are unlikely to use it. Practice-based educators should be supportive of students' use of technology to enhance their learning and practice strategies.
What follows provides a brief overview of some of the equipment that disabled students may choose to use whilst on practice-based placements. For more detailed information, see website - http://www.tcd.ie/disability/services/assistive-tech/index.php for more details.
Some students – particularly those who have dyslexia and/or a visual impairment – may want to use their own laptops to take notes whilst on practice-based placements, recognising the need to follow all processes and procedures for managing, storing and ensuring the security of patient-related data within the placement setting. With the increasing use of memory sticks, this is now relatively simple. Notes can easily be deleted when the student leaves. Policies and procedures are now commonly used on placements to manage this.
Some placement providers are now regularly using electronic patient records; those who do so cannot guarantee that they are accessible to disabled users. It is worth checking with the student and or the Assistive Technology support in the University if the student has any additional technology requirements.
Potentially useful devices are a portable mouse with built-in software or a pen drive. When plugged into a computer, these pieces of equipment provide the student's preferred assistive technology, which might magnify an area of the screen or enable speech output. These do not always work with hospital-based computers, as the networks have in-built security systems that may not allow the software access.
If the electronic notes system is inherently inaccessible or will not work with assistive technology, the practice-based educator will need to think of alternative methods by which a disabled student can keep patient notes.
Other useful lower-tech solutions include:
- Hand-held CCTVs/video magnifiers for enlarging text (these act to magnify text to a useable size for someone who has a visual impairment)
- Pocket-size digital recorders/note takers/LiveScribe pens – allowing students to take notes as the go about their duties preventing them from forgetting tasks and duties.
- Task lighting (usually lamps which provide flexible lighting levels through the use of different types of bulb and/or dimmer switches) to help someone who has a visual impairment to be able to see detail
- Distance viewers, which may be useful to students who have a visual impairment, especially when participating in group teaching sessions that include the use of flip charts and PowerPoint presentations, or if observing a patient at a distance; e.g. in a gym, looking at gait pattern – the student can then get close to the screen to see detail
- Speaking digital timers
- Audio labelling equipment
- Electronic colour detectors.
Example: Ciara is a 2nd year Midwifery student midwifery with Dyslexia. Ciara has significant difficulty in both reading and spelling and consequently has difficulty with remembering and pronouncing patient names, and taking notes. Midwifery students have a 4‐week placement in either of the following areas: antenatal, intranatal or postnatal. Ciara failed her first year placement in a busy city maternity hospital as a consequence of these difficulties. Ciara attended a pre-placement meeting with her Disability Officer and placement staff, to discuss reasonable accommodations for a repeat placement over the summer months.
As assistive technology offers a good practical solution to some of Ciara's difficulties, this was discussed in relation to confidentiality and disclosure. Consequently the following reasonable accommodations were agreed:
- Allow student to use relevant medical applications, such as abbreviations and terminology dictionaries, on iphone or android phone. The student should ensure that she uses these applications in an appropriate situation, and at an appropriate time.
- Allow student to use Livescribe pen to take patient histories / case notes. The student should ensure that notes are cleared from the pen memory at the end of each shift, and that the pen is stored in a secure place. An off-ward space in which to use assistive technology will be provided.
- Where possible, provide student with extra time to complete notes.
- Provide student with assistance in reading handwritten and typed notes, lists and labels.
- Ciara successfully completed her placement and in the interim has developed her own method of note-taking shorthand and uses a small reference notebook for frequently used terminology.
Use of hearing devices to assist students with hearing impairments
Sally is third year medicine student has a hearing impairment with high frequency hearing loss in both ears. Sally met with her Disability officer/ placement officer to discuss a need for accommodations to enable the completion of her academic work and an independent support; Sally described the present impact on her impairment as:
- Unable to listen to high frequency sounds such as a human heartbeat resulting in a difficulty to complete the necessary patient reporting.
- Difficulty in listening to patients/lectures who communicate at a fast pace. Sally relied solely on lip reading for communication in large areas.
- Such difficulty made Sally to become anxious about completing her necessary placement and oral examinations.
The student was advised to meet with the Disability Service assistive technology officer for a full needs assessment to evaluate how technology can bridge the learning gap to enable the completion of academic and placement roles. From this meeting a number of technology accommodations were procured and put in place for the student:
- An upgraded hearing Siemens hearing aid was procured in consolation with Sally audiologist, this allowed the student more functionality to use her aid with loop systems, and personal radio aid systems which allowed for the increased transmission of sound to her ear. This device enables Sally to listen and take in information in a more effective manner without reliance on a human support.
- An Electronic Siemens stethoscope was researched and procured for Sally. This device allowed for the transmission of high frequency sound to her hearing aid via Bluetooth without the loss of quality or performance. The device has enabled to Sally complete her placement work in a more effective manner and has increased her independence in completing her placement activities as per her placement peers.
Nursing student with dyslexia
Julie is a second year nursing student with Dyslexia. Julie's profile indicates a deficit in speed of processing (5th percentile) affecting reading (2nd percentile) and spelling (12th percentile). Julie met with her Disability Officer/ placement officer to discuss her difficulties under the following area:
- Unable to spell the necessary medical terminology correctly and in an efficient manner leading to poor academic results and the need for extra time to complete academic work .
- Difficulty making out notes and tying them to the correct terminology, increase low self-esteem and confidence in completing the necessary academic work to the standards required.
The student was advised to meet with the Disability Service assistive technology officer for a full needs assessment to evaluate how technology can bridge the learning gap to enable the completion of academic and placement roles. From this meeting a number of technology accommodations were procured and put in place for the student
- Use of a Livescribe pen – which enabled the student to recorded what is been said verbally while she writes and link the two forms of communication together for easy reference. It allowed Julie to take shorthand notes when visiting patients but enabled her to enlarge that data into a more detailed patient report by returning to the interview via the audio file in a quick and easy method. The use of the device was agreed with the placement area in question and confidentiality agreement signed to ensure patient data was protected.
- The placement provided the student with an off-ward space in which to use assistive technology, in particular when writing up case notes.
- The student was allowed to use relevant medical applications, such as abbreviations and terminology dictionaries, on iPhone or android phone. The student used these applications in an appropriate situation, and at an appropriate time.
Personal Emergency Evacuation Plan
Personal emergency evacuation plan are advisable for students with a physical, medical or sensory disability were mobility is affected in navigating the many buildings students have to navigate in any placement situation in which a student is placed. This is will be identified in the needs assessment process carried out by the Disability Service. In conjunction with the Placement Safety Officer and the building owners in which the student is placed a Personal Emergency Evacuation Plan will be put in place. Further details can be found at: Personal Emergency Evacuation Plan.
Example: An Initial Teacher Education student with cerebral palsy has visited a placement prior to starting and is concerned about access and egress whilst on placement in the school. This student contacts their Disability Officer to discuss what best to do. This student had a PEEP whilst in Trinity and is now confident in the Trinity etting so wants to do the same for placement. The Director of Placement agrees to discuss PEEP needs and ensures this happens prior to placement. The Principal in the School is confident in dealing with this issue as they have dealt with pupils who needed Peeps previously.
Management of Risk for Students with DisabilitiesThese guidelines have been developed by the Disability Service within Trinity College Dublin, to propose a format for the interaction between the students registered with the Disability Service, Disability Service staff, University supports and academic departments, with the aim of facilitating the participation of students with disabilities within the practical elements of their chosen courses and university life.
The process outlined within these guidelines is proposed to be part of the overall needs assessment process, which is carried out with students when they register with the Disability Service within TCD (http://www.tcd.ie/disability/current/registration.php).
For students on professional courses, the process outlined within these guidelines is proposed to take place as part of the placement planning process with students registered with the Disability Service (http://www.tcd.ie/disability/services/placement-planning.php).
Further details can be found at: Guidelines for the Management of Risk for Students and Staff with Disabilities.
Example: A fourth year physiotherapy student reports to her supervisor while on placement, that she is experiencing high levels of fatigue and difficulty concentrating in the morning time, as a result of her current medication. The supervisor informs the department of her concerns and as the student was already registered with the Disability Service, the department advised the student to contact her Disability Officer to engage in the placement planning process. A reasonable accommodation was proposed that client appointments would be scheduled for the afternoon and evening shifts where possible. The student was also advised to contact her doctor for a medication review in the context of the side-effects that she was experiencing.