Disability type

their  healthcare  needs  will  be  covered.    Indeed,  Jim  (CLEL)  cautioned  that   reactions  of  the  patient  towards  the  student  with  a  disability  can  vary  and   they  may  not  be  so  tolerant  of  the  student’s  need  for  reasonable  adjustment,   for  example,  having  to  speak  slower  or  repeat  things.    The  student  needs  to   have  sufficient  insight  into  their  disability  and  the  consequences  that  

reasonable  adjustment  may  have  on  others  that  they  work  with  in  addition  to   the  patient’s  perception.    As  well,  the  connotations  of  the  amount  and  type  of   support  the  student  requires  does  need  careful  planning  as  it  can  have   consequences.    This  was  illustrated  by  Veronica  (PE)  who  recalled  one   student  who  was  going  to  come  out  with  a  support  worker  and  this  

concerned  her  in  that  from  a  patient  perspective,  it  could  be  construed  as   being  surrounded  by  too  many  people  and  consequently  impact  on  their  well-­ being  and  cooperation  to  participate  in  the  assessment  /  intervention  being   provided.    The  actual  practicalities  of  this  type  of  support  were  greeted  by  a   modicum  of  concern  on  Veronica’s  part  and  entailed  extra  planning  and   thinking  through  on  top  of  her  existing  workload.  

4.3.1.3  Disability  type      

According  to  Andrea  (VT),  the  type  of  disability  in  respect  of  associated   challenges  does  make  a  difference.    If  for  example,  a  student  has  multiple   difficulties  in  relation  to  dyslexia,  tasks  such  as  spelling  and  processing   information  can  magnify  the  challenges  as  the  student  may  need  to  spend   more  time  with  the  patient  to  assess  them  or  explaining  information  to  

patients.    In  Andrea’s  view,  settings  where  appointments  are  time-­bound  can   make  the  practice  educator  anxious  and  this  in  turn  can  reflect  on  the  

student’s  assessment.    Andrea’s  comment  about  slowing  down  the  

assessment  process  was  mentioned  too  earlier  by  Jim  (CLEL)  who  said  in   his  experience  patients  can  sometimes  become  frustrated  because  a  student   can  slow  down  the  assessment  process  because  of  their  disability.    If  the   patient  is  in  pain  or  not  feeling  well  this  can  exacerbate  their  symptoms.    This   hints  at  the  fact  that  some  patients  may  not  be  so  tolerant  of  the  need  to  

adjust  to  the  student’s  needs  -­  for  example,  to  slow  down  the  delivery  of   information  that  the  student  requires.    

Further  examples  of  the  impact  of  disability  type  was  provided  by  a  number   of  interviewees,  notably  Keith  (CLEL)  who  asked  if  a  student  in  a  wheelchair   would  be  able  to  reach  for  dressings  in  a  stock  cupboard,  and  whether  there   would  be  good  access  to  all  parts  of  the  built  environment?    Another  unusual   example  was  provided  by  Mary  (PE)  who  recounted  an  experience  when  she   had  a  student  with  a  brain  injury.    She  said  this  was  so  different  to  other   students  with  a  disability  in  that  when  the  student  became  fatigued,  their   limbs  had  a  tendency  to  contract.    There  were  no  coping  strategies  to   manage  this  so  the  student  was  dependent  on  the  team  to  straighten  their   limbs.    

Lillian  (ST)  had  an  insider  perspective  of  two  contrasting  disabilities  -­  her   own  which  was  predominantly  physical-­based  and  a  fellow  student  who  had   a  mental  health  difficulty.    Both  students  were  allocated  to  the  same  

placement.    This  is  Lillian’s  experience:  

I  know  one  student  who  experienced  a  mental  health  difficulty  and  the   challenges  that  they  experienced  were  very  different  to  the  challenges   I  experienced.    For  one  placement  there  was  another  student  that  I   was  paired  with  who  could  not  drive  for  this  particular  placement   duration.  The  student  experienced  mental  health  difficulties  including   anxiety  and  could  not  use  public  transport  because  of  the  anxiety.     This  was  extra  pressure  for  me  on  top  of  dealing  with  my  own  chronic   pain  and  the  subsequent  impact  on  my  placement  as  I  felt  under   pressure  to  attend  each  day  of  placement,  if  I  didn’t  then  I  was   potentially  disrupting  the  other  student’s  placement.    I  also  had  to   concentrate  on  driving  and  also  listening  to  this  other  student’s  

challenges  that  they  were  encountering  because  of  their  anxiety  -­  this   was  very  hard  for  me  to  deal  with,  it  wasn’t  my  responsibility  to  sort   their  problems  out.    I  felt  so  responsible  and  it  was  extra  pressure.    I   really  feel  that  the  university  ought  to  think  more  carefully  when  they   pair  students  together  for  placement…this  other  student  really  should   have  been  paired  with  another  student  who  did  not  have  the  same   amount  of  pressure  as  me  because  of  the  chronic  pain  that  I   experienced.        

Lillian  emphasised  the  importance  of  the  right  allocation  for  the  right  student.     She  also  recounted  her  relief  at  being  allocated  a  placement  in  learning   disabilities  as  due  to  the  challenging  behaviour  exhibited  with  this  client   group,  she  worried  that  if  she  had  been  attacked  this  could  have  resulted  in   her  previous  injurious  region  of  the  body  being  fractured  again.    This  to  me   expresses  a  hint  of  feelings  of  potential  vulnerability.      

Mark  (ST)  asserted  that  he  managed  his  dyslexia  on  placements  and  did  not   encounter  any  major  challenges.    Furthermore  he  said:  “It  really  is  not  a  big   thing  to  have  a  disability  like  dyslexia  and  I  feel  that  my  needs  were  easy  and   simple  to  accommodate”.    It  is  interesting  to  note  that  Mark’s  experiences  of   practice  education  on  the  whole  appear  to  be  positive  ones  yet  by  contrast,   some  of  the  students  interviewed  who  also  had  dyslexia  encountered   negative  experiences.    Andrea  (VT)  revealed  that:  

The  type  of  disability  does  make  a  difference  for  example,  those  with   dyslexia,  if  it’s  just  one  problem  such  as  spelling  that  is  fairly  

straightforward  and  potentially  they  can  adjust  well  to  this  but  if  they   have  multiple  difficulties  such  as  processing  information  that  can  be  a   challenge  as  they  might  need  more  time  for  assessments  or  

explaining  information  to  patients;;  settings  where  appointments  are   time-­bound  can  make  the  educator  anxious  and  can  in  turn  reflect  on   the  student’s  assessment.    This  can  also  impact  on  things  like  time   management  and  organisation  therefore  making  it  a  complex   challenge  for  the  student.    

Here,  Andrea  is  saying  the  experience  of  disability,  the  manifestation  of  the   disability  is  unique  to  the  student  in  that  with  any  one  type  of  disability,  there   may  be  a  number  of  challenges  they  have  to  contend  with  such  as  

processing  information  in  addition  to  difficulties  with  spelling.    This  potentially   means  the  student’s  disability  may  not  present  as  being  straightforward  in   mitigating  the  challenges  experienced.    The  environment  is  also  an  

influencing  factor,  according  to  Andrea,  such  as  time-­bound  settings  which   add  to  the  pressure  of  work.    Another  key  point  arising  is  the  pressure  on  the   practice  educator;;  ultimately,  they  have  some  responsibility  for  the  student’s   actions  in  terms  of  ensuring  that  delegation  of  tasks  and  expectations  of  the   placement  are  clear.    Nonetheless,  if  the  student  is  experiencing  difficulty  

keeping  to  time,  this  may  reflect  and  impact  upon  the  practice  educator’s   workload.      

A  final  example  is  illustrated  by  Peter  (VT)  who  said  that  in  some  instances,   having  a  disability  can  be  beneficial,  he  said:  “for  those  with  a  mental  health   difficulty,  if  they  are  not  emotionally  stable  then  they  may  experience  

problems  when  treating  patients  with  mental  health  problems  but  on  the   other  hand,  the  student  may  be  more  empathetic”.    This  resonates  with  the   concept  of  insider  perspectives  on  disability,  having  that  deeper  

understanding  of  what  the  patient  is  experiencing  because  the  student  has   been  through  that  experience  themselves,  which  can  sometimes  lead  to   better  outcomes  for  the  patient.      

4.3.2  MANAGEMENT  OF  IDENTITY    

4.3.2.1  Disability  identity    

The  potential  for  misunderstandings  regarding  the  student  with  a  disability   and  the  consequences  thereof  resonated  strongly  with  some  interviewees.   For  example,  Lillian  (ST)  stated  that  one  day,  her  practice  educator  

suggested  -­  several  times  -­  that  she  go  home  early  as  she  looked  tired.     Lillian  was  also  experiencing  quite  a  bit  of  pain.    The  response  from  Lillian   was  that  it  should  be  her  choice  as  to  whether  she  wanted  to  go  home  earlier   than  planned  and  that  people  have  good  intentions  but  it  can  backfire.    She   explained  that  the  visiting  tutor  may  assume  (rightly  or  wrongly)  she  (Lillian)   was  not  coping  with  the  demands  of  the  placement  and  was  down  on  her   hours.    This  scenario  seems  to  hint  at  the  importance  of  the  need  for  the   student  to  be  in  control  of  their  destiny,  as  Lillian  stated:  “I  know  I  can   manage  my  disability,  I  can  manage  it  myself”.    This  scenario  highlights  the   need  for  the  student  to  also  control  the  public  perception  of  themselves.  They   are  aware  of  the  stigma  and  of  being  perceived  as  not  being  able  to  cope.   They  wish  to  manage  not  just  their  disability  in  terms  of  how  they  function  in   the  work-­place,  but  also  their  reputation  and  public  perception.    Lillian