Nurses with Dyslexia – Difficulties in Practice

The RCN (2014: 3) presented a definition of nursing:

The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

Additional to this definition, the practice of nursing requires of the nurse a variety of skills including personal patient care; critical thinking; delegation; patient education; and physical, psychological, social and spiritual care (RCN 2014). All these skills require a combination of both knowledge and commitment to the values of nursing. Nursing can be both physically and psychologically demanding and stressful at times. It requires the nurse to have a wide variety of skills including clinical decision-making, accurate documenting, mental arithmetic and prioritising. Add to this the ability to retain

57 a vast knowledge base on clinical conditions, pharmacology, human physiology and a wide variety of patient treatment and patient management strategies.

A number of studies highlighted difficulties experienced by the dyslexic nursing student/registered nurse in clinical practice (Illingworth 2005; Morris & Turnbull 2006, 2007a; Gale & Price 2006; White 2007; Crouch 2008; Ridley 2011; Sanderson-Mann & Wharard 2012; Ikematsu et al. 2014). Firstly, it is of interest how these difficulties are described and the different terms used. The term ‘difficulty’ is defined by the New Oxford Dictionary (2001) as ‘a thing that is hard to accomplish, deal with or understand’. One US study (Tumminia & Weinfield 1986) described how nurse educators view learning-disabled students as ‘both a frustration and a challenge’. The study by Ikematsu at al. (2014), which explored the incidence and nature of nursing students with special educational needs in Japan, used the term ‘extremely difficult students’ to describe a percentage of nursing students with special educational needs; however, these included nursing students with ADHD and Asperger’s as well as dyslexia. The language and phrases used might be described as discourses, which will be discussed later in this chapter.

Different authors have listed a range of difficulties observed amongst nurses and nursing students with dyslexia. However, there is some communality in the difficulties listed amongst the participants in each study. Table 3.4 lists these difficulties from each individual study:

Table 3.4 – Difficulties in clinical tasks experienced by dyslexic nursing students/nurses

58 Morris, D., Turnbull, P. (2006) ‘Clinical Experiences

of students with dyslexia.’ Journal of Advanced Nursing, 54(2): 238-247

 Short term memory problems  Hand/eye co-ordination/manual

dexterity

 Dyscalculia (drug calculations)  Documentation

 Recalling and pronouncing drug names Sanderson-Mann, J., Wharard, H.J., McCandless, F.

(2012) ‘An empirical exploration of the impact of dyslexia on placement-based learning and a comparison with non-dyslexic students.’ Diversity and Equality in Healthcare, 9(2): 89-99

 Clinical Handovers to other staff  Nursing Documentation

 Clinical Observations

 Drug calculations/administration Child, J., Langford, E. (2011) ‘Exploring the learning

experiences of nursing students with dyslexia.’ Nursing Standard 25(40): 39-46

 Short term memory problems  Reading/writing difficulty  Spelling difficulty

 Pronunciation difficulty

 Need for more time to complete tasks

Shellenbarger T. (1993) ‘Helping the dyslexic nursing student.’ Nurse Educator 18(6): 11-13

 Difficulty following directions  Getting items in incorrect order  Carrying out lengthy list of instructions  Difficulty with directional terms such as

left and right

 Difficulty meeting deadlines White, J. (2007) ‘Supporting nursing students with

dyslexia in clinical practice.’ Nursing Standard, 21(19): 35-42

 Problems with spelling  Slow at reading and writing

 Reading and pronouncing unfamiliar or long or unusual words

 Untidy handwriting  Poor short term memory  Poor concentration span Ridley, C. (2011) ‘The experiences of nursing

students with dyslexia.’ Nursing Standard 25(24): 35-42

 ‘When reading, mixing words’  ‘Retaining of information’  ‘Forgetting things easily’  ‘With background noise, I get

distracted’ (p.38) Crouch, A. (2008) Needs/experiences of dyslexic

students and support in clinical practice. The

University of Northampton. Funded by the Higher Education Academy for Health Sciences and Practice

 Forgetfulness

 Difficulty with spelling, grammar and writing

 Problems with words and numbers  Slow at doing things

Morris, D., Turnbull, P.A (2007b) ‘Survey-based exploration of the impact of dyslexia on career progression of UK registered nurses.’ Journal of Nursing Management 15(1): 97-106

 Record keeping/documentation  Need for more time

 Drug administration/calculation  Difficulty in communicating verbally  Poor memory/ recalling information  Poor handwriting

59 Price, G.A., Gale, A. (2006) ‘How do dyslexic nursing

students cope with clinical practice placements? The impact of the dyslexic profile on the clinical practice of dyslexic nursing students: Pedagogical issues and considerations.’ Learning Disabilities 4(1): 19-36

 Word recognition  Spelling mastery

 Time taken to retrieve and use language effectively

 Handover  Chart keeping

Ijiri, L., Kudzma, E.C. (2000) ‘Supporting Nursing Students with Learning Disabilities: a metacognitive approach.’ Journal of Professional Nursing, 16 (3): 149-157

 Handwriting, spelling  Calculations

 Organisation skills  Memory

The difficulties listed in Table 3.4 demonstrate the wide variability in the difficulties nursing students/registered nurses with dyslexia experience in clinical practice. This further relates to the discussion in Chapter 2 where Rose (2009) spoke of co-occurring difficulties, specifically aspects of language, motor co-ordination, mental calculation, concentration and personal organisation, which can occur as part of the dyslexia pattern, but are not by themselves markers of dyslexia. Some of these co-occurring difficulties described are apparent amongst these difficulties listed in Table 3.4, thus adding further evidence to the variability of the presentation of dyslexia.

A more recent study by Crouch (2017) explored how dyslexia impacts upon twelve nursing and midwifery students. It also revealed difficulties with documentation, reading unfamiliar words, numeracy and short-term memory, which has similarities to some of the difficulties listed in Table 3.4.

The sample sizes in the studies listed in Table 3.4 were quite small, varying between seven and 18, apart from Morris and Turnbull (2007b) whose study concerning registered nurses had 116 participants who answered a postal questionnaire. These studies were all qualitative in nature, indicated by the focus upon the individual

60 experiences of the participants. Qualitative research is described as a form of social enquiry that focuses on the way people make sense of their experiences and the world in which they live (Holloway & Wheeler 2002: 3). As the difficulties listed in Table 3.4 indicate, dyslexia can be presented in several different ways (Shellenbarger 1993). It could be determined that one person with dyslexia will not present with exactly the same characteristics as another person with dyslexia. However, in an attempt to further categorise and organise the difficulties in Table 3.4 and to eliminate the different descriptions presented in the studies, which are often describing essentially the same difficulty, a new table is presented. Table 3.5 identifies four common difficulties identified from the data categorising the findings from the studies into these four sections.

61 Table 3.5 – Categories of common areas of difficulty from study findings

Memory Documentation Drug Administration Nursing Tasks  Short-term memory problems  Forgetfulness  Poor memory/ recalling information  ‘Forgetting things easily’  ‘Retaining of information’

 Completing and writing nursing documentation  Reading/writing

difficulty

 Spelling difficulty  Problems with spelling  Slow at reading and

writing

 Difficulty with spelling, grammar and writing  Record keeping/

documentation  Poor handwriting  ‘When reading, mixing

words’

 Untidy handwriting  Chart keeping  Spelling mastery  Time taken to retrieve

and use language effectively  Drug calculations/ administration  Dyscalculia (drug calculations)  Recalling and pronouncing drug names  Drug administration/ calculation  Reading and pronouncing unfamiliar or long or unusual words  Word recognition  Difficulty following directions  Carrying out lengthy lists of instructions  Slow at doing things

 Need for more time  Handovers  Clinical observations  Difficulty in communicating verbally  ‘With background noise, I get distracted’

With reference to specific difficulties experienced by dyslexics within a daily work environment, Moody (1999) related the typical problems that adults with dyslexia experience to potential effects on efficiency at work (see Table 3.6; text in bold). White (2007:36) added clinical nursing practice examples to Moody’s examples to identify a relationship to nurses with dyslexia (italic text):

62 Table 3.6 – Difficulties experienced by nurses with dyslexia in practice

Findings by other researchers examining the clinical performance of nursing students with dyslexia have revealed similar difficulties. Tumminia and Weinfield (1983) found that students had difficulty articulating instructions given to them by others. Shuler (1990) found students with dyslexia were disorganised and had difficulty meeting deadlines and following directions. Shellenbarger (1993) found students had problems following directions and placed items in an incorrect order, especially if there was a list of instructions. Additionally, they had difficulty carrying out procedures where lengthy lists were involved. In contrast, other studies have highlighted the positive aspects of dyslexia. Davies and Braun (1997) suggested that people with dyslexia can offer a range of skills, such as being intuitive and insightful, being highly aware of their environment and being able to think and perceive multi-dimensionally. The British Dyslexia Association (2003) noted that dyslexics often demonstrate an ability to think

 Literacy skills – reading and writing reports

 Memory – remembering information or instruction, for example, in handover, doctors’ rounds and case conferences

 Sequencing ability – undertaking a complex activity or procedure involving many steps

 Visual orientation – confusing left and right or up and down

 Hand/eye co-ordination – may result in poor presentation of written work or difficulty in undertaking some clinical skills

 Speech – may talk in a disorganised way, especially in meetings or on the telephone

 Organisational skills – poor time management and work environment can look disorganised

63 and work differently, enabling them to produce innovative and creative solutions to problems.

Wiles (2001: 23) suggested that thinking holistically means that nurses with dyslexia can use a multi-dimensional approach to patient care and can visualise a patient as an integrated whole. Ikematsu et al. (2014) noted dyslexic nurses may be excellent in recognising subtle changes in patients’ facial expressions or physical signs. Wiles (2001) also stated that dyslexic nurses use novel and creative problem solving measures that show an exceptional understanding of patients’ individual needs. However, many often do not know or recognise the positives of dyslexia, including those who have dyslexia themselves (White 2007).