Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology

Integrative nursing in Europe - A competency profile for nursing students validated in a Delphi-study

BACKGROUND

Integrative nursing is a framework for providing holistic care and includes complementary therapies and non-pharmacological interventions. There is no common European approach on how to educate healthcare professionals on complementary therapies and non-pharmacological interventions for symptom management. Nurses report a lack of formal education as the main barrier to applying integrative nursing.

OBJECTIVES

The aim of this study is to develop and validate integrative nursing learning outcomes in a competency profile for bachelor nursing students.

METHODS

A two-round Delphi study was conducted with experts on integrative nursing and/or nurse education from eight European countries. The expert panelists rated their level of agreement with learning outcomes in relation to "Knowledge, Skills, Responsibility and Autonomy" on a nine-point Likert scale (1 = strongly disagree/9 = strongly agree) and were invited to add comments in an open text field. The Rand manual's description of levels of appropriateness was used, and experts' suggestions were analyzed thematically and used for reformulating or adding learning outcomes.

RESULTS

In the first round, 19 out of 23 experts participated, versus 18 in the second round. In all, thirty-five learning outcomes within the three areas Knowledge, Skills and Responsibility/Autonomy were rated. After two Delphi rounds, twenty-four included learning outcomes were classified as appropriate, with median levels of appropriateness between 7 and 9; none had been classified as inappropriate. The learning outcomes include general knowledge about selected complementary therapies and non-pharmacological interventions, safety, national rules and regulations, communication and ethical skills and competencies for self-care actions and for applying simple evidence-based complementary therapies and non-pharmacological interventions in nursing practice.

CONCLUSIONS

The competency profile consist of validated competencies; the high degree of consensus from the expert panelists makes the learning outcomes relevant for structuring a teaching module for nursing students about integrative nursing.

Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada

OBJECTIVE

To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy.

DESIGN

Descriptive qualitative.

SETTING

Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents.

PARTICIPANTS

Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years.

METHODS

We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data.

RESULTS

Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type.

CONCLUSION

Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.

Cocurricular Clinical Opportunity: Addressing Student Attitudes, Knowledge, and Skills With Disability Education

BACKGROUND

Multiple organizations have urged inclusion of disability content in health care professional's education and training. Few nursing schools in the United States have adopted dedicated disability curricula nor studied its impact on attitudes, knowledge, and skills of disability education. Evidence suggests that inadequate education contributes to health care disparities and unmet needs of people with disabilities.

METHOD

A 2-hour cocurricular clinical experience was developed, using established competencies, and offered to senior nursing students. Students participated in multimodal experiences, with an emphasis on clinical exposure in various facilities serving children and adults with disabilities.

RESULTS

Five cohorts of students (N = 34) participated in the fellowship. Data illustrate the strong need to continue and require the curricula.

CONCLUSION

Faculty should develop disability education secondary to population prevalence and in accordance with the American Association of Colleges of Nursing's essential competencies. [J Nurs Educ. 2021;60(11):637-641.].

Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care

OBJECTIVE

To conduct an initial exploration of the experiences of women with different types of disability when they attempt to obtain contraceptive care.

DESIGN

Multiple-category focus group design.

SETTING

Multiple community sites.

PARTICIPANTS

Seventeen women with disabilities of reproductive age.

METHODS

We purposively sampled women with different types of disability and conducted four focus groups organized by disability type: physical disability, intellectual and developmental disability, blind or low vision, and deaf or hard of hearing. We used a semistructured focus group guide to elicit participants' positive and negative experiences with contraceptive care. We analyzed focus group transcripts using content analysis.

RESULTS

Participants identified challenges to obtaining high-quality contraceptive care in three main thematic areas: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Participants with physical disabilities encountered inaccessible clinic rooms and examination tables, and those with sensory disabilities or intellectual and developmental disability described inaccessible clinic forms and information. Participants from multiple disability groups described negative attitudes of health care providers and health insurance limitations.

CONCLUSION

As described by our participants, the processes and infrastructure of contraceptive care were based on an assumption of an able-bodied norm. Reliance on such a norm, for example, offering a paper pamphlet to a blind woman, is not helpful and can be harmful to women with disabilities. Increased attention to the reproductive health care needs of women with disabilities is important for improving health care equity and quality.

Appraisal of disability attitudes and curriculum of nursing students: a literature review

Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability. Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student's negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student's education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students' communication with disabled people. Medical Teacher, 33(1), 44-52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao, 22(65), 551-563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives, 36(1), 60-61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the comprehensive state empathy scale. Nurse Education Today, 59, 75-81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives. Nurse Education in Practice, 16(1), 111-118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.

Does volunteering change attitudes towards people with disabilities? A qualitative study of the experience of orthodox Jewish nursing students

BACKGROUND

People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed.

DESIGN

A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultra-orthodox (Haredi) students volunteering with people with disabilities.

METHODS

Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis.

RESULTS

Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability.

CONCLUSIONS

Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.

Disability-inclusive compassionate care: Disability competencies for an Indian Medical Graduate

The new curriculum of the Medical Council of India (MCI) lacks disability-related competencies. This further involves the risk of perpetuating the medicalization of diverse human experiences and many medical students may graduate with little to no exposure to the principles of disability-inclusive compassionate care. Taking into consideration the UN Convention, the Rights of Persons with Disabilities, Act 2016, and by involving the three key stakeholders – disability rights activists, doctors with disabilities, and health profession educators – in the focus group discussions, 52 disability competencies were framed under the five roles of an Indian Medical Graduate (IMG) as prescribed by the MCI. Based on feedback from other stakeholders all over India, the competencies were further refined into 27 disability competencies (clinician: 9; leader: 4; communicator: 5; lifelong learner: 5; and professional: 4) which the stakeholders felt should be demonstrated by health professionals while they care for patients with disabilities. The competencies are based on the human rights approach to disability and are also aligned with the competencies defined by accreditation boards in the US and in Canada. The paper describes the approach used in the framing of these competencies, and how parts of these were ultimately included in the new competency-based medical education curriculum in India.