- Email: [email protected]
Reasonable adjustments for everyone: Exploring a paradigm change for nurse educators
Accepted Manuscript Reasonable adjustments for everyone: Exploring a paradigm change for nurse educators Connie Harris PII:
S1471-5953(18)30363-9
DOI:
10.1016/j.nepr.2018.08.009
Reference:
YNEPR 2445
To appear in:
Nurse Education in Practice
Received Date: 16 May 2018 Revised Date:
13 August 2018
Accepted Date: 18 August 2018
Please cite this article as: Harris, C., Reasonable adjustments for everyone: Exploring a paradigm change for nurse educators, Nurse Education in Practice (2018), doi: 10.1016/j.nepr.2018.08.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
REASONABLE ADJUSTMENTS FOR EVERYONE: EXPLORING A PARADIGM CHANGE FOR NURSE EDUCATORS
RI PT
Author and affiliations: Connie Harris
Doctoral student, University of Northern Colorado School of Nursing, Greeley, CO 80639, USA
SC
Faculty, University of Central Oklahoma Department of Nursing, 100 N. University Dr.,
M AN U
Edmond, OK 73034, USA
Corresponding author:
E-mail addresses: [email protected]; [email protected]
Acknowledgements:
TE D
Tel.: +1 405 974 5178
The author would like to gratefully acknowledge the encouragement and support received from
EP
Dr. Katherine Sullivan, University of Northern Colorado School of Nursing during the writing
AC C
and submission process of this manuscript.
Conflict of Interest: None
Funding Sources: None
ACCEPTED MANUSCRIPT 1 ABSTRACT The number of students with learning difficulties enrolled in nursing programs has increased. Under the current educational paradigm, nurse educators grant requests for reasonable
RI PT
adjustments from students with diverse learning needs in an attempt to promote equity and inclusivity in nursing programs. This system has fundamental flaws which reduce its
effectiveness and perpetuates the differences between students with learning difficulties and their
SC
peers. A new educational paradigm based on Universal Design principles is proposed.
Comparisons are made between Universal Design classroom teaching and management strategies
M AN U
and current evidence-based pedagogy. The first steps toward adopting a new paradigm are discussed and examples offered. Reasonable adjustments which support the diverse learning needs of all students are feasible and practical. This paradigm change can be implemented by
Learning needs Neurodiversity
AC C
Universal Design
EP
Keywords:
TE D
individual nurse educators or as a campus-wide initiative.
ACCEPTED MANUSCRIPT 2 Reasonable Adjustments for Everyone: Exploring a Paradigm Change for Nurse Educators Introduction In 1948, a movement promoting student diversity, equity, and inclusion began when the
RI PT
United Nations General Assembly (UN) identified education as a basic human right (UN, 1948). In the seventy years since this declaration, educational barriers continue to exist for many
individuals, including nursing students with learning difficulties (Levey, 2014; Neal-Boylan and
SC
Miller, 2017). Traditional solutions which rely on individualized adjustments to meet the
learning needs of each student are impractical. Greater numbers of neurodiverse learners now
M AN U
enroll in institutions of higher education where resources to meet student learning needs at an individual level are limited (Gabel and Miskovic, 2014).
The phrase neurodiverse leaner is used in this article to describe variations in the ways students, enrolled in prelicensure nursing programs, learn and process information. This includes
TE D
students with attention deficit hyperactivity disorder (ADHD) and specific learning disabilities, difficulty understanding or using spoken and/or written language. The article’s focus is not disability, but rather an emphasis on developing effective educational environments supportive
EP
of all students’ learning needs.
In response to these challenges, a new paradigm for nursing education is needed; one
AC C
which is practical, sustainable, and cognizant of the diverse learning needs which exist among today’s students. Nurse educators should take a proactive approach to solving the problem by developing teaching strategies and creating course designs which are beneficial and accessible to all students. Education within this new paradigm must adapt to the three settings where student instruction occurs: the classroom, lab/simulation, and clinical settings. Although each area is
ACCEPTED MANUSCRIPT 3 vital to the successful training of nursing students, this article focuses on the classroom setting to analyze the current and proposed paradigms for educating neurodiverse nursing students. Neurodiverse Learners in the Traditional Paradigm
RI PT
Data describing the academic performance of neurodiverse college students varies and is difficult to obtain. Researchers estimate that 8 to 12 percent of students attending college have additional and diverse learning needs (Gabel and Miskovic, 2014). Traditional methods of
their academic success (Weis et al., 2016).
SC
classroom instruction, course assignments, and methods of assessment may create hindrances to
M AN U
To mitigate barriers and improve access to education, many countries protect the educational rights of neurodiverse learners by mandating that reasonable adjustments or academic accommodations are available for students with learning difficulties (UN, 2016). These adjustments are intended to remove barriers to learning without creating undue financial or
TE D
administrative hardship for the academic institution or educator. Reasonable adjustments, however, should not decrease academic rigor, create an unfair advantage for the student, or guarantee academic success (Walker, 2017).
EP
Students in many countries have the option of seeking additional support i.e., reasonable accommodations, and are not obliged to disclose if they so wish. In the United States, they have
AC C
the option to request reasonable adjustments for academic support or they can self-manage their learning needs (Walker, 2017; Weis et al., 2016). Research, however, reports lower academic performance outcomes among neurodiverse students who do not seek or fully use the resources offered by support services specialists compared to peers who use these services (DuPaul et al., 2017). Problems with the Traditional Paradigm
ACCEPTED MANUSCRIPT 4 From this author’s perspective, the greatest flaw with the current paradigm is the failure to accomplish its most salient objective: to promote student diversity, equity, and inclusion in nursing education programs. Instead of inclusivity, the system accentuates the differences
RI PT
between people. To receive learning support, students must disclose how they are different from other students; in response to the student’s request, nursing faculty must individualize the
teaching/learning process for the student based on the requested adjustment. The actions required
the following consequences within nursing education:
Some students conceal their learning difficulty from the faculty and their peers. They
M AN U
•
SC
of nursing students and faculty members to ensure that reasonable adjustments are made create
refuse to obtain support services or fail to fully utilize these services because of a real or perceived stigma associated with being different from their peers (Kendall, 2016; NealBoylan and Miller, 2017).
A lack of experience in working with students who have learning difficulties prevents
TE D
•
nursing faculty from gaining insight into the challenges these students face. Educators with the least amount of knowledge about students with learning difficulties are reported to have
•
EP
the most negative attitudes among members of the nursing faculty (Levey, 2014). College administrators cannot allocate additional resources for a “hidden” population of
AC C
students and cannot provide individualized support to assist with their learning difficulties since an accurate report of the number of neurodiverse students is unknown (Gabel and Miskovic, 2014; Kendall, 2016). •
Nursing faculty may recognize that some students in their classes struggle with learning,
but are constrained by the system and cannot ask about any diagnosed learning difficulty or require students to seek assistance (Walker, 2017).
ACCEPTED MANUSCRIPT 5 •
Examples of specific classroom adjustments include the use of digital pens for
notetaking, access to instructor’s lecture notes, and medical spell check software. The most frequent adjustments recommended by disability specialists for students with learning
RI PT
difficulties are modifications regarding exam environments and extensions in time frames to complete exams and assignments (Weis et al., 2016). A student’s request for adjustments, however, cannot require the nurse educator to alter pedagogical methods used in the
SC
classroom. Because of this, even if adjustments for taping lectures or assistance taking class notes are granted, these accommodations may not ultimately enhance learning outcomes for
M AN U
students with neurodiverse learning needs (Weyandt and DuPaul, 2013).
Solving the traditional paradigm’s problems requires a change in perspective. An academic student support system that proactively incorporates strategies designed to support the learning needs of all students through innovative pedagogical methods and course designs is
TE D
superior to a system that only responds to the needs of students on a case-by-case basis (Scott et al., 2003). The new educational paradigm will not abolish specialist support or reasonable adjustments; instead, these resources will continue to be available to students who seek
EP
additional assistance with complex learning difficulties where true individualization is vital to the student’s academic success.
AC C
A New Paradigm: Universal Design Universal Design (UD), a term coined by Ronald Mace, originated as a manufacturing
and architectural concept for building structures and designing products that can be used without adaptation by the greatest number of people (Scott et al., 2003). Variations in the concept of UD have been adopted by educators to promote practices which support inclusion and diversity in academic settings. Examples include Universal Design for Learning (UDL) and Universal
ACCEPTED MANUSCRIPT 6 Design for Instruction (UDI). Both are committed to the development and dissemination of teaching/learning practices, assessments, and learning environments that benefit the diverse learning needs of all students (Dallas and Sprong, 2015).
RI PT
Nurse educators who are unfamiliar with the concepts of UDL/UDI are usually interested in learning more about the process, but are generally reluctant to implement the practices and philosophies of a new paradigm without more training and resources to support its use (Levey,
SC
2016). Since the premise of UDL/UDI involves developing inclusive teaching strategies, any changes made to a nursing course, classroom environment, or pedagogy must be appropriate for
M AN U
all students in the classroom. Equity and inclusion in the UD paradigm means that all nursing students receive the instruction based on principles of learning applicable to all individuals. The question nurse educators may now ask is, “Will UD strategies be beneficial for all students or will they hinder the learning outcomes for students without learning difficulties?”
TE D
Adopting a change in paradigm is stressful and can be overwhelming and intimidating, especially if one is not convinced that the new paradigm will be effective. Nurse educators need to be proactive and not wait for administrative policy changes or legal mandates to make
EP
decisions about the pedagogy and management of nursing courses. To test the new paradigm’s feasibility and effectiveness, an examination of study strategies and pedagogies traditionally
AC C
recommended for neurodiverse learners is evaluated to determine their appropriateness for all students.
Course and Classroom Universal Design Adjustments The literature is replete with suggestions to help neurodiverse students achieve academic
success. Weyandt and DuPaul (2013) offer practical study strategies and teaching methods for
ACCEPTED MANUSCRIPT 7 neurodiverse students. Three suggestions are used as examples of simple UD adjustments that nursing faculty can adopt to support neurodiversity in the classroom. 1. Use a System for Organization and Stay Organized = Course Organization
RI PT
Some students with learning difficulties struggle with executive functions, the ability to plan and organize activities, schedules, and responsibilities (Sharfi and Rosenblum, 2016). One way nurse educators can support executive functions for students is to use the learning
SC
management system’s (e.g., Blackboard, Moodle) calendar feature to send reminders to students
students (Simmons, et al., 2018).
M AN U
of assignment due dates. Automated reminder apps can aid executive functions for all nursing
2. Use Multimodal Sources of Information = Developing Course Materials Universal design for learning is more than just developing instructional activities that appeal to students’ visual, auditory, or kinesthetic learning style preferences. The Center for
TE D
Applied Special Technology (CAST) has a website with resources for educators to aid in the development and application of UD principles. Links to this website and other UD resources are included at the end of this article. Two examples of modifying teaching materials are provided: When videos are used in class or online, include captions and a transcript if possible.
EP
•
Captions can improve comprehension and content retention for individuals with hearing
AC C
impairment, English-as-a-second-language students, and persons with or without learning difficulties (Gernsbacher, 2015).
•
Optimizing text in documents or slide presentations ensures the needs of students with low vision or color-blindness are considered. This modification involves using font styles in sizes that are easy to read with sufficient text-to-background contrast and text in font colors that can be seen by all students (CAST, 2018).
ACCEPTED MANUSCRIPT 8 3. Break Studying Into Smaller Segments = Active Learning Strategies Some study techniques recommended for neurodiverse students have equivalent counterparts in active learning pedagogy. An example of this is RAP, a home-study strategy to
RI PT
improve students’ reading comprehension. RAP is an acronym for: Read a paragraph, Ask what the passage means including two important details which support the main concept, and then Paraphrase the passage (Hua et al., 2014). The classroom equivalent to RAP is Think-Pair-Share,
SC
an evidence-based active learning exercise designed to enhance students’ critical thinking skills. With this activity, students are asked to think about the content just discussed during class, sit in
M AN U
pairs with another student, and share with their classmate what they've learned using their own words (Kaddoura, 2013). Final Thoughts
The previous three examples of course and classroom adjustments are not complex or
TE D
difficult to implement; many nurse educators may use some of these examples without realizing these are UD practices. An appealing aspect of transitioning to this new educational paradigm is the simplicity of its implementation and the control available to nurse educators when enacting
EP
the change.
Implementing UDL/UDI principles can occur in stages. The educator may start with
AC C
minor steps to adopt the paradigm by trialing inclusive teaching strategies for a specific class period or by making major changes affecting the full length of the course in that academic term. Since the nurse educator is responsible for meeting the diverse learning needs of all students, a change in paradigms does not need to wait for a campus-wide change in policy. Implementing UD concepts in nursing classrooms which support equity and inclusion of students with diverse
ACCEPTED MANUSCRIPT 9 learning needs is a practical and sustainable alternative to granting reasonable adjustments to students on a case-by-case basis.
CAST: Universal Design for Learning in Higher Education http://udloncampus.cast.org/page/udl_landing#.WuaNr8gvyM8
RI PT
Links to Universal Design Resources:
http://www.udlcenter.org/implementation/examples References:
SC
National Center on Universal Design for Learning: Implementation Examples
M AN U
Center for Applied Special Technology, 2018. Optimizing text for learning. Retrieved from http://udloncampus.cast.org/page/media_text#.W3DH1OhKiM8 (Accessed 30 July, 2018).
Dallas, B., Sprong, M.E., 2015. Assessing faculty attitudes toward universal design instructional
TE D
techniques. Journal of Applied Rehabilitation Counseling 46(4), 18–28. DuPaul, G.J., Dahlstrom Hakki, I., Gormley, M.J., Fu, Q., Pinho, T.D., & Banerjee, M., 2017. College students with ADHD and LD: Effects of support services on academic
EP
performance. Learning Disabilities Research & Practice 32(4), 246-256. doi:10.1111/ldrp.12143
AC C
Gabel, S.L., Miskovic, M., 2014. Discourse and the containment of disability in higher education: An institutional analysis. Disability & Society 29(7), 1145-1158.
Gernsbacher, M.A., 2015. Video captions benefit everyone. Policy Insights from the Behavioral and Brain Sciences 2(1), 195-202. doi:10.1177/2372732215602130
ACCEPTED MANUSCRIPT 10 Hua, Y., Woods-Groves, S., Ford, J.W., Nobles, K.A., 2014. Effects of the paraphrasing strategy on expository reading comprehension of young adults with intellectual disability. Education and Training in Autism and Developmental Disabilities 49(3), 429-439.
thinking. Educational Research Quarterly 36(4), 3–24.
RI PT
Kaddoura, M., 2013. Think pair share: A teaching learning strategy to enhance students' critical
Kendall, L., 2016. Higher education and disability: Exploring student experiences. Cogent
SC
Education 3(1). doi:10.1080/2331186X.2016.1256142
Levey, J.A., 2014. Attitudes of nursing faculty towards nursing students with disabilities: An
M AN U
integrative review. Journal of Postsecondary Education and Disability 27, 321-332. Levey, J.A., 2016. Measuring nurse educators’ willingness to adopt inclusive teaching strategies. Nursing Education Perspectives 37(4), 215–220.
Neal-Boylan, L., Miller, M., 2017. Treat me like everyone else: The experience of nurses who
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had disabilities while in school. Nurse Educator 42(4), 176-80. Scott, S.S., McGuire, J.M., Shaw, S.F., 2003. Universal design for instruction: A new paradigm for adult instruction in postsecondary education. Remedial and Special Education 24(6),
EP
369-379.
Sharfi, K., Rosenblum, S., 2016. Executive functions, time organization and quality of life
AC C
among adults with learning disabilities. Plos One 11(12), e0166939. https://doi:10.1371/journal.pone.0166939
Simmons, L., Crook, A., Cannonier, C., Simmons, C., 2018. There’s an app for that: The impact of reminder apps on student learning and anxiety. Journal of Education for Business 93(5), 185-195. https://doi.org/10.1080/08832323.2018.1441120
ACCEPTED MANUSCRIPT 11 United Nations, 1948. Universal declaration of human rights. Retrieved from http://www.un.org/en/universal-declaration-human-rights/ (Accessed 26 April 2018). United Nations, 2016. Convention on the rights of persons with disabilities: Article 24,
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Education. Retrieved from https://www.un.org/development/desa/disabilities/conventionon-the-rights-of-persons-with-disabilities/article-24-education.html (Accessed 1 May 2018).
Teaching and Learning in Nursing 12(1), 67–68.
SC
Walker, S.Y., 2017. Accommodations part I: What are they and where did they come from?
M AN U
Weis R., Dean, E.L., Osborne, K.J., 2016. Accommodation decision making for postsecondary students with learning disabilities: Individually tailored or one size fits all? Journal of Learning Disabilities 49(5), 484-98.
Weyandt, L., DuPaul, G.J., 2013. Students with ADHD: Current issues and future directions.
AC C
EP
TE D
Springer, New York.
S1471-5953(18)30363-9
DOI:
10.1016/j.nepr.2018.08.009
Reference:
YNEPR 2445
To appear in:
Nurse Education in Practice
Received Date: 16 May 2018 Revised Date:
13 August 2018
Accepted Date: 18 August 2018
Please cite this article as: Harris, C., Reasonable adjustments for everyone: Exploring a paradigm change for nurse educators, Nurse Education in Practice (2018), doi: 10.1016/j.nepr.2018.08.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
REASONABLE ADJUSTMENTS FOR EVERYONE: EXPLORING A PARADIGM CHANGE FOR NURSE EDUCATORS
RI PT
Author and affiliations: Connie Harris
Doctoral student, University of Northern Colorado School of Nursing, Greeley, CO 80639, USA
SC
Faculty, University of Central Oklahoma Department of Nursing, 100 N. University Dr.,
M AN U
Edmond, OK 73034, USA
Corresponding author:
E-mail addresses: [email protected]; [email protected]
Acknowledgements:
TE D
Tel.: +1 405 974 5178
The author would like to gratefully acknowledge the encouragement and support received from
EP
Dr. Katherine Sullivan, University of Northern Colorado School of Nursing during the writing
AC C
and submission process of this manuscript.
Conflict of Interest: None
Funding Sources: None
ACCEPTED MANUSCRIPT 1 ABSTRACT The number of students with learning difficulties enrolled in nursing programs has increased. Under the current educational paradigm, nurse educators grant requests for reasonable
RI PT
adjustments from students with diverse learning needs in an attempt to promote equity and inclusivity in nursing programs. This system has fundamental flaws which reduce its
effectiveness and perpetuates the differences between students with learning difficulties and their
SC
peers. A new educational paradigm based on Universal Design principles is proposed.
Comparisons are made between Universal Design classroom teaching and management strategies
M AN U
and current evidence-based pedagogy. The first steps toward adopting a new paradigm are discussed and examples offered. Reasonable adjustments which support the diverse learning needs of all students are feasible and practical. This paradigm change can be implemented by
Learning needs Neurodiversity
AC C
Universal Design
EP
Keywords:
TE D
individual nurse educators or as a campus-wide initiative.
ACCEPTED MANUSCRIPT 2 Reasonable Adjustments for Everyone: Exploring a Paradigm Change for Nurse Educators Introduction In 1948, a movement promoting student diversity, equity, and inclusion began when the
RI PT
United Nations General Assembly (UN) identified education as a basic human right (UN, 1948). In the seventy years since this declaration, educational barriers continue to exist for many
individuals, including nursing students with learning difficulties (Levey, 2014; Neal-Boylan and
SC
Miller, 2017). Traditional solutions which rely on individualized adjustments to meet the
learning needs of each student are impractical. Greater numbers of neurodiverse learners now
M AN U
enroll in institutions of higher education where resources to meet student learning needs at an individual level are limited (Gabel and Miskovic, 2014).
The phrase neurodiverse leaner is used in this article to describe variations in the ways students, enrolled in prelicensure nursing programs, learn and process information. This includes
TE D
students with attention deficit hyperactivity disorder (ADHD) and specific learning disabilities, difficulty understanding or using spoken and/or written language. The article’s focus is not disability, but rather an emphasis on developing effective educational environments supportive
EP
of all students’ learning needs.
In response to these challenges, a new paradigm for nursing education is needed; one
AC C
which is practical, sustainable, and cognizant of the diverse learning needs which exist among today’s students. Nurse educators should take a proactive approach to solving the problem by developing teaching strategies and creating course designs which are beneficial and accessible to all students. Education within this new paradigm must adapt to the three settings where student instruction occurs: the classroom, lab/simulation, and clinical settings. Although each area is
ACCEPTED MANUSCRIPT 3 vital to the successful training of nursing students, this article focuses on the classroom setting to analyze the current and proposed paradigms for educating neurodiverse nursing students. Neurodiverse Learners in the Traditional Paradigm
RI PT
Data describing the academic performance of neurodiverse college students varies and is difficult to obtain. Researchers estimate that 8 to 12 percent of students attending college have additional and diverse learning needs (Gabel and Miskovic, 2014). Traditional methods of
their academic success (Weis et al., 2016).
SC
classroom instruction, course assignments, and methods of assessment may create hindrances to
M AN U
To mitigate barriers and improve access to education, many countries protect the educational rights of neurodiverse learners by mandating that reasonable adjustments or academic accommodations are available for students with learning difficulties (UN, 2016). These adjustments are intended to remove barriers to learning without creating undue financial or
TE D
administrative hardship for the academic institution or educator. Reasonable adjustments, however, should not decrease academic rigor, create an unfair advantage for the student, or guarantee academic success (Walker, 2017).
EP
Students in many countries have the option of seeking additional support i.e., reasonable accommodations, and are not obliged to disclose if they so wish. In the United States, they have
AC C
the option to request reasonable adjustments for academic support or they can self-manage their learning needs (Walker, 2017; Weis et al., 2016). Research, however, reports lower academic performance outcomes among neurodiverse students who do not seek or fully use the resources offered by support services specialists compared to peers who use these services (DuPaul et al., 2017). Problems with the Traditional Paradigm
ACCEPTED MANUSCRIPT 4 From this author’s perspective, the greatest flaw with the current paradigm is the failure to accomplish its most salient objective: to promote student diversity, equity, and inclusion in nursing education programs. Instead of inclusivity, the system accentuates the differences
RI PT
between people. To receive learning support, students must disclose how they are different from other students; in response to the student’s request, nursing faculty must individualize the
teaching/learning process for the student based on the requested adjustment. The actions required
the following consequences within nursing education:
Some students conceal their learning difficulty from the faculty and their peers. They
M AN U
•
SC
of nursing students and faculty members to ensure that reasonable adjustments are made create
refuse to obtain support services or fail to fully utilize these services because of a real or perceived stigma associated with being different from their peers (Kendall, 2016; NealBoylan and Miller, 2017).
A lack of experience in working with students who have learning difficulties prevents
TE D
•
nursing faculty from gaining insight into the challenges these students face. Educators with the least amount of knowledge about students with learning difficulties are reported to have
•
EP
the most negative attitudes among members of the nursing faculty (Levey, 2014). College administrators cannot allocate additional resources for a “hidden” population of
AC C
students and cannot provide individualized support to assist with their learning difficulties since an accurate report of the number of neurodiverse students is unknown (Gabel and Miskovic, 2014; Kendall, 2016). •
Nursing faculty may recognize that some students in their classes struggle with learning,
but are constrained by the system and cannot ask about any diagnosed learning difficulty or require students to seek assistance (Walker, 2017).
ACCEPTED MANUSCRIPT 5 •
Examples of specific classroom adjustments include the use of digital pens for
notetaking, access to instructor’s lecture notes, and medical spell check software. The most frequent adjustments recommended by disability specialists for students with learning
RI PT
difficulties are modifications regarding exam environments and extensions in time frames to complete exams and assignments (Weis et al., 2016). A student’s request for adjustments, however, cannot require the nurse educator to alter pedagogical methods used in the
SC
classroom. Because of this, even if adjustments for taping lectures or assistance taking class notes are granted, these accommodations may not ultimately enhance learning outcomes for
M AN U
students with neurodiverse learning needs (Weyandt and DuPaul, 2013).
Solving the traditional paradigm’s problems requires a change in perspective. An academic student support system that proactively incorporates strategies designed to support the learning needs of all students through innovative pedagogical methods and course designs is
TE D
superior to a system that only responds to the needs of students on a case-by-case basis (Scott et al., 2003). The new educational paradigm will not abolish specialist support or reasonable adjustments; instead, these resources will continue to be available to students who seek
EP
additional assistance with complex learning difficulties where true individualization is vital to the student’s academic success.
AC C
A New Paradigm: Universal Design Universal Design (UD), a term coined by Ronald Mace, originated as a manufacturing
and architectural concept for building structures and designing products that can be used without adaptation by the greatest number of people (Scott et al., 2003). Variations in the concept of UD have been adopted by educators to promote practices which support inclusion and diversity in academic settings. Examples include Universal Design for Learning (UDL) and Universal
ACCEPTED MANUSCRIPT 6 Design for Instruction (UDI). Both are committed to the development and dissemination of teaching/learning practices, assessments, and learning environments that benefit the diverse learning needs of all students (Dallas and Sprong, 2015).
RI PT
Nurse educators who are unfamiliar with the concepts of UDL/UDI are usually interested in learning more about the process, but are generally reluctant to implement the practices and philosophies of a new paradigm without more training and resources to support its use (Levey,
SC
2016). Since the premise of UDL/UDI involves developing inclusive teaching strategies, any changes made to a nursing course, classroom environment, or pedagogy must be appropriate for
M AN U
all students in the classroom. Equity and inclusion in the UD paradigm means that all nursing students receive the instruction based on principles of learning applicable to all individuals. The question nurse educators may now ask is, “Will UD strategies be beneficial for all students or will they hinder the learning outcomes for students without learning difficulties?”
TE D
Adopting a change in paradigm is stressful and can be overwhelming and intimidating, especially if one is not convinced that the new paradigm will be effective. Nurse educators need to be proactive and not wait for administrative policy changes or legal mandates to make
EP
decisions about the pedagogy and management of nursing courses. To test the new paradigm’s feasibility and effectiveness, an examination of study strategies and pedagogies traditionally
AC C
recommended for neurodiverse learners is evaluated to determine their appropriateness for all students.
Course and Classroom Universal Design Adjustments The literature is replete with suggestions to help neurodiverse students achieve academic
success. Weyandt and DuPaul (2013) offer practical study strategies and teaching methods for
ACCEPTED MANUSCRIPT 7 neurodiverse students. Three suggestions are used as examples of simple UD adjustments that nursing faculty can adopt to support neurodiversity in the classroom. 1. Use a System for Organization and Stay Organized = Course Organization
RI PT
Some students with learning difficulties struggle with executive functions, the ability to plan and organize activities, schedules, and responsibilities (Sharfi and Rosenblum, 2016). One way nurse educators can support executive functions for students is to use the learning
SC
management system’s (e.g., Blackboard, Moodle) calendar feature to send reminders to students
students (Simmons, et al., 2018).
M AN U
of assignment due dates. Automated reminder apps can aid executive functions for all nursing
2. Use Multimodal Sources of Information = Developing Course Materials Universal design for learning is more than just developing instructional activities that appeal to students’ visual, auditory, or kinesthetic learning style preferences. The Center for
TE D
Applied Special Technology (CAST) has a website with resources for educators to aid in the development and application of UD principles. Links to this website and other UD resources are included at the end of this article. Two examples of modifying teaching materials are provided: When videos are used in class or online, include captions and a transcript if possible.
EP
•
Captions can improve comprehension and content retention for individuals with hearing
AC C
impairment, English-as-a-second-language students, and persons with or without learning difficulties (Gernsbacher, 2015).
•
Optimizing text in documents or slide presentations ensures the needs of students with low vision or color-blindness are considered. This modification involves using font styles in sizes that are easy to read with sufficient text-to-background contrast and text in font colors that can be seen by all students (CAST, 2018).
ACCEPTED MANUSCRIPT 8 3. Break Studying Into Smaller Segments = Active Learning Strategies Some study techniques recommended for neurodiverse students have equivalent counterparts in active learning pedagogy. An example of this is RAP, a home-study strategy to
RI PT
improve students’ reading comprehension. RAP is an acronym for: Read a paragraph, Ask what the passage means including two important details which support the main concept, and then Paraphrase the passage (Hua et al., 2014). The classroom equivalent to RAP is Think-Pair-Share,
SC
an evidence-based active learning exercise designed to enhance students’ critical thinking skills. With this activity, students are asked to think about the content just discussed during class, sit in
M AN U
pairs with another student, and share with their classmate what they've learned using their own words (Kaddoura, 2013). Final Thoughts
The previous three examples of course and classroom adjustments are not complex or
TE D
difficult to implement; many nurse educators may use some of these examples without realizing these are UD practices. An appealing aspect of transitioning to this new educational paradigm is the simplicity of its implementation and the control available to nurse educators when enacting
EP
the change.
Implementing UDL/UDI principles can occur in stages. The educator may start with
AC C
minor steps to adopt the paradigm by trialing inclusive teaching strategies for a specific class period or by making major changes affecting the full length of the course in that academic term. Since the nurse educator is responsible for meeting the diverse learning needs of all students, a change in paradigms does not need to wait for a campus-wide change in policy. Implementing UD concepts in nursing classrooms which support equity and inclusion of students with diverse
ACCEPTED MANUSCRIPT 9 learning needs is a practical and sustainable alternative to granting reasonable adjustments to students on a case-by-case basis.
CAST: Universal Design for Learning in Higher Education http://udloncampus.cast.org/page/udl_landing#.WuaNr8gvyM8
RI PT
Links to Universal Design Resources:
http://www.udlcenter.org/implementation/examples References:
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National Center on Universal Design for Learning: Implementation Examples
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Center for Applied Special Technology, 2018. Optimizing text for learning. Retrieved from http://udloncampus.cast.org/page/media_text#.W3DH1OhKiM8 (Accessed 30 July, 2018).
Dallas, B., Sprong, M.E., 2015. Assessing faculty attitudes toward universal design instructional
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techniques. Journal of Applied Rehabilitation Counseling 46(4), 18–28. DuPaul, G.J., Dahlstrom Hakki, I., Gormley, M.J., Fu, Q., Pinho, T.D., & Banerjee, M., 2017. College students with ADHD and LD: Effects of support services on academic
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performance. Learning Disabilities Research & Practice 32(4), 246-256. doi:10.1111/ldrp.12143
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Gabel, S.L., Miskovic, M., 2014. Discourse and the containment of disability in higher education: An institutional analysis. Disability & Society 29(7), 1145-1158.
Gernsbacher, M.A., 2015. Video captions benefit everyone. Policy Insights from the Behavioral and Brain Sciences 2(1), 195-202. doi:10.1177/2372732215602130
ACCEPTED MANUSCRIPT 10 Hua, Y., Woods-Groves, S., Ford, J.W., Nobles, K.A., 2014. Effects of the paraphrasing strategy on expository reading comprehension of young adults with intellectual disability. Education and Training in Autism and Developmental Disabilities 49(3), 429-439.
thinking. Educational Research Quarterly 36(4), 3–24.
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Kaddoura, M., 2013. Think pair share: A teaching learning strategy to enhance students' critical
Kendall, L., 2016. Higher education and disability: Exploring student experiences. Cogent
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Education 3(1). doi:10.1080/2331186X.2016.1256142
Levey, J.A., 2014. Attitudes of nursing faculty towards nursing students with disabilities: An
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integrative review. Journal of Postsecondary Education and Disability 27, 321-332. Levey, J.A., 2016. Measuring nurse educators’ willingness to adopt inclusive teaching strategies. Nursing Education Perspectives 37(4), 215–220.
Neal-Boylan, L., Miller, M., 2017. Treat me like everyone else: The experience of nurses who
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had disabilities while in school. Nurse Educator 42(4), 176-80. Scott, S.S., McGuire, J.M., Shaw, S.F., 2003. Universal design for instruction: A new paradigm for adult instruction in postsecondary education. Remedial and Special Education 24(6),
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369-379.
Sharfi, K., Rosenblum, S., 2016. Executive functions, time organization and quality of life
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among adults with learning disabilities. Plos One 11(12), e0166939. https://doi:10.1371/journal.pone.0166939
Simmons, L., Crook, A., Cannonier, C., Simmons, C., 2018. There’s an app for that: The impact of reminder apps on student learning and anxiety. Journal of Education for Business 93(5), 185-195. https://doi.org/10.1080/08832323.2018.1441120
ACCEPTED MANUSCRIPT 11 United Nations, 1948. Universal declaration of human rights. Retrieved from http://www.un.org/en/universal-declaration-human-rights/ (Accessed 26 April 2018). United Nations, 2016. Convention on the rights of persons with disabilities: Article 24,
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Education. Retrieved from https://www.un.org/development/desa/disabilities/conventionon-the-rights-of-persons-with-disabilities/article-24-education.html (Accessed 1 May 2018).
Teaching and Learning in Nursing 12(1), 67–68.
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Walker, S.Y., 2017. Accommodations part I: What are they and where did they come from?
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Weis R., Dean, E.L., Osborne, K.J., 2016. Accommodation decision making for postsecondary students with learning disabilities: Individually tailored or one size fits all? Journal of Learning Disabilities 49(5), 484-98.
Weyandt, L., DuPaul, G.J., 2013. Students with ADHD: Current issues and future directions.
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Springer, New York.