An exploration of the concept of reasonable adjustments in pre-registration nursing education in Scotland

Nursing education providers in the United Kingdom have a statutory Public Sector Duty (Equality Act, 2010) to provide reasonable adjustments to meet the individual support needs of students with disabilities while maintaining academic and professional standards. Anecdotal evidence suggests the type of reasonable adjustment offered within and between academic and practice settings is inconsistent. This abstract outlines the findings of a doctoral study to explore the concept of reasonable adjustment in pre-registration nursing education in Scotland.

A sequential, explanatory, mixed-methods study underpinned by pragmatism was undertaken. Eight respondents provided phase one data via a telephone survey prior to five focus groups (17 participants) and four individual interviews being completed in phase two (n=21). Descriptive statistics, descriptive and thematic analysis, and documentary analysis were completed, and data synthesised to augment the findings.

Considerable differences across Scottish pre-registration nursing education programmes were revealed. Although facilitating equal opportunities for students with disabilities was intended, several factors influenced the types of reasonable adjustment available including attitudes, disclosure, education setting, and perceptions surrounding the law and education standards, as well as individuals’ personal values and beliefs. Four interrelated themes emerged:
- Reasonable adjustments: a wicked problem
- The influence of context: location and status
- To disclose or not disclose?
- Safety first
resulting in the overall conclusion reasonable adjustment is a wicked problem.

Wicked problems are complex, difficult, ill-defined, multi-factorial and subjective, and have no easy answer (Rittel & Webber, 1973). While every student is arguably entitled to individualised, student-centred support suitable for different situations, the diversity of resolutions applied to the problem of reasonable adjustment is not surprising due to the variety of perceptions held by various nursing education stakeholders. Thus, it is recommended stakeholder collaboration is promoted to openly debate ‘good’ resolutions to inform clear guidance to underpin policy and practice.