1. Introduction

The National League for Nursing [1] identifies diversity in nursing as “essential” to health equity and healthcare system development. Additionally, an objective of the American Association of Colleges of Nursing [2] is to advance and facilitate diversity and inclusiveness. However, [3] reports that institutions of higher learning rarely incorporate disability when describing campus diversity; despite the fact that one out of every five adults in the United States lives with a disability [4] , and nurses may provide care to these individuals. The Americans with Disabilities Act (ADA) Amendment maintains the definition of a disability as “a physical or mental impairment that substantially limits one or more major life activities…” [5] . However, May [6] , surveyed nursing faculty about knowledge of the ADA, and only 46 (21%) received a passing score of 78%.

Little data or research has been gathered from the perspective of physically challenged nursing students attending a baccalaureate program, specifically addressing both didactic and clinical accommodations. The purpose of reporting these case studies is to describe the perspectives and self-reported experiences of three selfidentified, physically disabled nursing students, in order to examine the phenomenon of diversity and inclusion of persons with disabilities in nursing education. The students who disclosed their disability provided valuable assessment opportunities for this phenomenon. This type of study is significant in order to access “hidden” populations due to the low enrollment of physically disabled students into these types of programs [7] .

2. Methods

Data Collection: The University’s institutional review board approved this study and all participants signed consent forms. The study was conducted using a representative, convenience sample of the three self-identified physically disabled students at two participating baccalaureate nursing programs. A ten-item survey was developed from the literature and distributed to participating students with instructions for return within two weeks. Follow-up was performed if clarification was needed. The ten-item survey was formatted as forcedchoice, free-answer, and open-ended questions, in order to provide an opportunity for the participants to describe their experiences in nursing education. Surveys were in English and had a return rate of 100% (n=3).

Participants: The participants in this study consisted of the only three self-identified physically disabled students attending a baccalaureate nursing program. They included two males and one female and were classified as two seniors and one as a junior. Each student was approached based on their previously disclosed physical disability, as identified through approved school assessments as required criteria for a disability.

Results: Results are descriptive and presented as self-reported information in case studies addressing three areas of focus: admission to a nursing program, experiences during enrollment, and anticipation of program completion and entry into the profession.

Case Study 1: This participant’s physical disability was characterized as an obstetrical brachial plexus affecting movement of both the arm and hand. The student became interested in entering a nursing program while doing volunteer work. After being accepted into a nursing program, the student was told it would be unsafe to continue and it would be better to choose another career by the program director. The nursing program advisor also told the student that a physical therapy evaluation would also be required. However, that request was later withdrawn as it was considered, “unfair to require when the other students did not need this examination”. Upon enrollment, this participant reported that alternative approaches were identified by having classmates or patients assist with achieving tasks such as: insertion of an indwelling catheter, starting an intravenous catheter (IV), and tying tourniquets. This participant found a nurse through the National Organization of Nurses with Disabilities (NOND) to come to the University laboratory and explore alternative means for demonstrating proficiency in clinical skills. They also noted that all nursing students needed assistance with clinical skills at some time for patient care. Although, the student did not request assistive devices, this student pointed out that faculty was generally supportive when they realized the student could be successful. One instructor helped obtain a special stethoscope that was heavier than normal and allowed for the proper application of pressure to hear when auscultating with one hand. This student noted that the clinical site nursing staff hesitated to offer opportunities to learn or participate, but by developing a relationship with their patient, the patient would ask that the student be allowed to try. In reflecting on how to move forward professionally, the student noted that although students with disabilities may perform differently, they could still learn to accomplish the same task. The student noted that there is a “special drive” to perform competently, and it was uncomfortable when classmates were surprised at success. This student saw the opportunity to help raise awareness about nursing students with disabilities, explaining that they take their barriers and turn them into strengths.

Case Study 2: This participant’s physical disability was characterized as legal deafness. This student became interested in entering a nursing program after online research. After being accepted into a nursing program, the student explored using note takers. Upon enrollment, the student found they were unnecessary. There was a challenge with softspoken lecturers who would face the blackboard when speaking about items to be noted, but not enough to prevent learning. This student obtained equipment online, a special audio enhanced stethoscope that made up for the deficit, along with using hearing aids. When asked about areas of resistance moving forward, this participant said there was none that they anticipated.

Case Study 3: This student became interested in entering a nursing program after working for 15 years in other health care fields. The participant’s physical disability was due to a missing hand from a congenital anomaly. Upon admission to the nursing program, the student commented, “I knew it would be the hardest journey of my life.” Upon enrollment, the student did not request assistive devices and noted that the faculty was generally supportive. The student found that the tourniquet from the laboratory was easier to work with than the one in the IV start kit from previous phlebotomy experience. This student also noted that students without disabilities sometimes needed assistance in clinical experiences. Reflecting on moving forward professionally, the student commented: “I am challenged but I can always figure things out…I have learned to adapt and overcome many obstacles all of my life and that is why I will work harder, if people will only give me a chance”.

All three students reported creating their own accommodations, as needed to succeed in courses and clinical experiences, while enrolled in their respective nursing programs.

3. Discussion

In this presentation of case studies, the experiences of three selfidentified students with physical disabilities in a nursing program were described. According to Ashcroft & Lutfiyya [8] , when the subject of physical disabilities comes up, clinical instructors become less understanding and offer reasons why the student will compromise patient care and safety, have a decreased ability to perform, and need more time and supervision. In this case series, however, students reported that instructors and clinical staff were overall supportive and open to accommodations when they could see it led to successful outcomes. Azzopardi et al., [9] asserts that since every disability is unique, the simulation laboratory is an ideal environment to analyze and create accommodations that will be safe and effective for patient care. Two of the respondents in the case studies reported spending many hours in the laboratory discovering and perfecting alternative methods of performing skills that achieved the expected outcome within evidence based practice guidelines. Speculation as to why there are few applications from students with disabilities includes potential candidates that self-select because they do not feel they meet admission requirements [7] . Participants in this study reported that there were challenges that they expected in the nursing program, but they were able to overcome them. Nursing programs that have flexible admission requirements, allowing for diversity in disabilities, could open doors for potential students that can enrich the cultural life of nursing programs, ultimately leading to nursing professionals who are sensitive to people with disabilities.

4. Limitations

The small number of participants are a limitation but also a reflection of the problem that these case studies attempt to address: describing the challenges and low enrollment of students with physical disabilities in nursing programs. Future studies should include larger numbers and varied students, physical challenges and nursing programs in order to verify investigative rigor. Future goals in this field of study about nursing students with physical disabilities: confirmability, interpretative power through meaning-incontext, recurrent patterns, saturation of themes and transferability of concepts and knowledge [10] .

5. Conclusions

Nursing students with physical disabilities can be successful in pre-licensure baccalaureate programs. Exploration and expansion of nursing student populations to include those with physical disabilities is warranted to enrich ideas of diversity in higher learning and to fulfill the professional goals of the NLN and AACN for diversity, inclusiveness, and cultural sensitivity.

Competing Interests

The authors declare that they have no competing interests.