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Exploring the learning experiences of nursing students with dyslexia

Child J, Langford E (2011) Exploring the learning experiences of nursing students with dyslexia. Nursing Standard. 25, 40, 39-46. Date of acceptance: February 14 2011.

Abstract
Aim To examine the learning experiences of nursing students with dyslexia during clinical placements to establish ways of improving support in practice. Method A phenomenological lifeworld approach was adopted using semi-structured interviews. Students reflected on their experiences during clinical placements, allowing the researcher to gain an in-depth knowledge of the students lived experience of dyslexia. Twelve student nurses, six with dyslexia and six without, were interviewed using a standard set of questions, and the data were collated and analysed. Using a comparison group of students without dyslexia was felt to be important to contextualise and compare the students experiences. Findings Three main themes emerged: the value of work-based learning days, the importance of the clinical placement mentor role and the need for advocacy. Both groups of nursing students contributed to recommendations relating to support in practice and those with dyslexia also shared their individual coping strategies. Conclusion Nursing students with dyslexia may benefit from sharing placement experiences with colleagues outside the clinical environment. They may also benefit from receiving support from their placement mentor and a representative from the university who knows about dyslexia.

Authors
Jenny Child, senior lecturer in adult nursing, and Elizabeth Langford, senior lecturer and study skills adviser, University of the West of England, Faculty of Health and Life Sciences, Bristol. Email: jenny.child@uwe.ac.uk

Keywords
Dyslexia, education, mentoring, research methods, students These keywords are based on subject headings, from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords. DYSLEXIA IS A CONDITION that presents as a combination of difficulties affecting reading, writing and spelling, as well as organisation, memory and sequencing (Morgan and Klein 2000, NURSING STANDARD

Peer 2002). Sequencing involves actions or events arranged or happening in a specific order or having a specific connection. These skills play an important part in managing complex sets of tasks, prioritising care scenarios, managing handover information and other important data, and conveying its relevance to the multidisciplinary team. Approximately 10% of the general population have dyslexia (British Dyslexia Association 2003), and 3-10% of the nursing population state that they have dyslexia (Sanderson-Mann and McCandless 2006). Dyslexia can affect individuals to varying degrees. The literature suggests that strengths associated with dyslexia include good comprehension, problem solving, and oral and occasionally visual skills (Reid and Kirk 2001). Nurse education requires the integration of theory and practice; therefore becoming a nurse involves the cognitive, affective and psychomotor domains of learning (Scullion and Guest 2007). The debate regarding theory-practice integration has been continuing in nursing for decades with differing views on how the nursing student learns best. The Nursing and Midwifery Council (NMC) (2004) requires a 50% split between academic and practice learning hours, and the nursing student has to undertake assessment of his or her learning in practice. This requires a practical demonstration of students learning through a number of indicators designed by the NMC (2010), which have to be achieved at the end of each placement. However, it is not uncommon for nursing students to reach the final year of their training and find that for the first time they are failing on their practice placements. Failure at this stage emphasises a number of issues relating to assessment and mentorship.

Literature review
There is little evidence about how dyslexia affects nursing students in workplace learning, and what educational institutions can do to support particular learning needs (McCandless et al 2006). However, this has been prioritised june 8 :: vol 25 no 40 :: 2011 39

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through the Equality Act 2010 and universities have a legal obligation to ensure students with dyslexia are not discriminated against in practice and educational settings. A search of computer-based academic literature published between 2008 and 2011 was carried out using the British Education Index, British Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). Key search terms used were dyslexia, education, mentoring, research methods and students. This highlighted the paucity of research on the needs of nursing students with dyslexia. To be fit to practise in the UK, all registered nurses need to have literacy and numeracy skills and to meet the NMCs (2004) learning outcomes. Under the terms of the Equality Act 2010, student health professionals are entitled to receive reasonable adjustments in both the educational institution and workplace to achieve these outcomes. These adjustments could involve support or time and are decided in collaboration with the year tutor and student adviser, but cannot in any way compromise the professional competencies or the learning outcomes set out by the NMC. However, it has been suggested that, although such adjustments are being achieved in academic environments, for example with study skills support and extension time for assignments and exams, they are not always made in the practice area (Wright 2000, Morris and Turnbull 2006). Anecdotally, the authors have found that students with dyslexia feel that there is a lack of support in clinical practice they feel isolated and without an advocate primarily because of a lack of understanding of dyslexia. Illingworth (2005) suggested that minimal understanding of dyslexia in the workplace makes nursing students reluctant to declare their disability at the start of their clinical placements. It is possible, therefore, that students with dyslexia experience emotional stress from concealing their disability. They may struggle to find ways to manage the condition while in clinical practice. Nurses, like everyone, are prone to error, and uncertainty in their actions and decision making (Thompson and Dowding 2004). However, many employers view students with dyslexia as more likely to make mistakes. Blankfield (2002) viewed negative attitudes as one of the biggest problems for the nurse with dyslexia, as a result of preconceived assumptions about what the student is and is not able to do. Many nursing students with awareness of their disability have personalised strategies including individual handover sheets, negotiated audio recordings of 40 june 8 :: vol 25 no 40 :: 2011

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handovers and student placement information packs to aid their memory or work plan. Nursing requires accurate and detailed documentation to the standard outlined in Record Keeping: Guidance for Nurses and Midwives (NMC 2009). This can create a challenge for the student with dyslexia, needing time to manage this activity without the benefit of a computer to help organise and check the spelling in his or her records. The medication round can be a complex activity, with students feeling they are required to work within a particular time frame, which can increase the stress of the activity. This stress can then interfere with their personalised strategies, making them more likely to make an error. Despite misconceptions that people may have of nurses with dyslexia making medication errors, Morris and Turnbull (2006) found that individuals heightened self-awareness of their disability actually promoted patient safety, because it made them more aware of the potential risks and gave them a greater understanding of their personal nursing ability, resulting in them being less likely to make errors in practice. The experiences of students with dyslexia on clinical placements need to be explored so that appropriate support strategies can be implemented. The Equality Act 2010 states that universities have a legal obligation to support the student with dyslexia both in clinical practice and academia. This involves meeting the individual to prepare work plans to aid his or her practice experience. Practical solutions to difficulties experienced by students on clinical placement are individualised (Morris and Turnbull 2006), making this a time-intensive activity to ensure that each personalised plan is prepared and implemented. There is evidence to support the role of the notebook in assisting students with dyslexia as it can relate to their reading, memory, moving, handling and pronunciation (Goodwin and Thomson 2004, Stainer and Ware 2008). Many students with dyslexia find that the notebook helps them to maintain focus, organise their work plan and provides an activity log. The notebook is something that they create to meet their individual needs. It may also be useful for students without a disability to support good nursing practice. Morris and Turnbull (2007) conducted research exploring nursing students disclosure of dyslexia during clinical placements. It was found that students perceived no benefit from disclosing their condition and that such disclosure represented a source of stress and anxiety to them. This is consistent with the authors workplace findings, which makes the support of this specialised group even more complex. NURSING STANDARD

Aim
The aim of this study was to examine the learning experiences of nursing students with dyslexia while on clinical placement to increase knowledge in this area and make recommendations to support students in practice.

Ethical considerations
Ethical approval was obtained from the university ethics committee and access to participants agreed with programme managers. One cohort of third-year adult nursing students was approached by letter and invited to take part in the research. Each person was given a participant information sheet and was asked to complete a consent form.

Method
The study design used a phenomenological lifeworld approach. Lifeworld-based research is focused on the world as it is experienced before the formulation of any hypothesis to explain it (Dahlberg et al 2008). This approach was used to allow participants to reflect on their experiences during their clinical placements. It also allowed the researchers to gain an in-depth knowledge of the students lived experience of dyslexia. In recognising the philosophical underpinnings of phenomenology, a convenient but purposeful sample of 12 students was selected from one university nursing department: six who had a formal diagnosis of dyslexia and six with no known disability. The participants gave informed consent in writing to take part in the study. The qualitative exploratory study involved one tape-recorded semi-structured interview per participant, with an independent interviewer. Each interview was about one hour in length, and the venue was arranged between the independent researcher and the participant. It was decided to interview students with and without dyslexia as the researchers aimed to identify issues related to the learning environment for each group. Individual interviews were used to explore themes using a set of questions (Box 1). The interviews were audio-recorded and transcribed before being analysed. A line-by-line method of analysis was used to categorise the data. From this analysis themes were identified. Themes common to both groups and those specific to the separate groups were sought. The researchers carried out a pilot study of the questions drafted for the interviews. Valuable feedback was gained in discussion with a professionally qualified, practising nurse with dyslexia with regard to the questions and their clarity. The questions remained the same, but two refinements were made where the wording was NURSING STANDARD

altered slightly to provide greater clarity. Questions for the interviews were carefully prepared and designed to create an environment in which students could discuss their experiences of clinical placement. The questions also sought to examine the role of the mentor in clinical placements and explore the design of a toolkit to support students on placement. Thematic analysis of the data was carried out, with each interview being anonymised with a code D1-D6 for students with a formal dyslexia diagnosis and 1-6 for students without a diagnosed disability. The overall analytical approach adopted followed the conventions of template analysis, where the researcher produces a list of codes (template) representing themes identified in the textual data (King 2004). The interviews were conducted and transcribed by an independent researcher. Two researchers (JC and EL) then read the data separately, identifying the themes and comparing their findings. The themes were then coded during the analysis stage.

Findings
Students with dyslexia and those without a known disability expressed a number of common concerns. There was also an additional set of themes that was specific to each group. Participants also provided a number of recommendations for practical and useful learning aids. Box 2 lists the common and specific group themes. Themes that linked both groups included:

BOX 1 Questions used in the student interviews

1. As far as you are aware, do you have any disabilities that affect your learning? Follow-up question: Have you gone through any specific procedures to identify this disability? Is it affecting you in your practice? During your clinical placement was there anything particularly helpful that has supported your learning? During your training did you encounter any problems with your clinical placement that have been difficult for you?

2. 3.

4. How have these problems affected your practice? 5. 6. 7. Have you felt able to discuss these problems with your mentor? What response have you received when you have raised or identified areas of need to your mentor? What did your mentor do to manage your individual needs?

8. Looking back, what would you have found beneficial in meeting these needs? 9. Have these difficulties affected your ability to complete your learning outcomes? If so, how?

10. If you were designing a toolkit to help you achieve your outcomes in placement what key tools would you require?

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4The value of work-based learning days. Seagraves et al (1996) defined work-based learning as learning at work from work for work. These days enable students to come out of the clinical placement and meet and engage with their peers in a learning forum, using the personalised practice environment experience to challenge academic learning, thereby enhancing practice learning and future practice. 4The importance of the clinical mentors role. 4The need for the academic institution to send clearly written information on clinical placement standards to the workplace mentor. This material is necessary to bring clarity to the mentors role, defining what is the responsibility and role of both the mentor and the student. BOX 2 Common themes, dyslexia themes and non-dyslexia themes
Common themes 4Value of work-based learning days.

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The three main themes that emerged from the data analysis were the value of work-based learning days, the importance of the clinical mentors role and advocacy for students with dyslexia. Personalised coping strategies and recommendations for developing a toolkit are also discussed. Work-based learning Work-based learning days help integrate theory and practice. Facilitated work-based learning days are integrated into the practice modules at the university, enabling students to have time outside the practice learning environment to obtain peer support and assimilate the learning that has taken place in the work setting. One student with dyslexia stated: The work-based learning day is brilliant because we all talk to one another and thats really helpful and depending on what facilitator youve got, but so far weve had quite good facilitators and you can talk to them or just other students, friends and thats sort of how we do it really (Student D3). Further evidence of their usefulness emerged from a student without dyslexia: Work-based learning days are really good because we do a lot of work towards the learning outcomes that we can then take into placement thats really good cause A it saves us a lot of time and B you know youre getting several other peoples perspectives (Student 1). Eleven of the 12 students identified the usefulness of work-based learning days in relation to consolidating learning and developing their verbal dexterity. This requires the students to engage professionally, using an educational forum, to manage and talk through their experience. Such days provided peer group support and were perceived as a valuable time for sharing experiences, working collaboratively and receiving the input and support of lecturers. The remaining student did not mention work-based learning in the interview. Importance of the clinical mentor role Both groups of interviewees stressed the importance of the mentors role. The mentor is a nurse who is a clinical educator and professional member of the practice-based setting who supports the nursing student during the clinical placement. There was evidence that interviewees perceived the quality of mentorship to be diverse. A common theme was the apparent lack of understanding by mentors with regards to the paperwork produced by the university, which maps out the NMCs (2010) learning outcomes and assessment criteria. This led to confusion and difficulty in terms of the nature of the support that the student received from the mentor. Some students felt that their learning outcomes were being signed off in a hurry at the end of their placement, not giving some of the evidential consideration which could NURSING STANDARD

4Value of mentor. 4Clarity of written material. 4Value of information packs. 4Induction visit before start of placement. 4Action plan as planning tool. 4Clarity about study time on and off the ward.
Dyslexia themes 4Dyslexia affects practice.

4Need for more time to complete tasks. 4Short-term memory difficulty. 4Confidence with learning difficulty. 4Spelling difficulty. 4Writing difficulty. 4Reading difficulty. 4Pronunciation difficulty. 4Graded language from level 1 to level 3.* 4Lack of understanding about dyslexia. 4Need for more information about dyslexia for clinical mentors and staff. 4Discrimination on disclosure of dyslexia. 4Judgemental attitudes on disclosure of dyslexia.
Non-dyslexia themes 4Training in assertiveness, conflict resolution and negotiating skills to be offered as part of the universitys curriculum.
*Students are expected to achieve their academic and practice learning over three levels: level 1 is year one, level 2 is diploma level and level 3 is degree level.

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develop their learning further. Others felt the mentors did not understand the learning outcomes, because of the complexity of the language used by the NMC and the university. There was a disparity between students expectations and needs and mentors allocation of support time for signing off students work (Williamson et al 2011), even though the Royal College of Nursing (RCN) (2007) provides comprehensive guidance in this area: Um, just finding time to pin somebody down and then you get the ones that really arent bothered, you have to chase them around with the book sign my book, sign my book Or you know, you have to sort of I know its my responsibility to learn things but, um, sometimes I just feel like they dont always hold their side of the bargain (Student 1). At times nursing students felt vulnerable when raising issues for discussion with their mentor: you dont feel confident, like things like nursing calculations, drug calculations. Youll ask them about it and theyll be like oh go and look it up in a book and Ill do it (laughs). But you dont feel confident that they fully know or can teach you properly how to do things and everybodys got different answers for the same questions (Student D3). Students in both participatory interview groups identified times when they believed that because of their questioning approach their mentor was not going to sign them off: I asked a senior nurse [charge nurse] to go throughthe learning outcomes with me and tell me what he thinks I should be doing, and he was really flippant and just said well as long as you know, we just sort of tend to sign them as long as you get on and practise and we see youre getting on well just sign anything and it was a bit shocking really (Student D3). Positive experiences with mentors were also reported during the study. Some students used professional colleagues as unofficial mentors and found this strategy to be effective: I had a team of mentors, I was in the green team and every student had a team so I didnt just have one person that I could ask, I had four people, so that if my mentor wasnt in there was always someone that was either going off shift or on shift that I could speak to, so that was really helpful, knowing I had more then one person to do things with (Student D6). Students with dyslexia expressed difficulties with spelling, reading, writing, pronunciation, short-term memory and managing learning needs. However, there was significant disparity NURSING STANDARD

between the ways in which interviewees had been treated and supported by mentors. The quality of mentor support could make a real difference to the learning experience for nursing students with dyslexia. Two interviewees recalled a memory of a conversation with the mentor: Yes because of my spellings, the way I spell and when I have to write in notes and stuff like that its quite hard. Um, and on one of my placements they did bring up like the legal issue if you did go to court and Ive like because Ive got a pen that I can rub out with (Student D2). So umm, the main things it affects are like umm, spelling Im really rubbish at spelling and it doesnt matter if I try to learn how to spell something I will forget it again and Ill mess it all up again (Student D4). Another interviewee described a more supportive intervention by a mentor: I cant pronounce pharmaceutical words Ive never seen before oh come on you know youre going to be working on all the medical wards, you need to learn these so wed sit down and go through some of them shed write a list of them Yeah, go and learn them and come back and well do a drug round and well see which ones you can remember (Student D4). The nurse mentor can play a key role in creating an atmosphere that enables nursing students with dyslexia to learn on clinical placement. Advocacy for students The view that the university should adopt an advocacy role on behalf of students with dyslexia emerged from the interviews. Many students were reticent about raising their diagnosis of dyslexia with their mentor in the workplace setting. This resulted from previous negative experiences. Some students felt they had experienced a degree of discrimination and were subjected to judgemental attitudes when they had disclosed their dyslexia. Students were therefore keen to avoid repeating that experience. As a result, many felt that they wanted the university to inform staff in the clinical placement area about their dyslexia: It would be good ifthe placement knew about your dyslexia before you started so that they were informed and just a little break down so that they have an understanding so theyre prepared (Student D1). It was clear that many students felt uncomfortable about when to share the fact that they had dyslexia with their mentors and found it difficult to find the appropriate time. Students stated that they wanted the information about their dyslexia, including their specific needs, to precede their arrival on placement: june 8 :: vol 25 no 40 :: 2011 43

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I would love the university to contact that placement and make them aware that they have a dyslexic student coming so that they can feed back to the team so that youre not there and every time someone says oh youve got some spelling mistakes there and you have to say continuously oh I am dyslexic I just like to maybe say it once. Are you aware that I have got dyslexia? Have the university contacted you? (Student D6). Interviewees also stated that most mentors did not know enough about dyslexia and that information about the condition should be made available to all mentors and clinical placement staff. Personalised coping strategies All students in the dyslexia group found that dyslexia affected their clinical practice while on placement. Their difficulties with short-term memory, spelling, writing, reading and pronunciation had an effect on their confidence in relation to their ability to learn. It was evident from the analysis that students with dyslexia had developed their own strategies for coping with the way in which their disability affected their performance during placements: Ive got things in place that you know, Ill have in my pocket, simple words like analgesia, Ill have that written down somewhere and my friend shes really dyslexic and she has a spell checker which I FIGURE 1 Main recommendations and shared responsibilities

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thought was a good idea which I was thinking of getting for my next placement because theyre only little and they can slip in your nurse uniform pocket (Student D4). Some students were strategic in their management of the placement, establishing the support that was available and how they could best obtain it. Others identified that it was best just to keep your head down, working through the skills sheets and using work-based learning to work through the issues with which they were struggling. Developing a toolkit Insightful and practical recommendations were mentioned by most of the interviewees in response to the question: If you were designing a toolkit to help you achieve your outcomes in placement what key tools would you require? Information packs about the individual placements that students could read before the placement commenced were identified as a useful tool. It was also thought that an induction day and/or a visit to the placement location before the first shift would be beneficial. The value of an action plan as a planning tool to aid learning while on clinical placement for the nursing student also emerged as a common theme. Some interviewees felt that there was a need for standardised information about allocating study time both on and off the ward, including information about allowing students time off the wards to attend study skills support sessions at the university. The need for guidelines clarifying the expectation of the nursing student at varying levels was also expressed. Many students found that some mentors understood the documentation better than others. This generated a lack of parity in the assessment process. Some mentors did not always have appropriate expectations of students practice, and therefore missed important learning opportunities. Many mentors did not understand the importance of the time frame for completing documentation, adding additional stress to the students learning and practice experience. Interviewees also felt clinical mentors and staff lacked understanding about the problems affecting people with dyslexia. They wanted the university to send information about dyslexia to the clinical placement areas. Students in the non-dyslexia group expressed that they required training in assertiveness, conflict resolution and negotiating skills. The main recommendations are summarised in Figure 1. They are represented under three areas of responsibility: the university, the practice placement and the student. These areas overlap and illustrate which of the groups could share responsibility for the recommendations listed. Placement issues highlighted problems associated with language and the speed at which it is used: NURSING STANDARD

4Information packs 4Dyslexia information 4Mentor packs 4Action plans

University

4Current

4Flow charts 4Pre-placement

day or visit

contacts

4Computer 4Dictionary 4Local information 4Journals 4Clarification of

achievement

Practice placement

4Handover

template sheet

4Abbreviation

and language

4Coloured overlays 4Diaries 4Wall planner 4Spell check

Student

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If Im asked to do lots of things, I cant necessarily take all the information in (Student D2). Both student groups identified the benefit of using student placement information packs to support their socialisation into the clinical area. One student developed a pack in collaboration with her mentor, which also supported the mentor in achieving her teaching and assessing course: I started off doing a student pack with the other nurse. So and Ive put a page in about my experience there and what I think they should know, a phone number that I think they should know, so weve started thatso Ive started it and shes doing her teaching and assessing now so as part of that she is going to finish off the packwe have made one up, and it does make a lot of difference if youve got a student pack there, it makes you feel more welcome as well (Student D5).

Discussion
It is evident from the study findings that similar practice needs are identified by students with and without a formal diagnosis of dyslexia. These similarities are related to the socialisation of students into the practice area, how their learning is addressed and how they are expected to assimilate readily into the placement culture. Standardised information was requested throughout, and mentors were expected to have a full understanding of the universitys paperwork. Greater clarity in the assessment process was also requested by the students. Time pressure was a key distinction between the two groups, with the participants representing the needs of the student with dyslexia identifying difficulties in their organisation skills, making handover a particular challenge. Anxiety about time and mentor attitude became a barrier when managing tasks such as the medicine round. A number of issues emerged from the data analysis. It is apparent that mentors need to have more training with regard to supporting students with dyslexia. Mentors are a key aspect of nursing students clinical placement experience and, as such, have a pivotal role in students learning (Pulsford et al 2002). Mentors need to be aware of the nature of dyslexia, including knowledge of positive, practical ways in which to help students with the condition. They should also be provided with update training when changes are made to the paperwork so that they can explain them to the nursing student. Students with and without dyslexia appear to require help to meet their learning outcomes, and mentors are in a key position to assist them with this. Clear lines of contact between the university and mentor are NURSING STANDARD

required, so that the university can offer appropriate support to mentors if required. The implications for the university include standardising support for students placement activity, ensuring personalised action plans are completed in collaboration with the mentor and the student. Strong links need to be developed and maintained with clinical placement mentors, and support and training offered where appropriate (RCN 2007). Standardised information is required, giving the mentor and student clarity about the university paperwork, bringing a transparent approach to the process, expectation and assessment, ensuring that each student gains a fair assessment. Development of personal skills, such as assertiveness, negotiating and conflict resolution, also needs to be incorporated into taught curriculum sessions within the university. These skills were felt to be important to the student in representing their learning needs and challenging issues that arise in practice. With regard to advocacy, results of this study would suggest that students with dyslexia require support in relation to disclosing their disability to staff in placement areas. The university could offer help in the form of a support group. This group could have a role in enabling students to communicate assertively their learning needs to staff in clinical placement areas. Alternatively, students with dyslexia could provide consent for a champion or advocate from the university to communicate their needs on their behalf. What also became apparent from the interviews was that most of the students with dyslexia required more time to adjust to placement routines, and localised skill sets. This, coupled with working on a busy ward, is a particular challenge for students with dyslexia. In the ward environment, this factor alone might influence the ability of the nursing student to be fit to practise. The central concern of many healthcare professionals, professional bodies that regulate the professions and the public, is the registered nurse or healthcare professionals competence to practice. The Equality Act 2010 is designed to protect people with a disability. It is imperative that students with disabilities are not treated less favourably than those without a disability. To date, improvements have been made with regard to improving the academic aspects of students experience in the university. This has involved improved mentor updates, closer auditing of placement areas and the introduction of academic staff working in the practice area (Williamson et al 2011). However, more needs to be done to support nursing students with dyslexia in clinical practice. This research has identified the importance of mentors having time to support students with june 8 :: vol 25 no 40 :: 2011 45

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dyslexia and understanding the difficulties that dyslexia presents. Improvements in support and knowledge are likely to be of benefit to students in terms of enabling good and safe practice.

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to others nationally and internationally who are redesigning their structures for student support and mentoring.

Conclusion
The key themes that emerged from this research were the value of work-based learning days, the importance of the role of the mentor in clinical placements and the need for advocacy from the university. It is evident there are areas of learning in practice that are both difficult and challenging for students with dyslexia. A range of tools and organisational methods could be implemented that would not only benefit students with dyslexia, but would also benefit all students on clinical placement. Creating an accessible learning environment that achieves parity for the student experience, regardless of disability or learning style, and supports the philosophy of inclusion rather than difference, is essential. Academic establishments, clinical placement staff and students all have a part to play in the successful clinical placement experience of nursing students with dyslexia. The clinical placement experience represents a collaborative enterprise that requires the successful transfer of communication and educative skills between students, the university and clinical placement staff NS

Limitations
This was a small-scale qualitative evaluation, which researched one area, focusing on local context and therefore the findings cannot be generalised to the wider setting. However, the data collected will be of interest and relevance IMPLICATIONS FOR PRACTICE 4Improved communication, training opportunities and learning materials,
offered by universities for clinical mentors, could enhance the experience of nursing students.

4Nursing students with dyslexia are likely to benefit from time spent with
a clinical placement mentor who understands the specific learning issues associated with dyslexia.

4Creating a support group for students with dyslexia in the university

setting is paramount, to provide assistance and time for students to assimilate their learning and share their personalised coping strategies with peers.

References
Blankfield S (2002) Greatest problem with dyslexia is attitude. Nursing Standard. 16, 42, 30-31. British Dyslexia Association (2003) Becoming A Dyslexia-Wise Employer. A Framework for Action. British Dyslexia Association, Reading. Dahlberg K, Dahlberg H, Nystrm M (2008) Reflective Lifeworld Research. Second edition. Studentlitteratur, Lund, Sweden. Goodwin V, Thomson B (2004) Dyslexia Toolkit: A Resource for Students and their Tutors. Second edition. Open University, Milton Keynes. Illingworth K (2005) The effects of dyslexia on the work of nurses and healthcare assistants. Nursing Standard. 19, 38, 41-48. King N (2004) Using templates in the thematic analysis of text. In Cassell C and Symon G (Eds) Essential Guide to Qualitative Methods in Organizational Research. Sage, London, 256-270. McCandless-Sugg F, Sanderson-Mann J, Wharrad H (2006) DysPEL: Dyslexia and Practice Environment Learning in Nursing. www.nottingham.ac.uk/ teaching/resources/methods/ practicals/dyspelst681 (Last accessed: May 20 2011.) Morgan E, Klein C (2000) The Dyslexic Adult In A Non-dyslexic World. Whurr Publishers, London. Morris D, Turnbull P (2006) Clinical experiences of students with dyslexia. Journal of Advanced Nursing. 54, 2, 238-247. Morris DK, Turnbull PA (2007) The disclosure of dyslexia in clinical placement: experiences of student nurses in the United Kingdom. Nurse Education Today. 27, 1, 35-42. Nursing and Midwifery Council (2004) Standards of Proficiency for Pre-Registration Nursing Education. NMC, London. Nursing and Midwifery Council (2009) Record Keeping: Guidance for Nurses and Midwives. NMC, London. Nursing and Midwifery Council (2010) Standards for Pre-registration Nursing Education. NMC, London. Peer L (2002) What is dyslexia? In Johnson M, Peer L (Eds) The Dyslexia Handbook. British Dyslexia Association, Leeds. Pulsford D, Boit K, Owen S (2002) Are mentors ready to make a difference? A survey of mentors attitudes towards nurse education. Nurse Education Today. 22, 6, 439-446. Reid G, Kirk J (2001) Dyslexia in Adults: Education and Employment. John Wiley and Sons, Chichester. Royal College of Nursing (2007) Guidance for Mentors of Nursing Students and Midwives: An RCN Toolkit. Second edition. RCN, London. Sanderson-Mann J, McCandless F (2006) Understanding dyslexia and nurse education in the clinical setting. Nurse Education in Practice. 6, 3, 127-133. Scullion P, Guest D (2007) Study Skills for Nursing and Midwifery Students. Open University Press, Maidenhead. Seagraves L, Osborne M, Neal P, Dockrell R, Hartshorn C, Boyd A (1996) Learning in Smaller Companies Final Report. Educational Policy and Development, University of Stirling, Stirling. Stainer L, Ware P (2008) Notebook to Support Practice Nursing. www.workingstrategies 4u.co.uk/nursing_notebook.htm (Last accessed: May 20 2011.) Thompson C, Dowding D (2004) Awareness and prevention of error in clinical decision-making. Nursing Times. 100, 23, 40-43. Williamson GR, Callaghan L, Whittlesea E, Mutton L, Heath V (2011) Longitudinal evaluation of the impact of placement development teams on student support in clinical practice. The Open Nursing Journal. 5, 14-23. Wright D (2000) Educational support for nursing and midwifery students with dyslexia. Nursing Standard. 14, 41, 35-41.

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