As a consequence of analysing the interview data and hearing - and learning - about the different types of disabilities that students experience, a disability can be broadly classified into two types - hidden and visible. Hidden
disabilities such as mental health issues (for example, anxiety or depression) were the hardest to deal with, particularly if the student had not disclosed their disability. Mental health as a condition is well documented in the wider literature particularly in relation to stigmatisation and lack of understanding regarding how best to help someone experiencing mental health difficulties. Interestingly, a number of interviewees expressed concern that practice educators appeared to possess insufficient knowledge and understanding as to how to support such students during their practice education experience. However, Keith (CLEL) cautioned that some students may not necessarily be aware of their disability until they are part-way through their university
programme. The consequences of delayed diagnosis can be overwhelming for the student and a simultaneous burden to the stresses of dealing with the demands of the healthcare programme they are on. Andrea (VT) pointed out some practice educators are good at being vigilant in that through the
process of cultivating a close working relationship with the student they may identify the student is struggling and as a consequence suggest the student explore this further through appropriate testing and support back in the university.
Dennis (CLEL) referred to differing levels of stigma attached to students presenting with a disability and said:
There are different levels of stigma attached to students presenting with a disability for example, someone with a mental health condition, this is a hidden disability. A visible disability is inescapable, it brings up the topic for you, naturally, and you can’t really get away with it. If the disability is hidden it can be much more difficult to raise with the educator. Some disabilities are clear even if not straightforward. With mental health the tendency is that it is not clearly explicit nor evident.
Dennis’s assertions raise some pertinent thoughts regarding the prevailing culture of disability and how society at large determines what is deemed acceptable or not. Remaining on the theme of visible and invisible
disabilities, Jim (CLEL) felt that in his experience staff tend to be supportive towards students with a disability, this is easier if the disability is visible or obvious such as a hearing impairment as opposed to an invisible one such as dyslexia or one which the student does not disclose. This - in his opinion - makes it harder for the practice educator to be supportive. Jim also said the practice educator may need to rely more on the student in terms of understanding the implications of their disability in order to be in a position to support the student if the disability is a hidden one. Jim also felt there was less parity in general for students with a disability and also between the different types of disabilities. It is important to note the prevalence of students with a mental health condition upon entry to healthcare programmes in higher education is on the increase and therefore we
(university and placement provider) need to accommodate their needs where appropriate.
Interestingly, a counter-argument in relation to disability being visible was provided by Mary (PE) who spoke about a student who wore leg braces over their uniform when the weather was hot and subsequently, this outward manifestation of disability became a visible as opposed to an invisible entity. The consequence of visible manifestation according to Mary was: “the
patient’s perception of the student was then based on their ability…due to their visible disability, this becomes a whole different challenge. I’ve only had one patient refuse to work with a student who had a visible disability”. Here, it would appear the patient was potentially forming a personal
viewpoint about the student because of the outward manifestation of disability. It is perhaps reassuring Mary said she has only had one patient refuse to work with a student with a visible disability but points to the dilemmas that can arise in an acute setting.
Further on in this section, patient perceptions of being treated by healthcare professionals with a disability and some of the factors that may figure in their
decision-making to refuse an assessment and subsequent intervention of their healthcare needs will be covered. Indeed, Jim (CLEL) cautioned that reactions of the patient towards the student with a disability can vary and they may not be so tolerant of the student’s need for reasonable adjustment, for example, having to speak slower or repeat things. The student needs to have sufficient insight into their disability and the consequences that
reasonable adjustment may have on others that they work with in addition to the patient’s perception. As well, the connotations of the amount and type of support the student requires does need careful planning as it can have consequences. This was illustrated by Veronica (PE) who recalled one student who was going to come out with a support worker and this
concerned her in that from a patient perspective, it could be construed as being surrounded by too many people and consequently impact on their well- being and cooperation to participate in the assessment / intervention being provided. The actual practicalities of this type of support were greeted by a modicum of concern on Veronica’s part and entailed extra planning and thinking through on top of her existing workload.
4.3.1.3 Disability type
According to Andrea (VT), the type of disability in respect of associated challenges does make a difference. If for example, a student has multiple difficulties in relation to dyslexia, tasks such as spelling and processing information can magnify the challenges as the student may need to spend more time with the patient to assess them or explaining information to
patients. In Andrea’s view, settings where appointments are time-bound can make the practice educator anxious and this in turn can reflect on the
student’s assessment. Andrea’s comment about slowing down the
assessment process was mentioned too earlier by Jim (CLEL) who said in his experience patients can sometimes become frustrated because a student can slow down the assessment process because of their disability. If the patient is in pain or not feeling well this can exacerbate their symptoms. This hints at the fact that some patients may not be so tolerant of the need to