Nursing and Dyslexia
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Brief description of Dyslexia
Dyslexia affects the area of the brain that deals with language, leading to differences in the way information is processed and affecting the underlying skills needed for learning to read, write and spell.
Many students with dyslexia may lack confidence in the clinical setting due to fear of discrimination and/or because of previous negative experiences. The effect of this can be reduced if staff members who are aware of students' issues are accepting and non-judgemental. Providing encouragement and support helps to establish an atmosphere of trust and safety. Patience is essential and removing, or at least not placing undue emphasis on time pressures, can relive stress.
Not all students with dyslexia have the same pattern of strengths and difficulties. It may be helpful, to identify the specific requirements of the individual student prior to placement. A simple checklist could be produced to identify these requirements which may be used to facilitate discussion of support strategies with the Clinical Educator.
If the student already has a regular Dyslexia Support Tutor, it may be useful to have a three-way meeting prior to or at the beginning of the placement. This can be used to establish the exact requirements of the clinical setting and how best the student can be supported. If the Dyslexia Support Tutor is included at this stage, the student can keep in contact throughout the placement for ongoing support.
Arrange an orientation process including the use of a map. A tutor or clinician could walk the student(s) through the environment, identifying significant places and people and their roles/functions. The student should be given the opportunity to practice entering number codes on doors as some people find it easier to remember the tactile pattern rather than the number alone.
Many students describe the experience of feeling that they have to constantly flag up issues with Clinical Educators and often feel that this is perceived as being a nuisance. This problem can be circumvented if contact names are provided for the students with times when those people are available to talk about issues specific to dyslexia.
The following strategies may be helpful for students who find reading and writing tasks difficult and/or tiring:
- Give the student clear guidelines for specific record keeping formats and if necessary provide help with planning and structure.
- Provide some proof reading for patient records.
- Offer good examples of previously written patient notes.
The following strategies may be helpful to help with the overall management and organisation of the clinical placement:
- Enquire of students on first contact whether they have any support needs, so indicating an open and non-judgmental approach within the department.
- Construct timetables to assist organisation - encourage students to be actively involved in this process by noting down their priorities for the shift at the beginning of the shift.
- Encourage students to keep a diary or notebook for forward planning and reflection (this could be recorded using audio-visual equipment).
- Allow more time for students to write up patient notes, students may need to have their notes checked before committing them to charts.
- Consider flexible working patterns that enable students to work at their most efficient level e.g. allowing notes to be written at intervals during the day rather than expecting them all to be written up at the end of the day.
- Be sympathetic to students using Dictaphones or mini-disks to record key points during patient assessment.
- Allow students to use proforma sheets or to take brief crib notes when performing patient assessments.
- Where possible encourage students to use computers to write up notes. This will improve spelling and grammar due to the inbuilt software features.
- If appropriate allow the student to use a palmtop or tablet computer for note keeping.
- Avoid overloading students' study time.
- Encourage peer support and group working if there is more than one student working in the clinical area.
- Students may need to have their skills observed during the initial stages of the placement in order to ensure safe and confident practice before meeting patients.
Overall, there are a number of areas where adjustments may need to be implemented or the approach may need to be modified in order to enable full participation in clinical placements. These should be discussed and negotiated by the student and Clinical Educator, and any specific adjustments should be recorded and signed by all parties.
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Teaching strategies associated with Dyslexia
These strategies are suggestions for inclusive teaching. This list should not be considered exhaustive and it is important to remember that all students are individuals and good practice for one student may not necessarily be good practice for another. You may also like to contact the Disability Specialist in your institution for further information. If you have any good practice that you would like to add to this list, please email your suggestions to email@example.com
- Provide sufficient time to discuss needs with the student before/during their initial teaching session
- Give guidance on selected key works.
- Provide articles which are clearly structured and well presented to minimise reading load.
- Identify new subject vocabulary in texts.
- Offer audio-visual sources on subject matter, e.g. OU programmes, TV documentaries or discussions, videos - these can help with structure as well as content.
- Introduce new terms and concepts by writing them up on a board or projector.
- Provide lists of vocabulary at the beginning of a module or semester to allow students sufficient time to absorb terms and put them into context.
- Encourage the use of electronic spelling and grammar checkers.
- Providing handouts at the beginning of a tutorial or lecture can be the most helpful strategy, since a student with dyslexia can then concentrate on what the speaker is saying without having to be concerned with full note-taking.
- If using an overhead projector, use a readable size of print (24pt font size minimum). Limit the amount of information on each overhead transparency to key points. Elaboration of key points should be given to the group on a separate handout. In this way the students have access to information which they may miss during the lecture and can read at home at their own pace.
- Use chalk/white boards only to give examples, elaborate a point or note key words or concepts or names - never for extensive note-taking. Make sure your writing is large and clear and students can read it.
- Don't rely on talking alone to deliver subject matter - vary the pace and activities used in sessions. Set up structured discussions and presentations in small groups which give students opportunities to experiment with language while discussing ideas and opinions.
- When lecturing, give the framework, overview and main points at the beginning and give markers along the way to help students distinguish important points. Show them the big picture before looking at the composite detail.
- Allow time for students to process information - break lectures into chunks with pauses for taking it in and time for questions. Break up learning tasks into small steps and allow time for reinforcement and over-learning of information.
- Build in lots of feedback to monitor students' understanding and develop their learning skills.
- Some dyslexic students can be easily distracted by noise, activity or visual clutter - allow them a choice of seating. Some students may need to sit at the back of the room so as not to be distracted by people sitting behind them.
- Allow the use of tape recorders or lap tops in lectures if the student feels this is necessary.
- Consider the use of mind maps or simplified diagrams.
- Writing for two or more hours in a personal script that deteriorates over time can prove very stressful. Other methods for tackling these educational requirements may provide more rewarding results - for instance, the use of technologies such as video, computer generated or graphical presentations and laptops.
- Offer models of written work; essays; reports; projects.
- During examinations students may need extra time for reading through the paper as well as writing and checking work. Consideration may be needed for spelling, written expression and organisational difficulty or a scribe or word processor may be required to help with written responses.
- Be aware of the extra time, effort and concentration the student may need to bring to tasks involving language.
- Be explicit in expectations. Make sure instructions given orally are clear and written down as a backup for students to check if needs be.
- Encourage students to formulate questions, then respond using straightforward language and demonstrate points with concrete examples.
Organisational Skills/Time Management
- Many dyslexic students can get lost in following sequences and instructions, they may need help in action planning and prioritising tasks, encourage students to make use of diaries and/or to do lists for managing tasks.
- Students may require specific and practical help with planning, structure and organisation.
- Students may need specific help in focusing on: conventions - introduction, sub-headings, conclusion, identification of main points, identification of relevant and irrelevant data, selection and inclusion of quotations and references, ordering points and making transitions between points and presentation.
- Provide solution sheets to allow students to check their errors.
- Consider using different colours for each aspect.
- Provide clear definitions of new symbols.
- Give the symbol and the word definition together.
- Allow students to use a calculator.
- Try to give both numerical and theoretical examples.
Guidelines of Good Practice for Marking the Work of Dyslexic Students
By reading a dyslexic student's work fast, it is usually easier to assess the work for the ideas, understanding and knowledge that are present. Fast reading is best done by: ignoring any mistakes of spelling, grammar, punctuation or syntax and not correcting or commenting on the spelling, grammar, punctuation or syntax.
Where possible and feasible two marks should be given: one based on the material and the use of ideas, the other on the technicalities of language. The mark actually recorded for the piece of work should be the mark awarded on the basis of the material presented and the use of ideas.
If you choose to mark only for material and the use of ideas, understanding and knowledge and to ignore spelling, grammar, punctuation and syntax, let the student know that you are doing so.
Comments will be more helpful if they indicate where a student has done well and explain why some work is good, rather than if they are adversely critical. They will be most effective if they are an explanation of what is required, or what is wrong. They need to be legible and in properly constructed English.
If time allows use two different pens, neither red: one for comments about material, the use of ideas, understanding and knowledge, the other for comments about spelling, grammar, punctuation and syntax.
Correcting Language when Discussion with the Student is Possible
Check the student's level of understanding of the technicalities of language and presentation; sometimes there is a conscious knowledge but an inability to use it; sometimes there is no conscious basic knowledge. It is useful to discuss the level of correction that the student will be able to use and what reference books the student may have, or may find useful.
- When the student has conscious knowledge of language and presentation you should mark the errors that occur in the margin against the line where they occur. The aim is to let the student find the errors and correct them. Use a system of symbols that is convenient, such as: 'sp' for spelling mistake, 'ss' for sentence structure, 'pn' for punctuation, 'gr' grammar, 'lt' layout.
- When the student has no conscious knowledge of language and presentation you will need to talk through the errors in the coursework and explain why the corrections are necessary.
Dyslexic people do not learn language skills subliminally, e.g. almost no dyslexic people can learn to spell correctly by copious reading. Often progress is made with a language skill when someone explains the skill in a way that makes sense to the dyslexic person. Without such explanations, comment and corrections about spelling, grammar, punctuation and syntax are futile: they add to the demoralisation of the student; they provide the student with no information that s/he can use to improve future work, and they are a waste of the tutor's time.
Correcting Language when Discussion with the Student is not Possible
Correcting language without discussion with the student is probably a waste of time. A reasonable procedure would be to take no more than five types of error that occur repeatedly, and to show, with clear, simple examples, why the errors are wrong and what would be correct.