Dyslexia, dyspraxia and dyscalculia: a toolkit for nursing staff - Royal

Dyslexia, dyspraxia and dyscalculia:

a toolkit for nursing staff

Acknowledgements

The format of this toolkit is based on that used by theUniversity of Southampton booklet Supporting studentswith dyslexia in practice. Grateful thanks go to theUniversity of Southampton, and in particular to JanetSkinner, for permission to use and develop this format.

Thanks should also go to colleagues from around the UKwho acted as a sounding board and in some casesprovided specific material.

Finally, invaluable insights into what it is like living (andworking) with one of these conditions have beenprovided by members’ personal stories – excerpts ofwhich are threaded throughout this toolkit. Thank you toeveryone who generously shared their story – I hope Ihave done you justice.

Author

Michelle Cowen

Lecturer/Academic Lead for Disability and Dyslexia at theFaculty of Health Sciences, University of Southampton

Consultant in dyslexia, dyspraxia and dyscalculia.

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

© 2010 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in aretrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording orotherwise, without prior permission of the Publishers or a licence permitting restricted copying issued by theCopyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. This publication may not be lent, resold,hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it ispublished, without the prior consent of the Publishers.

RCN Legal Disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for use withinthe UK but readers are advised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed.Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it isimpossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to anyperson or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what iscontained in or left out of this guidance.

Dyslexia, dyspraxia and dyscalculia:a toolkit for nursing staff

R O Y A L C O L L E G E O F N U R S I N G

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Dyslexia, dyspraxia and dyscalculia:a toolkit for nursing staff

Contents

Acknowledgements Inside front cover

Foreword 2

1 Introduction 3

2 Disability Legislation 4Reasonable adjustments 4Fitness for Practice 5Responsibilities of an employer 6Responsibilities of the employee 7Disclosure 7

3 What is a specific learning differenceand how do these impact on theindividual in the workplace? 8Introduction to specific learningdifferences 8Coping strategies 8Positive aspects of specific learningdifferences 9The emotional impact of a SpLD 9Challenges in clinical practice 10

4 Introduction to dyslexia 11What is dyslexia? 11Characteristics of adults with dyslexia 11Positive attributes 13

5 Introduction to dyspraxia 14What is dyspraxia? 14Characteristics of adults with dyspraxia 14Positive attributes 15

6 Introduction to dyscalculia 16What is dyscalculia? 16Characteristics of adults withdyscalculia 17Positive attributes 18

7 Overcoming difficulties: self helpstrategies and tips to supportcolleagues 19Difficulties with documentation 19- Reading documentation 20- Writing notes 22- Spelling 24Difficulties organising workload 25- Remembering things 26- Coping with distractions 28- Managing time 28Problems with psycho-motor skills 29- Demonstrating manual dexterity 29- Sequencing of tasks 30Difficulties with drug administration 30- Reading drug charts 31- Calculating drug doses 32Liaising with colleagues 34- Discussing clinical issues 34- Reading aloud 35- Writing in front of others 35

8 Using equipment to help you 36Funding for equipment 36Hardware available 37Software available 37Other equipment 37

9 Sources of help and further advice 38

10 Useful reading 41

11 References 45

Find your way around: you can navigate through this document by clicking on the links in the contents pageor ‘Back to contents’ and ‘Back to start of chapter’ at the base of each page.

Foreword

This toolkit has been created to provide a practical guide to dyslexia,dyspraxia and dyscalculia. It aims to orientate the user on the nature ofthese conditions and their potential impact on an individual. It also sets outto raise awareness of our legal and professional responsibilities in respectof these conditions.

However, the main focus of the toolkit is to suggest practical strategies andtips that might help. Rather than trying to separate the conditions, whichoften overlap, areas of clinical practice which might be particularlychallenging for individuals with these conditions have been identified.Linked to each area of potential difficulty are two sets of tips; the first areself help strategies that individuals can try themselves, the second is acomplementary list of strategies to help colleagues which will hopefully beinvaluable to those working as mentors, preceptors or indeed anyone whocares about those they work with, and who wants to help them reach theirpotential. Both lists of suggested strategies are derived from an in depthunderstanding of the underpinning issues surrounding dyslexia, dyspraxiaand dyscalculia, and experience of seeing what has worked with others overthe years.

The toolkit has been designed to be used by anyone working as a healthcare assistant, associate practitioner, student or registered nurse andacknowledges the diverse settings in which nursing staff work. The focus ismainly on difficulties that might exist in the workplace as there are alreadygood resources available related to academic study. Furthermore, educationproviders are likely to offer specialised study support for those with adiagnosed learning difference who register with them.

All of the strategies included in the toolkit can be used in a variety ofsettings including in a hospital, primary care, or anywhere else that the roletakes nursing staff. Undoubtedly, some of the suggested strategies will beeasier to implement in certain areas and it is likely that some may need tobe modified or adapted in certain clinical settings – but the toolkit doesprovide a starting point.

Divided into sections to enable the reader to dip in and out as required, theunderpinning theory and background information has been kept to aminimum to keep the toolkit to a manageable size and enable it to becarried around in practice. More detailed and extensive information isprovided in the RCN publication Dyslexia, dyspraxia and dyscalculia: a guidefor managers and practitioners. Both documents identify sources of supportand additional reading.

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D Y S L E X I A , D Y S P R A X I A A N D D Y S C A L C U L I A – T O O L K I T

Back to contents


3Back to contents Back to start of chapter

Introduction

For many years the Royal College of Nursinghas recognised the impact of dyslexia,dyspraxia and dyscalculia on its members,and has sought ways of supportingindividuals with these conditions to helpthem to reach their potential in whateverrole or setting they work.

In 2006 the RCN Practice Education Forumcommissioned a review of the literature ondyslexia in relation to practice (Dale andAiken, 2007) which highlighted a wealth ofissues and helped raise awareness,certainly in relation to dyslexia – the mostcommon of the three conditions. While theliterature review recognised the challenges,it was not able to offer any real solutionsand there continued to be a need for apractical guide for managers, employers andthe nurses themselves to identify strategieswhich can help. This toolkit aims to do justthat.

The toolkit begins with an overview of theDisability Discrimination Act (1995 and2005) and its implications. This is followedby a broad overview of specific learningdifferences – the umbrella term used to referto dyslexia, dyspraxia and dyscalculia – andtheir overall effect on the individual. A moredetailed introduction to each of theindividual conditions follows, before themain focus of the toolkit – strategies to help.The toolkit concludes with an overview ofequipment which might be of help to theindividual.

It is important to acknowledge that thenumber of RCNmembers affected by thesethree conditions is substantial. Roughestimates suggest that 1 in 10 of the generalpopulation are affected and there isevidence to suggest than in certain caringprofessions this is much higher (Taylor,2003; Hartley, 2006). One university foundthat 14 per cent of its student nurses had

1been formally diagnosed as having eitherdyslexia or dyspraxia, although the numbersmay be even higher when you add in thosenot formally diagnosed.

Finally, recent legislation which has includedthe Disability Discrimination Act (HerMajesty's Stationery Office (HMSO)1995/2005), Special Educational Needs andDisability Act (SENDA) (HMSO, 2001) andthe Equality Act (HMSO, 2009) mean that wecan no longer ignore these issues. The RCNthrough its Disability Equality Scheme –ability counts (2007); and through specificrecognition of the impact of dyslexia,dyspraxia and dyscalculia, are leading theway and clearly demonstrating their strongcommitment to disability equality.

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DisabilityLegislation

Aims of this section

� To provide you with an overview ofrecent legislation which relates todisability and inclusion.

� To explore the implications of thislegislation in relation to the need forreasonable adjustments whilstmaintaining professional standards.

� To identify the responsibilities of anemployer and employee.

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Over the past two decades a range oflegislation has been passed addressing theneeds of individuals with a recogniseddisability, which the 1995 DisabilityDiscrimination Act (HMSO, 1995) defined as:

“any condition which has a significant,adverse and long term effect on theperson’s ability to carry out everydaytasks.”

Under the terms of the Act specific learningdifferences (SpLDs) such as dyslexia,dyspraxia and dyscalculia were all classifiedas a ‘disability’ and it therefore becameunlawful to discriminate against anyonewith one of these conditions on the basis ofthat disability. This covered a range of areasincluding employment, education andaccess to goods and services.

In 2005 the Act was updated and requiredorganisations to have a ‘positive duty’ to“promote equality of opportunity andpositive attitudes; eliminate unlawfuldiscrimination and encourage disabledpeople’s participation.” (HMSO, 2005).

Finally, the most recent piece of legislationis the Equality Act (HMSO, 2009) whichbecame law in April 2010 and bringstogether all of the previous equality anddiversity related legislation. This is classedas a ‘Consolidatory Act’ which will come intoeffect from October 2010 and will replacethe previous legislation including theDisability Discrimination Act which will berepealed 1.

In view of the legislation which exists it isimperative that everyone working with staffwho have dyslexia, dyspraxia or dyscalculia,whether as an employer, manager, colleagueor mentor/preceptor are fully aware of theirlegal responsibilities.

Reasonable adjustments

Under the terms of disability legislationindividuals are entitled to receive“reasonable adjustments” to help themovercome their difficulties.

The key word here is ‘reasonable’ anddeciding what constitutes a reasonable levelof adjustment. There is no legal definition ofreasonable in this context, and it is up to theindividual to agree whether they considersomething to be reasonable or not. Perhapsit is important to point out that individualsmust therefore be prepared to potentiallydefend any decisions that they make ifchallenged, and it is essential that adecision to judge a requested adjustment as‘unreasonable’ is only taken after verycareful thought, and if necessaryprofessional advice. There are welldocumented cases of individuals receivingsignificant amounts of compensation whereadjustments have been either refused orsubsequently ignored.

Whilst all requests must be considered, thelaw does not expect us to make

1 Except in Northern Ireland where the DisabilityDiscrimination Act remains on statute.



unreasonable levels of adjustment and thisneeds to be considered when assessing‘fitness to practice’ (see next section). Latersections of this toolkit suggest ‘reasonable’strategies that could be used to support acolleague, but even these can become‘unreasonable’ if required to excess. Forexample, a nurse with dyslexia may need tobe shown how to do something severaltimes before it ‘clicks’ and this is fine –however, if you have shown them 10 times ina morning and they still cannot remember, itis becoming a problem. Intensive support isnot sustainable and might be considered asunreasonable, unless it is for a very specifictask on a short term basis.

Requests for adjustments may come from avariety of sources. In the case of dyslexiaand dyspraxia the individual will have aspecialist report from an educationalpsychologist or other approved person,which details the areas of ‘need’ and theadjustments required. However thesereports very rarely make recommendationsrelated to the workplace as the personcompiling the report is unlikely to have therelevant experience to do so. Furthermore,the assessment has often taken place whenthe individual was at university and themain focus may relate more to the academicaspects of the course than the clinical role.Recommendations may also come from anoccupational health department or fromother suitably qualified professionals,including doctors and occupationaltherapists.

For dyscalculia the situation is even morecomplex as at present there is no officiallyrecognised screening tool that isappropriate for adults, although one isunder development (see section 6 ondyscalculia for more details). It is thereforeunlikely that specific recommendations willhave been made.

Finally, a request for a specific adjustmentmay come directly from the individual

concerned as they will have the greatestinsight into their particular areas of need.These requests should be considered in thesame way as recommendations frommoreformal sources. The key factor indetermining eligibility for an adjustment isthe formally diagnosed presence of adisability, not the source of the request.

Fitness for practice

Whilst disability legislation requires us tonot discriminate against an individual with adisability, it does recognise that certainprofessions need to set and maintainprofessional or competence standards.

Section 54 (6) of the Equality Act (HMSO,2009 p 36) defines a competence standardas “an academic, medical or other standardapplied for the purpose of determiningwhether or not a person has a particularlevel of competence or ability”.

Student nurses who have declared adisability will still be expected todemonstrate that they are ‘fit for practice’.This means that they must meet all of thelearning competencies and skills that allother students are required to do. However,the fundamental difference is that‘reasonable adjustments’ should be in placebefore competence is assessed.

It is also important to remember thatapplication of competence standards is nota defence against direct discrimination.Stereotypical assumptions should not bemade, particularly in the case of ‘what if’type situations. For example, that a nurse‘might not’ be able to perform in certainemergency situations, unless there is clearevidence to support this.

The Nursing and Midwifery Council (NMC) intheir Standards of proficiency for pre-registration nursing education (2004) statethat the required level to enter the registeris the ability to:

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“...manage oneself, one’s practice, andthat of others, in accordance with TheNMC code of professional conduct:standards for conduct, performanceand ethics, recognising one’s ownabilities and limitations.”

NMC (2004b, p5)

This clearly puts a professional onus on theindividual to acknowledge any areas wherethey would not feel competent to practiceand to take a personal responsibility to notput themselves in these situations.

Responsibilities of an employer

Having seen that disability legislationrequires organisations to promote equalityof opportunity and demonstrate positiveattitudes towards disability, it is theresponsibility of everyone within thatorganisation to help this to happen.However, those in a management,supervisory or mentorship/preceptorshiprole will need to ensure that colleagues andstudents for whom they are responsible, areallowed any reasonable adjustments whichhave been agreed.

Employers also have a responsibility to helpstaff where areas of difficulty are identified.The NMC expects staff to have regularperformance appraisals (at least annually)during which aspects of poor performanceare dealt with. In its publication Reportinglack of competence; a guide for employersand managers (NMC, 2004a) the NMCstates it would not normally becomeinvolved in a case under fitness to practiceunless the employer had already taken“considerable measures” to tackle thesituation in the workplace first. Employersare therefore expected to identify trainingneeds, set clear objectives and provide theemployee with sufficient opportunity toimprove the areas of weakness.

Some individuals with dyslexia, dyspraxia ordyscalculia will find certain clinicalenvironments more challenging than others.For example ITU or an emergencydepartment (ED), with their high level ofnoise and distractions, may not suit someindividuals whilst others may find loneworking in a community setting difficult.Where possible, members of staff who havefound their working environmentexacerbates their difficulties should behelped to find employment in a moresuitable environment.

Finally, although there is often concernexpressed regarding safety issues it shouldbe noted that nurses with dyslexia,dyspraxia and dyscalculia are usually veryaware of their strengths and potentialchallenges. As a result they are extremelycareful about checking things they are lessconfident about in order to avoid makingmistakes, particularly those that involvepatient safety (Morris and Turnbull, 2006).This is highlighted in this personal story – it

Personal stories: A&E staff nurse

I was initially diagnosed as havingdyslexia in 1992 when I was halfwaythrough my nurse training. At this time itwas seen as a barrier to nursing and I wasasked to leave, because it would be“dangerous to have a nurse withdyslexia”.

After successfully exploring other careers,I realised that I was more than capable oftraining to become a nurse, and in someways would be less dangerous thansomeone without dyslexia, as I would beaware of my problems and double checkcalculations and spellings of drugs toensure accuracy.

In 2008 I qualified with a 2.1 honoursdegree in adult nursing and now work in abusy A&E department, and love it !!!!



should be noted that when the nurse inquestion originally commenced training in1992, the Disability Discrimination Act hadnot been introduced. The nurse laterrecommenced her training and as the storyshows has proved that it is possible.

For further guidance on the responsibilitiesof an employer in relation to the DDA pleasesee Section 6.1 in the guide for managersand practitioners.

Responsibilities of theemployee

The NMC, through its code of conduct (NMC,2008), clearly expects practitioners to workwithin the limits of their abilities, thusputting the responsibility to acknowledgeany limitations and act in a responsible andprofessional manner to address these onthe individual.

Failure to do so could result in a potentialallegation that the nurse is unfit to practicethrough a ‘lack of competence’. This newcategory was introduced through theNursing and Midwifery Order of 2001 andcame into effect in August 2004. It wasdesigned to deal with “intractable cases oflack of competence after all other avenueshave been exhausted”, and defines lack ofcompetence as:

“…a lack of knowledge, skill orjudgment of such a nature that theregistrant is unfit to practice safely andeffectively in any field in which theregistrant claims to be qualified, orseeks to practise.”

NMC (2004a)

This therefore assumes that an employeewill only seek employment in areas in whichthey feel able to practice safely. For the vastmajority of nurses this will not cause anyparticular problems, but there may be

occasions where an individual has identifiedspecific areas of difficulty that may be mademore challenging by the environment. Thismight be as a result of background noise,frequent distractions or lone working. Whilstit is hoped that the employee will be able todevelop strategies to overcome thedifficulties (see later sections of this toolkit)there may be cases when the individual mayneed to consider moving to a more suitableenvironment or role.

Disclosure

The choice of whether or not to disclose aspecific learning difference is a personal oneand is something that needs to beconsidered carefully. Employers need topromote a culture of inclusivity, whereindividuals feel able to discuss their specificneeds without fear of discrimination ornegative attitudes.

At the same time the individual needs to beaware that unless they disclose theirdisability, and in certain cases provideevidence, that they will not be able toreceive the ‘reasonable adjustments’ thatthey require and are putting themselves at adisadvantage.

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3

Introduction to specificlearning differences

Specific learning difference (SpLD) is anumbrella term used to describe a range ofconditions including dyslexia, dyspraxia anddyscalculia. While these conditions all havedistinct areas of difficulty associated withthem (which will be explored in Sections 4,5, and 6 of this toolkit) their neuro-cognitiveprofiles often overlap. This sometimesresults in an educational psychologistchoosing not to attach a specific ‘label’ suchas dyslexia or dyspraxia in their report, butwill instead ‘diagnose’ the individual ashaving a specific learning difference. Of thethree dyslexia is arguably the mostcommon, and also the one on which themost research has been conducted andliterature published. Consequentlythroughout this toolkit there will be

What is a specificlearning differenceand how do theseimpact on theindividual in theworkplace?


� To identify what is meant by a specificlearning difference (SpLD).

� To explore the impact of a SpLD onthe individual in the workplace.

instances where dyslexia is referred to inisolation – that is not to suggest that theother two conditions are not equallysignificant to the individuals concerned butmerely reflects the literature base whichcurrently exists.

In terms of identifying which conditionaffects an individual, it could be argued thatthe label itself is less important than theneed to recognise the specific areas ofdifficulty that they are faced with. Therefore,whether the individual is diagnosed with‘dyslexia’, ‘dyspraxia’, ‘dyscalculia’ or a‘specific learning difference’ is immaterial.All of these are classed as a disability underdisability legislation and individuals withany of these conditions will requireunderstanding and support to help them toreach their potential.

The situation is further complicated by thefact that each of the ‘conditions’ representsa spectrum of difficulties. For each of thepotential difficulties listed as commonlyattributed to dyslexia, dyspraxia ordyscalculia, the individual will besomewhere on a continuum ranging from nodifficulty at all in that area through to severedifficulties. This makes all three conditionsincredibly diverse.

Perhaps because the conditions are sodiverse, and therefore potentially difficult toquantify, there are those who choose not tobelieve that they exist. Instead they preferto view them as a middle class euphemismfor slow learning or under achievement – afactor which does nothing to help thosestruggling to overcome very real difficultiesassociated with their learning difference.While it will no doubt take some time to re-educate these cynics, there is now asignificant body of scientific research fromacross the world that proves the conditionsdo exist and which help us to identify waysof supporting the individuals affected bythem.



Personal stories

“I do not believe that dyslexia is a classic‘disability’ because it is a difference in thebrain make up and that difference makesme the way I am... I think that my brain isokay and it is what makes me a goodnurse.”

Coping strategies

These individual variations are furthercompounded in adults by the developmentof very successful and innovative personalcoping strategies that have beenhighlighted in several research studies ondyslexia (Lefly and Pennington, 1991; Miles1993). These may be techniques that theindividual has developed, such as thoseidentified in Section 7 or sometimes by justavoiding areas that are particularlychallenging. Avoidance may on occasions bean appropriate strategy, for examplechoosing to avoid difficult spellings such as‘diarrhoea’ by substituting ‘loose stools’may work, at least in the short term.However it is important for the individual toacknowledge areas that are being avoidedand endeavour to find other ways ofconquering the difficulty. This is particularlyso in the case of a student nurse who mayneed to be able to do it once they qualify,and mentors must ensure that students arebeing assessed on all requiredcompetencies.

Positive aspects of specificlearning differences

While a lot of attention is paid to the areasthat a person with dyslexia, dyspraxia ordyscalculia might find difficult, it isimportant to recognise the strengths thatthey also posses. Nursing often attractsindividuals with these conditions because oftheir caring and compassionate nature. Wealso know that they are likely to be creativeand good at problem solving. Finally andperhaps because of the daily challengesthey face, there is a lot of evidence whichhighlights how hard working anddetermined to succeed they are.

The emotional impact of a SpLD

For many adults with a specific learningdifference one of the greatest challenges iscoping with a late diagnosis, which hasoften been triggered by academic failureduring their training or further studies.Despite advances in the recognition anddetection of SpLDs in children there are stilla significant number of people who are notpicked up until much later in life. This washighlighted in relation to dyslexia by theNational Working Party on Dyslexia inHigher Education study (Singleton, 1999).This included data from 195 institutions andexposed the “true” extent of the problemwhen it discovered that 43 per cent of thetotal university dyslexic population wereonly identified as being dyslexic after theiradmission to university. A similar pattern islikely to exist for dyspraxia and dyscalculia.

While diagnosis often brings relief, as itexplains why things might have beendifficult, there is often also anger andfrustration that the condition was notrecognised and help provided much sooner(Cowen, 2005).

Furthermore, the fact that these conditionsare classed as disabilities brings its ownchallenges and requires a lot of sensitivity.The following quote comes from a practicenurse who highlights a feeling shared by alot of people with dyslexia.

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The ‘disability’ label is a highly emotive oneand it is easy to see how this might makepeople feel. The nurse in the quote sums itup beautifully when she explains that herbrain is just designed differently and thatdoes not change who she is. Neverthelessthere are times when the ‘label’ can be apositive thing – it is a necessity to accesscertain types of support, such as provisionof certain equipment or other types ofreasonable adjustment. We need torecognise that neuro-diversity exists andthat individuals with the conditions thatcome under its umbrella are just the sameas everyone else.

Finally, individuals may experience stress ifthey fear discrimination and struggle toconceal their problems. They may lack selfconfidence and feel isolated. Having theopportunity to talk to others in the samesituation may be beneficial, not only for theemotional support, but also the opportunityto share helpful tips and strategies.

Challenges in clinical practice

Whether an individual is working as a healthcare assistant, associate practitioner,student or registered nurse the challengesof the clinical environment remain the same.It is busy, unpredictable and complex.Strategies that might have been developedat school or university may not betransferable and tips for survival publishedby specialist groups such as the BritishDyslexia Association may not translate wellinto a clinical setting. Finally, clinical practiceand the roles within it are incredibly diverse,with individuals working autonomously or inteams; in primary, secondary or tertiary caresettings across a myriad of specialties.

It is therefore imperative that those workingin a health care setting, who have dyslexia,dyspraxia or dyscalculia, are able to devisestrategies that will work for them in thepractice setting. All of the strategies and tips

suggested in Section 8 are designed to beused in practice although somemight needslight modification in certain specialisedsettings.



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Introduction todyslexia


� To provide a brief introduction todyslexia.

� To identify aspects of the individualslife which may be affected by theirdyslexia.

memory, sequencing, auditory and/orvisual perception, spoken language andmotor skills.”

Peer (2002)

Some of these areas of difficulty arerelatively well known. However, it is theless publicised aspects which are likely tocause the most problems in clinicalpractice with organisational difficultiesoften presenting the ultimate challenge.

Dyslexia is also the most prevalent of thethree conditions. Nationally it is estimatedto affect 10 per cent of the population,although the incidence in caringprofessions such as nursing may be higher.It is therefore imperative that we canrecognise it and provide appropriate helpand support to those affected by it.

In 2006 the Royal College of Nursingcommissioned a review of the literature ondyslexia in nursing practice (Dale andAiken, 2007). Available on the RCN websitewww.rcn.org.uk it provides acomprehensive and valuable overview andis highly recommended reading.

Characteristics of adults withdyslexia

As with all specific learning differences it isimportant to remember that everyindividual will have their own personalprofile of strengths and areas of difficulty.The following list of potential areas ofdifficulty is drawn from Reid and Kirk, 2001;Reid, 2003; Dale and Aiken, 2007 andSkinner, 2008, along with extensivepersonal experience of working withindividuals with dyslexia. Although ithighlights the breadth of areas affected itmust be remembered that no oneindividual is likely to experience all ofthese.

What is dyslexia?

Of the three conditions covered in thistoolkit dyslexia is probably the one thatmost people are familiar with. In a smallsurvey of RCNmembers attending anEducation Forum study day, 32 per cent saidthey felt very well informed of the issuessurrounding dyslexia, as opposed to 6 percent regarding dyspraxia and 10 per cent fordyscalculia. However, despite this apparentlevel of awareness Salter (2010) hassuggested that whilst most people haveheard of dyslexia very few can accuratelydescribe the skill areas that it affects.

As a condition, dyslexia has been definedin many ways, as our knowledge andunderstanding of its complexity develops.The following definition by Peer – writtenon behalf of the British DyslexiaAssociation – has been chosen as it isconcise, easy to understand but still clearlyidentifies the major issues. Peer describesdyslexia as:

“a combination of abilities anddifficulties which affect the learningprocess in one or more of reading,spelling and writing. Accompanyingweaknesses may be identified in areasof speed of processing, short-term

www.rcn.org.uk

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Memory difficulties:

� may take longer to ‘fix’ information intotheir long-termmemory

� may require information to be presentedmore than once

� dyslexic people often find it more difficultto discard irrelevant or redundantinformation which could lead to ‘memoryoverload’ and confusion

� may have problems rememberingcolleagues or patients names, drugnames and medical conditions

� may find it difficult to remember phonemessages or other information to pass onto colleagues

� may find it difficult to learn routines andprocedures

� may find it difficult to transfer learninginto a new setting (apply theory topractice).

Organisational difficulties:

� may appear to have a short attentionspan and be easily distracted

� may have difficulty following instructions

� may have difficulty in ordering their ideas

� may have problems sequencing the orderof tasks correctly

� may have problems with filing andlooking up information alphabetically orsequentially

� may find it difficult to react quickly inbusy environments or in an emergency

� may find it difficult to multitask as thisrequires a good memory, timemanagement skills as well as the abilityto work sequentially and be organised;having to do these simultaneously mayoverload their coping strategies.

Time management – individuals withdyslexia may find it difficult to:

� plan ahead or plan their work schedule

� estimate howmuch time is needed for aspecific task

� complete tasks on time

� students may find it difficult to balancecoursework and placementcommitments.

Reading – individuals with dyslexia may:

� feel embarrassed about reading aloud

� misread unfamiliar words

� read very slowly and find scanning orskimming difficult

� find text is distorted, particularly blackprint on white

� find it difficult to read with noisedistractions

� have difficulty understanding medical andpharmacological language particularlythose words which look or sound similar

� have difficulties with abbreviations

� have difficulty reading information fromwhiteboards

� have difficulty reading information oncharts

� need to re-read things several times toget the meaning.

Writing and spelling – some individualsmay have difficulty with:

� legibility

� writing in an appropriate language

� writing concisely

� writing accurately – their work maycontain frequent spelling andgrammatical errors



� checking for mistakes in their writtenwork

� writing under time pressure, someindividuals may write very slowly andneed to re-draft their work

� spelling technical terms such as drugsand medical terms, especially thosewhich look or sound similar

� identifying numbers and letters and/orgetting them in the correct order

� filling in forms, especially when requiredto do so at speed.

Language – some individuals may:

� feel embarrassed about language

� struggle to find the right word to say

� mispronounce unfamiliar words

� find it difficult to express themselvesorally and talk in a disjointed way

� find it difficult to give clear instructionsand/or information and have a tendencyto ‘go off on a tangent’

� have problems presenting verbalinformation in a structured way, forexample in handovers may jump fromtopic to topic rather than following alogical sequence

� sometimes experience a ‘mental block’and be unable to express ideas clearly,particularly under stress

� take everything ‘literally’ or at face value(beware of words with double meanings).

Motor skills:

� may have right and left coordinationdifficulties

� some students may take much longer tolearn to follow a sequence (for example,wound dressing).

Positive attributes

With all of the specific learning differences,individuals have particular strengths whichare also typically associated with thecondition. In the case of dyslexia they arelikely to be:

� caring/empathetic

� intuitive

� good strategic thinkers

� good at problem solving

� creative and original

� determined and hard working

� holistic thinkers.

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There is evidence that dyspraxia frequentlyoverlaps with other developmentalconditions including attention deficitdisorder (ADD), attention deficithyperactivity disorder (ADHD) andAsperger’s syndrome.Whilst some adultswith dyspraxia will only display signs ofdyspraxia they are felt to be in the minority,and the co-existence of one or more of theseother conditions is much more likely (Colley,2005).

Characteristics of adults withdyspraxia

As with all specific learning differences it isimportant to recognise that every individualwill have their own personal profile ofstrengths and areas of difficulty. Thefollowing list of potential areas of difficultyis drawn from a range of both published andunpublished sources including Portwood(1999, 2000) and Colley (2005). While ithighlights the breadth of areas affected itmust be remembered that no one individual,however severely affected, is likelyexperience all of these symptoms. Indeedthose with mild dyspraxia are only likely toexhibit a few of these symptoms.

Attentional problems, poorconcentration:

� may veer off at tangents during aconversation

� may find it difficult to answer directquestions

� concentration is poor and many adultsdisplay the symptoms of Attention DeficitDisorder (ADD)

� tends to be over sensitive to noise.

Language:

� speech can be loud and fast

� they may have problems organising the

5

What is dyspraxia?

Dyspraxia is a developmental coordinationdisorder (DCD) which results when parts ofthe brain fail to mature properly as theydevelop. Reasons for this are complex andstill the subject of research. However,theories exist surrounding factors affectingfoetal development during pregnancy,prolonged labour and the effects ofprematurity (birth before 38 weeks) or postmaturity (birth after 42 weeks) (Portwood,2000).

Dyspraxia is thought to affect up to 10 percent of the population, with 4 per cent beingseverely affected (Colley, 2005). There isalso some evidence in children that boys aremore likely to be dyspraxic, at a ratio of fourboys to every girl (Portwood, 2000)although this is less evident in adults.

The Dyspraxia Foundation describesdyspraxia as an:

“...impairment or immaturity in theorganisation of movement. Associatedwith this there may be problems oflanguage, perception and thought”.

Dyspraxia Foundation (2010)

Introduction todyspraxia


� To provide a brief introduction todyspraxia.

� To identify aspects of the individual’slife which may be affected by theirdyspraxia.



sequence of their speech, in other wordsramble and not prioritise key informationwhere necessary

� there can be problems with intonation

� may have problems pronouncing certainwords

� they may misinterpret what they hear

� can have problems picking up on non-verbal signs and in judging tone or pitchof voice.

Obsessional characteristics:

� presence of obsessional behaviours,probably as a result of developingroutines to give their lives structure; thismay be identified as an obsessionalcompulsive disorder (OCD).

Coordination difficulties:

� problems in differentiating left from right

� problems using certain pieces ofequipment

� poor hand eye coordination

� poor handwriting due to problems withfine motor movement

� inadequate grasp causing problems withdropping things.

Emotional problems:

� low self esteem

� emotionally fragile (may become verydistressed at minor things)

� highly excitable, may find it difficult tocontrol emotions

� may suffer from clinical depression.

Problems with organisation andmemory:

� poor concept of time, often late forappointments

� information processing problems

� poor sequencing

� problems recording information

� poor memory

� difficulty following instructionsparticularly when more than one at atime

� may be slow to finish a task due totendency to daydream.

Gross motor co-ordination problems:

� poor balance, posture and fatigue makeit difficult to stand for long periods

� can be clumsy, spilling things or trippingover.

Perception

� poor visual perception

� over sensitivity to light.

Positive attributes

Like the other specific learning differences,individuals with dyspraxia have particularstrengths associated with the condition, andtend to be:

� caring

� creative and original

� determined and hard working.

16



Introduction todyscalculia


� To provide a brief introduction todyscalculia.

� To identify aspects of the individualslife which may be affected by theirdyscalculia.

for facts) and poor working memory (atemporary storage facility for informationthat is currently being processed), both ofwhich are commonly associated withdyslexia. This leads to the inevitablequestion of whether someone really hasdyscalculia or dyslexia?

It must also be acknowledged that there area significant number of people who have‘self diagnosed’ their dyscalculia becausethey are bad at maths. In some cases this isdue to poor teaching, anxiety or a lack ofinterest in the subject. While they no doubthave very real problems, Butterworth andYeo (2004) and Hannell (2005) suggest thatthese individuals will improve quickly whenthey receive appropriate instruction,whereas those with true dyscalculia willrequire much more intensive support.

This suggests that the number of peoplewho have ‘true dyscalculia’may be muchsmaller than originally thought. If we viewdyscalculia as being much more than beingbad at maths and linked to a much morefundamental problem, namely a totalinability to conceptualise numbers, thenumber of people affected dropssignificantly. This total lack of concept ofnumbers means that if you ask someonewith dyscalculia “which number is bigger –10 or 100?” they would have no idea.

As an employer or university would normallyrequire a formal diagnosis of dyscalculiabefore they were obliged to considerreasonable adjustments, the challenge ofobtaining that diagnosis needs to beconsidered. Unlike dyslexia and dyspraxia,where a variety of screening tools andstandardised assessments are available toassist the diagnostic process, the situationis less advanced in relation to dyscalculia.Tools such as the Dyscalculia Screenerdeveloped by Butterworth (2003) weredesigned to be used with children up to theage of 14 and only give reliable results inthis age group. Consequently a more adult

6

What is dyscalculia?

Dyscalculia is probably the mostcontroversial of the three conditions coveredin this toolkit. There is widespread debatesurrounding its true nature, which makes itdifficult to both diagnose and to estimate itsincidence. The most widely quoteddefinition of dyscalculia was put forward bythe Department for Education and Skills in2001:

“...a condition that affects the ability toacquire arithmetical skills. Dyscalculiclearners may have difficultyunderstanding simple numberconcepts, lack an intuitive grasp ofnumbers, and have problems learningnumber facts and procedures. Even ifthey produce a correct answer or use acorrect method, they may do somechanically and without confidence.”

DfES (2001)

Based on this very broad definition, someauthors estimate the incidence to bebetween 4 per cent and 6 per cent of thepopulation (Bird, 2007). However it isinteresting that Geary (1993), an AmericanPsychologist, attributes the difficulties thatdyscalculics have with maths as due to apoor long-term semantic memory (memory



focussed tool DysCalculiUM is currentlybeing developed and tested byLoughborough University (Beacham andTrott, 2005). This focuses more on theunderstanding of concepts andinterrelationships associated with the moreadvanced mathematics required for highereducation. However, those involved in itsdevelopment have already highlighted thatas a result it may not provide reliable orvalid results for students studying sciencebased courses.

Characteristics of adults withdyscalculia

As with the specific learning differencespreviously discussed, it is important toremember that every individual will havetheir own personal profile. The following listof potential areas of difficulty is drawn fromPoustie (2000), Hannell (2005), Bird (2007)and Hendrickx (2010), and highlights thebreadth of areas which might be affected insomeone who has ‘true’ dyscalculia. Due tothe significant impact these are likely tohave on a nurse’s ability to carry out safedrug calculations, it is essential that acorrect diagnosis is made by a suitableexpert and that individuals are not labelleddyscalculic when they are merely weak atmaths.

General numerical problems:

� problems reading numbers

� problems writing numbers down (mayeven copy incorrectly)

� problems sequencing numbers (fromsmall to large, for example)

� loses track when counting

� conceptual difficulties with size (which isbigger – 10 or 100?)

� no appreciation of the concept of decimalplaces

� conceptual problems with units ofmeasurement (mcg, mg, g )

� difficulty learning times tables

� difficulties remembering and diallingphone numbers

� difficulties in interpreting results

� difficulties reading graphs/charts

� difficulties understanding writtennumbers (in word rather than numericalformat)

� finds it difficult to estimate or giveapproximate answers (this is often taughtas the first stage in performing acalculation)

� unable to recognise that an answer isunreasonable

� paraphasic substitutions (where onenumber is substituted for another eitherwhen writing or using a calculator – theperson may verbally say the correctnumber but push a totally differentbutton).

Calculation related problems:

� problems aligning numbers in sums

� problems understanding what is meantby word based mathematical questionsin a test or exam

� needs to use fingers to work out simplesums

� much slower to work out answers

� problems performing calculations

� problems remembering and applyingformulae

� difficulties remembering what symbolssuch as ‘+’, ‘-‘, or ‘x’ mean.

Time related problems:

� may have problems rememberingappointment times

18



� may have difficulties in interpreting a 24hour clock.

Day-to-day living:

� may have problems identifying clothessize

� may get confused between left and right

� problems handling money

� may have problems recognising faces asthey are seen as a form of symbolrecognition.

Positive attributes

As with all the other specific learningdifferences, individuals with dyscalculia willhave personal strengths and tend to:

� excel in non mathematical subjects.



7

The following section on self help strategiesand tips to support colleagues has beendivided up into specific areas of practicewhich anyone working as a nurse, whetherstudent or qualified, or as a health careassistant or associate practitioner mightneed to be able to undertake. Clearly someactivities are unique to certain roles but bycovering the range commonly associatedwith registered nurse level it will help thoselooking to achieve this level to appreciatethe complexity of the role and be able toprepare accordingly.

In reality there are large areas of overlapbetween the difficulties associated withdyslexia, dyspraxia and dyscalculia in theworkplace. The suggested strategies aretherefore grouped in relation to the area ofdifficulty, rather than the ‘diagnosedcondition’. It is hoped that this will allowindividuals to select the strategies that best

Overcomingdifficulties: selfhelp strategies andtips to supportcolleagues


� To identify practical strategies thatcan be used by individuals to helpovercome difficulties they maypersonally face.

� To suggest support mechanisms thatcan be introduced to help colleaguesto achieve their potential.

help them in the workplace. Nursing is acomplex activity however, and the areas ofdifficulty and suggested strategies will alsono doubt overlap. To ensure completenessand facilitate the ‘dip in and out’ philosophyof this toolkit, areas of difficulty, and ways oftackling them, will be included in all relevantsections.

It is important to remember that everyindividual will have a unique profile, andthat no individual will have difficulties in allof the areas listed. The key is for theindividual to develop strategies to overcometheir personal areas of difficulty. Themajority of the suggestions included are atthe level that would be considered a“reasonable adjustment”. Wheresuggestions potentially exceed this they arehighlighted as a strategy which would needto be discussed on an individual basis.

Finally there is a large body of evidence,including that by Lefly and Pennington(1991) and Miles (1993), whichacknowledges how adults are often able todevelop very successful coping strategies.However, it is also well documented thatthese may have only been developed up to acertain level and that, as the task becomesmore complex, they may not be sufficient. Itis therefore likely that individuals withdyslexia, dyspraxia or dyscalculia will needto continue to develop strategiesthroughout their professional life.Furthermore, while it is appropriate that wehelp and support student nurses, the NMCexpects a qualified nurse to be capable of‘independent practice’ and we must ensurethat students are able to achieve this by thepoint of registration.

Difficulties with documentation

Nursing requires accurate and detaileddocumentation to the standard outlined inthe NMC publication Record keeping:guidance for nurses and midwives (NMC,

Reading documentation

In relation to reading documentation (notesand charts for example) some individualsmay:

� read very slowly

� find that they need to re-read somethingseveral times to get the meaning

� find it hard to scan or skim read

� experience visual stress – this may causetext to appear distorted, particularly ifreading black print on white paper

� find it difficult to read with backgroundnoise

� have difficulty reading medicalterminology or drug names, particularlywhere there are other terms whichlook/sound similar

� find it difficult to read and interpretinformation on charts particularly whereinformation is presented in differentlayers or there is a need to read acrossand up/down

� find it hard to work out readings oncharts and may give an inaccuratereading without being aware of it

� have difficulties reading other peopleshandwriting in medical notes, on drugcharts and in nursing documentation.

20



Personal stories

“I was called to see the lead nurse todiscuss concerns around documentationissues. She asked me to write down themistakes in some of my notes…. Thishelped her to understand my difficultiesand want to help me as she had noconcerns about my practice.

Following a meeting with managers,human resources and my union rep I wasassessed by access to work – theyrecommended that I should audio tape mynotes and have clerical support (10 hoursper week) to type them up.”

2009). For many nurses with dyslexia,dyspraxia or dyscalculia this may create aparticular challenge. Modern technology – apart of normal day-to-day life, has providedus all with access to spell and grammarcheck facilities when using computers.Student nurses with dyslexia or dyspraxiaare also likely to have been provided withsophisticated software for their assignmentwriting, which may have masked certainareas of difficulty whilst in University. Thechallenge therefore is to find strategies toovercome areas of difficulty and be able toproduce neat, fluent and professional handwritten documentation where required.Documentation requires skills in reading,writing, spelling and organisation of ideas.

The following personal ‘story’ highlightshow one health visitor had some problemswith documentation, but how her employersuccessfully used access to work funding tohelp her to overcome the difficulties (thereis more about access to work in Section 8and the accompanying guide for managersand practitioners).



Self help strategies

� Give yourself enough time to readthings and re-read them ifnecessary.

� Use a small alphabetical notebook(or card system) to record difficultwords and remind you of theirmeaning.

� Carry a list of commonabbreviations and their meaning.

� Use an electronic dictionary tolook up unfamiliar terms.

� Use a coloured overlay, ifappropriate.

� Print things on cream/off whitepaper

� Set up your computer screen touse a coloured background(choose the colour that is best foryou).

� If appropriate (in other words, ifyou have a personal copy)highlight key points to emphasisethem.


Personal storiesNewly qualified staff nurse

“I have Meares Irlen syndrome where myeyes don’t like reading black writing on awhite background, it makes my eyeswater and the words go blurry. I lose myplace easily whilst reading and I feel tiredafter reading just a small amount… I gotglasses with coloured lenses to combatthis and it works... looks like I am wearingsunglasses though! ”


Strategies to helpcolleagues

� Allow extra time for reading.

� Present the individual with essentialreading well in advance of meetings– highlighting important parts ifappropriate.

� Provide opportunities to discussreading.

� When producing word processeddocuments try to make it ‘dyslexiafriendly’ in other words:

– write in a logical sequence

– avoid small print (use font size 12or above)

– use a dyslexia friendly font (forexample arial, verdana, tahoma orlucinda sans are best)

– use bullet points in preference tosentences where possible

– use simple words/avoid overuseof jargon or uncommon words

– do not justify the right handmargin – this makes the spacesbetween words uneven andharder to read if you are dyslexic

– space the information so it is notcramped, use short paragraphs tobreak up dense text

– where possible print documentson off white/cream paper.

22



Writing notes

In relation to writing notes and on chartsand forms some individuals may find itdifficult to:

� organise their thoughts coherently

� write in appropriate language

� use punctuation correctly

� write legibly

� write concisely

� spell correctly (see next section onspelling)

� chose the correct version of words suchas there/their

� write under time pressure if their writingis very slow or they need to redraft theirwork

� identify numbers and in some cases getthem in the right order

� fill in forms, especially when required todo so at speed.


Writing notes

� Give yourself enough time to writeup notes and other paperwork.

� Try and find somewhere quietwhere you are less likely to beinterrupted.

� Divide your ideas into sectionsand tackle one section at a time.

� Create a personal list of difficultwords to check when required.(see section on spelling).

� Familiarise yourself with the layoutof different forms and charts –ideally take home a blank copy tolook at when you are less rushed.

� Devise ‘templates’ or checklists fordifferent types of documentation,for example patient assessment,discharge summaries, letters.

� Use an electronic dictionary ifpossible.

� Develop effective checkingprocedures and proofreadingskills.

� Use a laptop or PC to write noteson if one is available.

� If your writing looks messy –experiment with different types ofpen (chunky/standard/slim) untilyou find one that helps.

� Consider using a handheldrecording device to record yourideas verbally – you can then copyit into the notes but you don’thave to think and write at thesame time (this may need to benegotiated – see Section 8 onusing equipment).



Writing notes

� Allow colleagues enough time towrite up their notes.

� Try not to disturb colleagues whoyou know need to really concentrateon their documentation.

� In the case of junior student nursesallow them to write a rough draft onscrap paper which you can checkbefore they write it into the notes(remind them to destroy thiscarefully afterwards).

� Help students to devise a checklist ofkey areas to include in certain typesof documentation.

� Consider devising a ‘sample’ or‘model’ for different types ofdocumentation, particularly forstudents or new staff, to show themthe level and content expected.

� Allow colleagues to word processreports etc where possible

– use bullet points in preference tosentences where possible

– use simple words/avoid overuseof jargon or uncommon words

– do not justify the right handmargin – this makes the spacesbetween words uneven andharder to read if you are dyslexic

– space the information so it is notcramped, use short paragraphs tobreak up dense text

– where possible print documentson off white/cream paper.


24



Personal storiesPractice nurse

“The nurse talked about how invaluablethe spell check facility on a wordprocessor is, and how it had helped herthrough school and university… she wenton to say how difficult it is now as she hasno access to one at work.”

Spelling

In relation to spelling individuals may find itdifficult to:

� spell certain words – these might not bedifficult words, some individuals canspell these correctly but struggle withquite straightforward words

� spell medical terminology and drugnames, particularly where there arewords that sound or look very similar, forexample gastrectomy and gastrostomy.


Spelling

� Keep a notebook containing thecorrect spelling of words that youneed to use regularly. This could bedivided into sections ondrugs/medical terms.

� When you need to spell an unfamiliarword – check with a colleague or in adictionary then add it to your list.

� Devise mnemonics (a rhyme orsomething) to help you rememberdifficult words.

� Write words that you are trying tolearn on post it notes or small cardsand stick them up around the house(by the kettle, fridge door, bathroommirror) – the more you look at themthe quicker you will learn them.

� Ask if you can have an electronicdictionary which copes with medicalterminology (see Section 8 on usingequipment).

Spelling

� Provide a list of common terminologyin your area for new staff andstudents.

� Help colleagues to feel able to ask ifthere is a word they are uncertainabout the spelling of.




Difficulties organisingworkload

Whilst most people are familiar with thespelling, reading and writing difficultiesassociated with some of the specificlearning differences, they may be less awareof the organisational problems associatedwith all three conditions. These range fromproblems with ‘working memory’ and‘automaticity’ which – although traditionallyassociated with dyslexia – may impact onthe other conditions too, through to morestraightforward ‘time’ related issuesassociated with dyscalculia.

Working memory is the term used todescribe the temporary storage/processingfacility which holds and manipulatesinformation that is currently being used. It isa bit like the RAM on a computer and is usedwhen we try to do tasks like listening,deciding what is important and then writingdown the relevant information. Like acomputer, its fine as long as we don’t askour working memory to do too much atonce….. but when we do, there is thepotential for the whole thing to ‘crash’. Thesituation is compounded when we add incomplications such as frequent distractionsand background noise at the same time,factors that someone with dyslexia will findparticularly difficult. It is also an area thatbecomes increasingly challenging as thelevel of expectation increases. Mentorsoften complain that a senior student ishaving problems organising their work, andquery why it was not picked up earlier. Thetruth is that when the requirement was to‘organise’ care for one or two patients thestudent could cope, but as they areexpected to take responsibility for a morecomplex caseload the cracks start to appear.

The other challenge linked in particular todyslexia, are problems associated with alack of ‘automaticity’. As the name impliesthis is about how we learn and ultimatelyinternalise processes, until we can do them

sub-consciously. Driving a car is a classicexample of this. When we first try to learn todrive the task seems overwhelming, with allthe things that have to happensimultaneously to be a safe competentdriver. If you ask an experienced driver howoften they consciously think about all ofthose individual factors, it is not very often –as these have become automatic. We knowthat individuals with dyslexia will takelonger to reach the point of automaticity butthat once they get there they are as safe andcompetent as anyone else.

Although it is not easy to separate thecomplex range of processes involved inorganising your workload, three key areashave been identified as potentiallyproblematic namely remembering things,coping with distractions and managing time.It should also be noted that the opportunityto work in a well organised workingenvironment will significantly help as isdemonstrated in the following story.

Personal storiesStaff nurse with dyslexia

“The ideas promoted in the productiveward programme have helped, as a trulyorganised layout and work routine helpsenormously.”

26


Remembering things

In relation to remembering things someindividuals may have difficulties with:

� remembering names of patients andcolleagues

� remembering drug names or medicalconditions

� learning routines or procedures

� following instructions

� remembering information to pass on tocolleagues (from phone calls,conversations with patients orcolleagues, observations etc)

� tasks that need to sequenced in aparticular order, for exampleremembering to check the brakes on thebed before getting the patient out of bed

� ordering their ideas

� listening and taking notessimultaneously such as in handover or alecture

� filing and looking up informationalphabetically or sequentially

� multi tasking as this requires a goodmemory, time management skills as wellas the ability to work sequentially and beorganised.


Remembering things

� Invent and use mnemonics.

� Use to do lists.

� Always carry something to write on and apen.

� Write important things to remember onsticky post-it notes and put them in keyplaces where you will see themfrequently, for example fridge door,bathroommirror.

� Use visual methods such as diagrams andmind maps to help you remember.

� Use flow diagrams where proceduresneed to be remembered in a particularorder.

� Set realistic targets for example to learn 1new drug every 2 days.

� Use auditory methods of learning – recordinformation on a digital voice recorder (ormobile phone) and listen to it when youcan for example when driving, walking thedog.

� Use a personal organiser (PDA or mobilephone) to set reminders for key tasks.

� Chunk difficult numbers into smallerchunks they are easier to remember thatway. For example the RCN phone number(020 74093333) is much easier to learn ifyou start by remembering that all UKnumbers start with a zero, then it istwenty, seventy four, oh nine, thirty three,thirty three.

� Use repetition; the more you repeatsomething the quicker you remember it.

� Use coloured pens and highlighters tohelp organise and prioritise.

� Devise prompt sheets for frequentlyencountered activities for example aroutine pre op admission, the ABCDEassessment of a deteriorating patient.



Note: an inability to cope withdistractions/interruptions may be adifficulty which prevents an individual frombeing ‘fit for practice’. Reasonableadjustmentsmust be implemented whererequired, following which the individualneeds to be able to consistentlydemonstrate the required level ofcompetence.

Remembering things

� Help a student/colleague to inventand use mnemonics.

� Encourage the individual to use ‘todo’ lists rather than trying toremember.

� Don’t give too many instructions atonce.

� Prepare printed ‘handover sheets’covering core information – theindividual can add to these but it willreduce the amount they need to writedown and avoids things beingmissed.

� Make sure that there is alwayssomething to write on (and a pen)near the phone.

� Help a colleague to draw up a planhighlighting important tasks/deadlines.

� Set clear, measurable targets.

� Allow enough time for the person tograsp key information, try not to rushthem.

� In the case of procedures allow theperson a chance to practice (ideallyas close as possible to when youexplained it or demonstrated it).

� Explain things more than once ifrequired.

� Where possible give instructions inwritten and verbal form (you couldconsider using a digital voice recorderto record sets of instructions).

� For students or new staff create anorientation pack for your area,outlining useful information androutines.




Managing time

In terms of managing time someindividuals may find it difficult to:

� plan ahead or plan their workschedule

� estimate howmuch time isneeded for a specific task

� be on time for appointments

� complete tasks on time

� read dates and times,particularly those using the 24hour clock.

Strategies to help colleagues

� Allow colleagues quiet time where possible tocomplete tasks such as paperwork.

� Avoid interrupting a colleague if it is at allpossible.


� Use timers/alarms toremind you of set timedeadlines eg when apatient needs to be readyfor theatre.

� Keep a diary or wall plannerto remind you of importantdates(meetings/deadlines).

� Build up a list of how longcertain procedures/tasksusually take (includingpreparation and clear uptime) for exampleperforming a bed bath 20-30 minutes, a simpledressing 20-30 minutes, acomplex dressing 45-60minutes (these aregenerous time allowancesbut it is better to allocatetoo much time than alwaysbe behind).

� Have a picture of a 24 and12 hour clock to show thedifferences.

Managing time

Coping with distractions


In relation to coping with distractions someindividuals may have:

� a short attention span and be easily distracted

� difficulty in discarding irrelevant or redundantinformation which can lead to overload andconfusion

� difficulty in reacting quickly in a busy environmentor during an emergency

� difficulty in balancing different commitments forexample a student who needs to write an essaywhilst on placement or a qualified nurseundertaking further study.


� Be honest with colleagues, tell them you findinterruptions difficult and ask them to avoiddistracting you if possible.

� Be honest with yourself, some clinical areasare more prone to interruptions than others –choose where you work.

� Try to find a quiet area if you really need toconcentrate on something like documentation– but tell people where you will be.

� Set realistic targets in terms of balancingdifferent commitments for example whenstudying (pre or post registration). Aim to read1 article per day, or write 250 words – it soonbuilds up.




29


� Help colleagues to build up a list ofhow long things take to do.

� For students/new staff setachievable time related tasks, forexample don’t expect them to plan awhole day at first, start with a fewhours/morning and build up.

� With students ask them to tell youwhat the key activities are at thebeginning of the shift – remind themof things they have forgotten.


� Practice handling instruments andequipment – if possible ask if youcan borrow a piece of equipment topractice (see personal story below).

� Investigate if other equipment isavailable which might be easier touse.

Demonstrating manual dexterity

Managing time


� Provide opportunities for practice.

� Explore availability ofspecialist/alternative equipmentwhich might be easier to use(providing this could constitute a‘reasonable adjustment’.


Problems with psycho-motorskills


The difficulties associated with thedevelopment of psychomotor skills aremainly attributable to problems with manualdexterity in the case of dyspraxia or to lackof automaticity, such as described in theprevious section (difficulties organisingworkload).

Problems with manual dexterity may resultin:

� problems handling equipment andinstruments

� poor hand-eye co-ordination.

Personal storiesStudent nurse with dyspraxia

“The student nurse was finding it difficultto fit a needle onto a syringe – her mentorgave her a set to practice with and after anevening practicing at home (away fromscrutiny and time pressures) she hadquickly mastered it.”


Sequencing of tasks

Lack of automaticity may mean that theindividual has problems:

� learning new routines and procedures

� sequencing the order of tasks correctly

� transferring learning into a new setting.

30



Difficulties with drugadministration

This is one of the most controversial areasand is one of the main reasons for nursesto be referred to the Nursing andMidwifery Council for alleged ‘lack ofcompetence’ (see Section 2).

It must be emphasised that there is noreason to automatically assume that anurse will not be able to administer drugssafely as a result of their dyslexia ordyspraxia. However individuals do need todevelop strategies to overcome any areasof difficulty they might experience. There isclear evidence to suggest that the vastmajority are able to do this; furthermoreas they frequently double or even triplecheck everything that they do in relation todrug administration it could be concludedthat they are therefore perfectly safe.


� Invent and use mnemonics to helpremembering sequences/routinessuch as ELIOT or TILE for moving andhandling.

� Use visual methods such as diagramsand mind maps to help you remember.

� Use flow diagrams where proceduresneed to be remembered in a particularorder.

� Use auditory methods of learning –record steps of procedures or otherkey information to listen to when youare doing other things (such as theironing). For example, this could beused to help you learn the latest ratiosfor CPR or the equipment needed toremove sutures.

� Use repetition; the more you repeatsomething the quicker you rememberit.

� Use coloured pens and highlighters tohelp you remember/organise yourthoughts.

� Devise prompt sheets for frequentlyencountered activities, for example aroutine pre op admission, the ABCDEassessment of a deteriorating patient –these can be added to/adapted if youmove to a new area.

� Use reflection to help you to transferprevious learning into new settings.

Sequencing of tasks


� Present information more thanonce and ideally in differentformats

� Provide frequent opportunities forpractice

� Help a student or colleague toinvent and use mnemonics

� Encourage use of reflection to helpindividuals to transfer previouslearning.

� Allow enough time for the personto grasp key information, try not torush them.

� Create flow charts/protocols tohelp colleagues to learnprocedures.

Sequencing of tasks



The situation is more complex in the case ofdyscalculia however. If an individual reallyhas true dyscalculia, and therefore has noconcept of numbers at all, it must bequestionable as to whether they cancalculate drug doses safely. However, as wesaw in section 6, dyscalculia is frequentlymisdiagnosed, and is often used as a labelfor poor maths skills. It is therefore likelythat there are nurses who believe that theyare dyscalculic but who do have thenecessary level of understanding to be ableto calculate drug doses safely. For thosewith true dyscalculia the requirement byHEI’s for GCSE Maths or level 2 numeracy toenter training, is likely to have deterredthose with the most serious problems.Whilst this is unfortunate for the individualsconcerned, the absolute safety requirementto be able to calculate drug doses anddispense drugs accurately is unequivocal.

This therefore leaves two potential areas ofdifficulty reading drug charts and calculatingdrug doses and it is therefore important thatstudent nurses develop, and are assessedfor competence during their training. Thismeans allowing the student to read the drugchart, select the correct drug and dispense itunder close supervision in accordance withNational and local guidelines. Newlyqualified staff often struggle in this area asthey see it as a new skill to learn. Althoughthey may have participated in drugadministration as a student they have notalways had sufficient opportunity to be theone selecting the drug from a crowded drugtrolley or cupboard. It is only by doing thisthat significant areas of difficulty will behighlighted.

Reading drug charts

In terms of reading drug charts individualsmay have problems:

� reading drug names especially wherethere are other drugs which look verysimilar


� Learn the names for drugs that youfrequently administer and what theydo.

� Compile a list of drugs with similarnames and find a way of clearlyidentifying the difference in spelling.

� Know how to use reference materialssuch as the BNF to look unfamiliardrugs up.

� Learn how to pronounce drug names– record the correct pronunciation ona digital voice recorded to listen to.

� Practice reading drug charts – as astudent ask for a blank copy to studyor do a specimen chart with yourmentor with some commonexamples.

Reading drug charts

� finding the required drug in the trolley orcupboard

� interpreting abbreviations such as tds,bd, prn

� understanding the 24 hour clock

� working out time intervals between prndrugs

� dealing with ‘conflicting instructions’ forexample paracetamol being allowed fourhourly but with a maximum of four dosesin 24 hours.

Calculating drug doses

In terms of calculating drug doses individuals mayhave problems:

� remembering the formula

� interpreting the formulae – knowing what to putwhere

� basic mathematical principles such asmultiplication or division

� converting units if different units are used onthe prescription and bottle/packet (ideally thisis now being avoided but does still happenparticularly out of hours)

� performing complex calculations, such as forchildren or in an ITU based on body weight.

Note: the following strategies are designed to beappropriate for individuals with dyslexia ordyspraxia who find drug calculations challenging.Where an individual has been formally diagnosedwith dyscalculia specialist advice is required todevise an individualised and intensive programmeof support.

32




� Provide students/new staffwith a list of commonly useddrugs for your area.

� If you use drugs with similarnames in your area considercreating a visual aid to showthe different drug names.

� Ensure that a BNF oralternative is available.

� Record drug names on adigital recorder (moststudents with dyslexia aresupplied with one of these touse in lectures) to help thestudent learn how topronounce them.

� In hospital settings – allowstudents to accompany youon a drug round and actuallydispense the drugs accordingto their level of training (ifyou are concerned that thiswill take too long let them todo one patient’s drugs tostart with and build up untilthey can do a whole bay asthey get quicker).

� In community settings –allow students to participatein drug administration asappropriate.

� Create a specimen drug chartthat relates to your area forstudents to practicereading/interpreting – ideallygive examples of stat, prnand regular drugs.

Reading drug charts


� Carry a cue card around with you to remindyou of the formulae.

� Look at one of the many books available toteach nurses a variety of types ofcalculation.

� Practice, practice, practice until you feelconfident.

� Calculate your answer independentlybefore checking with a colleague. If youdon’t agree bring in a third person – yourcolleague might have got it wrong not you.

� If your employer allows the use ofcalculators use one to check your answer(see note below).

� Consider enrolling on adult numeracyclasses to brush up key skills.




Personal storiesClinical nurse specialist (reflecting on aplacement whilst a student)

“I struggled to do the maths and the staffwould deliberately avoid doing any drugcalculations with me. I was capable ofdoing the calculations but I needed moretime to complete them, which they did notseem prepared to give. Some staff wereovertly rude, and I remember one seniorstaff nurse refusing to even do drugs withme because (as she shouted across thenurse’s station) I was ‘useless’.”

Calculators – there are a lot of people whooppose the use of calculators whenperforming drug calculations as they feelan individual must be able to do itmanually. Check if your trust has a policy,and if possible just use the calculator as away of checking your answer.


� Allow the individual time to work itout at their own pace, don’t rushthem.

� Provide relevant clinical examples forpractice, colleagues may strugglewith abstract calculations.

� Help colleagues to feel open aboutasking for help/someone to check acomplex calculation – it might take alittle bit longer but it is better to besafe.

� Encourage a student or colleague tolook at one of the many booksavailable on nursing calculations –then if possible help guide themthrough structured teaching in smallprogressive steps.

� Teach rules and give concreteexamples – it is much harder to graspabstract concepts.

� If your employer allows the use ofcalculators encourage colleagues touse one to check their answer (seenote below).

� In emergency situations wherecalculations need to be performedquickly and with lots of potentialdistractions allow a colleague to asksomeone else to do it.


34



Liaising with colleagues

The final area of potential difficulty toconsider relates to our interactions withcolleagues, both within our own professionand across the multi disciplinary team.While most individuals will have developedhighly successful personal strategies, theremay be occasions, particularly in a largegroup, where they feel ‘exposed’ and canbecome anxious or embarrassed. This couldbe on a ward round, during a caseconference/discussion, part of a handoverto colleagues, in a meeting or during ateaching session. The main areas that causeconcern revolve around discussing clinicalissues, reading aloud and writing in front ofothers.

Discussing clinical issues

In terms of discussing clinical issuesindividuals may have difficulties in:

� organising thoughts coherently

� pronouncing medical terminology

� understanding abbreviations.

Personal storiesNewly qualified staff nurse

“One bad thing I found was in handoverand on handover sheets where peopleused abbreviations for procedures,illnesses etc. I found that an abbreviationon one ward means one thing and onanother ward it means somethingdifferent which is very confusing.”


� If possible jot down your ideas ofwhat you want to say and use theseas prompts or a checklist.

� Observe ward rounds/caseconferences/handovers before youneed to actively participate.

� Continue to build your awareness ofmedical terms and find out thecorrect pronunciation – get someoneto tell you how it should bepronounced its much better thantrying to work out pronunciationfrom a dictionary.



� Try to create an environment whichhelps colleagues to feel comfortable– anxiety will only make problemsworse.

� Don’t let people draw attention tomispronounced words, eveninadvertently.

� Try not to use abbreviations as somepeople find them difficult to interpretand they may mean different thingsto different people.



Writing in front of others

Writing in front of others might be difficultas a result of:

� spelling difficulties (particularly whenwriting on a vertical surface such as awhiteboard)

� problems organising ideas, particularlywhen required to listen and write thingsdown such as during a ‘brainstorming’session

� problems writing legibly

� a slow writing speed.


Reading aloud

Reading aloud may be difficult due to:

� problems pronouncing terminology

� a slow reading speed

� visual disturbances

� reluctance to use equipment, such as acoloured overlay, in front of others.


See also the Section on ‘readingdocumentation’

� If you know you will need to readsomething aloud try to get a copy inadvance to practice.

� If you can get an electronic copy (youmight need to scan a hard copy)format it in a way that helps you, forexample change the font style andsize, create extra paragraph breaksto divide it up into smaller sections,or use bullet points.

� Use highlighters or coloured pens todraw attention to key areas.

Reading aloud


� Probably the best strategy would beto try to avoid doing this whereverpossible. The advantage in a groupsituation is that there are others whomight be very happy to be the scribeor note taker.

� Provide typed minutes of meetingswherever possible.

Writing in front of others


� Do not ask someone with dyslexia toread aloud unless you have giventhem the material well in advance.

Reading aloudStrategies to helpcolleagues

� Do not put others on the spot. Ifsomeone appears reluctant to act asscribe or note taker, don’t push theminto it.

Reading aloud

Using equipmentto help you

In our increasingly technological world agreat of equipment is currently available toassist individuals with a specific learningdifference. However, for many the challengeis being fully aware of what is out there ormaybe in gaining access to it.

There are also issues regarding the use ofcertain equipment in a clinical area or in apatient’s own home, and permission willneed to be obtained in advance. Forexample, the use of a digital voice recorderto record your own voice and ideas tendsnot to be a problem but colleagues mightwish not to be recorded and this should berespected. Where recording devices areused care needs to be taken to ensure thatconfidentiality is maintained; the voicerecorder (or alternative device) should notbe left lying around and material should beerased as soon as it is possible.

While most staff are happy with the use of avoice recorder for personal use, thesituation becomes more complex, andcontroversial, when an individual wishes torecord a conversation with a patient or clientsuch as during an admission interview. Ifthere is a local policy this should befollowed, although the trusts contacted inrelation to this have all admitted that it isnot an area they have considered and nonehave yet created any guidance for staff.Despite this, when queried employers haveoften expressed discomfort at the use of avoice recorder in this context, and there is aclear need for some guidance on thissubject.

For most individuals their first exposure tothe available technology is as a pre or postregistration student. Most universitiesprovide access to ‘assistive technology’ on-

campus for students with a recogniseddisability; however, most students wouldlike to be able to use the same technology,for personal use, at home or at work.

Funding for equipment

While it might seem strange to considerfunding first, the reality is that a ‘needsassessment’ to determine what equipmentan individual might benefit from, is a costlyprocess. Therefore, in most cases it isnecessary to secure funding right from thestart. For the majority of people this takesplace through the Disabled StudentAllowance (DSA) and is secured when theyare undertaking formal education. Studentsenrolled on a course which represents 50per cent or more of a full-time degreeprogramme are normally eligible for theDSA. However, qualified staff who wish to‘top up’ a diploma to a degree would not beeligible, as they only require 120 credits –which represents a third of a degree.

For those who cannot access funds throughthe DSA there are two main options – to relyon the free version of certain types ofsoftware that are available, or to apply forfunding through the access to work fund.There is more information regarding accessto work funding available in theaccompanying report. It should be notedhowever, that equipment and softwareprovided through access to work does notbelong to the individual and may only beavailable for use in the working environmentand not at home. Furthermore, it wouldusually need to be returned when theemployee moves job.

The following list highlights just some of theassistive technology that is currentlyavailable. As this is a constantly developingarea it is likely that the list will quicklybecome out of date as more products comeonline. It should also be noted that noteverything on this list can be funded under

36



8



the Disabled Student Allowance or throughAccess toWork.

Hardware available

� Computers – whether desktop, laptop ornetbook.

� Digital voice recorders – can be used torecord audio files which can then beuploaded into a computer (see also voicerecognition software).

� Electronic dictionaries – standard ormedical version.

� Mobile phone – particularly the new stylesmart phones.

� Personal Digital Assistant (PDA).

� Digital cameras – when used withappropriate software (see below) thesecan be used to take pictures of text,select an area and have it read back toyou.

� Digital pens – used to highlight areas oftext. Depending on the software used,individual words can then be explained oreven synthesised into speech to aidpronunciation. Areas of scanned text canalso be uploaded into a computer.

� Electronic note making devices such asDigiscribble or a tablet PC – these workwith a digital pen and can be used totransfer a hand drawn mind-map into thecomputer.

Software available

� Note taking programmes such as AudioNotetaker (lansyst) – help students toorganise recordings from a digital voicerecorder and add annotation.

� Reading programmes such as TexthelpRead andWrite Gold, ClaroRead Plus orKurzweil 3000 – read scanned or typedtext out loud.

� Voice recognition software such asDragon Naturally Speaking – allows theperson to dictate notes into a computer.Some programmes also transcribe from adigital voice recorder, however as thesoftware needs to be trained to recognisethe individuals voice it does not alwayscope well with a variety of voices such asfrom lectures and meetings.

� Claroview – a coloured overlay feature forcomputer screens.

� Mind mapping software such asInspiration, Mind Genius, Claro Mindfull,Spark Learner and Mind Manager – canbe used to create mind-maps in a rangeof styles.

It should also be noted that commonly usedsoftware packages such as MicrosoftWindows or Apple Mac offer the facility tochange background colours and theappearance of the screen. Evenstraightforward procedures such aschanging font size and style can make adramatic difference.

Other equipment

� Coloured overlays – semi transparenttinted sheets used to reduced visualdisturbances by placing them over a pageof text.

� Tinted glasses – same principle ascoloured overlays but in spectacle form.

Further information on many of theseproducts is available through the linksincluded in Section 9.

38



Sources of help and further advice

9

Dyspraxia

The Dyspraxia Foundation8West Alley, Hitchen. SG5 1EG

www.dyspraxiafoundation.org.uk

Dyscalculia

The Dyscalculia Centrewww.dyscalculia.me.uk

General

www.equalities.gov.uk

Equality Act 2010What do I need to know?

Disability quick start guide

iansyst Limited (assistive technology)www.iansyst.co.uk

Skill: National bureau for students withdisabilitieswww.skill.org.uk

Equality and Human Rights Commissionwww.equalityhumanrights.com

Employers Forum on Disabilitywww.efd.org.uk

Access to work: Information for employersleafletwww.jobcentreplus.gov.uk

Dyslexia

The British Dyslexia Association98 London Road, Reading. RG1 5AU

www.bda-dyslexia.org.uk

Dyslexia ActionPark House,Wick Road, Egham, Surrey.TW20 0HH

www.dyslexia-inst.org.uk

The Helen Arkell Dyslexia CentreFrensham, Farnham, Surrey. GU10 3BW

www.arkellcentre.org.uk

Independent Dyslexia Consultantswww.dyslexic-idc.org

Professional Association of Teachers ofStudents with Specific LearningDifferences (PATOSS)www.patoss-dyslexia.org

Association of Dyslexia Specialists inHigher Education (ADSHE)www.adshe.org.uk

The Dyslexia Teaching Centre23 Kensington Square, London.W8 5HN

www.dyslexiateachingcentre.co.uk

The Dyslexia UnitUniversity of Wales Bangor, Bangor,Gwynedd. LL57 2DG

www.dyslexia.bangor.ac.uk

www.dyslexia.bangor.ac.uk

www.dyslexiateachingcentre.co.uk

www.adshe.org.uk

www.patoss-dyslexia.org

www.dyslexic-idc.org

www.arkellcentre.org.uk

www.dyslexia-inst.org.uk

www.bda-dyslexia.org.uk

www.jobcentreplus.gov.uk

www.efd.org.uk

www.equalityhumanrights.com

www.skill.org.uk

www.iansyst.co.uk

www.equalities.gov.uk

www.dyscalculia.me.uk

www.dyspraxiafoundation.org.uk



NHS Employers

www.nhsemployers.org

Royal College of Nursing: diversity andequality

www.rcn.org/support/diversity

The British Psychological Society

(to obtain a list of chartered psychologistswho can undertake a formal assessment fora SpLD)

www.bps.org.uk

Association of Educational Psychologists

(to obtain a list of educational psychologistswho can undertake a formal assessment fora SpLD)

www.aep.org.uk

Other useful resources

Loughborough University: Dyscalculia andDyslexia Interest Group (DDIG)

A collaborative group, originally set up bystaff from Loughborough University,Coventry University and De MontfortUniversity, providing advice and support inrelation to mathematical problemsassociated with dyscalculia or dyslexia.

www.ddig.lboro.ac.uk

University of Nottingham School ofNursing, Midwifery and Physiotherapy

Offers a resource known as RLO – ReusableLearning Objects – related to a range oftopics. These provide a multi sensoryapproach to learning which often benefitsthose with a SpLD; there are two RLO on thetopic of dyslexia.

www.nottingham.ac.uk

University of Southampton DyslexiaServices

The booklet Supporting students withdyslexia in practice placements (on whichthis toolkit was modelled) is available fordownload, as is a the useful bookletDyslexia in the workplace which can beaccessed through a link on the left handmenu.

www.southampton.ac.uk

University of Worcester Institute of Healthand Society

Offers a link on its nursing course pages(Dip HS or BSc or Graduate Diploma) to anadvice booklet which has been written by astudent nurse for students with dyslexia onclinical placements.

www.worcester.ac.uk

Assistive technology

Digiscribble

www.scanningpensco.uk

ClaroRead andWrite, ClaroView, ScreenRuler

www.clarsoftware.com

Dragon Naturally Speaking

www.nuance.com

EndNote Bibliographical Software

(organises reference lists)

www.adeptscience.com

Inspiration

www.inspiration.com

Kurweil Reader

www.sightandsound.co.uk

www.sightandsound.co.uk

www.inspiration.com

www.adeptscience.com

www.nuance.com

www.clarsoftware.com

www.scanningpensco.uk

www.worcester.ac.uk

www.southampton.ac.uk

www.nottingham.ac.uk

www.ddig.lboro.ac.uk

www.aep.org.uk

www.bps.org.uk

www.rcn.org/support/diversity

www.nhsemployers.org

40



Mind Managerwww.mindjet.com.uk

Mindgeniuswww.mindgenius.com

Reading Pen and Oxford Dictionarywww.wizcom.com

Spark Learnerhttp://spark-space.com/

TextHelp Read andWrite Goldwww.texthelp.com

Free versions of software

Somemanufactures offer free versions ofassistive technology software. These areusually a more basic format than thosecommercially available and they maytherefore lack some of the advancedfunctionality. Nevertheless they areextremely useful and offer a valuableresource to those unable to secure funding.The following websites offer a range ofassistive technology programmes – justfollow the onscreen links or menus to accessthose that will help with identified areas ofdifficulty.

www.abilitynet.org.uk/atwork-resources

www.techdis.ac.uk/getfreesoftware

www.techdis.ac.uk/getfreesoftware

www.abilitynet.org.uk/atwork-resources

www.texthelp.com

http://spark-space.com

www.wizcom.com

www.mindgenius.com

www.mindjet.com.uk



10

Useful reading

Note: all the publications referenced inthis toolkit represent useful reading andare therefore included here and in thereference list.

Bartlett D and Moody S (2000) Dyslexia inthe workplace, London: Whurr.

Beacham N and Trott C (2005)Development of a first-line screener fordyscalculia in higher education, SKILLJournal, 81, pp.13-19.

Bird R (2007) The dyscalculia toolkit:supporting learning difficulties in maths,London: Paul Chapman Publishing.

British National Formulary (2010) Britishnational formulary, London: BMJ.

Burden R (2005) Dyslexia and self concept:seeking a dyslexic identity, London: Whurr.

Blankfield S (2001) Thick, problematic andcostly? The dyslexic student on workplacement, Skill, 70, pp.23-26.

Butterworth B (2003) Dyscalculia screener,London: nferNelson.

Butterworth B and Yeo D (2004)Dyscalculia guidance: helping pupils withspecific learning difficulties in maths,London: nferNelson.

Colley M (2005) Living with dyspraxia, aguide for adults with developmentaldyspraxia (3rd edition), London: DANDA.

Cowen M (2005) How do student nurses,who are facing possible discontinuation oftheir training, feel about being screened fordyslexia and are those feelings influencedby the outcome of the screening?Unpublished MSc thesis, Southampton:University of Southampton.

Chin SJ and Ashcroft JR (1993)Mathematicsfor dyslexics, London: Whurr.

Dale C and Aiken F (2007) A review of theliterature into dyslexia in nursing practice,London: RCN.

Department for Education and Skills (2001)Guidance to support pupils with dyslexiaand dyscalculia, London: DfES (Ref0512/2001).

Department of Health (2001) Lookingbeyond labels: widening the employmentopportunities for disabled people in thenew NHS, London: DH.

Dyspraxia Foundation (2010)What isdyspraxia? Hitchin: Dyspraxia Foundation.Available at www.dyspraxiafoundation.org(last accessed 28 March 2010).

Edwards J (1994) The scars of dyslexia:eight case studies in emotional reactions,London: Cassell.

Everatt J (1997) The abilities anddisabilities associated with adultdevelopmental dyslexia, Journal ofresearch in reading, 20(1), pp.13-21.

Everatt J, Weeks S and Brooks P (2007)Profiles of strengths and weaknesses indyslexia and other learning difficulties,Dyslexia, Volume 14 (1), pp.16-41.

Geary DC (1993) Mathematical disabilities:cognition, neuropsychological and geneticcomponents, Psychological bulletin, 114,pp.345-362.

Hannell G (2005) Dyscalculia action plansfor successful learning in mathematics,London: David Fulton.

Hartley J (2006) What are UK schools ofpharmacy providing for undergraduateswith disabilities?, The PharmaceuticalJournal, 276, 15 April, pp.444-446.

Goodwin V and Thomson B (2004) Dyslexiatoolkit: a resource for students and theirtutors (2nd edition), Milton Keynes: OpenUniversity.

Health Professions Council (2006) Adisabled persons guide to becoming ahealth professional – a guide forprospective registrants and admissionsstaff, London: HPC. Available at www.hpc-uk.org (accessed 28 March 2010).

Hendrickx S (2010) The adolescent andadult neuro-diversity handbook: Asperger’ssyndrome, ADHD, dyslexia, dyspraxia andrelated conditions, London: JessicaKingsley.

HerMajesty’s Stationery Office (1995) TheDisability Discrimination Act, London: HMSO.

Her Majesty’s Stationery Office (1998) TheData Protection Act, London: HMSO

Her Majesty’s Stationery Office (2001)Special Educational Needs and DisabilityAct, London: HMSO.

Her Majesty’s Stationery Office (2005) TheDisability Discrimination Act, London:HMSO.

Her Majesty’s Stationery Office (2009)Equality Act, London: HMSO.

Jacques B (2004) How to develop adyslexia friendly workplace, PeopleManagement, 19, pp.50-51.

Jefferies S and Everatt J (2004) Workingmemory: its role in dyslexia and otherspecific learning difficulties, Dyslexia, 10(3), pp.196-214.

Kane A and Gooding C (2009) Reasonableadjustments in nursing and midwifery: aliterature review, London: NMC.

Lefly DL and Pennington BF (1991) Spellingerrors and reading fluency in compensatedadult dyslexics, Annals of Dyslexia, 41,pp.143-162.

Malmer G (2000) Mathematics and dyslexia– an overlooked connection, Dyslexia, 6(3),pp. 223-230.

McCormick M (2000) Dyslexia anddevelopmental verbal dyspraxia, Dyslexia,6(3), pp.210-214.

McLaughlin ME, Bell MP and Stringer DY(2004) Stigma and acceptance of personswith disabilities: understudies aspects ofworkforce diversity, Group andOrganisation Management, 29(3), pp.302-333.

McLoughlin D, Fitzgibbon G and Young V(1994) Adult dyslexia: assessment,counselling and training, London: Whurr.

McLoughlin D, Leather C and Stringer P(2002) The adult dyslexic: interventionsand outcomes, London: Whurr.

Miles TR (1993) Dyslexia: the pattern ofdifficulties (2nd edition), London: Whurr.

Morris D (2007) A survey based explorationof the impact of dyslexia on careerprogression of UK registered nurses,Journal of Nursing Management, 15, pp.97-106.

Morris D and Turnbull P (2006) Clinicalexperiences of students with dyslexia.Journal of Advanced Nursing, 54(2),pp.238-247.

Morris D and Turnbull P (2007) Thedisclosure of dyslexia in clinical practice:experiences of student nurses in the UnitedKingdom, Nurse Education Today, 27(1),pp.35-42.

Nursing and Midwifery Council (2004a)Reporting lack of competence; a guide foremployers and managers, London: NMC.

Nursing and Midwifery Council (2004b)Standards of proficiency for pre registrationnursing education, London: NMC.

42





Nursing and Midwifery Council (2008) TheCode, London: NMC.

Nursing and Midwifery Council (2009)Record keeping: guidance for nurses andmidwives, London: NMC.

Nicolson R (2000) Dyslexia and dyspraxia:commentary, Dyslexia, 6 (3), pp.203-204.

Peer L (2002)What is dyslexia?, in JohnsonM and Peer L (editors) The dyslexiahandbook, London: British DyslexiaAssociation.

Pollak D editor (2009) Neurodiversity inhigher education: positive responses tospecific learning differences, Chichester:Wiley-Blackwell.

Portwood M (1999) Developmentaldyspraxia: identification and intervention:a manual for parents and professionals(2nd edition), London: David Fulton.

Portwood M (2000) Understandingdevelopmental dyspraxia: a textbook forstudents and professionals, London: DavidFulton.

Poustie J (2000)Mathematics solutions: anintroduction to dyscalculia, part A,Taunton: New Generation UK.

Reid G (2003) Dyslexia, a practitioner’shandbook (3rd edition), Chichester: JohnWiley.

Reid G and Kirk J (2001) Dyslexia in adults:education and employment, Chichester:John Wiley.

Riddick B (1996) Living with dyslexia: thesocial and emotional consequences ofspecific learning difficulties, London:Routledge.

Royal College of Nursing (2007) Disabilityequality scheme – ability counts, London:RCN. Available atwww.rcn.org.uk/publications/pdf/disability_equality_scheme.pdf (last accessed 23

March 2010).

Sabin M (2003) Competence in practice-based calculation: issues for sursingeducation. A critical review of the literature,Learning and Teaching Support Network(LTSN). Available atwww.health.heacademy.ac.uk/publications/occasionalpaper (last accessed 22 March2010)

Salter C (2010) Dyslexia, in Hendrickx S(editor) The adolescent and adult neuro-diversity handbook: Asperger’s syndrome,ADHD, dyslexia, dyspraxia and relatedconditions, London: Jessica Kingsley.

Sanderson-Mann J and McCadless F (2006)Understanding dyslexia and nurseeducation in the clinical setting, NurseEducation in Practice, 6(3), pp.127-133.

Simmons FR and Singleton C (2006) Themental and written arithmetic abilities ofadults with dyslexia, Dyslexia, 12 (2), pp.96-114.

Singleton CH (1999) Dyslexia in highereducation: policy, provision and practice.Report of the national working party ondyslexia in higher education, Hull:University of Hull.

Skinner J (2008) Supporting students withdyslexia in practice settings, Southampton:University of Southampton.

Taylor H (2003) An exploration of thefactors that affect nurses record keeping,British Journal of Nursing, 12(12), pp.751-758.

Trott C (2009) Dyscalculia, in Pollak D(editor) Neurodiversity in highereducation: positive responses to specificlearning differences, Chichester: Wiley-Blackwell.

von Aster MG and Shalev RS (2007)Number development and developmental

www.rcn.org.uk/publications/pdf/disability_equality_scheme.pdf

www.rcn.org.uk/publications/pdf/disability_equality_scheme.pdf

44



dyscalculia, Developmental Medicine andChild Neurology, 49, pp.868-873.

White J (2006)Making reasonableadjustments in clinical practice for disabledhealth students: health professions Walesposition paper. Unpublished papersummarising the HPW conferenceMakingreasonable adjustments: enabling disabledworkers to deliver healthcare, 8thDecember 2005, Cardiff InternationalArena.

White J (2007) Supporting nursing studentswith disabilities in clinical practice, NursingStandard, 21 (19), pp.35-42.

Wray J, Harrison P, Aspland J, Taghzouit J,Pace K and Gibson H (2008)

The impact of specific learning difficulties(SpLD) on the progression and retention ofstudent nurses, Higher Education Academy.Available at www.health.heacademy.ac.uk



11

References

Beacham N and Trott C (2005) Developmentof a first-line screener for dyscalculia inhigher education, SKILL Journal, 81, pp.13-19.

Bird R (2007) The dyscalculia toolkit:supporting learning difficulties in maths,London: Paul Chapman Publishing.

British National Formulary (2010) Britishnational formulary, London: BMJ.

Butterworth B (2003) Dyscalculia screener,London: nferNelson.

Butterworth B and Yeo D (2004) Dyscalculiaguidance: helping pupils with specificlearning difficulties in maths, London:nferNelson.

Colley M (2005) Living with dyspraxia, aguide for adults with developmentaldyspraxia (3rd edition), London: DANDA.

Cowen M (2010) Dyslexia, dyspraxia anddyscalculia: a guide for managers andpractitioners, London: Royal College ofNursing.

Cowen M (2005) How do student nurses,who are facing possible discontinuation oftheir training, feel about being screened fordyslexia and are those feelings influencedby the outcome of the screening?Unpublished MSc thesis, Southampton:University of Southampton.

Dale C and Aiken F (2007) A review of theliterature into dyslexia in nursing practice,London: Royal College of Nursing.

Department for Education and Skills (2001)Guidance to support pupils with dyslexiaand dyscalculia, London: DfES (Ref0512/2001).

Dyspraxia Foundation (2010)What isdyspraxia? Hitchin: Dyspraxia Foundation.Available at www.dyspraxiafoundation.org(last accessed 28 March 2010).

Geary DC (1993) Mathematical disabilities:cognition, neuropsychological and geneticcomponents, Psychological bulletin, 114,pp.345-362.

Hannell G (2005) Dyscalculia action plansfor successful learning in mathematics,London: David Fulton.

Hartley J (2006) What are UK schools ofpharmacy providing for undergraduateswith disabilities? The PharmaceuticalJournal, 276, 15 April, pp.444-446.

Health Professions Council (2006) Adisabled persons guide to becoming ahealth professional – a guide forprospective registrants and admissionsstaff, London: HPC. Available at www.hpc-uk.org (accessed 28 March 2010).

Hendrickx S (2010) The adolescent andadult neuro-diversity handbook: Asperger’ssyndrome, ADHD, dyslexia, dyspraxia andrelated conditions, London: JessicaKingsley.


Her Majesty’s Stationery Office (1998) TheData Protection Act, London: HMSO


Her Majesty’s Stationery Office (2009)Equality Act, London: HMSO.

Lefly DL and Pennington BF (1991) Spellingerrors and reading fluency in compensatedadult dyslexics, Annals of Dyslexia, 41,pp.143-162.

46



McLaughlin ME, Bell MP and Stringer DY(2004) Stigma and acceptance of personswith disabilities: understudies aspects ofworkforce diversity, Group andOrganisation Management, 29(3), pp.302-333.

McLoughlin D, Leather C and Stringer P(2002) The adult dyslexic: interventionsand outcomes, London: Whurr.

Miles TR (1993) Dyslexia: the pattern ofdifficulties (2nd edition), London: Whurr.

Morris D (2007) A survey based explorationof the impact of dyslexia on careerprogression of UK registered nurses,Journal of Nursing Management, 15, pp.97-106.

Morris D and Turnbull P (2006) Clinicalexperiences of students with dyslexia,Journal of Advanced Nursing, 54(2),pp.238-247.

Morris DK and Turnbull PA (2007) Thedisclosure of dyslexia in clinical practice:experiences of student nurses in the UnitedKingdom, Nurse Education Today, 27(1),pp.35-42.

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Dyslexia, dyspraxia and dyscalculia: a toolkit for nursing staff - Royal