Naomi Sharples (n.sharples@salford.ac.uk)
Nurse Tutor, University of Salford School of Nursing
Commissioned for the Demos Project - June 2002.
Naomi Sharples, Nurse Tutor at the University of Salford, describes some of the project management issues surrounding an innovative project to recruit deaf people into Mental Health Nursing.
I was recruited to post due to my knowledge of the project, the deaf community and my sign language skills to provide support for the students, University staff and placement supervisors and their teams. My knowledge has been determined through my experience of managing services for deaf people and underpinned by a degree in Linguistics and Deaf studies, as well as current knowledge of the British Deaf Community and the challenges faced by this linguistic minority group.
The aim of the Deaf Access project is to create an educational environment that is accessible, supportive and effective for deaf people. This environment will enable deaf students to attain the qualification of RMN (Registered Mental Nurse). They should then progress to become employed in services, where they are valued for their professional skills.
There are currently no Deaf qualified nurses working in the National Deaf Services in the National Health Service (NHS) or the independent sector. This has led to the loss of a potential pool of skilled carers, to professions in other areas. Deaf people can already qualify as social workers, psychologists, occupational therapists, teachers and counsellors. A study by David Wright of Sheffield University, of nurses working for the NHS, who went deaf after qualification, showed that there was no reason why deaf people could not work as nurses to the standards required by the UKCC.
Four national deaf services, the English National Board (ENB), Unison, representatives from the independent sector and Salford University came together to look at the possibility of a small group of deaf people accessing the pre-registration mental health-nursing programme. This will ultimately benefit deaf clients within mental health services and address the needs of the new National Strategy for Mental Health Services for Deaf people "A Sign of the Times".
Descriptive research methodology used to address the development of the project is in the form of a case study (Carter, 1991). As suggested by Bell (1999) the information for the case study has been collected through reflective journal entries. Formed part of my PGCE portfolio.
The case study approach was selected due to the flexibility of information sources, and the ability to apply this information to a framework for valuing diversity. This approach is supportive of the time frame of the project life, i.e. 6.5 years.
The 'instance' to be investigated is the introduction of deaf student nurses to the University of Salford School of Nursing. The aim of the study is to identify issues that are unique to the University and those that are a common feature of diversity in H.E today. In turn the hope is to provide supportive information for other project leaders, tutors, administrators and students in creating effective culture, structure, systems, and skills to value diversity in education.
It is important to note at this point that the project philosophy aspires to the belief that views the Deaf Community as a linguistic minority group rather than the alternative of viewing this community through the medical label of deafness as a deficit.
This former identity allows more room for valuing the skills, behaviours, beliefs, identities and missions of people whose first or preferred language is British Sign Language (BSL). As Padden (1991) suggests the British Deaf Community can be viewed through the interconnected domains of Audiological, Social, Political and Linguistic components.
There is a major issue of objectives here; with the School of Nursing meeting the needs of deaf people is there an aim to value diversity, manage diversity or attend to equal opportunities?
Equal opportunity theories develop policies that provide structures within which employers can ensure they do not break the law whereas by managing and valuing diversity an organisation should provide the same support for white males as for a disabled female. This proactive model looks at the individual or a groups skills and competencies instead of the reactive model of equal opportunities where employers design policies to avoid or deal legislatively with groups of people who have been historically disadvantaged (Pilbeam, 1998).
However, there are recognised benefits for organisations that provide equal opportunities in the work place. They have a large and diverse pool of potential employees who bring skills and capabilities to the workplace. Where the diversity of the organisation reflects the customer's or student's background and cultural identity the organisation is in a better position to meet the needs of the customer. It follows therefore that people who feel included are more likely to stay with the organisation and be supportive flexible and productive (Pilbeam, 1998).
The business-focused reasons for equal opportunities in organisations have been taken a step further in the theory of managing diversity. Managing diversity in organisations is supported by equal opportunity legislation but goes on to include all stakeholders not only those who are from a minority group protected by legislation. The philosophy is to develop a workforce which is diverse, multi-cultural and from as wide a pool as possible, to make the most of all employees to the benefit of the individuals and the organisation.
Kitson and Monteiro (1992) suggest that deaf people enhance deaf services through:
It is recognised that to meet the needs of the consumers and stakeholders, organisations needs to go beyond equal opportunities into the realms of managing and valuing diversity.
Managing diversity is often compared to or used as a term to explain issues around equal opportunities in employment. However, there are some clear differences between the two issues. Managing diversity is viewed against the backdrop of global companies and the diverse ethnographic, physiological and cultural make up of employees and employers, where managers continue to develop ways of increasing the skills and knowledge base of the work force to the benefit of the company and the people who comprise it (IPD 1996). This ethical stance is underpinned by the knowledge that a skilled knowledgeable work force will lead to a creative, dynamic organisation. On the other hand equal opportunity theory is supported by policies and legislation, focusing on ensuring that people are not negatively affected in the work place due to their gender, disability or race.
Managing diversity is a holistic organisational approach where the need is identified to promote diversity issues and all employees are involved. The model and strategy belong to the organisation, not only to the personnel or human resource department.
It is argued that to manage diversity is to be proactive and therefore the theory is at odds with ideas such as 'positive action' where attempts are made to redress an imbalance that already exists. Managing diversity starts at year 0 and designs an organisation where people are recruited, retained, trained and promoted because of their knowledge skills and competencies. Differences are not ignored, we are not 'all the same really', instead differences are an accepted, integral, part of the organisational culture.
Critics of the managing diversity philosophy have suggested that the theory is overly introspective. Thomas (1990) points out that to manage diversity an organisation needs firstly to be diverse; in this respect established organisations would always be at a disadvantage. However, there is increasing pragmatism in the area of human resources that suggests managing diversity and equal opportunity theory are able to complement each other.
This is supported by LaFasto (1993) who suggests that managing diversity is not at odds with equal opportunities and the legislation / policies that support it. LaFasto describes a three-stage process where the organisation moves from 'Complying' to 'Managing' to 'Valuing'. When an organisation is 'complying' it is;
Reacting to the pressure not the problem.... Compliance and obligation. Keep the law out of our business.... Avoid legal consequences.
Whilst in the 'managing' phase;
Diversity is important as a competitive business practice and we are here to run a business. We need to attract the right people. Job stability / continuity is important to success. Turn over costs money.
In the 'valuing' stage the organisation believes;
Individual self-esteem is important to performance. People who feel comfortable in their work environment are more likely to feel confident in their ability to contribute. Business, social and moral values are one and the some. Job is a part of life not vice versa...Productive people = a high performing organisation.
LaFasto describes the changes from 'complying' to 'managing' to 'valuing' and this concept influenced the development of the cline below.
![[increasing scale]](../../pics/resources/nurse/diversity.gif)
"managing diversity covers a range of approaches and emphases, some closer to equal opportunities some very different."
... Ford (1996) supports LaFasto suggesting that many organisations are supportive of the need to use both equal opportunities legislation and policies to underpin the development of diversity.
It is interesting to note that, despite the plethora of rhetoric, it is very unusual to meet an organisation that does actively value diversity. To value diversity is to be able to value the differences between individuals and to encapsulate the positive attributes that are encompassed in those differences to the benefit of the organisation. It is directly opposed to judging people against the norms of an organisation; it necessitates a shift from the current paradigm of individuals recognising and conforming to the organisation to where the organisation conforms to the individual differences of all the people involved.
To manage or value diversity in an organisation, whether it is believed to be underpinned by Equal Opportunities or not, requires a framework for implementation. Kandola and Fullerton (1998) identified eleven-implementation models. They were able to distill the frameworks into a model for actioning diversity in an organisation and this will form the framework for the case study.
The University of Salford is committed to the widening participation agenda (WPP);
the University of Salford has been committed for over a decade to attracting to its courses, students who, because of their backgrounds, would not readily have considered higher education, and its widening participation strategy has been evolving over that period.
In the new WPP strategy 'disability' is not mentioned very often, rather the strategy looks at social class, ethnicity, and collaboration with local colleges, employer initiatives. It could be construed that disability issues are an integral aspect of all these initiatives, though to suggest such an important issue is integral or assumed may lead to assumptions that the structure and systems within the University fully support students with disabilities.
It is clear that all HE institutions are undergoing changes to their culture, structures and systems to support students with diverse needs and clarity of actions, sharing knowledge, networking for best practice is the way forward.
On reflection as project lead, and as a person new to the University, I found the University systems need to be understood. As a person with a 'vision' of deaf people as qualified nurses, getting to grips with the more mundane operational side of things is not a motivator for me. However by sharing my visions and what was needed to achieve these with the administrators who provide the vehicles proved valuable.
This process takes time and should really only involve people who are necessary. When too many people are involved good organisational communication is challenged and this can lead to long delays. Knowing who's who in the organisation is critical. Projects such as these rely heavily on good administrators who have a wealth of knowledge and skills in their area and who posses the creativity to manage a system appropriately when it doesn't meet the needs of the project.
Four students were recruited to start the course in September 2000, with another eight recruited in 2002. When the students were recruited they were invited to have an assessment of needs through the 'Access Summit Centre' who are funded by the Manchester Universities to assess and implement support for disabled students. Of 4 deaf students 3 took this opportunity and the reports that followed supported and guided me as personal tutor in ensuring the students needs were met in the form of Human Aides to Communication (HACs) and technological assistance.
The learning environment was not audited for access however, this is a part of the evaluation of the project and changes to the learning environment have taken place from student, interpreter and tutor feedback.
The University has not yet undergone an assessment for environmental access for students with disabilities, so no information was available on the availability of loop systems, text phones, video phones, flashing alarms etc. This encouraged me to take a proactive stance and buy in as much technology as required to improve access, however, it is still not perfect. In the clinical placements the students are either in an environment that is visually accessible or if they are in hearing clinical environments they are provided with the technology and human resources for access according to their need.
Technology tends to work once you have negotiated with the student what will be the most useful tool. However, human resources, are much more susceptible to 'Queasiness, Qualms and Question' i.e. they are human and sometimes ring in sick.
With such a shortage of interpreters and note takers this could leave the students unsupported or it means that I may need to communicate for other lecturers. Due to the fact that this curriculum has never been interpreted before, interpreters may have doubts about their ability to interpret the session or the ability of the lecturer / clinician to deliver the session in an accessible way. Only once has an interpreter questioned the ability of the students to fulfil the criteria for the course. Interpreters do change the dynamics of a group and as a lecturer and student this has to be accepted. Interpreters may question aspects of your delivery, offering advice or support that is useful though it can also feel threatening to someone who is new to teaching. However, there are ways of enhancing the experience of all involved so that none of the participants are undermined.
When the 3Qs raise their heads one becomes consumed with this particular support issue and it can feel to the detriment of the core task of providing student nurse education and thus society with qualified nurses both deaf and hearing. To enhance the interpreter's experience of working in an HE setting, be prepared to:
To ensure that these issues are fully addressed we have employed a 'translator' / human aid to communication coordinator. This person will give the students more access, consistency, will organise training for tutors in the use of interpreters, will organise pre-lesson handouts for the interpreters and identify the most suitable technology.
When the 3Qs raise their heads one has to be consumed with this particular support issue and it can feel to the detriment of the core task of providing society with qualified nurses both deaf and hearing. To get around my fear and suffering at the hands of HACs and my need to negotiate with colleagues on a regular basis because of the lack of notes pre-lesson for the interpreter to prepare, the shape of the room, the financial system, the lecturer that teaches in acronyms, the lecturer who wants the interpreter to join the students in with group exercises... we employed a 'translator'. This person will give the students more access, consistency, will organise training for tutors in the use of interpreters, will organise pre-lesson handouts for the interpreters and will identify the most suitable technology.
The project received management commitment in the form of representatives from the Greater Manchester Education and Training Confederation, the Director of Mental Health Education University of Salford and an Education Officer from the English National Board for Nursing and Midwifery, initially being involved in the project steering group. However, with the multitude of commitments and changes in roles and responsibilities over the two and half years the project has been running the steering group has dwindled in size and meetings no longer appear representative of people in top management positions to those who are in positions of support and commitment.
The core people who are regular steering group attendees are influential in their organisations and do offer realistic support to the project. This suggests that influencing skills, knowledge base, deaf awareness, and educational awareness are as important as top management commitment.
Other people in positions of responsibility who are interested in the essence of the project rather than the operational aspect include the Dean of Faculty, the Mental Health Nursing officer for the Department of Health (DoH), the Chief Nursing Officer for England, DoH minister and lead nurses from all the National Deaf Services, NHS and independent sector. It is important to get this level of individuals and organisations onboard so they are in a position of knowledge to inform their peers and superiors of developments in diversity in health care education.
As part of the project the objectives are required to be clear and achievable. They are:
Accountability for the delivery of the project lies with the project leader (i.e. myself) and financial accountability rests with the Director of Mental Health Education, Sandra Beswick. The steering group is accountable to the project in so far as they are expected to provide support, creative ideas, and guidance for the project leader.
As stated above the steering group has dwindled to a small core, however, this core is extremely committed to the project and are able to fulfill their objectives. When the group was in the process of becoming smaller there was a dilemma of whose responsibility is was to encourage the members to attend. As project leader, I felt that badgering people for support was not a useful mechanism nor did it support my role and I preferred to wait to see what core group arose from the larger group to then see if my support requirements could be met. At the moment this situation is fine, we are meeting as a group on a monthly basis. The group receives an update on the project; discuss any outstanding issues and then focus on developments such as the 2004 conference to disseminate the findings from the project.
Accountability for finance did pose some issues initially though these have been resolved. As project lead, personal tutor and base group facilitator to 30 students both deaf and hearing, accountability is an issue. Pressure comes from all sides, am I doing the best for the project? Am I a good personal tutor to my students? Am I a lecturer that is developing new and innovative learning strategies to provide a quality learning environment? To answer yes to all these questions simultaneously would be difficult, but to ask 'has the project has provided access to nursing for BSL users and will it change the face of nursing in the future?' The answer is yes.
The effectiveness of the communication about the project is an interesting issue. On a macro level through organisations such as the European Society for Mental Health and Deafness, the Department of Health contacts and other Service contacts, things are going well. At an operational level, communication about the project and issues that arise will be improved by more regular contact between the steering group members and myself. This could be in the form of an e-group or virtual resource to update people and to access information and resources. When the University has decided upon the software that it will use to facilitate such communication, this method will be put into action.
Co-ordination of the project is going well, the evaluation of the project was subject to delay due to personnel replacement issues but is now well underway.
The responsibility for the coordination of the other student requirements such as application forms, interviews, accommodation, expenses... now remains firmly within the formal university structures. As project lead it is tempting to try to do everything yourself. I have had to learn to trust that people and systems will function effectively and will not knowingly undermine the project, which is my greatest fear.
Co-ordination of the delivery of the nursing curriculum is in my hands and those of my colleagues. The new translator coordinates access to the curriculum. We work closely together to ensure that we are providing as accessible an environment as possible without subtracting anything from the course or adversely affecting the learning of other students. Having small student groups and delivering learning through Problem Based Learning scenarios is proving very useful. The group has specific ground rules that should ensure that group discussions are accessible to all.
The national deaf services are very aware of the project and the clinical placements are well managed in conjunction with the practice placement officer in the school and the Clinical Education Coordinators in the Trusts. The students on the project are above the usual commissioned numbers and this puts more pressure on clinical placements at a time when there is already an enormous pressure.
This aspect of the project informs my practice regarding the students' needs on an ongoing basis and it will also inform the eventual framework for access clearly outlined in the project objectives. The evaluation covers all aspects of the student educational and clinical experience from a student, mentor, lecturer, user and environmental perspective. It is subject to some delay at the moment and though this has been recently rectified it is concerning that valuable information may be lost. However, with the new group of students starting in September 2002 it is possible that there will be a positive recovery in time for the project dissemination conference in January 2004.
Major challenges remain. To put the project on the equal opportunity / valuing diversity cline would be impossible due to the number of organisations involved. When considering equal opportunities in the context of education it is safe to suggest that at the moment we are providing equal opportunities for deaf people in nurse education, however, there is a degree of imposed assimilation for the students and this will remain until deaf people are in more empowering positions in nursing and nurse education.
In the classroom, the students are valued as all students are for their contribution to the course and for their insights from a linguistic minority group, how this impacts on them as individuals and how lessons learned from this minority group are transferable to other potentially excluded groups and individuals. Already we are finding that hard of hearing students and students with dyslexia are coming for support because of the transferability of some of the support mechanisms provided.
We continue to learn about true access and true inclusion - for example, the group refuses to participate in any lecture or session unless they all have full access, they would never accept the idea of splitting the deaf students from the hearing students for logistical reasons. The consideration the students have for each other is refreshing even though there are times when the deaf students do feel isolated from the main group, especially when on placement. We are looking at improving students IT skills to address this issue; again all students will benefit from this support not only deaf students.
When working on a project such as this, with the cultural tensions that the system challenges, it is easy to forget what is actually happening. The first group of signing student nurses are now in their 3rd year, we are breaking new ground in nursing and in education. Next year these students will be qualified nurses and they will have to continue to break new ground in clinical environments. They will continue to access the University for post qualifying courses and the School of Nursing will continue to find more innovative ways to support the students in their desire to continue their life long learning as mental health practitioners.
The Deaf community in Britain will have moved a step further towards empowerment, another door is open.
Bell J. (1999) Doing Your Research Project. Open University Press. Buckingham, England.
Carter.E.D. In Cormack.D.(1991) The Research Process in Nursing. 2nd Edition. Blackwell Publication.London.
Corbridge M. Pilbeam.S. (1998) Employment Resourcing. Pitman Publishing. London.
Department of Health (2002) 'A Sign of the Times'. Department of Health Stationary Office.
IPD (1996). Equal Opportunities and Diversity. Workbook 4. Institute of Personnel and Development. Manchester Open Learning.
Kandola R and Fullerton J. (1998) Diversity in Action. IPD Press. London.
LaFasto (1993) in Torrington D. Hall L. (1998) Human resource management. 4th edition. Prentise Hall. Europe.
Padden.C. In Gregory.S. (1991) Constructing Deafness. Open University Press.
Roosevelt Thomas.R. (1991) Beyond Race and Gender. AMACOM publishing. New York.
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