Clare Walters

Background
Nursing students with reported disabilities are increasing. Adjustments and accommodations within the classroom and clinical environment should be considered to promote inclusion and academic success.

Aim
To synthesise the evidence from published research on academic support structures or interventions for nursing students with a disability.

Design
An integrative review was undertaken.

Methods
A systematic search of six electronic databases (CINAHL, APA PsycINFO, Education Research Complete, ERIC, ProQuest Central, and Scopus) was undertaken from 1984 to October 2024. Nine articles met the inclusion criteria for this integrative review, with two additional papers identified by forward and backward hand-searching. The final 11 identified articles were quality appraised. The integrative review was conducted in accordance with PRISMA.

Findings
Results identified a range of support interventions or structures to promote inclusion and academic success. However, students and staff reported a lack of standardised guidance from universities, registration authorities, and the legislation relating to interventions and support for students with a disability. The challenges reported focused mainly on difficulties in adjusting to university tasks (e.g., writing skills) or performing their role within the clinical environment.

Discussion
Adjustments and accommodations should be considered to promote inclusion and academic success of nursing students with a disability. Higher education and healthcare organisations need to identify ways to support students with a disability in nursing programs. Regulatory bodies should introduce guidance to address any potential discrepancies between access to study and fitness to nursing practice.

Conclusion
Early identification of students with disabilities is important and needs to be centred on students’ ability rather than disability.

Keywords
DisabilityNursing studentsUniversityClinical placementReasonable adjustment

Background

Inter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff.

Aims

To explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT.

Method

A qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed.

Findings: Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels.

Conclusion

IHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.

Background Inter-hospital transfers (IHT) from Emergency Departments occur when a patient requires transfer to an alternative facility for speciality treatment and are often time critical. Inter-Hospital Transfer may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department. Remaining staff take on extra roles and responsibilities, potentially increasing risk to patients and staff. Scant research regarding staff members who are ‘left behind’ when an escorted IHT takes place is available. The impact of IHT on staff members with differing levels of experience and the use of decision-making protocols remains largely under explored. Aims This thesis aimed to understand how RNs and physicians of differing experience levels feel when they are left behind due to an IHT occurring, and their perceptions surrounding the decision-making protocols for IHT. Method An exploratory, narrative, qualitative approach that utilised the Lazarus Theory (Lazarus & Folkman, 1984) of Stress and Coping, and the Broaden and Build Theory (Fredrickson, 2004) as a concept theory, was undertaken. Thematic analysis was used to analyse the data. Semi-structured interviews were completed and data analysis utilised NVivo to generate nodes and themes. Findings Five themes were identified: ‘the impact of being left behind’, ‘the burden of transfer’, ‘missed care’, ‘a triangulation of competing needs and the decision-making process’ and ‘the effect of IHT on staff with different levels of experience’. Registered nurse participants with less experience felt the impact of being left behind greater than more experienced RNs. Missed care was of most concern to RNs. Physicians described concern for nursing colleagues and the vulnerability of the department. Providing cover for the hospital Medical Emergency Team and providing IHT escorts for other departments was also of concern to physicians. Conclusion The impact of an escorted IHT on those left behind is of serious concern and is described differently by less experienced RNs compared to their more experienced counterparts. Physicians described the department as vulnerable when an escorted IHT took place. Ad-hoc decision-making protocols are utilised with no evidence to suggest set protocols would be of benefit. Further research into the impact and safety of the removal of staff for IHT on staff and patients who are left behind is required.