The Americans with Disabilities Act
Implications for Nursing Education

Publication

Revised Implications for Nursing Education Programs

In 1993, the SREB Council on Collegiate Education for Nursing Education published a report — The Americans with Disabilities Act: Implications for Nursing Education — that provided guidelines to help nurse educators comply with the 1990 Americans with Disabilities Act (ADA).

The Americans with Disabilities Act was amended by the ADA Amendments Act in 2008 (US Department of Justice, Office of Civil Rights. December 29, 2008). While the original ADA compliance guidelines are correct, this revision includes the new provisions of the amended Act.

The SREB Council on Collegiate Education for Nursing acknowledges the significant contribution of Pamela G. Watson, Sc.D., Dean and Professor of Nursing and Chief Academic Officer, University of Texas Medical Branch, who reviewed and revised the original document.

The guidelines should not be viewed as legal advice or opinions on specific matters. The Council does not assume responsibility for implementation of the guidelines. ADA compliance responsibilities vary by institution. Therefore, nurse educators are urged to discuss the revised guidelines with their campus ADA liaison or legal counsel.

Understanding the Impact of the ADA Amendment Act of 2008

The 2008 ADA Amendments Act was created by Congress because of evidence that the ADA definition of disability was narrowly interpreted in the United States court system. Even ADA related Supreme Court decisions reflected this trend. (Office of Civil Rights, December 29, 2008). Hence Congress became concerned that the intent of the ADA was not being implemented as planned. Many people with disabilities, who should have been protected by the ADA, were being excluded from protection. This revelation caused Congress to take measures to insure wider ADA protection for those with disabilities.

Disability Definition

In the 2008 ADA amendments, the definition for disability did not change from the original Act or as it appears in the Rehabilitation Act as amended (US Department of Justice. 1973). A disabled person is someone who has a) A physical or mental impairment that substantially limits one or more of his or her major life activities; b) A record of such impairment; or c) who is regarded as having such impairment.

Disability Interpretation

With the new ADA amendments it is the interpretation of disability that has changed. Interpretation is more expansive, affording protection to a wider spectrum of individuals with disabilities. Accordingly, in determining whether an individual is disabled, three stipulations are now evident.

  1. The effects of ameliorating agents cannot be considered. For example, a person with epilepsy whose seizures are controlled by medications or one who uses an assistive device such as a hearing aid to correct hearing loss or one who uses learned behavioral adaptations to create the appearance of normalcy is still considered to have a qualifying condition if one or more life activities are affected.
  2. Impairments that are in remission or episodic are also covered if when active these conditions have a similar affect on one or more life activities (Washington Labor, Employment & Employee Benefits Law Blog. January 13, 2009).
  3. The term — life activities is now more broadly defined to include seeing, hearing, eating, smelling, sleeping, breathing, walking, speaking, bowel and bladder control, learning, reading, writing, spelling, concentrating, thinking, communicating, perceiving and other neurologic functions, working, performing self care and other manual tasks. (Washington Labor, Employment & Employee Benefits Law Blog. January 13, 2009)

Impact on Nursing Programs

Because the ADA Amendments have only been in effect since 2009, the actual impact on nursing education programs is not known. However, it seems reasonable to assume more qualified applicants representing a wider range of impairments/disabilities will seek accommodations under ADA.

Qualified Person with a Disability

A qualified individual with a disability is one who with or without reasonable accommodations or modification, meets the program’s essential eligibility requirements known as the Core Performance Standards.

Defining Reasonable Accommodations

If an applicant or student self reports that he or she cannot meet one or more of the core performance standards without accommodations, the nursing program must determine whether accommodations can reasonably be made. Applicants and students are responsible for making disabilities known and formally seeking accommodations. The school must develop procedures for students to receive appropriate assistance and guidance if they
identify potential difficulties with meeting the core performance standards.

The ability to provide reasonable accommodations varies with size and resources available to an institution. The following are examples of reasonable accommodations.

  • Assuring that facilities are readily accessible for use by individuals with disabilities
  • Restructuring or altering clinical experiences
  • Modifying academic program plans
  • Modifying examinations including location, timing and testing conditions
  • Giving supplementary learning materials
  • Providing qualified readers or interpreters

Recommendations for Nursing Education Programs

  • Institutional resources should be available to advise applicants and students who qualify under the ADA.
  • Institutions should provide appropriate admissions staff, faculty and administrators with training on the ADA and ADA guidelines.
  • The core performance standards should be made available to:
    • All potential applicants, nursing faculty, staff and students, for example, published in catalogs, application materials and descriptions of the program State Boards of Nursing and accrediting groups for nursing
    • Agencies where educational experiences for nursing students occur
  • The nursing program should cooperate with other institutional units to identify auxiliary aids and services, such as building accessibility and hearing devices that may be needed for “reasonable accommodations.”
  • Nursing programs should have procedures to assist students who qualify under the ADA.

Core Performance Standards

Each institution should make explicit essential eligibility requirements for its nursing program by citing the core performance standards. The standards set forth cognitive, sensory, affective and psychomotor performance requirements. Each core performance standard should be accompanied by examples of activities nursing students are required to perform. Each standard should be reflected in objectives for nursing courses in the
programs of study.

Under the ADA, nursing programs cannot base admission, acceptance or continued enrollment on the core performance standards. Instead, the standards should be used to assist applicants and students in the determination of need for ADA related accommodations and medications. The core performance standards are intended to constitute an objective measure of:

  1. A qualified applicant’s ability with or without accommodations to meet the program performance requirements.
  2. Accommodations required by a matriculated student who seeks accommodations under the ADA.

Applicants and students with disabilities seeking accommodations under the ADA, as amended, should be referred to the Department of Education Office for Civil Rights document titled, Students with Disabilities Preparing for Postsecondary Education: Know Your Rights and Responsibilities (US Department of Education. September 2007)

The following Sample Core Performance Standards may assist nurse educators in developing core performance standards for undergraduate and graduate programs that prepare graduates for entry level or advanced practice roles as registered nurses.

1 The Council’s ADA Task Force, led by Linda Davis (University of Alabama at Birmingham), included Linda Bowlin (University of Arkansas for Medical Sciences), Katherine J. Futch (Grady Memorial Hospital, Atlanta) and Mary Hazzard (Western Kentucky University).

Sample Core Performance Standards

Requirements Standards Examples
Critical thinking Critical thinking ability for effective clinical reasoning and clinical judgement consistent with level of educational preparation
  • Identification of cause/effect relationships in clinical situations
  • Use of the scientific method in the development of patient care plans
  • Evaluation of the effectiveness of nursing interventions
Professional Relationships Interpersonal skills sufficient for professional interactions with a diverse population of individuals, families and groups
  • Establishment of rapport with patients/clients and colleagues
  • Capacity to engage in successful conflict resolution
  • Peer accountability
Communication Communication adeptness sufficient for verbal and written professional interactions
  • Explanation of treatment procedures, initiation of health teaching.
  • Documentation and interpretation of nursing actions and patient/client responses
Mobility Physical abilities sufficient for movement from room to room and in small spaces
  • Movement about patient’s room, work spaces and treatment areas
  • Administration of rescue procedures-cardiopulmonary resuscitation
Motor skills Gross and fine motor abilities sufficient for providing safe, effective nursing care
  • Calibration and use of equipment
  • Therapeutic positioning of patients
Hearing Auditory ability sufficient for monitoring and assessing health needs
  • Ability to hear monitoring device alarm and other emergency signals
  • Ability to discern auscultatory sounds and cries for help
Visual Visual ability sufficient for observation and assessment necessary in patient care
  • Ability to observe patient’s condition and responses to treatments
Tactile Sense Tactile ability sufficient for physical assessment
  • Ability to palpitate in physical examinations and various therapeutic interventions

References

Liebert, D. (2003). Access to Higher Education for the Mentally Ill: A Review of Trends, Implications and Future Possibilities for the Americans with Disabilities Act and the Rehabilitation Act. International Journal of Psychosocial Rehabilitation. 7, Retrieved on February 18, 2010 from http://www.psychosocial.com/IJPR_Liebert.html

Southern Regional Education Board. (2004). Americans with Disabilities Act: Implications for Nursing Education. Retrieved March 1, 2010 from http://www.sreb.org/page/1390/the_americans_with_disabilities_act.html

US Department of Education, Office of Civil Rights. (September 2007). Students with Disabilities Preparing for Postsecondary Education: Know Your Rights and Responsibilities. Retrieved March 1, 2010 from http://www2.ed.gov/about/offices/list/ocr/504faq.html

US Department of Education, Office of Civil Rights. (March 2009). Protecting Students with Disabilities: Frequently Asked Questions about Section 504 and the Education of Children with Disabilities. Retrieved March 1, 2010 from http://www2.ed.gov/abou/offices/list/ocr/504faq.html US Department of Justice. (March 1973). The Rehabilitation Act of 1973. Retrieved May 4, 2010 from http://www/access-board.gov/enforcement/Rehab-Act-text/intro.html

US Department of Justice. (January 1990). Americans with Disabilities Act of 1990. Retrieved on May 4, 2010 from http://www.ada.gov/statute.html

US Department of Justice. (August 7, 1998). The Rehabilitation Act Amendments Section 508. Retrieved March 1, 2010 from http://www.access-board.gov/sec508/guide/act.html

US Department of Justice. (December 29, 2008). The Americans with Disabilities Act Amendments Act of 2008. Effective January 1, 2009. Retrieved March 1, 2010 from Ed.Gov website, http://frwebgate.access.gpo.gov/cgibin/ getdoc.cg?dbname=110_cong_bills&docid=f:3406enr.txt.pdf

Washington Labor, Employment & Employee Benefits Law Blog. (January 13, 2009). Legal Update: ADA Amendments Act of 2008. Retrieved on March 1, 2010 from http://www.waemploymentlawblog.com/blog/2009/010legal-update-ada-amendments-act-of- 2008.html