Case Study – Nursing and Language / Comprehension Difficulties

Case Study 1 – Source: SKILL Website (accessed 25th October 2004). Iain Pearson My Personal Experience

For as long as I can remember I have had difficulty with reading and retaining some information, what does this mean? Well, the opinion of a few teachers at my schools was not that I had a disability which was brought on by seizures meaning that at the time in my life when I was supposed to be learning, I was instead in and out of hospital.

As far as they were concerned I was “just a wee bit slow” or the one the makes me laugh now “lazy”. Starting at the very first day of my educational journey, which was not one I can say I enjoyed, I had difficulty reading. Not that I did not understand what I was reading but the tiny fragments of information which shape our life (words) danced over the page like snowflakes in a blizzard. This was not a situation I could explain to the teachers, as dyslexia was not recognised as much then as it is today. At parents evening those comments of “just a wee bit slow” or “lazy” where banded around with such regularity that I suspect they where beside my name on the register.

So as my education hit primary three it was decided it would be best if I was held back a year with another person in that year. Therefore it was back to primary two with the head teacher saying “you have been picked to go back and help the pupils in primary two” then this comment was in order to save embarrassment and the judgement of others. Now I think I will put it on to a card and look at it when I need a laugh.

Primary two, three and four passed with my frustration building and reinforcing the point of view in my own mind I was “a wee bit slow” or “lazy” despite how hard I tried. Not long after, the education authority decided that the school was to close and primary five and the remaining primary school years would be spent at another school. And as ever I was branded “a wee bit slow” or “lazy” and given a private home tutor which I pointlessly protested about but it ended up working out fine.

She was called Gina and was able to listen and explain when I did not understand something and was there until high school. After she left I had another tutor called Fiona. Both helped me through my first year of high school. However, after they finished things were no different and the “wee bit slow” and “lazy” returned. By this point I thought about having that printed on a t-shirt and I also knew that something was wrong. I had heard about dyslexia and the mannerisms which it had. I recall once mentioning the fact to a guidance teacher the possibility that I could be dyslexic and she said, and I quote, “some people are a bit slower than others, or perhaps you should put some more effort into your work”. Then and there it hit me, maybe I was a bit slow and a bit lazy after all the years of people telling me, that must be right.

Although my family believed there was something wrong as well the school would not listen to me so why listen to them. I convinced myself that the thought of dyslexia was a way of denying the truth.

Careers day, I have always wanted to be a nurse but with the qualifications that I was about to leave with it just would not get it done. I was to be limited in the choices of career I would have. Nursing was one word on a page that said not suitable career. I know, I thought, I will try classes that will get me that bit closer which I did. The careers advisor said “work in a shop it is good money in some places”. No nursing course, no point in moping about it, was my initial thought and that remained there for eight years as did the realization that the words on delivery dockets still danced about the page and I would forget things if I had several tasks to do. Somehow to my great astonishment, I got promoted but the words still danced and I still forgot things and to top it I hated the job because I still wanted to be a nurse.

So I went for interviews with colleges and went to Anniesland College where I met some of my best friends and a tutor Eileen who actually praised my work and encouraged me to work towards being a nurse (I am remembering the piece of paper that said nursing was not a suitable career). So I did and got my SVQ in health, a higher and an HNC in healthcare and a place on the Mental Health Nursing Course which I got before my HNC. Words still danced about the page but that didn’t bother me as much as it used to so things had settled down for me and I looked forward to starting my course and the three years of work it would take to get my dream job.

Caledonian University, at last after ten years of trying. It was tough make no mistake and I noticed the tougher it got the more the words danced on the page and the more I forgot. On my first placement I was talking to a client who was denying a fact about his illness and I was discussing this with them when I realised I was being hypocritical. During this time I was doing an annotated bibliography and was struggling so I took the bull by the horns and spoke to my tutor Nancy who put the wheels in motion and sorted out the test. After the test Mitzi the psychologist said “yes you are dyslexic”.

Thank god what a relief after years of thinking I was “a wee bit slow” or “lazy” I wasn’t I was dyslexic which I never thought I would be pleased about. The university gave me an adapted computer and I met Kate and Chris the support tutors who between them have helped me with every assessment and special arrangements for exams. And I now look at my dyslexia as an advantage rather than a disability.

The point of this story is this disability does not prevent people from becoming a nurse only the lack of self belief does, I am not a dyslexic student nurse I am a student nurse who happens to have dyslexia. The person you are makes you suitable to be a nurse and I became the person I am because my parents, brother, friends Michelle, Chrissy, Jenny, John, Eileen and my support tutor Chris.

Source: Quality and Performance Improvement Dissemination and Department for Education and Employment. October 1999. Modern Apprenticeships and People with Disabilities.

Key Facts

Sector: Health and Social Care
Gender: Female
Age: 23
Region: North East
Employer: Nursing Home
Disability: Behavioural Problems at School (and borderline dyslexia)
Adjustment: Flexibility and encouragement shown to powerful effect by employer and training provider


Education Prior to MA

Sarah had a chequered school career! In her final years she was constantly in trouble with staff at her local comprehensive school. Her attendance record was 40% in Year 11 and she left with only 4 GCSEs at Grades E to G in Science (2), Mathematics and English. She puts this down to a lack of respect – in both directions, but bouts of poor behaviour are not in dispute.

About the only positive episode in her final year at school was two separate weeks on placement at a local nursing home. This had been arranged in part because her mother, to whom she was (and is) close, was employed there as a care assistant and in part because Sarah already worked there as a domestic at weekends. The work experience was a great success: staff at the home noticed that, whatever other problems Sarah may have had, she struck an immediate rapport with the elderly residents.

Transition to the MA

Sarah was interviewed by a careers adviser at school. She was informed that in order to follow her chosen career of nursing, she would need to get good examination results. Sarah accepted this but felt that the careers adviser was not completely independent of the schools influence. Sarah resented being told she would have to improve her attendance record and generally make more of an effort to fit in. she decided to make her own arrangements in terms of her future career.

Sarah did seriously consider the option of staying on at school to do a GNVQ course in Health and Social Care but the school refused to take her back. She also considered applying to do the same course at the local FE college but concluded she would prefer to get a job and earn some money. She applied to join the nursing home as a care assistant and was taken on for a three-month trial period.


Sarah was recruited initially for a job, not as an MA. She was willing to learn practical skills which had an immediate relevance to her duties, but was reluctant to undergo any off the job education and training, especially any learning in a classroom environment.

She did a Health and Safety course on day release and was subsequently encouraged, both by her mother and managers at the home, to opt into an NVQ2 programme being run by a local training provider. This went OK but was not the big breakthrough. Sarah was enjoying her job more and getting on well with the residents but still found it difficult both to take instructions from managers and to be diplomatic with her peers. Her literacy skills were also in need of improvement.

The training provider went bankrupt soon after Sarah obtained her NVQ2 in Direct Care and so there was no external pressure for her to progress. She did, however, continue to participate in job-related training (e.g. kinetic system of moving and handling patients).

The MA and Adjustments

The MA

Some two and a half years after Sarah had completed her NVQ2, a new training provider contacted the home and offered its services. Sarah was sufficiently interested to go along to an initial day at which her portfolio was assessed and future options discussed. The outcome was that she was registered as an MA and enrolled onto an NVQ3 programme.

Her new training provider assessed and accredited her prior learning, which included her on the job experiences as well as formal learning since the NVQ2. Critically, she was encouraged to learn at her own pace and given customised support when needed. She attended sessions at the provider’s premises on a fortnightly basis and undertook other course related work at the home.

The main problems to overcome were in relation to Key Skills, particularly literacy. Whether this weakness arose from her regular absences from school or whether she has mild dyslexia was not entirely clear. Her spelling in particular was very weak.

Sarah made swift progress however with the job related project work. One assignment required her to explore stock control techniques. With encouragement from the home’s matron, she not only studied this function but also took over responsibility for it, achieving a 40% saving in expenditure on incontinence aids.

Sarah achieved her NVQ3 in Continuing Care in 1997 and, with the active support of the TEC, her employer and training provider, moved onto NVQ4. she is currently pursuing this and has already achieved her vocational assessor award D32/D33.


Sarah’s employers do not feel they have needed to make any adjustments as such. They did, however, make the critical intervention when Sarah was 16: they gave her a chance. It would be difficult to imagine a much less impressive school record, yet they were willing to trust their judgement based simply on Sarah’s enthusiasm during her causal employment and work experience, and on her empathy with the elderly residents. Since then they have done three key things:

  • They have encouraged her to continue training but without putting on any pressure.
  • They have given her opportunities to develop her skills on the job. She now has the status of senior carer and is actively involved in the support and assessment of junior care assistants.
  • They have helped Sarah to develop her personal skills. Her first appraisal noted that she had “no respect for her peers”. Her most recent appraisal commented that she has become a “smashing supervisor”.

The training provider has also played a key role. Sarah’s tutor for the first period commented that Sarah’s body language was often distant, if not actively hostile. This reflected unease in the learning environment but also, perhaps, nervousness about Key Skills: for example, Sarah would never take up the pen when volunteers were required for flip chart work.

The training provider’s key contributions have been in allowing Sarah space to develop at her own pace and providing constant encouragement. This was demonstrated recently when they entered Sarah for the regional MA of the Year Award. Having won the regional award for the Care and Public Services sector she went forward to the national award, not only winning in her sector but also being chosen as National MA of the Year. As a result of Sarah’s success in the competition, she was invited to speak at a number of high profile conferences, and has met a wide range of interesting people and celebrities.

Current development work is focused on management skills, particularly those requiring written work. Now that Sarah is herself assessing younger trainees’ work and writing action plans, it is essential that she has confidence in her spelling and grammar. This illustrates a recurring point in this case study: Sarah is happy to work on weaknesses but only when she can see relevance and an end product.

Sarah has recently given birth to a son, but has still been able to continue with working towards her NVQ level 4. speaking about the MA, Sarah said “apart from having my son, the MA is one of the best things that has ever happened to me”.

Another of Sarah’s achievements was receiving a letter from the school she had attended congratulating her on her success. This was something that gave Sarah great satisfaction.

Future Plans

Sarah is now a valued member of the home’s middle management. She is taking on increasing responsibilities and hopes to combine this with achieving her NVQ4 later this year.

In the longer term, she hopes to manage a residential home (as opposed to a nursing home for which she would need nursing qualifications). Co-incidentally the home has been taken over by a company with more than 30 residential establishments of various types, so there should be further scope for career development.

Points of Interest

The key points to emerge from this case study are:

From an employer perspective:

  • Be willing to give a young person with a poor school record a second chance.

From a careers adviser’s perspective:

  • Take care to be seen as genuinely independent even if this requires a certain distancing from the school’s stance.

From a training supplier perspective:

  • Allow trainees space to develop at their own pace and in ways which engage the individual.

From the perspective of all the key players:

  • Never underestimate the impact of encouragement and support.

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