Disability-Inclusive Accommodations in Nursing Education—Addressing Health Equity Needs

The Accreditation Council for Graduate Medical Education (ACGME) and other medical associations have committed to the elimination of health care inequities by enriching and broadening the physician workforce.Through its Department of Diversity, Equity, and Inclusion, the ACGME works to provide tools for the graduate medical education community to build safe, inclusive, and equitable learning environments for physicians, including disability-inclusive practices. 1This work has led to extensive data collection on, and increased representation of, medical students with disabilities. 2However, there is a paucity of information regarding nursing students with disabilities.Jackson et al 3 share groundbreaking findings establishing baseline disability data for US nursing schools.This cross-sectional study uses data from nursing schools to examine disability prevalence and types of didactic and clinical accommodations used in traditional prelicensure Bachelor of Science in Nursing programs.Nineteen schools responded to solicited invitations to participate in a survey, identifying 562 nursing students with self-reported disabilities.This is a prevalence estimate of 8.4% of total enrollment, which exceeds the current prevalence in medical schools of 5.9%.Prevalence estimates are accurate as the data are obtained from US nursing schools' federally mandated documentation of disability decisions.Disability accommodations services varied due to school size, from variations in admission practices, disability expertise, or resource allocation.The study identified the critical need to prioritize future research in psychological disabilities (3%) and attention-deficit/hyperactivity disorder (2.1%), as these were most prominent.In addition, the study captured the heterogeneity of self-identified disabilities and categorized the diversity of accommodations.The authors noted a scarcity of nursing students with mobility and sensory disabilities and called for future studies to address barriers for these students to enter and fully participate in the nursing profession.Finally, the authors called for further study of student performance and efficacy of accommodations.The major limitation of the study by Jackson et al 3 is that the data are based solely on selfdisclosed disabilities.Both previous studies of medical students with disabilities and this current study of nursing students with disabilities are limited by the exclusion of students who did not selfdisclose.Some reasons for nondisclosure include ableism and the unique culture of medicine.As we work toward equity in health professions education, we must look at ableism, and structural ableism in particular.Although there is no singular definition of ableism, it is generally, "stereotyping, prejudice, discrimination, and social oppression toward people with disabilities." 4,5milar to other forms of oppression, ableism describes valuing some attributes over others, including a reflexive preference for nondisability. 5This system of preference is not only reflected in thoughts and actions of individuals but is also deeply ingrained within systems and structures.An analogy to understanding how ableism affects our culture is to understand how critical race studies recognize the importance of understanding Whiteness to better understand how racism operates. 5,6Disability professionals provide services to people with disabilities in capacities such as health care professionals, educators, direct support staff, social workers, and liaisons in students disability services.They are often nondisabled individuals who are the gatekeepers of services for people with disabilities.Research indicates high levels of disability bias among disability professionals. 5On an individual level, a disability liaison with an implicit or explicit bias in student disability services may negatively affect the experience of students with disabilities.On a larger scale, disability