Nurse Educator Attitudes Toward People with Disability in The
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NURSE EDUCATOR ATTITUDES TOWARD PEOPLE WITH DISABILITY IN THE SOUTHEASTERN UNITED STATES by LORENA LYON RICK HOUSER, COMMITTEE CHAIR KARL HAMNER ALICE MARCH DOUGLAS MCKNIGHT KAGENDO MUTUA ALLEN WILCOXON A DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Education in the Department of Educational Leadership, Policy and Technology Studies in the Graduate School of The University of Alabama TUSCALOOSA, ALABAMA 2014 Copyright Lorena Lyon 2014 ALL RIGHTS RESERVED Abstract The purpose of this quantitative study was to assess the attitudes of nurse educators toward people with disability. This study also compared the relationship between nurse educator attitudes toward disability and their definition of disability. Furthermore, the research investigated the influence of age and professional years of experience on the nurse educator’s attitude toward people with disability. Prior research shows that nurses and nursing students have negative attitudes toward people with disability and there is a gap in research on the attitudes of nurse educators. In addition, the literature suggests a link exists between educator attitude and student attitude development. If the nurse educator has a negative attitude toward people with disability, it will influence the developing attitude of the student nurse. The subjects, 126 nurse educators from Baccalaureate programs in the Southeast, completed the World Health Organization’s (WHO) multidimensional Attitudes to Disability Scale (ADS) and provided disability model preference, professional experience, and demographic data using a web-based survey. Demographic results showed that nurses had an average age of 53 years, an average of 29 years as a nurse, and 13 years as an educator. Results indicated that nurses had generally positive explicit attitudes toward people with disability and preferred for a bio-psychosocial view of disability as defined in the International Classification of Function, Disability, and Health (ICF). The data showed no relationship existed between attitude and definition of disability or attitude and the age and years of experience as a nurse educator. A Principle Component ii Analysis (PCA) performed on the ADS resulted in reordering and renaming of the subscales to enhance its use with nurse educators. The original ADS subscales, inclusion, discrimination, gains, and prospects were changed to belonging, discrimination, gains, and opportunity. Keywords: people with disability, nurse educator, attitude, ADS, Attitudes to Disability Scale, ICF, International Classification of Function, Disability, and Health iii List of Abbreviations AACN American Association of Colleges of Nursing ADA Americans with Disability Act ADS Attitudes to Disability Scale ANA American Nurses Association ANOVA Analysis of variance ATDP Attitudes Towards Disabled People BSN Bachelor of Science in Nursing CCNE Commission on Collegiate Nursing Education DA-IAT Disability Attitude Implicit Association Test ICF International Classification of Function, Disability, and Health IOM Institute of Medicine MSN Masters in Science in Nursing NLN National League for Nursing PDD Preferred definition of disability PCA Principle component analysis RN Registered nurse SPSS Statistical Package for the Social Sciences USDHHS United States Department of Health and Human Services WHO World Health Organization iv Acknowledgments I wish to recognize the numerous people who have supported me through this endeavor. These include classmates, coworkers, my family, and numerous faculty members. I am grateful to Dr. Rick Houser, the chairperson of this dissertation, for his kind, patient assistance and expertise throughout the process. I would also like to thank all of my committee members, Karl Hamner, Alice March, Douglas McKnight, Kagendo Mutua, and Allen Wilcoxon for their feedback and support. I appreciate all of the nurse educators who took time to respond to my survey. Without their willingness to participate and their commitment to graduate education, I could not have succeeded. I am indebted to my entire family for their ongoing support and frequent words of encouragement. This research would not have been possible without the support of my wonderful partner, Bob and my equally wonderful children, Janet, Sam, and Hannah, who have all been great motivators and cheerleaders. It is because of them, that quitting was never an option. Additional recognition goes to the multiple nurses in my family including my mother, her sister and their mother. Nursing is indeed a calling. v Contents Abstract ........................................................................................................................................... ii List of Abbreviations ..................................................................................................................... iv Acknowledgments........................................................................................................................... v List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................. x Chapter I - Introduction .................................................................................................................. 1 Significance of Study ...................................................................................................................... 3 Purpose of Study ............................................................................................................................. 4 Research Questions ......................................................................................................................... 5 Summary ......................................................................................................................................... 5 Chapter II - Review of Literature .................................................................................................... 8 Disability ......................................................................................................................................... 8 Medical Model .............................................................................................................................. 10 Social Model ................................................................................................................................. 12 International Classification of Function, Disability, and Health .................................................. 14 Conceptual Framework ................................................................................................................. 16 vi Attitudes ........................................................................................................................................ 21 Healthcare Professionals and People with Disability ................................................................... 23 Curriculum .................................................................................................................................... 27 Research and Nurse Educator Attitudes Toward People with Disability ..................................... 32 Research Questions ....................................................................................................................... 34 Problem Statement ........................................................................................................................ 35 Chapter III - Methodology ............................................................................................................ 37 Participants .................................................................................................................................... 37 Materials and Procedure ............................................................................................................... 39 Attitudes to Disability Scale for People with Disabilities ............................................................ 42 Defining Disability........................................................................................................................ 44 Demographic Data ........................................................................................................................ 46 Procedures ..................................................................................................................................... 47 Data Analysis ................................................................................................................................ 48 Chapter IV - Results...................................................................................................................... 50 Preliminary Analyses .................................................................................................................... 50 Demographics ............................................................................................................................... 50 Principal Component Analysis of the ADS .................................................................................. 61 Summary ....................................................................................................................................... 67 Chapter V - Discussion ................................................................................................................