Ableism and the discourse of risk and safety in patient-facing work-integrated learning

In many countries, such as Canada, the USA, England, and Australia, to graduate from a regulated profession such as nursing, students must complete a set of work-integrated learning (WIL) hours and demonstrate their ability to safely perform physical skills and apply knowledge in relation to professional standards. For a disabled nursing student (DNS) undergoing training in higher education institutions (HEI), securing proper accommodations to participate effectively in WIL experiences has been difficult due to concerns related to risks to self and patient safety. This study used critical discourse analysis to investigate the framing of risk and safety in association with providing DNS with accommodation in WIL. Our data were collected from an intensive codesign (group-based discussion) session with participants (n = 16), including clinicians and DNS, from four institutions (two WIL-sites and two HEI organizations). Using an iterative thematic approach based on Foucauldian framework, our analysis revealed three ways in which health professionals discursively framed risk and safety: (a) beliefs that a lack of disclosure by disabled students decreases patient safety and indicates poor self-reflection, (b) concerns that accommodating students poses a risk to institutions offering WIL experiences and to the relationships between HEI and institutions offering WIL-sites, and (c) a framing which challenges the dominant discourse by thinking about safety and risk more expansively. Our findings suggest the first two of these framings are ableist and function to enact barriers to access for DNSs in WIL, whereas the third framing serves the goal of inclusion. Recommendations to address the current ableist discourse within the Canadian nursing context are provided, which may also be applicable across other regulated health professions.