Universal Design for Instruction as a Catalyst for Transforming Nursing Education
Levey, Janet A.
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Session presented on Saturday, April 9, 2016, and Friday, April 8, 2016: The Institute of Medicine (IOM, 2010), American Association of Colleges of Nursing (AACN) (2008), and National League for Nursing (NLN, 2005) have called upon nursing education to transform its paradigm to embrace technology, evidence-based practice, cultural diversity, interdisciplinary communication, leadership skills, critical judgment, and teamwork using innovative and effective pedagogies that engage all types of learning styles. In meeting educational reforms, nursing faculty are challenged to provide meaningful and inclusive learning experiences for all learners, with and without disabilities (Aaberg, 2012; Crary, 2012; Fleming, Mckee & Huntley-Moore, 2011; Levey, 2014, in press; Neuman et al., 2009; Marks & Ailey, 2014; Rosenberg & O'Rourke, 2011; Dupler, Allen, Maheady, Fleming, & Allen, 2011). Universal design for instruction (UDI) is relatively new to postsecondary education and is a strategy for meeting the diverse learning needs of students. UDI is a proactive teaching approach focused on instructional design and teaching strategies that benefit the broadest range of learners, with and without disabilities (Embry & McGuire, 2011; McGuire, 2011; Lombardi, Murray, 2011; Lombardi, Murray, & Dallas, 2013). UDI is not a form of accommodation (Orr & Hamming, 2009). Accommodations are mandated by law when a student provides documentation of a disability recognized under the Americans with Disability Act Amendments Act of 2008 (ADAAA) (42 U.S.C. 12102 (a) (A)). Faculty adoption of UDI teaching practices is by choice, not mandate. The UDI framework is more than technological access to course content; it is an accessible pedagogy approach to the teaching/learning process and its environments (Rose, 2006). Over the past 15 years, UDI principles have been developed and applied to postsecondary education for accessible learning environments (Embry & McGuire, 2011; McGuire & Scott, 2006; McGuire, Scott, & Shaw, 2003, 2006; Shaw, 2011; Lombardi et al., 2011; Lombardi, Murray, & Gerdes, 2011; Roberts Park, Brown & Cook, 2011; Shaw, 2011). However, the UDI framework has been slow to diffuse into nursing education (Levey, 2014, in press). Faculty role development and UDI awareness was frequently cited as key to teaching effectiveness and success inclusive practices in the postsecondary classroom (Embry & McGuire, 2011; Hennessey & Koch, 2007; McGuire & Scott, 2006; McGuire et al., 2006; Parker , Robinson, & Hannafin, 2007; Roberts et al., 2011). Though not formally recognized by faculty, UDI principles are often self-discovered through a process of trial and error when responding to the diverse learning needs of students (Scott. McGuire, Foley, 2003; Scott, McGuire, & Shaw, 2003). The purpose of the literature review was to ascertain the current state of UDI in nursing education. The aim was to assess specific use of UDI in educational environments (e.g., classroom, online, clinical, simulation and skills labs). Literature from 2000 to 2015 was searched to percolate articles reflective of UDI usage in the 21st Century. A combination of key terms included: universal design, universal design for learning, universal design for instruction, universal instructional design, nursing education, postsecondary, college, university or higher education. Boolean operators of "scholarly journals," "OR," and "language" in English resulted in 151 articles. An ancestry approach and hand search revealed three additional articles which complemented the exploration of relevant articles. Duplicates were removed and 45 articles remained for the inclusion/exclusion screening analysis. Inclusion criteria for this literature review were (a) quantitative, qualitative, mixed-method research studies; (b) major featured articles, literature or integrative reviews; (c) universal design for instruction principles were identified in the title, key word, abstract or body of the article; (d) in postsecondary, college, university or higher education; and (e) within date parameters. Articles were excluded if they did not meet the inclusion criteria. Twenty-eight articles were advanced for the literature review. A table was created to assist with the analysis using the headings of author(s)/date, purpose, design/setting/sample, strengths/limitations, findings. Another table was created to identify the use of UDI in nursing educational environments (e.g., classroom, online, clinical, simulation and skills labs). The analysis of the literature revealed a lack of role development for new faculty and limited UDI awareness and knowledge were barriers to the use of UDI pedagogy. Most articles on the use of UDI in nursing education were from outside the nursing discipline (e.g., Postsecondary Education, Education and Disability, Rehabilitation). A prevailing theme was faculty and academic institutions limited UDI awareness and orientation programs (Embry & McGuire, 2011; Embry et al. 2005; McGurie, 2011; Levey, 2014). A negative outcome might be faculty are unknowingly excluding students with different learning styles or disabilities based on instructional design and teaching strategies used in learning environments (Levey, 2014; Pliner & Johnson, 2004). The body of literature focused on nursing students with disabilities, identifying a significant gap in research based on UDI practices benefiting all students, including those without disabilities. The use of UDI in nursing educational settings mainly identified technology and equipment in the classroom and clinical setting (e.g., computers, software, and amplified stethoscopes). Marcyjanik & Zorn (2011) authored the only article which highlights the use of UDI principles in nursing education; however, it was limited to online learning. The gap between UDI research and practice was further exacerbated when materials, content, assessments, instructional design, and teaching strategies were not addressed. Further study of UDI in nursing educational settings is warranted. The findings of the literature review highlight the need for professional in-services to launch awareness and knowledge of UDI teaching practices in nursing education. The IOM, AACN, and NLN have called for a transformation in nursing education reflective of best teaching practices which are effective, innovative, and inclusive for all learners. The use of UDI principles is a means by which to answer the call to reform educational practices and is a catalyst to welcoming learning diversity in the nursing educational settings. The interactive presentation will engage the audience to: 1) Define the UDI framework, 2) Differentiate between accommodations based in ADA and inclusive teaching practices based in UDI, 3) Examine UDI application in classroom, online, clinical, simulation and skills labs, 4) Propose one UDI strategy to incorporate in a teaching/learning environment.