Nurses with disabilities: a pilot test of the Nurses’ Attitudes toward Nurses with Disabilities Scale

The survey was administered to a convenience sample of registered nurses working in three Puget Sound area tertiary care hospitals. Participants were recruited via flyers posted in break rooms on patient care units and email messages. Each of the three study sites employs approximately 1000 registered nurses. To be eligible, subjects had to be registered nurses, currently employed on a patient care unit of a hospital (either inpatient or outpatient) and have had at least six months experience in their current position.

This study was approved by the University of Washington Human Subjects Division, the Benaroya Research Institute at Virginia Mason and all appropriate committees at participating facilities prior to subject recruitment. In addition, approval was obtained from the Seattle University Institutional Review Board prior to final data analysis.

Responses were received from 145 registered nurses: 131 met eligibility criteria. Sample characteristics are summarised in Table 1. Participants reflected the aging demographics of the nursing work force, with a mean age of 44 (range = 23–65). Years of experience in nursing were similarly high, with an average of 17 years (range = 8–39). As expected, since nursing remains a female-dominated profession, 98% of the respondents were female. Over three-quarters of the study respondents held a baccalaureate degree or higher, with 13 at the master’s level and three having attained a professional or doctoral degree. The majority of respondents were staff nurses (87%) as opposed to administrators or managers. About 14% self-identified as having some kind of disability. There was no statistically significant difference between the three sites on any of these characteristics (see Table 1).

Study respondents reported working in 29 different work units, representing critical care, emergency room, operating room (OR), post-surgical care, medical/surgical units and outpatient clinics. For data analysis, these were aggregated to intensive care unit (ICU), medical/surgical units, OR/post-surgical care units, outpatient clinic/short stay units, other (not elsewhere classified) and other (not identified by the respondent). Almost one quarter of the respondents work primarily in an ICU environment, over one third work in a medical/surgical setting, about 14% work in outpatient clinics or short stay units, and about 16% practice in an OR or post-surgical care unit. There were no statistically significant differences in distribution of work location between the three sites (Chi-square = 12.782; df = 10; p = 0.24).

The Organisational Climate subscale was comprised of 14 items, making up four factors, which are described below (see Table 2).

The Feelings/Attitudes subscale was comprised of 15 items that looked at respondents’ attitudes toward nurses with disabilities working on their units. Within this subscale, four factors were identified, which are described below (see Table 3). For data analysis, because the majority of the items in the subscale expressed negative attitudes, all items expressing positive attitudes were transformed into negative structures, resulting in ‘adds value’ becoming ‘detracts value’. The remaining six items did not sufficiently load on any factor and were thus eliminated.

The survey included four items measuring respondents’ experience with individuals who have disabilities (see Table 5). Two of the items allowed more than one answer to be marked; thus, the highest level of experience marked was included in the analysis. This information was used to explore whether or not experience with individuals with disabilities impacts attitudes toward nurses with disabilities or perceptions of factors that might contribute to the disability climate. More than half of the respondents indicated that they either had a physical or sensory disability themselves or they had a close friend or family member with such a disability. The vast majority of respondents had cared for at least one patient with a physical or sensory disability, and over 75% had worked with a health care professional who had such a disability. Most respondents had some exposure to individuals with disabilities in grade school, high school or college.

There were no significant differences in perceptions of climate factors or attitudes based on age or years of nursing experience (see Table 6).

Respondents answered two questions regarding disability status and experience/exposure, which were converted to four dichotomous variables: (1) whether or not they had a physical or sensory disability themselves; (2) whether or not they had experience working with a health care professional of any kind who had a physical or sensory disability; (3) whether or not they had patients with disabilities; and (4) if they had no exposure to individuals with disabilities in their professional lives. Analysis revealed several areas with significant differences based on the levels of exposure to individuals with disabilities (see Table 6). Respondents who had no experience with individuals with disabilities demonstrated significant differences in their responses to the social inclusion component (F_(24,105) = 1.687, p = 0.038). Respondents who had experience caring for patients with disabilities demonstrated significant differences in their responses to the supportive climate component (F_(31,97) = 5.264, p = 0.000), the physical plant accessibility component (F_(12,116) = 2.644, p = 0.004) and the incapable/non-workable component (F_(35,93) = 2.408, p = 0.000). The group with patient exposure showed a more positive perception of physical plant accessibility in the workplace than the group with no exposure at all. The group with patient exposure also showed a more positive attitude toward the capability of nurses with disabilities than those without any patient exposure. Furthermore, the group with patient exposure had significantly more positive responses to the absolute barrier component than the group with no exposure at all (F_(12,115) = 3.166, p = 0.001). It is important to note that these associations among these disability variables and outcomes do not control for other forms of exposure to disabilities, such as experiencing one’s own disability or experience with a peer who has a disability.

Respondents were classified according to whether they held an associate degree or diploma school certificate, a baccalaureate degree or a master’s degree or higher. Analysis revealed no significant differences in perceptions of climate factors or attitudes based on level of education, with the exception of the ADA awareness component (F_(19,111) = 1.844, p = 0.026); the higher the level of education, the more likely the respondent has some awareness of the ADA.

Respondents were asked to identify the unit on which they spend most of their current work time from a list of 63 possible units. Responses spanned only 24 of the options. These were consolidated into ICU, med/surg, OR, outpatient, other (not elsewhere classified) and other (not identified by the respondent).

Analysis of variance revealed significant differences in responses within three out of the four Organisational Climate subscale components based on practice area (see Table 6). On the total Organisational Climate subscale (F_(5,124) = 3.641, p < 0.05), the post hoc Scheffe test shows significant differences between ICU and outpatient/short stay (p < 0.05). Overall mean scores were higher for outpatient/short stay, suggesting that Organisational Climate is more positive in those units. Responses differed significantly with respect to social inclusion (F_(5,123) = 2.846, p < 0.05), primarily driven by the difference in means between the ICU (mean = 4.0431) and the outpatient units (mean = 5.4167). The post hoc Bonferroni test was significant for ICUs and outpatient units (p < 0.05). Practice area was also significantly related to supportive climate (F_(5,124) = 2.541, p < 0.05), but post hoc tests were not significant. There were no significant differences amongst practice areas with respect to ADA awareness (p > 0.05). Practice areas significantly differed with respect to physical plant accessibility (F_(5,124) = 3.813, p < 0.05); both Scheffe and Bonferroni post hoc tests show significant differences between ICU and outpatient areas (p = 0.017; p = 0.003), scores suggesting that physical plant accessibility is more positively perceived in outpatient areas than in ICUs.

Practice areas significantly differed on the incapable/non-workable component of the attitudes subscale (F_(5,124) = 2.426, p < 0.05); however, post hoc tests did not show significance. There were no significant differences with respect to the remaining components of the subscale (p > 0.05).