Annotated Bibliography

User Generated

rzvyl2147

Humanities

Description

An annotated bibliography is a document containing selected sources accompanied by a respective annotation. Each annotation consists of a summary, analysis, and application for the purpose of conveying the relevance and value of the selected source. As such, annotations demonstrate a writer’s critical thinking about and authority on the topic represented in the sources.

In preparation for your own future research, an annotated bibliography provides a background for understanding a portion of the existing literature on a particular topic. It is also a useful precursor for gathering sources in preparation for writing a subsequent literature review.

Review the six articles attached on the research topic of special needs education. There are two quantitative research articles, two qualitative research articles, and two mixed methods research articles.

Prepare an annotated bibliography that includes the following:

  • A one-paragraph introduction that provides context for why you selected the research articles you did.
  • A reference list entry in APA Style for each of the six articles that follows proper formatting. Follow each reference list entry with a three-paragraph annotation that includes:
  • A summary
  • An analysis
  • An application as illustrated in this example
  • A one-paragraph conclusion that presents a synthesis of the six articles.

Use subheadings to separate each major section; meaning list "Qualitative Annotated Reviews" and thenpresent the two articles. Then continue to do the same for the quantitative and mixed method. Bottom line, make sure it's clear what type of article is being reviewed. Don't skip around; meaning present the articles in order:qualitative articles, then aquanitative articles, and finally the mixed methods articles.

Format your annotated bibliography in Times New Roman, 12-point font, double-spaced. A separate References list page is not needed for this assignment.

Unformatted Attachment Preview

1-SUMMARY of the information you found in that specific source. The summary section gives your reader an overview of the important information from that source. Remember that you are focusing on a source's method and results, not paraphrasing the article's argument or evidence. The questions below can help you produce an appropriate, scholarly summary: ● What is the topic of the source? ● What actions did the author perform within the study and why? ● What were the methods of the author? ● What was the theoretical basis for the study? ● What were the conclusions of the study? Remember, a summary should be similar to an abstract of a source and written in past tense (e.g. "The authors found that…" or "The studies showed…"), but it should not be the abstract, written in your own words. 2-CRITIQUE/ analysis of each source. In this section, you will want to focus on the strengths of the article or the study (the things that would make your reader want to read this source), but do not be afraid to address any deficiencies or areas that need improvement. The idea of a critique is that you act as a critic—addressing both the good and the bad. In your critique/analysis, you will want to answer some or all of the following questions ● ● ● ● ● ● ● ● ● ● ● ● ● ● Was the research question well framed and significant? How well did the authors relate the research question to the existing body of knowledge? Did the article make an original contribution to the existing body of knowledge? Was the theoretical framework for the study adequate and appropriate? Has the researcher communicated clearly and fully? Was the research method appropriate? Is there a better way to find answers to the research question? Was the sample size sufficient? Were there adequate controls for researcher bias? Is the research replicable? What were the limitations in this study? How generalizable are the findings? Are the conclusions justified by the results? Did the writer take into account differing social and cultural contexts? 3-APPLICATION-justify the source's use and address how the source might fit into your own research. Consider a few questions: ● How is this source different than others in the same field or on the same topic? ● How does this source inform your future research? ● Does this article fill a gap in the literature? ● How would you be able to apply this method to your area of focus or project? ● Is the article universal? Remember, annotated bibliographies do not use personal pronouns, so be sure to avoid using I, you, me, my, our, we, and us. 99 International Journal of Learning, Teaching and Educational Research Vol. 15, No. 11, pp. 99-110, October 2016 A Qualitative Study of the Perceptions of Special Education Personnel about Inclusive Practices of Students with Disabilities Jeanine Birdwell, EdD, Lori Kupczynski, EdD (corresponding author), MarieAnne Mundy, EdD and Steve Bain, DMin Texas A & M University-Kingsville Center for Student Success 700 University Blvd. Kingsville, TX 78363 Abstract. Students with disabilities in the State of Texas are now required to participate in state wide academic assessments with passing rates tied to federal funding. This qualitative research studied the perceptions of district personnel regarding instructional practices for students with disabilities utilizing open-ended, semi-structured interviews of a principal, special education director, diagnostician, and special education teacher from each of two districts. District 1 exclusively used the inclusion model while District 2 used a combination of inclusive and pull-out programs to provide special education services. The interviews were analyzed utilizing coding which generated the following themes: the importance of positive relationships between general and special education educators and between students and teachers, individualization of the needs of each student, and the importance of the availability of resources such as appropriate staff and dedicated time on the successful implementation of inclusion. Keywords: Texas education; student disabilities; inclusion; educational resources Introduction Ensuring that every student has access to general education curriculum rather than equitable curriculum through placement in general education classrooms is considered an issue of social justice (Turnball, 2012). Increased focus on state wide assessments and accountability for every individual student has caused districts to reconsider best practices for instruction and placement of students with disabilities. In addition, there is no clear guideline to demonstrate successful implementation of such services. Districts with special education populations demonstrating low performance levels benefit from implementation of alternate service models and inclusion style services in the general education classroom. Students with disabilities who receive academic support and services © 2016 The authors and IJLTER.ORG. All rights reserved. 100 to ensure their academic success are impacted by this problem. Contributing to this problem are many possible issues including support services dedicated to inclusion implementation and educational placement. This study contributes to the research knowledge base necessary to address this issue by gathering qualitative data to reveal successful and unsuccessful inclusive practices in high schools in South Texas districts 4A and larger as expressed by school principals and lead special education personnel. The University Interscholastic League (2016) assigns school districts in Texas a classification ranging from 1A-6A based on student enrollment. Review of Literature No Child Left Behind (NCLB) state level accountability standards and systems for mathematics and reading were developed and implemented with the intention that every student would have and maintain proficiency in both math and reading by the 2013-14 school year. Administrators are also required to examine the annual progress of student subgroups, including those with disabilities. NCLB was an active force in convincing administrators to assess the importance and necessity of access to general education curriculum in the general education setting for all students. Students with disabilities, if they are to be expected to meet statewide assessment standards, need access to regular education curriculum (Ross-Hill, 2009). The Individuals with Disabilities Education Act (IDEA) and NCLB push the need for inclusive instruction. The triumph of both laws hinges on the expertise and mindset teachers portray in the classroom (Ross-Hill, 2009). Few educators would disagree with federal law, but instructional practices may not reflect that ideology. While general education teachers may be supportive of inclusion in theory, most of them do not feel that, in practice, they can integrate students with disabilities successfully into their classrooms (Santoli, Sachs, Romey & McClurg, 2008). Least Restrictive Environment The principle of least restrictive environment (LRE) is a critical component of the Individuals with Disabilities Education Act. LRE necessitates that children with disabilities be educated alongside students who do not have disabilities as much as possible. Aron and Loprest (2012), found that 95% of students with disabilities are in public schools, but they are outside the general education classroom. As a student reaches high school, he or she is more likely to be removed from the general education (Aron & Lomprest, 2012). Inclusion becomes increasingly difficult at the high school level due to course content and curriculum complexity, instruction models, achievement gaps, high stakes testing, and accountability to outside agencies like colleges (Rice, 2006; Keefe & Moore, 2004; Dieker, 2001; Mastropieri & Scruggs, 2001). Inclusion The principle of inclusion requires that all students have the opportunity to participate in society, or in the case of education, the general education setting. Critics of this notion argue that the strengths and weaknesses of the child must be considered along with the environment. Each student has a different level of capacity (Lindsay, 2003). Inclusive education refers to the dedication to educate students with disabilities, to the appropriate maximum extent, in the general education classroom he or she would traditionally attend. Inclusion involves providing needed instructional and/or related services to the © 2016 The authors and IJLTER.ORG. All rights reserved. 101 child and involves only that the child advances from being in the class (Yell, 2006). In accordance with the principle of least restrictive environment, inclusion suggests that students with disabilities are placed in the general education classroom with needed supplementary aids and services. Students are only removed from that setting if necessary services cannot be provided in the general education setting. There are many benefits to inclusion for all students, but without proper implementation and support it can be a frustrating process for all stakeholders (Hammel & Hourigan, n.d.). In the general education setting, special education students are often held to higher educational standards and develop better social skills (Ripley, 1997). Special Education Service Models Models for special education services are best described as being a continuum of services and placements. A commonly misunderstood principle is that the least restrictive environment for all students is the general education classroom. While the regular education classroom may be the least restrictive environment within the special education continuum, it may not be the best environment for every student with a disability. In many individual cases, in order to meet a student’s needs a variety of potential placements and services may be required (Farris, 2011; Lindsay, 2003). Variations on placements and services include: a student with a disability may be placed in the general education classroom with the general education teacher meeting all needs; or a special education teacher may serve a consultant style role within the general education classroom or may be more extensively involved in the delivery of services. This model is known as co-teaching or the collaborative teaching model. In this particular model, services are delivered in the general education setting with seldom removal of the student from that environment for service participation. In the resource model, a dedicated special education class is attended as needed while a significant portion of the day is spent in the general education setting. The self-contained model requires students to spend minimal time within the general education setting with the majority of services being delivered in a dedicated special education setting or classroom. This model is typically reserved for students for which inclusion has proved unsuccessful and leverages the advantages of small group instruction and increased attention from educators. Research from 2000-present The attitude of the general education teacher towards inclusive practices is a key factor in implementation of inclusion (Daane, Beirne-Smith & Latham, 2000; Henning & Mitchell, 2002). Henning and Mitchell (2002) noted that, “teacher perceptions about exceptional students may be the factor with the greatest effect on student success” (p.19). In 2000, Daane, Beirne-Smith, and Latham looked at the perceptions of both administration and teachers regarding the collaboration process of inclusion in elementary grade levels. All parties participating in the study agree that students with disabilities have the right to education in the general education setting. Conversely, all parties also agreed that instruction for students with disabilities in the general education setting was not effective due to concerns with preparedness of the general education teacher, discipline concerns, and workload for the general education teacher. © 2016 The authors and IJLTER.ORG. All rights reserved. 102 Research conducted by Ramirez (2006) and Smith (2011) also supports the findings that the majority of administrators believe that special education students have the right to be educated in the general education environment at the cost of academic benefits. A series of qualitative interviews conducted by Daane, Bierne-Smith and Latham (2000) and Mulholland & O’Connor (2016) revealed that teachers believe more collaboration is necessary between general education and special education teachers regarding student individualized education plans (IEPs) and instructional planning for the inclusion process to be more effective. Collaboration is critical for successful implementation of inclusion and should include all stakeholders: administration, general education teacher, special education teacher, counselor, social worker, related service providers, paraprofessionals, and family (Salend, 2005). Collaboration is an ongoing process and all parties must be open minded participants for the development of a comprehensive plan (Daane et al, 2000). General educators need more guidance on curriculum differentiation, and the implementation of accommodations and modifications. However, scheduling conflicts, lack of knowledge, and lack of time often impede collaboration time (Daane et al, 2000) (Worrell, 2008). Muholland and O,Connor (2016) found that their teachers endorsed time restraints as a limitation to collaboration. According to Rice (2006), teachers are also concerned with the legal, ethical, pedagogical, and procedural aspects of IEP implementation. Legally, general education teachers become responsible for ensuring the service times specified in the IEP are being met. A solid foundation in special education laws, issues and terms, is critical for the general education teacher to successfully implement an IEP (Liston, 2004; Worrell, 2008). Principals need understanding of legal regulations, legislation, and practices regarding students with disabilities, as well (Lasky & Karge, 2006). Lack of training on effective implementation of accommodations and modifications is a frequently reported issue (Galano, 2012; Rice, 2006). Galano (2012) noted that teachers’ attitudes towards inclusion are significantly correlated to the level of training. Shoulders and Krei (2016) found that the more hours general education teachers spent in professional development and coteaching the higher the efficacy in student engagement. Similarly, limited training in special education also resulted in principals having negative views of inclusion (Galano, 2012). Santoli et al. (2008) found a group of Southeastern middle school teachers who felt confident in their teaching strategies and collaborative strategies in working with special education students, increasing the likelihood of successful implementation of inclusive practices. Without a positive attitude towards academic outcomes, teachers are just going through the motions. There is a significant relationship between teacher expectations and student success (Henning & Mitchell, 2002; Santoli et al., 2008). Monsen and Frederickson (2004) also identified that special education students’ performance on standardized test scores is directly correlated to the attitude of their general education teachers and their teachers’ view on inclusion. The effectiveness of educational inclusion services can be influenced by the campus administrator (Praisner, 2003). In her research with elementary school principals, Praisner found that implementation of inclusive practices occurred more frequently when the principal had positive views of inclusion. © 2016 The authors and IJLTER.ORG. All rights reserved. 103 Galano (2012), Ramirez (2006), and Smith (2011) also found a correlation between the promotion of inclusive placements and principal’s attitude. Role of the Campus Administrator in Inclusion Implementation With the growing implementation of inclusion services, the role of the principal is widened to include more paperwork, an increase in the number of personnel needed, and therefore more duties (Praisner, 2003). Administrators can lead in a way that maintains status quo, or lead in a way that promotes social change. Strong leaders build relationships in the community and build capacity of a campus team. These relationships allow for the implementation of practices that foster a culture that supports diverse learners (Riehl, 2000). Principals promote inclusion in their actions, words, interests, activities, and organization of staff and resources. Villa, Thousand, Nevin & Liston (2005) described that the degree of administrative support for inclusive practices was the strongest predictor of the attitude of the general education teacher towards inclusion. Support can be provided in the form of school climate (Cook, Semmel, & Gerber, 1999), opportunity for collaboration (Barnett & Monda-Amaya, 1998), or professional development (Shade & Stweart, 2001). Dieker (2001) described successful inclusion implementation has hinging on six co-teaching practices. First was a positive climate between students and teachers supporting an attitude of acceptance through cooperative learning. Secondly, inclusion is only accepted primarily through the staff’s positive perception. Additionally, active student centered learning is necessary to help create an environment with engaged students while allowing for peer tutoring opportunities. Further, accommodation integration can be achieved through activity based instruction. High academic and behavioral expectations for every student are necessary as well. Mutual planning time between co-teachers must also be used effectively to plan lessons. Finally, multiple evaluation methods such as written assessments, presentations and projects in addition to performance tasks should be used to gauge student learning. DiPaola and Walther-Thomas (2003) identified skill areas critical for principals in ensuring growth of student with special needs. Principals must have knowledge of each disability along with the learning, behavioral or medical challenges of each. In addition, they must possess thorough knowledge of laws and educational rights of special needs students so that they may communicate with families. Equally important, principals lead the implementation of research based teaching practices on campus. Lastly, principals need a clear understanding of the supports necessary to make inclusion successful (DiPaola & Walther-Thomas, 2003). They are responsible for securing support services, supplies and necessary resources (Frederico, Herrold, & Venn, 1999). Methodology Two high school principals from a 4A or larger district in the South Texas region and six lead special education personnel from each of those districts were interviewed. The qualitative data was coded for themes to determine successful instructional practices in regards to students with specific learning disabilities. Population and Sample The researcher began interviews by selecting two high school principals from 4A or larger high schools in the South Texas region. Next, interviews were © 2016 The authors and IJLTER.ORG. All rights reserved. 104 conducted with six lead special education personnel recommended by the principal from the district. Principals and lead special education personnel were selected through purposive sampling. The purposive sampling in this study is informational in nature in order to capitalize on the strengths and weaknesses of inclusion programs in Texas high schools 4A and larger in the South Texas Region. Principals and lead special education personnel were selected based on their involvement with special education students on the high school campus. The purpose of interviewing the principals and lead special education personnel from each district was to identify their perceptions of successful instructional practices for students identified with specific learning disabilities. Each district has autonomy in developing service models for special education services, allowing for differences in instruction and therefore achievement. Instrumentation The study involved the gathering of data through open-ended, semistructured interviews with purposefully selected participants. This questionnaire was composed of twelve open-ended questions. The purpose of the questionnaire was for participants to express their experiences with inclusive practices with students with disabilities and to share their opinions about practices that contribute to successful implementation of instruction for students with disabilities. Interview Protocol: 1. What is your position with the district and how many years of experience do you have? 2. Are you familiar with the terms inclusion, resource, and co-teaching? 3. If so, how would you describe each one? 4. What instructional service models are used in this district? 5. What is your role in the implementation of services for students with learning disabilities? 6. How does the district implement inclusive instructional support? 7. What have been your experiences with inclusion and resource instruction? 8. What do you think are the factors that contribute to successful implementation of inclusion services? 9. What do you think are the biggest obstacles in implementation of inclusion? 10. Do you believe that instructional setting affects academic success of students with specific learning disabilities? Why or why not? 11. What is your ideal vision of instructional services for students with specific learning disabilities? 12. Are there any comments you would like to add? Procedures and Data Analysis Data was gathered by conducting one-on-one interviews with selected participants. The participants were asked to provide their personal experiences in response to the interview questions. A digital audio recorder was used to record the entire interview in order to ensure accuracy. The digital recording for each interview was saved in an audio computer file and transcribed. The data was analyzed through descriptive coding. © 2016 The authors and IJLTER.ORG. All rights reserved. 105 Results District Profiles District 1 is a large district in the South Texas region. Based on the 2014 State of Texas Assessment of Academic Readiness End Of Course (STAAR EOC) data, the special education population is 9% of the district population and 77% of the students are economically disadvantaged. This district is predominately Hispanic (94%). Figure 1 summarizes the ethnic breakdown of the student population. District 1 [CATEGORIENAAM ] 5% Other 1% Hispanic White Other [CATEGORIENAAM ] 94% Figure1: Ethnic Groups of District 1 District 1 used the inclusion model to provide services to students with learning disabilities. Interviews revealed that inclusion services were provided by either a special education certified teacher or a paraprofessional and that most students were served in English and/or Math for twenty to thirty minutes three days per week. District 2 is also a large district in the South Texas region. Based on the 2014 STAAR data, 10% of the district population receives special education services and 41% of the district is economically disadvantaged. District 2 is predominately Hispanic (56%). Figure 2 illustrates this information. © 2016 The authors and IJLTER.ORG. All rights reserved. 106 District 2 [CATEGORIENAAM [CATEGORIENAAM ] ] 1% [CATEGORIENAAM .3% ] 2% Hispanic [CATEGORIENAAM ] 40% White [CATEGORIENAAM ] 56% African American Asian Native American Figure 2: Ethnic Groups of District 2 Participants from District 2 reported using a combination of coteaching, other inclusive practices, and resource support to provide services for students with learning disabilities. Co-teaching was done by two certified teachers five days per week for the entire class period. Inclusion support was provided by a certified teacher or a paraprofessional. Frequency and duration ranged, and depended on the needs of the student. Resource services were provided in a location other than the general education classroom. The class was taught by a teacher who is certified both in the content area and in special education. Seven female and one male participated in the semi-structured interviews. Ages ranged from 34-63. Two of the female participants were Hispanic, and the other participants were Caucasian. Table 1 presents the pseudonym, position and district for each participant. Table 1: Research Participants Interview # Participant 1 2 3 4 Dan Sue Jan Cindy 5 6 7 8 Amy Mary Elizabeth Ann Position District High School Principal Special Education Director Educational Diagnostician Lead Special Education Teacher High School Principal Special Education Director Educational Diagnostician Lead Special Education Teacher 1 1 1 1 2 2 2 2 Both principals defined the terms inclusion and co-teaching in similar ways. Inclusion was seen as a classroom composed of both general education students and special education students of varying instructional levels. Primary © 2016 The authors and IJLTER.ORG. All rights reserved. 107 delivery of instruction is performed by the general education teacher with a special education teacher or paraprofessional as a support system. In coteaching, “both teachers deliver the primary lesson” and students have the opportunity to “learn in two different ways”. It was explained that teachers in this model have “the same conference time to plan together” in order for both teachers to be “on the same page”. Personnel in special education agree that coteaching and inclusion both involve the education of special education students in the general education setting with some instruction provided by a special education teacher or paraprofessional. The recurring idea shared by the six special education professionals is that theirs is a role of support. Directors support services by providing training opportunities and sending staff to workshops. Diagnosticians and special education teachers support general education teachers in a variety of ways. Special education teachers support all students in the classroom by “re-teaching, redirecting, and varying instructional strategies”. The theme of relationships emerged as the primary factor affecting successful inclusive practices. Both principals reported that the relationship between the general education teacher and the special education teacher is the leading predictor of whether inclusion will be successful. Special education personnel agree. Successful inclusive practices depend on the “attitude of the general education teacher.” “The teachers have to be willing to learn new instructional strategies and willing to accommodate for our students.” The special education teachers also stressed the importance of building relationships with the special education students in the classroom. All personnel interviewed spoke frequently of the importance of individualization when it comes to the education of special education students. Both principals agreed that individualized supports should be in place for each student, and that some students require a smaller setting to find their “comfort zone” and address their “learning style.” The most important limiting factor in the implementation of inclusion identified by all respondents was time. All participants stressed that it is crucial for inclusion and general education teachers to have a common planning time for inclusion to be a success, but that scheduling and the master schedule were obstacles. The participants also spoke of needing more staff to implement services. According to one participant, “some of our teachers are supporting three different teachers. It is hard to plan and have any ownership of that many classrooms.” Money and time also affect the ability of the districts to provide training to their teachers. All respondents voiced a need for increased training. Respondents noted that training for general education teachers is needed to ensure understanding of the inclusion models and disability education. Conclusions Several themes emerged from the semi-structured interviews. All participants discussed the importance of relationships in successful inclusive practices. Relationships must be developed between general education and special education teachers, as well as between teachers and the students. The © 2016 The authors and IJLTER.ORG. All rights reserved. 108 second theme was the need for individualization in making decisions regarding educational settings for students with learning disabilities. Participants agreed that the needs of each student must be considered individually, on a case-bycase basis. Participants also agreed that the availability of resources limits the successful implementation of inclusion. Specifically, time and staff were named. Time is necessary to develop collaborative relationships between teachers and between teachers and students, and to plan for instruction. Lastly, respondents voiced a need for training for both general education and special education teachers. Topics included the implementation of accommodations and modifications and the nature of disabilities for general education teachers, and content area curriculum for special education teachers. The findings of this study suggest that there is no one size fits all model for all students with learning disabilities. Participants in this study expressed the idea that a continuum of services be available to meet the needs of each student. The results of this study provide information to be used by lead special education personnel, Administrators, and Admission, Review, and Dismissal committees as they seek to meet the needs of every student including students with disabilities. This research suggests that instructional arrangements, or the placement of a student with a disability in general education or resource classrooms, may not be a significant factor contributing to academic achievement for students with disabilities. This study limited qualitative data to interviews with administrators and lead special education personnel in each district. Future research could include perspectives from other stakeholders such as general education teachers, parents, and students. References Aron, L., & Loprest, P. (2012). Disability and the education system. The Future of Children, 97-122. Barnett, C., & Monda-Amaya, L. (1998). Principals' knowledge of and attitudes toward inclusion. Remedial Special Education, 19(3), 181-192. Cook, B., Semmel, M., & Gerber, M. (1999). Attitudes of principals and special education teachers toward the inclusion of students with mild disabilities: Critical differences of opinion. Remedial and Special Education, 20(4), 199-207. Daane, C., Beirne-Smith, M., & Latham, D. (2000). Administrators' and teachers' perceptions of the collaborative efforts of inclusion in the elementary grades. Education, 121(2), 331-338. Dieker, L. (2001). What are the characteristics of effective middle and high school cotaught teams for students with disabilities. Preventing School Failure, 46, 14-23. DiPaola, M., Walther-Thomas, C. (2003). Principals and special education: The critical role of school leaders (Doc. No. 18-7) Gainsville, FL: Center for Personnel Studies in Special Education, University of Florida. Farris, Troy K. (2011). Texas high school principals’ attitudes toward the inclusion of students with disabilities in the general education classroom. (Unpublished doctoral dissertation). University of North Texas, Texas. Federico, M., Herrold, W., & Venn, J. (1999). Helpful tips for successful inclusion: A checklist for educators. TEACHING Exceptional Children, 32(1), 76-82. Galano, Joseph A. (2012). Urban elementary school principals’ attitudes toward the inclusive environment. (Doctoral dissertation). Seton Hall University. Retrieved from Dissertation and Theses (ETD’s). Paper 1808. © 2016 The authors and IJLTER.ORG. All rights reserved. 109 Hammel, A., & Hourigan, R. (n.d.). The fundamentals of special education policy: Implications for music teachers and music teacher education. Arts Education Policy Review, 174-179. Henning, M. B., & Mitchell, L. C. (2002). Preparing for inclusion. Child Study Journal, 32(1), 1929. Retrieved July 12, 2014, from Academic Search Premier Database. Keefe, E., & Moore, V. (2004). The challenge of co-teaching in the inclusive classroom at the high-school level: What the teachers told us. American Secondary Education, 32(3), 77-88. Lasky, B., & Karge, B. (2006). Meeting the needs of students with disabilities: Experience and confidence of principals. NASSP Bulletin, 90(1), 19-36. Lindsay, G. (2003). Inclusive education: a critical perspective. British Journal of Special Education, 30(1), 3-12. Liston, A. (2004). A qualitative study of secondary co-teachers. Orange, CA: Argosy University. Mastropieri, M., & Scruggs, T. (2001). Promoting inclusion in secondary classrooms. Learning Disability Quarterly, 24, 265-274. Monsen, J., & Frederickson, N. (2004). Teachers' attitudes towards mainstreaming and their pupils' perceptions of their classroom learning environment. Learning Environment Research, 7, 129-142. Mulholland, M., & O’Connor, U. (2016). Collaborative classroom practice for inclusion: perspectives of classroom teachers and learning support/resource teachers. International Journal Of Inclusive Education, 20(10), 1070-1083. Doi:10.1080/13603116.2016.1145266 Praisner, C. (2003). Attitudes of elementary school principals toward the inclusion of students with disabilities. Exceptional Children, 69, 135-145. Ramirez, R.C. (2006). Elementary principals’ attitudes toward inclusion of students with disabilities in the general education setting. (Doctoral dissertation). Baylor University. Available from ProQuest Dissertations and Theses database. (UMI No. 3216381). Rice, N. (2006). Opportunities lost, possibilities found. Journal of Disability Policy Studies, 17(2), 88-100. Riehl, C. (2000). The principal's role in creating inclusive schools for diverse students: A review of normative, empirical, and critical literature on the practice of educational administration. Review of Educational Research, 70(1), 55-81. Ripley, S. (1997). Collaboration between general and special education teachers. ERIC Clearinghouse on Teaching and Teacher Education Washington D. C., 1-5 Ross-Hill, R. (2009). Teacher attitude towards inclusion practices and special needs students. Journal of Research in Special Education Needs, 9(3), 188-198. Salend, S. (2005). Creating inclusive classrooms: Effective and reflective practices (5th ed.). Columbus, OH: Merrill. Santoli, S., Sachs, J., Romey, E., & McClurg, S. (2008). A successful formula for middle school inclusion: Collaboration, Time and Administrative Support. Ressearch in Middle Level Education, 32(2), 1-8. Shade, R. A., & Stewart, R. (2001). General education and special education preservice teachers' attitudes toward inclusion. Preventing School Failure, 46(1), 3741. Retrieved July 10, 2014, from Academic Search Premier Database. Shoulders, T. L., & Scott Krei, M. (2016). Rural Secondary Educators' Perceptions of Their Efficacy in the Inclusive Classroom. Rural Special Education Quarterly, 35(1), 2330. Smith, Charles Watson. (2011). Attitudes of secondary school principals toward inclusion of students with disabilities in general education classes. (Doctoral dissertation). Retrieved from Electronic Theses & Dissertations (Paper 368). Turnball III, H. (2012). Free at last: Kennedy, King, and the meaning of liberty in the © 2016 The authors and IJLTER.ORG. All rights reserved. 110 disability rights movement. Research & Practice for Persons with Severe Disabilities, 37(3), 210-216. University Interscholastic League. About the UIL. Retrieved November 2, 2016 from www.uiltexas.org/about. Villa, R., Thousand, J., Nevin, A., & Liston, A. (2005). Successful inclusive practices in middle and secondary schools. American Secondary Education, 33(3), 33-50. Worrell, J. (2008). How secondary schools can avoid the seven deadly "sins" of inclusion. American Secondary Education, 36(2), 43-56. Yell, M. (2006). The law and special education (2nd ed.). Upper Saddle River, NJ: Merrill. © 2016 The authors and IJLTER.ORG. All rights reserved. Available online at www.sciencedirect.com ScienceDirect Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 4th World Congress on Technical and Vocational Education and Training (WoCTVET), 5th–6th November 2014, Malaysia Implementation of Inclusive Education For Special Needs Learners with Learning Disabilities Maizatul Azmah Ab.Latiff a, Wan Azlinda Wan Mohamedb, Mohd Azrani Asranc* a,b University Tun Hussein Onn Malaysia, Batu Pahat, 86400, Malaysia Sekolah Kebangsaan Putrajaya18(1), Putrajaya, 64150, Malaysia c Abstract Conducting interviews is a very important qualitative research technique that helps researchers obtains answers from respondents by exploring their perspectives on a particular idea, program, or situation. In this study, the researchers would like to explore the implementation of inclusive education in Special Education Program Integration with Learning Disabilities in primary school. Specifically, this study aims to identify the form of implementation of the program, the form of collaboration and adaptation performed by the subject teacher and resource teacher. To achieve the purpose of the study, the researcher designed structured interview questions for the principal, senior assistant special education teachers, subject teachers and resource teacher. Interview questions were then pilot tested in a primary school in the state of Malacca. Two administrators and two teachers who were involved in the Inclusive Education Program have been selected to be interviewed in this pilot test. Structured interview data were analyzed. Based on the interview, 68 units of themes have been established. These analyzed data were given to three experts to evaluate. Cohen's Kappa index for the validity and reliability of the interview questions were used and Cohen's Kappa coefficient of agreement at 0.7 was obtained. Thus, the set of interview questions is found to be suitable for this study. In addition to this structured interview, the study will also be supported through other findings such as observations and document analysis. © Published byby Elsevier Ltd.Ltd. This is an open access article under the CC BY-NC-ND license © 2015 2015The TheAuthors. Authors.Published Elsevier (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of Faculty of Technical and Vocational Education, University of TunOnn Hussein Onn Malaysia. Peer-review under responsibility of Faculty of Technical and Vocational Education, University of Tun Hussein Malaysia. Keywords:Qualitalive research, Structured Intervie, Inclusive Education Program, Cohen’s Kappa Index * Corresponding author. Tel.:+06-016-9294129; fax:+06-03-88886659 E-mail address:maizatulazmah@yahoo.co.uk 1877-0428 © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of Faculty of Technical and Vocational Education, University of Tun Hussein Onn Malaysia. doi:10.1016/j.sbspro.2015.08.115 82 Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 1. Introduction Inclusive Education Program in Malaysia began in 1962, 1988 and 1999. These differences in years are based on the type of target students with special needs. In 1962, the Inclusive Education Program was implemented for visually impaired students (Tambi, 1997). In 1988, the program was implemented in Special Education Integration Program with Learning Disabilities (Bosi, 2004). This program is the largest contributor to increase enrollment in Inclusive Education Program now. In 1999, Inclusive Education Programs was implemented in technical schools (Shaari, 2005). In Malaysia, the Inclusive Education Program is an education program for students with special needs who are educated in a regular class at government schools or non-government schools for nearly all of the day, or at least for more than half of the day (Malaysia, 2013). Studies related to the Inclusive Education Program in Malaysia are not new. Several researchers in previous studies have conducted it with a different focus. Some of the studies include, “The Perceptions of Inclusive Practices in Malaysia” (Jelas, 2000); “Malaysian Preschool Children with ADHD in Inclusive Setting” (Saad, 2003); “Pilot Study Implementation of Inclusive Education in Malaysia (Bosi, 2004); “Pilot Study on the Commitment and The Role of Teachers in The Implementation of the Approach to Inclusive Education in Malaysia (Saad, 2005); “The Management of Inclusive Education Program in Technical and Secondary Day School” (Shaari, 2005); and “A case Study on Inclusive Education Program Implementation for Autistic Pupils at a Primary School” (Muhammad & Mahmud., 2010). In 2013, a guideline was issued by the Ministry of Education. This guideline briefly describes the procedure for placing pupils in inclusive classes, the age of pupils involved, the typical ratio of pupils and students with learning disabilities in the inclusive classroom, and the responsibilities of relevant parties (in school) in the implementation of Inclusive Education Program. This study will use this guideline to explore the implementation of Inclusive Education Program in Malaysia. This study will only focus on Special Education Integration Program with Learning Disabilities in primary schools. Since most of the research on Inclusive Education program uses quantitative research and/ or mixed methods research, the researchers felt the need to conduct a full qualitative research. This is because in qualitative research, there are various forms of interview design that can be developed to obtain thick, rich data utilizing a qualitative investigational perspective (Creswell, 2007). In this study, the researchers will design a set of interview questions to obtain information from the respondents. Through the interviews, the researchers will have in-depth information relating to the experiences and views respondents by exploring their perspectives on the implementation of inclusive education in Special Education Program Integration with Learning Disabilities in the primary school. The interview was conducted as a pilot study to test the validity of a set of questions developed by the researchers. The pilot study was conducted at School A, Merlimau, Malacca. The interviews became a key instrument in the study of the implementation of Inclusive Education in Special Education Integration Program with Learning Disabilities. Thus, the set of questions must be valid and reliable in order to answer the research objectives effectively. Other than testing the validity of the questions by verifying them through the agreements of experts, themes from the findings in interviews were also established. 2. Purpose and objectives The purpose and the objectives of the study is as follows. 2.1 Purpose of study The purpose of this study is to design a set of interview questions for qualitative research. The set of questionnaires will be validated in a pilot study. This validated interview questions will be used in the study to explore the implementation of Inclusive Education Program in Malaysia. Among the questions posed in this study are: i) ii) How do teachers implement the Inclusive Education Program? What forms of collaboration can occur in the implementation of the Inclusive Education Program? Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 iii) What are the adaptations made by subjects’ teacher and resource teacher to the implementation of Inclusive Education Program? 2.2 Objectives of the study The objective of this study is to: i) Test the validity of the set of interview questions set by the researcher ii) Establish the themes of study from the findings of the interviews iii) Obtain the agreement of experts in order to validate the set of interview questions 3. Research design Qualitative research design can be complicated depending on the level of experience the researcher may have and with particular type of methodology. As researchers, efforts to develop and expand knowledge and experience in the form of qualitative research is very necessary in order to better utilize a variety of research paradigms for further investigations (Tuner, 2010). In qualitative research design, an interview protocol is one area of interest to researchers. Interviews help researchers collect in-depth information on respondents’ views and experiences on a particular idea, program, or situation. In fact, in order to strengthen the findings from interviews, researchers usually makes additional data collection such as through observation and document analysis. Pilot tests should also be carried out to help researchers determine whether there is a weakness, limitation, or other flaws in the set of interview questions. Through the pilot test, the researchers can check and improve the set of questions before performing the actual study (Kvale, 2007). The pilot test will also help researchers refine research questions. The place of study chosen should be simple and not complex (Yussof, 2001). This allows researchers to make more frequent visits, observations and interviews at the school and save time. Respondents should be carefully selected for an interview (Creswell, 2007Ϳ. Researchers should also conduct a pilot study on respondents who are prepared in an open and honest sharing of information or "their story" (p. 133). This is because the interview is easier done in a comfortable environment in which respondents can share the information. 3.1 Research Instruments Research instrument is a device used to measure the variables studied (Konting, 2009). With this instrument, the study is more systematic, organized, focused and have high reliability (Merriam, 2001). In this study, the main instrument is the researchers. This is because the study was carried out based on the thinking of researchers (Yussof, 2001). According to Miles and Huberman (1994), researchers should get a better understanding of making data interpretation because of the dynamic interaction between researchers and informants. 3.1.1 Interview In this study, the researchers choose the structured interview technique because it is suitable for this research. In addition, the structured interview gives more space for the respondents to express their opinion on the scope required. Structured interviews are given consistently to several respondents. Thus, the answer given by the respondents is consistent in the scope of the question. The questions' construction is relatively easy to build. The researchers use protocol questions as proposed by Hill, Knox, Thompson, Williams, Hess and Ladany ( 2005), Protocol questions are a list of questions prepared by the researchers to find answers to the research questions. Protocol questions are arranged according to: a) Introduction questions b) Transition questions c) The key question 83 84 Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 d) Closing questions However, the researchers will also provide additional follow-up questions for the respondents when more information is needed (probing questions). According to Berg (1995), additional questions will provide additional reliability to respond to repeated topics and responses that have been given. This interview was also conducted with flexibility to respondents and is not subject to the order of questions in the interview protocol (Merriam, 2001Ϳ͘The questions used were "open-ended" questions. This is because the research questions should be effective and have the five elements: the words should be open; the question must be as neutral as possible; the question must be asked one by one; the question must be clear; and be cautious when asking the "why" questions (McNamara, 2009). In this pilot study, interviews were carried out to the principal, senior assistant special education teacher, subject teachers and resource teacher. All interviews were then analysed using NVivo8 software. 3.2 Data Collection School A, Merlimau Malacca has been selected as the pilot school to test the validity of the interview questions. Interviews were carried out with the principal, senior assistant special education teacher, subject teacher and resource teacher. Each interview takes approximately 45 minutes to 2 hours. All interviews are recorded using a tape recorder and video recording. 3.3 Data Analysis Data analysis is the process of making sense of the data collected (Merriam, 2009). If the data is not analysed, the data collected will not bring any meaning. Researchers also need to analyse the data each time the data is collected (Miles & Huberman, 1994). This shows that the process of data analysis is an on-going process. In this study after the data is collected, the data is analysed. Data in the form of speech and actions of respondents are collected were then transcribed into word (verbatim). Researchers will conduct data screening (select, focus, simplify, abstract, changing the meaning of the data easy to handle and count) (Miles & Huberman, 1994) In this study, researchers compared the data obtained from respondents, as proposed by Mohammed (2012). The researcher then obtains themes and categories using NVivo8 software. The six steps proposed by Malakolunthu (2001) are namely: a) b) c) d) e) f) Data cleaning The encoding of data Updating the data Analysis of documents Understand of documents; and Analytical categories There are two types of validity: internal validity and external validity. In order to ensure internal validity, there are five strategies (McCall & Simmons, 1969) that can be used in qualitative research which is as follows: a) b) c) d) e) The method of triangulation; Inspection and peer review as well as supervisors to ensure the validity of the interview instrument; The review by the informants in this research by allowing them to read, view and verify the interpretation done; Involve respondents in all phases of the research study; and Explain the hypothesis, subjectivity and theoretical orientation of the researchers at the beginning of the study. External validity is ensured through the use of a lot of information, various themes and the maximum variation data until the data reached saturation. To preserve the validity of the content of the study, the researcher obtains information from teachers and administrators to use a different set of questions to get feedback on. In this study, researchers have obtained the consent of the Index Cohen Kappa coefficient (Cohen, 1960). Based Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 on Cohen's Kappa analysis, the researcher has sought the cooperation of three qualitative experts who knows how to evaluate the calculation of Cohen's Kappa coefficient level or consent of the themes of the interviews. The theme is chosen based on the domain of the transcription of the interview. There are several opinions about the Cohen’s Kappa index analysis to determine the degree of agreement among experts in qualitative research. According to Steven (1958), an agreement among the experts is important to determine the reliability in illustrating the themes. In 1977, Landis and Kosh have suggested ways to calculate Cohen's Kappa agreement using the scale (Landis & Kosh, 1977). Table 1 shows the Cohen’s Kappa scale of agreement. Table 1. Cohen's Kappa scale of agreement Cohen's Kappa agreement using the scale. Below 0.00 Scale of agreement Very poor 0.00 – 0.20 Poor 0.21 – 0.40 Moderate 0.41 – 0.60 Moderate good 0.61 – 0.80 Good 0.81 – 1.00 Very good This analyzed questionnaire was given to three experts to evaluate. After that, researchers will sit together to calculate the value of Cohen’s Kappa agreement. Every agreement of the unit is noted. The coefficient of agreement for each expert is separately recorded and then aggregated to obtain a coefficient of agreement for the entire process. Then, the researchers calculate Cohen's Kappa formula as follows: K = fa – fc N - fc Which is: K - the coefficient of agreement fa - unit of agreement fc - units likely set at 50 percent expected agreement N - number of units (themes) that tested the agreement 4. Results and discussion 4.1 Cohen’s Kappa analysis Table 2 shows the scale of agreement from the 3 experts who were given to evaluate the analyzed interview questionnaire Table 2. Scale of agreement Scale of agreement fa-fc/N-fc Expert 1 64/68 64-34 68-34 30//34 0.88 Sum of coefficient of agreement Average Coefficient of agreement 0.88+0.82+0.5/3 0.7 fa-fc Expert 2 62/68 62/68 68-34 28/34 0.82 Expert 3 51/68 51/68 68-34 17/34 0.5 85 86 Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 Overall, there are 68 units of themes established. The operational definition of each theme was given to the experts to evaluate. According to Cohen (1960), 40 units are sufficient to find the consent of each theme (unit). Through the pilot study, the Cohen’s Kappa coefficient of agreement at the level of 0.7 was obtained as well. Not many comments and suggestions given in writing as experts had verbal discussions with researchers. Improvements were made based on oral and written opinion given by the three appointed experts. 4.2 The results of the interview Findings from the interviews conducted reveals that respondents can understand the interview questions set. This is because, when the researcher described the purpose of the interview questions, the respondents agreed that a set of questions developed can achieve the objectives of the research. Prior to going to the selected school to conduct the interview, the researchers have contacted the school, special education teachers and senior assistant to explain to them about the study so that respondents can respond truthfully and share their ideas and viewpoints about inclusive education freely as suggested by Creswell (2007). The findings were analyses using NVivo8 software and researchers acquired 68 units of themes. This shows that the set of interview questionnaire reaches the standard theme in which Cohen suggested that the minimal is 40 units (1960). Through the evaluation and suggestions made by experts, the researchers will also propose to conduct interviews to the mainstream teachers who are not conducting the teaching and learning of Inclusive Education Program. In addition, questions related to the theme of the special pedagogical needs will also be provided. Subject teachers should also know the methods and approaches that should be used appropriately when teaching in an inclusive classroom. 5. Conclusion This study is only a pilot study on the implementation of the Inclusive Education Program conducted in the Special Education Program Integration at a primary school in Malacca. This study is an initial step taken by the researchers to test the validity of the interview questions that will be used in an interview before the actual study. It is also not intended to prove any theory or model of the implementation of Inclusive Education. However, it opens up space for discussions and improvements to make the study more rigorous and systematic. Thus, the set of interview questions must be validated to ensure that the data obtained may help researchers answer the research questions more accurately. In addition to this structured interview, other forms of data collection will be used in order to provide the researcher with a well-rounded collection of information for analyses. Acknowledgment The researchers would like to thank the principle and teachers at School A, Merlimau Melaka for their cooperation during the pilot study. References Berg, B. (1995). Qualitative research methods for the social sciences. Boston: Allyn and Bacon. Bosi, W. (2004). The pilot implementation of inclusive education in Malaysia; A Review. PhD Thesis. Massey University, unpublished. Cohen, J. (1960). A coeffisient for agreement for nominal scales. Educational dan Psychological Measurement, pp. 37-46. Creswell, J. W. (2007). Qualitative inquiry & research design: choosing among five approaches (2nd ed.). Thousand Oaks,CA: Sage. Malaysia (2013). P.U.[A].230, Education (Special Education) Regulations 2013. Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, pp.196-205. Jelas, Z.M (2000). The Perceptions of Inclusive Practices: the Malaysia perspective. Educational Review. Vol. 52, No.2. pp 188-196. Konting, M.M. (2009). Education research methodology. Kaedah Penyelidikan Pendidikan. Dewan Bahasa dan Pustaka Kuala Lumpur. Kvale, S. (2007). Doing interviews. Thousand Oaks, CA: Sage. Landis, J. & Kosh, G.G. 1977. The measurement of observer agreement for categorical data. Biometrics, 33 : pp. 159-174. Maizatul Azmah Ab.Latiff et al. / Procedia - Social and Behavioral Sciences 204 (2015) 81 – 87 Malakolunthu. (2001). Pengumpulan dan analisis data kualitatif: Satu imbasan dalam Marohaini. Penyelidikan Kualitatif: Pengalaman kerja lapangan kajian. Kuala Lumpur: Universiti Malaya. McCall, G.J. & Simmons, J.L. (1969). Issues in participant observation: a text and reader. Addison-Wesley Publication. pp. 19-23. McNamara, C. (2009). General guidelines for conducting interviews. Last accessed 11th January, 2010. Doi. http://managementhelp.org/evaluatn/intrview.htm Merriam, S. B. (2009). Qualitative research: A guide to design an implementation. Revised and Expanded from Qualittaive Research and Case Study Application in Education. Merriam, S. B. (Ed.). (2001). The new update on adult learning theory. New. Directions for Adult and Continuing Education, San Francisco: Jossey-Bass. Miles, M.B. & Huberman, A.M. (1994). Qualitative data analysis: an expanded sourcebook (2nd ed). Thousand Oaks, USA. Sage Publications. 134. Mohamed, K. J. (2012). Embedding literacy skill for preschools with hearing impairment in special education school. PhD Thesis. Universiti Kebangsaan Malaysia, unpublished. Muhammad, K. & Mahmud, W. W.A. (2010). Implementation of Inclusive Education in autistic children in a primary school: A case study. Proceedings of The 4th International Conference on Teacher Education; Join UPI Conference & UPSI. Bandung, Indonesia,pp.8-10 Saad, S. (2003). Malaysian preschool children with attention deficit hyperactivity disorder (ADHD) in inclusive setting. PhD Thesis. University of Warwick, unpublished. Saad, S. (2005). Commitment and the role of teachers in the implementation of inclusive education approach in Malaysia. Educational Research Seminar. Batu Lintang Teacher Institute, 2005, 15 to 16 September 2005, Holiday inn Kuching 1-10. Shaari, S. (2005). Management of inclusive education programme in the technical and secondary day schools. PhD thesis. Universiti Sains Malaysia, unpublished. Steven, S.S. (1958). Problems and methode of psychophysics. Psychological Bulletin. LV, pp. 177-196. Tambi, A, Z. (1997). Implementation of inclusive education of special children learning disabilities at a school in Kuala Lumpur, Unpublished. Pelaksanaan program pendidikan inklusif kanak-kanak khas bermasalah pembelajaran di sebuah seklah di Kuala Lumpur. Thesis Masters, Kuala Lumpur: Universiti Malaya. Tuner, D.W. (2010). The Qualitative Reports. Volume 15. No. 3, pp 754-760. Last accessed 12 April 2013. Doi http://www.nova.edu/sss/QR/QR15-3/Qid.pdf. Yussof, M. (2001). Qualitative inquiry: Experience of field work studies. Penyelidikan kualitatif: Pengalaman kerja lapangan kajian. Kuala Lumpur: Universiti Malaya. 87 Original Research Students With Chronic Conditions: Experiences and Challenges of Regular Education Teachers The Journal of School Nursing 2017, Vol. 33(4) 307-315 ª The Author(s) 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1059840516674053 journals.sagepub.com/home/jsn Janice Selekman, DNSc, RN, NCSN, FNASN1 Abstract School nurses have observed the increasing prevalence of children with chronic conditions in the school setting; however, little is known about teacher experiences with these children in their regular classrooms. The purpose of this mixed-method study was to describe the experiences and challenges of regular education teachers when they have students with chronic conditions in their classroom and implications for the school nurse. The national sample consisted of regular education teachers. The methodologies consisted of focus groups and an online survey. Seven themes emerged: Teachers want to be informed about their students with chronic conditions, teachers lack information about the conditions, there is a lack of preparation in preteacher education programs about students with chronic conditions, teachers feel frustration and stress in working effectively with these students, teachers shared concerns about their students, teachers are asked to perform healthrelated tasks for students, and teachers made recommendations of what they need from the school nurse. Keywords chronic diseases, elementary, high school, middle/junior/high school, special education/disabilities The prevalence of children with chronic conditions in the schools has increased significantly since 1994 when 12.8% of students were considered to have a chronic condition. That number more than doubled by 2006 to 26.6% (Van Cleave, Gortmaker, & Perrin, 2010). The U.S. Department of Health and Human Services, Office of Adolescent Health reported that in 2016, approximately 31% of adolescents ‘‘suffer from at least one moderate or severe chronic condition’’ (2016, para. 1). These increases were initially due to improved health care leading to a longer life span, increased awareness that children in the classroom have chronic conditions, increased inclusion in the classroom, and decreased numbers of children placed in special schools. However, the increasing prevalence continues in conditions such as asthma, obesity, diabetes, food allergies, mental health conditions, and neurodevelopmental disorders (Perrin, Anderson, & Van Cleave, 2014). Federal laws mandate a free and appropriate education to all children in the least restrictive environment with reasonable accommodations made in order for them to take full advantage of the educational experience. Chronic conditions are those that last at least 1 year and require ongoing medical attention and/or limit learning or other activities of daily living (USDHHS, 2010). Because children spend half of their waking hours in the school setting and a significant number have a chronic health condition, health care becomes an issue in the schools. According to the National Association of School Nurses (NASN, 2007), 41.3% of public schools had a full-time registered nurse, 25.3% had no nurse at all, and the rest had a nurse for part of each week. When school nurses are not present, health care for children with chronic conditions often becomes the responsibility of secretaries and teachers. The purpose of this study was to describe the experiences and challenges of regular education teachers when they have students with chronic conditions in their classroom. Review of the Literature The literature on this topic is sparse, but the themes over two decades have been similar related to children with chronic conditions in regular education classrooms. They indicate teacher concerns, including how to respond to medical emergencies, lack of teacher preparation for this population of students, and the extra time needed to provide health care in the classroom resulting in a decrease in teaching time. 1 University of Delaware, Wilmington, DE, USA Corresponding Author: Janice Selekman, University of Delaware, 324 Waycross Road, Wilmington, DE 19803, USA. Email: selekman@udel.edu 308 A dated small study by McCarthy, Williams, and Eidahl (1996) explored teacher experiences with children with chronic conditions in the school, as well as their concerns in educating these students. Teacher concerns included how to respond in medical emergencies, student absences, student fatigue, student behavior problems, parents, and the students’ peers. Teachers also reported that concern about medical emergencies was greatly reduced if a school nurse was present in the school. Clay, Cortina, Harper, Cocco, and Drotar (2004) queried educators in one state and found that 59% reported no academic training in working with children with a chronic illness and 64% reported no on-the-job training in dealing with these children. They concluded that schoolteachers were not prepared to deal with issues presented by students with chronic illness. Hill and Hollis (2012) surveyed elementary teachers in one state on the amount of time they spent on health issues. They found that time ranged from 36 to 73 min per day, including calling parents. They also found that when a school nurse was present, more than 80% of teachers felt there was increased communication with the school nurse related to students’ health-care needs, less teacher time spent on health issues, more time spent teaching, and increased confidence that students with chronic illnesses are safer. In a study by Baisch, Lundeen, and Murphy (2011), teachers from all grades spent an average of more than 26 min on health-care issues per day without a school nurse and just over 6 min per day when a school nurse was present. Shippen et al. (2011) explored the strategies teachers implemented in general classes to accommodate students with disabilities compared to special education teachers. General education teachers reported an absence of coursework in their preservice education programs regarding accommodations needed for students with disabilities, which resulted in their lack of comfort with these students. The researchers recommended both content and experiences for teachers to foster confidence and positive attitudes toward those with chronic conditions. Some of the studies on this topic focus exclusively on one condition. For example, Bishop and Boag (2006) measured teachers’ knowledge about and attitudes toward epilepsy. Their findings indicated teachers lacked knowledge about epilepsy and its impact on the classroom and affected students’ academic performance. Teachers felt unprepared to recognize and respond appropriately to seizures. Responding teachers wanted to know how to discuss epilepsy with the other students in the class and suggested that increased exposure to information on this condition and its management be included in teacher preparation courses. While approximately 1 in 4 students has a chronic health condition, only 12.9% of the total student body receives the services of special education (U.S. Department of Education, 2016). The Individuals with Disabilities Education Improvement Act (IDEA) covers 13 categories of conditions including learning disability, autism spectrum disorder, The Journal of School Nursing 33(4) emotional disturbance, speech/language impairment, visual impairment, hearing impairment, deaf-blindness, orthopedic impairment, intellectual disability, traumatic brain injury, multiple disabilities, and ‘‘other health impaired’’ (OHI). OHI is defined as ‘‘having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli that results in limited alertness with respect to the educational environment’’ and can include conditions ranging from attention deficit hyperactivity disorder (ADHD) and cardiac conditions to diabetes (U.S. Department of Education, 2004, para. 1). In addition to those requiring special education are students with other chronic conditions that require accommodations without special education, such as those with life-threatening allergies, cystic fibrosis, and inflammatory bowel disease. The significance of this study is that it is the first national study exploring teacher experiences and challenges from both qualitative and quantitative perspectives. Teaching children with chronic health needs can result in stressors on teachers, requiring a change in teaching strategies, a change in the amount of teaching time teachers have to cover content to the class, and asking teachers to perform actions that are within the realm of the practice of nursing rather than within the role of educator. By increasing school nurse awareness of the needs and stressors of teachers regarding this population of students, school nurses can become more proactive in their planning and interventions. This study also can provide data to enhance advocacy for the need for school nurses in those schools that do not have full-time school nursing services. Method Design This two-phase study used a mixed-method design using both qualitative and quantitative data. The qualitative component of the study (Phase 1) was completed first. Phase 1 consisted of focus groups and Phase 2 was an electronic survey. The study was approved by the institutional review board of the University of Delaware. Phase 1: Focus groups Phase 1: Sample/setting. Participants in the focus groups included practicing public school regular education classroom teachers (Grades 1–12) with at least 1 year of experience who were attending a biennial national teachers’ conference sponsored by the American Federation of Teachers (AFT) in July 2013. Those participants who registered for the AFT conference were sent a description of the study by the AFT and asked to participate if they were a public schoolteacher in Grades 1–12. This stipulation limited the number of eligible participants. Consent to participate and be audio-recorded was obtained prior to beginning the focus Selekman group. Each session was 60–90 min. Six focus groups were convened with 2–4 participants per group. While the room was difficult to find, 17 of the 27 who registered for a session participated. They represented five states (New York, New Jersey, Georgia, Minnesota, and Rhode Island) and included one occupational therapist and two paraprofessionals; these nonteachers were allowed to stay in the groups, but their feedback was removed from the analysis. Therefore, there were 14 teachers in Phase 1. Focus group procedure. The researcher moderated each focus group with either a school nurse researcher or the assistant director of the AFT Nurses and Health Professionals division. All sessions were audio-recorded; notes were also taken by one of the two facilitators present during the sessions. The discussions allowed teachers to share their experiences and preparation/knowledge when having children with chronic conditions in their regular education classrooms. The semi-structured questions that guided the discussion were gleaned from the professional literature and included the following: 1. 2. 3. 4. 5. 6. In the past 3 years, what chronic conditions have your students had? Tell us about an experience you have had teaching a child with a chronic condition. Include the challenges that were present, how you had to adapt your teaching, the concerns you had, and what helped. What information do you wish you knew before having these children in your class? What preservice training and professional development was provided to you regarding children with chronic conditions in the classroom? What resources (school staff, school nurses, written materials, professional development, individualized education programs [IEPs], or 504 plans) were most helpful? What medical treatments, if any, are you asked/mandated to do? The tapes were transcribed by a paid service and then all transcriptions were checked against the original tapes by the primary researcher. Concepts related to the topic of the study were placed on index cards and sorted multiple times by four research assistants until consistent themes emerged. Validation of the themes was confirmed by the three focus group facilitators. Phase 1: Results. The sample of 14 teachers was evenly distributed among those who taught elementary, middle, and high school. The mean years taught was 16, with a range from 2 to 35. The teachers reported that they taught an average of 23 students with known chronic conditions in the past 3 years; the total number of students they taught per year ranged from 24 to 120. 309 Table 1. In the Past 3 Years, I Have Taught Students With the Following Conditions. Focus Groups (N ¼ 14) Online Survey (N ¼ 1,280) Asthma Attention deficit hyperactivity disorder (93.2%) Asthma (88.5%) Learning disabilities (78.9%) Allergies (especially to foods) Attention deficit hyperactivity disorder Learning disabilities Autism spectrum disorder Diabetes Mobility conditions (cerebral palsy, walker or wheelchair use, muscular dystrophy, muscle problems) Seizures Sensory disorders (vision/ hearing) Sickle cell disease Others (mentioned by one or two): emotional disturbance, Down/intellectual disability, HIVþ, speech and language, depression/anxiety, Tourette syndrome, cystic fibrosis, kidney problem, substance abuse, stroke due to a brain tumor, ‘‘tubes coming out of their bodies,’’ and ‘‘a kid who was very violent’’ Allergy other than food (76.2%) Food allergy (70.6%) Autism spectrum disorder (65.2%) Anxiety disorder (58.3%) Speech impairments (56.5%) Depression (49.9%) Diabetes (48%) Vision disability (42.1%) Bipolar disorder (41.4%) Significant obesity (35.7%) Deaf/hearing deficits (34.5%) Seizure disorders (34.3%) Other: (obsessive-compulsive disorder, intellectual disability, heart conditions, sickle cell disease, skin disorders, addictions, color blindness, eating disorders, and cancer) Analysis of the focus groups resulted in seven themes: decreased communication, a lack of information about the chronic conditions, a lack of preparation in preteacher education programs, increased frustration and stress, concerns teachers had for students with chronic conditions, healthrelated tasks teachers were asked to perform for students, and recommendations of what would be most helpful to regular education teachers now. When asked to identify the chronic conditions they saw most frequently in their students, asthma, allergies, and ADHD were the top three (Table 1). The most prevalent theme that emerged from the focus groups was the need for communication. Theme 1: Lack of communication. Teachers expressed frustration and disappointment that it often took weeks or months until someone shared with them that a student in their classroom had a chronic condition that required their attention. Teachers shared how they found out about a student’s condition once they expressed concern about a behavior or performance problem. One stated, ‘‘In November when I complained to the nurse about a student, she said, ‘‘Well, didn’t you know she was a diabetic?’’’’ Some had a 310 formalized way of finding out which students had health conditions, but these were not always legal. Comments included, ‘‘The school nurse brings a sheet of who has asthma, allergies, diabetes, or anything we need to know about the child’’ and ‘‘The principal and the nurse gave us a list of all students in the building and what they had and what medications they were taking.’’ Theme 2: Lack of information about the conditions. The second strong theme was a lack of and a desire for information about the conditions their students have, especially what they should look for that indicated the child was in trouble and what they should do while they are waiting for help to arrive. Teachers in the focus groups described how they accessed information about the conditions, with personal family experiences and WebMD the most frequently noted. The impact of this lack of information was evident when one teacher stated, ‘‘I didn’t understand his ADHD. I never dealt with anyone who had it. I wasn’t very patient. I thought the kid was being disrespectful.’’ When asked if the school nurse was helpful in providing information, a teacher stated, ‘‘I don’t have time to talk to the nurse about the condition because we share her [with another school] and by the time I am done teaching, she is gone.’’ Theme 3: Frustration and stress. Teachers expressed frustration and stress from a number of perspectives. Students with chronic conditions may require more teacher time (‘‘Some of the other students didn’t benefit from my help because he was monopolizing my time in a way’’). A number of teachers felt they were blamed for the students’ poor performance on state tests. Comments such as the following demonstrate this point. ‘‘Teachers have to be aware that they’re going to get the blame even though there’s really no blame to take.’’ ‘‘Everything is still placed on the teacher. What is the teacher NOT doing right so this child is not moving along? They aren’t looking at the child’s IEP (Individualized Education Program). They aren’t looking at the child’s chronic condition.’’ ‘‘Even when I gave him all that help, it almost felt useless. It was really frustrating.’’ Teachers also expressed frustration with parents, especially those who do not advocate for their own children and those who refuse the development of IEPs. One teacher said, ‘‘It’s really sad. I have kids who we identify as needing services, maybe first grade, but the parent will say ‘no, I don’t want them to have special education.’ And then they will wait until fourth grade and the child is still not reading and then they will say, ‘OK, give them services,’ and then I’ve got 3 years to make up.’’ Theme 4: Teacher concerns. The teachers expressed concerns about the high absenteeism rates of children with some chronic conditions. This raised concerns as to how to help the student make up class work and keep up with peers. Additional concerns expressed included the following: (a) ‘‘How do I know if they are using their disability as a crutch The Journal of School Nursing 33(4) or an excuse to get out of work?’’ (b) ‘‘What do I do when a diabetic is bringing in the wrong foods from home?’’ (c) ‘‘There is an attitude of ‘the student knows how to deal with it.’ But what if he doesn’t?’’ (d) ‘‘I don’t know if it is legal for me to ask them anything about their condition?’’ and (e) ‘‘How do I discuss the child’s health-care needs when the parents are not English speakers and/or not legally in the U.S.?’’ Theme 5: Deficient information provided in their preteacher education. Teachers in the focus groups were overwhelmingly critical of the lack of content and experiences provided in their preteacher education programs. Almost half of the teachers had not received any information on children with chronic conditions and how these might impact on their teaching modalities. Three had an undergraduate course about the conditions that are included in IDEA, but nothing medical was included, and another had only one lecture on this topic. As new teachers, they indicated they felt unprepared to understand and deal with the health-care needs of their students. Theme 6: Teachers were required to provide nursing care. With one exception where a school nurse was present fulltime, teachers indicated they had the responsibility to provide ‘‘nursing care’’ to their students. One teacher stated she was told by the office, ‘‘If it is not bleeding, broken, or a breathing issue, don’t send them to the office. You take care of it.’’ The degree of preparation for these skills and medication administration varied. A teacher in the focus groups indicated she was given a handout on how to administer rectal Diastat for seizures and was to keep the medication in her desk drawer. Another watched a video on EpiPen use but did not have a practice session and reported she did not feel comfortable or confident in the skill. Theme 7: What teachers want from the school nurse? Because teachers are apparently not receiving information in most of their preteacher education programs regarding children with chronic conditions in their classrooms, teachers in the focus groups expressed an emphatic need for professional development, especially on the conditions they see most frequently. Phase 2: Electronic survey Phase 2: Sample. A convenience sample was used for the electronic survey 6 months after Phase 1 focus groups. A subset of the AFT membership received an e-mail via SurveyMonkey1 that included a cover letter indicating eligibility; consent was implied with survey completion. The number of questionnaires distributed is unknown, as AFT does not have mailing lists specific for regular education teachers in 1st through 12th grades. Of the 1,575 who completed the survey, 245 indicated they were considered to be special education teachers and were eliminated from the analysis. Another 50 questionnaires were eliminated when Selekman responses on the questions indicated that they did not qualify, for example, being a substitute teacher, being retired, and having roles that were not in the classroom. The total sample of participant responses included in the analysis was N ¼ 1,280. Survey. The survey utilized for this study was developed prior to Phase 1 of the study by a selected team that included a special education professor and a school psychologist who teach in their respective fields at a large research-intensive university, a national school nurse researcher, and a school nurse educator. Based on concerns respondents expressed during the focus groups about their lack of knowledge, it was determined that two questions should be added regarding the content teachers received during their preteacher education about children with chronic conditions. The final survey consisted of 48 questions: 24 were multiple choice or one-word fill-in (e.g., number of students taught per year), 19 were questions using a Likert-type scale, 2 asked for lists (e.g., the student medications they keep in their desks), 1 asked participants to rank order their student concerns, 1 asked for suggested content to be included in prelicensure programs, and 1 asked what would be most helpful to them now with these students. There was a space after most questions for the participants to write comments. The survey was initially piloted using a convenience sample of elementary and middle school teachers in the South Atlantic and mid-Atlantic region. Three reviewers familiar with survey methodology and the needs of children with chronic conditions in the classroom were queried regarding content validity. They included a middle school principal who had initially been a first-grade teacher, a middle school honors teacher, and a statistician. There was 100% agreement regarding the content, with formatting recommendations from the statistician; these were incorporated into the final version of the tool. Reliability checks were not conducted. Phase 2: Results. Results were downloaded in a deidentified format into Excel and no answers could link back to participants in any way. Surveys were analyzed with SPSS 221. The participants in Phase 2 represented at least 23 states, with 62.4% teaching in urban schools, 23.8% in suburban schools, and 13.8% in rural schools. Participants had taught for an average of 17.5 years with a range of 1–48. The majority of participants had a master’s degree (72.3%), with 21.7% having a bachelor’s degree. Distribution of the participants revealed 30.6% representing grades 1–2, 30% representing grades 3–5, 28% representing grades 6–8, and 32.9% representing grades 9–12 (with some teaching in multiple levels). On average, teachers taught 15 students with chronic conditions in the past year (2013–2014; range: 0–350). Of the top 10 conditions seen by teachers in their classrooms, 70% were the same between the focus group findings and the online survey (Table 1). Over 75% of teachers had students with ADHD, asthma, learning disabilities, and allergies. It is also essential to acknowledge that half of the 311 Table 2. The Needs of Each Child With a Chronic Condition in My Classes Have Been Clearly Communicated to Me. Percentage indicating rarely or never on a 5-point Likert-type scale (N ¼ 1,280) Grades Grades Grades Grades 1–2 3–5 6–8 9–12 48.3 44.4 40.5 52.7 Table 3. The School Nurse Provides Guidance About Children With Chronic Conditions in My Class. Percentage indicating rarely or never on a Likert-type scale (N ¼ 1,280) Grades Grades Grades Grades 1–2 3–5 6–8 9–12 32.8 33.1 28.6 41.5 top 10 conditions identified by survey participants are considered to be mental health conditions. In questions related to being informed about students in their classroom, 45.3% of the online sample (N ¼ 1,280) indicated they did not receive any early warning at the start of the school year that they were to have a child with a chronic condition in their classroom. For those who were informed, 37.7% were informed by the school nurse, 30.2% by the parent, 28% by the school counselor/psychologist, 27.4% by another teacher, 16.9% by the student, and 15.7% by the principal. Using Pearson w2, there was statistical significance of having a school nurse in the building 5 days per week and routinely being informed at the start of the school year that they would have a student with a chronic condition (p ¼ .002). When asked if the needs of each child with a chronic condition were clearly communicated to them, 47.6% of the survey participants indicated never or rarely on a 5-point Likert-type scale (always, often, sometimes, rarely, and never; Table 2). When asked if the school nurse provided guidance about the children with chronic conditions in their class, 28.6–41.5% of the survey participants indicated never or rarely on the same scale (Table 3). When asked who was most helpful in helping them feel confident in working with children with chronic conditions, 37% gave credit to special education teachers, 29% gave credit to the school nurse, and 25.6% gave credit to the parent. Using a Likert-type scale of never, rarely, sometimes, often, and always, 15% of the survey participants indicated that they often or always feel overwhelmed having children with chronic conditions in their classroom; 31.7% felt overwhelmed sometimes. Using the same scale, 29.1% indicated they experience more stress having a child with a chronic 312 The Journal of School Nursing 33(4) Table 4. Ranking of Factors That Most Concern You About Your Students With Chronic Conditions. Concern/Grade Table 5. Number of Extra Minutes per Day in Direct and Indirect Health Care Provided by Teachers in the Classroom. 1–2 3–5 6–8 9–12 Grade High absenteeism rate Student with a chronic condition is underperforming in school Behavior issues Poor concentration Student fatigue/low energy Failure to complete daily assignments Rejection by peers/bullying 1 3 2 1 1 2 1 2 2 4 5 6 7 3 4 5 6/7 6/7 3 4 5 6 7 3 5 4 6 7 Note. N ¼ 1,280. condition in their classroom than when they do not have a child with a chronic condition in their classroom; another 21.6% experience this stress sometimes. One teacher commented on the survey, ‘‘I don’t understand why this profession expects so much of the teacher. She already wears many hats and now it becomes her responsibility to handle medical affairs.’’ Teachers were asked to rank their concerns regarding students with chronic conditions (Table 4). The top concerns were their high absenteeism rate, the concern that students with chronic conditions are underperforming in school, and behavior issues. When asked about the amount of content received in their preteacher education program, 52.3% indicated they had NO training on children with chronic conditions during their basic teacher education; an additional 16.9% had only one lecture on this topic. Teachers in the upper grades had less basic condition-specific information than those who worked with younger children. Only 8% indicated that their teacher education content was helpful for this facet of their role. Because of the longevity in the classroom of some of the participants in the survey, an attempt was made to see whether those graduating from a teacher education program in the past 10 years had more content on children with chronic conditions than those who had graduated before that time. While more did receive the content, the association is weak (p ¼ .08). Survey participants indicated that 44.3% of schools had a school nurse 5 full days per week; 11.2% had no school nurse at any time. For those who did not have a full-time school nurse, the question was asked who provides the health care; the answers included the secretaries (33%), the principal (22.7%), teachers (22.3%), health aides, and parent volunteers. Of the 1,280 survey participants, 110 (8.6%) were asked to keep medications or treatments in their desks. These included EpiPen, medications for ADHD (controlled substances), inhalers/asthma pumps/albuterol, antiseizure medications, glucose tablets, diabetes testing supplies, and insulin. More than 86% of teachers did not believe it was 1–2 3–5 6–8 9–12 Extra Minutes of Direct Extra Minutes of Indirect Health Care Health Care Total 45.7 35.9 28.9 19.2 40.6 43.2 35.8 34.8 86.3 79.1 64.7 54 their responsibility to give medications in school, but many felt pressured to do it. One survey participant stated, ‘‘I am not at all comfortable with providing treatment to students, but fear my job would be in jeopardy if I did not do as I was instructed.’’ Using Pearson w2, there was statistical significance in having a school nurse in the building 5 days a week and NOT being asked to keep medications in their desk or classroom (p ¼ .000). While not wanting to be responsible for medications, only 15.9% felt that it was not their responsibility to deal with the health components of a child’s chronic condition while in the classroom, with 68.8% believing they should be partly responsible. The survey asked teachers to estimate the average number of minutes each day that they spend providing direct health-care services to students and the number of minutes they spend providing indirect care, such as communicating with parents about a student’s needs and writing alternative lessons or plans based on a student’s IEP requirements. The amount of time spent ranged from 19 to 45.7 minutes per day in direct health care (average ¼ 33 minutes), with more time needed for elementary school children, and 34.7 to 43.2 minutes a day in indirect health care (average ¼ 38 minutes); the amount of time spent was less for high school students (Table 5). Over 26% indicated that planning for a child with a chronic condition lessens their ability to plan for their other students often or always; another 31% indicated sometimes to this question, on a 5-point Likert-type scale. Teachers wanted to know what to look for, what they should do in an emergency, and what they should know about the condition. They asked for real scenarios that will prepare them and they wanted more hands-on experience with CPR (Cardiopulmonary Resuscitation) and EpiPen use. The teachers in both Phase 1 and Phase 2 expressed a unanimous need for professional development on the disorders they see most frequently. They want to know the impact the disorders have on learning and what accommodations work; they expressed a desire to know how to read an IEP and to know which students have them; and they wanted guidance on how to advocate for a 504 accommodation plan and wanted to know what else could be put on it other than extended testing time. They want information on FERPA (Family Educational Rights and Privacy Act) and clarification of what they can share and have shared with them. Selekman 313 Being nofied in a mely manner COMMUNICATION Stress and frustraon Pre-teacher educaon With parent, school nurse, school administraon, healthcare provider Being educated on what to look for and what to do By the school nurse Figure 1. Framework for teachers’ needs related to students with chronic conditions. Discussion There was a great deal of consistency between the findings of the qualitative and quantitative components of the study, as well as with that found in the literature. The characteristics of the sample were very similar in the percentage of elementary, middle, and high school teachers represented, with a fairly even distribution among groups. The average number of years teaching was similar (16 for the focus group and 17.5 for the survey) as was the average number of children with chronic conditions taught in the past year (23 vs. 15). It is also interesting that the percentage of fulltime and no school nurses present in the schools, as perceived by the teachers in the survey (44.3% and 11.2%), closely approximates the findings from the 2007 study by NASN (41.3% and 25.3%). Although the number of schools with no school nurse is down to 11% in this study, it must be kept in mind that these statistics are the impressions of the teachers and not based on any state data. However, Biag, Srivastava, Landau, and Rodriguez (2015) found that the level of teacher satisfaction with school nurse services correlated with the number of hours the nurse was on site. Of the top 10 conditions seen by teachers in their classrooms, 70% were the same between the focus group findings and the online survey (Table 1). Some of the concerns expressed by teachers related to having children with chronic conditions in their class are the same as those cited by McCarthy et al. in 1996: increased student absences and needing to know how to respond in an emergency. The dearth of content reportedly taught in preteacher education programs was as much a concern in 2004, where 59% reported no information presented in their academic program (Clay, Cortina, Harper, Cocco, & Drotar, 2014) as in the present study; 52.3% reportedly had no content on children with chronic conditions, and another 17% having had limited content. The extra amount of time needed by teachers to attend to the health needs of their students has also not improved. The 26–73 min per day documented by Hill and Hollis (2012) and Baisch et al. (2011) is slightly less than the 19–45 min of direct health care provided per day and the 34–43 mi of indirect health-care interventions reported in this study. This translates into the loss of approximately 1 hr of teaching time per day. In addition, Hill and Hollis (2012) determined that teachers felt that communication and confidence increased when a school nurse was present and Baisch et al. (2011) calculated that the time teachers spent on health-care issues was decreased by more than 75% when a school nurse was present. This national study supports that when a school nurse is in the building full time, teachers were informed significantly more consistently at the start of the school year that they would have a student with a chronic conditions in their classroom and were asked to provide fewer nursing skills. The two recommendations from teachers are clear: There is a significant need for increased communication of information in the school setting, and preteacher education must address the significant issues of children with chronic conditions in the classroom. There was a consistent request for professional development for teachers in the schools related to the health needs of children with chronic conditions. Development of a Model Based on the themes that developed from this study, the following model was developed (Figure 1). The centerpiece of the model is communication. This includes being notified in a timely manner so that measures can be in place at the start of the school year to assist the student; communication with the parent, the school nurse, school administration, and the student’s health-care provider if needed; and communication to educate teachers on what to look for and what to do. 314 Much of this education should come from the school nurse. The presence or lack of communication directly impacts on teacher stress and frustration levels. However, these findings also have great relevance for university programs that prepare teachers regarding content on the common disorders that children may have, which have an impact on the teacher’s role. Limitations There are four limitations identified in this study. Only 14 (52%) of the 27 teachers who had signed up to participate in the focus groups actually participated; this may have been due to the difficulty in finding the room. This resulted in only five states being represented in the qualitative component of the study. As the survey was distributed by the AFT, only 23 states may have received the questionnaire, again limiting the anticipated national representation. The third limitation was that the survey was not checked for reliability. Finally, correlations were not done to compare some teacher responses to the percentage of time they indicated a school nurse was on site. Implications for School Nursing The implications for school nursing are clear. Communication with teachers is essential. Having a school nurse full time in the schools makes a positive difference for teachers, especially related to teacher stress and time available for teaching. School nurses must be proactive and be aware of the increased stress put on teachers by not knowing about their students and the actions to take regarding student health issues. General education teachers have clearly identified the information they would like; the school nurse has the knowledge and is in an excellent position to provide it. School nurses must work in conjunction with educators so that each can be an advocate for the other. Conclusion On average, teachers have 15 students with chronic conditions in their classrooms each year. This study demonstrated that public schoolteachers in Grades 1–12 want increased communication with anyone who can assist them in understanding the health needs of the children in their classrooms. They want this information before the children come to their class so that they can prepare to meet their needs; they want to know what signs to look for and what to do until the school nurse or emergency care arrives. In general, they did not feel well prepared by their preteacher education programs. While school nurses have been advocating for their inclusion in the school setting, the support from teachers has generally not been included. Many teachers are being forced to perform health-related skills for which they are not The Journal of School Nursing 33(4) prepared and do not wish to do. They are losing instructional time and increasing their stress working with parents and others to deal with classroom issues involving children with chronic conditions. This study will allow their voices to be heard, especially by school nurses. Multiple specific areas were identified where the school nurse can intervene to assist both teachers and students...
Purchase answer to see full attachment
User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Explanation & Answer

Attached.

Running head: ANNOTATED BIBLIOGRAPHY

Annotated Bibliography
Student’s Name
Institution Affiliation

1

ANNOTATED BIBLIOGRAPHY

2

Introduction
According to the US Census Bureau, nearly one out five individuals in the US have a
disability of one form or another. Research has also revealed that the number of students who are
in need of special education in the US and all over in the world is high. The research on the need
to have special education among students with special needs has intensified lately. This research
is aimed at enhancing the aspect of inclusivity for all in the education sector. This explains why
all the sources annotated below are related to the issue of special education and inclusivity for
students with special needs.
a) Quantitative Annotated Reviews
Hendricks, D. (2011). Special education teachers serving students with autism: A
descriptive study of the characteristics and self-reported knowledge and practices
employed. Journal of Vocational Rehabilitation, 35(1), 37-50.
The article, Special education teachers serving students with autism: A descriptive study
of the characteristics and self-reported knowledge and practices employed, by Hendricks was
meant to evaluate the professional experience and expertise that special education students
should have. Upon noticing that autism affects a significant number of students in the school, the
author set out to explore the most effective teaching strategies for handling students with autism.
Hendricks used quantitative research and precisely self-support survey by engaging a total of 498
special education teachers. The author found out that one out 110 children has autism and the
number has been on the rise. In conclusion, the studies showed that schools need to review the
efficiency of the teaching strategies employed by teachers handling students with autism with the
sole intention of improving tutoring experience and service delivery

ANNOTATED BIBLIOGRAPHY

3

The research question is well framed, relevant and valid to the topic of the article. It is
evident that the article addresses the research question exhaustively and comprehensively in a
detailed and in-depth manner. Hendricks borrows from other scholars who have conducted
similar research and statistics from renowned government bodies and statutes that emphasize the
need for special education among students with autism to support his claims and allegations. He
starts by reviewing the current state of students with autism and then gives a theoretical
explanation of the relevance of his research study. Hendricks has managed to communicate his
intended message in a clear and concise manner. He employs quantitative research with adequate
sample size, 498 respondents, to answer the research question. The author engaged a large
sample size and took into consideration the social and cultural contexts to minimize research bias
emanating from varying perceptions and interests of the respondents. The primary limitation was
that his research could not be generalized because it was only conducted in one region. The
conclusion is justifiable based on the convincing nature of the results.
Unlike other sources discussing the need for special education for students with autism,
this source emphasizes on the competency of the teacher or the instructor. The article is crucial
when researching how to improve the efficiency of teaching strategies deployed in special
education. There are very few sources which have focused on the need to develop teacher
competency, and this article has managed to fill the gap in the literature. The insight gathered
from the research article can be applied in enhancing teacher professional development.
Although the article can be used universally to give an idea on the topic of specialized education
among students with autism, it is not prudent to generalize the findings of this research.
Lequia, J., Wilkerson, K. L., Kim, S., & Lyons, G. L. (2015). Improving transition
behaviors in students with autism spectrum disorders: A compreh...


Anonymous
I was having a hard time with this subject, and this was a great help.

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4

Similar Content

Related Tags