Institutional support for neurodivergent students in baccalaureate nursing education: An integrative review.

BACKGROUND: Neurodivergent students are increasingly recognized within higher education, alongside growing attention to the need for neurodiversity-informed approaches to learning, accommodation, and student support. Despite increasing attention to disability inclusion and neurodiversity, limited evidence has been synthesized regarding institutional support and barriers affecting neurodivergent students in baccalaureate nursing education, particularly within clinical learning environments. AIM: To synthesize evidence regarding institutional support, barriers, and emerging practices affecting neurodivergent students in baccalaureate nursing education, with particular attention to clinical learning environments. DESIGN: Integrative review guided by Whittemore and Knafl's framework and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: A systematic search of PubMed, CINAHL, PsycINFO, ERIC, and Scopus was conducted for peer-reviewed literature published between January 2014 and May 2026. Relevant pre-2014 sources identified through reference-list searching and citation tracking were also included when they met the substantive eligibility criteria. Consistent with integrative review methodology, empirical studies, reviews, legal and policy analyses, and conceptual sources relevant to institutional support, accommodation practices, faculty experiences, and clinical learning environments were included. Fourteen empirical studies were appraised using the Mixed Methods Appraisal Tool, while 16 non-empirical sources underwent structured narrative relevance appraisal. Findings were synthesized through thematic analysis. RESULTS: Thirty evidence sources were included in the integrative synthesis. Four interconnected themes were identified: clinical environments as sites of heightened barriers and ableism, faculty knowledge gaps and training needs, inconsistent accommodation implementation and institutional processes, and emerging institutional practices and inclusive innovations. Clinical education emerged as a particularly challenging context because of sensory demands, evaluative gatekeeping, hierarchical supervision, and normative expectations regarding competence and professional performance. Emerging strategies, including structured faculty development, proactive clinical planning, individualized placement support, and institution-wide inclusive practices, demonstrate promising approaches for improving support for neurodivergent nursing students. CONCLUSION: The findings suggest that barriers experienced by neurodivergent nursing students are shaped primarily by institutional structures, educational systems, and professional norms rather than by individual deficits. Advancing inclusive nursing education requires standardized clinical accommodation frameworks, structured faculty development, stronger collaboration among educational and clinical stakeholders, and rigorous evaluation of institution-level interventions. Moving beyond reactive accommodation toward proactive, system-level inclusion represents an important step toward strengthening equity, inclusion, and workforce diversity in nursing education.