Psychometric evaluation of the 11-item English language usage scale in commencing nursing students
Introduction
Globalisation and the widening participation agenda in the higher education of English-speaking countries have increased the number of students from culturally and linguistically diverse (CALD) backgrounds enrolling in university programs, including undergraduate nursing education (Harrington and Roche, 2014; Heaslip et al., 2017; McKendry et al., 2014). Changing student demographics have radically altered the traditional monolingual profiles of Australia, New Zealand, the United Kingdom and North America in recent decades, with one university reporting having over 100 languages represented among their student groups (Elder and von Randow, 2008). Often, these students from CALD backgrounds experience considerable challenges during their transition into undergraduate nursing studies, due to inadequate English language proficiency (Glew, 2013).
In Anglophone countries where English language is the medium of instruction in universities and professional communication, early identification of nursing students who may experience academic difficulties due to language issues is paramount for student success (Glew, 2013; Ralph et al., 2019; Salamonson et al., 2019). Without early identification and support, the risk of academic (Glew et al., 2015; Jefferies et al., 2018) and clinical (Mikkonen et al., 2016) underperformance is high for both international students with English as an additional language (EAL), and domestic students who speak a language other than English at home (Zheng et al., 2014).
Universities in Australia require an assessment of all four elements (speaking, listening, reading and writing) of English language proficiency through an internationally recognised English language proficiency test, such as the International English Language Testing System (IELTS) and the Test of English as Foreign Language (TOEFL) (Craven, 2011). Despite this requirement, research continues to report students having difficulty in using academic English to meet the demands of discipline-specific studies in tertiary programs such as nursing (Ralph et al., 2019; San Miguel and Rogan, 2015). In Australia, domestic students with EAL are not required to undertake an English language proficiency test for admission, unlike full-fee-paying international students who must meet a minimum admission benchmark in English proficiency for tertiary program enrolment. It has been reported that international students who have undergone formal English language examination prior to entry perform better academically and are less likely to drop out of their nursing studies than domestic students with EAL (Zheng et al., 2014). Hence, it is vital that early identification of English language skills of all nursing students is undertaken on program commencement. This ensures those with inadequate academic English language skills are identified in order to receive the academic support necessary to successfully transition, progress and complete their nursing studies. As there is no entry requirement for all potential students with EAL to be assessed for their English language skills, a brief and easy to administer diagnostic scale is needed to identify those students who may be at risk of underperforming due to a lack in English language skills.
Section snippets
Background
Effective communication is central to the roles and functions of a nurse. Within the health professional setting, effective communication promotes team work, resolves conflict and is pivotal in the safe delivery of quality, patient-centred care (Missen et al., 2016). Poor communication because of a lack of language skills can cause misunderstanding and confusion which has been associated with clinical incidences that jeopardise patient safety (Blackman et al., 2014). It is therefore imperative
Design
Using a prospective, correlational study design, a survey was initially administered, followed by survey respondents' academic grade on completion of their first assessment in the current unit of study. Where applicable, the ‘Consensus-based Standards for the selection of Measurement Instruments (COSMIN)’ guide for developing and evaluating measurement instruments was used (de Vet, 2011; Mokkink et al., 2010).
Results
Of the 1723 students enrolled in this unit of study at the beginning of the semester in 2018, 1161 (67%) voluntarily returned the survey. However, 61 cases were not included in the data analysis due to incomplete or missing data. The remaining 1100 (64%) surveys had all items of the ELUS-11 completed, and these respondents also provided written consent for their survey to be linked to their academic performance.
The mean age of students was 25.4 (SD: 8.0) years, ranging from 18 to 58 years (
Discussion
The results of this study provide empirical support for a one-factor structure of the ELUS-11, with strong internal consistency. Although the development of the scale was designed to measure speaking, listening, writing, and reading – four elements of language usage, only a one-factor solution emerged as a comprehensive structure from the factorial validity analyses, which included items from all four elements of English language usage. This was also confirmed by the scree plot, which indicated
Conclusion
The most significant finding of this study was that the ELUS-11 is a reliable tool in identifying students at risk of academic underperformance at the commencement of their nursing studies. This is a robust and cost effective self-report screening tool that is easy to administer at course entry. The ELUS-11 can screen both international and domestic students on English language usage. This widens the potential of entry screening beyond commencing international students to all students who may
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author contributions
YS, PJG and BE were responsible for the study conception and design. DJ and PJG collected the data, PJG collated the data and YS performed the data analysis. YS, PJG, LMR, DJ, DM, BC and BE were responsible for drafting the manuscript. YS, PJG, LMR, DJ, DM, BC and BE made critical revisions to the paper for important intellectual content. No conflict of interest has been declared by the authors.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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