A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes

Abstract

Australia is increasingly becoming a culturally diverse country, with this trend being reflected in nursing education as significant numbers of students enrol from backgrounds where English is a second/other language (ESL). These students will enable the provision of culturally competent care that a culturally diverse health system requires (Ohr et al., 2010), however they require significant levels of support to not only achieve academically in their nursing programme, but also to perform at the expected level during clinical placements (Boughton et al., 2010). Difficulties communicating with colleagues, patients and their families in the clinical setting have been identified among the challenges that ESL nurses face (Boughton et al., 2010; Jeong et al., 2011). A review of the literature indicates sporadic research into the education of nurses from ESL backgrounds. This paper discusses and raises awareness of common themes such as the challenges of adjusting to Western culture and using the advanced and technical English required by higher education and healthcare. This paper also discusses mixed results reported from a number of English language support programmes. This indicates a need for further research in this area to strengthen support for these nurses who can assist in the provision of culturally competent care.

Introduction

Australia is becoming a culturally diverse country with twenty six percent of the population born overseas (Australian Bureau of Statistics, 2012). While eighty one percent of the population speak only English, the primary language spoken in Australia, ‘forty nine percent of longer-standing migrants and sixty seven percent of recent arrivals speak a language other than English at home’, with 3.1% of recent migrants not speaking English at all (Australian Bureau of Statistics, 2012). In response to the emergence of a multicultural society, various governmental workforce strategies are encouraging the employment of health care professionals from various linguistic and cultural backgrounds to enable the provision of culturally competent care that Australia requires (Ohr et al., 2010). Culturally competent care is the provision of effective health care that recognises and respects difference in culture, and ensures that the care provided does not diminish, but tries to meet cultural needs, thereby preserving and protecting cultural diversity (McMurray and Clendon, 2011). Twenty seven percent of students in Australian universities came from backgrounds where English is a second/other language (ESL) (Australian Bureau of Statistics, 2011) and this figure is reflected in the student nurse population which will potentially contribute to meeting the cultural and linguistic needs of Australia's multicultural health system.

While overseas students have been actively recruited, studies by Shakya and Horsfall (2000) and Sanner and Wilson (2008) found that nursing students with ESL backgrounds tend to have difficulty with general and technical aspects of English, which can affect academic performance (Guhde, 2003; Brown, 2001; Malu and Figlear, 1998), and contribute to higher attrition rates than students who are native speakers of English (Phillips and Hartley, 1990; Choi, 2005; Salamonson et al., 2011). According to Boughton et al. (2010), students with ESL backgrounds require a high level of support to achieve academically during their nursing programme and perform at the expected level during clinical placements. Challenges for these students working in the clinical setting include difficulties communicating with colleagues, patients and their families (Boughton et al., 2010; Jeong et al., 2011). Among these are problems with pronunciation, telephone communication, failure to comprehend colloquial expressions and medical/nursing jargon. Shakya and Horsfall (2000) found that while nurses with ESL backgrounds could demonstrate minimum English proficiency required for course acceptance, development of advanced English communication skills related to clinical practice was urgently needed in clinical settings.

A significant element in providing culturally competent care is the ability to communicate clearly and effectively as the nurse–patient relationship is built on communication, and as such, effective use of language is essential. Candlin (1995) argues that communicative competence is vital for nurses if they are to effectively accommodate, empathise and affiliate with patients, and thus build trusting relationships that underpin good nursing practice. An integral component of communicative competence is linguistic competence, which includes the ability of the healthcare provider to speak clearly and correctly with patients (Guttman, 2004), particularly important as many nursing roles such as patient education, counselling, advocating, and advising consist of mediating through discourse only (Candlin, 2002). The National Competency Standards for Registered Nurses (RN) requires that RNs ‘communicate effectively with individuals/groups to facilitate provision of care’ (Competency 9.2 Australian Nursing and Midwifery Council, 2006), however no guidelines are provided as to how nurses with ESL backgrounds can be supported to develop effective communication with their patients. Current literature regarding the effectiveness of support for ESL students is limited.

A review of the literature indicates that there has been sporadic research in education of students with an ESL background in both nursing and other disciplines, and this is consistent with previous findings (Phillips and Hartley, 1990; Malu and Figlear, 1998; Omeri et al., 2003; Konno, 2006; Chiang and Crickmore, 2009). Studies from the USA, Australia, the UK and New Zealand have focused primarily on the issues and challenges faced by the students. Similarly, Andrade (2006) found a limited number (56) of studies (in the general higher education sector) relating to factors influencing adjustment, and interventions designed to specifically address the needs of international students which are descriptive rather than evaluative in nature. Common themes identified in the literature that will be discussed in this paper include the challenges of adjusting to Western culture, difficulties using academic English and the technical language of healthcare, and the support programmes for ESL students that have been implemented with mixed results.