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
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.
Section snippets
Challenges faced adjusting to language and culture
Difficulty adjusting to Western culture and using the English language is a prominent theme demonstrated in several studies. Andrade's (2006) review of studies published between 1996 and 2005 identified a comprehensive range of factors that influenced social adjustment and academic achievement of international students. For example, first year international students found difficulty understanding lectures because of the speed of lecture delivery, and the vocabulary used. Furthermore,
Challenges using academic english
One of the problems ESL students face completing their studies and participating effectively in the clinical setting appears to be related to the higher level of academic language required in higher education, along with the technical language used in healthcare. Higher level English refers to functioning at the higher level on Bloom's taxonomy (1956, as cited in Jacques, 2000) of educational objectives which includes tasks of analysis, synthesis and evaluation. Cognitively demanding oral and
English language support programmes
While few in number, there are conflicting results of the success of English language support programmes, however the majority show successful outcomes. Baik and Grieg (2009) evaluated an ESL tutorial programme in a Faculty of Architecture aimed at developing discipline-specific language and academic study skills, while students concurrently learned the content of the subject. Despite the limitations of small numbers (n = 25) for this quantitative study in one faculty, the results suggest that
Conclusion
Reviewing the literature has highlighted a variety of complex and interacting challenges for nurses with ESL backgrounds in adjusting to Western culture and using the advanced and technical English of higher education and healthcare. Mixed results regarding the success of English language support programmes demonstrate that further research is needed to develop and refine language support that will promote the development of CALP. With increasing cultural diversity in healthcare, nurses with
References (40)
- et al.
From needs analysis to curriculum development: designing a course in health-care communication for immigrant students in the USA
English for Specific Purposes
(2002) - et al.
A tailored program of support for culturally and linguistically diverse (CALD) nursing students in a graduate entry Masters of Nursing course: a qualitative evaluation of outcomes
Nurse Education in Practice
(2010) Arguing about how the world is or how the world should be: the role of arguement in IELTS tests
Journal of English for Academic Purposes
(2004)- et al.
Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program
Nurse Education Today
(2011) - et al.
Meeting the challenges of cultural diversity in the academic setting
Nurse Education in Practice
(2003) - et al.
The experiences of students with English as a second language in a baccalaureate nursing program
Nurse Education Today
(2008) - et al.
The Cummins Model: a framework for teaching nursing students for whom English is a second language
Journal of Transcultural Nursing
(1999) - et al.
Perceived barriers for ethnically diverse students in nursing Programs
Journal of Nursing Education
(2006) International students in English-speaking universities: adjustment factors
Journal of Research in International Education
(2006)Migration, Australia, 2009–2010
(2011)
Reflecting a Nation: Stories From the 2011 Census, 2012–2013
National Competency Standards
Improving the academic outcomes of undergraduate ESL students: the case for discipline-based academic skills programs
Higher Education Research & Development
Culture and diversity in the nursing classroom: an impact on communication and learning
Journal of Cultural Diversity
Transcultural issues in nurse patient communication
Geriaction
Improving English proficiency of post-graduate international nursing students seeking further qualifications and continuing education in foreign countries
The Journal of Continuing Education in Nursing
Literature review: issues surrounding education of English-as-a-second language (ESL) nursing students
Journal of Transcultural Nursing
Investigating the language needs of culturally and linguistically diverse nursing students to assist their completion of the bachelor of nursing programme to become safe and effective practitioners
Nurse Education Today
Interdependence of first and second language proficiency in bilingual children
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