Using Narrative Inquiry to Explore the Experience of One Ethnically Diverse ESL Nursing Student

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Abstract

Nursing education is tasked with the responsibility to ensure that the future nursing workforce mirrors the diversity of the patients it serves, but high attrition of ethnically diverse nursing students continues to plague prelicensure nursing programs. A great deal of quantitative evidence exists about variables that correlate to the higher attrition rate of ethnically diverse students. What is missing in the literature is the voice of the individual student solicited through a constructivist ontological lens. Therefore, the aim of this study was to explore the lived experience of one ethnically diverse nursing student who speaks English as a second language (ESL). Using a narrative inquiry approach, the life story of an Indian immigrant who successfully completed the nursing program was obtained through interviews and other artifacts. The student's life story was then reconstructed into a 3-dimensional narrative using a social constructivist perspective. Authenticity was established through unstructured interviewing, data triangulation, member checking, and careful examination of interview transcripts. Three themes were culled from the participant's narrative: family, language, and persistence. Analysis showed that family can be a source of additional stress for ethnically diverse students, but the support that family members provide tends to outweigh the negatives. Linguistic challenges related to English proficiency can lead to culturally insensitive behavior and discrimination toward ESL students. Persistence is a deeply individual phenomenon that is difficult to generalize or quantify. More research is needed to better understand the lived experience of ethnically diverse students who speak English as a second language. That knowledge will help nurse educators in creating culturally inclusive learning environments for ethnically diverse/ESL students that will support persistence and decrease attrition.

Introduction

Nurse educators continue to face an increase in the diversity of students they teach. I currently work at a community college in a large metropolitan area that has an over 80% Hispanic/Latino student population, and many of those students speak English as a second language (ESL) (U.S. News and World Report, 2016). This high percentage of ethnically diverse/ESL students is encouraging because an urgent need exists for a more diverse nursing workforce to care for an increasingly diverse patient population (Diverse, n.d.). Despite the recognized need, nursing programs' retention and graduation rates of these students remain low. Low nursing student retention is a persistent problem in the United States and other English-speaking countries such as Australia, Great Britain, and Canada (Mooring, 2016). Attrition rates have been reported as high as 50%, and ethnically diverse students make up a disproportionately larger portion of those numbers (Harris et al., 2014, Mooring, 2016, Olson, 2012).

High attrition of nursing students is a vexing problem, and nurse educators need to continue to examine the reasons behind it. As I started to peruse the nursing education literature in search of answers, I found it to be replete with quantitative and qualitative evidence about the many challenges experienced by ethnically diverse/ESL students (Mikkonen et al., 2016, Mooring, 2016, Olson, 2012). Reviewing the literature also led me to reflect on my own experience as a 19-year old immigrant to the United States and ESL student in an associate degree nursing program in the 1980s. I realized that quantitative evidence alone would not satisfactorily answer my question on why some ethnically diverse students persist and successfully complete a program while others do not. I concluded that exploring their experiences through the underutilized narrative inquiry approach would help me gain a more salient understanding of the educational experience of ethnically diverse/ESL students. Therefore, the purpose of my inquiry was to explore the lived experience of one ethnically diverse ESL nursing student with particular attention to experiences that involve language and how they are embedded in the student's narrative.

Section snippets

Study Design

It is clear from the nursing education literature that we have identified a number of challenges encountered by ethnically diverse students and that seem to correlate to attrition (Mikkonen et al., 2016, Mooring, 2016, Olson, 2012). However, the voice that is missing is that of the individual student. Using narrative inquiry and the life story interview method, in particular, can generate new knowledge that is distinctive because it comes from the individual and his or her unique experiences.

Findings (Mary's Story)

Three distinct themes were culled from Mary's narrative: family, language, and persistence.

Reflection and Implications for Nurse Educators

The way you see people is the way you treat them, and the way you treat them is what they become.

—Johann Wolfgang von Goethe

When I started with this inquiry, I could not have anticipated how transformative it would be for me, and I am deeply appreciative for Mary's willingness to share her story with me. As I was reconstructing her life story, I realized that Mary's narrative brought my understanding of her into sharper focus and crystallized into a deep appreciation for who Mary is as a human

Conclusion

Despite the progress we have made in attracting and admitting ethnically diverse students, we continue to experience significant difficulties with retaining and graduating them. Nursing student attrition is a complex and multifactorial problem that will continue to challenge nursing programs for the foreseeable future. Much more research is needed and especially about individual student perspective and experience. Narrative inquiry research offers nurse educators an in-depth look into the lived

Acknowledgments

I would like to thank Dr. Jeanette McNeill for her encouragement and support during the revision and resubmission process of this manuscript.

References (27)

  • Diverse

    Merriam-Webster's online dictionary

  • B. Green

    Narrative inquiry and nursing research

    Qualitative Research Journal

    (2013)
  • R.C. Harris et al.

    Addressing the challenges of nursing student attrition

    Journal of Nursing Education

    (2014)
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    Acknowledgment of financial support: No grant support or other financial assistance was received for this study.

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