A Support Program for English as an Additional Language Nursing Students

Transcription

1 554014TCNXXX / Journal of Transcultural NursingChoi research-article2014 Education Department A Support Program for English as an Additional Language Nursing Students Journal of Transcultural Nursing 2016, Vol. 27(1) The Author(s) 2014 Reprints and permissions: sagepub.com/journalspermissions.nav DOI: / tcn.sagepub.com Liza Lai Shan Choi, RN, BN, MN 1 Abstract Canada is among the most diverse countries in the world. To provide meaningful health care, the Canadian health care system requires nursing health care teams reflecting this diversity. Meeting this demand should be a specific goal of Canadian nursing schools. Nursing students with English as an Additional Language (EALs) are graduating and passing national licencing exams at a lower rate than nursing students whose first language is English. It is the premise of the article that EALs require both academic and nonacademic forms of support during their years of nursing education. A literature review reveals that EALs facing academic crisis benefit from individual and group English language support, aimed at improving their understanding and use of English in an academic environment. Studies also suggest that group sessions help improve EALs psychosocial functioning. This article provides an overview of the establishment and implementation of a proactive nursing support program, purposely designed to address the challenges faced by EALs. Keywords EAL, nursing students, support program Introduction Canada is among the most diverse countries in the world, with 20.6% of its population born elsewhere. The percentage of visible minorities in Canada has increased fivefold between 1981 and 2011 (Chui, Flanders, & Anderson, 2011). To provide meaningful health care to all Canadian residents, it is imperative to have nursing health care teams reflecting this country s diversity. Nursing schools are an important source of nursing staff. It has been long recognized in English language academic settings that nursing students with English as an Additional Language (EALs) struggle more than peers whose first language is English (Choi, 2005; Gardner, 2005; Gudhe, 2003; Junious, Malecha, Tart, & Young, 2010; Scheele, 2011; Starr, 2009; Truong-Donnelly, McKiel, & Hwang, 2009). Research data suggest that EALs fare worse than their English counterparts (non-eals), both in nursing school graduations and in national licensing examination results (Gilchrist & Rector, 2007). Literature Review To consider strategies to aid EALs, it is necessary to understand the issues and challenges these students face. The following is a review of the literature specifically examining those factors that negatively affect EALs chances of success. These include challenges communicating in English generally and specifically in the language of nursing care, a lack of interaction with non-eal peers, the failure of educational institutions to recognize the need for additional faculty/ department support for EALs, the new social surroundings EALs face, and their sense of isolation (Choi, 2005; Crawford & Candlin, 2012; Malecha, Tart, & Junious, 2012; Olson, 2012). In particular, Olson noted that in addition to academic barriers, EALs may face psychosocial challenges of isolation along with fulfilling traditional roles at home. Given the clear challenges EALs face, a number of studies have examined the utility of academic support programs for these students. These studies showcase a number of programs with varying degrees of success (Brown, 2008; Gardner 2005; Gudhe, 2003; Weaver & Jackson, 2011; Wilson, 2006). Certain support programs focused on EALs perception of the challenges posed by studying in English. Gudhe (2003) examined the usefulness of individual tutoring and English pronunciation classes. In that study, the support program was specifically designed to aid in English pronunciation, writing skill, and reading and verbal skill. Weaver and Jackson (2011) examined the efficacy of a 4-day program offered to first-year EALs in improving academic writing, comprehension, and communication in English. Although this study 1 Mount Royal University, Calgary, Alberta, Canada Corresponding Author: Liza Lai Shan Choi, RN, BN, MN, School of Nursing and Midwifery, Faculty of Health and Community Studies, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, Canada T3E 6K6. lchoi@mtroyal.ca

2 82 Journal of Transcultural Nursing 27(1) demonstrated the positive impact of the academic support, an unanticipated benefit noted was the sense of community formed among EALs, by bringing together students needing this support. One particular improvement in the provision of support programs for EALs has been the recognition that nonacademic considerations are also important. The nonacademic component of the support group developed by Gardner (2005) focused on establishing supportive networks of faculty, registered nurses from minority backgrounds, and peer nursing student mentors. Group gatherings of the EALs with these professionals and non-eals promoted a sense of camaraderie, combatting feelings of isolation and stress. Brown (2008) coupled academic activities with nonacademic supports. In addition to both peer and faculty mentoring as a form of academic support, this support group included an activity to improve English fluency. As work in this area matures, it is important to recognize that effective support for EALs requires that both academic and nonacademic factors be addressed. Institutional barriers will have to be overcome through committed dedication of departmental faculty and support staff resources. This article details the establishment; structure and implementation of an EAL nursing support group model addressing both academic and nonacademic challenges, through group and individual formats. Establishing the EAL Nursing Support Program The idea for an EAL support program arose in 2007 after a faculty member was assigned to work with the EALs. This faculty member served in both a liaison role and a mentoring role. In most cases, individual EALs were referred to the faculty mentor only after the identification of significant issues, which had been ongoing for some time. Most EALs encountered in this way were already in academic crisis. The initial efforts of the faculty mentor to meet EAL needs were quite ad hoc and reactive in nature. The faculty member s initial experiences with EALs in crisis revealed that the reasons underlying the academic crisis were not always cognitive in nature. Instead, education was needed in interpersonal skills, learning about the intricacies of Canadian culture and the Canadian health care milieu. Based on these early experiences, the faculty mentor determined that EAL support must intentionally be designed to be forward-thinking and provide proactive support. Hence, the support group was focused on achieving academic EAL success by addressing psychosocial and/or scholastic issues prior to any identified crises. It was at this point that a program of structured activities was developed from which the model of EAL support arose. The first proactive EAL support program for the EALs was established in the winter semester of The program was promoted in first- and second-year nursing classes. communications were also sent to all students and faculty. Further announcements were made at faculty-wide staff meetings and posters were posted throughout the university. As well, EALs who had participated in the initial support group also endorsed the program. During this first semester and in the following academic year of , the number of EALs seeking support grew from 2 to 32 nursing students. The contact list at one point exceeded more than 60 addresses. Twelve EAL and non-eal peer mentors and six faculty members were involved in this program. Faculty with an interest in the area of nursing education and diversity were actively recruited to assist. Peer mentors, mostly senior-level nursing students, were interviewed by the faculty liaison to review the goals and expectations of the program. Goal and Objectives of the EAL Support Program Goal The primary goal of the EAL Support Program is to proactively guide and nurture EALs in both academic and nonacademic challenges, through group and individual formats. The objectives were to the following: To promote the participation of EALs and non-eals in the support program To nurture a sense of community among participants of the support program To provide workshops to enhance the ability and confidence of first- and second-year EALs to communicate in both the classroom and clinical settings To respond to individual EALs by directing students to university resources, as appropriate To establish a peer mentorship program To provide opportunities for one-on-one support where appropriate with the faculty mentor dedicated to the support program Structure of EAL Nursing Support Program The support program was managed by a planning committee and comprised four components (Figure 1). The planning committee consisted of the lead faculty mentor and student leaders who were mostly third- or fourth-year EALs and non-eals. This committee administered the four program components: workshops, mentoring, group gatherings, and newsletter. Workshops Workshops were offered to small groups of EALs. These focused on pronunciation of English words and nursing terminology. Specific advice was provided to EALs on cadence,

3 Choi 83 EAL Nursing Student Support Group Faculty Student Leaders Planning Commi ee Work Shops Faculty Peer Mentors & Mentees Gatherings News Le er Figure 1. The structure of the support group. tongue placement, and breathing in order to enunciate clearly. In most cases, a faculty member instructed four to six EALs. The aim of this workshop was to increase fluency in English generally, and specifically health care terminology. It has been shown that familiarizing EALs with specific medical terminology gave students confidence to use these terms repeatedly, which in turn led to increased critical understanding of that particular term (Whitehead, 2006). Faculty and Peer Mentors The faculty mentor fulfilled a number of roles: providing leadership to the support program; coordinating participating faculty and staff; facilitating group gatherings of EALs; setting up the various workshops aimed at pronunciation, diction, and accent reduction; and setting up peer mentoring relationships for the participating EALs. The group of peer mentors was selected from non-eals or EALs who participated in the initial support group. Those interested in becoming peer mentors were individually interviewed by the faculty mentor to ensure suitability and to review their roles and expectations. The faculty mentor considered factors such as personality and motivation in forming peer mentor mentee pairings. The pairs were tasked to meet regularly every 1 to 2 weeks. They were assigned the following topics to discuss: nursing school experiences, study advice, sharing of stories, and the role of mentors in their education Individual mentoring of the EALs by the faculty mentor was also available. In most cases, appointments were set, allowing sufficient opportunity to discuss and explore both academic and nonacademic matters of concern. Group Meetings of EAL Nursing Students Bimonthly large group gatherings, facilitated by the faculty mentor, were organized to provide EALs with an opportunity to share successes and challenges in their nursing education. Faculty mentors and non-eals were invited to attend. The large group sessions initially served as a venue for EALs and non-eals to interact socially. It was only as these large group gatherings continued on a bimonthly basis that the original intent and objectives of these meetings began to change in order to explore a number of nursing education issues. Areas that were explored included effective communication methods in clinical settings, understanding the

4 84 Journal of Transcultural Nursing 27(1) intricacies of interprofessional interaction in a North American context, and exploring academic expectations during clinical rotations. EALs were given the opportunity to practice their clinical communication skills without any impact on their formative or summative evaluations. Newsletter A newsletter, showcasing essays from EALs and non-eal peer mentors was published, distributed in hard copy and electronic format on a bimonthly basis. Newsletter submissions described EAL nursing education experiences both in class and during their clinical rotations. The newsletter also provided an additional route for communication among the EALs, non-eals, faculty, and staff. Conclusion The EAL nursing support group program incorporates the best practices identified in the literature. It allows the challenges experienced by EALs to be examined and addressed. The inclusion of workshops to help with the enunciation of common English and complex nursing terms was purposeful. By expanding the English and nursing lexicon of EALs, it is hoped that EALs will be able to express their thoughts with increased confidence in clinical and classroom settings, thereby advancing their critical thinking abilities. Moreover, Whitehead (2006) showed that increased usage of complex nursing terms led to increased understanding and critical clinical thinking. Another key aspect in the design of this EAL nursing support group was to deliberately provide a forum where EALs could bring forth the nonacademic challenges they were experiencing. The large group gatherings plus peer and faculty mentoring helped mitigate the various psychosocial challenges faced by EALs. In addition to these forms of psychosocial support, EALs were given advice about Canadian culture and the clinical nursing milieu. It is hoped that by addressing both academic and nonacademic domains, EAL learning will be enhanced, as seen in a number of literature reviews and studies (Hansen & Beaver, 2012; Lum, Dowedoff, Bradley, Kerkes, & Valeo, 2014; Mulready- Schick, 2013; San Miguel, Townsend, & Waters, 2013; Scheele, Pruitt, Johnson, & Xu, 2011). A study is under way to critically examine the impact of this support program has had on the educational experience of EALs. More specifically, a qualitative study examining this support group is currently under way. Study participants will be asked if their individual educational goals were met and if the EAL nursing support program played a role in mitigating the psychosocial challenges they faced. Additionally, the impact of the nursing support program of the EALs who become professional nurses will be a fruitful area of future inquiry one yielding considerable insight about the impact of this support program s functioning in the long term. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. References Brown, J. (2008). Develop an English-as-a-Second Language program for foreign-born nursing students at a historically Black university in the United States. Journal of Transcultural Nursing, 19, Choi, L. (2005). Literature review: issues surrounding education of English-as-a-Second Language (ESL) nursing students. Journal of Transcultural Nursing, 16, Chui, T., Flanders, J, & Anderson, T. (2011). Immigration and ethno cultural diversity in Canada (Statistics Canada Catalogue No XWE ). Retrieved from gc.ca/nhs-enm/2011/as-sa/ x/ x eng. cfm Crawford, T., & Candlin, S. (2012). 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 programs. Nurse Education in Practice, 13, doi: /j.nepr Gardner, J. (2005). A successful minority retention project. Journal of Nursing Education, 44, Gilchrist, K. L., & Rector, C. (2007). Can you keep them? Strategies to attract and retain nursing students from diverse populations: Best practices in nursing education. Journal of Transcultural Nursing, 18, Gudhe, J. A. (2003). English-as-a-Second Language (ESL) nursing students: Strategies for building verbal and written language skills. Journal of Cultural Diversity, 10(4), Hansen, E., & Beaver, S. (2012). Faculty support for ESL nursing students: Action plan for success. Nursing Education Perspectives, 33, Junious, D., Malecha, A., Tart, K., & Young, A. (2010). Stress and perceived faculty support among foreign-born baccalaureate nursing students. Journal of Nursing Education, 49, Lum, L., Dowedoff, P., Bradley, P., Kerekes, J., & Valeo, A. (2014). Challenges in oral communication for internationally educated nurses. Journal of Transcultural Nursing. Advance online publication. Malecha, A., Tart, K., & Junious, D. L. (2012). Foreign-born nursing students in the United States: A literature review. Journal of Professional Nursing, 28, Mulready-Schick, J. (2013). A critical exploration of how English language learners experience nursing education. Nursing Education Perspectives, 34, Olson, M. (2012). English-as-a-Second Language (ESL) nursing student success: A critical review of the literature. Journal of Cultural Diversity, 19,

5 Choi 85 San Miguel, C., Townsend, L., & Waters, C. (2013). Redesigning nursing tutorials for ESL students: A pilot study. Contemporary Nurse, 44, Scheele, T. H., Pruitt, R., Johnson, A., & Xu, Y. (2011). What do we know about educating Asian ESL nursing students? A literature review. Nursing Education Perspectives, 32, Starr, K. (2009). Nursing education challenges: Students with English as an additional language. Journal of Nursing Education, 48, Troung-Donnelly, T., McKiel, E., & Hwang, J. (2009). Factors influencing the performance of English as an Additional Language nursing students: instructors perspectives. Nursing Inquiry, 16, Weaver, R., & Jackson, D. (2011). Evaluating an academic writing program for nursing students who have English as a second language. Contemporary Nursing, 38, Whitehead, T. (2006). Comparison of native versus nonnative English-speaking nurses on critical thinking assessments at entry and exit. Nursing Administration Quarterly, 30, Wilson, V. W. (2006). Mentoring as a strategy for retaining racial and ethnically diverse students in nursing programs. Journal of Multicultural Nursing & Health, 12(3),