Welcome back, faithful readers! As we discussed in Part 1 of this two-part blog, English as a Second Language (ESL) and English as an Alternate Language (EAL) students face a large number of challenges as they adapt to the English language and the American culture. In today’s post, I’ll highlight ways we can work together for the mutual benefit of ESL/EAL students, nursing faculty, and nursing care alike.
ESL and EAL students face all of the same financial, family, and time management challenges as every other nursing student, but in addition, studies have shown that they tend to have a higher attrition rate than native English speakers. Beginning nursing school with an English language proficiency that is above a school’s minimum requirement can help offset some of these challenges. For example, if a student is able to come to the United States for an intensive or year-long English language program prior to starting nursing school, this can help offset some of the communication and cultural issues and help them get a great TOEFL, IELTS, etc. score. In addition, in an online article called “Reflections on Diversity, Mirroring patient’ ethnicity in the RN workforce,” Victoria Navarro, RN, MSN, MAS, president of the Philippine Nurses Association of America and Joseph Mojares, RN, BSN, president of the Philippine Nurses Association of Northern California, encourage students to:
- “Not be embarrassed to ask questions to clarify what others mean so you can learn the correct pronunciation and terminology.
- Constantly immerse yourself in English-speaking environments and expose yourself to mainstream media at work and at home.
- Challenge yourself by taking classes in communication, leadership and public speaking so you can improve your English.
- Find mentors and preceptors who can encourage you and give you suggestions about how to present yourself and communicate.”
The good news is that ESL/EAL students have become increasingly successful in programs that have an (or are working on) increasing awareness of adapting teaching and testing methodologies to non-native speakers. The added benefit of adapting teaching techniques is that it can benefit all students, not just ESL and EAL, since there are many different types of learners in any given classroom. For example, when encouraging students to role play or complete activities in a simulation lab, you’re not only engaging them in active learning, which has a much higher retention rate than passive learning, but you’re also benefitting kinesthetic or tactile learners as well as ESL students. In addition, giving your ESL students an outline of a lecture or sharing your PowerPoint lecture slides can help them frame their thoughts in both English and their native language, and it can also help the rest of the students with their organizational skills.
Changing your testing methods and writing better exam questions take a bit more time than adapting teaching strategies, but by following the principles of linguistic modification, as outlined in Kaplan’s white paper, “Assisting Nursing Students through Linguistic Modification of Multiple Choice Questions,” according to Dr. Jamal Abedi, you can reduce the “the reading load on non-native English speakers and allow them to achieve scores comparable to those of native English-speaking students without affecting native English speakers’ scores, positively or negatively.” Dr. Susan Bosher, with whom Kaplan Nursing partnered to create our Plain English for Nurses feature in our Integrated Testing & Remediation program, identified six steps to achieve linguistic modification. They are:
- Maintaining nursing content vocabulary and terms
- Using a sequential and straightforward order of nursing content
- Using clear, direct, and concrete language that avoids impersonal constructions, vagueness, and abstractions
- Eliminating extraneous material
- Breaking down long, complex sentences into shorter, simpler sentences, and
- Avoiding dependent clauses (also called subordinate clauses), reduced, embedded clauses, and participial phrases (In case you’re like me and you’ve forgotten what clauses are, might I suggest reading https://en.wikipedia.org/wiki/Clause before modifying your next exam question.)
In short, write test questions that are more simply constructed, with fewer pronouns and complex sentences, and you’ll help break down the language barrier on exams, which will reduce the measurement error or bias that results when ESL/EAL students take multiple choice question tests. Since I find that a picture is often worth at least a thousand words, when the aforementioned steps are put into practice, the results would look something like this:
The above example comes from the Fundamentals of Nursing Focused Review Test (also known as a Practice Test) within our benchmark testing and remediation program, which we call Integrated Testing. The standard wording, or test question on the left, is the NCLEX-style test question. The question on the right is the alternate wording that has been modified for clarity. This wording appears only after a student has finished his/her practice test, which allows the student to practice the clearer version alongside the NCLEX version. Over time, students can better understand the language on the test so they don’t waste valuable time guessing what a question is trying to ask them on Test Day (otherwise known as improving their cognitive academic language proficiency, if you’re feeling fancy).
In October 2010, I had the opportunity to hear Dr. Madeline Leininger, the pioneer of transcultural nursing, speak at a conference sponsored by Kramer School of Nursing at Oklahoma City University. Prior to this experience, I only knew that increased diversity within the nursing profession was extremely important because of the growing multicultural population within the USA, but after hearing Dr. Leininger speak, I learned about the importance of including alternate perspectives, such as international health issues and organizations, cultural differences, and transcultural content into the training of nurses. This is a paramount benefit when inviting ESL and EAL students to attend your nursing program, and I hope you’ll agree that with a few small adjustments on the school’s part, perhaps even a few of the ones listed above, you’ll be able to reap the benefits of a more diverse nursing student population.
Continue reading an addendum on this blog entry, here.
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