Finding a Voice: Supporting ESL Nursing Students’ Communication in Clinical Placement
A project completed in 2010, undertaken by Universal College of Learning, to identify the factors most likely to support effective communication in clinical placements for undergraduate nursing students in New Zealand for whom English is a second language (ESL students).
The main aims of the project were to:
- identify factors critical to success for ESL student nurses when they are learning within a clinical setting
- examine the experiences of ESL students as they completed a clinical placement and compare them with those of the students’ clinical lecturers and preceptors.
The project used a mixed methods approach involving:
- a review of the literature
- semi-structured interviews with seven individual students before, during and after their final clinical placement
- semi-structured interviews with preceptors
- a focus group conducted with clinical lecturers
- paper-based exercises designed to focus and stimulate the interview and focus group discussion and to collect data on students’ level of confidence in communicating.
Project LeaderUniversal College of Learning (UCOL)
The key findings from the project included:
- ESL nursing students face particular challenges because their programme includes a significant amount of clinical placement. Effective communication in English during this placement is a criterion for successful completion. While entry to the programme is usually dependent on a test of English language ability, these tests are often based on academic rather than practical requirements. The English required for the academic part of the programme is very different from the spoken English required for successful communication on placement.
- The findings of this study indicate there are several factors that support ESL students’ mastery of the communication required for placement. These factors are the student’s level of English language proficiency, the extent to which the student is able to adopt the proactive approach that will enable full access to learning opportunities within the placement, and the choice of preceptor and placement setting. These factors need to be addressed to provide students with the best chance of success.
- The findings from the study point to the importance of facilitating students’ entry to the placement community of practice, and their access to its interactions. The four major factors identified acted either to support or inhibit students’ participation in the placement community, and therefore influenced their learning, including mastery of effective communication skills. The study identified two critical factors intrinsic to the student, and two factors that could be considered as extrinsic to the student.
- The first intrinsic factor was the student’s proficiency with English language. Of particular importance was the student’s ability to use the sophisticated sociopragmatic language skills that are integral to effective nursing, and that enable the development of therapeutic relationships with clients and working relationships with colleagues. The student’s use of learning strategies, including the ability to adopt the proactive approach best suited to learning on placement, was the second intrinsic factor.
- Extrinsic factors likely to support the student’s integration within the community of practice were the quality of the preceptor and the tone of the placement environment. The preceptor’s attitude to and training for the role were critical in either facilitating or blocking the student’s entry to the interactions of the placement; of similar importance was the atmosphere of the placement environment, especially as it related to an inclusive or exclusive attitude towards the student.
The key recommendations and implications from the project included:
Direct instruction in appropriate language use | ESL students need direct instruction on the sociopragmatic rules governing appropriate language use in the clinical situation: how to chat with a staff member, how to ask a patient to do something uncomfortable, how to interrupt a surgeon, or how to clarify an instruction given by a senior staff member, for example.
Supporting ESL nursing students | Tertiary educators have a responsibility to provide students with the support they need to have a reasonable chance of success in their programme. In the case of nursing programmes, ESL students should be offered the experiences and support that will adequately prepare them for clinical placements, and the opportunities to develop the skills likely to facilitate success. This preparation should include explicit instruction and practise in the kinds of oral communication that will be required on placement, and in particular on the pragmatic rules of language use that govern appropriate use of language in this situation. This will require input from specialist language teachers as well as from nursing faculty.
Practising communication skills | Armed with the appropriate language skills, students need access to the interactions within the placement, in order to apply and practise these skills and to observe the communication of expert others.
Learning style | Students need to be guided towards the most effective learning style, through direct instruction in the strategies that will enhance their ability to enter the practices of the community. This instruction should be structured as part of the programme of study.
Appropriate preceptors | Other staff members in the placement have a dramatic impact on the quality of the students’ learning. A preceptor who is confident and comfortable working with an ESL student, and who has the skills to facilitate learning, can help the student to feel secure and confident in his or her developing abilities. Likewise, an environment where staff members are welcoming to ESL students and that displays an inclusive rather than discriminatory atmosphere, can do much to foster the confidence that is needed for a student to feel he or she is a legitimate member of the team. Placing ESL students with appropriate preceptors in supportive settings is an important consideration for tertiary nursing educators.