Journal of Nursing Education

The Adult ESL Baccalaureate Nursing Student

Jane McCausland Kurz, MSN, RN, CCRN

Abstract

Long before the invasion of European settlers, America was multicultural - American Indians did not share a monolithic culture. Two thirds of the current worldwide immigration is to the United States. By 2020, 35% of the American population are expected to be of ethnic minority (Tifft, 1989). In California alone, 46% of the population is expected to be of ethnic minority in just 10 years (Memmer & Worth, 1991). English is not the primary language for most immigrants and a large proportion are not literate in English. Most relevant for this article are the facts that Asians and Hispanics comprise the two fastest growing populations in the United States. According to the most recent census, 7.2 million Asians now live in the United States (U.S. Bureau of the Census, 1990). As many as 47 million Hispanics are predicted to be living in the United States by 2020 (Cassera, 1990).

The number of international students has grown dramatically over the past 20 years, with new students arriving at an increased rate of 7.5% annually (Upvall, 1990). In 1986, foreign students represented 10% of the college population in the United States. However, at the 15 institutions where their numbers were largest, they accounted for 11% to 25% of the total enrollments (Shearer, 1989).

Currently, 1.8 million nurses are registered in the United States. Of these, 2.6% are Asian and 1.4% are Hispanic (Farrell, 1988). Though fewer than 4% are foreigneducated, in some institutions 50% of the nurses are from other countries (Burner, Cummingham, & Hattar, 1990). These data are relevant as nursing has traditionally been a middle-class, nonminority profession. However, as demographics shift, educators should expect that the nursing student population will reflect the general population.

One might expect that the increasing ethnic diversity in adult learners should lead to an increase in the number of journal articles and research related to this multicultural phenomenon. However, a paucity of information is available for faculty who must meet the challenges of adult English-as-a-second-language (ESL) students (McLeod & Kreitlow, 1991; Phillips & Hartley, 1990; Shearer, 1989).

Nakanishi (1990) reviewed five leading adult education journals between 1976 and 1986. He found only one brief article on minority, immigrant, and refugee populations. From 1985 through 1990 only 1% of adult education literature mentions one or more of the various ethnic minority groups in the United States (Ross-Gordon, 1991). Yet, in 1988, Farrell reported that 3% of nursing students were Hispanic and 4.5% were American Indian or Oriental. Consequently, adult education research focusing on minority populations is timely.

Adaptation of the Foreign Adult Learner

Foreign students attending school in the United States lose the security of family, friends, and jobs. Many do not have the opportunity to return home until their education is completed. They usually pay out-of-state tuition with some funding from their own countries, from foundations, or from the college. This financial support often covers tuition, books, and a stipend, but not living arrangements for school breaks. There are many expenses that may not be anticipated or covered. These are part of the stresses that could impede the adaptation of the foreign student to the new environment.

Sam and Eide (1991) examined foreign students at their university. Included among individuals with the poorest mental health were married students living away from their spouses, single females, Asians, and Arabics. These students exhibited symptoms of depression, anxiety, paranoia, and somatic complaints. Ebbin and Blankenship (1986) reviewed 96,804 student visits at a student health center. They found that the foreign students used the center significantly more than the domestic students, usually showing depression and anxiety. Other authors have…

Long before the invasion of European settlers, America was multicultural - American Indians did not share a monolithic culture. Two thirds of the current worldwide immigration is to the United States. By 2020, 35% of the American population are expected to be of ethnic minority (Tifft, 1989). In California alone, 46% of the population is expected to be of ethnic minority in just 10 years (Memmer & Worth, 1991). English is not the primary language for most immigrants and a large proportion are not literate in English. Most relevant for this article are the facts that Asians and Hispanics comprise the two fastest growing populations in the United States. According to the most recent census, 7.2 million Asians now live in the United States (U.S. Bureau of the Census, 1990). As many as 47 million Hispanics are predicted to be living in the United States by 2020 (Cassera, 1990).

The number of international students has grown dramatically over the past 20 years, with new students arriving at an increased rate of 7.5% annually (Upvall, 1990). In 1986, foreign students represented 10% of the college population in the United States. However, at the 15 institutions where their numbers were largest, they accounted for 11% to 25% of the total enrollments (Shearer, 1989).

Currently, 1.8 million nurses are registered in the United States. Of these, 2.6% are Asian and 1.4% are Hispanic (Farrell, 1988). Though fewer than 4% are foreigneducated, in some institutions 50% of the nurses are from other countries (Burner, Cummingham, & Hattar, 1990). These data are relevant as nursing has traditionally been a middle-class, nonminority profession. However, as demographics shift, educators should expect that the nursing student population will reflect the general population.

One might expect that the increasing ethnic diversity in adult learners should lead to an increase in the number of journal articles and research related to this multicultural phenomenon. However, a paucity of information is available for faculty who must meet the challenges of adult English-as-a-second-language (ESL) students (McLeod & Kreitlow, 1991; Phillips & Hartley, 1990; Shearer, 1989).

Nakanishi (1990) reviewed five leading adult education journals between 1976 and 1986. He found only one brief article on minority, immigrant, and refugee populations. From 1985 through 1990 only 1% of adult education literature mentions one or more of the various ethnic minority groups in the United States (Ross-Gordon, 1991). Yet, in 1988, Farrell reported that 3% of nursing students were Hispanic and 4.5% were American Indian or Oriental. Consequently, adult education research focusing on minority populations is timely.

Adaptation of the Foreign Adult Learner

Foreign students attending school in the United States lose the security of family, friends, and jobs. Many do not have the opportunity to return home until their education is completed. They usually pay out-of-state tuition with some funding from their own countries, from foundations, or from the college. This financial support often covers tuition, books, and a stipend, but not living arrangements for school breaks. There are many expenses that may not be anticipated or covered. These are part of the stresses that could impede the adaptation of the foreign student to the new environment.

Sam and Eide (1991) examined foreign students at their university. Included among individuals with the poorest mental health were married students living away from their spouses, single females, Asians, and Arabics. These students exhibited symptoms of depression, anxiety, paranoia, and somatic complaints. Ebbin and Blankenship (1986) reviewed 96,804 student visits at a student health center. They found that the foreign students used the center significantly more than the domestic students, usually showing depression and anxiety. Other authors have found a significant correlation between the quality of social interaction with people in the host country and students' depression (Ebbin & Blankenship; Searle & Ward, 1990; Svarney, 1989).

One experience common to foreign students is "uprooting." This term refers to abrupt transition from a familiar environment to an alien one. It is exacerbated when international students must cope with a number of changes (Upvall, 1990). She states that there are four stages following uprooting. The first, the "honeymoon state," is characterized by the individual's enchantment with the host culture concomitant with a lack of understanding of that culture. In the second stage, the "hostility stage," the individual becomes very critical of the host culture. The "stage of improved adjustment" follows when the individual becomes proficient in understanding the language. Finally, in the "stage of biculturalism," the individual accepts the new culture within its norms. Upvall examined full-time students in her study and showed that academic satisfaction did not correlate with adjusting to uprooting. Conversely, students who engaged in nonacademic activities with Americans and expressed comfort with the English language were more likely to demonstrate adequate adjustment following uprooting.

By understanding the uprooting model, educators can help international students to restructure their environment for success. In addition, the use of emotional and social supports through formal counseling, culturally sensitive advisement, and use of student/peer-support groups assist in the process (Brown, 1987).

Baccalaureate Nursing Programs

Nursing programs are accepting nontraditional students in increasing numbers partly to maintain declining enrollments. These students frequently represent diverse racial and ethnic groups for whom English is a second language (Phillips & Hartley, 1990). Minority students are not, however, graduating from American universities and nursing programs in proportion to their representation in the nation's population (Tucker-Alien, 1989). They experience disproportionately higher attrition rates than traditional students (Phillips & Hartley). Due to cyclic nursing shortages and costs of incomplete educational programs, this graduation rate is a concern to nurse educators and the nursing profession.

At issue is the ESL student, defined as a student who attended grade school outside the United States using a language other than English, or who was raised in a non-English-speaking home, who continues to use his or her native language at home, and who uses English only in environments where the native language is not used (Memmer & Worth, 1991). Difficulties for the ESL student are most pronounced in reading, listening, speaking, and writing. Approaches that help in the retention and graduation of the ESL nursing student are those common to any student; however, implementations of these strategies need to be individualized.

Teaching Strategies

Institutions of higher learning often require a placement test for math, writing, and reading comprehension. The sole approach reported in the literature for ESL students (Memmer & Worth, 1991) is the Test of English as a Foreign Language (TOEFL). Usually, if students do not achieve scores at a predesignated level, they are not admitted. They must take remedial courses to correct deficiencies.

The instructor has a number of strategies to enhance learning once the student is admitted to the program. In some cultures, students do not approach the teacher for any assistance. The American instructor needs to invite students to call, make an appointment, or stop in the office with any concerns (Shearer, 1989). English reading skills with the foreign student are often better developed than their verbal or auditory skills. A course syllabus should include the instructor's name, office telephone number and location, semester class schedule, required readings, exam dates, and any other necessary information. Every student should have a syllabus.

The lecture is the most commonly used teaching strategy in the United States (Farrah, 1991). It is helpful to the ESL student to have typed copies of the lecture contents and to have extra time to copy transparencies used during lectures. Students often find it helpful to record lectures and review their tapes and notes using bilingual dictionaries (Phillips & Hartley, 1990; Shearer, 1989).

Students who feel uncomfortable with English tend to withdraw in front of native speakers. This reticence hinders development of English proficiency (Dick, 1989). In a review of 21 generic nursing programs, Memmer and Worth (1991) reported that one school with a high ESL student retention rate encouraged ESL students to participate in a conversation lab. It was held daily with a brown bag lunch to practice English. Chen (1990) used 142 foreign college students to show that there was a significant correlation between communication adaptability and cross-cultural adjustment. Foreign nursing students have the additional advantage in that they are forced to improve their verbal abilities in the clinical area where they provide direct care to clients. It has been reported that exposure to real, content-meaningful communication in a language provides the motivation and opportunity to increase skills (Phillips & Hartley, 1990). Some institutions report improved verbal skills when they match native students with ESL students. Conversation exchanges occur at receptions, through telephones, or during study sessions (Fragiadakis & Liecwinko, 1986; Phillips & Hartley; Shearer, 1989).

Experiential teaching strategies are useful when the goal is to acquire skills or to change attitudes and the transmission of information. Phillips and Hartley (1990) reported on a survey involving 1,388 ESL students. It showed that most preferred kinesthetic and tactile learning styles as opposed to visual and auditory modes. Shearer (1989) stated that she used roleplaying and videotaped interviews with her ESL students. All instructors and students reported positive results. Johnson Í1991) used case studies, questionnaires, small and large group discussions, and simulations to transcend cultural and language barriers in a professional leadership course. Since a large group of students had a common language, he separated them by language. Their small groups could discuss information from lectures and videotapes in their native tongues. One spokesperson summarized the transactions in English. By the end of the semester, everyone had the chance to present a summary. Johnson used games as another experiential teaching strategy to illustrate certain leadership principles. They were always followed by debriefing sessions. He advocates their use in intercultural settings. They help students become their own instructors within their particular cultural milieu.

Phillips and Hartley (1990) state that lexical errors were considered most serious and academically unacceptable with ESL students. They suggest that instructors treat writing assignments as work that evolves over time. Referrals for writing labs or remedial learning centers often assist the student. Assignments that request a student to include personal feelings or thoughts will lead to better developed written communication skills.

Educating Educators for Multicultural Classrooms

Many adult educators completed their secondary education before today's renewed immigration and heterogeneous classrooms. Educators require intercultural competence rather than ethnic survival skills. Fantini (1991) states that this competence is the ability to deal with diversity in a positive way. It involves skills, attitudes, awareness, and knowledge that foster effective interactions with others across cultures, races, and religions.

The adult educator needs to gain knowledge about cultures through reading and communicating with experienced practitioners. These cultural experts should have classroom and workplace experiences. The educator already interacting with the diverse student population will benefit by becoming an astute observer and listener. That instructor might find it helpful to focus on six cultural phenomena that Giger and Davidhizar (1991) identified in all cultural groups. These include: communication, space, social organization, time, environmental control, and biological variations, such as food preferences.

The experiential approach plays an important role in changing attitudes and sensitizing educators to problems stemming from cross-cuitural misunderstanding. One simulation game, "BaFa BaFa," is reported to be very effective. Two different groups are used in the simulation. One is family-oriented and the other is businessoriented. Through designed exercises, the participants experience the conflicts commonly found between two different cultures. Orem (1991) states that the need for cross-cultural training stems from our inability to recognize how our values and behaviors differentiate us from others.

Monocultural education impoverishes the instructor and the student. It restricts imagination, stunts critical thinking, stifles curiosity, breeds arrogance and insensitivity, and provides fertile ground for racism (Modgil, Verma, Mallick, & Modgil, 1986). Due to changing demographics, we can no longer afford negative stereotyping. Everyone must work together to transcend barriers to education.

References

  • Brown, M. ( 1987). The effects of a support group on student attrition due to academic failure. Journal of Nursing Education, 26, 324-327.
  • Burner, O., Cummingham, P., Hattar, H. (1990). Managing a multicultural nurse staff in a multicultural environment. Journal of Nursing Administration, 20(6), 30-34.
  • Cassera, B. (1990). Adult education in a multicultural society. Routledge, NJ: Chapman and Hall.
  • Chen, C. (1990). Communication adaptability and interaction involvement as a predictor of cross-cultural adjustment. (ERIC Document Reproduction Service No. ED 327 907)
  • Dick, R. (1989). A case for exclusive sections of the basic oral communication course: International ESL students. (ERIC Document Reproduction Service No. ED 306 763)
  • Ebbin, ?., Blankenship, E. (1986). A longitudinal health care study: International versus domestic students. Journal of American College Health, 34, 177-182.
  • Fantini, A. (1991). Becoming better global citizens: The promise of intercultural competence. Adu It Learning, 3(\\ 1-19.
  • Farrah, S. (1991). Lecture. In: Galbraith, M. (Ed.), Adult learning methods. Malabar, FL: Kreiger Publishing.
  • Farrell, J. (1988). The changing pool of candidates for nursing. Journal of Professional Nursing, 4, 145.
  • Fragiadakis, H-, & Liecwinko, A. (1986). The conversation exchange program: Foreign and American students together. (ERIC Document Reproduction Service No. ED 274 194)
  • Giger, J., & Davidhizar, R. (1991). Transcultural nursing. St. Louis, MO: Mosby-Year Book.
  • Johnson, P. (1991). Transcending cultural differences through experiential teaching techniques. Adult Learning, 3(11), 28-29.
  • McLeod, K, & Kreitlow, B. (1991). Crossing the cultural barrier. Adul t Lea rn ing, 3(2), 7.
  • Memmer, M., & Worth, C. (1991). Retention of ESL students: Approaches used by California's 21 generic baccalaureate nursing programs. Journal of Nursing, Education, 33, 389-396.
  • Modgil, S., Verma, G., Mallick, K., Modgil, C. (1986). Multicultural education; the interminable debate. Philadelphia: The Fahner Press.
  • Nakanishi, D. (1990). Asian Americans and adult education: The social and political resocialization of a diverse immigrant and refugee population. In: B. Cassera (Ed.), Adult education in a multicultural society. Routledge, NJ: Chapman and Hall.
  • Orem, R. (1991). Preparing adult educators for cultural change. Adu It Learning, 3(2), 8-10.
  • Phillips, S., & Hartley, J. (1990). Teaching students for whom English is a second language. Nurse Educator, 15(5), 29-32.
  • Ross-Gordon, J. (1991). Needed: A multicultural perspective for adult education research. Adult Education Quarterly, 42(1), 1-16.
  • Sam, D., & Eide, R. (1991). Survey of mental health of foreign students. Scandinavian Journal of Psychology, 32(1), 22-30.
  • Searle, W., & Ward, C. (1990). The prediction of psychological and sociocultural adjustment during cross-cultural transitions. International Journal of Intercultural Relations, 14, 449-464.
  • Shearer, R. (1989). Teaching foreign students. Journal of Nursing Education, 28, 427-428.
  • Svarney, R. (1989). Counseling foreign law students. Journal of Counseling and Development, 68, 228-231.
  • Tifft, S. (1989, August 21). The search for minorities. Time, pp. 64-65.
  • Tucker-Alien, S. (1989). Losses incurred through minority student nurse attrition. Nursing and Health Care, 10, 395-397.
  • Upvall, M. (1990). A model of uprooting for international students. Western Journal of Nursing Research, 12, 95-107.
  • U.S. Bureau of the Census. (1990). Summary population and housing characteristics. Washington, DC: Government Printing Office.

10.3928/0148-4834-19930501-10

Sign up to receive

Journal E-contents