Journal of Nursing Education

Major Article 

Continued Influence of an English-as-an-Additional-Language Nursing Student Support Group

Liza Lai Shan Choi, MN, RN

Abstract

Background:

English-as-an-additional-language (EAL) nursing students are more likely to experience academic challenges than traditional nursing students whose primary language is English. To support EAL student success, a novel support group was established to address both the academic and nonacademic issues faced by these students.

Method:

A hermeneutic approach was used to explore the perceived influence of a nursing student support group on EAL student success in a Canadian undergraduate nursing setting. Through individual interviews, a rich understanding of the lived experience of EAL nursing students was obtained.

Results:

The EAL Nursing Student Support Program provided a holistic approach to EAL student success, encompassing both academic and psychosocial support provisions embedded in discipline-specific curricula. Individual interviews regarding support group provisions revealed the perceived importance of balance, resiliency, helping others, culture, a safe place, social aspects, and group environment.

Conclusion:

The continued success of this program necessitates the funding of this support group and other disciplinary support programs that provide comprehensive, discipline-specific approaches to EAL support, arguing against the centralized model of academic aid seen in many postsecondary institutions. [J Nurs Educ. 2019;58(11):647–652.]

Abstract

Background:

English-as-an-additional-language (EAL) nursing students are more likely to experience academic challenges than traditional nursing students whose primary language is English. To support EAL student success, a novel support group was established to address both the academic and nonacademic issues faced by these students.

Method:

A hermeneutic approach was used to explore the perceived influence of a nursing student support group on EAL student success in a Canadian undergraduate nursing setting. Through individual interviews, a rich understanding of the lived experience of EAL nursing students was obtained.

Results:

The EAL Nursing Student Support Program provided a holistic approach to EAL student success, encompassing both academic and psychosocial support provisions embedded in discipline-specific curricula. Individual interviews regarding support group provisions revealed the perceived importance of balance, resiliency, helping others, culture, a safe place, social aspects, and group environment.

Conclusion:

The continued success of this program necessitates the funding of this support group and other disciplinary support programs that provide comprehensive, discipline-specific approaches to EAL support, arguing against the centralized model of academic aid seen in many postsecondary institutions. [J Nurs Educ. 2019;58(11):647–652.]

Many studies have documented the struggles of English-as-an-additional language (EAL) students tasked with the challenge of postsecondary education in an additional language (Choi, 2018, 2019; Havery, Townsend, Johnson, & Doab, 2019; King, Porr, & Gaudine, 2017; Martin et al., 2018; Ramjan et al., 2018; Salamonson et al., 2019; Tranter, Gaul, McKenzie, & Graham, 2017)—that is, nontraditional students completing postsecondary education in a language that differs from their first spoken language (Segers & van den Broek, 2017). Despite discrimination, peer rejection, and communication challenges (Choi, 2018), the EAL student population has repeatedly proven their ability to succeed and persevere when provided with proper educational supports and institutional strategies designed to help EAL students succeed (Choi, 2018, 2019; Havery et al., 2019; King et al., 2017; Martin et al., 2018; Ramjan et al., 2018; Salamonson et al., 2019; Tranter et al., 2017). Enhancing EAL student success is especially important in diverse countries such as Canada, where more than 20% of the population identifies as foreign born (Statistics Canada, 2017b) and more than 70% of immigrants speak a first language other than one of the two official languages (Statistics Canada, 2017a).

In an effort to support the EAL nursing student population at Mount Royal University (MRU), the MRU EAL Nursing Student Support Group was developed in 2009 in order to encourage academic achievement, create a safe place for study and disclosure, establish a supportive school culture, and provide social networking opportunities. The support group template integrates both academic and psychosocial support strategies through academic workshops, peer and faculty mentoring, large group gatherings, and bimonthly newsletters (Choi, 2016). By providing students with a safe and secure place to study, thrive, and seek guidance for individual concerns or troubles, the EAL Nursing Student Support Group has aimed to help students increase control over their environment and their ability to confidently execute daily activities.

A supportive school culture refers to a culture in which faculty are invested in making students feel cared for and appreciated (Deal & Peterson, 2016). Faculty and mentors at the EAL Nursing Student Support Program accomplish this goal by helping EAL students struggling with academic and/or social challenges in an atmosphere free of judgement or academic evaluation. A supportive school climate is further achieved by supporting the cultural needs of EAL students who often suffer from cultural discord and uncertainty (Choi, 2018; Havery et al., 2019; Tranter et al., 2017).

As many EAL students struggle with social isolation and discrimination (Tranter et al., 2017), the EAL Nursing Student Support Group strives to create social networking opportunities where EAL students are encouraged to connect with other students who share similar challenges and experiences (Choi, 2018). In doing so, students have the potential to learn from one another and build confidence in their endeavors.

The EAL Nursing Student Support Group also acknowledges that EAL student success can be facilitated by supportive faculty and peers invested in helping vulnerable students succeed in new cultural and linguistic environments. Through mentoring, both faculty and more experienced EAL students can help create a supportive environment conducive to the academic growth and development of EAL students entering nursing education at the postsecondary level. Research examining student engagement and involvement suggests that providing students with formal opportunities to help one another with their studies is conducive to both student success and successful completion of postsecondary studies (Larkin & Dwyer, 2016). According to Kahu and Nelson (2018), “simply put, students who are engaged with their studies are more likely to be successful” (p. 59) as engagement represents “an individual student's psychological state: their behavioral, emotional and cognitive connection to their learning” (p. 59).

Finally, the EAL Nursing Student Support Program acknowledges that students must be supported in achieving school–life balance in order to succeed academically and maintain mental well-being. This is an important issue affecting many postsecondary students, as previous studies have reported that a significant portion of students struggle to balance academic responsibilities with competing demands (Evans, Bira, Beltran Gastelum, Weiss, & Vanderford, 2018; Park & Headrick, 2017; Stallman & Hurst, 2016).

This study is a continuation of a previous set of investigations (Choi, 2018, 2019) examining the lived experiences of postsecondary students enrolled in an EAL nursing student support group, completing a 4-year Canadian Bachelor of Nursing degree in an additional language. The primary focus of this study is the continued impact of enrollment in the EAL Nursing Student Support Group. Objectives for this study include:

  • To determine if and why EAL nursing students value this EAL nursing student support program.
  • To document the experiences of EAL nursing students through individual interviews.
  • To examine the effectiveness of the EAL Nursing Student Support Program as defined by the participants.
  • To delineate the needs of the EAL nursing students.

Method

This study was informed by a hermeneutic approach to phenomenology, which strives to capture the lived experiences of its subjects through the exploration of individual narratives (Moule, Aveyard, & Goodman, 2016). This approach acknowledges that narratives “provid[e] glimpses of the meanings that reside within human experience” (Crowther, Ironside, Spence, & Smythe, 2017, p. 826), which can be used to understand an individual's subjective experience.

Participants were interviewed and questioned regarding their lived experiences as Canadian nursing students completing a 4-year Bachelor of Nursing degree in an additional language. Interviews were guided by a set of open-ended questions attempting to capture the perceived impact of enrollment in an EAL nursing student support group. Interviews were recorded and transcribed for the identification of common themes underlying each participant's experience. Themes were then discussed among the research team and analyzed for merit and validity. The research team consisted of the principal investigator and two research assistants with previous research experience and undergraduate and/or graduate training in research. The research assistants were involved in the literature review, data analysis, and manuscript preparation.

Participants were selected for the study if they (a) were 18 years or older, (b) were enrolled in the MRU Bachelor of Nursing Program as either part-time or full-time students, (c) reported a first language other than English, and (d) were present or previous members of the MRU EAL Nursing Student Support Group. Participants were not compensated for their involvement, and participation in the study was entirely voluntary. Participants were welcome to end the interview at any time if distress arose, and mental health resources on campus were also reviewed with each student at the completion of each interview.

Data Analysis

Audiotapes of participant interviews were used to examine verbal content for emerging themes. Themes were then interpreted, revealing a clearer picture of the lived experiences of these students.

Interviews themselves used a series of open-ended questions that specifically examined (a) whether the EAL Nursing Student Support Group contributed to academic success as defined by the participants, and (b) which components of educational support the participants found most helpful. Participants were encouraged to elaborate on those factors that led to continued success as a nursing student.

Ethics Approval

Ethics approval was granted by the MRU Ethics Board.

Results

Participant Demographics

Participant demographics are depicted in Table 1.

Participant Demographics

Table 1:

Participant Demographics

Themes

Individual interviews revealed seven themes common to the lived experiences of each EAL nursing student. These themes included: Balance, Resiliency, Helping Others, Culture, Safe Place, Social Aspects, and Group Environment.

Balance. Many participants struggled to balance their personal lives with their responsibilities at school and/or work. Compared with traditional students, participants reported the added challenge of fitting into a new social environment and studying in another language. For some, academic overload was further coupled with the stress of raising a family and keeping up with finances. A participant explained:

My kids are complaining, “Mom, you're not playing with us. You're always doing your homework.” Sometimes I play with them, but not all the time…. I want to focus on my studies and also with my family. I can't divide myself into three parts— work, study, and the family.

Another participant stated, “I got fired because of school. My schedule doesn't fit their business hours…[and] they decided to tell me last minute, so I'm trying so hard to get a new job.”

Resilience. Despite the added challenge of fitting into a new social environment and studying in another language, many participants persevered through their challenges and succeeded in their studies. The participants believed that social networking, academic achievement, and a supportive school culture helped them conquer adversity and develop resilience. One participant explained:

Through people helping me, I got to know more people. I saw them working really hard and succeeding with their grades, so I thought I could do that too…. I gained insight into future years of nursing school…. Other people's stories gave me inspiration to work harder. They relieved some of my fears and anxieties about the future and not being able to do good.

Students also built resiliency through academic achievement. By learning from past mistakes and applying knowledge gleaned from the EAL Nursing Student Support Group, students found success in their schoolwork and became more resilient as individuals. One participant explained:

I think I'm more resilient now because of nursing school. All the stress and curve-balls that were thrown at me, I found ways to work it out. I found at the end, I became better than before.

Another participant explained, “I got good grades because this group…introduces how to learn effectively. I feel comfortable and competent in the university.”

Students also felt that the supportive school culture established by the EAL Nursing Student Support Group helped them build resilience in their studies. Participants felt supported in their struggles as EAL students and felt that someone was “interested in [their] welfare” (according to one participant). A participant explained, “You [facilitating faculty mentor] were the first person I was able to open up to. Programs like these make it more obvious that the school actually cares about their students.” Another explained, “I feel comfortable here. It's hard to explain…. I feel like someone has my back.”

Helping Others. The theme of “helping others” was apparent in several participant interviews. Participants felt that mentors and faculty at the EAL Nursing Student Support Group were genuinely interested in their well-being, and willing to “help people and not expect anything in return.” A participant explained:

Being able to teach people or pass on stuff that you learned… [that's] why I joined. I felt like I should do something more rather than just go to clinical, go to lectures, go home, study, and then repeat the same cycle.

Many participants were also inspired to become student mentors themselves and give back to the community. A participant stated, “Via mentoring…I am having fun. It is nice to help others.” One participant explained, “I want to promote this group…. I can present myself as one of the EAL members who got this opportunity to help other students.”

Culture. Participants were cognizant of cultural differences between their country of origin and that of Canadian culture. Many students felt isolated and struggled to fit into their new social environment. For some, adjustment to Canadian customs and traditions was also met with discrimination and rejection. One participant explained:

It's difficult to find a [Canadian who] understand[s] you…. [People say,] “you should try to understand me. You are in Canada, you need to change. You don't understand our culture, you need to be educated on it.”

Participants also felt that their lack of knowledge regarding Canadian culture interfered with their ability to form effective and therapeutic relationships with patients in the clinical setting. For example, one participant explained:

[The other students] are more comfortable [talking] to patients about the Western trendy daily things…which I can't, as I am not familiar with them. That's why I am so quiet in [the] clinical setting. They talked about topics (TV shows), which I am not interested [in].

However, students felt at ease in the EAL Nursing Student Support Group because they were surrounded by members of other ethnic minorities who often struggled with the same cultural challenges. A participant stated:

[The EAL Nursing Student Group is a] common ground for cultural viewpoints… You don't feel like you are totally different from other people and their beliefs… It was quite [helpful] getting to know other people's experiences as well, being able to learn from them, being able to find some connections.

Similar to earlier iterations of this study (Choi, 2018, 2019), participants in this study also suggested that having an ethnic role model to look up was important to them, stressing the need for culturally diverse faculty members. As many students felt a disconnect between themselves and their instructors, ethnic role models served as an important source of motivation and encouragement necessary for perseverance through the nursing program. A participant explained:

We don't open [up] that much to other profs. They don't really understand what you are feeling…the language, the culture. They all have good intentions and great professors that want to accommodate and understand you, but I feel comfortable here.

A participant stated:

I am so glad that I can look up to someone like you [the facilitating faculty mentor]. I am not sure I would join the support group if [it was] run by a non-Chinese [person], like [a] Caucasian. It is important to me to have someone who has similar background like me. You did it and I can make it too.

Safe Place. Many students cited the importance of having a “safe place” for disclosure, free of judgment or evaluation. One participant explained:

The experience is relaxing. I have nothing to do with you [facilitating faculty mentor] academically. You're not my prof and I don't have to hand in an assignment to you. We can talk about whatever I want … [I] feel safer to express my feelings.

Another participant stated:

I wanted…to have somebody here to talk and express my own opinions with, without thinking. I [wouldn't] say this to my colleagues…anything you say, it's an open window and everyone will know. It's good to have an outlet to express my thoughts by talking to you.

Having a safe place for disclosure and a trusted individual to confide in helped many students cope with the demands of education in a foreign language and the challenges of adjusting to a new social environment. A participant explained, “Talking to you [facilitating faculty member] helps lessen my stress…. [It helps] to cope in a lot of ways, to release that stress. Just… talking to you helps academically.”

Social Aspects. For this cohort of students, social aspects appeared to be the predominant reason for joining the EAL Nursing Student Support Group. Compared to the previous iteration of this study (Choi, 2018), the majority of students in this cohort were not in academic crisis. In fact, many students excelled in their studies and joined the group mainly for its networking opportunities and sense of community. When asked what students would like to achieve from this group, one participant explained:

Honestly, I just want to meet new friends…. I want to meet more friends like me, [who are] an ethnic minority…. I want us to have a voice, to be encouraged and supported [by] each other. I would like to [participate in] more social activities and have fun.

Another participant stated:

I feel this group helps to keep my mind, body, and spirit together…. [It] helps [me] make friends in [the] same field…. It is a strength when you know and have [a] connection with [a] few other students/peers in the same field.

Group Environment. Learning in a group environment provided students with an opportunity to meet a variety of like-minded individuals with similar challenges and backgrounds. Exposure to other students fostered peer friendships and allowed participants to learn from one another in a relaxed and supportive environment. One participant explained:

Being able to communicate in a group and also being able to help one another academic wise, it can reinforce your knowledge…in your lecture and clinical… Being able to share the experiences with other people, or an older mentor, actually, it gives [you] reassurance and…a few tips on what [you] should expect and how [you] should prepare.

Peer mentoring also served as an important strategy for facilitating student success and developing student engagement opportunities. Mentees were given valuable advice and direction in their studies, and student mentors were given opportunities to practice leadership skills and give back to the community.

Discussion

Research findings revealed seven themes common to the lived experiences of participants enrolled in the EAL Nursing Student Support Program. These themes included Balance, Resiliency, Helping Others, Culture, Safe Place, Social Aspects, and Group Environment.

Similar to many traditional nursing students, participants in this study struggled to balance their personal lives with their responsibilities at school and/or at work. However, EAL students were also challenged with additional stressors inherent to education in an additional language. The cumulative effect of these stressors presented a significant source of stress for participants, highlighting the vulnerable position that many EAL students find themselves in when pursuing an education in Canada. These findings reiterate the importance of providing EAL students with both academic and psychosocial forms of support, as the postsecondary system presents a wide array of challenges that span beyond just academic stressors.

The EAL Nursing Student Support Program helped students develop resilience by encouraging academic achievement, creating a safe place for study and disclosure, establishing a supportive school culture, and providing social networking opportunities. This finding also reiterates the importance of social aspects involved in EAL student success, stressing the need for a holistic approach to EAL student support.

The theme of Helping Others suggested that once students were able to meet their own academic and psychosocial needs, they became inspired to help other students succeed and realize other opportunities for self-development. Through application of the EAL Nursing Student Support Group template put forth by Choi (2016), students were provided with not only immediate forms of assistance but also continued opportunities for learning and personal development. This additional tier of EAL student engagement is important in ensuring continued EAL student success, further demonstrating that EAL students can succeed and persevere when provided with proper educational support (Choi, 2018, 2019; Havery et al., 2019; King et al., 2017; Martin et al., 2018; Ramjan et al., 2018; Salamonson et al., 2019; Tranter et al., 2017).

By providing students with a safe and secure place to study, thrive, and seek guidance with individual concerns or troubles, the EAL Nursing Student Support Program helped students become more comfortable in their new social environment and in their ability to execute daily activities. It appeared that students had to find a sense of belonging before they could realize other opportunities for self-development.

In contrast to the first iteration of this study (Choi, 2018), students in this study turned to the EAL Nursing Student Support Group mainly for its networking opportunities and sense of community. Most of these students were not in academic crisis. In fact, many participants excelled in their studies. This difference may be explained by demographic differences between cohorts, suggesting that different students present with different academic and/or psychosocial needs. These findings suggest that although many EAL students struggle with academic challenges, academic assistance is only one domain of support that EAL nursing student support groups can provide. In order to cater to a diverse range of students with differing needs and backgrounds, a successful support program should provide both academic and psychosocial support provisions.

By encouraging students to learn in a group environment (Choi, 2016, 2018), the EAL Nursing Student Support Program minimized student isolation and directed students to an abundance of peer resources and support systems. The group dynamic also fostered a sense of community and ultimately helped otherwise isolated students adapt to a new social environment.

As Canada continues to become more diverse and complex (Statistics Canada, 2016), it is important for academic institutions to understand how to best support students from culturally and linguistically diverse backgrounds. These findings stress the need for continued EAL student support and comprehensive support provisions aimed at providing both academic and non-academic support. By providing meaningful support provisions best suited to EAL student needs, nursing faculties can increase student retention and aim to produce a workforce capable of providing culturally competent care.

Implications for Nursing Education

The EAL Nursing Student Support Program provides a holistic approach to EAL student success, encompassing both academic and psychosocial support provisions embedded in discipline-specific curricula. The continued success of this program necessitates the ongoing funding of this support group and other disciplinary support programs that provide a comprehensive, discipline-specific approach to EAL support. This study provides evidence arguing against the centralized model of academic aid seen in many postsecondary institutions, encouraging individual faculties (i.e., business, education, engineering) to develop a comprehensive support program better suited to the unique needs of EAL students enrolled in their program. However, further research is required to ascertain the applicability of these research findings to other settings. Educators from other faculties or international settings are encouraged to develop support programs best suited to students in their disciplines, as the opportunities presented through the EAL Nursing Student Support Group were developed with a discipline-specific focus in mind, best suited to Canadian nursing students completing a 4-year Bachelor of Nursing program.

Future Directions

Further avenues for inquiry include a longitudinal study examining the career trajectory and long-term success of EAL students who took part in this support program during their undergraduate studies. Another aspect to explore is the influence of the faculty member. Important questions include: Is ethnicity important? Do ethnic faculty role models make a difference in EAL student success?

References

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Participant Demographics

Participant No.Age Range (Years)Country/Place of OriginStatusYear of StudyFirst Joined the EAL Nursing Support Group (Year)
1⩽20Hong KongVisa12014
2⩽20KoreaCanadian citizen12014
321 to 30KoreaLanded immigrant12013
421 to 30ChinaLanded immigrant22013
531 to 40Sri LankaLanded immigrant22013
6⩽20CanadaCanadian citizen22013
7⩽20ChinaLanded immigrant22013
821 to 30JapanVisa22013
9⩽20AfricaCanadian citizen22013
1021 to 30IndiaLanded immigrant12014
1121 to 30ChinaLanded immigrant12014
1221 to 30QuebecCanadian citizen42014
Authors

Ms. Choi is Associate Professor, School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, Alberta, Canada.

This research was supported by funding from an internal Mount Royal University grant. The author thanks the research assistants involved in this project; Nadja Brochu for her role in the literature review, data analysis, and manuscript preparation; Christina Volstad for her role in the literature review and data analysis; the participants for sharing their lived experiences; and Linda Binding, for her continuous involvement and support in this endeavor.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Liza Lai Shan Choi, MN, RN, Associate Professor, School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, AB, Canada T3E 6K6; e-mail: lchoi@mtroyal.ca.

Received: March 16, 2019
Accepted: August 21, 2019

10.3928/01484834-20191021-06

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