Improving Communication in ESL Nursing Students Health Care Providers

IMPROVING COMMUNICATION IN ESL NURSING STUDENTS AND OTHER HEALTHCARE PROFESSIONALS 1 Presented by KATHRYN DEKEMEL-ICHIKAWA PHD, CCC-SLP SOUTHEASTERN LOUISIANA UNIVERSITY HAMMOND, LA and SUZANNE CARR PHD, R.N. LONG ISLAND UNIVERSITY BROOKLYN CAMPUS 2 NURSING SHORTAGE  The U.S. is experiencing a critical shortage of nurses that is expected to intensify with the need to care for an aging population  Approximately 118,000 RNs are needed to fill current vacant positions nationwide.  Projections indicate 1.2 million new and replacements nurses will be needed by the year 2014. (American Association of Colleges of Nurses, 2005) 3 RECRUITING AND RETAINING ESL NURSING STUDENTS  Due to the increasing numbers of foreignborn individuals in the U.S., nursing programs now face the challenge of educating students who speak English as a Second Language (ESL).  Many ESL nursing students may not be “fluent” in General American English (GAE), which may result in their having difficulties with academic coursework and clinical work. (Guhde, 2003). 4 RECRUITING AND RETAINING ESL and LEP NURSING STUDENTS (cont.)   Studies confirm that ESL nursing students face higher attrition rates than their nonESL peers, especially during the first semester (Guhde, 2003). Nurse-training programs need to focus on helping ESL students improve verbal and interactive communication skills, since nurses are required to engage in extensive interactions with physicians, hospital staff, patients, families, etc. 5 DEFINITION OF “ACCENTS” & “DIALECTS” Accent- “a phonetic trait from a person’s original language (L1) that is carried over to a second language (L2).”  Dialect- “sets of differences, wherever they may occur, that make one English speaker’s speech different from another’s.” (ASHA, 2006)  6 Seeking “Accent Modification” Individuals may voluntarily seek “accent modification” for a variety of reasons including:  Need/desire to improve communication for purposes of job mobility and/or career advancement  Desire to achieve further assimilation and acceptance in the L2 culture and environment  7 TEXAS WOMAN’S UNIVERSITY NURSING SUCCESS PROGRAM   In an effort to address the nursing shortage in the state of Texas, Texas Woman’s University (TWU) created the Nursing Success Program. This program was designed to recruit and retain nursing students identified as being “at risk for attrition due to academic and/or communication factors. 8 Components of the Nursing Success Program   Academic and tutoring components of the program were designed and implemented by principal investigator (PI) Suzanne Carr, Ph.D., R.N. of the TWU Nursing School. Speech Improvement and Accent Modification components of the program were designed and implemented by PI Kathryn DeKemel-Ichikawa, Ph.D., CC-SLP of the Communication Sciences and Disorders Dept. at TWU. 9 Screening & Evaluation Procedures   All students enrolled in the TWU Nursing Success Program were administered a speech-language screening and a hearing screening. Screening Form A was designed for ESL students. Form A contained an identifying information section, case history (to ascertain student’s L1, length of exposure to English, self-ratings & perceptions of English proficiency & pronunciation), a phoneticallybalanced reading passage, & a brief articulation test. 10 Screening/Evaluation (cont.)  Screening Form B was designed for native speakers of General American English & was similar in format to Form A.  Content did differ somewhat across the two forms; e.g., the words on the Brief Pronunciation Test in Form B were compiled from a list of “frequently mispronounced words” excerpted from the text Fundamentals of Voice and Articulation (Meyer, L.V., 1999). 11 Screening/Evaluation (cont.)  Upon completion of screening/evaluation, 17 ESL students were determined to be eligible for the Accent Modification Program.  Additionally,one student (a native American English speaker) was determined to be eligible for traditional speech therapy because of an uncorrected w/r substitution. 12 Screening/Evaluation (cont.)  Two students failed the pure tone hearing screening and were referred for full audiological evaluation.  Further evaluation revealed one student had otitis media (which was treated by an ENT) and the other had mild sensorineural hearing loss. 13 Accent Modification Program  The 17 ESL students who qualified for the accent modification program came from various countries in Asia and Africa and had differing L1 backgrounds (see Table 1). 14 TABLE 1. First Languages (L1) Spoken by Students in Accent Modification Program L1 Igbo (Ibo) DESCRIPTION Spoken by approximately 18 million people in the southeastern region of Nigeria. Spoken by a total of 2,500,000 people in Kenya (East Africa). A Semitic language spoken in Ethiopia (East Africa). A tribal dialect spoken in the Central provinces of Nigeria (West Africa) 15 Kamba Amharic Igarra TABLE 1 (cont.) Swahili A Bantu language widely spoken in East Africa, from southern Somalia to northern Mozambique. A dialect of Min Nan Chinese spoken by approximately 70% of people on the island of Taiwan. Taiwanese Mayalayam South Indian dialect of Tamil spoken in the coastal area of Kerala state in India, formerly known as the Malaba coast. The official language of both North and South Korea; also one of the two official languages in neighboring Yanbian, China. Korean 16 ACCENT MODIFICATION SESSIONS    The ESL students were seen twice per week for one hour in small groups for accent modification. Accent modification was provided by four TWU graduate student clinicians under the supervision of PI DeKemel-Ichikawa. Sessions focused on (a) production of speech sounds of GAE; (b) prosodic patterns of GAE; (c) morphosyntax; (d) introduction of American figurative/abstract language forms; and e) correct pronunciation of medical terminology from the nursing program curriculum (see APPENDIX A for Sample Lesson Plan) 17 Speech Improvement Program   Classroom-collaborative (CC) sessions based on the central theme of Speech Improvement for Health Care Professionals were designed and team-taught by the two PIs (see APPENDIX B for list of weekly topics). CC sessions were held once per week (total= 12 sessions) for ALL Nursing Success Program students (including those who were simultaneously enrolled in the Accent Modification Program). 18 RESULTS   Results of post-testing using the Psycholinguistic Aspects of Foreign Accent (PAFA) by Dato (1999), as well as anecdotal data gleaned from TWU clinicians’ weekly therapy logs revealed that all 17 students mastered the objective of being able to produce their targeted phonemes correctly in isolation and at the word level by the end of the semester. Approximately 1/2 of the students showed ability to produce target phonemes correctly at the phrase and sentence level; several students were beginning to show carryover of correct production into structured conversational speech, as well as the ability to selfmonitor and self-correct errors by the end of the semester. 19 RESULTS (cont.)   Approximately 1/2 of the students showed gains in the area of prosody, as evidenced by reduced rate, ability to pause appropriately at phrasal and sentential boundaries, and ability to use correct stress patterns on multisyllabic words. Anecdotal evidence indicated that those ESL students who reported “practicing” more at home (with word lists and audiotapes) appeared to make the greatest progress. 20 RESULTS (cont.)    The Accent Modification students were given a survey at the end of the semester to ascertain their perceptions about the effectiveness of the program. 90% of the students indicated they felt the program had been “very beneficial” to them and the remaining 10% indicated that the program had been “beneficial” to them. Students were also asked to rank which aspects of the Accent Modification Program were most beneficial to them. The students ranked “practice on individual sounds” as the most beneficial aspect of the program, followed by “learning to slow my rate of speech and place correct stress on syllables.” 21 RESULTS (cont.)  The students in Nursing Success Program were given a survey and asked to rank which Speech Improvement lessons they felt were most beneficial to them.  The students ranked (1) Conflict Resolution in the Workplace; (2) Nonverbal Communication; and (3) Interviewing as being most beneficial. 22 Suggestions for Future Research   Extension of the current study by following the ESL students into their clinical settings to determine if speech gains transfer to interactions with patients, physicians, families, etc. Replication of the study and long-term follow-up of ESL students to determine if programs that contain a collaborative and integrated focus on academic study skills, overall communication improvement and accent modification are effective in preventing higher attrition rates in nursing and other allied health programs for this population. 23 REFERENCES/SUGGESTED READINGS    American Association of Colleges of Nurses (2005). Nursing Shortage Fact Sheet. http://www.aacn.nche.edu/Media/FactSheets/Nursing Shortage.htm Bou-French, P., & Garces-Conejos, P. (2003). Teaching linguistic politeness: A methodological proposal. International review of applied linguistics in language, 41 (1), 1-22. Derwing, T.M. (2003). What do ESL students say about their accents? The Canadian modern language review, 59 (4), 547-566. 24 REFERENCES/SUGGESTED READINGS (cont.)     Dato, D. (1999). Psycholinguistic aspects of foreign accents. Evaluation form. Derwing, T.M., Munro, M.J., & Wiebe, G. (1998). Evidence in favor of a broad framework for pronunciation instruction. Language learning, 48 (3), 393-410. Guhde, 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), 113-117. Kasper, G., & Blum-Kulka, S. (Eds.) (1993). Interlanguage pragmatics. NY: Oxford University Press. Meyer, L.V. (1999). Fundamentals of voice and 25 articulation (12th ed.). Boston, MA: McGraw Hill. APPENDIX A: SAMPLE LESSION PLAN Objective Teaching Strategies Media/Materials 1. The client will produce the phonemes /l, r, , ð, i,  /. with 85% accuracy at the word, phrase, sentence, and structured conversational level. Progress will be measured via daily tallies, intelligibility rating scales, and clinician probes. 1. Clinician will model correct sound production and provide auditory, visual and tactile feedback as needed. 1. Vowel and consonant chart; selected word and sentence lists; instructional materials from Mayer Voice and Diction text 26 APPENDIX A: Sample Lesson Plan (cont.) Objective Teaching Strategies Media/Materi als 2. The client will produce correct prosodic patterns of General American English (GAE) such as rate, rhythm, pitch, inflection, intonation, pausing & stress at the phrase, sentence, oral paraphraph, and structuredconversational level. Progress will be measured via clinician probes, tallies, and language sampling. 2. Clinician will model prosodic patterns of GAE during various activities and Additional auditory-visualtactile cues will be provided as needed (e.g., tapping out syllables and stress patterns, pacing board, etc.) Audiotaped feedback will be used to help client self-monitor prosodic patterns. 2. Selected word, phrase and sentence stimuli from Voice and Diction and Let’s Articulate; paragraphs from journals, books, magazines for oral reading. 27 APPENDIX A: Sample Lesson Plan (cont). Objective 3. The client will produce correct GAE morphosyntax at the sentence and structured conversational level (e.g., noun-verb agreement, use of bound morphemes such as possessive „s, regular noun plural -s, regular past tense –ed, etc.) Progress will be measured via rating scales, daily tallies, and clinician probes. Teaching Strategies 3. Clinician will monitor client‟s expressive language for morphosyntax errors while client engages in various activities (e.g., structured drills, oral paragraph reading, structured conversation). When an error occurs, client and clinician will “parse” the error and identify the formal grammar rule. Client will then be asked to engage in message repair. Media/Materials 3. Tape recorder; Formal grammar book such for looking up formal syntax rules. 28 APENDIX A: Sample Lesson Plan (cont.) Objective 4. The client will exhibit understanding and use of abstract/figurative language forms of GAE such as metaphors, proverbs, similes, idioms, etc. (Target = mastery of 4 to 5 new forms per session). Progress will be measured via clinician-tallies and probes. Teaching Strategies 4. Clinician will present 4- 5 new abstract/figurative language forms per session (e.g. “Run hot and cold” or “Get the ball rolling.”). Client must explain the literal meaning of these items, and give a “sample” situation or context in which the item might be used. Clinician will urge client to “try out” these new abstract language forms “in the real world” and report back on usage during the next session. Media/Materials 4. New abstractfigurative language forms from A Dictionary of Idioms. 29 APPENDIX B. SPEECH IMPROVEMENT CLASSROOM-COLLABORATIVE CALENDAR WEEK Week 1 ACADEMIC TOPIC Perception SPEECH IMPROVEMENT TOPIC Speech-Language-Hearing Bingo Review Syllabus Keeping a Calendar Online Screenings Speech-Language-Hearing Week 2 Computer Usage Learning Styles Stress Assessment Week 3 Cognitive Screenings (continued) Strategies Memory Techniques Anxiety antidotes COMMUNICATION MODALITIES: Reading/Writing; Speaking/ Listening; Extralinguistic 30 APPENDIX B (cont.) Week 4 Using a Textbook Active Listening During Lectures Effective Study Groups Presentations Researching and Presenting INFORMATIVE SPEECHES in the Workplace (e.g., Inservices, Staffings, Conferences, etc.) Presenting Week 5 in Class (Informative Speeches) Active Reading & Writing Processes Writing Nurses Notes Nursing and Evaluating INFORMATIVE SPEECHES Week 6 Care Plans Patient Case Studies PROCESSES OF SPEECH PRODUCTION: Respiration, Phonation, Articulation, Resonance 31 APPENDIX B (cont.) Week 7 Multiple Choice Test Questions Intro to Medication Calculations Week 8 Medical Vocabulary Pretest Nursing Process and Lesson Plans Week 9 Improving Reading, Speech and Comprehension COMMUNICATING WITH PATIENTS AND FAMILY MEMBERS (includes discussion of communication disorders seen in patients) ENHANCING VOCABULARY ACQUISITION (tips for mastering medical terminology; wordlearning techniques, etc.) ENHANCING PRONUNCIATION: SoundSymbol relationships; International Phonetic Alphabet; Frequently Mispronounced Words 32 APPENDIX B (cont.) Week 10 Medical Vocabulary Oral Presentations Assessment Lab Written CommunicationRESUME WRITING Week 11 Relaxation and Oral Visualization CommunicationINTERVIEWING for a Job in the Healthcare Setting Critique Week 12 Medical Calculations of Oral Presentations 33 APPENDIX B (cont.) Week 13 Test-taking CONFLICT Finding Relaxation & Support General Vocabulary Week 14 Addressing RESOLUTION in the Workplace Through Communication NONVERBAL Learning Needs Using Self-Developed Questions to Study COMMUNICATION in the Workplace 34 Contact Information        Kathryn DeKemel-Ichikawa, Ph.D, CCC-SLP Southeastern Louisiana University Dept. of Communication Sciences and Disorders Box 10879 Hammond, LA 70402 Ph: 985-549-3427 Email: Kathryn.Ichikawa@selu.edu       Suzanne Carr, Ph.D. School of Nursing Long Island University Brooklyn Campus Ph: 718-780-4051 Email: Suzanne.Carr@liu.edu 35