Gregory Hadley
In
this article we will study the reasons why nurses are still unable to speak
English even after years of study.
I will then explain the problem of learner anxiety, which I feel is a
major obstacle for students both in our classrooms and later on in the
hospitals. We will review the
major contributing factors to learner anxiety. From my experience, using the communicative
approach has helped alleviate the problem of anxiety in my classes as well
as enable students to speak more English, and I will describe the results I
have had in my classes through using this approach.
The Current
Challenge
Any
foreigner who has recently come to Japan will tell you that going to a hospital
can be a very trying experience.
Especially if the person is of European or African descent, many times
hospital staff can become so anxious they are left speechless. Some even tell stories where they have
observed nurses frantically discussing who will be the one to speak to
"the gaijin". If the
foreigner is very sick and frightened, as is often the case, he may become angry. This usually worsens the already
stressful situation. The number of
foreigners coming to Japan are increasing, and these types of encounters are
becoming more and more common.
This is especially the case in the rural hospitals where people are not
used to seeing foreigners.
Foreigners
are usually surprised to find out that all nurses who study at Nursing
Specialty Schools (Kango Senshu Gakko) are required by the koseisho to
study 120 hours of foreign language instruction. Most schools offer English, because of it's international
scope, and the abundance of native or near-native speakers in Japan.
Why
are our graduates from nursing school, after studying English for two to three
years past the high school level, still unable to speak English? The traditional method of teaching
English in nursing schools often consists of mastering the grammar and
vocabulary in textbooks. The
students listen to lectures, take notes, and are at times asked to verbally
answer some cursory questions.
This is a continuation of the type of instruction they received in high
school. Unfortunately, this method
by itself is simply not working.
What
is it that prevents them from communicating with their foreign patients? One reason is that our nurses are
learning to read and write English, but are not learning to speak the
language. This is why I feel our
nurses need to learn Communicative English, which we will discuss later. The other is the debilitating factor of
student anxiety.
Anxiety: A Major Barrier
When
I first began teaching nursing students, I noticed they were extremely shy in
class. It was difficult to get
them to respond to almost any question.
In fact, the more I tried, the more frightened most of the students
would become. Others would
sleep. Whether I tried the drills
in the textbook or some that I would make on my own, many times I would be met
with dazed, confused or nervous stares.
Only after great effort and some clowning around on my part would some
the students begin to participate.
This would take almost all of the 100 minute period. Since the class met only once a week,
by the time the next class started I would find myself encountering that same
wall of anxiety that seemed tower before me. I would often leave class discouraged and exhausted. I wondered if there could be any way to
break through this "anxiety barrier" and reach my students.
Although
researchers differ on exactly how to define the terms stress or anxiety, a lot
of research over the years has studied their effects upon second language
acquisition. Naimon, Frohlich,
Stern and Todesco (1978) found in their study that a high fear of rejection,
classroom anxiety and other feelings can affect whether or not a student will
be successful in learning a second language. Wittenborn, Larsen and Virgil (1945; reported in Pimsleur,
Mosberg and Morrison, 1962) showed a correlation between low and high scoring
language students by their corresponding levels of anxiety and
self-confidence.
Much
of the impact that anxiety has upon nursing students may have to do with how
they think about themselves in relation to studying English language. Lazarus and Folkman (1985) showed in
their research that if a situation is viewed as a threat, people will
tend to have increased anxiety.
Also, if a person doesn't feel as if he has the confidence to succeed in
attaining a certain goal, the anxiety becomes even more severe (Bandura, 1977).
This
research sheds much light upon the effects that a traditional English class may
have on many of our nursing students.
Imagine for a moment what it must be like for our students: They are crowded into a room with 40 to
50 other students. Very few are
willing to speak up for fear of making a mistake in front of 50 of their
peers. Many already lack
confidence in their ability to speak English. All their lives, they have heard people repeat the phrase,
"English is difficult, isn't it?" To further reinforce this thought, they are given textbooks
requiring them to master grammar and medical terms that are far beyond their
current level of comprehension.
Hardly anyone would want to try and participate in a class where they
felt set up to fail from the very beginning. Add to this factor that the teacher may be a foreigner who
is speaking to them in a foreign language and you can quickly see the typical
English class is a place that has a very threatening atmosphere. It is no wonder that many nursing
students feel anxious about speaking English once they are on the hospital
floor. They learned to feel that
way in English class. This anxiety
was definitely working against my students. However, stress in itself is not necessarily bad. Researcher Hans Seyle, in his book The
Stress of Life, remarked wryly that only the dead are totally without
stress (1976).
Research
on anxiety has separated it into two types: debilitative and facilitative
anxiety (Alpert and Haber 1960, cited by Scovel 1978). Debilitative anxiety is destructive and
counterproductive to learning English.
It is characterized with a fear of failure and lack of confidence to
succeed. Facilitative anxiety,
however, is helpful. It can
prepare one to be adequately concerned over a task, such as the anxiety one may
feel before giving a speech. It is
characterized by confidence that one can succeed if making an effort. What our students experience in their
English class (and later in the hospital) is clearly debilitative anxiety.
My
personal strategy has been not to remove anxiety, but to find ways to change it
into facilitative anxiety. The
approach I feel best works in my classroom is the Communicative Approach. What I do in class are not simply
"feel good" techniques.
I've seen a significant turn around in attendance, motivation,
participation and, most importantly, communicative ability in my classes.
The Communicative Approach
There
are numerous textbooks and teaching materials being published which carry the
name "communicative".
What exactly is the communicative approach? Communicative Language Teaching, or CLT, has been around since
the late seventies. Precise
definitions of the approach vary among it's exponents. Researchers Finocchiaro and Brumfit
(1983) define it as an approach where meaning and effective communication, not
grammar, is the most important factor, and communicative competence is
goal. Communicative competence is
the ability to use language in an appropriate manner.
Breen
and Candlin (1979) feel that to be communicative means for the teacher to be
less controlling in the class and become an interdependent member in the
learning-teaching group. The role
of the teacher is to value the contribution students make to learning, and to
nurture the process of education through interaction. The students are responsible to learn how to learn
the target language, but this responsibility is shared with the group as well
as individually.
While
some supporters of the Communicative Approach feel that people should forget
grammar studies and strive to communicate from the beginning, I agree with
Professor William Littlewood of the Institute of Language Education in Hong
Kong, who feels the study of grammar is an important foundation for speaking
English (Littlewood, 1981). The
work of the high school teachers has made the job of foreign English teachers
much easier. Learning grammar and
vocabulary are only half of the process.
Students must move beyond the form of the language to communicate
meaning (Littlewood, 1981).
This
process of moving through grammar and vocabulary to the communication of
meaning is a key element of the communicative approach. My own style of teaching is closely in
line with the approach that Littlewood advocates, which starts with
pre-communicative activities, which are defined as structural and
quasi-communicative, and then to move onward to true communicative activities,
which are defined as functional and socially interactive (Littlewood, 1981). To accomplish this goal, I take my
class through a process of drills, jazz chants, information gap activities and
role play.
Process
I
start out the first class by drawing a big circle on the board and putting a
large letter "E" in the middle of the circle. I tell them, "This circle
represents the entire English language.
This English is hard."
I then draw a much smaller circle within the large circle. "But this is the English
that you must learn in class. This
English is easy. You can do
this. I know that you can." Many times we start out our weekly
class by repeating the phrase, "English is easy. I can do it!"
This helps to instill confidence in their ability to speak English. I show that their class goals are
attainable, if they will try.
I
simplify the demands of the text for my students. Suitable texts for Nursing English are not easy to
find. The one I use in my class is
Let's Speak, Let's Learn by Niiki, Sukegawa and Engle. Most of the dialogue and grammar are
simple and practical enough to be used in my approach. I do not emphasize grammar, but instead
focus on understanding and communicating the ideas in the dialogue.
I
read the dialogue several times while walking up and down the rows of the
classroom. The students
listen. Then as an entire class,
we will practice the dialogue once or twice chorally. When I am sure they understand the general meaning of the
dialogue I go on to the next stage.
I
lead the class in a series of jazz chants that are based upon the dialogue and
situations in the lesson. I do
this for a couple of reasons:
first, to practice pronunciation, rhythm and listening; but also to move
the students away from simply reading the text to having fun with the
language. This type of enjoyable
experience tends to help lower student anxiety.
After
this activity, I break the class up into small groups of about four to six
students each. I find this has the
effect of making the class feel smaller.
Not only do the students have a group in which they work together and
support each other, but the emphasis has been taken off of me and is put upon
them as they must begin to communicate with each other in English. In the small groups they will practice
the dialogue several times. While
they are practicing, I wander through the class and listen. When the students are doing well, I
encourage them. I refrain from
correcting the students too much, and only do so when I encounter serious
errors.
By
this time most of the students understand the dialogue and vocabulary in the
lesson. Most have gained enough
confidence to use the language in their small groups. This is a major step forward, and crucial for success in the
next stages.
However,
we have still only practiced the form of the language. If I were to stop here, they would have
only learned a series of unrelated phrases. The class must move from form to practice. The key is when students begin using
what they've learned in a living conversation. To accomplish this goal, I rely heavily on information gap
activities.
An
information gap activity is one of the main techniques of the communicative
approach. In it, one person or
group is given a sheet with information that the other person or group does not
have, and vice versa. Both groups
have some of the same information on their sheets. Using what they have in common, the person or group
interacts in English so that by the end of the exercise, both sides should have
shared all their information, and both their sheets look identical.
On
average, it takes a couple of times of trying this activity before the students
really catch on. Once they do, they
find it one of the most enjoyable parts of the class. Only two rules prevail during this exercise. One is not to show the other partner
your sheet while communicating.
This would destroy the whole purpose of the information gap
activity. The other is to strive
to speak only English. Since I
base my information gap exercises on what we've studied in the lesson, there is
usually no excuse for not working out the activity in English.
Next
we simulate the communicative functions of the lesson through role play. I write on the blackboard the
communicative functions the dialogues are teaching, such as introductions,
asking questions or introducing another nurse. I put numbers besides these functions. I then put the class back into groups
and tell them to decide which persons in their group will perform these
functions. The reason is because
later they will come in front of the class and perform these functions in the
form of a skit.
The
stress and anxiety had been lessening gradually up to this point. When they realize they will have to
speak in front of the class, the anxiety level naturally gets higher. To change this into facilitative
stress, I show them that their goals are attainable: If they can practice the dialogue in their skits, speak some
English and answer some questions, they are guaranteed success. When they understand that they can do
well if they study and practice, they tend to study quite hard in their groups.
After
the groups have decided who will do what, they close their books. From here we play the skit that we call
"Sick
Gaijin". With me playing the role of the
foreigner, the groups will come up and role play some of the dialogue they have
practiced. I encourage them not to
worry about repeating the dialogue word for word, but to just talk to me. After each group finishes, I encourage
the class to applaud and to encourage each group in their efforts, even if in
the beginning of the term they can do no more than speak a few words. Just coming up in front of the class and
speaking is a great accomplishment.
Later
in the term we make this activity more and more realistic by using the real
hospital equipment which is available at the school. Our school has the luxury of having a room next door to our
classroom which looks exactly like a hospital patients room. We use this room extensively to come as
close as possible to simulate reality.
We act out scenarios from dealing with an angry, frightened patient to
life-threatening emergency situations.
The shock of seeing and then dealing with such simulated emotional
outbursts is very difficult for the nursing students to handle in the
beginning, and I must encourage them a lot to make progress. I am happy to say that over half of my
students gradually learn to remain calm and communicate in spite of these
difficulties.
Results
In
the beginning most of the class is very anxious with this approach. Putting them on the "hot
seat", so to speak, is for most of them a radically different way to learn
English. I explain that the stress
they experience during the skit is the same they will feel in the hospital when
they see a foreigner. I encourage
them to work together and overcome this anxiety in class as training for the future. I remind them of their goal to simply communicate
their ideas and gather accurate information from their foreign patients.
As
the students begin to realize how the class applies to their future as nurses,
the overall motivation of the class increases. It is by this time most of the students actually start to
believe they really can accomplish the communicative goals of the class. Everyone works together in their
groups. Nobody sleeps. I have very few absences.
I
have seen even some of my most bashful students begin to communicate quite well
for their level in English. Of
course, there are always some students who were extremely shy, bored or grossly
unmotivated from the very beginning and remain that way throughout the entire
term. I suspect many of these
students have the same attitudes in their other classes as well. There are others who never really
acquired even a passive knowledge of English, due to the varying levels of
English education in schools.
These students I treat with gentleness, and encourage them to
study. I hope that a positive
experience they have in their classes will motivate them to continue to study
even after graduation. I'm glad to
say, however, that these students are a
minority in my classes.
The
majority of the class becomes like a support group as they work together to
learn English. It is not uncommon
to hear students cheering each other on as they come up to the front of the
class. When mistakes are made, I
frequently observe the groups immediately studying to correct their errors
before I even have a chance to tell them.
The nursing students begin to teach themselves English. During the course of the term, I have
seen my classes shift from an atmosphere where the students felt inferior and
threatened, to an atmosphere in which they felt confident and encouraged. The barrier of anxiety is definitely
much lower by the middle and end of the term. The students no longer look confused and fearful. We finish classes feeling
energized. Test scores at the end
of the term are usually quite high, as the motivation to study is quite
high.
Conclusion
In
this article we have looked at the needs for nurses to be able not only to
read, but to communicate on simple terms in English with their foreign
patients. I have shown that student anxiety is a major obstacle in Nursing
English classrooms. While nursing
students are often shy and lack confidence in their ability to speak English,
this situation can be turned around using a Communicative Approach. Students soon learn that English
communication is attainable, and classroom study has practical application for
their future.
Through
the techniques described in this article, I have seen an increase in the
motivation and communicative skills of my students. It is hoped that sharing my experience can be of some value,
and that it will offer help in curbing anxiety, and free our nurses to excel
both in the classroom and in the hospital.
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