Improving the Oral Communication Skills of Undergraduate Nursing Students With Language Support: A 6-Month Follow-Up

Ramjan, Lucie M.; Ramjan, Lucie M.

Introduction: The global widening participation agenda in higher education along with increasing cultural and linguistic diversity, has led to a shift in the number of students who have English as an Additional Language (EAL), studying in countries such as Canada, Australia, the United States and United Kingdom (Garone & Van de Craen, 2017). In a discipline like nursing, it is essential that students are able to effectively communicate and interact with healthcare professionals and the public. For nursing students, vocabulary expands beyond textbook (Hull, 2016) terminology to a medical language which includes acronyms, abbreviations, and other expressions that must be explained in different ways among other health professionals and patients (Hull, 2016). Difficulties with pronunciation can also increase anxiety for nursing students during practicums, resulting in feelings of being stigmatised and unsupported (Allan & Westwood, 2016). As a result, both native English-speaking and EAL students may find it difficult to communicate in a clinical setting. While widening participation is important, higher education institutions need to implement strategies to support student retention and success, as these students are likely to experience challenges communicating in academic and clinical placement settings (Crawford & Candlin, 2013).

Methods:This study used a prospective, correlational survey design to examine the relationship between students’ use of academic literacy support and oral communication performance as measured by a Coherence, Lexical, Grammatical, Pronunciation (CLIP) index. The CLIP is a measure of oral communication competence based on a 4-item index with a descriptor framework for speaker use of: (i) fluency and coherence; (ii) lexical resource; (iii) grammatical range and accuracy; and (iv) pronunciation (Seedhouse et al., 2014). The CLIP index was embedded as an assessment requirement in four clinical skills-based units and assessed at the end of each semester in the first two years of the Bachelor of Nursing program, at a large multi-campus university in western Sydney, Australia. In this study, first and second year students were assessed in Semester 1 at baseline and also six months later in Semester 2. The CLIP index scores were linked to academic grades, enrolment status and use of academic literacy support.

Results:In 2015 a total of 1669 nursing students were assessed in both Semesters 1 and 2. Overall, mean oral communication scores improved from 15.8 (SD: 3.7) to 17.2 (SD: 3.3) (p<0.001). Increases were also seen across all four components of the CLIP index (coherence, lexical resource, grammatical range and accuracy and pronunciation). There were seven (7) variables which included attendance at academic literacy support, the age and gender of participants, their country of birth, if they were the first-in-family at university, the language which was spoken at home, and enrolment category. A logistic regression model was used for these variables in examining the total CLIP index score and the predictors of improvement. The results revealed that students who engaged with academic literacy support were more than 1.5 times likely to gain an overall CLIP score increase (Adjusted Odds Ratio: 1.58, 95% CI: 1.26-1.98) in Semester 2, controlling for age, gender, language spoken at home, being born in Australian, being an international student, and first-in-family at university.

Discussion:This study adds strength to the available research. Others have identified the importance of using simulation to directly observe and evaluate not only clinical skills but competency in interdisciplinary communication (Choi, 2005; Mikkonen et al., 2016). Student improvement in oral communication using the CLIP index was evident among those seeking academic literacy support. The CLIP index tool can be used to track students’ oral language skill needs over the course of their study, and can recognise and alert academics to the ‘at-risk’ student, who may require additional intensive support through on-campus programs.