The need for English by Japanese nurses has been rising mainly due to the increase in the population of foreign residents, an influx of medical information from abroad, and demands for international cooperation of Japanese nurses. These factors indicate three kinds of needs: communicating orally on medical and other matters with non-Japanese speaking patients; understanding written nursing and medical English; and using academic English for studying, training or working abroad (Ueki and Dorelle, 2000;Watanabe, 1998). English education for student nurses should meet these needs, but this has been much less emphasized than professional education.
At present, student nurses are occupied with a tight curriculum and are not particularly keen on learning English due to lack of interest in English in general, despite the fact that English is compulsory in nursing schools. In addition, the current English education situation in Japan raises concerns regarding at least two issues in terms of practice. One of them is the ability to communicate in English, and the other is the acquisition of lexical knowledge of technical terms.
Most student nurses are senior-high school graduates. Historically, the acquisition of communicative English at junior and senior-high schools has not been focused on in Japan (Law, 1995). Furthermore, students' concern with "how the other would feel", (for instance the fear of being ridiculed by others because of mistakes or the embarrassment at being different from others by speaking fluent English), originates in Japanese culture and could make students resist communicative language approaches and a communicative language classroom culturally inappropriate (Greer, 2000).
According to the guidelines established by Japanese Education Ministry for junior high school (Monbusho, 1989a) and senior high school (Monbusho, 1989b), basic English has been taught in these schools. Technical terms in nursing and medicine are not taught as part of English education to junior and senior-high school students in general, and newly-enrolled student nurses study English including nursing and medical English which they have never encountered before.
To attack these problems and find effective teaching ways, it is important to first grasp students' attitudes and motivations towards English and understand their needs, especially at an early stage.
One of the important factors constituting attitudes is language learning motivation (Wenden, 1991), which has not been a focus in language teaching in Japan. Kimura, Nakata and Okumura (2001) state a possible explanation for this phenomenon are that the most popular teaching methods in Japan have been teacher-centered and that class sizes are usually large, and therefore individual factors of learners tend to be ignored. Kimura, Nakata and Okumura investigated motivations of Japanese EFL learners, though not including student nurses, and their data support Reid's (1987) findings that Japanese learners who lack a predominant learning style may not be so easily motivated to learn a foreign language.
Nevertheless, it is widely believed that learners' attitudes are the key element for successful teaching, and Svanes (1988) notes that high achievers are likely to develop positive attitudes as they proceed with learning. Dörnyei (1998) describes language motivations as complex, and suggests that motivational factors such as instrumental motivation should receive special attention in EFL contexts where learners have not had sufficient experience with the target language community. Considering the need for English by nurses stated above, instrumental motivations related to nurse's work could have the possibility to become strong factors in successful learning in English education among student nurses. Therefore, this study was performed focusing particularly on the need for English by nurses.
Very little data on attitudes and motivations of student nurses towards English acquisition have been reported. This questionnaire study was designed to examine how newly-enrolled student nurses' attitudes and instrumental motivations towards studying English related to their future work. Motivational factors that could help to overcome problems regarding student nurses' acquisition of English communication ability and of lexical knowledge of technical terms are also indicated and discussed.
The subjects were 187 newly-enrolled students (52 males and 135 females) attending a nursing school in Ehime, Japan. The questionnaire was distributed to 93 students in April 2000, and to 94 students in April 2001. Most participants were senior high-school graduates (95.7%) and had studied English for 6 years, that is 3 years at a junior high school and a further 3 years at a senior-high school. The remaining participants (4.3%) were junior high school graduates, junior college graduates and university graduates.
Among them, 32.6% had experience working in part-time or full-time jobs, or had part-time jobs at the time of the study. All of these jobs were occupations in the medical field, such as nurse's aide (67.2%) or caretaker (26.2%), which was a characteristic of the subjects of this study.
The questionnaire items were designed to focus on students' attitudes, motivations and requests, and were written in Japanese. All items were checked for validity by three teachers of the nursing school who had each worked as nurses for over 15 years. The questionnaire consisted of 30 simple closed questions with 3 or 4 choices each for most of them, which could encourage students to respond and to show clear indications of their opinions. It also had 11 open questions which were expected to reveal more accurate responses (Nunan, 1992). The questionnaire was distributed and collected in class.
Table 1 shows that most students (96.1%) are aware that English is necessary for nurses regardless of their job experiences (see 'Participants' under 'Methods'). Only 3.8% of the respondents answered that English was unnecessary at work, and the reasons they mentioned seemed to have originated from their limited understanding of the present situation in Japan (Table 1).
Absolutely necessary |
Necessary |
Unnecessary |
Total |
|
Job-inexperienced |
12 (9.8) |
107 (87.0) |
4 (3.2) |
123 (100) |
Job-experienced |
5 (8.5) |
51 (86.4) |
3 (5.1) |
59 (100) |
Total |
17 (9.3) |
158 (86.8) |
7 (3.8) |
182 (100) |
Note: Percentages are given in parentheses.
Reason |
Number of students who put down the statement |
Speaking Japanese and communicating by gesture are good enough |
1 |
Because we are Japanese, we need to speak only Japanese |
1 |
I have never seen foreigners at hospitals in Japan |
1 |
English is not used by nurses |
1 |
There will be no particular problems if nurses don't use English at work |
1 |
Nurses are not medical doctors, therefore they don't need English |
1 |
(No answer) |
(1) |
The students' awareness of the need for English by nurses appeared to be related mostly to the requirement of understanding written English in medical charts and prescriptions and English medical terms (Table 2, items (a) and (d)). The respondents also expected cases where nurses needed to understand results of laboratory tests written in English (item (b)) and read English manuals and/or instructions (item (e)), as well as communicate with non-Japanese patients in English (item (c)), but though not as frequently as nurses would face written English in medicine or nursing. In contrast, most of them responded negatively to the items related to academic matters. The responses of the job-inexperienced subjects and those of the job-experienced subjects showed very similar tendencies, but the job-experienced subjects appeared to be more certain about the frequent need of understanding written English in medicine and nursing (items (a) and (d)), and to be less in agreement with the frequent need of English communication with non-Japanese patients (item (c)).
Item |
1)* |
2)* |
3)* |
4)* |
Total |
a) To understand English used in medical charts and/or prescriptions |
136
|
34
|
15
|
0
|
185
|
b) To understand results of laboratory tests written in English |
88
|
67
|
23
|
4
|
182
|
c) To communicate with non-Japanese patients in English |
33
|
111
|
34
|
7
|
185
|
d) To understand medical terms (names and abbreviations of diseases, medicines and tests etc.) |
139
|
37
|
10
|
3
|
186
|
e) To read English manuals and/or instructions on medical instruments, and attached documents of medicines or test reagents |
39
|
96
|
35
|
16
|
186
|
f) To read articles in English medical or nursing magazines |
4
|
40
|
70
|
73
|
187
|
g) To read English academic papers |
1
|
24
|
77
|
84
|
186
|
h) To understand English presentations and/or to present work at international conferences etc |
4
|
29
|
76
|
76
|
185
|
i) To train or study abroad |
7
|
58
|
65
|
56
|
186
|
j) To supervise or work with non-Japanese trainees from abroad |
14
|
60
|
74
|
38
|
186
|
Note: 1)* I expect to experience it frequently. 2)* I expect to experience it but not frequently. 3)* I don't know. 4)* I expect not to experience it.
Total = total number of respondents,
( )= percentages of the total number of respondents,
[ : ]=[percentages of job-inexperienced respondents : percentages of job-experienced respondents]
Conversely, Table 3 shows that 39.8% of the respondents put the primary importance on speaking ability, which is more than those who answered reading ability was most needed by nurses (31.0%). On the whole, the order of importance they rated was speaking>listening>reading>writing. There were no significant differences observed between the job-inexperienced subjects and the job-experienced ones. The discrepancy between these findings and the preceding one which implies that reading ability is most frequently needed at work, might reflect the students' concern that in general Japanese nurses' speaking ability is lower than their reading ability and it needs to be developed further so as to communicate with non-Japanese patients in English.
First |
Second |
Third |
|
Speaking |
64 (39.8) |
40 (24.8) |
41 (25.5) |
Reading |
50 (31.0) |
22 (13.7) |
75 (46.6) |
Listening |
46 (28.6) |
91 (56.5) |
17 (10.6) |
Writing |
1 (0.6) |
8 (5.0) |
28 (17.4) |
Total |
161 (100) |
161 (100) |
161 (100) |
The data in Table 4 (item (h)) indicate that student nurses are highly motivated to study medical and nursing terms. This finding is supported by the results that the students' awareness of necessity for English appeared to be related mostly to the need to understand English medical terms and English used in medical documents (Table 2, items (a) and (d)).
Table 4 (item (f)) also showed that 84.4% (=26.3%+58.1%) of the respondents hoped to communicate with non-Japanese patients in English in the future. Considering the fact that nearly half of the respondents answered they did not hope to train or study abroad (item (b)), and more than half of them did not hope to read English medical or nursing magazines and academic papers (items (c) and (d)) and were not interested in other academic involvement (item (e)), communicating in English with patients may have the possibility of becoming a strong motivation.
This study primarily focused on instrumental motivations related to the participants' future work, but the results showed that they had other strong instrumental motivations such as 'traveling abroad' (Table 4, item (a)). Kimura, Nakata and Okumura (2001) reported that 'traveling abroad' was one of the main reasons Japanese students learn English. The results of this study suggest that Japanese student nurses would not be exceptions, and further research on other motivational factors needs to be performed on student nurses.
Item |
1) |
2) |
3) |
Total |
a) To travel abroad |
94
|
81
|
12
|
187
|
b) To train or study abroad |
24
|
70
|
92
|
186
|
c) To read articles in English medical or nursing magazines |
4
|
58
|
120
|
182
|
d) To read English academic papers |
4
|
38
|
142
|
184
|
e) To understand English presentations and/or to present work at international conferences etc. |
2
|
27
|
156
|
187
|
f) To communicate with non-Japanese patients in English |
49
|
108
|
29
|
186
|
g) To communicate with non-Japanese patients in Japanese |
55
|
112
|
18
|
185
|
h) To understand English technical terms and sentences in medical charts, prescriptions and laboratory test reports etc |
151
|
36
|
0
|
187
|
Note: 1) Yes, I very much hope to do it. 2) Yes, if it is possible. 3) No, I don't.
Total = total number of respondents,
( )= percentages of the total number of respondents,
[ : ]=[percentages of job-inexperienced respondents : percentages of job-experienced respondents]
Table 4 also presents the striking results that 89.7% (=29.7%+61.0%) of the respondents hope to communicate with non-Japanese patients in Japanese in the future (item (g)), despite the fact that more than 80% of the respondents also hope to communicate with non-Japanese patients in English (item (f)). To grasp the causes for these equivocal attitudes of the students would be important for teachers in order to motivate them and help them in obtaining English communication ability. Therefore, the students' attitudes on toward communicating in English with patients were further investigated.
The importance of nurse-patient communication seemed to have penetrated the attitudes of almost all respondents (Table 5), which was supported with a high negative correlation between item (a) and item (b). The students might take engaging in English communication with English-speaking patients as a part of nurse's responsibility as larger percentages of the respondents (74.6%) answered they would try to use English to communicate with non-Japanese patients (item (d)) than those (61.0%) who answered that they would communicate in English with non-Japanese people on the street (item (c)).
Statement |
1) |
2) |
3) |
Total |
a) It is important for nurses to communicate well with patients |
173
|
2
|
0
|
175
|
b) There will be no problems if nurses can't communicate well with patients |
0
|
10
|
167
|
177
|
c) I will try to answer in English if non-Japanese people who don't understand Japanese ask me something in English on the street |
108
|
57
|
11
|
177
|
d) I will try to answer in English if non-Japanese people who don't understand Japanese ask me something in English at a hospital when I am on duty as a nurse |
129
|
38
|
6
|
173
|
e) Non-Japanese people who visit Japanese hospitals and receive treatment in Japanese hospitals should understand Japanese |
48
|
68
|
46
|
162
|
f) Because English is the international language, it is recommended that Japanese staff and non-Japanese patients receiving treatment in Japanese hospitals communicate in English |
65
|
68
|
21
|
154
|
Note: 1) Yes, I agree. 2) I don't know. 3) No, I don't agree.
Total = total number of respondents,
( )= percentages of the total number of respondents,
[ : ]=[percentages of job-inexperienced respondents : percentages of job-experienced]
Questions No.13 to 15 (Tables 6 and 7) were intended to investigate students' objective opinions regarding the duty of hospital staff from the viewpoint of the patient, assuming that the students visited a hospital where hospital staff did not understand Japanese. No notable differences were observed between the answers of the job-inexperienced subjects and those of the job-experienced. The results listed in Table 6 indicate that the students can imagine patients' inconvenience or distress caused by the lack of nurse-patient communication. Teachers could mention these points to remind student nurses of the importance of English communication with patients.
Statement |
Number of students who put down the statement |
I would feel distress, resignation or anxiety |
66 (38.4) |
I would think the hospital staff should have studied English to communicate with patients |
36 (20.9) |
It is shameful that the hospital staff could not communicate in English or Japanese |
20 (11.6) |
I would be angry at the hospital staff for being incapable of communicating in English or Japanese |
18 (10.5) |
I would communicate with the hospital staff by making gesture or drawings |
16 (9.3) |
I would be in a panic |
12 (7.0) |
I would think the hospital staff should have understood Japanese |
4 (2.3) |
Note: ( ) = percentages of the total number of respondents
Table 7 shows that the majority of respondents (74.1%) think English is the most appropriate communication medium. Together with the reasons for using English (Table 7), the results again suggest that the students are aware of the importance and usefulness of English as a communication tool.
Suppose you get sick or are injured in a foreign country where you don't understand or speak their own language.
Statement |
Number of students who put down the statement |
I would use English |
126 (74.1) |
I would make gestures or drawings |
26 (15.3) |
I would still use Japanese because is the only language I can speak |
10 (5.9) |
I would make conversation by means of writing English |
8 (4.7) |
Note: ( ) = percentages of the total number of respondents
Reason |
Number of students who put down the statement |
English is the international language |
50 (39.7) |
English is a common language |
42 (33.3) |
There should be at least a few people around who understand English |
12 (9.5) |
I expect most people in most countries can understand English |
7 (5.6) |
English is the only language I have studied except Japanese |
4 (3.2) |
(No answer) |
(11 (8.7)) |
Note: ( ) = percentages of the total number of respondents,
* = Q14) How would you communicate with the hospital staff who don't understand Japanese?
The data presented in Table 5 (item (d)) showed that approximately 75% of the respondents would try to answer in English to non-Japanese patients who didn't understand Japanese if they were on duty as a nurse.
Yet, nearly 30% of them agreed that non-Japanese patients in Japanese hospitals should understand Japanese (Table 5, item (e)) and only around 40% of them supported English communication between Japanese staff and non-Japanese patients (Table 5, item (f)). This coincides with the findings that a great number of the students hope to communicate in English and also in Japanese (Table 4, items (f) and (g)). These results indicate that the students' attitudes towards carrying out English communication with non-Japanese patients are rather passive, and they rely on non-Japanese patients speaking and understanding Japanese. This tendency was more obvious for the job-experienced subjects (Table 5, items (c), (d) and (f)). In order to motivate students to acquire communicative English, it will be essential to clarify the factors that discourage them from communicating in English.
Almost all respondents pointed out their poor English ability, especially their low English communication ability (56.8%) as a reason for not communicating in English with non-Japanese patients (Table 8). In addition to these reasons, their reliance on Japanese language contributed to their being against English communication between Japanese staff and non-Japanese patients (Table 8). Most of the students (71.4%) who resisted communicating in English with patients answered they would call for colleagues who could speak better English, which again suggests their lack of confidence in English (Table 8).
Reason |
Number of students who put down the statement |
My English communication ability is low |
25 (56.8) |
I don't understand English |
8 (18.2) |
I am poor at English |
7 (15.9) |
I have no confidence in speaking English |
4 (9.1) |
Note: ( ) = percentages of the total number of respondents,
* = Q8, item d) I will try to answer in English if non-Japanese people who don't understand Japanese ask me something in English at a hospital when I am on duty as a nurse.
Reason |
Number of students who put down the statement |
Either English or Japanese seems to be OK |
9 (42.9) |
Because hospitals in the topic are Japanese ones and we are in Japan |
8 (38.1) |
I can't speak English |
4 (19.0) |
Note: ( ) = percentages of the total number of respondents,
** = Q8, item f) Because English is the international language, it is recommended that Japanese staff and non-Japanese patients receiving treatment in Japanese hospitals communicate in English.
Reason |
Number of students who put down the statement |
I would call for colleagues (or supervisors) who could speak better English |
10 (71.4) |
I would make gestures or use drawings |
4 (28.6) |
Note: ( ) = percentages of the total number of respondents,
* = Q8, item d) I will try to answer in English if non-Japanese people who don't understand Japanese ask me something in English at a hospital when I am on duty as a nurse.
These results indicate that although the students are aware of the importance of nurse-patient communication and the usefulness of English in communication, their negative feelings towards English hinder their even hoping to engage in English communication with non-Japanese patients and having the motivation to do so. Further study into students' attitudes regarding teacher's use of language in a classroom revealed their negative feelings towards English more clearly.
As shown in Table 9, approximately 98% of the respondents preferred a Japanese teacher of English to use Japanese in the classroom. Almost half of them preferred L1 over L2, and the students who expected a teacher to speak L1 and L2 at an equal rate were the greatest in number. There were no significant differences found between the job-inexperienced and the job-experienced subjects.
Preference |
Number of students agreeing with the statement |
1) Almost 100% L1 |
33(18.5) |
2) 75% L1 and 25% L2 |
50(28.1) |
3) 50% L1 and 50% L2 |
77(43.3) |
4) 25% L1 and 75% L2 |
3 (1.7) |
5) 100% L2 |
15 (8.4) |
Note: L1= Japanese, L2= English,
( ) = percentages of the total number of respondents
Table 10 shows that L1 translation is reportedly needed not only for lexical acquisition, but also for semantic and syntactic knowledge, and classroom instructions. The total numbers of students who chose item 1, or items 2a+2b, or items 3a+3b, or items 4a+4b, were similar, suggesting no strong preference for particular use of L1. The percentages of respondents who required both L2 and L1 (items 2b, 3b and 4b) were much higher than those for L1 only (items 2a, 3a and 4a), which indicates most of them are willing to be challenged.
Items |
Number of students who chose the statement |
Total |
1) Translation of English sentences and words |
92 (100) |
- |
2) Explanations for English sentences and words
|
|
112 (100) |
3) Explanations for grammatical points and pronunciations
|
|
107 (100) |
4) Classroom instructions
|
|
114 (100) |
Note: L1= Japanese, L2= English,
( ) = percentages of the total number of respondents who agreed with each item.
The reasons for students' language preference in the classroom are listed in Table 11. The data show that there are students who fear English, hate English or lack confidence in their English ability. A few of the respondents mentioned that they did not understand the contents of the class when only English was used and they got irritated, which eventually put them off more. Although there were students who had positive attitudes toward L2 learning, many of them claimed their English proficiency was low, and because of that they required L1 translation to understand L2.
The data presented in Table 11 also suggest that use of L1 could create a relaxed atmosphere in a classroom. According to Rogers' humanistic psychology (Brown, 1987, p70), student-centered teaching contributes greatly to their learning process, which indicates that teachers need to look at mental aspects of students and reflect them in teaching. Using L1 for these students may increase the students' ability to develop their English comprehension.
Reason |
Number of students who put down the statement |
I cannot fully understand what is taught in classes when a teacher uses only English |
18 (27.7) |
I do not understand English at all. I am poor at English |
16 (24.6) |
I may get used to English if I keep listening to a teacher speaking English, but I do not understand all English used in a class |
11 (16.9) |
I absolutely hate English |
4 (6.2) |
I want to hear English at least in English classes, because I do not have other opportunities |
4 (6.2) |
My English listening ability is poor |
3 (4.6) |
I want to increase my English listening ability |
3 (4.6) |
I do not think it is an English class if only Japanese is used in a class |
2 (3.1) |
I feel relieved when I hear Japanese translation after English |
2 (3.1) |
Japanese is easier to understand because I am Japanese |
2 (3.1) |
Note: ( ) = percentages of the total number of respondents
This study suggests that newly-enrolled student nurses are aware of the importance of nurse-patient communication in nursing and the usefulness of English in communication. Therefore, taking part in English communication with non-Japanese patients could become a strong motivation in the acquisition of communicative English. At present, it is probably too challenging to expect all Japanese nurses to communicate with non-Japanese patients in English about serious or complicated medical matters, or to expect all student nurses to study English aiming to reach this level, but the acquisition of simple nursing English such as English for carrying out daily conversations with patients, for taking personal histories and giving simple directions in laboratory tests, could be a strong instrumental motivational factor for newly-enrolled student nurses.
The main obstacles appear to be the students' negative feelings towards English, such as fear of English, dislike of English and a lack of confidence. Therefore teachers need to neutralise these feelings, for example, by creating a non-threatening classroom environment. In this study, the students expressed a strong preference for L1 use in L2 acquisition, and it seems reasonable from the viewpoint of student's psychology that teachers accept their preference at the beginning of the first term, a starting point which may have crucial effects on the teaching process for the newly-enrolled student nurses. Then increase comprehensible input by exposing the students to English more and more as time passes and as the students' level progresses, since the results of this study also suggest that most of the students are willing to be challenged. Burden (2002) points out the "I'm poor at English" syndrome which has been prevalent among many Japanese English learners. He suggests a teaching approach which leads learners to have a sense of accomplishment through manageable tasks in order to displace the "I'm poor at English" syndrome. A teaching approach of this kind may also be applied to student nurses.
The author would like to express sincere gratitude to Professor Carol Rinnert, Hiroshima City University, for her invaluable comments and insightful suggestions.
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