[nurse educate]

Someone mentioned foreign born students briefly in another thread, whch reminded me of something I observed over the past semester. Students asking me (the proctor) to define a word or phrase. Opinions? I have mine, but I'd like to hear what others say first.

[Leda]

As a long time nurse educator it is my position that given that the question/questions are well written and contain language that should be clearly understood by any nursing student at that point in their education I will not/do not define or interpret a word or a phrase on a nursing examination during the time the test is being administered. Once the student has submitted the exam for grading I will define the word or phrase, but not during the exam. Exam questions should be clearly written with care taken to be sure that the questions are not culturally biased. If this principle has been followed then I think it is fair practice to decline the student's request to define a word or pharse during the exam.

This practice may seem punitive, but in my experience it is not the lack of nursing knowledge that contributes to student's difficulty answering NCLEX-style nursing exam questions. The problem for many students is their limited ability to understand relatively common English words and pharses. Since the NCLEX will not define a word or phrase during the exam, it is important that all nursing students develop the ability to read and understand questions that are written at a reading level that mirrors actual NCLEX questions.

I would like to add that it is not just the ESL students that have difficulty with words or phrases on nursing exams, I have found that a great number of US born students lack basic English literacy. This lack of literacy results in misreading or failing to understand the question being asked. I strongly advise all students to study with both a Webster's English language dictionary and a Taber's (or similar text) Medical Dictionary. Student's are advised to look up and define all unfamiliar words. Not all students follow this advice but those that do benefit from the practice.

[nurse educate]

Originally Posted by Leda

As a long time nurse educator it is my position that given that the question/questions are well written and contain language that should be clearly understood by any nursing student at that point in their education I will not/do not define or interpret a word or a phrase on a nursing examination during the time the test is being administered... Exam questions should be clearly written with care taken to be sure that the questions are not culturally biased. If this principle has been followed then I think it is fair practice to decline the student's request to define a word or pharse during the exam.

This is apparently very difficult to do. I recently had a discussion about the word "Jello" with some colleagues, one of which felt that some students may not know what it is. Who really decides what is culturally biased?

This practice may seem punitive, but in my experience it is not the lack of nursing knowledge that contributes to student's difficulty answering NCLEX-style nursing exam questions. The problem for many students is their limited ability to understand relatively common English words and pharses. Since the NCLEX will not define a word or phrase during the exam, it is important that all nursing students develop the ability to read and understand questions that are written at a reading level that mirrors actual NCLEX questions.

I would like to add that it is not just the ESL students that have difficulty with words or phrases on nursing exams, I have found that a great number of US born students lack basic English literacy. This lack of literacy results in misreading or failing to understand the question being asked. I strongly advise all students to study with both a Webster's English language dictionary and a Taber's (or similar text) Medical Dictionary. Student's are advised to look up and define all unfamiliar words. Not all students follow this advice but those that do benefit from the practice.

I do agree with you that words and phrases should not be defined during the test itself. And I certainly agree with the argument that the NCLEX will not define words or phrases for them either. But I believe your suggestion of looking up unfamiliar phrases does seem a bit unrealistic, because, in my experience, the things that students are often struggling with are everyday 'figure of speech' phrases we, as native born Americans (or those who have lived here for many years) take for granted. These phrases do not necessarily come up in the lecture itself. Example: I was observing a test review, where a number of foreign born students did not understand the phrase 'not looking forward to'. They interpreted it as 'not going to'. It was a patient education type of question, and therefore ruled the question out as the right choice.

Obviously, when we are talking about a medical/nursing word, it should not be defined, reardless of one's native language. I once had a student ask me what 'reinforce' meant during a test. This word, I'll venture to guess, was mentioned in the lecture, so there was no way I could even justify defining it for her. I don't even know in which context the word was used. But either way, this is one she should have asked about, if she didn't know.

[VickyRN]

In both my former and present nursing instructional settings, no preferential treatment is shown towards ESL students. The students are held to the same standards as the rest of the class. However, we do have to be careful about idiomatic or cultural phrases with which the student may not be familiar. This is unfair to the ESL student. One example is "Cracker Jacks" - one of our ESL students did not understand this term and missed the MC test item because of it. She clearly understood the content - The fault was in the way the test item was worded.

I read somewhere that the medical terminology used in the NCLEX is so sophisticated that a fluency level in English of 5+ years is required to fully grasp the subtle nuances of the questions. Many ESL students have only been in the country for 2 or 3 years, so this places them at a disadvantage.

We have a mentoring program in place at my new place of employment. Students are flagged by pretest scores and other demographic or financial data as being "at risk" and are assigned a faculty mentor. The faculty mentor will follow the same students throughout the program with one-on-one sessions to help the student succeed.

[Leda]

The nursing program that I work at does have a program for high-risk students quite similar to that described by Vicky. "At-risk" students are provided with a variety of programs and services designed to promote their success. Unfortunately some students don't wish to avail themselves of these services.

I agree that it is indeed phrases and words in everday English language that causes the most difficulty for students. I once had an ESL student that could not comprehend what the word "hemline" meant, in the context of an uneven hemline being a possible indicator of scoliosis in a female adolescent client. This is indeed the challenge for nurse educators and those who write the actual NCLEX questions to be certain that words and phrases such as these are eliminated from questions if at all possible.

I also agree that just looking up a word will not correct everything but it is a start, especially for US born, English only speaking students with very weak vocabularies. The nursing program I am affiliated with has a very high percentage of ESL students so we are challenged on a daily basis to foster their English language fluency in both the spoken and written word. We continue to fine-tune our approach to this situation. Any suggestions on effective approaches to this would be greatly appreciated.