ELL and mental health

Moogie · May 26, 2011

As you say, it sounds like this is a language barrier and not a question of her not knowing the content. I understand what you're saying about her not being able to demonstrate the communication skills that are necessary for mental health nursing but I'm not sure I would fail her because of this. She obviously has the knowledge, just not the communication skills for this particular course.

Is there support for ELL students on your campus? Are students required to show proficiency in English (i.e., TOEFL) prior to admission to the nursing program? Frankly, I think that it's a huge disservice to students to allow them to enter a program without sufficient knowledge of English. It's a waste of their time and money and a waste of campus resources.

I taught clinicals at a school that actively recruited international students but provided them with little support once they got to the nursing program. Some got through; some didn't. I think the whole experience could have been better for them and for their patients had they gotten extra support in communication skills before they got into the program. (I had a clinical group of 10 students with 5 of them being ELL. They were wonderful students but it was terribly overwhelming, especially since I was a new instructor.)

elkpark · May 26, 2011

I haven't encountered that in my experience teaching psych nursing, but I've certainly seen it with med students and residents in psychiatric settings over the years -- individuals who are clearly v. bright and "know their stuff" v. well, but have great difficulty interacting with clients because of heavy accents and lack of familiarity with common US English idioms.

I don't know what the answer is -- as you note, there are lots of clinical areas where extended direct, face-to-face verbal communication isn't so important, but that's certainly not the case in mental health settings.

Have you consulted with your superiors/supervisors/bosses at the school about how you should handle this situation? I would certainly not want to be making a decision about a quandary like this all by myself. If it's going to come down to failing the student, I would want to have the school administration aware of the situation and behind me on that. Or, have them all behind me on passing her even though she isn't really meeting the performance standards to which the other students are being held. This is definitely the kind of thing that sounds to me like it should be a group decision/consensus within the school faculty and administration.

Best wishes!

jmqphd · Jun 1, 2011

I haven't encountered that in my experience teaching psych nursing, but I've certainly seen it with med students and residents in psychiatric settings over the years -- individuals who are clearly v. bright and "know their stuff" v. well, but have great difficulty interacting with clients because of heavy accents and lack of familiarity with common US English idioms.
I don't know what the answer is -- as you note, there are lots of clinical areas where extended direct, face-to-face verbal communication isn't so important, but that's certainly not the case in mental health settings.
Have you consulted with your superiors/supervisors/bosses at the school about how you should handle this situation? I would certainly not want to be making a decision about a quandary like this all by myself. If it's going to come down to failing the student, I would want to have the school administration aware of the situation and behind me on that. Or, have them all behind me on passing her even though she isn't really meeting the performance standards to which the other students are being held. This is definitely the kind of thing that sounds to me like it should be a group decision/consensus within the school faculty and administration.
Best wishes!

How can a student (medical, nursing, student, or resident) determine if a patient is concrete if they themselves don't know... "how are a peach and a pear alike?" Or what we mean when we say "a stitch in time saves nine?"

My husband went through neurology residency with a brilliant fellow who was Chinese and otherwise a great neurologist. But this language thing was a distinct problem. It's not all verbal. There are facial expressions, tones of voice and body gestures that are different across cultural lines.

All other issues being the same... if the student cannot pass the written (NCLEX/HESSI) type questions, I don't think you're doing them a favor by passing them. Otherwise, if they are safe clinically... I'd try to find a way to pass them, unless my hand was forced by clinical weaknesses and limitations.

JH2006 · Jun 1, 2011

This kind of situation is going to happen more and more as students whose first language isn't English are admitted to nursing programs. I had experience working with Internationally Educated Nurses for a couple years, overseeing them in medical and psych rotations. Though most had sufficient English to communicate therapeutically with their patients, a couple I had to consider barely a pass near the end of clinical UNTIL an opportunity came up where the students could be assigned to patients/family of same mother tongue & did they every blossom. Of course they knew what they were doing, in a therapeutic interaction, and yes, there certainly are different cultural cues for patients of diverse backgrounds that they picked up on. These experiences gave them just enough confidence that their English improved and they were able to be recommended for a pass without hesitation. So, perhaps your student may have that opportunity. I think that if the student was intent on pursuing psych/mental health as a specialty, then it would be unlikely she should pass without further improvement in English and interviewing techniques. For ~most other specialties, she is probably meeting minimum requirements for communication & with more experience her English will improve as she expands her practice as a new grad. I'd pass her but recommend she continue to work on English speaking skills.

Hope this helps. :twocents:

Jilly

seizetheday · Jun 2, 2011

As you say, it sounds like this is a language barrier and not a question of her not knowing the content. I understand what you're saying about her not being able to demonstrate the communication skills that are necessary for mental health nursing but I'm not sure I would fail her because of this. She obviously has the knowledge, just not the communication skills for this particular course.
Is there support for ELL students on your campus? Are students required to show proficiency in English (i.e., TOEFL) prior to admission to the nursing program? Frankly, I think that it's a huge disservice to students to allow them to enter a program without sufficient knowledge of English. It's a waste of their time and money and a waste of campus resources.

Part of my concern in this is that it devalues mental health nursing if I say you can still pass as long as you have the theoretical content even if you can't demonstrate the skills. Would this be passable in medsurg - if you knew the content but couldn't demonstrate the skills? Maybe lets say a disability where the student had no hands - would they still pass as long as they knew how to do the procedures, even if they couldn't do them themselves? Not really trying to play devils advocate but more trying to figure out the nuances of this situation.

I agree fully that admitting them without the necessary English skills is completely unfair to the student. They are required to submit TOEFL scores but it seems the cut off gives them sufficient proficiency for most areas for general communication but not for the level of communication required in mental health where it is in and off itself a skill. I highly doubt she intends to do psych nursing however a pass says that I am putting my name to her having met the basic competencies in this area when in fact she hasn't - however no remedial supports (further practice, lab time, mentoring) will help as it is a language barrier that will take significant time to address.

I have spoken to the admin in the program and we will be meeting further, still no resolution!

Moogie · Jun 2, 2011

I definitely see your point. You're right. Does this devalue mental health nursing? Communication is a skill that students need to successfully learn. If a student can't learn that particular skill for whatever reason, should the student pass? Yet, this is different from a student who can't communicate for another reason, say, a lack of empathy for folks who are mentally ill or refusal to participate in activities such as group therapy.

I think you're between a rock and a hard place here.

I found a lit review that deals with some of the issues you're facing with this student. Maybe some of the studies mentioned will be of help. Here's the citation:

Omeri, A., Malcom, P., Ahern, M., & Wellington, B. (2003) Meeting the challenges of cultural diversity in the academic setting. Nursing Education in Practice, 3 doi: 10.1016/51471-5953(02)00026-4

I hope you are able to get some resolution to this and that your administration will have your back, regardless of what you decide.

seizetheday · Jun 3, 2011

I definitely see your point. You're right. Does this devalue mental health nursing? Communication is a skill that students need to successfully learn. If a student can't learn that particular skill for whatever reason, should the student pass? Yet, this is different from a student who can't communicate for another reason, say, a lack of empathy for folks who are mentally ill or refusal to participate in activities such as group therapy.
I think you're between a rock and a hard place here.
I found a lit review that deals with some of the issues you're facing with this student. Maybe some of the studies mentioned will be of help. Here's the citation:
Omeri, A., Malcom, P., Ahern, M., & Wellington, B. (2003) Meeting the challenges of cultural diversity in the academic setting. Nursing Education in Practice, 3 doi: 10.1016/51471-5953(02)00026-4
I hope you are able to get some resolution to this and that your administration will have your back, regardless of what you decide.

Thanks, I'll definitely take a look at that article as well. There are times when cultural issues apart from language are also at play. A very sensitive area to navigate.

I met with our human rights / ethics center representative but they were reluctant to say much beyond I should do everything I can to give her the opportunity to develop the skills she needs to pass. I can't teach her English though so not sure how to work that in.

A positive in this is that I have fantastic support from admin - in that whatever happens they will back me.

Moogie · Jun 3, 2011

You have a true gift in a supportive administration that will back you up in this matter. When I was a brand-new instructor, I had a clinical group with 5 ELL students and no support whatsoever from administration. I had no mentoring and no one to talk to about the situation. I finally did mention it to a more senior faculty member and she sort of laughed, then said that no instructor, especially a newbie, should be given a load like that. But she admitted that no one would have done anything to change that clinical assignment. It was a disservice to me and, more importantly, to all the students in that group.

BTW, the weird thing about the school at which I taught was that they had a nurse educator who had gone for a second master's in teaching ELL students but did not utilize her as a resource. They gave her a regular clinical group, just like the rest of the faculty.

I did eventually quit that job but I still want to teach. So either I am a hopeless idealist or a complete masochist! :)

I have learned quite a bit about teaching ELL students! If you need more resources, LMK and I can try to unearth a few from the dark recesses of my computer. I've been looking for one article that specifically discussed how to deal with language barriers in the clinical setting but cannot find it.

seizetheday · Jun 21, 2011

Just thought I'd update...I passed her! Still not 100% sure about the decision but she truly did the best she could and worked hard, and responded really well to feedback (and I was hard on her). Her technique was still poor, mediocre at best but when we got past the English, the skill was there.