Bilingual Nursing Education is it a myth or is it a reality?

Bilingual nursing education has increasingly gained attention worldwide, and rightfully so, with global economic changes, increased migration, and increased demand for quality care. Increase in migration and mobility of people across the world, the likelihood of experiencing language barriers while providing and receiving care is high.

Language barriers, however, are hurdles that hamper the development of effective communication between nurses and patients. Eliminating language barriers is a crucial step in providing culturally competent and patient-centered care. Nurses are responsible for providing care to patients regardless of their culture, religion, ethnic background, or language.

This is particularly true in the U.S.A and other countries such as Mexico, Thailand, Canada Europe(England, Spain, France) where the demand for bilingual healthcare providers is critical. The nursing profession, which comprises a very large percentage of the healthcare workforce, is in direct contact with the growing number of foreign patients coming to the USA for care. This has implications in the delivery of care and subsequently the quality of care outcomes. Attempts to meet these expectations are not without challenges.

It further reviews the bilingual nursing education in countries that have experience with programs that have been in effect for some time. It is hoped that programs in the USA can gain insight from the experience in these countries that could be used to avoid mistakes and benefit from successes. The recommendations are formulated with the intention of positioning institutes of higher education in the USA to be able to take advantage of the greatest opportunities for success and ultimately to integrate S.I.M.P.L.I.C.I.T.Y. in order to ensure that the expectations are met.

Bilingual education may mean different things to different people depending on who is providing the interpretation. King (2003, p. 17) defined bilingual/multilingual education as “the use of two or more languages as mediums of instruction”. It is advantageous for the nursing profession to provide bilingual nurses with a means to improve their ability to provide safe, quality patient care, improve opportunities for exposure to new/advanced knowledge, and improve the opportunity for jobs with better compensation. In response to the increasing challenges faced with the delivery of competent care in terms of both culture and language, healthcare facilities in the United States, as an example, must provide staff with certified language proficiency, identify the patient’s communication needs, and respect the patient’s right to be informed in a manner that provides a clear patient understanding in order to become accredited (Arocha & Moore, 2011)

Challenges of bilingual nursing education In addition to linguistic competency, bilingual nursing education will also need to include a cultural component so as to provide the students with an understanding of the expectations of the foreign patients, which would most likely be quite different from the local expectations. This cultural competency can be critical to the patient's understanding of their care and their ability to comply with treatment plans that eventually lead to quality care outcomes.??

Critical questions concerning the meeting of quality care and patient safety standards due to communication difficulties of the English as a Second Language (ESL) nursing students are the most critical facing bilingual nursing education in the United States (Irvine, Roberts, Tranter, Williams, & Jones, 2008; Olson, 2012; Doutrich, Wros, Valdez, & Ruiz, 2005). It is very important to note that for students who are studying in a bilingual nursing program, where English is not the native language, they must not only be proficient in academic English but also in medical/nursing terminology which is, by itself, a second language (Guhde, 2003). Furthermore, several studies found that ESL nursing students generally had low learning performance (Colosimo & Xu, 2006; Evans & Stevenson, 2009; Sanner & Wilson, 2008) and a low professional self-concept (Angel, Craven, & Denson, 2012; McDermott-Levy, 2011).

China. Influenced by globalization, the ministry of Education (China), in 2001, initiated a 3- year national program aimed at expanding the level of foreign language instruction to be 10% of the total courses (He, Xu, & Zhu, 2011). With one of the three aims of the bilingual nursing programs in China being to promote the export of Chinese nurses, the authors discussed the impact of bilingual nursing education and the success of the international qualifying exam required by all US State Boards of Nursing and the Commission on Graduates of Foreign Nursing Schools (CGFNS) which was introduced to China in 2003. He, et al. (2011) reviewed the history of bilingual nursing education in China (dating back to 1985), identified the current issues and trends, and offered direction for the future of bilingual nursing education in China. However, the main focus of the article was to address the perspective of teaching in a bilingual nursing program. Although the majority of nursing students in China were enthusiastic about the bilingual program at the beginning of their school year, they often felt overwhelmingly challenged due to their limited ability to communicate in English as well as the bilingual nursing content. As a result, relatively few of them were successful in the program (He, et al., 2011).

How S.I.M.P.L.I.C.I.T.Y. can help to mitigate these disparities and be the cornerstone of success?

S.I.M.P.L.I.C.I.T.Y. is a proven framework that will work in any environment including but not limited to bilingual nursing education. S.I.M.P.L.I.C.I.T.Y.

As I have discussed in previous articles, I will integrate?S.I.M.P.L.I.C.I.T.Y. Please see my article “Integrating S.I.M.P.L.I.C.I.T.Y in the Nursing Academic Curriculum.” Published on February 11, 2019.

S.I.M.P.L.I.C.I.T.Y stands for:

Standardized:

The nursing curriculum and processes must be standardized based on the?C.C.N.E, A.C.E.N Vocational Nursing & BSN Essentials?and incorporated throughout the curriculum, the?N.C.L.E.X?blueprints.

Introduce:

As we have experienced, there exist thousands of diseases that must be covered. Only those diseases in direct correlation within the N.C.L.E.X. blueprints should be introduced in order to avoid unwanted fatigue.

Modernize:

Nursing education needs to be modern and adaptable for 21st-century nursing students. Nursing schools should?decrease the technological barriers?by providing an educational experience on the go.

Facilitate further all participants by creating and integrating Learning Management Systems (L.M.S) that will allow students to have access to all educational components and collaborate continuously with other students and nurse educators without the limitations of physical location and any technological barriers.

Practice:

Nursing schools should provide students with multiple practices academic experiences such as standardized exams tests, quizzes based on nursing competencies, and topics covered.

A.T.I & Elsevier/Evolve?has adapted this new approach by integrating additional resources that will help the student to meet academic rigor.

Some of those programs are?A.T.I?&?E.A.L?(Evolve Adaptive Learning),?E.A.Q?(Evolve Adaptive Quizzing),?Sherpath?(a single platform that incorporates E.A.L and E.A.Q), and the?H.E.S.I Next Generation. Let's not forget the new kid on the block that is getting a lot of traction in U-World

All resources mentioned above all have the following things in common:

All of them have incorporated the same approach that I have defined as S.I.M.P.L.I.C.I.T.Y in the way or the other in order to provide a seamlessly academic experience that eliminates potential academic barriers for the [participant.

Lasting:

Providing a curriculum experience that will have a long-lasting effect on your students and not a burnout effect.

Integration& Interdisciplinary Academic Experience :

Nursing schools should provide a multidisciplinary approach that includes multiple levels of providers(OT, PT, PA, RN, LVN, Respiratory Tech, Nurse Aide). This approach may have the desired effect along with early simulation exposure will further facilitate students to become well versed and adaptable within the health care arena.

Critical Judgment:?

Increase student critical thinking through a variety of in-class exercises such as live case studies and clinical scenarios.

Implementation:?

Educators need to implement new strategies of teaching and learning to further minimize the potential teaching and learning barriers that exist within our nursing programs and nursing student body. As we all come one step closer to NCLEX NextGen we all play a fundamental role in what level we teach our students and what steps are we taking in order to address and minimize the academic gaps. This will facilitate the development and implementation of a Learning Management System that will allow students to access all educational components from anywhere, at any time, and on any device.

Transparent:?

All academic student learning outcomes assignments must be clear, concise, and effective from the first day, for every course, and for every assignment due. Decreasing ambiguity and creating rubrics on how each student is been evaluated increases students retention and overall satisfaction

Yield:

All the above letters of?S.I.M.P.L.I.C.I.T.Y?will result in a?higher yield.?

S.I.M.P.L.I.C.I.T.Y. will translate in a higher increase in the percentage of the N.C.L.E.X passing rate and overall student satisfaction. In conclusion, bilingual education is feasible when you have a concrete blueprint such as S.I.M.P.L.I.C.I.T.Y to build a bilingual program that creates flexibility and that meets the demand of the ever-growing population. S.I.M.P.L.I.C.I.T.Y will facilitate translating into a higher increase in the percentage of the N.C.L.E.X LV/RN passing rate and overall student satisfaction.

In conclusion, within nursing education, there exists no cookie-cutter formula nor a single method to ensure N.C.L.E.X success (Spurlock & Hunt, 2008). However, incorporating a method such as?S.I.M.P.L.I.C.I.T.Y?along with a good balance of in-house testing and predictive test software such as the?H.E.S.I and the A.T.I?will further facilitate and supplement a congruent and well-balanced nursing education, that can help predict N.C.L.E.X success (Langford & Young, 2013).

Bilingual Nursing Education is important for the following reasons:

• Bilingualism Improves Life-Long Learning Skills
• It Helps to Remove International Language Barriers.
• It Leads to Collaborative Learning.
• Increased economic opportunities and reinforced local workforce with diverse cultural nurses that can address the needs of the local population.

Conclusion:

I hope my article provided a fresh and unique approach to decode what we all as nursing school administrators and nurse educators can accomplish within nursing education.

It is my belief that creating a single collective body will further galvanize the future of nursing education. We must provide an academic environment for all stakeholders (faculty and students) that will decrease academic barriers and increase possibilities that everyone can pursue the American dream and provide a better future for their loved ones.

Nurses are responsible for providing care to patients regardless of their culture, religion, ethnic background, or language. Incorporating all possible partners from clinical and academia will result in having one continuous voice and becoming a single collective body that will address our actual disparities within our profession and further enhance our profession and the next generation of nursing students with all the appropriate resources.

References:

Andersson, T., & Boyer, M. (1970). Bilingual Schooling in the United States. Austin, TX, USA: Southwest Educational Development Laboratory.

Angel, E., Craven, R., & Denson, N. (2012). The nurses’ self-concept instrument (NSCI): A comparison of domestic and International student nurses’ professional self-concepts from a large Australian University. Nurse Education Today, 32(6), 636-640. doi: 10.1016/j.nedt.2011.09.006.

Arocha, O., & Moore, D. V. (2011). The new Joint Commission standards for patient-center communication: White paper. Retrieved from https://www.languageline.com/main/files/ wp_joint_commission_022211.pdf

Association of Southeast Asia Nations (n.d.): Overview. Retrieved from HTTP:// www. aseansec. org/about_ASEAN.html ASEAN Economic Community Blueprint (2008).

Baker, C., & Phongpaichit, P. (2005). A history of Thailand. Cambridge, USA: Cambridge University Press.

Caputi, L., Engelmann, L., & Stasinopoulos, J. (2006). An interdisciplinary approach to the needs of non-native speaking nursing students: conversation circles Nurse Educator, 31(3), 107-111.

Colosimo, R., & Xu, Y. (2006). Research on shame: Implications for English as a second language nursing students. Home Health Care Management Practice, 19, 72-75.

Crystal, D. (2003). English as a global language. New York, USA: Cambridge University Press. Davidhizer, R., & Shearer, R. (2005). When your nursing students is culturally diverse Health Care Manager, 24(4), 356-363.

Doutrich, D., Wros, P., Valdez, M., & Ruiz, M. (2005). Professional values of Hispanic nurses: The experience of nursing education. Hispanic Health Care International, 3(3), 161-170.

Dutcher, N., & Tucker, G. R. (1997). The use of first and second languages in education: A review of international experience. Washington, D. C., USA: Pacific Islands Discussion Paper Series: The World Bank.?

Jay Balante,?Diane van den Broek,?Kate White,?How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses, International Journal of Nursing Studies, 10.1016/j.ijnurstu.2021.103930,?118, (103930), (2021).