Nursing students coping with English as a foreign language medium of instruction Wafika A. Suliman a, ⁎, Angele Tadros b a College of Nursing – Jeddah, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Mail Code 6565, P.O. Box 9515, Jeddah 21423, Saudi Arabia b Language and Cultural Studies Department, College of Nursing – Riyadh, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia summary article info Article history: Accepted 30 July 2010 Available online xxxx Keywords: Coping Foreign language Nursing students Aim: To explore the strategies used by nursing students in coping with English as a foreign language medium of instruction. Method: A descriptive repeated-measure design was used. A convenience sample of 78 students completed the assessment tool at three different times. Coping was measured with Folkman and Lazarus' (1988) Ways of Coping Questionnaire. In addition, a Free Response Questionnaire was designed to elicit possible solutions for the participants' limited competency in the English language. Changes in mean scores from time 1 to time 2 and from time 2 to time 3 were examined using paired t- test independent samples. Results: The study showed that positive reappraisal, planful problem-solving, self-controlling, and seeking social support have decreased significantly (p b .05) from time 1 to 2, whereas confrontive coping and distancing have increased significantly from time 2 to 3, (p b .05). Further, while analyzing the free responses (Part 2), two themes emerged: language-related solutions; and accountability related solutions. Conclusions: This study provides evidence that nursing students utilize a variety of strategies, which change over time. The responsibility for coping with English rests with the collective efforts of the student, faculty, and management. Crown Copyright © 2010 Published by Elsevier Ltd. All rights reserved. Background Using English as a medium of instruction is a common practice in university-based nursing education programs in the Middle East, where Arabic is the mother tongue. However, on joining college, nursing students are expected to switch from using Arabic as a medium of instruction to English as the language of study and workplace, from sitting as passive listeners at school to negotiating and participating in the learning process at college, from being spoonfed to being responsible for their own education, from total reliance on the teacher to reliance on their own judgment, and from being a repository for rote-memorization of facts to being critical thinkers. In other words, the students are expected to move from school where critical thinking is at bay to where they are expected to negotiate, make decisions and justify their choices. Overwhelmed by these expectations, they feel stressed as they continue with their studies at college. A similar situation has been foregrounded in Dudley–Evans and Swales (1980), who point out that the Middle Eastern Educational system is characterized by rote learning, adding that information stored by memorization “cannot easily be retrieved in a selective way or used in a manner supportive of a particular line of argument” (p. 94). The issues the students face on joining college are complex since they discover that the English at their disposal and the kind of education they received are out of balance with the communicative demands of the nursing program. Accordingly, they fall back on copying from the texts they read without understanding. Whatever the requirements of the question – be it compare/contrast, evaluate or criticize – the knowledge they have so faithfully memorized is regurgitated indiscriminately without focus or organization. As Adamson (1990) observes, the most common coping strategies for doing assignments are copying and memorization. Similarly, in most developing countries, for example China, teachers tend to emphasize the lower order thinking skills which are characterized by rote learning and memorization (Wang and Farmer, 2008). Previous studies have explored not only general situations related to stress-coping strategies among nurses (Chan et al., 2009; Hegge and Larson, 2008), but also particular situations related to language barriers due to the increasing proportion of culturally diverse students within the USA (e.g., O'Neill et al., 2005; Sheen, 2008), Australia (e.g., Shakya and Horsfall, 2000), Canada (e.g., Jalili-Grenier and Chase, 1997), UK (e.g., Ross et al., 2006), and within Auckland (New Zealand Nurses' Organization, 2006). Nursing shortage is a global crisis (Oulton, 2006) and skilled foreign nurses, especially those with competent standards in English as a Second Language (ESL), have been recruited from developing to developed countries to supplement the domestic nursing workforce in the aformentioned countries. Nurse Education Today xxx (2010) xxx–xxx ⁎ Corresponding author. Tel.: + 966 2 6755370x29222, + 966507488276(mobile); fax: + 96626755370x29210. E-mail addresses: thaherw@ngha.med.sa (W.A. Suliman), tadrosa@ngha.med.sa (A. Tadros). YNEDT-01852; No of Pages 6 0260-6917/$ – see front matter. Crown Copyright © 2010 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.07.014 Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/nedt Please cite this article as: Suliman, W.A., Tadros, A., Nursing students coping with English as a foreign language medium of instruction, Nurse Educ. Today (2010), doi:10.1016/j.nedt.2010.07.014