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UA Program

ATS Teaching Project 2009-2010: Test Development For Nursing Students With English As A Second Language Stephen Wagner Mentored By: Deborah Tibbs MSN, RN, BC, CCM Miami University Department of Nursing


UA Program


Test Development For Nursing Students With English As A Second Language Background Earlier this semester Professor Tibbs invited me on board as an Undergraduate Associate [UA] to look for solutions in challenges in test writing for nursing students with English as a second language [ESL]. In the UA Program application essay submitted earlier in the semester, I mentioned that I am hard of hearing student with English as a second language and have experienced struggles in the past in regards to test taking and scholarly papers. Due to the steady but increasing numbers of students with ESL at Miami University (Lloyd, 2009), there lies a problem for nursing faculty to have proper guidelines for test writing that maintain testing integrity but foster comprehension. We have a responsibility to improve diversity in the nursing profession. Because of the increasing diverse population in our country, nursing students with ESL will be a valuable asset in the front lines of providing health care. Objectives My first objective was to use my personal knowledge as an ESL student to review current and past NSG 353 exams for questions that I may find confusing or potentially problematic. I sought after and reviewed relevant evidence-based-nursing articles and other professional literature for recommendations that can be applicable for nursing education. Whenever possible, I carried out informal interviews with registered nurses with an ESL background at Mercy Hospital-Fairfield where I am currently employed. Originally, there was a plan to have a videotape session during one of Professor Tibb’s lecture. Unfortunately I could not contribute in that area relating to scheduling problems and being unable to listen to the recorded videotapes due to my hearing loss. Last but not least, I wanted to research on possible technologies on the Internet that may provide innovative solutions and cost effectiveness to help nursing faculty in

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test writing for ESL students. Findings & Recommendations Review of literature identified that ESL nursing students struggle with barriers or burdens relating to language, academics, resources, and culture which nursing educators need to use resources available to reinforce them and be aware that the students not are only struggling with English but also nursing care planning and terminology is a new language in itself (Bosher & Bowles, 2008; Lujan, 2008; McAdams-Jones & Williams-Schults, 2008; Cunningham, Stacciarini, & Towle, 2004; Starr, 2009). Findings indicate that in a majority of cases, modification improved examinees' comprehension of test items (Bosher, & Bowles 2008). I strongly recommend nursing faculty read articles by Bosher & Bowles (2009); Cunningham, Stacciarini, & Towle (2004); and Lujan (2008) for strategies in test writing. I had the opportunity to talk with a Spanish speaking nursing graduate working as a Patient Care Assistant at Mercy Hospital-Fairfield, she explained that she did not pass the NCLEX-RN examination and expressed that the language of the test contributed to her difficulty in understanding and increased her anxiety during the test. There are promising resources on the Internet such as Google Translate website that can transcribe documents in 51 available languages. While it is promising, my concern would be accuracy and variations within each language. Another concern is that while we want to help students comprehend, we want to improve their English proficiency. I suggest that a resource to be made available within Miami University student services at all campuses to help faculty enhance tests by not only transcribing into the student’s native language but also have the translation side by side with the English text which can help the student improve their competency in the English language. Refer to my Spanish reference guide that I developed for

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school nurses in the Middletown City Schools District (K-5) attached as an example. I strongly recommend that the Miami University Nursing Department, if not done yet, develop an ongoing orientation program for ESL students to improve test taking skills and reinforcement in English and the nursing language. Test writing for ESL nursing students is a challenging process but it can be done. Reflection I learned that test writing takes a lot of work and is time consuming. I gained more respect for nursing instructors because of the challenges they take in test writing and evaluating questions. The project was more challenging than I thought. While there are many articles proposing strategies or recommendations, they are either vague or too generalized and there are not many studies conducted to determine if the recommended strategies for ESL students have been successful. I attended two ATS seminars and it gave me insight on how scholars/teachers plan and develop their work to be presented among faculty. This project helped my research skills in a different way that in the past I applied research towards scholarly papers but now I am applying evidence-based-research into practice.


UA Program Bosher, S., & Bowles, M. (2008). The effects of linguistic modification on ESL students’


comprehension of nursing test items. Nursing Education Perspectives, 28(3) 165-172. Cunningham, H., Stacciarini, J.R., & Towle, S. (2004). Strategies to promote success on the NCLEX-RN for students with English as a second language. Nurse Educator, 29(1) 15-18. Lloyd, S.A. (2007). Diversity update Fall 2007. Retrieved December 13, 2009 from the Miami University website date_2007.pdf Lujan, J. (2008). Linguistic and cultural adaptation needs of Mexican American nursing students related to multiple-choice tests. Journal of Nursing Education, 47(7) 327330. McAdams-Jones, D., & Williams-Schultz, L. (2008). Leaving your comfort zone: immersion in English for the foreign born. Nursing Education Perspectives, 29(3) 134-135. Starr, K. (2009). Nursing education challenges: students with English as a additional language. Journal of Nursing Education, 48(9) 478-487.