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Leaving your comfort zone: immersion in English for the foreign born.

WHEN THE "POWERS THAT BE" mandated desegregation, my parents immediately checked the "yes" box, sending me to school in a culture that was not my own and where I (DMJ) was not invited. Perhaps that is why I try to lessen the pain for the many foreign students in our English-speaking nursing programs. It is also why I sent two of my children, at age 15, on journeys across the world with People to People Student Ambassadors. I do not want them to fear other people, their language, or their culture. President Dwight David Eisenhower shared a dream with the world when he developed People to People International in 1956, stating that "ordinary citizens of different nations, if able to communicate with one another, would put their differences aside and live in peace" (


In my nursing classes we discuss diversity from the perspective of intercultural communication and understanding. I invite a social worker friend (LW), the coordinator for leadership and diversity at a neighboring community college, to talk with my students about communication. She leads the students through varying levels of interaction, from repulsion toward those who are different, to tolerance, and finally to the appreciation of differences. She then hands out a simple drawing of an iceberg, pointing out that what we see is only the tip of the iceberg while the mass is beneath the surface. While we note the foods, clothing, music, and art of other cultures, below the surface are characteristics and traits that are hard to get to know: notions of modesty, concepts of beauty, theories of disease, the nature of friendship, approaches to problem solving, incentives to work, conceptions of justice, and the many other characteristics, norms, mores, and values that we absorb in our own culture through social osmosis.

In my classes, there are students from across the globe who come to America for an American education. Although these students speak conversational English, they often live with students from their own countries, speaking their native language during their leisure time. When I talk about the ascending, descending, and transverse colon in the abdominal cavity below the diaphragm, I lose them because of those tricky small words, prepositions and conjunctions, such as like, to, under, and around, that are hard to get to know. These students, when they are in the clinical area, provide excellent patient care, but it is not clear if they understand what their patients tell them. At the school of nursing, we became concerned that we were not making the best use of valued nursing slots when we admitted students who were doomed to struggle and possibly fail.

I think I understand the problem. When I lived on an American base in West Germany for four years, I traveled frequently and had many German acquaintances. But there were soldiers who lived on the base, shopped on the base, and limited their friendships to other Americans on the base. When these soldiers returned home, they knew no German and knew nothing of the German culture.

To understand another culture, you must leave your comfort zone and be a part of the environment of others. In that way you will learn to think in another language and learn the colloquial terms--something that is particularly important with the English language, where one sound can mean so many things. Think of weigh, way, whey, and jeans and genes.

To help our students learn English in the nursing environment, my school gave me the opportunity to develop an English-as-a-second-language-for-nursing-students program. A registered nurse educator from one of the local hospitals, who speaks the language of some of our foreign-born students, volunteers his time as the program's liaison and facilitator. This is our first year, and we can see benefits already. Faculty refer students to the program as the need arises. We encourage the students to speak and think nursing-in-English, so that they can converse with patients and understand what is being taught in the classroom, lab, and clinical setting. Nursing has its own vocabulary (think bed pans, urinals, and activities of daily living) that is not learned in high school.

We also encourage our American-born, English-speaking students to attend our study sessions, particularly those who are struggling with the transition from high school to college. Nursing is serious. The material is new. And students must be serious about their study habits and their life plans. All students may contact the liaison for an appointment to work on issues one on one. They may take as many sessions as are needed to work on study habits and questions about nursing procedures or content.

The American-born students are a valuable asset for the English-as-a-second-language-for-nursing-students. They take part in conversations with them and introduce them to their social lifestyles, folkways, and mores, essentially forcing the foreign born to speak more English. When the foreign-born students laugh at the jokes told by their new friends and tell jokes in English on their own they will be much more comfortable in groups where English is the primary language spoken.

There is no easy solution to most problems. But recognizing that there is a problem is essential. We are taking steps to solve some of the problems presented by our diverse population of students.

Dianne McAdams-Jones, MEd, RN, is an assistant professor, Department of Nursing, Utah Valley State College, Orem. LaShawn Williams-Schultz, MSW, MPA, is an instructor at Salt Lake Community College, Salt Lake City. Contact Ms. McAdams-Jones at
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Title Annotation:Quick Reads
Author:McAdams-Jones, Dianne; Williams-Schultz, LaShawn
Publication:Nursing Education Perspectives
Article Type:Essay
Geographic Code:1USA
Date:May 1, 2008
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