Academic Support, EAL, English-as-an-Additional-Language, Nursing Students, Psychosocial Support, Support Program



  1. Choi, Liza Lai Shan


Abstract: English-as-an-additional-language nursing students are more likely to experience academic challenges than nursing students whose primary language is English. In an attempt to improve the learning environment for this group of students, a novel support group was established to address both academic and nonacademic issues. The impact and effectiveness of this support group are explored using an interpretative analytic approach. The findings suggest that English-as-an-additional-language support programs based on the principles of academic safety, purposeful design, curriculum relevance, positive faculty influence, and proactive enrollment have the most potential to facilitate student success.


Article Content

English-as-an-additional-language (EAL) students in postsecondary nursing education are known to experience greater rates of underperformance and attrition than their peers (Crawford & Candlin, 2013; Donnell, 2015). In addition to academic challenges, EAL nursing students are often confronted with an array of psychosocial challenges that include discrimination, marginalization, lack of social support, cultural discord, and psychological distress (Crawford & Candlin, 2013; Jeong et al., 2011; Olson, 2012).


In an effort to support EAL prelicensure baccalauraeate nursing students and minimize their disparity in academic performance, an innovative support program was designed at a Canadian faculty of nursing to address a multitude of issues (Choi, 2016). The innovative design of this program purposely integrates both academic and psychosocial support strategies by providing academic workshops, peer and faculty mentoring, large-group gatherings, and bimonthly newsletters (Choi, 2016). This article highlights findings from an interpretive analysis focused on the lived experience of students. Important considerations for educators involved in EAL nursing student learning are presented.



To ascertain success elements of the support program, an interpretive analysis focusing on the lived experience of students was used to examine its impact. Required consent forms were signed by participants, and ethics approval was granted prior to the initiation of the study. Interviews with 24 students, 65 percent of the participants, were audiotaped, deidentified, and transcribed. A team consisting of a faculty researcher and two research assistants performed a line-by-line analysis of transcripts. Each statement was interpreted, categorized by meaning, and tabulated. The tabulated data were then examined by the entire research team, and themes were identified through consensus.


Academic Safety

As expressed by a number of the nursing students, a key feature of the EAL Nursing Student Support Program was that there were no academic consequences for participating. Students were provided with support and guidance in an atmosphere free of judgment or academic evaluation. Faculty members involved in the program had no connection to students outside the support activity. All information disclosed to program faculty was kept confidential in order to relieve student fears that their performance would somehow affect their academic standing.


Students were free to express themselves and learn from their mistakes. This sentiment is reflected in the following student statement: "I find it very supportive to have instructors among us where we can ask for advice and ask questions to. Their presence does make a difference to our meeting!" The open atmosphere ultimately removed barriers to EAL student success. For example, one participant stated, "I feel comfortable here. It's hard to explain.... I feel like someone has my back."


Design of the Program

To cater to a diverse range of students with differing needs and backgrounds, the EAL Nursing Student Support Program was purposely designed to incorporate both academic and nonacademic provisions. By taking a holistic approach to student success and addressing a multitude of issues brought forward by students, the program has aimed to increase the probability of student success, as defined by the students.


EAL student interview data confirmed interventions must address both academic and nonacademic challenges in order to be effective. Academic provisions for nursing education should aim to help students develop linguistic competence, effective academic writing in the nursing program, and successful learning strategies. Nonacademic provisions should address psychosocial needs and cultural competency in order to alleviate feelings of isolation, encourage social networking, and minimize cultural discord. Support programs that address both academic and nonacademic challenges have the potential to influence student success while simultaneously encouraging positive adjustment to the social environment of a nursing education program.


Curriculum-Specific Design

The support program purposefully provided all academic aid within the discipline-specific context of a nursing education program. Student participants believed this curriculum-based design was necessary because support provided for nursing students must be relevant and meaningful. Student interview data, as well as actual improvements in student grades and/or clinical performance, indicate this type of student academic support is more effective than the centralized model of academic aid usually provided in nursing education programs. One student explained: "I got good grades because this group[horizontal ellipsis]introduces how to learn effectively. I feel comfortable and competent in the university."


This finding also speaks to the communication-intensive nature of nursing training, which differs from other academic disciplines. Thus, if this type of support program is to be offered in faculties outside nursing education, educators will have to ascertain what discipline-specific skills are most relevant to their curriculum and EAL student population.


Role of the Faculty Mentor

When designing an effective and purposefully designed support program, it is important to consider the role of the faculty mentor. Findings from this study suggest that an ideal faculty mentor is passionate, empathetic, culturally competent, appreciative of diversity, and competent in the areas of communication and teaching. Consistent with the literature, the findings suggest that ethnic role models provide an additional tier of support for students from underrepresented ethnic backgrounds (Choi, 2016; Olson, 2012), which other mentors cannot provide. As there is a lack of ethnic role models in postsecondary education, this finding provides support for the need to call attention to this disparity (Choi, 2016; Olson, 2012). To best support EAL students from ethnic minorities, it is imperative that educators take this factor into consideration.


Proactive Aspect of the Support Program

Students at risk for attrition or underperformance increased their probability of success by participating in this innovative program because they gained knowledge and the support necessary to avoid academic crisis. In line with findings from previous studies, results demonstrated that a proactive approach to support interventions was most conducive to student success, suggesting that enrollment in an EAL nursing student support program should be encouraged as soon as possible (Olson, 2012), even as early as program registration (Donnell, 2015). However, there is a dearth of literature specifically addressing this issue, providing a possible thread for future scholarly investigation.



The recommendations put forth in this article present potentially important considerations for nurse educators and academic stakeholders at the postsecondary level. The findings suggest that an EAL nursing student support program based on the principles of academic safety, purposeful design, disciplinary relevance, positive faculty influence, and proactive enrollment has the most potential to facilitate student success. By supporting students in a comprehensive and individualized manner, academic institutions will have the greatest probability of addressing the wide breadth of academic and nonacademic challenges brought forward by the EAL student, both academic and nonacademic in nature.




Choi L. L. (2016). A support program for English as an additional language nursing students. Journal of Transcultural Nursing, 27(1), 81-85. doi:10.1177/1043659614554014 [Context Link]


Crawford T., & Candlin S. (2013). A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes. Nurse Education in Practice, 13(3), 181-185. doi:10.1016/j.nepr.2012.09.008 [Context Link]


Donnell W. M. (2015). A correlational study of a reading comprehension program and attrition rates of ESL nursing students in Texas. Nursing Education Perspectives, 36(1), 16-21. [Context Link]


Jeong S. Y., Hickey N., Levett-Jones T., Pitt V., Hoffman K., Norton C. A., & Ohr S. O. (2011). Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program. Nurse Education Today, 31(3), 238-244. doi:10.1016/j.nedt.2010.10.016 [Context Link]


Olson M. A. (2012). English-as-a-second language (ESL) nursing student success: A critical review of the literature. Journal of Cultural Diversity, 19(1), 26. [Context Link]