Abstract

This study aims to evaluate the learning complications encountered by nursing students in the English language at the undergraduate level. The study's sample comprised eight principals, eight English lecturers, and 200 students randomly selected from various nursing schools in Karachi. A descriptive and survey approach is adopted, which was subsequently analyzed using SPSS v-20. The findings revealed that 68% of the participants acknowledged that nursing students faced learning difficulties in the English language, while 32% of the participants expressed otherwise. Moreover, 66% of the participants confirmed that English teachers know to provide English language content, while 26% of the participants expressed scepticism, 47% of the participants using ICT-based teaching, and 35% of the participants held contrasting views. The study also revealed that most nursing teachers encountered challenges teaching the English language. The study recommends appointing competent and trained teachers for effective ICT-based teaching.

Key Words

Nursing; ESL; ICT; Teaching English; Pakistan.

Introduction

Learning is an inherent activity that humans engage in throughout their lives and forms the core of the educational process. While much learning occurs outside the school environment, the definition of learning varies depending on the theoretical perspective. Zhang et al. (2022) propose the "blank state" theory, which posits that humans are born without innate knowledge, but possess a "mental power". Learning notions provide conceptual contexts that define in what way shreds of evidence are engrossed, handled, and recollected. Perceptive, demonstrative, and ecological factors, in addition to earlier experiences, all together contribute to an individual's understanding of the world. Moodi et al. (2022) identify 12 aspects of learning, including empathy, motivation, and social skills, as well as communication, creative thinking, and problem-solving.

Effective communication is essential for maintaining healthy relationships, and English has become the lingua franca for communication worldwide. Gulkhayo (2022) notes that English is the third most commonly spoken language globally, with one out of every six individuals speaking it. English proficiency is also vital for success in education, as it is the language of instruction for many academic resources. Pakistan has a sizable population of English speakers, although Cookey and Ijioma (2022) note that many individuals in the country may not have a full grasp of the language. This study aims to identify learning difficulties in English among graduate-level nursing students in Pakistan to enhance their professional achievements, given the constant evolution of nursing practices and technology.

Mushtaq et al. (2022) highlight the practical value of English as a language of international communication, trade, and diplomacy, as well as the arts, humanities, and social sciences. As a result, English is a mandatory second language in Pakistan. English proficiency can provide individuals with better career prospects, personal development, and economic opportunities. Mann and de Bruin (2022) assert that bilingualism is a way of life and that nursing personnel requires English proficiency to communicate with patients, physicians, family members, and colleagues. The nursing process involves assessing patient needs, formulating nursing diagnoses, and developing care plans. Standardized languages for nursing documentation are crucial for tracking care and studying the impact of nursing interventions.

This research aims to evaluate the efficiency and effectiveness of the English learning process for nursing students at the graduate level in Pakistan. Isoda and Kondo (2022) contend that a clear framework is necessary to assess learning difficulties and improve learning standards. By identifying challenges and implementing effective teaching methods, this research can enhance nursing students' English proficiency and improve their professional achievements.

Thomas et al. (2022) undertook this research problem due to its logical justification and the prevalence of the issue among nursing students and other students across the board. The language used by healthcare professionals can be referred to as "hospital English," "English for healthcare workers," or "English for nursing care." Communication between laypeople and hospital staff can be influenced by various factors, such as a patient's sleep deprivation or the use of narcotic medication. Awwad et al. (2022) identified numerous factors that affect the communication process, including a client's physical health and emotional well-being, the senses involved, functional ability (such as hearing), and distractions in the busy hospital environment. Thus, the primary objective of this study was to evaluate the learning difficulties faced by nursing students in English at the graduation level. To accomplish this research objective, the following specific research questions were formulated:

? What variables affect nursing students learning of the English subject?

? Which poor educational resources prevent nursing students from studying the subject of English?

? What obsolete and incoherent instructional methods prevent nursing students from developing interest and understanding?

? What are the methods by which the Karachi nursing board examines and addresses learning difficulties?

Review of the Related Literature

Cognitive Theory

Psychological therapists have confidence that learning is a result of internal processes, focusing on studying, and understanding awareness, unlike behaviourists. They contend that this kind of learning, which is tied to changes in the capacity and responsiveness of the individual, cannot be immediately witnessed. The founder of learning subjective theories is regarded as Gestalt theory.

The works of German Gestalt therapists, who placed emphasis on the capacity of the person to organise and convert what is acquired into a general pattern or Gestalt, had an impact on cognitive perspectives (Böhm, 2021). They held the view that the whole is larger than the sum of its parts and that the concept of behaviour is often destroyed when behaviour is broken down into its component pieces. Cognitive theories, which emphasized mental processes and the comprehension of difficult material, replaced behavioural theories as the dominant paradigm. These views emphasized that rather than learning happening from the outside in, it actually happens from the inside out. Turner et al. (2021) research on Meta perception-learners' knowledge of their learning, capacity for reflection on their thinking, and capacity for learning management was just published.




Social Cognitive Theory

Learning is influenced by a variety of elements, not just environmental ones. In the 1960s, genuine examination of various viewpoints started to permeate conventional psychological thought about gaining. People can learn by watching others, for instance, and self-efficacy, which refers to a learner's confidence in his or her capacity to complete a task, is important for learning (Bandura, 2002). The first official formulation of social learning theory was published by Yaman et al. in their book Social Learning and Personality Development in 2022. Behavioural theory is the evident ancestor of the social learning theory, however, the two theories diverge significantly.




Humanistic Theory

According to Maslow's theory, to achieve self-actualization, humans should be somewhat content with their lower-level demands (security and convenience) (Drucker, 2012). Carl Rogers agreed with the student-centred perspective and held to the idea of a semantic continuum, in which some concepts are situated on one end but lack any significance to the learner on the other (Chaka, 2021). Their education is entirely intellectual, unrelated to the feelings of the individual, and unplanned. The humanist viewpoint recognizes that people have the ability to make their own decisions and are not controlled by unconscious forces or outside reinforcement.

They have made the same assumption as idealists that each person is free to pursue their own aims and attempt to get past these constraints in order to improve their mental faculties (Demchenko et al., 2021). They don't adhere to the scientific approach to human research. The phenomenological approach is revered by humanists in both research and therapy. From a humanistic standpoint, the instructor prioritizes helping the students discover their interests.




Ways of Effective English Language Teaching

There are many approaches to teaching English effectively, each with its unique composition and cones. English language structures are explicitly taught, and students have countless chances to use the dialectal in significant contexts (Rahmati et al., 2021). Depending on the teaching setting and available funds, language objectives are focused.




English-Only Approach/Direct Method

One of the simplest methods for teaching the language is using simply English. Neither the teacher nor the student should use their native tongue at any point during instruction when using this method. Only English should be used for all instructions (TIP et al.). Since it can be taught with a visual aid, vocabulary should be taught first because it is the most easily understood. By persevering and letting it emerge naturally, this strategy is the most effective way to learn a language. In this approach, instruction is conducted totally in the language of the learner (???????a, 2022).




The Grammatical Approach or Grammar Translation

This is effective when the instructor uses the students' primary language, besides English, as it heavily relies on the teacher's translation ability (Biber et al., 2021). English grammar rules should be taught theoretically in the students' native language, with examples given in Basic English sentences that the teacher can interpret back to the native language to establish a strong parallel. Vocabulary is also of paramount importance, as students need an extensive knowledge bank of English words to comprehend and form their own English grammatical structures (Moukrim et al., 2021). Getting a firm grasp on this aspect of English language learning largely depends on the interpretation of and from the target language.




The Aural Approach or Audio-lingual 

The aural English teaching method focuses on the most natural way to learn a language, which is through listening. The Aural approach is audio-based and does not emphasize reading or writing until long after the students can comprehend the language on a speaking level (Otondo & Osorio, 2021). The true approach entails conversation. At first, the majority of the audience will be students. To offer the children something to connect the words they are hearing to, the teacher may use visual cues like objects. Then, rather than through in-depth instruction or writing, they will be asked to utter the words aloud, understanding vocabulary and fundamental grammar through hearing and speaking (Sidabutar, 2021). The theory behind this approach is based on language-acquiring habits. There is much routine in dialogues of every situation.




The Immersion or Immersive Approach

For older students who have the option of continuing their study abroad, the immersion method is one of the greatest ways to learn a language. To adopt this method, a person who wants to study English only needs the materials needed for travel and does not need to be enrolled in an English language course (Schloss et al., 2021). If the students want an academic-heavy approach, they can enrol in foreign exchange programs through colleges or other academic programs that allow prolonged travel. One of the easiest ways to pick up a language quickly is to stay in a foreign place and learn it via total immersion and necessity (Hein et al., 2021). People who speak that language and media in that language will be all around students. Breaking free from the distractions of one's native tongue and learning to think and talk in English is a great strategy.




The Translative Approach or Natural Approach 

The translative Approach is comparable to the Grammatical Approach, but it places a greater emphasis on the organisation of the English language than on the pupils' native tongue (Bernasconi, 2021). This method needs to be taught by a teacher who is fluent in the same language as the students they are teaching, and the students themselves need to be fluent in the same language. This approach heavily utilizes note cards, allowing students to write English vocabulary and grammar rules on one side and translate the term or concept into their native tongue on the reverse (Fjeld, 2021).




 English Instruction Methods and Techniques for Nursing Students

Learning Styles

Learning style is a broad concept that encompasses the general approach favoured by a student when learning a subject, acquiring a language, or managing a difficult issue. El-Sabagh (2021) defines learning style as a general example that provides an expansive heading to learning and makes the same instructional strategy beloved by some students and disliked by others. Within the realm of learning styles, individuals reflect sensory style dimensions (visual, auditory, and hands-on) and social style dimensions (extroverted outgoing/introverted) (Hu et al., 2021).




Learning Strategies

The Greek phrase "strategy of 'command of a general'" is where the word "strategy" originates, and it alludes to a general's wartime tactics. Learning techniques can aid students in improving how they perceive, gather, store, retain, and retrieve language-related information (Thomas et al., 2021). Finding conversation partners or encouraging oneself to complete challenging language assignments are only two examples of learning methods for language that students can employ to improve their learning (Pawlak, 2022). The deliberate decisions and actions that students take to fulfil a learning aim are known as learning strategies. Key learners have a strong grasp of what a task entails, the capacity to coordinate techniques that best suit the task needs and their learning strengths, and metacognitive awareness of their thinking and learning approaches (Mukherjee et al., 2022).




Role of ICT and Digital Technology in Teaching English to Nursing Students

Information can be created, managed, and distributed via ICT. Its definition is broad and encompasses devices like computers, the internet, phones, TVs, radios, and audio-visual aids. ICT also includes any software or hardware used to access, manage, integrate, review, produce, or convey information and knowledge. (Handayani et al., 2022). This concept includes digital technology as the services and apps used for these devices' associated communication and information processing tasks. ICT offers learners timely and precise feedback. Additionally, it is thought that the use of ICTs in the classroom could encourage deep learning and help teachers better meet the varied requirements of various students. Constructivist teaching methods might benefit from ICT-supported learning environments (Habibullayevna, 2022).

Research Methodology and Procedure

Research Approach

The study utilized a mixed research approach that involved both quantitative and qualitative data collection and analysis. The descriptive survey approach was used to collect data from the target population.




Target Population

The population under study comprised principals, English teachers, and female students in nursing schools located in Karachi, Pakistan.




Sampling Technique

The study used a stratified random sampling technique to ensure that the sample was representative of the population. The sample was divided into strata based on the different subgroups of the population, and a random sample was selected from each stratum.




Sample Size

The sample size consisted of 8 principals, 8 English teachers, and 200 female nursing students. The sample was chosen randomly from the population and was adequately powered to generate reliable and valid results.




Data Collection Instrument

Various research tools such as questionnaires, interview protocols, and observation were used to collect data from the selected sample. The instruments were pre-tested to ensure their validity and reliability.




Pilot Testing

The research instruments were pilot-tested for validity and reliability. The study proposal, along with the research tools, was obtainable to the faculty and researchers in the Department of teacher education for validation. The instruments were revised based on their feedback and were finalized for data collection.




Data Collection

The data was collected personally by the researcher from the selected nursing schools in Karachi.

Data Analysis

The collected data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. The analysis involved the use of statistical formulas such as t-test, simple mean, and percentage. Data was arranged and analyzed using a Likert Scale with five options for each statement. The results were reported using descriptive and inferential statistics to provide a comprehensive understanding of the findings.




Ethical Considerations

The research study was directed with careful consideration of ethical issues. Anonymity was maintained for both the institutions and research participants. Prior permission was obtained from the heads of institutions and respondents, and participants were willing to participate in the study. Written permission was obtained from the research supervisor, and no unauthorized copying or manipulation of data occurred.




Definitions of Terms

Learning Difficulties

Learning difficulties refer to the challenges that students may encounter with collecting, information interpretation, storage, modification, and retrieval. In particular, during these cognitive operations, pupils might not proactively activate learning strategies or previously learned knowledge (Khasawneh, 2022).




Student of Nursing

A student of nursing is an individual undergoing training to become a nurse, either at a school or in a hospital setting (Johannessen et al., 2022).




Discipline of English

The discipline of English refers to the preparation to train individuals to obey rules or a code of performance to control their intellectual commotion in the context of the English language (Siska et al., 2022).

Conclusions and Recommendations

Conclusion

This study has shed light on the learning difficulties of nursing students in the subject of English at the under graduation level. The research methodology adopted was a descriptive survey approach, and the research tools used for data collection were validated and reliable. The study evaluated various factors related to English teachers of nursing students, including personal choices in planning for class, subject matter knowledge, source of motivation, teaching strategies, teaching methodologies, social interaction, personal motivation toward teaching, learning environment, and role as facilitators or helpers.

The findings of the study indicate that the majority of English teachers of nursing students have a good grip on the subject matter knowledge and choose teaching methodologies in which they feel comfortable teaching. They also care about their students and try to develop listening and writing skills among them. The teachers are a source of motivation for their students and admire them for their positive learning approaches. They adopt democratic values in the language class and remain cooperative during the class.

Overall, this study provides interesting insights into the methods used by English professors to instruct nursing students and can be used as a starting point for more studies in this field. The study also emphasises the significance of employing efficient teaching techniques to address the English learning challenges faced by nursing students. The results of this study are believed to be beneficial to academics, educators, and policymakers involved in the field of nursing education. This study can provide valuable insights, foundations, theories, approaches, and models of learning for the advancement of knowledge in the discipline of English. Principals, instructors, and teachers of nursing institutions can make informed decisions to create a conducive learning environment for nursing students learning English. English language teachers can more effectively engage in teaching-learning activities for nursing students. Graduation-level students and parents can work towards bringing about a positive change in teaching and learning English. The Pakistan Nursing Council can modify the schedule and reset the curriculum hours for English teaching to all classes of nursing students.

It is important to note that the researcher was unable to investigate the overall issues facing nursing schools in Pakistan due to a lack of time and resources. Therefore, this study was limited to nursing schools in Karachi and was restricted to principals, teachers, and students of nursing schools in the area.




Recommendations

1. Brainstorming is an effective technique for enhancing learning, but it is not widely used by nursing teachers. Therefore, it is strongly recommended that nursing teachers adopt the brainstorming technique in their classrooms to help nursing students overcome learning difficulties.

2. Nursing students may experience learning challenges as a result of limited learning resources, student differences, and inadequate instructor preparation. It is suggested that nursing students be encouraged to face these difficulties confidently and that teachers be provided with adequate training and resources to support their teaching.

3. Traditional teaching methods can hinder nursing students' learning. Innovative and effective teaching methods should be adopted to make learning more comfortable and attractive for nursing students. Teachers should use ICT-based teaching methods to create an interesting and conducive learning environment for nursing students.

4. Freedom, liberty, and choice are essential for effective learning. Nursing students should be given the freedom to sit voluntarily in nursing schools to create a safe and free learning environment.

5. Relevant and need-based content is essential for the active learning of nursing students. Teachers should deliver relevant and up-to-date learning content to enhance nursing students' learning.

6. Teachers should call nursing students by their proper names to create a positive learning environment. Financial help and scholarships should be provided to nursing students to help them pay their dues to the institutions and afford their routine expenses.

7. The institutions of training teachers should be equipped with the latest technologies to equip teachers with the latest teaching techniques. Professional development opportunities should be provided to teachers to share modernized knowledge and skills with nursing school teachers.

For future research, it is recommended that studies be conducted on various aspects and functions of learning in institutions of higher education to further enhance nursing students' learning experiences. 

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