ENGLISH

Enhancing Communication Skill in Diverse Learners

                        Andrea Morgan-Eason, LaGuardia Community College, NY

 Morgan-Eason, MS, is an Assistant Professor of Nursing in the Health Science Department

Abstract

 The diversity of healthcare students is increasing, mirroring the changing faces of the population of the United States. Educating culturally diverse students has become a major challenge for schools preparing healthcare professionals. Faculty in higher education has been called upon to explore teaching strategies that will not only enhance the student’s learning, but prepare him/her for the working environment. This paper will focus on four teaching strategies that can be used in a community college setting to enhance the students’ communication skills.

 Introduction

The demographics of the United States’ population reflect an increasing segment of racially and ethnically diverse persons. According to the United States Census Bureau, both the non-Hispanic White and Asian population has grown considerably over the past ten years due to higher levels of immigration. Presently, there are 50.5 million Hispanics in the United States and many more undocumented, with the Asian population steadily growing (U.S. Census Bureau, 2010).

 The changing demographics of the U.S. underscore the need for a diverse health professional workforce to ensure high quality healthcare. In order to accomplish this, health care leadership has identified a need for more culturally competent healthcare services. The Pew Health Professions Workforce has also made a recommendation to ensure that the health profession workforce reflects the diversity of the nation’s population (Amaro, Abriam-Yago, & Yoder, 2006).

 Although the U.S. has attempted to institute useful measures to increase diversity among students accepted into health professional programs, these measures are directed towards admission, curriculum development, faculty recruitment and support services. Faculty is still being challenged to educate, retain and graduate ethnically diverse students.  There is a need for faculty to re-examine courses, teaching strategies for areas where diverse students need a more useful approach to maximize their learning needs and prepare them for the workforce. One of the areas of greatest concern is students’ communication skills. Studies have shown that there is a need to recognize the language difficulties of diverse students, with adequate everyday communication, because it can be inadequate for health professionals (Parkhurst, 2010, Gilchrist & Rector, 2007). Offering a course in oral communication that integrates professional communication skills into discipline-specific content while using alternative teaching strategies, results in the acquisition of professional communication skills. More importantly of results in higher graduation rate (Parkhurst, 2010, Gilchrist & Rector, 2007, Evans, Tindale, Cable & Mead, 2009). 

 Background

As the number of ethnically diverse students is increasing, there is a need for faculty to meet the learning needs of these students. The diverse students may possess language difficulties that can affect their academic achievement. Some of the challenges the students who are enrolled in healthcare professional programs may encounter include: deciphering multiple-choice questions, managing the time constraints of multiple choice tests, interpreting concepts related to the majority of American culture and mastering medical and non-medical terminology in English (Parkhurst, 2010, Gilchrist & Rector, 2007). Many of them also may have unique communication educational needs. Many health care courses, in general, concentrate on communication, both verbal and written, that is required of the health professionals (2007). This requires faculty to revisit their teaching strategies and create innovative ways to enhance the diverse students’ language abilities and improve on their communication skills, with their patients and families.  

 Conceptual Framework

The Cummins Model can be useful in assessing student language issues and assisting faculty in creating appropriate teaching methods to improve the students’ language abilities and communication skills (Amaro, Abriam-Yago & Yoder, 2006).The Cummins Model has two continua in which language proficiency can be conceptualized. The first continuum distinguishes between context-embedded (offering contextual clues to assist in the understanding of language, such as facial expression and feedback from the listener) and context-reduced (offering few clues). The second continuum distinguishes between cognitively undemanding (to use on subconscious activities, such as everyday routines) and cognitively demanding (requiring a conscious focus on understanding language and concepts) (Abriam-Yago, Yoder & Kataoka-Yahiro, 1999).

 In preparing innovative teaching methods for the diverse learners, the model shows how a faculty member can move a topic that is cognitively demanding and context-reduced, an area where most healthcare programs courses fall under, to a context-embedded situation by reviewing and revisiting his/her teaching methods (1999). For example, in teaching students about a disease process, instead of utilizing a textbook, have the student read a journal article about the disease and have a class discussion. Journal articles may have figures, tables and illustrations as well as questions to be answered after the reading that can be of more interest to the students and less of a challenge to master and understand (Gilchrist & Rector, 2007).

 Teaching Strategies

Developing effective teaching strategies for diverse students is an ongoing process and differs from student to student. There are numerous generalized teaching strategies; such as ones that involve students in the learning process and others to encourage students to actively participate; but there are few specific teaching strategies that address the ethnically diverse students (Flinn, 2004). The following  teaching strategies have been identified as useful in the classroom setting with culturally diverse students: open discussion, small group tasks, lesson models, peer tutoring, case studies, focus groups, role modeling, seminars, hands-on activities, writing groups and multimedia games (Gilchrist & Rector, 2007, Brown, Kirkpatrick, Mangum & Avery, 2008, Reams & Bashford, 2011). Faculty, in order to begin to facilitate the education of diverse students, first must recognize the cultural and language issues and adapt alternative teaching strategies to assist them (Gilchrist & Rector, 2007).

Application of Adapted Teaching Strategies

Role Playing

 Role play has been used in healthcare programs for varying reasons. For example, in both the nursing and medical professions, role play has been used to improve communication skills, cultural competence and application of ethics (Joyner & Young, 2006, Chaturvedi & Chandra, 2010). Role play adds variety and enhances learning in the classroom as students prepare for their clinical practice (Joyner & Young, Gilchrist & Rector, 2007). Utilizing role play requires an understanding of the learning objectives, in order to ensure that the lesson will be learned. For example, when role play is used to practice skills and techniques, faculty should design the role play with emphasis on overcoming problems. In addressing changes in understanding, feelings and attitudes, the role play needs to emphasize problem solving and relationship building instead (Joyner & Young).

 At LaGuardia Community College, the nursing program students are from varying cultures, role play has been used in numerous ways. Prior to the students’ first clinical rotation, therapeutic communication is taught through role play. Each student has the opportunity to practice in the role of the nurse, in order to learn how to facilitate communication that can assist in assessing the patients’ needs. During role playing, the students are able to practice both verbal and non-verbal communication techniques (Rosenberg & Gallo-Silver, 2011).

 Role play can assist those students who have English as a Second Language. Students who have difficulty with language proficiency can easily be intimidated and shy. Role playing with the manikins it gives them an environment to feel comfortable to practice pronunciation and enunciation of medical terminology (Gilchrist & Rector, 2007). The faculty in the lab does provide guidance when needed in the proper pronunciation and correct usage of medical terminology. This is a teaching strategy students do seem to enjoy, because they are actively engaged. Students have commented on how role play does provide the hands-on experience which gives them more confidence in their communication skills before going in the clinical area for the actual experience (Rosenberg & Gallo-Silver, 2011). 

 Story-telling

Story-telling is an approach to teaching and learning that develops from the past experience of teachers, clinicians and students (Koening, & Zorn, 2002). In the healthcare profession, storytelling can be used to teach the students about social issues, the meaning of illness, assessment, intervention and best practices (Overcash, 2010). It can enhance listening skills, improve students’ communication and interviewing skills, and can provide the student with the ability to engage with other people (Anderson, Ford, & Thrope, 2011; Quaintance, Arnold, & Thompson, 2010; Scott & Debrew, 2009).

 Storytelling can be used to describe certain disease processes. The faculty, when teaching about a specific disease process, starts by sharing their own personal experiences of caring for a patient who had that particular disease; this in turn allows the students to share their own personal stories. By sharing stories both students and faculty are able to find a common bond that enhances the students’ participation in class, creates a comfortable learning environment, improves the learner’s ability to understand and offers a personal dimension that the students can remember (Overcash, 2010).

  Storytelling can be used in the clinical area during post conference. During post-conferences students are encouraged to share the stories of their experiences.  The telling of stories allows for free talk, clarification, question and answer periods, all which involve increasing and enhancing the students’ listening and communication skills (Stein, Billings & Kowalski, 2009). Students are also encouraged to write their stories in their journals, which provide opportunities for learning, reflection, critical thinking and assist in improving their writing skills and medical terminology (Christiansen, 2011). The progress in all areas is noted after reading their entries over the semester.

Assigning Readings

 Students are more willing to seek and apply information to support their practice, if the reading assignments focus on a variety of presentation styles, activities and information sources. Familiarizing the students with the assigned readings and teaching them how to read and comprehend the assigned texts; can encourage students to intellectually engage with and learn from text, and improve their critical thinking skills (Kassiola, 2007).

 Reading assignments are critical in healthcare programs. According to Beeson and Aucoin (2005) reading assignments remain one of the most widely used strategies for teaching nursing students. Students need to not only hear the subject being taught, but also has to be able to read and apply what has been read. Reading assignments can assist students with their vocabulary, communication skills and medical terminology (Gilchrist & Rector, 2007).

 In assigning reading to culturally diverse students the recommended first step is to introduce the students to the textbook and teach the students how to read the textbook. This process is helpful to the students and can result in students using the textbooks more frequently. Another way of encouraging students to read the assigned readings is for the faculty to review the assigned reading and utilize the textbooks in class. This form of role modeling can motivate students to use the textbooks and read more efficiently. Anecdotally, over the past five years, when this process was used in the classroom the students seemed engaged in learning, fostered communication and improved their critical thinking skills.

Technology

 The importance of information technology is growing in healthcare practice, and future healthcare workers need to be knowledgeable and skilled in this area. One of the biggest challenges in healthcare programs is to find ways to prepare the diverse students for dramatic technological changes, requiring the integration of information technology in the curriculum (Hegarty, Condon, Walsh & Sweeney, 2009).  Educators have found ways not only to integrating technology in their curriculum, but using technology to assists students with their clinical performance, communication skills and problem solving (Hegarty, Condon, Walsh & Sweeney, Kingsley, 2007).

 Technology-advanced simulation training in health profession education allows educators to provide experiences for students early in their programs of study and leads them to be more prepared to address situations that may occur in clinical settings (Haas, Seckman & Rea, 2010). It is also associated with large effects on outcomes for knowledge, skills and behaviors (Haas, Seckman & Rea). The skills of critical thinking, problem- solving and clinical decision-making are essential for health care workers to function effectively and the use of technology can facilitate these processes (Hegarty, Condon, Walsh & Sweeney, 2009).

 The Simulation laboratory provides students with hands-on patient experiences that they will encounter in the clinical area. The simulation laboratory provides case scenarios in which students have to actively communicate with the simulated patient, are challenged to accurately assess the patient and treat accordingly, and encourages the students to think critically and problem solve. This environment creates an opportunities for students to be assisted with their written and oral communication skills.

Conclusion

The healthcare system is in need of healthcare professionals that have the language ability and cultural knowledge to meet the healthcare needs of ethnic and language minority immigrants. Therefore the recruitment, admission, retention and graduation of diverse students are essential to meets the demands of these multicultural communities. Developing effective adaptive teaching strategies, such as role play, storytelling, assigned reading and technology are innovative teaching methods that can maximize the diverse students’ educational needs and greatly improve their communication skills for transition into the workforce.

References

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SUMMARY

With the rapidly changing population demographics of the United States and the significant growth of diverse multicultural groups, schools and professionals are being challenged as to how to provide the best comprehensive educational and support services to their increasingly diverse student population. The changes between 1980 and 1990 have been dramatic. The growth rates within this time span range from approximately 13 percent for African Americans to 108 percent for Asian Americans (Sue, 1991). It is estimated that by the turn of the century, approximately 30 percent of the United States population will be from a racial/ethnic minority group (Office of Ethnic Minority Affairs, 1995).

The increasing diversity within the schools is also demonstrated by the higher visibility of other groups of diverse learners, including, but not limited to, children with disabilities, children and families identified with the deaf culture, and gay and lesbian youth.

The challenges in working with an ever growing pluralistic school population encompass many areas. The provision of relevant multicultural curriculums, the use of culturally sensitive assessment and intervention strategies, the training of school staff in the provision of these services, the recruitment and retention of multicultural and diverse professionals, and the integration of diverse communities and parents in an authentic and empowering manner are only a few of the critical issues facing those working with today's students. Professionals are also challenged by the need to consider the impact of complex social/environmental problems, which in many contexts have negative consequences for children from various racial/ethnic and social class backgrounds. Only a few of these major issues will be highlighted.

THE TRAINING OF CULTURALLY SENSITIVE PROFESSIONALS

Although there has clearly been a greater recognition of the need for training in multicultural competence across professions, many programs still conceptualize this training as more of an "add-on"; that is, programs require only one or two courses for their particular professional specialty. This is in contrast to a more comprehensive and integrated "paradigm shift" in the teaching of all helping professional courses (Nuttall, Sanchez, & Webber, in press).

The training of school staff and other related professionals can be conceptualized by using a model that emphasizes three major components: awareness, knowledge, and skills (Sue, Arredondo & McDavis, 1992; Sue et al., 1982). The awareness component involves professionals examining their own values, myths, stereotypes, and world view. Knowledge entails developing a non-stereotyping, flexible understanding of cultural, social, and family dynamics of diverse groups, along with a comprehension of the

critical sociopolitical, historical, and economic contexts in which people from diverse multicultural groups are embedded. Skills require the development of culturally sensitive, flexible, and empowering treatment and assessment strategies that are accompanied by communication skills, the integration of multicultural and diversity issues in various treatment modalities, multicultural consultation, and advocacy skills.

Depending on the school, staff, and community context, flexible training can take place on many levels, such as formal multicultural issues course work, in-service training, long-term consultation and analysis, multicultural program development, and reciprocal relationships with the surrounding multicultural communities.

A MODEL FOR SERVING DIVERSE LEARNERS

A useful model that allows for the integration of many of these critical variables is the Ecological Model developed by Bronfenbrenner (1979) and enhanced by others (Knoff, 1986; Nuttall, Romero, & Kalesnik, 1992). According to this model, we try to understand or evaluate a student (the microsystem) in the context of his/her mesosystems (immediate family, extended family, friends, network), macrosystems (culture or subculture), and exosystems (social structures).

This model places the diverse learner, school staff, and parents/community in an ecological context, which then allows both for a broader understanding of the critical issues affecting students from diverse backgrounds and the development of relevant service and educational models. These educational models need to be highly sensitive to the particular community and social contexts of which the diverse learners and school staff are members.

For the diverse learner and the school staff, the ability to conceptualize and integrate culture and issues of diversity within a developmental perspective is also crucial, given the changes in developmental tasks at each life stage and the various ways that these "tasks" are expressed and resolved within various cultural groups (Lee, 1995). Relevant to the diverse learner in schools, these issues must be integrated within the specialized early intervention programs offered to children with developmental issues (Lynch & Hanson, 1992). Early intervention services are an extremely important part of the total, life-stage conceptualization for low income, diverse learners because such learners are more vulnerable to developmental concerns.

CULTURALLY SENSITIVE ASSESSMENT AND TREATMENT STRATEGIES

Through the development of multicultural competencies within the areas of awareness, knowledge, and skills, the probability increases of psychologists using assessment and treatment strategies that meet the needs of a wide range of culturally diverse groups.

The need for flexible and culturally sensitive assessment techniques has continued to be stressed by many in the field (Facundo, Nuttall, Walton, 1994; Nuttall, Sanchez, Borras, Nuttall, & Varvogli, in press). Examinations of the critical features in assessment should include the sociocultural context of the diverse learner and his family, the sociocultural background of the examiner, such as issues of awareness of biases and stereotypes, and the selection of appropriate testing, interview, and survey instruments. All of these measures enhance the possibility of more relevant and culturally sensitive assessments. Furthermore, the consideration of issues related to language and its complexities is another major factor in providing relevant and meaningful assessments.

The need for changes in the conceptualization of children's abilities and how skills are assessed, particularly with diverse learners, has also led to strategies that focus on problem-solving abilities. Maker, Nielson, and Rogers (1994) described the need for change in assessments within a diverse school settings, including the assessments of students who are to be considered "gifted." The authors presented various assessment programs that rely on Gardner's theory of multiple intelligences (1983) and they provided an analysis of problem-solving strategies for individual children. These procedures stress the process of problem solving and they offer an examination of each child's pattern of multiple intelligences in an attempt to get away from the more traditional and, at times, rigid analyses based on formal intelligence and skills testing. Likewise, the model of Maker, Nielson, and Rogers (1994) has great implications for the assessment of children of all levels and children from diverse backgrounds. Their model allows for individual analyses of children's particular problem-solving style and strengths, which are then encouraged, while areas for remediation are addressed.

Intervention strategies also need to incorporate the critical issues of culture and social context. Works on specific cultural groups, such as Lock (1995) on interventions with African American youth, Jackson (1995) on counseling youth of Arab Ancestry, Thomason (1995) on counseling Native American clients, Zapata (1995) on working with Latinos, and Yagi & Oh (1995) on interventions with Asian American youth, provide valuable guidelines on working with specific populations and serve to increase awareness of the specific cultural factors relevant to that particular cultural group. Awareness of, and the ability to assess, specific factors such as acculturation, language proficiency (including guidelines on the use of translators), and sociocultural history, further enhances the provision of culturally affirming treatment strategies (Paniagua, 1994; Vazquez Nuttall, DeLeon, & Valle, 1990).

The need to deal with diverse groups must also include work with gay and lesbian youth (LaFontaine, 1994) and youth with disabilities (Sanchez, in press), particularly as we proceed with educational inclusion models which are further enhancing the diversity presented within school systems.

TRAINING STUDENTS TO BE CULTURALLY SENSITIVE

With the changing composition of today's student population, the need to provide educational programs that address the complex issues related to multiculturalism and diversity is becoming more and more evident. Schools and educators must begin to develop curriculums that integrate awareness, knowledge, and skills within educational materials. It is critical that diversity and multiculturalism not be conceived as being accomplished by adding a course, a lecture, or a one-day "multicultural fair." A total curriculum transformation needs to take place where the critical issues of diversity and multiculturalism are integrated into all aspects of students' academic achievement, social skills development, and relationship with the community at large.

An example of such an attempt is the work of one of the authors (Li, 1993, 1994) who developed a psycho-educational course to help students increase their self-awareness, acceptance and appreciation of the self and others, and communication skills. The course was tried in two multicultural schools and in one school comprised mainly of minority children. The response from the students and teachers of both regular and special education classrooms was positive. They noticed the nurturing climate developed through the course.

The opportunity for children to begin to integrate into their lives issues related to multiculturalism and diversity is vital to the development of acceptance and respect for others from diverse backgrounds. Along with traditional educational models that present historical and social information about people from diverse backgrounds, the creation of models that stress the development of awareness and cultural sensitivity skills needs to take place (Omizo & D'Andrea, 1995). Under this general category of enhancing multicultural awareness and respect for diversity is the critical need for confronting issues of racism and prejudice. The need for direct discussion and exploration of these issues within schools needs to be conceptualized as another critical element of the work done by those involved with the diverse learner within multicultural settings (Ponterotto & Pedersen, 1993).

INVOLVING PARENTS AND COMMUNITY AS AUTHENTIC PARTICIPANTS

Another major component in working with diverse learners is that of establishing "authentic" relationships with parents and the community. This is a critical element of any effort directed towards increasing multicultural understanding and the development of a truly pluralistic school and community environment. To become actively involved in school is hard for immigrant parents who are not familiar with American school systems. Workshops on American schools including structure, rules, services, and the rights and responsibilities of parents and children are found to be helpful, even empowering, to these parents.

The need for direct work with parents and communities has been stressed by Atkinson and Juntunen (1994): "... school personnel must function as a school-home-community liaison, as an interface between school and home, school and community, and home and community" (p. 108). Casas & Furlong (1994), writing with regards to Hispanic parents, but offering ideas clearly applicable to other multicultural groups, stress the advocacy role of school counselors both to "...increase parent participation and facilitate the increase empowerment..." (p. 121) of parents and the community. This is a critical role that needs to be taken on not just by school counselors, but by all school staff working with diverse learners in an increasingly multicultural environment.

HUMAIROH LUBIS

ISLAMIC EDUCATION MANAGEMENT

STATE INSTITUT OF ISLAM

NORTH SUMATERA

2012