Good Practice Report: The Student Literacy and Language Strategies Program

Transcription

1 Good Practice Report: The Student Literacy and Language Strategies Program Dr Paul Glew Dr Kathleen Dixon Ms Jaylene Shannon Associate Professor Yenna Salamonson University of Western Sydney - School of Nursing and Midwifery Abstract This report presents an academic literacy and language skills program model implemented over five years as an intervention for commencing undergraduate nursing students in a School of Nursing at an Australian university. Implementation of the program entailed an embedded curriculum strategy and suite of tailored interventions to support students during their transition into undergraduate nursing studies. The report includes discussion of literature on student screening, evaluation of the uptake and effectiveness of the program, and examination of emerging issues for nursing programs in relation to student improvement in academic literacy and language skills. This report considers: linguistic and education background factors that may influence student learning in an undergraduate program; the identification of students who may benefit from support in improving academic literacy and language skills; and the design and implementation of interventions tailored to enhance the academic literacy and language development of undergraduate nursing students. Background In 2009 the Australian University Quality Agency (AUQA) Good Practice Principles report presented recommendations for university course providers to address the literacy and language needs of undergradaute students in tertiary programs (Australian Universities Quality Agency, 2009). The AUQA principles were incorporated into standards by the Tertiary Education Quality and Standards Agency (TEQSA) requiring universities to provide support to students in the areas of literacy and language from course commencement and throughout their higher education studies in order to meet graduate attributes and industry needs (Tertiary Education Quality and Standards Agency, 2012, 2013). Underpinning these principles and standards were findings that some students were underprepared with the literacy and language skills necessary for success in tertiary studies in Australia (Australian Universities Quality Agency, 2009; Tertiary Education Quality and Standards Agency, 2012, 2013). Since the AUQA report, questions have been raised in the literature about how education providers in the tertiary sector may identify and address the literacy and language needs of students (Harper, Prentice, & Wilson, 2011) and academics have raised ongoing concerns about the need to develop the literacy and language skills of university students, particulary those from diverse cultural backgrounds and students who speak English as an additional language (EAL) (Dunworth, 2009, 2010; Murray, 2010, 2011a, 2011b, 2012a, The student literacy and language strategies program, Good Practice Report 1

2 2012b, 2013). Simulatenuosly, in the nursing profession the Australian Health Practitioners Registration Authority (AHPRA) (2011) introduced increased standards for English language skills as a requirement for nurse registration (Nursing and Midwifery Board of Australia, 2011). In combination these regulatory standards have resulted in universities and nursing programs needing to examine the use of post-enrolment literacy and language skills screening of students, the provision of literacy and language support programs, and graduate outcomes for employability (Arkoudis, Baik, Bexley, & Doughney, 2014; Dunworth, 2010; Murray, 2012a, 2013). The School of Nursing and Midwifery at the University of Western Sydney (UWS) has embraced the cultural and linguistic diversity of the population in its region, and has admitted students through multiple entry pathways with the aim of meeting their literacy and language needs by implementing an embedded Student Literacy and Language Strategies (SLLS) program. This program was developed over a period of five years from 2010 with the goal of supporting both commencing and continuing nursing students, and preparing nursing graduates who would benefit the profession and population in the region. In particular, the School recognised that nursing students from disparate educational, cultural and linguistic backgrounds can experience a wide range of challenges in commencing and undertaking their studies, and that these most frequently included the development of the necessary literacy and language skills to undertake the program (Zheng, Everett, Glew, & Salamonson, 2014). The enrolment of students from diverse backgrounds was accompanied by the responsibility of ensuring that the students attained the highest possible levels of literacy and language skills during their studies. In a nursing program where only 15 percent of students entered through traditional secondary school pathways, providing literacy and language support through the SLLS program became part of the mainstream fabric of the School and aimed to offer sufficiently flexible support to students juggling multiple commitments to study, family and paid work. The highly diverse background of students in the School meant that many were first in family to attend university, and only just over half of the student cohort commencing each year used spoken English at home. The variety of pathways into the nursing program also contributed to disparities in preparedness for tertiary studies (Salamonson et al., 2011; Salamonson, Everett, Koch, Andrew, & Davidson, 2008; Salamonson, Koch, Weaver, Everett, & Jackson, 2009). The SLLS program responded to these needs in preparedness by providing a suite of embedded literacy and language support opportunities. There was a particular focus on students as they commenced with the aim of ensuring they achieved improvements in professional written and spoken communication, vital for confident, safe, and competent practice in clinical and academic contexts. The SLLS program also aimed to promote student gains in literacy and language skills, and to motivate students to achieve improved levels of proficiency in written and oral communication skills, essential to success in nursing studies, quality in patient care and best practice in the nursing profession. The SLLS program built the development of communication skills into the curriculum content through well-designed learning support materials and blended learning approaches. These evidence-based learning strategies aimed to assess and enhance literacy and language competencies by: The student literacy and language strategies program, Good Practice Report 2

3 Assessing commencing students using a post-enrolment English language assessment (PELA) writing task and English language acculturation scale (ELAS) Embedding literacy and English language support into core units Referring students requiring just in time literacy and communication support to Professional Communication Academic Literacy (PCAL) Staff who are experienced in teaching English as a second and other language (TESOL) and offer consultations and workshops in writing and speaking skills development Developing a Professional Communication Academic Literacy Skills resource workbook Referring students to Clinical Communication Workshops to improve literacy and oral language skills for nursing practicums Distinctiveness and recognition of the SLLS program The SLLS program was developed through collaboration between nursing and academic literacy academics who sustained a vibrant community of practice. The program has been distinctive in the sector in providing a suite of successful, embedded literacy and language support services to students from highly diverse, cultural, linguistic and educational backgrounds. The effectiveness of the program was enhanced by a commitment and clear sense of purpose of the PCAL Staff, appointed during the development phases of the program, and also by a cross-disciplinary teaching team of academics with nursing and literacy education backgrounds, who sustained a frequent communication schedule through cycles of development, delivery, evaluation, revision and dissemination. This team built the program through the exchange of disciplinary knowledge on nursing, and academic literacy and language pedagogies. The approaches used led to improvements in student uptake of the support and contributed to the overall focus of the School on the development of the academic literacy and language skills of students, their satisfaction in the program and increased retention. In 2012, the team became the recipients of the university s Vice Chancellor s Excellence in Teaching Award. A 2014 report from the Centre for the Study of Higher Education presented the UWS School of Nursing and Midwifery, student literacy strategies program as an example of practice in higher education used to effectively develop professional and academic skills using a whole-ofprogram approach (Arkoudis et al., 2014). This report provided an English language proficiency and employability framework for Australian higher education institutions. The report used the program to illustrate the embedding of literacy and language skills within a Bachelor of Nursing program to support students in developing their academic and professional communication capacities to meet the demands of their undergraduate studies and graduate requirements for the nursing profession. It outlined the components of the program such as the provision of clinical communication workshops and embedding of literacy and language support within core units (Arkoudis et al., 2014). Components of the SLLS program Given that a high level of literacy and language skills are required for success in nursing studies, clinical practicums, and for nurse registration and employment in health care settings, undergraduate nursing programs need to evaluate the preparedness of commencing students. As Australian universities do not generally conduct literacy and language testing for domestic The student literacy and language strategies program, Good Practice Report 3

4 students for admission, students from diverse cultural and linguistic backgrounds who commence nursing program may struggle to cope with the demands of these higher education studies (Salamonson et al., 2011). Therefore, the SLLS program utilised a holistic, multifaceted learning support approach to developing the academic literacy and language abilities of students through the provision of a range of support initiatives. This incorporated evidence based approaches to literacy and language support using integrated approaches and scaffolded learning to provide instruction through a variety of individual, workshop-based and online teaching strategies that engaged students throughout their undergraduate studies. Program coherence was achieved using a systematic approach that underpinned and coordinated the strands of the SLLS program, comprising collaborative curriculum development and teaching. Figure 1 illustrates the suite of support initiatives in the SLLS program and is followed by discussion of their implementation and outcomes. 2. Embedded Support in Core Units 1. PELA and ELAS Screening 3. PCAL Staff (TESOL) Student Literacy and Language Strategies Program 4. PCAL Skills Resource Book 5. Clinical Communication Workshops Figure 1 Overview of the Student Literacy and Language Strategies Program PELA and ELAS screening The SLLS program targeted the early identification of student literacy and language needs by developing, implementing and validating screening tools that have diagnostic efficacy and cost efficiency. At course commencement students completed a brief survey including a selfadministered 5-item English language acculturation scale (ELAS) (Salamonson, Attwood, Everett, Weaver, & Glew, 2013; Zheng et al., 2014) and a post-entry English language assessment (PELA) writing task (Barthel, 2009; Glew et al., 2014). Results from this screening were used to identify and provide support to students in developing their literacy and language skills for their nursing studies. With widening participation in tertiary studies, it has been recommended that post-entry language assessments be used to screen students who may be at risk of academic underperformance (Dunworth, 2009; Murray, 2010, 2011a). This recommendation has been considered by a number of universities, who have implemented various diagnostic tools for postentry literacy and language screening (Barthel, 2009; Office of Learning & Teaching, 2013). However, with many screening tools there can be considerable costs associated with their administration to identify students who are most at risk of academic underperformance due to a The student literacy and language strategies program, Good Practice Report 4

5 lack of adequate literacy and language skills. For this reason the PELA writing task in the SLLS program was developed for use with large cohorts of commencing students based on a concise writing skills criteria with three descriptor levels (Barthel, 2009; Glew et al., 2014; Hillege, Catterall, Beale, & Stewart, 2014a). This brief PELA involved a 20 minute assessment that focused on writing skills according to a language literacy criterion of Level 1 (proficient), Level 2 (borderline), and Level 3 (poor, and requiring additional support). Students screening with a PELA Level 2 writing task were identified as requiring some assistance with literacy and language skills in order to succeed in their studies, while students with a PELA Level 3 were identified as being at a high level of risk of academic underperformance due to their poor literacy and language skills, and as such were not likely to have adequate academic literacy and language skills for university studies (Glew et al., 2014). In the initial stages of the SLLS program students requiring support, based on the results of the PELA writing task, were allocated into specific tutorials (Hillege et al., 2014a). A study in 2010 by Hillege et al. (2014) on 747 commencing nursing students revealed that 147 students (19.7%) in this cohort were identified as requiring academic literacy support, indicated by a literacy screening PELA Level of 3. Of those identified as needing support, 107 of the students consented to engage in subject tutorials with an additional focus on academic literacy. Notably, these students achieved subject assessment results that were comparable to the students who commenced with a PELA Level 1 or 2. Moreover, they achieved significantly higher results (p =.007) in the essay for the subject than the other students (N = 40) identified as needing support that chose to attend conventional tutorials. This embedded support approach resulted in many of the students in the targeted tutorials successfully passing the core assessment tasks, despite having an initially poor PELA Level of 3. Regardless of the disparity in their initial writing capabilities, the results for students in the targeted tutorial groups at completion of the unit were found to be comparable to those of the overall student cohort. Moreover, the results of these PELA Level 3 students in their additional assessment tasks across another three nursing units indicated that the academic literacy and language skills they acquired were transferable (Hillege et al., 2014a). This was a key outcome, with students who received support being able to transfer their skills. They also recognised the value of SLLS program to the whole-of-program with one student stating: The information was so useful that we could apply what we learnt in essays in all the subjects. Also to mention the general confidence as it was our first time in university and we didn't know exactly what to do. However, after these sessions everything was just clear and university writing was made easy. (UG3 Student) Embedded support in core units The SLLS program was implemented in core undergraduate nursing units, commencing in 2010 with the Becoming a Nurse unit, and in the Professional Communication unit from By incorporating literacy and language support into a core nursing unit, students have had the opportunity to build their academic literacy and language capacities while discussing and evaluating important nursing concepts (Glew, 2013; Hillege et al., 2014a). The ongoing implementation of the program has made a marked difference in the student uptake of the SLLS The student literacy and language strategies program, Good Practice Report 5

6 program, and in their confidence in engaging in scholarly activities, clinical assessments involving oral communication, and professional nursing practicums. In 2011 the embedding of the SLLS program into the Becoming a Nurse unit incorporated information literacy and referencing workshops. Many commencing students were unfamiliar with basic concepts in relation to using academic sources, for instance, they were unable to distinguish a journal article from a book chapter reference, and they frequently cited nonscholarly websites as sources. In 2012 a series of five explanatory online resources were developed and embedded into the Professional Communication unit. The resources were found to be effective in supporting student learning about the use of citation and referencing, and students were able to discuss questions about these resources with the PCAL Staff. Notably the nursing students (n = 1089) in the unit accessed these resources on the unit website a total of 12,475 times, and there were observable improvements in the use of effective referencing in written assessment tasks. Self-directed learners have really found these exceptionally helpful and I believe they have given these students a head start. (PCAL Staff) The Professional Communication unit was identified in a national report on English language proficiency and employability frameworks as an exemplar of good practice in integrating the development of literacy and language skills into a disciplinary-based teaching and learning program (Arkoudis et al., 2014). The report identified key outcomes for this first year nursing unit in developing the written and oral skills of students in communication for professional and academic contexts, and in designing assessments using collaboration between nursing academics and literacy and language specialist staff to assess student skills for use in professional contexts (Arkoudis et al., 2014). PCAL Staff PCAL Staff were appointed by the School to provide focussed just in time support for students through individal consultations, and workshops as part of the SLLS program. This support was particularly targeted to students commencing in their first year of the nursing program. The PCAL Staff brought a wealth of practical expertise in scaffolding literacy and language development and in providing strategies that students used to attain success in their nursing studies. Students were supported on an individual and group basis, by either self-selecting this support, or through direct referral by academics and clinical facilitators. Since the commencement of the SLLS program, there has been a substantial increase in student uptake of the support services and in student engagement with the PCAL Staff. For instance, in 2010 there were only 350 student consultations with PCAL Staff recorded; however, this increased to 1841 student consultations in 2011, and by 2012 there were over 3400 student consultations with the PCAL Staff. During this period there was also an increase in the number of PCAL Staff appointed to support the students. With the growing demand for support in 2013, the SLLS program introduced several support workshops conducted by the PCAL Staff, resulting in continued uptake with an increase to 3611 student consultations that year. Most notably, by 2014 the impact of the SLLS program was marked by a total of 6811 nursing student The student literacy and language strategies program, Good Practice Report 6

7 consultations with the PCAL Staff. This total included individual consultations with students (n = 4112), and student attendance at the support workshops (n= 2769) conducted by PCAL Staff. The staff identified many positive impacts on students accessing the program with an evaluation by one being: Tailored support allows students to become self-motivated learners and increases their confidence and understanding of English grammar and academic writing (PCAL Staff) Student evaluation surveys of the program also found that students receiving academic literacy and language support expressed increased confidence in academic writing. The students reported experiencing increased confidence in their oral communication and interpersonal skills. Comments revealed that students gained an improved understanding of writing: I used to write the way I talked, but now I can write differently in a scholarly, academic manner. I understand that if I don't write simply and clearly, reading can be difficult for other people to understand. (UG1 Student) The collaborative, cross disciplinary nature of the teaching team was a distinctive and highly effective feature of the SLLS program. Nursing academics teaching in the Professional Communication unit, engaged with the PCAL Staff to support student literacy and language skills development through the unit. The first assessment in the unit involved a paraphrasing task conducted in the first weeks of the session. Feedback from this task equipped the students with the skills needed for the second task involving essay writing. The paraphrasing task was designed as a result of the AUQA (2009) Good Practice Principles and TEQSA (2012) standards which required that student literacy and language needs be diagnosed early in their studies and that a program provides ongoing opportunities to develop these skills using an integrated curriculum approach. The SLLS program supported by the PCAL Staff was instrumental in implementing a spiralled support approach to literacy and language throughout the first year curricula and into the second and final years of the nursing program. PCAL Skills resource book Another distinctive feature of the SLLS program was the Professional Communication Academic Literacy (PCAL) Skills resource book. This resource was designed as a workbook for the undergraduate nursing program, and made available in printed and electronic versions through the university bookstore and student online learning sites (UWS School of Nursing and Midwifery, 2014). The book included models of writing and activities to develop students skills to meet the expected standards of academic writing. This innovative workbook assisted students in acquiring written communication skills needed for academic and professional contexts. It allowed for self-paced developed of these skills and provided a common metalanguage for students and tutors to frame literacy and language usage. The resource book contributed to the scaffolding of academic literacy and language development as a whole-of-program approach. University staff reported considerable student update of the resource since 2010 with approximately 3000 paper copies sold through the bookstore, and up to 1000 students accessing this resource annually, as well as an uptake of the resource by students outside of the School of Nursing. The student literacy and language strategies program, Good Practice Report 7

8 Although much of the content has a nursing focus, the book can be used as a resource for any discipline, and it is particularly useful for mature aged students and those from non-english speaking backgrounds. (University Academic Relationship Coordinator) Clinical communication workshops Three-day Clinical Communication Workshops were offered four times a year commencing in 2010, providing students with opportunities to develop skills that assisted them to communicate effectively with colleagues and academic staff on campus, and patients and clinicians during nursing practicums (Hillege, Glew, Beale, & Stewart, 2014b). On average each of these workshops were attended by 20 students with participation being voluntary for any students who self-selected to attend. The workshops were also conducted for students who were identified as being at risk due to experiencing difficulties with oral and written communication whilst on clinical placement. Although workshop attendance was compulsory for those students referred by clinical facilitators and clinicians, the student feedback such as the following comment was indicative of this literacy and language focused learning experience. The workshop in my opinion was a wonderful opportunity I m pleased to announce it was a great success, and look forward to many more workshops like this in the future to enhance my learning and skill development. (UG Student) The activities in the Clinical Communcation Workshop incorporated the skills of listening, speaking, reading and writing. Examples of content included the use of medical terminology and of common nursing abbreviations, telephone skills, report writing, interviewing skills, managing handovers and documenting information (Hillege et al., 2014b). These tasks engaged a communicative and interactive approach through role plays, games, quizzes, pair and small group work, and peer conferencing and appraisal. In reflection on these learning activties in the workshops students offered a range of comments, for instance: Excellent; They are awesome ; Very satisfied. I m so glad I joined the workshop ; This will also help me in future career paths thanks to the communication skills taught. I commend the staff for a great effort. ( UG Students). Feedback from clinical placement summaries also indicated that students who attended the clinical communication workshops showed improved communcation competence during their following clinical practicums (Hillege et al., 2014b). For instance, one clinical facilitator reported on a student s progress pre and post attendance at Clinical Communication Workshops: Pre: Unable to maintain effective communication with ward staff and patients ; Post: Developed confidence in skills and knowledge able to give a thorough handover of her patients (Clinical Facilitator 2) Additional speaking workshops were also implemented that aimed to improve student confidence when speaking in groups, increase their comprehension during oral communcation, and enhance collegial relationships (Glew, 2013). The importance of conversational confidence is vital in academic and health care contexts. Nurse educators need to make many professional The student literacy and language strategies program, Good Practice Report 8

9 judgements about the clinical competence of students involving their use of nursing skills combined with effective nursing communciation (San Miguel & Rogan, 2009; San Miguel, Rogan, Kilstoff, & Brown, 2006). The PCAL Staff and nursing academics worked collaboratively in the workshops to develop the oral communication skills of the students using topics focused on interactions for social and nursing contexts. These workshops were found to enhance the communication skills of the students by building their capacities to engage confidently, safely and competently with others (Hillege et al., 2014b). Influence and impact of the program Implementation of the SLLS program has contributed to enhancing the learning experience of students during their transition into university studies in nursing, and has had a positive impact on improving the retention of students in the nursing program. The Dean of the School, Professor Griffiths (R. Griffiths, personal communication, October 14, 2014) commended the SLLS program for the significance that nursing students and academic staff place on this support in the School, and gave credit to the program in contributing to an increase in 2013 in the rate of student retention. As a model of good practice, the SLLS program has incorporated processes for the development, implementation and evaluation of a program integrating key aspects of the Good Practice Principles (Australian Universities Quality Agency, 2009), particularly through the embedding of literacy and language skills development into core units in the curriculum. The program has incorporated quality assessment standards for English language proficiency (Tertiary Education Quality and Standards Agency, 2013) by identifying students requiring support during their transition to university, developing the literacy and language skills of students during their studies, and seeking feedback from students on the support. The uptake of the SLLS program has promoted skills that foster student confidence and competence in oral and written communication for academic studies and clinical contexts, and has effectively assisted students in developing skills vital for success in nursing studies and for professional contexts. The university has supported the embedding of the SLLS program in the School as an ongoing model of practice for student support, and has approved internal research grant project funding in Implementation of the program will involve substantial funding in 2015 with the appointment of permanent PCAL Staff in the School, the mainstream timetabling of PCAL support workshops, the integration of literacy and language screening as a standard assessment process for all students commencing in the core nursing unit of Professional Communication, and university website development that will provide all students with SLLS program information and online access to a redesigned online version of the Professional Communication Academic Literacy Skills resource book. The student literacy and language strategies program, Good Practice Report 9

10 References Arkoudis, S., Baik, C., Bexley, E., & Doughney, L. (2014). English language proficiency and employability framework: For Australia higher education institutions. Retrieved 19 January, 2015, from _Final_Report_ pdf Australian Health Practitioner Regulation Agency. (2011). New English language skills registration standard from 19 September Retrieved September 20, 2011, from Standard.aspx Australian Universities Quality Agency. (2009). Good practice principles for English language proficiency for international students in Australian universities. July 1, 2013, from y%20card/final_report-good_practice_principles.aspx Barthel, A. (2009). Post-enrolment language assessment: A cross institutional project. Paper presented at the Association for Academic Language and Learning Ninth Biennial Conference, Brisbane, Australia. Retrieved from Dunworth, K. (2009). An investigation into post-entry English language assessment in Australian universities. Journal of Academic Language and Learning, 3(1), A1-A13. Dunworth, K. (2010). Clothing the emperor: Addressing the issue of English language proficiecny in Australian universities. Australian Universities Review, 52(2), Glew, P. J. (2013). Embedding international benchmarks of proficiency in English in undergraduate nursing programmes: Challenges and strategies in equipping culturally and linguistically diverse students with English as an additional language for nursing in Australia. Collegian, 20(2), doi: /j.colegn Glew, P. J., Hillege, S. P., Salamonson, Y., Dixon, K., Good, A., & Lombardo, L. (2014). Predictive validity of the post-enrolment English language assessment tool for commencing undergraduate nursing students: Manuscript submitted for publication. Harper, R., Prentice, S., & Wilson, K. (2011). English Language Perplexity: articulating the tensions in the AUQA Good Practice Principles. The International Journal of the First Year in Higher Education, 2(1). doi: /intjfyhe.v2i1.51 Hillege, S. P., Catterall, J., Beale, B. L., & Stewart, L. (2014a). Discipline matters: Embedding academic literacies into an undergraduate nursing program. Nurse Education in Practice, 14(6), doi: org/ /j.nepr Hillege, S. P., Glew, P. J., Beale, B. L., & Stewart, L. (2014b). Collaboration: The key to facilitating effective communication skills for clinical practice in nursing students with English as an additional language: Manuscript submitted for publication. Murray, N. (2010). Considerations in the Post-Enrolment Assessment of English language proficiency: Reflections from the Australian context. Language Assessment Quarterly, 7(4), doi: / Murray, N. (2011a). University post-enrolment English language assessment: a consideration of the issues. The Journal of the Education Research Group of Adelaide, 2(1), Murray, N. (2011b). Widening participation and English language proficiency: a convergence with implications for assessment practices in higher education. Studies in Higher Education, 38(2), doi: / The student literacy and language strategies program, Good Practice Report 10

11 Murray, N. (2012a). A report on a pilot English language intervention model for undergraduate trainee nurses. Journal of Academic Language & Learning, 6(1). Murray, N. (2012b). Ten Good Practice Principles ten key questions: Considerations in addressing the English language needs of higher education students. Higher Education Research & Development, 31(2), doi: / Murray, N. (2013). Widening participation and English language proficiency: a convergence with implications for assessment practices in higher education. Studies in Higher Education, 38(2), doi: / Nursing and Midwifery Board of Australia. (2011). English language skills registration standard. Retrieved from Standards.aspx. Office of Learning & Teaching. (2013). Degrees of proficiency: building a strategic approach to university students' English language assessment and development., 18 January, 2015, from Salamonson, Y., Andrew, S., Clauson, J., Cleary, M., Jackson, D., & Jacobs, S. (2011). Linguistic diversity as sociodemographic predictor of nursing program progression and completion. Contemporary Nurse, 38(1-2), Salamonson, Y., Attwood, N., Everett, B., Weaver, R., & Glew, P. (2013). Psychometric testing of the English language acculturation scale in first year nursing students. Journal of Advanced Nursing, 69(10), doi: DOI: /jan Salamonson, Y., Everett, B., Koch, J., Andrew, S., & Davidson, P. M. (2008). English-language acculturation predicts academic performance in nursing students who speak English as a second language. Research in Nursing & Health, 31(1), Salamonson, Y., Koch, J., Weaver, R., Everett, B., & Jackson, D. (2009). Embedded academic writing support for nursing students with English as a second language. Journal of Advanced Nursing, 66(2), San Miguel, C., & Rogan, F. (2009). A good beginning: The long-term effects of a clinical communication program. Contemporary Nurse, 33(2), San Miguel, C., Rogan, F., Kilstoff, K., & Brown, D. (2006). Clinically speaking: A communication skills program for students from non-english speaking backgrounds. Nurse Education in Practice, 6(5), Tertiary Education Quality and Standards Agency. (2012). Higher education standards framework. Retrieved June 25, 2013, from Tertiary Education Quality and Standards Agency. (2013). Quality assessment: English language proficiency. Retrieved July 1, 2013, from UWS School of Nursing and Midwifery. (2014). Professional communication: Academic literacy resource book for nursing and midwifery. Richmond, NSW, Australia: University of Western Sydney. Zheng, R. X., Everett, B., Glew, P., & Salamonson, Y. (2014). Unravelling the differences in attrition and academic performance of international and domestic nursing students with English as an additional language. Nurse Education Today, 34(12), doi: The student literacy and language strategies program, Good Practice Report 11