A. Design of the study This mixed methods study involved first, focus group researches with junior nursing students, EOP instructors and professors of nursing in Chinese university for assessing the nursing English learning needs. After needs analysis, problem-situated instruction for nursing English was designed to meet the needs for the intervention group students whereas the control group students were taught by current standard EOP teaching-analyzing sentences from the grammatical point of view, comparing the usage of some words and expressions, and then translating them sentence by sentence into Chinese. Examination papers were used for evaluating students’ nursing English abilities and their mastery degree of the textbook. Chinese questionnaire designed by Jiang XB  was used to evaluate students’ attitudes for teaching quality. ·
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B. Participants 36 students volunteered for the control group, and 32 students volunteered for the intervention group. Ages ranged from 20 to 22 years old. The students’ native language was Chinese. No statistically significant link was found between two groups in scores of college English program (College students in China generally undertake a 2-year English language program as a mandatory course.), CET (College English Test) Band 4 and general oral English test (p>0.05) (Table I). EOP educators are all majored in nursing who have good master of English with the EOP teaching qualifications accredited from the university. Students were assured their grades would not be influenced by a decision regarding participation, group assignment, or performance in the activity. Written consent was obtained.
C. Needs analysis-Focus group researches At the beginning of the study, focus group researches were conducted in a total of 336 junior nursing students, 8 professors of nursing as well as 6 EOP instructors from Chinese nursing college. A list of questions was prepared regarding such issues as the nursing English learning needs of the students, the nursing English skills which the respondents thought the students needed to develop, the difficulties which they experienced in English learning, as well as the respondents’ attitudes towards teaching methodology, content and numbers of students in English course. The main aim of conducting focus group researches was to personally elicit information regarding the interviewees’ perception of nursing English learning needs, which helped to design the teaching instruction. One of the researchers conducted and tape-recorded focus group researches with junior nursing students, EOP instructors and professors of nursing. The responses provided by the interviewees were recorded and then transcribed by the researcher. Quantitative and qualitative analyses of the responses of students and the instructors showed that they were quite similar, although the instructors provided more details than did the students. As relates to professional English language skills, both students and instructors reported that it’s essential to learn nursing English well, but students’ English language 187 ability was insufficient to meet the challenge of the job market and English texts they were expected to read in their specialized courses. Most of the instructors were particularly dissatisfied with the low reading and listening abilities of the former students and indicated that they have no other alternative but to translate specialized English texts in order to put the message across to the students. Regarding students’ speaking ability, instructors and students alike reported that it’s the most difficult language ability and the students lack the experience or confidence to speak; they need to improve their speaking skills for group discussion and presentations. Nursing experts felt that students should learn how to write case reports and improve their writing and speaking skills so that they could communicate more effectively with foreign patients and foreign experts in nursing. Students reported that they prefer EOP instructors with both English talents and nursing backgrounds and they should be conducted in the language laboratory or simulating wards in order to help them improve their speaking and listening skills. They were of the opinion that the four skills of speaking, listening, reading, and writing should be integrated in the English course content. Some of the EOP instructors suggested that teachers should assign relevant topics or questions related to the teaching material for oral presentations. All the respondents believed in the necessity of changing their nursing English education. The nursing English course should provide students with specialized English language experiences. For example, students should be provided with opportunities to speak in clinical situations, to participate in group discussions, and to give professional presentations etc ..
D. Intervention In the current curriculum, medical terminology teaching, nursing related article translation and diseases introduction in English are emphasized in the classroom. With the same school teaching program for nursing English, the control group received the current standard EOP teaching in the classroom. Whereas, the intervention group received problem-situated instruction designed by the research group after needs analysis in the language laboratory. Based on the textbook, EOP instructors designed or abstracted questions related to the topic. The questions were related to case reports, nursing skills, nursing handovers, health education and nurses’ ward rounds etc .. Through the questions, we demonstrated a clinical situation and problem for students, while students were dealing with the questions, they were supposed to do the preparation before class, read the textbook quickly to find the related information in class when they saw the questions, analyze the reading, make the notes to summarize and interpret their answers and reasons in the group discussion. In discussion, students experienced the nurse’s roles to report the clinical case information, to use professional words, to communicate with colleagues and clients in English. We used LINDGE computer software  from Shanghai LINDGE software ltd. in nursing English teaching in the language laboratory. The oral English model of the software helped the instructors to divide the intervention group students into smaller groups of 5 to 6 students for discussion. Teaching and classroom management such as courseware playing, media playing, questioning students and answering students’ questions were all done through the interface of the LINDGE software. A two-class-period of 80 minutes was connected by four questions. Usually, 4 minutes were given to students to read, organize and write their answers and about 8 minutes were given for group discussions for each question, left minutes were distributed for teachers to explain the correct answers and key points of the text material behind each discussion.
E. Instruments Two instruments were used in this study: (1) tests and (2) questionnaire. Test l(Table 2) was designed for evaluating students’ nursing English language skills and vocabulary development at the end of the semester through a variety of tasks. The paper was designed by the blinded faculty, an experienced EOP educator. Once the first draft of the examination paper was prepared, 8 experts were gathered to regulate question types and content in the examination paper two times for testing students’ nursing English using abilities more adaptively. English speaking part in this examination paper was measured by one foreign teacher, majored in nursing, 188 whose native language is English, and the other parts were examined by a blinded faculty through computer. Test 2 was drawn out from the examination bank which was designed based on education program of the textbook. In order to establish the reliability of the tests, Cronbach a coefficient was estimated and identified as 0.838 for test 1 and 0.797for test 2 aggregated for both groups, figures which are regarded acceptable and satisfactory as in general, acceptable reliability indexes range from 0.70 and above. Validity of the test 1 was 0.91and 0.95 for test 2, which is regarded satisfactory . The second instrument is the Chinese questionnaire (appendix which was translated into English) for students’ evaluation of teaching quality. It comprised 27 items for exploring the perspectives of junior nursing students’ attitudes towards teaching goals, attitudes, content, methodology and effects. Students were asked to express their opinions about each statement by marking the options on a five-point Likert scale ranging from 5 (very much agree) to 1 (very much disagree) in the Chinese questionnaire.
F. Data collection and analysis Date for the study were collected over the whole semester, from Aug. 201Ito Jan.2012. All data were analyzed using statistical package for the social sciences (SPSS), version 17.0 for Windows; t test was used in the evaluation of data; statistical significance was considered to apply when p <0.05. >