Advances in Social Science, Education and Humanities Research, volume 326

3rd International Conference on Current Issues in Education (ICCIE 2018)

Developing English Speaking Materials for

Nursing Students
Unun Fadliah Sugirin
Graduate School Graduate School
Yogyakarta State University Yogyakarta State University
Yogyakarta, Indonesia Yogyakarta, Indonesia
[Link]@[Link] sugirin@[Link]

Abstract—Good quality students’ learning outcomes By looking at such situations in Indonesia, the
are dependent on good teaching materials. Good government has to stimulate the nurses to work
teaching materials are those developed based on an abroad. Reference [1] reports that there are some
appropriate needs analysis. In this era of globalization, countries that offer opportunities to Indonesian nurses
nurses must be skillful not only in nursing, but also in
communicating in English with non-Indonesian patients.
since 1996 such as the USA, Saudi Arabia, the United
Therefore, one of the goals of nursing education is the Arab Emirate (UAE), Kuwait, the Netherlands, Great
mastery of spoken English. Related to this issue, the Britannia, Brunei, and other Middle East countries.
research reported in this paper aims to develop the All those countries have specific criteria and
appropriate speaking materials for the second semester requirement for the job. The government also has a
students of nursing program based on their needs. This program to enrich the knowledge and skill of the
is a research and development study conducted at a nurses through the Indonesia-Japan Partnership
nursing school in Yogyakarta. The development of the Economic Program (IJEPA). This is international
materials went through seven steps: conducting needs recruitment where the nurses who are accepted to this
analysis, designing the course grid, developing the first
draft of the textbook, getting the expert judgment,
program are able to work in hospitals and clinics in
revising the product, implementing the product, and Japan for a certain time. However, this program is not
evaluating the product. The data were obtained from appealing to many nurses for only a few nurses apply
questionnaires and interview. The questionnaires were for it. The language problem is one of the obstacles
analyzed using quantitative data analysis, while the [1].
interview data were analyzed using qualitative data
analysis. The research findings reveal the real needs of In addition to those programs, Indonesia has
nursing students, the teacher’s viewpoints on the been in the ASEAN Economic Community (AEC)
practice of instructions, and the descriptions of English since the end of 2015, opening other opportunities to
for nurses used in their field of work. the nurses to work in ASEAN countries. However,
they should prepare themselves to face the
Keywords—english for nursing, speaking, speaking requirements of the host countries in terms of
material development. standard competencies, educational background,
culture, and communication competencies. They have
to pass the Medical Licensing Examination (MLE) of
I. INTRODUCTION the host country in which the majority of the ASEAN
countries uses English for the exam. Otherwise,
The rapid growth of population from the graduates
foreign nurses who want to work in Indonesia also
of nursing schools in Indonesia makes the
have to fulfill the criteria that have been determined
government come at two facets: the surplus and
by the government. This policy is beneficial to
shortage of nurses. Reference [1] mentions:
increase the domestic nurses’ competencies.
“The total prediction of nurse production was
Reference [2] states that foreign nurses who will work
approximately 30,000 per year in 2015 … The
in Indonesia have to follow the MLE in Bahasa
Government of Indonesia is only able to provide
Indonesia. However, the obligation of mastering
formation and budget allocation for a maximum of
Bahasa Indonesia is revised by the government due to
3,000 nurses yearly. … It is predicted that private
the President policy that is enacted to attract investors
health sectors can only absorb approximately 2,500-
to Indonesia. The policy allows foreign workers to
3,000 new nurses yearly. Therefore, only 1/3 of the
work in Indonesia without having to master Bahasa
total production of new nurses in Indonesia can be
Indonesia [3].
recruited properly. Placement of the remaining 2/3
(15,000) of the total nurse production is still Previously in 2012, to welcome the AEC era the
uncertain”. government has initiated to shape a working team to
boost medical tourism in Indonesia called Indonesian
Wellness and Healthcare Tourism (IWHT). This team

Copyright © 2019, the Authors. Published by Atlantis Press.

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Advances in Social Science, Education and Humanities Research, volume 326

is working to promote Indonesia Healthcare through Furthermore, reference [7] found that about 70%
culture and tourism. Some preparations were made to of the students of nursing needed to improve their
support this program, such as those in infrastructure speaking skills. Considering these facts, the
and human resource sectors [4]. researcher assumed that both the students and
lecturers of English in nursing schools needed to have
Based on the data, the importance of English
teaching materials for speaking that accommodate
as the most needed language in the workplace cannot
their needs appropriately.
be denied. English will not only be needed to work in
foreign country, for in fact it is also needed to II. LITERATURE REVIEW
communicate with domestic co-workers, colleagues,
The high demand for English in the world of work
and patients in the future.
is the basis for the development of English for
Nursing schools as the institutions that Specific Purposes (ESP). It is a branch of English
produce professional nurses take an important role in Language Teaching (ELT) that focuses on the
enhancing the nurses’ competencies, including purpose of learning the language rather than the
language competencies. A nursing school is one type nature of the language. Many experts have defined
of higher education institutions. Reference [5] ESP. Reference [8] emphasizes that ESP is an
mentions that nursing education includes vocational, approach rather than a product. The content of the
academic, and professional education. Vocational teaching depends on the learners’ reason for learning.
education is directed primarily at the readiness and Reference [9] attempt to extend a series of
mastery of certain nursing skills as a nurse. Academic characteristics, absolute and variable, to resolve
education is focused on the acquisition and arguments about what ESP is. The absolute
development of nursing disciplines that include characteristics of ESP are to meet specific needs of
undergraduate, master’s, and doctorate degree. the learners, the methodology, activities, and the
Professional education is geared to achieve nurses’ language appropriateness used in the learning process
professional competencies. suitable with the purpose of learning and the
discipline it serves, while the variable ones
As one type of vocational education
characterize ESP for specific discipline to be taught to
institutions that prepares the graduate to be ready to
adult or secondary level learners in which the
work in the real work place, nursing schools should
methodology of teaching may differ from general
prepare everything needed through their curriculum.
English or English for children.
The curriculum should accommodate the industry
demands such as the mastery of technology and Moreover, Reference [10] mentions that “ESP
information, leadership, and communication skill. course is narrower in focuses than English Language
Regarding the communication skill, the nursing Teaching course”. It can be concluded that ESP is an
institutions accommodate it by presenting English in a approach in language teaching that deals with learners
course lecture. who have particular needs in learning the language.
The content of material that will be taught has to be
The English teacher also used general English
suitable with the context and social culture that will
material to teach the students. The students were
be faced later by the learners. The development of
taught more deeply in technology than in medical
needs of the English language in the world of
settings. As a consequence, the materials did not give
professional work supports the birth of ESP including
adequate understanding to the students because the
English for Nursing. Various need analyses have been
materials were not directly related to their major.
conducted to identify the need for English in Nursing.
Moreover, the skills emphasized in the learning Reference [11] states “These needs analyses have
and teaching process were more focused on reading identified various issues that create challenges for
than speaking. It made the students do not have English Second Language (ESL) nursing students:
sufficient time to practice and improve their speaking personal, academic, discipline-specific, cultural, and
skills. Meanwhile, language as a tool for language”. Other needs analyses have sought to
communication also takes an important role. identify the language and communicative skills and
Reference [6] proposes: tasks of nursing as a profession [11]. Communication
“The result of needs analysis shows that one of the practice of nursing emerges constantly between the
requirements to get a job in international hospitals for nurse and the patient, the patient’s family, the nurse’s
graduates of nursing schools is the ability to co-workers, supervisors, and many others.
communicate orally in English. However, most Communication in this profession can be a
nursing schools teach reading rather than speaking. complicated process, and the possibility of sending or
Besides, the existing English textbooks in the market receiving incorrect complex messages frequently
for nursing students focus on the reading skill. The exists. Reference [12] states that “a language
available speaking materials by Oxford University belonging to a particular group which identifies and
Press intended for native English students are not defines membership promotes power and authority
appropriate for Indonesian students. The language is through communication and as such exclude others
too difficult for the students of nursing schools”. from certain forms of knowledge”. Thus as nurses,

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Advances in Social Science, Education and Humanities Research, volume 326

learners have to know the particular terms commonly material

used in the clinical setting that they always experience Students’ To find out students’ role in the
Role learning process
in order to avoid misunderstanding in communication. Teachers’ To find out the teachers’ role in the
Related to the ESP significance, this research Role learning process
employed Content-Based Instruction (CBI). The
reason to use this approach in language teaching was III. METHODOLOGY
because this approach was more concentrated in the
content of the material that suitable with the learners’ A. The Participants
context in ESP. It will make the learning process be This study involved 100 students who were
focused on the topics that have been arranged based selected using random sampling technique, 2 nurses
on the learners’ purpose in learning the language. with experience of working abroad or with foreigners,
According to [13] CBI is an approach in which and 1 English lecturer.
teachers use a topic to elevate learners’ knowledge
rather than grammar rules or vocabulary lists. B. The Data
Moreover, reference [14] states that “Content-based In this study, there were two data collection
Instruction (CBI) refers to an approach to language instruments. They were interview guidelines and
teaching in which teaching is organized around the questionnaire guideline. The interview was conducted
content or information that students will acquire to the English teacher during the needs analysis.
rather than around linguistics features”. Moreover, there were three types of questionnaires
used in this research. The first questionnaire was in
Learning materials should be developed accurately the form of close-ended questions, given to the
in order the materials can be used to aid in the students to get information related to their needs,
classroom activities both for teachers and learners. learning needs, and background. The second
Reference [15] mentions that good materials should questionnaire was presented in close- and open-ended
motivate learners so that they can achieve their goals, questions and was given to nurses who have worked
be relevant and useful for their life, give chances to with foreigners by using English as the media for
use the target language by considering the language communication. It was aimed to gather much
features of the language, accommodate different information from the real work situation.
learning styles, and provide feedback.
IV. RESULTS AND DISCUSSION
Therefore, the materials should be an aid that
helps learners to learn the language. Materials have to A. Results from the Questionnaires
provide a chance to improve skills in the target
language. Motivation can also emerge through good 1). Target needs
materials so that the learners have a spirit to practice Target needs are what the learners need to do in
the language and get experience from it. In line with the target situation. Target needs are closely related to
those criteria, reference [8] state some ideas related to some terms such as necessities, lacks, and wants. The
good materials: (a) good materials stimulate the researcher concluded that the English learning
learners to learn; (b) good materials cover some topics materials for the nursing students should embrace
that attract learners’ attention, and thus both teachers how they were prepared to communicate with the
and learners can maximize their thinking capacity to patients, family, doctors, and other fellow nurses in
solve the problems; and (c) good materials should nursing process activities (Table 2). Then, related to
provide scaffolding unit which will lead the learners the lack of the nursing students, it can be concluded
into various activities to gain maximum knowledge. that the nursing students still had low ability in all
situations and aspects of speaking skill especially in
Needs analysis in this study is carried out based on grammar, fluency, and vocabulary aspect (Table 3).
the model proposed by reference [8] as follows: Moreover, related to the result of Table 3, all nursing
students wanted to improve all aspects of their
TABLE I. NEEDS ANALYSIS
speaking skills. They realized that they still lacked
Category Aspect The Purpose of The Questionnaire ability in speaking (Table 4).
Target Necessities To find out the needs of students in
Needs the target situation in the future
Lacks To find out the gap between what the
students have known and what they TABLE II. NECESSITIES
should master
Wants To find out the students’ needs that In relation to your profession as a nurse, what is %
need to be inserted in the materials your purpose in learning to speak English?
Learning Input To find out the suitable input for a. I want to use English in nursing assessment 57
Needs English speaking materials that related to health data collection by
students really want interviewing the patient or patient's family.
Procedures To find out the suitable procedures b. I want to use English in the nursing 53
that the students want the most assessment to communicate patient data to
Setting To find out the class management to the doctors and fellow nurses.
do the task of the English-speaking c. I want to use English to respond to patients’ 45

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questions about their health problems based TABLE III. LACKS

on the results of nursing assessment.
How good is your speaking skill %
d. I want to use English to provide information 43
in English in the situation
to the patient about the consequences that No. SB B C K
below
will arise if they do not do treatment to
a. Doing an interview with the 0 0 5 95
health problems.
patients about his/her health
e. I want to use English to communicate with 60
history
the patient when the treatment process is
b. Doing an interview with the 0 0 3 97
performed.
patients’ family about patient
f. I want to use English in conveying the 25
health history
patient's condition to the doctor and the
c. Clarifying the treatment process 0 0 0 10
patient itself after the treatment process is
to the patient 0
done.
d. Describing the patient’s health 0 0 6 94
g. Others 0
progress to the doctor
What speaking material do you learn this %
e. Describing the patient’s health 0 0 5 95
semester?
progress to the patient
him/herself and the family
a. Requesting and providing information 45
f. Explaining to the patient about 0 0 1 85
related to the treatment process.
the treatment process that will be 5
b. Responding to the patients in the treatment 10
done
process
g. Explaining to the patient 0 0 1 85
c. Giving opinions to doctors and patients in 30
everything about the treatment 5
the nursing process
process
d. Giving advice to the patients during the
h. Giving instructions to patients 0 0 1 83
treatment process
when the treatment process is 7
e. Providing an overview of the patients’ 40
performed
condition to the doctor and other nurses
i. Conveying patient’s complaints 0 0 4 96
f. Providing an explanation of the treatment 23
to the doctor
process procedure
j. Giving opinions to the doctor 0 0 0 10
g. Giving instructions to patients in the 0 related to the treatments process 0
treatment process k. Engaging in conversation with 0 0 2 80
h. Others (self-introduction) 36 the patient while providing 0
services in the treatment process
As a nurse, what kind of skill you have to %
master in relation to your daily task in the l. Giving advice to the patients on 0 0 2 80
work place? their complaints during the 0
treatment process
a. I am able to use an appropriate language 35
when giving a report about the progress of m. Others (mentioned)
the patient's condition to the doctor. Choose your difficulty in speaking English %
b. I am able to use an appropriate language 37 a. Difficulty in speaking with proper intonation 75
when giving a report on the progress of the b. Difficulty in speaking with proper pronunciation 75
patient's condition to the patient family. c. Difficulty in fluency 95
c. I am able to use an appropriate language 37 d. Difficulty in speaking by using the right 96
when explaining the purpose of doing the grammar
nursing process to the patient. e. Lack of vocabulary 95
d. I am able to use an appropriate language 40 f. Others (mentioned)
when explaining the purpose of doing the
treatment process to the patient.
e. I am able to use an appropriate language 66
when giving orders to patients when the TABLE IV. STUDENTS’ WANTS
treatment process is done
In a speaking class, what elements do you want to %
f. Others (mentioned)
improve?
a. Speaking with proper intonation 100
In speaking class, what is your priority to be %
learned? b. Speaking with pronunciation 100
a. How to communicate directly with the 70 c. Speaking fluently 100
patients/family of the patients related to the d. Speaking by using the right grammar 100
process of identifying health problems e. Speaking with the proper vocabulary selection 100
experienced by the patient. f. Others (mentioned)
b. How to provide information about the 40
disease indications experienced by the
patient. 2). Learning needs
c. How to explain to patients about plans that 30
can be done to help in overcoming the
Learning needs can be defined as what the
problem of diagnostic disease. learners need to do in order to learn. In investigating
d. How to give orders to the patients when the 60 the learning needs, the researcher used five aspects in
treatment process takes place. the questionnaire. The aspects related to the learning
e. How to ask patients about his/her health 40 needs were learners’ role, teachers’ role, input,
progress after the treatment process.
f. Others (mentioned) procedures, and setting. Most of the students wanted
playing a role in practicing the treatment process and
they wanted to imitate and practice the proper
pronunciation. The researcher understood that the
students wanted to be actively involved in the

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Advances in Social Science, Education and Humanities Research, volume 326

classroom process (Table 5). Moreover, students TABLE VII. PROCEDURE

wanted the teacher to be the facilitator in the learning Choose the activities that you expect to be %
process by providing a topic that would be learned learned in the class.
and practiced in the learning process (Table 6). To a. Dialogue 95
b. Role plays 53
make the students easy to understand the input
c. Explaining pictures 53
materials, the majority of the students wanted the d. Sorting a random image of a process in 45
material to be presented in the form of video and nursing activities
audio, dialogue and monologue, and also vocabulary e. Discussion about the nursing process 55
list that helped them in the learning process (Table 7). f. Describing the patient's health condition 78
based on the example documentation in
Furthermore, most of the students wanted to practice front of the class
a dialogue as the learning activities. Then, the g. Explaining the procedure of a treatment 55
materials provided opportunities to them to practice process that exists in a text
the dialogue (Table 8). In the setting aspect, the h. Practicing with a peer to use the phrases 65
majority of the students preferred to work in groups commonly used by nurses and patients in
the treatment process
and in pairs when learning speaking. Thus, the h. Others (mentioned)
activities in the classroom had to give them chances
to work in pairs or in groups (Table 9).

TABLE VIII. SETTINGS

TABLE V. TEACHER’S ROLE Choose the ways that you want in carrying %
out the learning activities.
In a speaking class, what do you expect your % a. Doing the tasks individually 47
English teacher do in order to help you enhance b. Doing the tasks in groups 80
your speaking skill? c. Doing the tasks in pairs 85
a. Prepare the topic of dialogue in accordance 95 d. Others (mentioned)
with the material in the treatment process.
b. Prepare the topic of dialogue that matches 90
the material in the treatment process. B. Results from the Interview
c. Prepare the role play script related to the 47
nursing process. This is the result of teacher interview can be
d. Others (mentioned) concluded that speaking skill was the main goal to be
mastered in this semester. Students must have an
improvement in this skill. The teacher also made a
clear that the students of nursing in the place of this
TABLE VI. INPUT
study still had the very low ability in English,
Choose what kind of input do you want in % especially in speaking skill so that in that semester the
practicing your speaking. teacher wanted to improve the students basic English
a. A monologue text about a patient's 70
condition report in a documentary form though it was still in the content of nursing based on
b. A monologue text concerning the 56 their major. While the result of the interview with the
explanation and procedure of treatment nurses who ever worked with foreigners revealed that
procedure the majority of nurses served foreigners and did
c. A dialogue containing the phrases used 45
in question and answer between nurses
conversation related to general nursing care, advice,
and patients in the treatment process. and medical procedures.
d. The monologue text is presented in the 50
form of a video. C. Developing Speaking Material for Nursing
e. The dialogue text is presented in the 63 Students
form of audio. After getting information from the questionnaire
f. Monologue / dialogue by using images 35
g. Vocabulary list 76
and interviews, the next step was to design learning
h. Others (mentioned) materials. In developing the speaking materials, the
researcher followed the steps as figured out (Fig.1).
The developing procedure of these speaking materials
has been verified by experts to meet the requirements
of validity and reliability of the findings. All the steps
in the design were adapted to find the real needs
analysis obtained from both the questionnaire and
interview.

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[4] The Jakarta Post. Tourism and health ministries to develop

medical tourism in Indonesia Available
from:[Link]
[5] Republik Indonesia. Undang – Undang RI Nomor 20,
Tahun 2003, tentang Sistem Pendidikan Nasional. 2003.
[6] Sismiati, & Mohammad, Adnan, L. Developing
instructional materials on English oral communication for
nursing schools. TEFLIN Journal, 1:23, 2012, pp.44 -58
[7] Saragih, E. Designing ESP materials for nursing students
based on needs analysis. International Journal of Linguistic,
6, 2014, pp. 1-12.
[8] Hutchinshon, T. & Waters, A. English for specific
purposes: a learning- centered approach. Cambridge:
Cambridge University Press. 1987.
[9] Dudley-Evan, T. & St. John, M. J. Developments in
English for specific purposes: a multi-disciplinary
[Link]: Cambridge University Press.
1997.
[10] Basturkmen, H. Ideas and options in English for specific
purposes. New Jersey: Palgrave MacMillan. 2006.
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Applied Linguistics. 2013.
[12] Allen, S. The importance of language for nursing: does it
convey commonality of meaning and is it important to do so?
Australian Journal of Advance Nursing, 2007, pp. 24, 47 –
51.
[13] Short, D. Assessing integrated language content
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[14] Richards, J., C. & Rodgers, T., S. Approches and methods in
language teaching. New York: Cambridge University Press.
2006.
[15] Tomlinson, B. Materials development in language
teaching. Cambridge: Cambridge University Press. 1998.

Fig. 1. Steps of Developing Materials

V. CONCLUSION
The data from the questionnaire and interview
reveal that speaking skill is the most needed skill by
the nursing students. Teachers should have their own
materials that suit the students’ needs. Among the
topics related to the nursing’ field, the students
needed and wanted the course to cover such materials
as how to educate the patient, telephoning skills,
communicating with patient and patient’s family, and
recognizing the workplace environment. Another
interesting finding also uncovers that the nursing
students still have a low ability in mastering English
especially in speaking skill even when they have
learned English since junior high or elementary
school. In the future research, it is interesting to dig
more deeply about the causes of their low English
proficiency.
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2014, tentang Keperawatan. 2014.
[3] The Jakarta Post. No language or kitas requirments for
foreign workers: Jokowi. Available from:
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language- or-kitas-requirements-foreign-workers-
[Link].

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