The Importance of English Language Proficiency for the Success of Nursing Education in Sri Lanka

There is an ever-growing demand for Sri Lankan nurses to be recruited for work placements overseas. Before being considered for employment abroad, nurses who are from the English as a Second Language context are usually asked to provide evidence of English language proficiency. Therefore, there is a parallel need to enhance their English language skills with the demand. Hence, improving the English Language among nursing students is vital as they seek to meet future healthcare needs globally. This study aimed to identify the challenges faced by nursing students due to low English Language proficiency and recommend mechanisms to overcome those challenges. Academic writing, understanding medical jargon, communication in health care settings, reading and comprehension are some of the major challenges seen among nursing students. These challenges lead to Second Language Anxiety, poor academic performance, and higher dropout rates in nursing education programmes. Therefore, it is high time policymakers and the authorities of higher education get together and mitigate the challenges in English language learning among nursing students in Sri Lanka by developing proper mechanisms; making English a compulsory subject, improving the use of medical terminology, improving communication skills in English and providing financial support to pursue professional courses in English. This will enable the nurses to provide quality and sustainable health care for the patients and pave the way for a promising future for the nursing profession in Sri Lanka.


Introduction
English occupies an enviable and esteemed position as the international or world language, which is used as the primary means of communication in many global contexts.In addition, it is used extensively for diplomatic, commercial, educational, engineering, legal, and medical purposes.Moreover, English has become the 'operating system' for global discourse, with a quarter of the world's population speaking it.
1 Faculty of Management, Social Sciences & Humanities, General Sir John Kotelawala Defence University, Sri Lanka. 2 Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
Corresponding author: Ms. Wasana S. Sudusignhe Email: sudusinghews@kdu.ac.lkWith the increase in global demand for healthcare professions, there is a parallel need for health-related personnel to enhance their English language skills.This is especially pertinent in the Sri Lankan context where there is an ever-growing demand among nurses to work abroad.The current economic situation of Sri Lanka has paved the way for nurses to join the workforce overseas.However, before being considered for employment, healthcare professionals, such as nurses, must pass an English proficiency exam or provide evidence of English language skills.In addition, it has been demonstrated that assessments used to predict job performance are administered in the language used on the job.Individuals with inadequate proficiency in this language may perform poorly on the examination or the job, or both.In a nutshell, the inadequate English proficiency of nurse https://doi.org/10.4038/seajme.v17i1.529

South-East Asian Journal of Medical Education
Vol.17, no.1, 2023 practitioners working in nations that speak English could adversely affect their subsequent professional efficacy or occupation.
Multiple studies have reported that English language proficiency correlates with the overall academic achievement of nursing students and is also an indicator of potential scholastic and credentialing success (Alqahtani, 2022).Therefore, nursing students who are learning in English as a second language context like Sri Lanka need a higher level of support and assistance during their study and it will enable them to achieve academic success as well as to reach the required standards in the clinical setting.
Improving the English Language among nursing students is important when developing culturally competent care.Especially when they begin their career in an international context, competency in English language is needed to develop an effective and efficient relationship with patients (Crawford & Candlin, 2013).Hence, there is a greater responsibility for nursing educators and policymakers to take necessary actions to upgrade English language skills among nursing students.

Challenges faced by nursing students due to low English Language proficiency
Students who study nursing in the context of English as a second language undergo numerous challenges in reaching success in terms of both academic and clinical settings.In comparison to students in other non-health fields of study, nursing students face a pair of separate obstacles (Mulready-Shick & Parker, 2013).On the one hand, they must acquire the vernacular of health sciences, and on the other, they must meet the rigorous academic standards of the field (Ching et al., 2020).Reading, writing, comprehension, and communication are some of the nursing education obstacles that have a major effect on English language acquisition.Since every phase of learning is founded on English-written textbooks, students enrolled in institutions of higher learning will be required to use English frequently and extensively.In addition to the requirement to be proficient in the language, it is more difficult for students to acquire medical terminology and comprehend it during their education.Further, communication plays a strong barrier among nursing students as they need to use medical jargon when communicating with other medical professionals and with patients.Furthermore, in a general academic context, nursing students encounter problems in understanding lectures (Ching et al., 2020).
The formal education of nursing students extends beyond their prospective duties of promotion, prevention, treatment, and rehabilitation in clinical or public nursing facilities.In addition, it promotes the development of healthcare through active participation in the composition and publication of scientific research (Padagas & Hajan, 2020).Nonetheless, an abundance of anecdotal evidence suggests that most nursing students grapple with the demands of academic writing (Whitehead, 2002).Lack of time and confidence, lack of extended writing, lack of reading and comprehension of academic texts or journals, citations, and academic jargon are identified as the barriers to academic writing (Itua et al., 2014).
Training in nursing entails the mastery of theoretical and technical knowledge as well as evidence-based research, as well as professional placements that enable nursing students to apply their conceptual understanding in practice.However, difficulties with speaking and writing in the host country's language frequently contribute to Second Language Anxiety in students.Second Language Anxiety has been conceptualized predominantly as composed of spoken and written apprehension.As part of communicating in a second language, a person may experience anxiety, physiological arousal, and thoughts of being judged and evaluated by others, which pose the greatest difficulty (Khawaja et al., 2017).

Recommendations
English should be a compulsory subject in the nursing curriculum of Sri Lanka in order to make improvements of it.This will make the students realize the significance and importance of learning English and enhance motivation for the learning process.A study carried out on the perceived learning challenges and coping strategies among Nursing and Health Sciences students at Al-Hussein Bin Talal University revealed that there is a necessity of devising an

South-East Asian Journal of Medical Education
Vol.17, no.1, 2023 English for specific purposes compulsory module which can address the nursing students' specific needs and meet their technical purposes in the English (Rabea et al., 2018).Another study conducted in Saudi Arabia also revealed that English language usage improved academic achievement.Furthermore, it also emphasized the need to offer more professional development programmes for nursing students to improve their English Language proficiency (Alqahtani, 2022).
Most nursing students seem to drop out of their courses and degree programmes due to the difficulties they have in understanding the content delivered in English.Moreover, they feel anxious and demotivated to work in a clinical setting where they need to refer to many technical terms.Therefore, nursing students should be subjected to more activities targeting improving their use of vocabulary related to medical terminologies.The English language instructors have a responsibility in designing interactive classroom-based activities which boost the enthusiasm among the students to learn English.
There is a greater need to improve communication skills in English among nursing students as Second Language Anxiety has become an evident challenge to pursuing their career goals.Further, it will broaden their future nursing roles as health educators, counsellors, and health promoters.When nursing students become confident and competent when using the English language, they will be able to communicate well in international work settings with no anxiety in the future.One of the reasons behind the lack of motivation among nursing students to follow professional courses in English is the high amount of examination and course fees.Especially in Lower Middle Income countries like Sri Lanka is that nurses will have to spend large sums of money on professional English courses such as the Occupational English Test and the International English Language Testing System which are necessary for them to achieve their career prospectus.Therefore, if the policymakers and the government can implement a subsidiary scheme or grant some incentives for nurses and nursing students to follow those examinations there will be an increase in their level of motivation.Moreover, it is recommended to conduct training and workshops for nursing students to improve their English Language proficiency.

Conclusion
Hence, it is evident that English language proficiency becomes an asset for the improvement of Nursing education in Sri Lanka.However, there are some significant challenges faced by nursing students in Sri Lanka in achieving success in English language proficiency.If the government, policymakers, and the authorities of higher education can actively engage in mitigating the challenges discussed above, the nursing students in Sri Lanka will be highly benefited.This would in turn enhance the process of sustainable development in Sri Lanka as well as create a promising future in the healthcare system in the country which is a timely need.