Theses Doctoral

Eliminating Idioms, Slang, and Unnecessary Wording from High-Stakes Examinations in Nursing Education

Parker, Timothy M.

The growing diversity of the United States (US) population demands an equally diverse nursing workforce to meet its healthcare needs effectively. It is a priority to assist students who are English Speakers of Other Languages (ESOL) to succeed, not just to take care of ESOL and non-English-speaking clients but to add to the nursing workforce. ESOL nursing and client language barriers in healthcare are challenging, but one leading solution is to help ESOL nursing students succeed. For all nursing students to succeed, they must pass the National Council Licensure Examination - Registered Nurse (NCLEX-RN), a multiple-choice high-stakes assessment offered only in English.

The problem: ESOL nursing students, who are otherwise knowledgeable, often do poorly on such tests. The NCLEX-RN can be difficult for ESOL nursing students since their lack of proficiency in American English slows their ability to interpret words and phrases in written format. This hinders the student’s ability to understand the relevancy of the words and how the words combine to produce meaningful scenarios and discourse. If test writers removed slang and words with multiple meanings, ESOL nursing students might have greater success on high-stakes examinations, such as the NCLEX-RN.

To find appropriate linguistically challenging questions, a search panel comprised of volunteering ESOL Associate Degree in Nursing graduates assembled relevant, challenging multiple-choice questions from high-stakes examination test banks. Each linguistically challenging question was categorized as containing idioms, unclear or unnecessary wording, or slang/difficult American English words. The researcher created a linguistically modified version by removing or replacing the problematic language identified by the search panel. An examination evaluation committee of experienced nursing instructors examined the linguistically modified questions to ensure that the true nursing clinical intention of the question had not been altered. This study used a convenience sample of ADN nursing students (N=169) who had completed Fundamentals of Nursing and Medical/Surgical Nursing 1. The research control group (n=85) received unmodified questions, whereas the experimental group (n=84) received linguistically modified questions. Examinations were distributed by alternating control and experimental examinations to each student.

This dissertation presents three reports on the results of removing linguistic complexity from examination questions. The first report presented in Chapter 2 examines the question, "Does ESOL nursing students' performance on linguistically modified examinations differ from performance on unmodified examinations?" This report examined the differences in scores achieved on the experimental versus the control versions of the examination. Nursing students performed statistically better in the experimental group (M = 79.9, SD 7.48) than in the control group (M = 75.08, SD 10.51), t(151.8) = 2.973, p = .003.

The second report, presented in Chapter 3, assesses if specific forms of American English adversely affect the performance of low-acculturated nursing students. This chapter presents an attempt to identify the possible effects of idioms, slang, or difficult vocabulary on the success of nursing students in high-stakes nursing examinations. Furthermore, this chapter compares which form of American English, idioms, slang, or difficult vocabulary is more difficult for low-acculturated nursing students. A mixed ANOVA using control versus experimental tests as the between variable and item category as the within variable showed that the group by item type interaction was nonsignificant (F (2, 56) = .016, p = .984), indicating that idioms, slang, and difficult vocabulary do not differ in the likelihood of leading students to select incorrect answers.

The third report, in Chapter 4, presents an investigation of the effect of linguistic bias on ESOL nursing students' success. Chapter 4 presents analyses of pass rates on the unmodified examinations achieved by high-acculturated and low-acculturated nursing students. Chapter 4 also presents an examination of the impact of language acculturation on the pass rates on linguistically modified and unmodified nursing examinations based on modified NCLEX-style questions that remove linguistic biases. This chapter presents an investigation of whether low acculturated nursing students who take the linguistically modified nursing examination achieve higher pass rates than those who take the unmodified examination.

Based on the results of the chi-square analysis, 35 (81.4%) of the 43 students in the low acculturation group received a passing grade on the modified (experimental) examination, compared to 12 (30.8%) of 39 students in this group passing the unmodified (control) examination. This difference was statistically significant, χ2(1) = 21.42, p = <.001. Results also showed that there is a relationship between high-stakes nursing examination questions containing idioms, slang, and unnecessary words and ESOL nursing student success. The study supported the impact of substituting idioms, slang, and unnecessary vocabulary with more standard English terms on students’ success on multiple choice high-stakes examinations. Although the results do not indicate that ESOL nursing students are more severely or directly affected by specific forms of American English, it does show that identifying these linguistic obstacles may help provide valuable information that may guide creators of high-stakes examinations in designing more bias-free examinations to assist ESOL nursing students succeed and enter the workforce.

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More About This Work

Academic Units
Health and Behavior Studies
Thesis Advisors
O'Connell, Kathleen Ann
Ed.D., Teachers College, Columbia University
Published Here
October 25, 2023