We had a situation literally when we presented the Diploma in General Nursing outside the EU/EEA project and training to real guidance professionals, the staff responsible for and interested in VARHA's student guidance, during the student guidance training day on May 12, 2023.
We heard stories about how the patience of supervisors seemed almost endless, for example, with a student for whom, due to their cultural background, saying no was nearly impossible—even when it would have been necessary in response to the question, 'Do you understand what needs to be done?' The student would answer, 'Yes,' even though, in reality, the information hadn't fully registered. A familiar situation?
Just as patiently and in various ways, we emphasize to students in the Diploma in General Nursing outside the EU/EEA project´s training that a good nurse asks questions. A good nurse is willing to say that they don't know or don't understand. And that learning is allowed during practice. In the Finnish care culture, trust is built when the nursing team knows what each member is capable of and how they can assist.
What can we do to succeed? The student must have the opportunity to prepare for situations in advance. If the task is, for example, showering a patient or resident, the situation is already inevitably happening when the taps are turned on! Water is flowing, and the trainee may not know how to say or ask if the water is the right temperature or if you can shower your armpits, etc.
The title 'situation on?' was accompanied by a question mark. Situational language learning is widely discussed and is very effective and motivating from the learner's perspective (e.g., Vaarala et al., 2016; Finnish Language Situational Learning Research Project 2016–2018). In the situations we described, it is impossible to learn a language while acting: when water is spraying in a steamy bathroom, the student's resources are no longer sufficient for finding words and expressions: Can one say, 'Spray yourself!' 'Could you spray yourself?' 'Are you able to spray yourself...?' Is the expression too commanding and impolite? Is it too vague and complicated for someone with hearing impairment or dementia...? And one should also note that the form of the verb 'suihkuttaa' changes as you modify the expression... These things must be considered and prepared for in advance. Where can a student find words in a situation that is new to them? Showering is basic nursing competence, but it's not about competence; it's about coping with the situation in Finnish. And not just coping, but managing the entire showering process in a way that is pleasant and safe for the patient.
Vinkit ohjaajille
1. Instruct the student to prepare for the situation in advance
The student can prepare in advance for upcoming tasks or nursing procedures, such as those scheduled for the next day or week.
- Before the situation (planned nursing scenario, conversation with a patient or family member, phone call...), the training supervisor discusses in advance the upcoming work situations. For example, showering > the student orients themselves in advance, what to say and how act in the showering situation.
- The instructor and student together clarify:what the task involves, what new vocabulary is related to the task, what expressions or colloquial language can be used, and any other unclear points.
Tasks for the student:
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- Anticipate the topic.You know what's coming:
- Familiarize yourself with the subject..
- List the main points..
- Learn vocabulary, and expressions and phrasesrelated to the situation. Practice also pronunciation!
- Take notes: Write down the things you need to ask before the planned nursing scenario.
- You can also create, for example, a mind map of the topic (Image 1).
- Ensure understanding in the speaking situation: for example, repeat what you were asked.
- Anticipate the topic.You know what's coming:
Image 1: Mind Map
2. Apply the closed-loop method in reporting.
The closed-loop communication method (CLC), also known as the closed-loop communication technique (see, e.g., Arhurst & Saklik 2019; Härgestam 2013), can be applied in various reporting situations, such as shift change, reporting on a transferred patient, or reporting on a new admission. The method can be applied in many other situations besides reporting – for example, when a student responds 'yes' to the 'did you understand?' question. Ensuring communication progresses through many different stages. Is there enough time for this, is there enough patience? However, the fundamental principle is always patient safety. It should not be compromised even when the student's language skills are developing.
The communication progresses as follows:
Tasks for the student:
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- The student listens to the nurse's report.
- The student extracts the essential information needed during the shift.
- The student takes notes or makes annotations for themselves.
- The student provides a report to the nurse, summarizing the key points.
- The instructor gives feedback on the report, for example, if essential details were missing, providing clarification through questions.
- The student makes corrections to the report.
- The student provides the revised report again to the instructor.
Lastly
The communication of a nurse is highly context-dependent, as summarized by Lehtimaja and Kurhila (2018). Subtle language phenomena and work situations are challenging for a language teacher to know or simulate in a classroom: It is not fruitful to assume that the language skills required for a nurse's work, with all its nuances, can be learned in advance in separate language courses. Instead, language teaching should be tied to real work situations, especially during training. Language learning should continue even while working, and employers have an obligation to provide opportunities for development. The integration of language learning into professional activities has been explored, for example, in the Urareitti project (Kuparinen 2017, Rajala & Takaeilola 2017).
The participants in the Diploma in General Nursing outside the EU/EEA project are already skilled professionals who have graduated as nurses in their home countries. For them, the practical training periods, in particular, provide the best environment to develop their professional language skills. Through the project, additional support for practical training guidance is provided, with both nursing and Finnish language teachers offering assistance.
This blog post is based on a presentation given at the Student Guidance Day of the Varsinais-Suomi Wellbeing Area on May 12, 2023.
Sirpa Rajala, Lecturer, Turku University of Applied Sciences
Mervi Rasilainen, Lecturer, Turku University of Applied Sciences
Lähteitä ja lisätietoa
Arhurst, J. & Salik, I. 2019. Closed Loop Communication Training in Medical Simulation. StatPearls 11 (22). Viitattu 15.5.2023. https://europepmc.org/article/NBK/nbk549899#free-full-tex
Härgestam, M.; Lindkvist, M.; Brulin C.; Jacobsson, M. & Hultin, M. 2013. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ Open 2013;3. doi:10.1136/bmjopen-2013–003525.
Kuparinen, K. 2017: Mikä muuttui, kun sairaanhoitajien kielikoulutus siirtyi luokasta työpaikalle? Teoksessa J. Lindström & K. Kuparinen (toim.), Yhdessä enemmän. Oppimisen paikkoja ja suuntia. Laurea Julkaisut 87. Laurea-ammattikorkeakoulu, 94–102. Saatavilla: http://urn.fi/URN:ISBN:978-951-799-479-0.
Kuparinen, K.; Rajala, S.; Granlund, J. & Laitala, H. 2018. ”Olen saanut hyvää potkua sinusta” – Yksilölähtöinen ja ammatillinen suomen kielen koulutus sairaanhoitajan työssä. Teoksessa T. Hirard & A. Eskola-Kronqvist (toim.). Urareitti-hankkeen satoa – Uusia malleja korkeasti koulutettujen maahanmuuttajien kielikoulutukseen, ohjaukseen ja osaamisen tunnistamiseen. Hämeenlinna: Hämeen ammattikorkeakoulu. Saatavissa myös: https://www.theseus.fi/handle/10024/152387
Lehtimaja, I. & Kurhila, S. 2018. Sairaanhoitajan ammatillisen kielitaidon kehittäminen työyhteisössä. Kieli, koulutus ja yhteiskunta, 9:5. https://www.kieliverkosto.fi/fi/journals/kieli-koulutus-ja-yhteiskunta-syyskuu-2018/sairaanhoitajan-ammatillisen-kielitaidon-kehittaminen-tyoyhteisossa
Rajala, S. & Takaeilola, M. 2017: Ammatillisen kielitaidon kehittyminen sairaanhoitajien pätevöitymiskoulutuksessa. Kieli, koulutus ja yhteiskunta 8:5. https://www.kieliverkosto.fi/fi/journals/kieli-koulutus-ja-yhteiskunta-lokakuu-2017-2/ammatillisen-kielitaidon-kehittyminen-sairaanhoitajien-patevoitymiskoulutuksessa.
Suomen kielen tilanteinen oppiminen -tutkimushanke 2016–2018. Helsingin yliopisto. Tutkimusryhmä. https://www.helsinki.fi/fi/tutkimusryhmat/suomen-kielen-tilanteinen-oppiminen
Vaarala, H.; Reiman, N.; Jalkanen, J. & Nissilä, L. Tilanne päällä! – Näkökulmia S2-opetukseen. Helsinki: Opetushallitus.
