Overview
EAL Student Needs
Students who speak English as an additional language (EAL) benefit from course design strategies that conceptualize abstract concepts, support decoding of medical terminology, scaffold clinical communication skills, and evaluate learning through varied modes of expression. Due to the pacing, density, and unfamiliar jargon of ABSN programs, EAL students may take longer to process oral and written information, miss subtle linguistic cues that indicate information importance, and require an increased cognitive load to juggle linguistic comprehension and content understanding (Cummins, 1980; Fradd et al., 2001). Additionally, cultural and linguistic communication skills in the clinical setting can pose challenges in fostering therapeutic client relationships and communicating effectively with other healthcare professionals (Cheng et al., 2025; Henry, 2023; San Miguel et al., 2006).
Why Use EAL?
Although English as a second language (ESL) is the more commonly recognized term and acronym, it lacks accuracy and does not encompass multilingual individuals. In the context of describing nursing students, ESL assumes English is their second language, when in fact it may be students' third, fourth, or fifth language. Additionally, ESL evokes the assumption that a "first" language is the same language used at home and in the community. To illustrate, consider a bilingual student who grew up speaking Arabic at home and French at school. Although Arabic was technically acquired first, French is this student's dominant language due to the broader use in school and community settings. In other words, Arabic is the student's heritage language while French is their dominant language. Using English as an additional language (EAL) embraces a range of individuals and their language backgrounds.
Resources
The following resources can help EAL students succeed in their didactic and clinical ABSN programs.
Course Design Strategies
These tools provide strategies and ideas to support EAL students within the course design.
- Course Design for EAL Students Job Aid outlines best practices to support EAL students.
- Examples of Multiple Means of Representation article lists examples that support EAL students under Guideline 2: Design options for language and symbols.
EAL Resource Library
These Knowledge Base articles provide additional resources for supporting EAL students.
- Cross-Linguistic Support article shares tools to help students build fluency in the technical language of health care.
- Includes links to the Orbis-created nursing glossary and self-assessments
- Clinical Communication
References
Cheng, C., Wang, Q., Bai, J., & Christensen, M. (2025, January). Challenges, support, and strategies concerning learning among nursing students who have English as an additional language: A meta-synthesis.
Nurse Education Today,
37, Article 106408.
https://doi.org/10.1016/j.nedt.2024.106408
Cummins, J. (1980). The cross-lingual dimensions of language proficiency: Implications for bilingual education and the optimal age issue.
TESOL Quarterly,
14(2), 175–187.
https://doi.org/10.2307/3586312
Fradd, S. H., Lee, O., Sutman, F. X., & Saxton, M. K. (2001). Promoting science literacy with English language learners through instructional materials development: A case study.
Bilingual Research Journal,
25(4), 479–501.
http://doi.org/10.1080/15235882.2001.11074464
San Miguel, C., Rogan, F., Kilstoff, K., & Brown, D. (2006). Clinically speaking: A communication skills program for students from non-English speaking backgrounds.
Nurse Education in Practice,
6(5), 268–274.
https://doi.org/10.1016/j.nepr.2006.02.004