ENGLISH REVIEW: Journal of English Education p-ISSN 2301-7554, e-ISSN 2541-3643 Volume 12, Issue 1, February 2024 https://journal.uniku.ac.id/index.php/ERJEE 245 FACTORS AFFECTING NURSING STUDENTS’ HESITANCY TO SPEAK ENGLISH: A STUDY AT UNIVERSITAS PELITA HARAPAN Santa Maya Pramusita Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia Email: Santa.pramusita@uph.edu Komilie Situmorang Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia Email: komilie.situmorang@uph.edu Bima Adi Saputra Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia Email: bima.saputra@uph.edu APA sCitation: Pramusita, S. M., Situmorang, K., & Saputra, B. A. (2024). Factors affecting nursing students’ hesitancy to speak English: A study at Universitas Pelita Harapan. English Review: Journal of English Education, 12(1), 245-252. https://doi.org/10.25134/erjee.v12i1.9085 Received: 13-10-2023 Accepted: 21-12-2023 Published: 28-02-2024 INTRODUCTION The active engagement of students in classroom participation has been identified as a significant factor contributing to the achievement of language learning goals. According to Sedova et al. (2019), there seemed to be a more pronounced correlation between the level of student’s engagement and their academic performance. This is because the process of producing the language under study allows them to put the theories about the language to the test. Through their responses, inquiries, and remarks in response to questions posed by the teacher or fellow pupils, they actively participate in the process of negotiating and developing comprehensible output (Benyo & Kumar, 2023). Engaged students hence have been found to achieve greater levels of satisfaction and persistence. Nevertheless, it has been noted that inside EFL classrooms, particularly in the context of speaking courses, students show a certain degree of hesitancy to actively employing the English skills they have acquired. For a considerable duration, EFL instructors have encountered significant difficulty pertaining to their students' reticence during oral communication classes. As mentioned by Murad et al. (2019), a significant number of Palestinian students enrolled at UCAS were reluctance in engaging in verbal exercises within the General English course. In a similar vein, Nety (2022) revealed that English lecturers in Universitas Dayanu Ikhsanuddin, Indonesia, had expressed concerns with the lack of verbal participation by their pupils during oral communication classes. Although students may participate in activities that included different Abstract: Proficiency in spoken English is commonly seen as avital aspect of language learning. Regrettably, a significant portion of ESP learners exhibit reluctance to engage in oral communication inside the language learning classroom, which can be attributed to various reasons. Therefore, the present study aims to investigate the relationship among linguistic factor, psychological factor, and sociocultural factor on nursing students’ hesitancy to engage in oral communication exercises. The data were collected using a questionnaire, while the association between variables was tested using the Gamma statistical test. The participants of this study consisted of 196 second-year nursing students in a private university in Tangerang. The sample was determined using the convenience sampling technique, which yielded a total of 195 respondents. A noteworthy correlation had been observed between the linguistic factors (p-value 0.001), psychological factor (p-value 0.001), and sociocultural factor (p-value 0,004) in connection to nursing students’ hesitancy. The correlation between factors is moderately strong, with the variables of all factors indicating a positive association with reluctance. The most influential factor alone went to linguistic factor with the value of 0.439. Consequently, the higher the factors, the greater the nursing students’ willingness to speak English, and vice versa. The lecturers should hence foster a safe and accepting environment in the classroom through fostering connections between themselves and the students. Keywords: nursing students; English for Specific Purposes; hesitancy; speaking activities Santa Maya Pramusita, Komilie Situmorang, & Bima Adi Saputra Factors affecting nursing students’ hesitancy to speak English: A study at Universitas Pelita Harapan 246 language skills, such as reading, writing, and listening, they had a hesitancy to speak in English. Upon completion of the research, the researchers identified three distinct elements that contribute to students' hesitancy, which were limited language proficiency, lecturer’s inadequate classroom management, and students’ low motivation. Syafiq et al. (2021) also found that ESP learners at Muhammadiyah University of Kudus encountered challenges to express their notion verbally. These challenges manifest in the form of hesitancy, fear of committing errors, inadequate vocabulary, and insufficient opportunities for practice. Despite having a specific idea in mind, students were hindered by their insecurity, primarily driven by their fear of committing grammatical errors. They are also concerned about potential ridicule from their peers when mistakes are made. In addition to this, a study conducted by Sjaifullah and Laksmi (2022) in English for Specific Purposes (ESP) classes at a State Polytechnic in Malang, Indonesia, revealed that students' inclination to engage in communication in their second language (L2) is not only influenced by their level of ability. Nevertheless, it is important to acknowledge that there are additional elements that might impact students' willingness to communicate in ESP classes. These aspects include the individuals involved in the conversation, the various activities conducted inside the classroom, the chosen themes and assignments, the establishment of classroom contracts, and the utilization of educational media. Researchers identified similar issues among nursing students in Universitas Pelita Harapan. The observation process revealed that most of the students displayed a tendency towards silence during the lecturers' explanations. There is a lack of inquiry, clarification, and expression of viewpoints among students. In the context of the lecture, it is observed that the students refrain from actively participating by raising their hands and providing answers when the lecturers pose questions. During group discussions, students tend to utilize the Indonesian language more frequently while interacting with their peers, despite the lecturer's encouragement for English usage. Moreover, these pupils persistently engage in the act of seeking the significance of unknown lexical items they encounter by utilizing Google Translate. Despite receiving instructions on utilizing context cues to deduce the meaning of unfamiliar words, the students persisted in employing Google Translate as a means of swiftly translating the words. They even relied heavily on Google Translate throughout spontaneous writing sessions and verbal poster presentations. The preliminary data derived from a series of interviews conducted with a sample of 15 nursing students have revealed several factors contributing to their tendency towards passivity. These factors include apprehension regarding potential grammatical errors in their verbal expressions, limited vocabulary, feelings of uneasiness, and a fear of facing criticism. The nursing students' unwillingness to communicate in English would significantly hinder their ability to develop their abilities, since they fail to use the knowledge they acquire. On the other hand, it is mandatory for nurses to possess English proficiency. As conveyed by Pradana et al. (2022), the healthcare industry consistently prioritizes communication among diverse ethnic and linguistic populations to develop strong relationships with patients, their families, visitors, and colleagues. Nursing students therefore must enhance their English proficiency, in order to establish strong rapport and demonstrate successful communication with international patients. The efficacy of communication in the interactions between nurses and patients will significantly impact patient outcomes. In the absence of efficient communication, confusion or potentially hazardous situations may arise. Giantari et al. (2023) identify multiple variables that hinder students' active engagement in the classroom. The aforementioned aspects encompass psychological, linguistic, and sociocultural dimensions. Psychological factors cover elements such as inhibition or lack of self- assurance, anxiety, shyness, and motivation. Linguistic factors include pronunciation, grammar, and vocabulary. Sociocultural factors consist of the learners' previous learning experiences, cognitive expectations, and environmental context. These factors influencing students' reluctance has gained significant attention in academic research, especially in the field of English for Specific Purposes (ESP). The anticipated outcome of this study is poised to provide valuable insights for English educators, enabling them to gain a deeper comprehension of the barriers impeding students' English-speaking abilities. It can also be employed to delineate instructional strategies aimed at fostering students' engagement in the educational process. Given the limited amount of research conducted on this subject, it is believed that investigations involving ENGLISH REVIEW: Journal of English Education p-ISSN 2301-7554, e-ISSN 2541-3643 Volume 12, Issue 1, February 2024 https://journal.uniku.ac.id/index.php/ERJEE 247 nursing students within the realm of ESP can provide a novel perspective. Referring to this background, this study was held to find out the relationship between the three factors and nursing students’ reluctance to speak English in classroom interaction, with the following research question: What is the relationship between language factor, psychological factor, and sociocultural factor on nursing students’ hesitancy to speak English? The research postulates that a correlation exists between these three variables and pupils' aversion to verbalize in English. METHOD This study employs a cross-sectional design to examine the correlations between variables. Wang and Cheng (2020) assert that a cross-sectional study is a type of observational study that involves the examination of data collected from a population at a particular moment in time. In a cross-sectional study, researchers concurrently assess the outcomes and exposures of the study participants. The study's population comprises 325 second-year nursing students who have successfully completed the English for Nursing course. The sample utilized in this study was obtained by the implementation of a random sampling approach. To determine the minimum sample size, the researchers utilized the Slovin formula, totaling 180 respondents. To mitigate the occurrence of dropouts, an additional 10% was incorporated into the minimal sample size, resulting in a total of 196 respondents for this study. The variables examined in this study encompass language, sociocultural, and psychological factors all of which will be associated with the variable of reluctance. The research used a questionnaire as the primary instrument, with a total of 35 items. As many as 8 items pertaining to students' hesitancy in utilizing the English language were adapted from the Idzni and Setiawan’s (2021) survey. These questions were designed using a five-point Likert scale, which was divided into two distinct categories: hesitant and unhesitant. In addition to this, a total of 8 inquiries pertaining to linguistic aspects, 11 inquiries concerning psychological aspects, and 8 inquiries relating to sociocultural aspects were adapted from the work of Ningrum and Novitri (2019). These inquiries were subsequently categorized into three distinct levels, namely less sufficient, sufficient, very sufficient. Prior to conducting the research, the instrument underwent testing to assess its validity and reliability. Validity and reliability tests were conducted on a sample of 30 respondents who possessed identical characteristics to those of the study's sample. According to the Pearson correlation test, the calculated r-value for each question item is greater than the r-table value (>0.3610). Therefore, it may be inferred that all question items in this research instrument are valid. The reliability of the instrument used in this study was confirmed through the calculation of Cronbach's Alpha values. The reluctance instrument yielded a value of 0.842, the Language Factor had a value of 0.874, the Psychological Factor had a value of 0.948, and the Sociocultural Factor had a value of 0.874. To gather the data, the researchers devised a Google Form questionnaire, obtained informed consent, and provided research explanations to the participants. In light of the online nature of the data collection process, the researchers disseminated the link to the questionnaire to a WhatsApp group comprising students. The findings of the Gamma statistical test conducted using SPSS 29.0 indicate that linguistic, sociocultural, and psychological factors have a significant impact on nursing students’ reluctance to speak English. RESULTS AND DISCUSSION The participants in this research comprised a sample of 196 second-year nursing students. The female respondents constituted the majority, accounting for 85% of the total, while the male respondents comprised 15% of the sample. The participants in this study can be classified into the young age category according to the age categories established by the World Health Organization (WHO), with an average age of 19 years among the respondents. Table 1. Frequency distribution of respondents based on their hesitancy, language factor, psychological factor, and sociocultural factor Variable Frequency Distribution Frequency (n) Percentage (%) Hesitancy Hesitant 118 60.20% Unhesitant 78 39.80% Total 196 100 Language Factor Less Sufficient 38 19.40% Sufficient 133 67.90% Very Sufficient 25 12.80% Total 196 100 Psychological Santa Maya Pramusita, Komilie Situmorang, & Bima Adi Saputra Factors affecting nursing students’ hesitancy to speak English: A study at Universitas Pelita Harapan 248 Factor Less Sufficient 35 17.90% Sufficient 130 66.30% Very Sufficient 31 15.80% Total 196 100.00% Sociocultural Factor Less Sufficient 37 18.90% Sufficient 136 69.40% Very Sufficient 23 11.70% Total 196 100.00% According to the data shown in Table 1, a significant proportion of participants (60.2%) expressed a sense of hesitation when it came to speaking English. The variables that contribute to nursing students’ reluctance are language (67.9%), psychological (66.3%), and sociocultural (69.4%). It is worth noting that each of these components indicates a predominantly satisfactory level of influence. This aligns with Wan's (2021) assertion that East Asian ESL students are often characterized as reserved, cautious, and introverted during classroom engagements and discourse. There exist multiple underlying reasons for this phenomenon, with the initial one being closely associated with cultural factors. The raising of East Asian children places significant emphasis on the cultivation of impulse control, shyness, and obedience as fundamental attributes. In line with this, Wardah (2021) asserts that the predominant educational approach in Indonesia continues to be teacher-centered, characterized by unidirectional communication between teachers and pupils. Consequently, students exhibit subdued and unassertive behavior during class sessions due to the lack of encouragement for active participation and questioning. The second factor pertains to individuals' limited language skills and the experience of anxiety in relation to foreign languages. Most of East Asian students lack exposure to an English-speaking environment, resulting in limited possibilities to develop their listening and speaking abilities. This finding aligns with the outcomes of a study conducted by Andas and Rutniatyanti (2020) that investigated the challenges faced by English language education students at a private institution in Indonesia. The primary hurdle identified by the students in their efforts to improve their English- speaking skills was attributed to their limited vocabulary and grammar proficiency. This phenomenon occurs due to their limited exposure to the English language and their lack of regular utilization of English in their daily interaction. The attitudes and experiences indicated above are likely to be commonly shared by a significant majority of participants (60.20%), which may explain their reluctance to use the English language. Furthermore, a significant proportion of the nursing students included in this research were beneficiaries of scholarships, originating from geographically isolated regions in Indonesia. These regions continue to employ a pedagogical approach that prioritizes teacher-centered instruction. The majority of individuals in question acquired proficiency in the English language during their adolescent years, with minimal exposure to its practical application in their daily routines. Consequently, their lexicon and comprehension of English remained constrained. According to the findings presented in Table 2 below, a significant proportion of participants, specifically 80 individuals, who possessed sufficient language proficiency expressed hesitancy in utilizing English for oral communication. In addition, a total of 79 participants who possessed sufficient psychological components expressed a sense of reluctance against utilizing the English language. A similar occurrence was observed in relation to sociocultural issues, where a notable proportion of 81 respondents who possessed sufficient proficiency displayed hesitancy in utilizing the English language. Table 2. Relationship between language factor, psychological factor and psychosocial factor nursing students’ hesitancy to speak English Variable Hesitancy Total Value App. Sig Hesi tant Un hesitant Language Factor 0.439 0.001 Less Sufficient 29 9 38 Sufficient 80 53 133 Very Sufficient 9 16 25 Total 118 78 196 Psychological Factor 0.434 0.001 Less Sufficient 27 8 35 Sufficient 79 51 130 Very Sufficient 12 19 31 Total Sociocultural Factor 0.403 0.004 Less Sufficient 28 9 37 Sufficient 81 55 136 Very 9 14 23 ENGLISH REVIEW: Journal of English Education p-ISSN 2301-7554, e-ISSN 2541-3643 Volume 12, Issue 1, February 2024 https://journal.uniku.ac.id/index.php/ERJEE 249 Sufficient Total 118 78 196 The findings of this study also indicate that there is a statistically significant association between the Language Factor, Psychological Factor, and Psychosocial Factor possessed by the participants and their level of Reluctance (App. Sig <0.05). The present study observed a significant positive correlation between the variables and the magnitude of the Language Factor (0.439), Psychological Factor (0.434), and Sociocultural Factor (0.403) in relation to the respondents' reluctance. Of all these factors, the language factor has the strongest relationship with nursing students' hesitancy, with a value of 0.439. Based on these findings, it can be inferred that an elevated level of language proficiency, along with psychological and sociocultural elements, contributes to an augmented inclination among students to exhibit hesitancy in utilizing the English language. The initial component under consideration pertains to psychological characteristics, which denotes a positive correlation with the phenomenon of reluctance as observed in this study. This implies that those with stronger psychological variables showed a greater inclination to engage in English conversation. The analysis results revealed that a total of 19 participants with high levels of psychological well-being reported a lack of reluctance in expressing their opinions, ideas, and engaging in English speaking activities. According to Nafisah et al. (2023) there exist multiple determinants that contribute to students' engagement in English classrooms, including the choice of discussion topics and the nature of assigned tasks. In order to foster a propensity for verbal expression among individuals, it is imperative to select a learning topic that captivates students, resonates with their personal experiences, and is sufficiently acquainted to facilitate their preparedness for discourse. In accordance with this notion, a study conducted by Ramli et al. (2021) found that the engagement level of English students at State Islamic Institute of Curup Indonesia in English communication was closely linked to the degree to which a particular issue was able to generate their interest. The more intriguing the topic, the more excited the students will be to communicate and participate in speaking exercises. The second determinant is related to the task type. It is imperative that the assigned task aligns with the student's personal preferences. Implementing pair or group work activities in the classroom setting affords learners enhanced opportunities for oral communication compared to individual speaking tasks. Aulia et al. (2020) argued that engaging in such activities fosters a more relaxed classroom environment, diminishes anxiety, and thus leads to an augmentation in both the amount and quality of practice. These two variables have the potential to enhance the motivation and self-confidence of participants, thereby encouraging them to engage in English speaking activities within the classroom setting. One other element that shows a positive correlation with students' hesitancy to engage in English conversation is language factor, encompassing pronunciation, grammar, and vocabulary. The present analysis revealed that 9 out of 25 respondents who possessed highly proficient verbal skills exhibited a certain degree of hesitancy. Leyaley (2023) posits that the occurrence of such a situation is highly probable in nations where English is not the primary language, and where English is infrequently utilized for everyday conversation, leading to potential discomfort among pupils while employing it. This is to say that their hesitancy to engage in English verbal communication inside the classroom setting stems from their lack of familiarity with the language. In addition to this, student hesitancy can also be influenced by other elements including communication apprehension, test anxiety, and fear of poor evaluation, hence exacerbating students' nervousness when engaging in English oral communication. According to the findings of Syahbani & Apoko (2023), it has been observed that students' performance can be influenced by the presence of anxiety related to speaking a particular language. The phenomenon has the potential to exert an impact on the proficiency of spoken language expression, resulting in persons exhibiting a diminished level of fluency relative to their actual abilities. Hence, while linguistic elements may be necessary, they alone are insufficient to ensure active student engagement in English speaking activities within the classroom setting. One additional aspect contributing to nursing students’ hesitancy is sociocultural influences, encompassing learners' prior educational encounters, cognitive expectations, and environmental circumstances. In the present study, it was observed that a majority of 14 out of 23 participants who possessed very satisfactory sociocultural variables exhibited a lack of reluctance in engaging in verbal communication tasks. This phenomenon can occur, particularly Santa Maya Pramusita, Komilie Situmorang, & Bima Adi Saputra Factors affecting nursing students’ hesitancy to speak English: A study at Universitas Pelita Harapan 250 when survey participants engage in conversations with interlocutors who possess greater competence than themselves. According to Cao (as cited in Wulandari, 2015), learners usually preferred engaging in conversation with interlocutors who possessed a higher level of competence than themselves. Additionally, learners were inclined towards individuals who displayed chatty and outgoing characteristics, as well as those who demonstrated a wealth of ideas that may serve to encourage further ideation. When learners have prior knowledge about the interlocutors, they are likely to experience a greater sense of comfort and ease in engaging in conversation. Furthermore, if the learner engaged in conversation had a higher level of proficiency, it will trigger the other learners to generate a greater number of ideas. The presence of an interlocutor has a significant role in influencing the learners to engage in verbal communication or refrain from doing so. Another sociocultural aspect that may impact nursing students' hesitancy is the role of the teacher. According to Zheng (2021), learners had a heightened propensity to engage in classroom activities and express curiosity when they maintained a positive attitude towards the instructor. The manifestation of a monotonous instructional approach by the educator may lead to a decline in learner involvement and diminished levels of active participation in classroom exercises. Raharja and Ashadi (2019) also highlighted the significance of instructors' participation in English classrooms, emphasizing that EFL teachers serve as influential agents in shaping students' engagement in classroom activities. These characteristics may potentially motivate respondents to actively engage in the activities facilitated by the teacher and actively participate in English language speaking practice CONCLUSION In summary, there is a positive correlation between nursing students’ reluctance to speak English and the three factors examined. Moreover, most of the respondents in this research exhibited hesitancy when it came to utilizing the English language. The psychological factor, which is positively associated with reluctance, is the initial determinant. This implies that as students' psychological well-being improves, their reluctance to communicate in English diminishes. Nevertheless, despite possessing an exceptionally favorable psychological state for learning, certain students continue to show hesitancy when it comes to participating in speaking activities. Additional investigation is required to ascertain the factors associated with this. The subsequent element associated with hesitancy is the language factors. Despite possessing sufficient linguistic proficiency, a minority of the respondents remain averse to speaking English. Negative factors such as communication anxiety, test phobia, and dread of receiving a poor grade may contribute to this. The final determinant is the sociocultural element, which states that students are more likely to speak English fluently in class if they possess stronger sociocultural attributes. The influence of sociocultural factors on the classroom environment and the attitudes of peers is substantial. ACKNOWLEDGEMENT The researchers would like to thank LPPM UPH for supporting the publication of this research paper. REFERENCES Andas, N.H. & Rutniatyanti, Y. (2020). Students’ speaking problem at the fourth semester of English study program in Sembilan Belas November Kolaka. ELT Worldwide, 7(1), 1–9. Aulia, M.P., Lengkanawati, N.S., Rodliyah, R.S. (2020). The Use of pair work to reduce speaking anxiety in an EFL classroom. 12th Conference on Applied Linguistics, pp. 134- 137. Benyo, A. & Kumar, T. (2023). Exploring the factors ensuring student participation in English classroom: An action research in Saudi context. Journal for Educators, Teachers, and Trainers, 14(2), pp. 85-98. Giantari, K., Kurniawan, E., Suherdi, D. (2023). Factors affecting students' reluctance to speak English in classroom interactions. TELL-US Journal, 9(2), pp. 285-300. Idzni, Z.D. & Setiawan, W. 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