近年來隨著台灣的國際化發展使得台灣的醫療人員，特別是醫生和護理師需要更好的英語能力來照顧外籍病患及與照護者溝通。然而，台灣大部分的護理師往往因為英語口說焦慮而無法以英語來與外籍病患及照顧者做良好的溝通，因此，本研究探討台灣護理師在職場上與外籍病患及照護者溝通的英語口說焦慮。主要探討下列之研究問題: (1)當在職場上和外籍病患及照護者溝通時，護理師的焦慮程度為何? (2)台灣護理師的英語口說焦慮為何? (3)護理師面對英語口說焦慮會使用何種因應策略? (4)護理師對英語口說焦慮的觀感為何? 本研究受測對象為就讀於醫事科技大學67位在職進修的二技護理系學生。所有受測者目前除進修期間外，也同時在各大醫療機構服務。此研究包含了量化及質性分析。其主要的工具為英語口說焦慮問卷，目的用來了解在職護理師之英語口說焦慮程度，焦慮來源及解決焦慮的策略。另一項工具為訪談，訪談包含了六個問題。在進行完問卷調查隔一週後，10位自願接受訪談的護理師即進行訪談。
研究結果顯示，受測者英語口說的焦慮程度為中等。受試者之焦慮來源包含缺乏英語口語能力，擔心與病患和照護者因溝通不良造成誤會所產生的後果，專業醫療相關字彙量過少故導致無法跟病患解釋醫學用語和擔心無法跟上外籍病患、照護者及醫師之英語口說的速度。在因應英語口說焦慮策略方面，緩和、準備及尋求同事幫助最常被使用。本研究的結果盼能協助專業英文老師，英語在職訓練講師，及醫療單位行政人員對台灣護理師面對外籍病患及照護者的口說焦慮程度有更深的了解，及提供其針對英語口語焦慮相關的解決策略。

The internationalization of Taiwan, emerged as a result of past political democratization, has greatly affected and changed economic climate. One manifestation of these changes is a remarkable expansion of medical services and treatment for international workers and students as well as immigrants. This requires healthcare providers in Taiwan, particularly doctors and nursing personnel, to acquire greater English proficiency so as to productively respond to international patients’ need. The present study, therefore, explored in-service nurses’ EFL speaking anxiety when they communicate with foreign patients and caregivers at their workplace. This study mainly addressed the following research questions: (1) What are the levels of EFL speaking anxiety of in-service nurses in Taiwan when they communicate with foreign patients and caregivers? (2) What are the sources causing EFL speaking anxiety of Taiwanese in-service nurses? (3) How do Taiwanese in-service nurses cope with their EFL speaking anxiety? (4) What are the nurses’ perceptions on their EFL speaking anxiety? The participants were 67 nursing students recruited from the department of nursing continuing education at a two-year medical technology-based college. Meanwhile, all participants also worked in different departments of healthcare institutions across Northern Taiwan. The main instruments are quantitative and qualitative methods. The questionnaire examined levels, sources, and coping strategies of in-service nurses’ EFL speaking anxiety. The survey was administrated in class, and the semi-structured interviews were scheduled and conducted individually with 10 voluntary participants in the following week.
Results showed that the EFL speaking anxiety of in-service nurses were at moderate level. In addition, the majority of anxiety sources reported by the participants included lack of oral linguistic competence specifically in medical terminology and general vocabulary, fear of consequences of misunderstanding between themselves and foreign patients and caregivers, not able to understand their requests, not able to follow foreign patients, caregivers’ and doctors rapid pace in spoken English. Based on the coping strategies, relaxation and peer seeking were the most frequently used strategies for the participants to deal with speaking anxiety. It is expected that the empirical findings of the present study may, to some extent, facilitate a better understanding of what are Taiwanese in-service nurses’ levels of EFL speaking anxiety, anxiety-provoking sources and strategies used to overcome such anxiety. Finally, the study is expected to serve as a reference for any future research on foreign language speaking anxiety among nursing personnel and also to provide ENP instructors, hospital board of directors, and on-job trainers with some pedagogical implications and empirical evidences to solve this anxiety-related issue.

Aida, Y. (1994). Examination of Horwitz, Horwitz, and Cope's construct of foreign language anxiety: The case of students of Japanese. The Modern Language Journal, 78(2), 155-168.
Allen, J. L., O’Mara, J., & Long, K. M. (1986). Communication Competence, Anxiety,
Avoidance Behaviors, and the Classroom Experiences of Nonnative English Speakers in the U.S. Paper presented at the 72nd Annual Meeting of the Speech Communication Association.
Bailey, K. M. (1983). Competitiveness and anxiety in adult second language learning:
Looking at and through the diary studies. In H. W. Seliger & M. H. Long (Eds.), Classroom oriented research in second language acquisition (pp. 67-102). Rowley, MA: Newbury.
Bekleyen, N. (2004). The influence of teachers and peers on foreign language
classroom anxiety. Language Journal, 123, 49-66
Bosher, S. Stocker, J. (2015) Nurse’s narratives on workplace English in Taiwan:
Improving patient care and enhancing professionalism. English for Specific
Purposes.38 (2015) 109-120
Brophy, J. (1999). Working with perfectionist students. (Re-port No. 4). Urbana, IL:
ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC
Document Reproduction Service No. ED400124)
Brown, H. D. (2001). Teaching by principles. New York: Pearson Education.
Çagataya, S. (2015) Examining EFL students’ foreign language speaking anxiety: The case at a Turkish state university. GlobELT: An International Conference on Teaching and Learning English as an Additional Language, Antalya- Turkey, Procedia: Social & Behavioral Sciences 1877-0428
Chen, L. L. (2007). International medical overview. Land- seed Hospital Management
Newsletter, 65, 8-9.
Chen, T., & Chang, G. B. (2004). The relationship between foreign language anxiety and learning difficulties. Foreign Language Annals, 37(2), 279-289.

Chia, H. U., Johnson, R., Chia, H. L., & Olive, F. (1999). English for college students in Taiwan: A study of perceptions of English needs in a medical context. English for Specific Purposes, 18(2), 107-119.

Chien, C. Y. (2006). Defining feasible English language needs for nurses in Taiwan through analysis o f teaching/learning exercises. Proceedings of 2006 International Symposium on ESP and Its Application in Nursing & Medical English Education (pp. 71-81). Kaohsiung: Fooyin University.
Chien, C. N., Lee, W., & Kao, L. H. (2008). Collaborative teaching in an ESP program. Asian EFL Journal, 10(4), 114-133.
Chien, C. Y. (2008). Cross-cultural communication styles for in-service nurses: A study for Nursing English curriculum. In Proceedings of 2008 international symposium on ESP (pp. 90-105). Taiwan: Fooyin University.
Clement, R., Dornyei, Z., & Noels, K. A. (1994). Motivation, self-confidence, and group cohesion in the foreign language classroom. Language Learning, 44(3), 417–448.
Council of Labor Affairs, R.O.C. (2013). Status of manpower. Council of Labor Affairs, R.O.C. (Taiwan). Retrieved 16 November, 2017 from http://statdb.cla.gov. tw/html/year/year01/d2010.htm
Council of Labor Affairs, R.O.C. (2014). Foreign workers in productive industries and social welfare by industry and nationality (End of Dec., 2013). Taiwan: Bureau of Employment and Vocational Training, Council of Labor Affairs, R.O.C. (Taiwan). Retrieved 16 November, 2017 from http://statdb.cla.gov.tw/ html/mon/c12030.pdf
Daly, J. (1991). Understanding communication apprehension: An introduction for language educators. In E. K. Horwitz & D. J. Young (Eds.), Language anxiety: From theory and research to classroom implications (pp. 3-13). Englewood Cliff, NJ: Prentice- Hall.
Dörnyei, Z. (2005). The Psychology of the Language Learner: Individual Differences in Second Language Acquisition. New Jersey: Lawrence Erlbaum Associates, Inc.
Dudley-Evans, T. (1998). An Overview of ESP in the 1990s. Paper presented at The Japan Conference on English for Specific Purposes, Fukushima.
Elkhafaifi, H. (2005). Listening comprehension and anxiety in the Arabic language classroom. The Modern Language Journal, 89(2), 206-220.
Ely, C. M. (1986). An analysis of discomfort, risk-taking, sociability, and motivation in the L2 classroom. Language Learning, 36, 1-25.


Ewald, J. D. (2007). Foreign language anxiety in upper-level classes: Involving students as researchers. Foreign Language Annals, 40, 122–142.
Fang, F. S. (1987). An Evaluation on the Needs Assessment of English Curriculum for Medical Students. Selected papers from the Fourth Conference on English Teaching and Learning in the Republic o f China (pp. 111-129). Taipei: Crane Publishing.
Fiadzawoo, J. K. (2015). Investigating speaking anxiety among adult Foreign Language (French) learners in the Faculty of Education, UDS, Tamale. Education Research Journal 5(2); pp. 14-26
Flowerdew, J., Miller, L., & Li, D. C. S. (2002). Chinese lecturers’ perceptions, problems, and strategies in lecturing in English to Chinese-speaking students. RELC Journal, 31, 116-138
Foss, K. A., & Reitzel, A. C. (1988). A relational model for managing second language anxiety. TESOL Quarterly, 22, 437-454.
Frost., R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468.
Fuller, G. D. (1978). Current status of biofeedback in clinical practice. American
Psychologist, 38, 39-48
Gardner, R.C. and MacIntyre, P.D. (1992) A Student’s Contributions to
Second-Language Learning. Part I: Cognitive Variables. Language Teaching, 25, 211-220. https://doi.org/10.1017/S026144480000700X
Gregersen, T., & Horwitz, E. K. (2002). Language learning and perfectionism: Anxious and non-anxious language learners' reactions to their own oral performance. The Modern Language Journal, 86(4), 562-570.
Guiora, A. Z., Beit-Hallamhmi, B., Brannon, R. C. L., Dull, C. Y., & Scovel, T.(1972). The effects of experimentally induced changes in ego states on pronunciation ability in a second language: An exploratory study. Comprehensive Psychiatry, 13, 421-428.

Guttman, M. S. (2004). Increasing the linguistic competence of the nurse with limited English proficiency. The Journal of Continuing Education in Nursing, 35(6), 264-270.
Hashemi, M. (2011). Language stress and anxiety among the English language
learners. Proceedia, Social and Behavioral Sciences, 30, 1811-1816.
Horwitz, E. K., Tallon, M., & Luo, H. (2010). Foreign language anxiety. In J.C. c Cassady (Ed.), Anxiety in schools: The Causes, Consequences, and Solutions for Academic Anxieties (pp. 95-115). New York: Peter Lang.
Horwitz, E. K., Horwitz, M., & Cope, J. (1986). Foreign language classroom anxiety.
Modern Language Journal, 70, 125–132.
Hou, En-An, 2017. An Investigation of Taiwanese Nursing Students’ English
Learning Behaviors and Environmental Factors Related to English Learning before and after Their Internship Experiences—A Case Study. Open Journal of Nursing, 2017, 7, 1439-1473
Huang, S. M. (2007). Developing internationalized medical services in Taiwan. Taiwan Economic Forum, 5(10), 39-43.
Hutchinson, T., & Waters, A. (1987). English for Specific Purposes: A Learning Centered Approach. Cambridge: Cambridge University Press.
Ismail, N. M. (2016). The effectiveness of an engaging program to reduce Saudi female university EFL students' foreign language anxiety and to enhance their motivation to learn English at Taif University. International Journal of Psychological Studies, 8, 92-105.
Jackson, J. (2002). Reticence in second language case discussions: Anxiety and aspirations. System, 30(1), 65-84.
Johns, A., & Dudley-Evans, T. (1991). English for Specific Purposes: International in scope, specific in purpose. TESOL Quarterly, 25, 297-314.
Karatas, H., Alci, B. Bademcioglu, M. & Ergin, A. (2016) An Investigation into University Students’ Foreign Language Speaking Anxiety. Procedia, Social and Behavioral Sciences, Esevier LTd. 1877-0428
Kim, S. Y. (2009). Questioning the stability of foreign language classroom anxiety and motivation across different classroom contexts. Foreign Language Annals, 42 (1), 138-157.

Kondo, D.S., & Yang, Y. L.(2004). Strategies for coping with language anxiety: The case of students of English in Japan. ELT Journal, 58(3), 258-265.
Krashen, S. D. (1980). The input hypothesis. In J. E. Alatis (Ed.), Current Issues in Bilingual Education: Georgetown University Round Table on Language and Linguistics (pp. 168-180). Washington, DC: Georgetown University Press.

Lai, Ying-Chun (2016) English for Nursing: An Exploration of Taiwanese EFL Learners’ Needs, Chang Gung Journal of Humanities and Social Sciences 9:1 (April 2016), 27-52
Latif A. & Afiqah N. (2015) A Study on English Language Anxiety among Adult Learners in Universiti Teknologi Malaysia (UTM). 3rd International Conference on Linguistics, Literature and Culture (ICLLIC 2014), Elsevier Ltd.
Leary, M. R. (1982). Social Anxiety. In L. Wheeler (Ed.) Review of Personality and Social Psychology. (pp. 97-120). Wheeler Beverly Hills: Sage.
Lee, C. Y. (1998). English for nursing purposes: A needs assessment for professional-oriented curriculum design. Selected Papers from the Seventh
International Symposium on English Teaching (pp. 615-625). Taipei: Crane Publishing.
Lee, C. Y. (2000). Purpose-specific English programming within a nursing setting.
Proceedings of the Foreign Languages Teaching and Humanity Education Symposium (pp. 283-292). Kaohsiung: Wen Tzao Ursuline College of Modem Languages.
Lee, S. C., & Joe, S. G (2006). A needs analysis of English for nursing professionals in southern Taiwan: A study on junior college graduates. Proceedings of 2006 International Symposium on ESP and Its Application in Nursing & Medical English Education (pp. 162-177). Kaohsiung: Fooyin University.
Liu, M., & Jackson, J. (2008). An exploration of Chinese EFL learners’ unwillingness to communicate and foreign language anxiety. The Modern Language Journal, 92, 71–86.
Lin, Y.H., Chang, T. R., Wu, A. J., Lin, S. C., Chen, K. J. (2012) A Proposal to
Reduce anxiety of outpatient staffs when dealing with non-Mandarin
speaking patients. Mackay Nursing Journal, 6(2), 28-36

Lu, Yi-Ling (2016). Experiences in the workplace community and the influence of
community experiences on ENP courses for nursing professions. Nurse
Education Today 40 (2016) 39-44
Lusky, K. (2008, January). ACP Hospitalist. Picture boards help those who cna’t
speak for themselves. Retrieved March 12, 2010, from
http://www.acphospitalist.org/archives/2008/01/pictures.htm
MacIntyre, P.D., & Gardner, R.C. (1989). Anxiety and second language learning:
toward a theoretical clarification. Language Learning. 32, 251-275.
MacIntyre, P. D., & Gardner, R. C. (1991). Methods and results in the study of
anxiety in language learning: A review of the literature. Language Learning, 41,
85–117.
MacIntyre, P. D., & Gardner, R. C. (1994). The subtle effects of anxiety on cognitive processing in the second language. Language Learning, 44(2), 283-305.
MacIntyre, P. D. (1999). Language anxiety: A review of literature for language teacher. In D. J. Young (Ed.), Affect in foreign language and second language learning (pp. 24-43). New York: The McGraw Hill Companies, Inc.
MacIntyre, P. D., Baker, S. C., Clement, R., & Conrod, S. (2001). Willingness to communicate, social support, and language-learning orientations of immersion students. Studies in Second Language Acquisition, 23, 369-388
MacIntyre, P. D., & Gregersen, T. (2012). Affect: The role of language anxiety and other emotions in language learning. In S. Mercer, S. Ryan, & M. Williams, (Eds.), Psychology for language learning: Insights from research, theory and practice. UK: CPI Antony Rowe, Chippenham and Eastbourne.
Madsen, H. S., Brown, B. L., & Jones, R. L. (1991). Evaluating student attitudes to second language tests. In E. K. Horwitz & D. J. Young (Eds.), Language anxiety: From theory and research to classroom implications (pp. 65-86). Englewood Cliffs, NJ: Prentice Hall.
McCroskey, J. C., Fuyer, J. M., & Richardmond, V.P. (1985). Don’t speak to me in
English: Communication apprehension in Puerto Rico. Communication Quarterly, 33, 185-192.
National Immigration Agency, MOI. (2017) Yearly Statistics, Republic of China,
Retrieved Nov. 11, 2017 from http://www.immigration.gov.tw/ct.asp?xItem=1336883&ctNode=29699&mp=1
Neeley, T. B., Hinds, P. J., & Cramton, C. D. (2012). The (un)hidden turmoil of language in global collaboration. Organizational Dynamics, 41(3), 236–244.
Onwuegbuzie, A. J., Bailey, P., & Daley, C. E. (1999). Factors associated with foreign language anxiety. Applied Psycholinguistics, 20(2), 217–239.
Oxford, R. L. (1999). Anxiety and the language learner: new insights. In Jane Arnold (Ed.) Affect in Language Learning. (pp. 58-67). Cambridge: Cambridge University Press.
Oxford, R. L. (2015). How language learners can improve their emotional functioning: Important psychological and psychospiritual theories. Applied Language Learning, 25, 1-15.
Pertaub, D. P., Slater, M., & Barker, C. (2001). An experiment on public speaking anxiety in response to three different types of virtual audience. Teleoperators and Virtual Environments, 11(1), 68-78.
Price, M. L. (1991). The subjective experience of foreign language anxiety interviews with high-anxious students. In E. K. Horwtiz & D. J. Young (Eds.) Language anxiety: From theory and research to classroom implications. Englewood Cliffs, NJ: Prentice Hall.
Ratanasiripong, P., Sverduk, K., Stanton, D., & Neale, H. (2003). Setting up the next generation biofeedback program for stress and anxiety management for
college students: A simple and cost effective approach. College Student Journal, 44, 97-100.
Robinson, P.C. (1989), “ An Overview of English for Specific Purposes,” In H. Coleman (ed.), Working with Language: A Multidisciplinary Consideration of Language Use in Work Contexts, 395-427, Berlin: Mouton de Gruyter.
Schwarzar (1986) (Ed.), Self-related Cognition in Anxiety and Motivation. Hillsdale, NJ: Erlaum.
Scovel, T. (1978). The effect of affect on foreign language learning: A review of anxiety research. Language Learning, 28, 129-142.
Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists Press.
Strevens, P. (1988). ESP after twenty years: A re-appraisal. In M. Tickoo (Ed.), ESP: State of the Art (pp. 1-13). Singapore: SEAMEO Regional Centre.

Su, S.,, H. C., & Fahn, R. L. (2007). Toward a process-oriented ESP course design for the EFL nursing professionals. Proceedings o f 2007 International Symposium on ESP and Its Application in Nursing & Medical English Education (pp. 325-341). Kaohsiung: Fooyin University.
Suliman, W.A., Tadros, A. (2010) Nursing students coping with English as a foreign language medium of instruction. Nursing Education Today, 31 (2011) p.402-407
Taiwan Tourism Bureau, Ministry of Transportation and Communications. (2016). Yearly statistics. Republic of China. Retrieved 11. 15, 2017 from http://admin.taiwan.net.tw/statistics/year.aspx?no=134
Tallon, M. (2006). Foreign Language Anxiety in Heritage Students of Spanish: To Be (Anxious) or not to Be (Anxious)? That is the Question (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3245300)
Thompson, L. E. (2007). Picture this: Language Barriers coming down: New Jersey distributes illustrated communication boards to help patients tell nurses what’s ailing them. Nursing Spectrum New York & New Jersey Edition, 19A(26), 12-13
Thompson, L. E. (2008). Picture this: Language barriers coming down: Capital Health System is part of a New Jersey initiative that uses posters to help patients tell nurses what’s ailing them. Nursing Spectrum Philadelphia State Edition, 17(3), 18-20.
Tsai, P. H. (2001). An Assessment of English Needs of Nursing Students and Professionals. Selected papers from the Tenth International Symposium on English Teaching (pp. 608-620). Taipei: Crane Publishing.
Von Wörde, R. A. (2003). Students' perspectives on foreign language anxiety. Inquiry, 8(1). Retrieved October 20, 2017 from http://www.vccaedu.org/inquiry/inquiry- spring2003/i-81-worde.html
Wang, H. H., Lin, M. L., Yang, Y. M., Tsai, H. M., & Huang, J. J. (2011). The effects of group health education on childbearing knowledge, attitude, and behavior among Southeast Asian immigrant women in Taiwan. Midwifery, 28(6), 754-759. http://dx.doi.org/10.1016/j.midw.2011.07.007.

Walton, J. M. (1981). Biofeedback: A proposed model for the treatment of teacher anxiety. The Personnel and Guidance Journal, 59-62
Woodrow, L. (2006). Anxiety and speaking English as a second language. RELC Journal, 37(3), 308-328.
Wu, L. F. (2005). ESP vocabulary learning and teaching. Proceedings of 2005
International Symposium on ESP and Its Application in Nursing & Medical
English Education (pp. 99-108). Kaohsiung: Fooyin University.
Wu&Lin (2014). Anxiey about speaking a foreign language as a mediator of the
relation between motivation and willingness to communicate. Perceptual and Motor Skills, 119(3), 785-798.
Yang, M. Y., & Su, S. M. (2003). A study of Taiwanese nursing students’ and in-service nurses’ English needs. Journal of Chang Gung Institute of Technology, 2, 269-284.
Young, D. J. (1990). An investigation of students’ perspectives on anxiety and speaking. Foreign Language Annuals, 23(6), 539-553.
Young, D.J. (Ed.). (1999). Affect in foreign language and second language learning: A practical guide to creating a low-anxiety classroom atmosphere. Boston: McGraw-Hill.

REFERENCE (CHINESE)
王玉媚 韓錦樺 黃美智(2007) 通譯員--搭起醫護人員與外籍病患溝通的橋樑
護理雜誌。54(4) ， 72-77。
呂秋慧 吳巧鳳 李秀蘭 余文彬（2009）。 降低門診護理人員使用溝通困難度， 志為護理，8(6)，87-96。
高美華 陳崇瑄 張美惠 黃琴惠（2007）。 提升產房護理人員常用英語能力之專案。長庚護理，18(4)，561-572。
蕭菁、 陳建和、 譚慶鼎(2009)。旅台外籍人士就醫期望，就醫感受與整體滿意度關係之探討。醫護科技期刊，11(3)，159-170。
陳永皇(2002) 台灣外語學習者之外語焦慮與英語能力的關係。未發表的碩士論文，國立高雄科技大學應用英語所。
蔡文正、 龔佩珍、 陳綾穗(2001). 外籍勞工滿意出入境設施英語服務。2006年11月14日取自http://web.zhes.tc.edu.tw/vicky/9212/news92120106.htm
蘇文青 、 嚴貞、 李傳房(2007). 符號學與認知心理學基礎理論於視覺設之運用。人文暨社會科學期刊，3(1)， 95-104。