Overview of the Nursing Students' Needs: The Initial Step in Designing English Instructional Materials

: Numerous factors influence students' learning outcomes. Among them is the teaches' use of high-quality instructional materials. Essentially, teachers provide materials to assist students in comprehending the material on a subject to reach the goal properly. When teaching English to nursing students, materials should be based on the students' unique needs, which are addressed in English for Specific Purposes (ESP). This research aimed to describe nursing students' needs for English Instructional Material in University context. This study employed mix method. The data collection techniques used were document, interview, and questionnaire. The document analysis revealed that the learning materials did not meet the needs of nursing students seeking to advance their careers. Additionally, the questionnaire and interview analysis results demonstrate the critical nature of developing English teaching materials for nursing students. As a result, English teaching materials for nursing students are needed to assist them in mastering the English language skills necessary to support their professional careers.

al., 2019). As Brown (Brown, 2006) stated, a teaching theory consistent with a shared understanding of students and the subject matter to be studied will point the way to a successful procedure in days provided to students under various specific learning context constraints. In this case, the lecturer should provide effective teaching materials that directly impact the learning process and the students' learning outcomes.
Generally, lecturers in the Nursing Department use books or modules of General English to teach their students. Students are expected to comprehend general English rather than master health science terminologies or communicative competence (Crawford & Candlin, 2013). The materials were also underdeveloped and continuously used by the lecturers over in years. Therefore, it is necessary to develop ESP-based materials to improve the overall quality of the teaching and learning process in the Nursing Department so that reliable and competent human resources in their respective fields can be produced and utilized. The most important criterion is that ESP is almost always goal-directed (Hasan J. R., Habibie. A., Ismail. A.K., 2019). The need analysis process, which aims to determine as accurately as possible what students should do through the media, serves as the foundation for the ESP course (Robinson, 1991).
Typically, instructional materials are those materials that are integrated into textbooks, modules, audio, video, and other learning sources, among other things (Lau et al., 2018a).
Teaching materials can be divided into two categories based on their subject matter: materials specifically designed for learning and materials that are not explicitly designed for learning but can be used for education (such as newspaper clippings, News, film, etc.) (Richards, 2010). In terms of its function as a media, teaching materials can be divided into printed materials, audio, multimedia, and web (Lau et al., 2018b). In this research, the researchers will mainly investigate the students' needs then design the teaching materials for nursing students that contain General English materials and ESP-based materials.
ESP is a general term that refers to a method of learning English with a specific purpose tailored to the needs of a particular science field or occupation (Nimasari, 2018). Hutchinson and Waters define ESP as an approach to learning a language based on the learner's needs (Hutchinson & Waters, 1987). Basturkmen said that the stage where the ESP teacher identifies language needs and what special skills the learner needs is called needs analysis (Basturkmen, 2010). Chatsungneon & Paweena stated that the three main factors of the development of the ESP program are (1) the improvement of the need for specific professional English learning, (2) the improvement of language, (3) the improvement of learning method and strategy (Chatsungnoen & Paweena, 2015). Moreover, they stated that the particular traits of the ESP program are as follow: 1) Authentic Materials; The specific goals of the ESP program that focus on students' need and their career support require the use of authentic materials.
2) Orientation to learning objectives; An ESP program predominantly refers to role-playing based on the communication context. For instance, in the English for Nursing subject, the students are asked to perform a simulation about asking-answering the patient demographic data.
3) An ESP program is adjusted to the need and its function.
When composing an ESP-based learning material, close collaboration between an English lecturer, an educational expert, and a science lecturer is necessary (Wang et al., 2019). These are the procedures that the researchers will execute to design learning materials that the lecturers have never accomplished in the Universities of Gorontalo province. The steps are designing the syllabus, selecting and organizing materials, and planning learning activities. It refers to Bracaj statement about the essential points that have to be considered in developing ESP-Based materials (Bracaj, 2014), as follow: 1) Selecting material; Good material should be taken from various sources, and it has to be able to develop language skills simultaneously. It also can exemplify learning activities.
2) Learning activities; Learning activities are closely related to the selection of materials.
The most important thing is that all the activities should be suitable for learning objectives.
3) Learning environment; An ESP lecturer has to create an attractive learning environment that can significantly motivate the students to achieve learning objectives.
In developing ESP materials, the team has to focus on the activity of students (learnercentered).

B. RESEARCH METHOD
In this research, the researchers conducted mixed-method. According to Creswell, the Mixed method involves collecting and mixing or integrating qualitative and quantitative data in a study (Creswell, 2017).
The researchers evaluated the documents, such as the syllabus and learning materials, to see the adjustments, activities, and objectives. The researchers also interviewed six English lecturers in the nursing department and distributed questionnaires to nursing students to know the students' responses to developing ESP-based materials. The questions of the needs analysis questionnaire were in the form of multiple-choice. It consisted of 27 questions. The purpose of the questionnaire was to find out the target needs and learning needs of students.
Meanwhile, the questionnaire of materials evaluation was proposed by using four options based on the Likert Scale that is frequently used in asking for opinions and attitudes (Joshi et al., 2015). They were four points strongly agree, agree, disagree, strongly disagree. The subjects in this study were students Department of Nursing from Three Universities in Gorontalo. The number of students at the Universitas Negeri Gorontalo is 40, the Universitas Muhammadiyah Gorontalo is 30, and 40 Students of Politeknik Kesehatan Gorontalo.

The Result of Documents Analysis
The aspects evaluated on English teaching materials and lesson plan for Nursing are the suitability of the material with the expected competencies. The usefulness of the material with the evaluation of the assessment, the presentation of illustrations supporting the material, the use of learning media, language rules, assignments, and exercises based on the expected competencies.
Based on the evaluation results conducted, in general, it was found that there were some similarities in the characteristics of teaching materials used by teaching lecturers of English for Nursing at universities in Gorontalo. The result of the analysis of the documents is presented in the following table.

The Result of Questionnaire Analysis
This section will be the basis for analyzing student responses to the development of Teaching Materials / Learning Modules for English for Nursing.

Diagram 1. Frequency of Student's Need of English for Nursing Materials
The diagram above shows that as many as 18% -77% of students assume that English learning materials related to nursing science are very crucial. Meanwhile, there are approximately 5% of students chose to disagree with this. It means most participants in this research wish to learn English learning materials for nursing science.
Diagram 2. Frequency of Students who assume that English for Nursing materials will support their Career in the future The students' materials have to be well designed to develop their skills in their job.
So that, it is necessary for lecturer to improve the quality of teaching by choosing and designing appropriate materials based on the need of the students. The diagram above 84% 16% 0% 0% 0% Do you think that English for nursing materials will support your career in the future?

Do you need to study English material that is related to Nursing science?
Strongly Agree Agree Slightly Agree Disagree Strongly Disagree shows that 16% -84% assume that material of English for Nursingsubject is meaningful for developing their professional career in the future.

Diagram 3. Frequency of Students who Assume that Speaking Material is Important to support their Career
The diagram above shows that around 22% -67% of students assume that the appropriate Speaking Material can significantly affect their professional career advancement.
Speaking skill is essential to be developed because nurses interact with the patients every time and meet local patients and foreigners. It prosecuted the nurses for speaking English well and being understandable.

Diagram 4. Frequency of the Need of English Reading Texts about Nursing
In English for Nursing, the students have to practice reading the English texts because most health book references are written in English. The students have to comprehend the English reading texts to improve their insights about nursing science knowledge.
Approximately 15% -85% of students ascribe the importance of English reading texts about nursing science. Comprehension material related to nursing is vital to be provided by the lecturer in English for Nursing subjects. The need to listen to native speakers' conversation audio can improve their comprehension and pronunciation.

Diagram 6. Frequency of the Students' Need of English Writing Material in English for
Nursing subject The diagram above shows that around 17% -81% of students wish English Writing Material related to nursing science to develop their English writing skills. The lecturer of English in English for Nursing subject has to know the students' need, especially the aspects that support their skill improvement in English.
The research team also asked for the students' English competence in English for Nursing subjects in this questionnaire. The result of the analysis is as follow:

Diagram 7. Frequency of Students' Perception about their Speaking Skill
Approximately 87% of students concede that their speaking skill is below average. There is only around three percent of students who think that they have good speaking skills. It indicates that the students are lack of practicing speaking English. A lecturer has to give chances to students to practice speaking English with exciting topics to discuss and that are closely related to nursing students.

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The diagram above shows that about 73% admit that they have Poor competence in writing in English. In the interview session, their lecturer also said that they are challenging in writing simple English text. In the book/module that the research team will design, the students will be provided materials and exercises to improve their writing skills, such as writing chronological order and report text.

Diagram 11. Frequency of Students' Perception about the Improvement of Interest in Learning English
The diagram above shows that approximately 18% -72% of students feel that English materials about nursing science can significantly improve their interest in learning English, and only about 10% of students are slightly agreeing.

Diagram 12. Students' Perception about the Improvement of Motivation in Learning
English The same thing can be seen in the diagram above that approximately 75% of students strongly agree that English material about nursing science can significantly improve their motivation in learning English. So far, the students are mostly faced with material about grammar that they think is very complicated. They wish that they will learn materials appropriate with their majority and support their professional career in the future. Based on this data, the research team will soon design appropriate learning materials in English for Nursing Students subject that can meet the target to improve the English communicative skill of nursing students in Gorontalo Province. In increasing students' interest and motivation for English learning, it should be considered to incorporate exciting topics into the English for Nursing subject. The following diagrams (13a, 13b, 13c, and 13d) illustrate students' perceptions of issues included in the English for Nursing subject materials.

Diagram 13d. Students' Perceptions about the importance of Reading Texts about
Nursing Science By the four diagrams above, it can be concluded that the students wished integrated materials about dialogues/conversation in the contexts of nursing science, interesting audio and video about nursing, basic grammar, and vocabulary related to nursing science, and reading texts about the world of nursing. Those materials aim to improve the four primary English language skills: listening, speaking, reading, and writing.
In addition, the students express the method that they wish the lecturer to apply in English for Nursing subject, as listed in the following diagrams. Diagram 14c. Students' Perception about both the Use of Book References and the explanation from the lecturer Based on the diagrams above ( 14a, 14b, and 14c), it can be concluded that the students want a meaningful learning activity. They want both the use of book references related to nursing science and the explanation from the lecturer.

Diagram 14a. Students' Perception about the Importance of Book References about
Discussing meaningful learning activities and the quality of the teaching and learning process is inextricably linked to the teacher's role in the classroom. The diagrams below depict students' perceptions of the lecturer roles they desire when teaching English for Nursing. In designing English materials that are appropriate to the students' needs, there should be considerations to its objectives, whether or not they can significantly improve their skills and English communicative competence. The following diagram is the students' perception about improving their English Language skills when using appropriate teaching materials that suit their needs.

Diagram 16. Students' Perceptions about the Improvement of Language Skills
The diagram above shows that approximately 55% of students agree that the use of appropriate teaching materials can significantly improve their English language skills, speaking, reading, listening, and writing.

The Result of Interview Analysis
In this research, the research team had interviewed six lecturers of English for Nursing subject in the Department of Nursing at Gorontalo Province.

Experience in Teaching ESP (English for Specific Purpose)
" "Most of my students have difficulty in listening and writing. For writing personal experiences, they have difficulty using correct grammar, so I really emphasize understanding Grammar so that they can produce well-structured writing." (Participant 6). This is supported by questionnaire data about students' abilities in four English skills: speaking, listening, writing, and listening skills. In speaking ability, approximately 87% of students feel that they have poor speaking skills, while only about 3% feel they have good speaking skills. Approximately 81% of students think their reading ability is very lacking in reading skills, and 11% think they have good skills. While 75% of students feel that their listening skills are not good, only about 2% of students have good skills in listening to conversations and audio in English. And lastly, there are approximately 73% of students stated that they have poor skills in writing English texts. This is also explained by the teaching lecturer, that students have difficulties when asked to write English texts, even for beginner level texts.

Discussion
English for Nursing Students subjects is essential to improve the students' English communication skills, which can support their professional career. For this reason, the students have to be equipped with good English language skills. The students also have to be exposed to appropriate language contexts, such as presenting reading text or practicing dialogue in the hospitals or other public health services.
Based on the document evaluation results, it can be seen that several aspects are still in the trimmer and good category. In the teaching materials, both handouts and modules are used. The dominant material is English grammar in general. Students are taught basic English grammar that they must master and only a few texts related to their profession as nurses. The rest are available language texts. The purpose of the English language course is essential to improve English language skills for the nursing profession, which can support the profession's quality in the future. For this reason, nursing students must be equipped with good English language skills that they can use. The context taught must be adapted to the needs of their profession, such as presenting conversational texts in a hospital or conducting patient examinations.
The general competencies of nursing students that are expected to be following the curriculum design are students who have good English competence/skills, both orally and in writing, which can support the quality of their profession. However, in the handout, the material provided is only General English material. For example, in the Vocabulary Building aspect, the vocabulary provided does not include vocabulary related to the world of health but English vocabulary in general. It is, of course, can affect the achievement of competencies that must be achieved. This refers to the statement by (Febriyanti, 2018) that the needs of students must be the focus of the English for Specific Purpose (ESP) approach and make students and their needs the primary consideration in determining the process and direction of learning to achieve effective and efficient teaching goals.
In the document evaluation, it can also be seen that the aspect of the suitability of the material with the learning design is still considered lacking. This is based on the incompatibility of the RPS prepared with the material and learning steps in the classroom. For example, in the lesson plan, it is stated that in meeting three, the material that should be taught is Asking and Showing Direction, but it turns out that what is taught in class is introducing yourself to others. This is certainly not following what is stated in the lesson plan.
The basic competence of nursing students based on the curriculum design is to master English language skills that can support their professional career development. The general English materials are predominantly given to students. For example, in vocabulary building sessions, the students are provided known English vocabularies than terminologies in health science. It can straightforwardly affect the learning outcomes. This data is supported by Robinson's statement that emphasizes the importance of needs analysis in define ESP. The definition is based on two key definitions criteria and several important characteristics aspects for ESP. The key criterion is that "ESP usually" is goal-directed. The ESP course evolves from the need analysis, which aims to determine as closely as possible what students should do through the media English (Robinson, 1991). In the third aspect, material selection and lesson plan adjustment are considered insufficient. Many topics do not match appropriately with the lesson plan. So, the lecturer has to be able to select the material based on the lesson plan.
The result of questionnaire analysis will be the basis for the research team to design English Materials for English for Nursing subjects. From the questionnaire analysis, it was found that most students wanted a material that was under the field they were studying, namely nursing. The material obtained in college supports students to develop their skills so that they can be applied in the world of work. As many as 16% -84% of students think that English for Nursing material is critical because it can support their profession and work in the future. From the four skills in English, the lowest ability is speaking. This can be sorted from the highest presentation: Speaking 87% less well, Reading 81% not good, Listening 75%, and 73% of the writing is not good. This is different from Febriany's research which in the questionnaire results, most of the students had a reasonably good ability in four skills.
Because of the lack of skills in English, appropriate teaching materials are significant to motivate students to be interested in learning English. Conversational topics about nursing, suitable reading materials, and knowledge can significantly improve their ability to understand English texts related to nursing. In the book designed by the research team, students will be equipped with writing skills such as writing Chronological Order and Report text. There should be an effort to develop English learning material to improve the students' learning outcomes because most of the students still lack basic English skills. The development process has to consider the students' needs and support their development of a professional career in the future.
Many English lecturers think that Basic Grammar is the essential aspect to be taught, so they primarily teach basic grammar to students for almost all meetings in the class. Grammar material cannot be ignored in teaching English, but we cannot use all the sessions to teach grammar. The result is the students feel bored and less motivated in learning English. This is in line with the opinion of Mackay and A.J (Roza, 2013) that English teaching at the university level that is still emphasized to the grammatical structure can make the students disappointed and become skeptical of their language skills. The students' difficulties may be due to the quality of the teaching and learning process, including the method, material selection, and activities in class. A good lecturer has to be aware more to improve their quality of teaching that can significantly affect the students learning outcomes.

D. CONCLUSION
The document analysis results indicate a need to develop teaching materials for English lecturers in the Nursing Department, as existing materials have failed to meet the needs of students. This can be seen in the students' low learning outcomes and inability to communicate effectively in English as measured by the questionnaire. The questionnaire analysis of student responses regarding the development of ESP-based English teaching materials also reveals that students desire English instruction tailored to the conditions they will encounter in the workplace. They expect a learning environment that is compatible with their professional background. According to the research findings, it is hoped that ESP-based English instruction takes several critical factors into account when developing learning designs and instructional materials. It encompassed student utility and potential, scientific structure, and material relevance to student needs and environmental demands, most notably those associated with the world of work.