Indonesian EFL Nursing Students ’ Learning Process : Obstacles & Expectations

Nursing students learn English language as specific purposes (ESP). They should be able to learn do communication in English to be a professional nurse. However, learning English was not an easy game to do. There will be some difficulties and adjustment along the learning process. Thus, the research is aimed at. A descriptive qualitative methodology as the foundation to investigate the obstacles in the learning process among Indonesian EFL nursing students and to examine the nursing students’ expectation in English learning process. Open-ended questionnaire and semi-structured interview would be the instruments to gain support some information. About 24 respondents and 3 of representatives of 7 th semester nursing students would be the respondents. The result showed that besides grammar, structure, and tenses application, four skills implementation, lecturer’s effects, and institution’s regulations (curriculum management distribution, time schedule management, connection problem between staffs authority and lecturer) would be the major obstacles. Meanwhile, better communication among nursing institute stakeholders about schedule, time management, curriculum and modifying classroom activities could be the better expectation emerged to reduce the EFL nursing students’ obstacles. This research concluded that adjusting the regulation for the English subject curriculum and altering nursing students to encourage and motivate themselves to learn about English could change the outcome and situation to build pedagogical implication and to plan more comprehensive English learning activities.


Introduction
Learning language needs process and time.Mastering other languages beside native language is one of advantageous in this globalization era.(Abidin, Pour-Mohammadi, 2012) mentions that our ideas, hopefulness, and expectation can be achieved by perceiving language.Besides, enhancing economic and social feature, learning foreign language can also link to the "real" communication among the people around the world and giving more comprehensive understanding of our native language (D'Astoli, 2016).
To learn and to acquire foreign language needs effort and many challenges may occur along the process of learning.Socio-cultural, psychological, educational, academic, and philosophical are probably give some obstacles to the learning process of English for EFL learners (Khan, 2011).In addition, learning English for EFL learners needs more time and space, because the learners have less opportunity to exercise English as the target language outside the classroom.Furthermore, Alaraj (2016) investigates external problems and difficulties among EFL students in Saudi Arabia through interview to gain students' feelings and thoughts.In his study, teaching and learning English to EFL student is not merely focus on one particular topic, but should cover the whole aspects in English need abilities; try to establish speaking vocabularies and reading comprehension and comprehend both spoken and written language as well.Additionally, EFL students are lack of productive skill; writing and speaking as well as receptive skill; reading and listening.That is why the students are difficult to understand several topics, manage some instructions in the manual books, medicines, and food, and respond to a telephone call, short conversation.Additionally, the challenge is also appear from individuals or the students themselves.Sometimes, they lack of confidence and feel demotivated when they enroll to the university or institution level of education.University or institution intends to establish students' professional development of a "self-learning" approach to create a proficient students and gain better learning experience for them who are prepared to ready for work (Meehan-Andrews, 2008).English language is not only used in the primary educational backgrounds, but also it is used in professional field of study.The need for English as a complementary language drives institutes and higher educational schools to provide English language as one of their curriculum programs.Further, Hashwani (2008) points out personalities, attitudes, anxiety, motivation, aptitudes, intelligence, and age are the aspects that affect foreign language learning.Student's attitude also determines the most important element which gives impact on learning a language (Fakeye, 2010).
Nursing institutes is one of non-educational background which applied English as foreign language as supplement lesson to support EFL nursing students to comprehend English in general and specific.Then, mastering English language among EFL nursing students can also help them to communicate and to build networking when they decide to continue study or to work abroad.Even though, English is a complementary lesson taught in nursing institute, but it is very essential and requirement for nursing students to construct final paper abstract in English language.Nevertheless, learning English for Indonesia EFL students is one of particular issues that should be accomplished.The curriculum facilitation, learning outcomes, and lack of related research about the implementation of English language in ESP for EFL nursing students in Indonesia are still rare.This study hopefully could cover the insufficient literature for research especially in revealing the challenges and EFL nursing students' expectation in developing better language needs and focus on English for professional nurse in Indonesia.In addition, the study would also contribute to the undergraduate teachers or nursing institutions to construct better learning planning program for their students to prepare not only to work as professional nurse, but also communicate in various languages to improve their own self-esteem and self-image as the positive values to gain better position as a nurse.Moreover, (Tam Truong Donnelly & Hwang, 2009) describe that most of EFL students, especially in nursing subject have difficulty to learn English because of language and cultural differences which relate to the lack of English skills.However, nursing students are eager to learn and get closer with English nursing lessons, master English skills, and connect with the professional nursing practice in general and in English communication with the others.
Additionally, Akbari (2015) also mentions that another EFL nursing students obstacle in learning foreign languages especially English for Iranian is the environment does not support the students to improve and make familiar with the native language because they only learn English in the classroom with the imitation of the time and no chance and program which lead them to learn English outside the classroom.They should manage themselves with the others to communicate and study English profoundly.Moreover, some regions are not simply connected with the technology, mass media, social media, and up-to-date information toward foreign languages.Some students may have difficulty in acquiring and adapting new languages because of the environment background.Sometimes, family cultural background also contributes to the students to learn foreign language.Some parents are so protect with foreign language because of fanatic religion and deeper cultural background which foreign languages are forbidden to be learned.Thus, the limitation of the study covers two main parts of aspects; internal aspect which is supported by nursing students' obstacles based on English prior obstacles as follow grammar, structure, tenses four language skills, vocabularies, etc.Meanwhile, for external aspect comes from motivation, lecturer's roles, environment, nursing students' characters.
Besides, research about EFL nursing students' obstacles and expectations in Indonesia scope of study is still rare.Therefore, by displaying some difficulties and suggestion in learning EFL to nursing students can contribute to the English language development especially in constructing teaching concept, materials, and goals in nursing institute.Further, lecturers can get insight about the difficulties and expectation on EFL nursing students in Indonesia, so the lecturers can develop better teaching instructions and activities for EFL nursing students in the classroom to achieve language needs.Then, the study can also contribute to the literature development on how to deal and cooperate with EFL students in general and nursing Indonesian Journal of English Language Teaching and Applied Linguistics, 2(2), 2018 students in particular for teaching aids, teaching development, and teaching management.

English for Foreign Language
EFL is stands for English as a Foreign Language which means that English language is not the primary language that is taught or learned at schools (Gebhard, 2006).In addition, (Harmer, 2007) described that EFL is used by people/students to learn language both English and any other languages to communicate with different people all over the world without removing their native language.Moreover, to engage with students, teacher should consider several aspects and characteristics of the students themselves.The research is more concern in taking respondents of undergraduate students of 7 th semester level which have range of adult learners' category between 21-23 years old.Several characteristics of EFL adult learners have been specified in general, as follows employ with abstract thinking skill, having a lot of life experiences, more discipline and know the needs for learning particular materials, having many expectation in dealing with classroom activities.Somehow, students' critical thinking can drive into aggressive character to the learning process or something that different from their expectation.It can cause into both positive and negative outcome either the students can be motivated by giving positive feedbacks or they will feel demotivated when the expectations are not being responded by the decision makers.The students also can be anxious and under-confidence in learning language if their efforts are fail and having unexpected experience in the classroom.

English for Specific Purposes (ESP)
English has broader senses of language complexity.English language itself has been used for several items, terms, and practical application of the world's field of study.To determine difference context and meaning.It is hard to identify language from one to another if the common ground is different.It may happen misunderstanding and misconception among the speaker and audience.Therefore, in early 1960's ESP (English for Specific Purposes) grew to accommodate the demand of ESP degree of MA (Birmingham University and Aston University, UK) and to provide students from different country all over the world to learn specific English purposes in United Kingdom at that time (Anthony, 2016).
Generally speaking, ESP or English for Specific Purposes has been drawn profoundly described by (Dudley-Evans & John, 1998) as a tool to distinct specific necessities of the learners and appropriate learning methodology in the classroom and to scope some terms into target language of specific terms of structure vocabulary, grammar, lexis, register, and discourse.In addition, ESP is specifically being taught in higher education level as follows in university level, but from certain countries like in Indonesia, ESP is learned from vocational school level.The need for communication in particular terms of field of study in workplaces for employee drive ESP to play its role to scaffold English as specific communication language in order to give some certain target language necessity, as follows English for Engineer, English for Science, English for Tourism, English for professional nurse (medical), etc. (Waters, 1987).

English for Professional Nurse
Furthermore, this research is mainly focus on English for professional nurse.The intention of English for professional nurse are to provide learners or professional workers to be able to communicate with medical and nursing studies, to accommodate learners not only to study terms in English vocabulary in medical and nursing, but also they can learn grammar, structure, and four skills of English as complementary basic level to comprehend and to implement English in their environment or in the classroom.Thus, the goal of English for professional nurse can be drawn as follows (1) to give comprehensive information to the nursing students, (2) to challenge nursing students' ability to practice English, (3) to provide specific materials based on the need for nursing students, (4) to enhance students' motivation and courage to show their ideas and opinion toward nursing topic in English (Savigne, 2004) Previous studies also embedded in this research to give more comprehensive perspective from various researches to strengthen the result of the study related to the EFL students and nursing students' obstacles in learning English language.Furthermore, Devos (2014) cited in Richard & Farrell (2005) said that language materials are defined as something cannot be judged and be predicted because its dynamic movements which comprise different respondents and different situations that can change instantaneously and it is impossible to record the movement all the time.In addition, it is rather difficult to observe critically and efficiently an EFL classroom because of its complexity (p.17).
Foreign language learners tend to have different perspective about learning foreign language.The material contents, the classmates, classroom circumstance, teaching guidelines, and the teachers might be one of the burdens in compelling foreign language in the classroom (Horwitz, 1988).
Besides communication and students' lack in understanding particular items in English term of nursing stuff, there are some other obstacles that occur during English language learning process among EFL nursing students.Müller (2011) mentioned that EFL nursing students have difficulties in acquiring vocabulary in nursing stuffs and its definition, need time to process spoken language and respond to addressee's feedback, so they sometimes ask for slower intonation and speed of speaking, hard to understand textbook or reading, and somehow being devastated when they have problem and stuck with their communication among the others.In line with that, Hou (2013) explained that English language is important part to be taught and be learned in medical field of study.The use of medical terms, medical medicines, and medical global communication could be found by professional nurses in global or international hospital.Thus, "it's quite essential to have good English ability for those people standing in the front line of healthcare, in particular, the nurses."Yet, Taiwanese EFL nursing students were anxious on their English performance.The findings shows that students' beliefs affect Taiwanese EFL nursing students' anxiety and hopefully the study would give better teacher-students learning activity especially for EFL nursing students.Moreover, another study by Khan (2011) showed that there are many challenges in teaching/learning English in Saudi Arabia.The problems occur when teaching English for foreign learner in the country which full of authorities and policies by the kingdom's government.The study was dividing the challenges by three categories; teacher's perspective challenges, learners' perspective challenges, and management perspective challenges.From the teacher's perspective, the challenges in teaching EFL learners in Saudi Arabia as follows teacher's qualifications, managing self-directed to the learners' background, teaching style including methodologies and techniques used in the classroom which different from teaching Arabic language that very popular and fully supported by the people and the government.Meanwhile, the learners' challenges would likely to have problems with grammar, tenses, and structure stuffs, less motivation and attitude toward learning English, and workload for some learners.Then, from the staffs or management challenges were more likely to be the work as professional, lack of using technology, and somehow ignore learners' complaints.Bayar & Solak (2015) also pointed out that by using qualitative methodology in identifying 22 Turkey students in relation with current challenges in learning English language were resulted in the problems in managing four language skills of English which were more difficult than mastering English grammar, structures, and tenses.Further, this study also investigated to the teacher who should consider learners' characteristics, their backgrounds, and strategies in teaching such materials of English language.Then, this study also suggested the foreign English teachers to take some trainings to upgrade and enhance their ability and professionalism to deliver language skills and materials to the students in the classroom.Definitely, to cover all those challenges, additional kits such as using video, pictures, course books, and internet-based teaching which may be selected to create better understanding and to raise students' interest in learning and enjoying English language subject.Indeed, some breakthrough efforts have been conducted in developing English language skills in foreign language countries, but there were still many challenges which burden the teaching-learning process in EFL classroom.Fareh (2010) also examined in Arab world's EFL students that conducted by using observations instrument to gain information from videos recorded by hundreds of English language teachers and making contact with those teachers during training workshops.The result stated that at least there were eight challenges that have been collected by the researcher as follow insufficient teaching methodology, more teacher-centered than students-centered, students' innate characters (impolite, unable to learn, to think, uneducable, lack of writing skill), confusing of choosing the approach whether using fully language skill approach or language skill needs approach, lack of developing specific skills (critical thinking, morale values, creative attitudes, etc.), problems in teaching materials' sources, appropriate assessments, and experiences to English language.

Research Methodology
The research is conducted by using descriptive qualitative research since it is focuses on collecting, organizing, and summarizing information on the problem under investigation to make complicated things simple and understandable (Hamied, 2017).Therefore, this research is aimed at investigating the obstacles in the learning process among Indonesian EFL nursing students and examining the nursing students' expectation in English learning process.
This research was conducted in a private nursing institute.About 24 nursing students were taken action as the respondent to fill in the questionnaire sheets.The nursing students' grade were from the 7 th semester students because they were rich with experiences and have been through the ups and downs in learning English from the first to the seventh semester.Then, 3 purposively respondents were chosen because from the lecturer's observation, they have better critical thinking than the rest of the respondents.Thus, those 3 respondents could contribute to answer several questions on face to face interview to complete the data to be analysis.Those 3 participants' names were all pseudonyms.
Furthermore, this research was using two kinds of data instruments.First, the researcher used open-ended questionnaire to the nursing students to gain general information regarding to the various obstacles which occur in the English learning process in the nursing institute.Then, a semi-structured interview was conducted to achieve more comprehensive information related to the learning obstacles and students' expectation in how the English teaching and learning processes should be formulated to improve better result in English subject.

EFL Nursing Obstacles in Learning English
After taking some instruments to gain information from English nursing students in private institute, there are three main obstacles that occur from the questionnaire instrument which recorded from 24 respondents of 7 th semester.The questionnaire resulted from the first research question which reveal EFL nursing obstacles in learning English.There are three main obstacles, as follow:

General Obstacles
The finding in the table below showed the big picture of nursing students' obstacles in learning English in the classroom.The finding showed that about 24 nursing students have selected grammar, general and nursing vocabularies as the top of the major obstacles in general issue.Meanwhile, 9 and 12 students chose tenses and pronunciation.Furthermore, few strengthen motives also showed from the several parts of interviews that nursing students' obstacles are addressed to grammar, structure, and tenses.Olive, (L18-19) pointed out that learning grammar and tenses need to understand each patterns for each condition.It means different treatment for the spoken and written forms.However, there was an interesting statement came from the interview session that attract another fact of classical obstacles (vocabularies, grammar, and structure).
"The hardest one are grammar and tenses.Because it should be constructed with some patterns and rules and so far, I don't find any suitable methods which make me understand grammar and tenses (Pam: L11-13)." The respondent felt difficult to understand those above obstacles because the respondent didn't find any effective methods.Moreover, the respondent seemed that the lecturers have not given any best solutions to overcome the classical obstacles.It showed from the part of interview's conversation below (Pam: L14-15): I : Was the lecturer's explanation unclear?Pam : Yes An interesting part in the finding showed that a lecturer's explanation in the classroom was not quite clear and the respondent confused because of the lecturer's teaching method or materials was not effective in the classroom.

Material Obstacles
The study also limited the sub finding into material obstacles because according to the pre interview, most of the students openly explained that become a professional nurse was not the major expectation after senior high school graduation.In addition, cultural and knowledge background also strengthen that they lack of motivation in learning English nursing materials.Unsurprisingly, the questionnaire resulted that 20 nursing students felt difficult to follow the materials about English for nursing in the classroom.The materials were too many and too compact which cause a difficulty among the students to absorb the materials' content.
"There wasn't any intertwine between one material and the others.There is no clear system in planning and implementing English learning from the first semester.For example, Basic I with its materials, continue with Basic II with the implementation or Basic I development.There is no exact regulations regarding English materials in the classroom.Those situations make the students uncomfortable because of unregulated materials.It seems that the materials are "random" so that we understand it "randomly" also.There are some differences from previous until recent lecturers." The unclear material contents also be determined by the ruined-system provided by the institution curriculum authority which deliver some overlaps in managing materials system when the shifting of lecturers happen.Hence, the students felt difficult to learn the materials because of its repetition, materials overlapping, and unclear learning implementation from one semester to another.

Four Language Skills Obstacles
Meanwhile, to make the result more comprehensive, the study also divide the nursing students' obstacles into four language skills.It is important because in learning process in the classroom, the lecturer also insert four language skills as the material embed in the classroom activity to gain students' language needs.The table below showed the amount of four language skills difficulty by the students according to the questionnaire.Basically, managing four skills in English, somehow difficult to be maintained as an EFL learners.The first language exposure, the characteristic of foreign language which is mostly used in the classroom context only.The result showed that nursing students have difficulty in covering the four skills.The first skill noted that 12 respondents have difficulty to understand the materials in listening skill.Meanwhile, 17 respondents felt that it was not easy to share ideas or do conversation in English when they have a speaking skill session.The profound questionnaire result also stated that EFL nursing students are difficult to speak up their mind and to share their opinion through spoken language or even conversation in the classroom.Then, about 18 respondents agreed that the difficulty to jot down the ideas into the written form would be a major problem in writing skill.Finally, 15 respondents recorded that limited vocabularies affected to the smoothness of reading comprehension activity.The result showed that the nursing students are difficult to comprehend productive skills (writing and speaking) rather that receptive skills (listening and reading).

The Lecturers' Shifting Effect
One unique feature that emerge in the data information finding taken from both instruments; questionnaire and interview.There is a situation that English lecturer in the institution changing rapidly.It seems contribute to the students' obstacle in learning English subject in the classroom.Further, the questionnaire revealed 11 respondents thought that some lecturers were static and monotonous in teaching EFL nursing students.It has been revealed from the respondent's comment on the lecturer's changing that: "…I didn't really like the first lecturer because he taught English from the very basic skill which was bored.But, for the scoring mechanism, the first lecturer was easier than the second one.It reflected from the pre-examination and the examination itself was more flexible to be conducted by the first lecturer.Presumably, it gives benefit for our GPA, but I felt guilty at that time because we got a good mark, but we got nothing (English materials).So, the students were worried about the lecturer's shifting would influence their GPA (Olive: L3-8)." The above description, at least there are two major points which explain the difficulty situation from the shifting lecturers.First, the students dislike the first lecturer (the very beginning one) because the teaching material contents were derived from the very basic English which may be good for the beginner who does not master English subject properly, but somehow, it could be bored when almost all the students master the very basic English subject when they were in senior high school.On the other hand, the scoring mechanism by the first lecturer seems easier to get a good mark without any effort or even any scoring parameter than the other lecturers.It made the students worried that they would not get any good (and "easy") score in English subject because more or less, it would affect also to their GPA.Nevertheless, the students realized that everything is not always determined by the scoring result.It is better to have English skill for the sake of the students' supremacy to face the real world as professional nurses (Olive: L9-11).
Then, 10 respondents chose that teacher's proficiency to deliver some particular materials also another obstacle in learning English.The interview information from Pam: L23-25 stated that: "… I think there are various styles of lecturers teaching in the classroom.Some of them only teaching and teaching, giving topics, without giving chance for us to rest and grasp the meaning." The information above showed a big description of a major issue by shifting the lecturer for so many times.The situations were changing rapidly from one lecturer to another.It makes the nursing students harder to adapt with one lecturer.It is quite difficult for them to stay and stick with one lecturer, then suddenly he/she is replaced with another lecturer or "disappeared".However, there is a bright side lie behind the lecturers' shifting activity in the institution.From time to time, the students can judge whose learning process, learning activities, and lecturing that give benefits, strengths, or even somehow lacks to their own English learning experience so far.Moreover, Susan (L11-13) in the interview session also added that every lecturers have their own styles of teaching and delivering the materials.The recent lecturer gave some games activities which can enhance vocabularies and create fun circumstances during learning English.Meanwhile, Olive (L13-15) mentioned that the new lecturer provides new teaching materials which encourages and also motivates the students to improve and to learn more about English subject.

Non-technical Obstacles
This study noticed two main non-technical obstacles; time management and nursing students' confidence.Ten nursing students claimed that time management is one of the obstacles in implementing English lesson in the classroom.Randomly reschedule the lesson is one of the problems that it is hard for the students to manage over time.Meanwhile, ten nursing students also stated they have problem with confidence.It also relates with students' cultural and knowledge background which contribute to the students' ability to absorb the lesson, enjoy the materials, and follow lecturer's instructions.

EFL Nursing Students' Expectations in English Learning Process
To accommodate better learning process, profound information should be collected in this research by taking interview to some students.The interview result showed that the participants have elucidated their expectations regarding to the learning English in the classroom.There are two major points resulted from sub theme description below.

Reformation of Institutions' Regulation and Smooth Shifting of Lecturer
It is important to have clear guidelines and procedures in one particular institution.It leads us the stability on how something should be run and done.This sub theme showed that some participants concern to the "rules of the game" should be reconstructed by the nursing institution's authorities.They expected to have a better regulation on how the learning process should be done.Some participants thought that: "I would say that better learning English should be done by making step by step movement and intertwine materials from one to another semester.From the easiest to the most complex one.… if along the way of teaching learning process the lecturer can't continue his/her teaching, the STIKes authority should handle it and give brief description to the new lecturer in order to avoid material repetition and boredom among the students.The point is wellcommunication between lecturers and curriculum authority at STIKes." (Susan, L24-29).
The students feel uncomfortable and bored when the recent lecturer teach the same materials.It indicates that there is no preparation in the concept of bridging knowledge and materials of teaching from the curriculum authority to the recent lecturer.
Furthermore, another result showed that EFL nursing students worried about the time management conducted in the STIKes institution.The information revealed that the time schedule applied in the nursing students' wasn't quite effective enough.
The schedule was tight because the STIKes authority arranges English subject a half day in a row from 8 AM to 12 PM.The students feel tired and exhausted to learn 4 hours without break.It is stated by Pam: L20-22 that: "… the time management, it is not quite efficient with the time allocated from morning time until middle of the day.It is very exhausted with a nonstop time learning and I feel uncomfortable with that." Thus, better communication is very essential to be developed in STIKes institution to gain better understanding and simultaneous teaching and learning process in the classroom.Therefore, the EFL nursing students expect to have a clear regulation regarding to the materials that are taught in the classroom.In addition, the nursing students hoped that the institution should care about the time management and the roles of managing the lesson perfectly.It is very important because indirectly it will affect also to their learning process management to become a skillful nurse who is able to communicate foreign language well.
Another consideration that the EFL nursing students have been proposed in the interview session and also still in line with the first expectation above was the trend of lecturer shifting which happened for so many times.Truly, the nursing students were not really affected with the shifting of lecturer in their English learning process, but it is better for the curriculum development authority to set up some plans in order to minimize material repetition, miscommunication, rigid adaption among the new lecturer and the students.
"… if along the way of teaching learning process the lecturer can't continue his/her teaching, the STIKes authority should handle it and give brief description to the new lecturer in order to avoid material repetition and boredom among the students.The point is well-communication between lecturers and curriculum authority at STIKes.(Susan: L26-29)"

Fun and Up-to-date Learning Activities
Nursing students also really concern about the English material contents which are taught in the classroom.It is not quite surprising thought since they have been faced many unpleasant moment with English subject.The learning mechanism in technical institutions as follow medical (nursing), engineering, arts, music, etc. have different curriculum, classroom activities, content of materials which are more practical than theoretical tend to place an additional subject such as English is considered to be put as second priority or complementary subject which is not quite interesting than the primary one.Therefore, some nursing students really recommended to reconstruct the English material contents to be more fun and up-to-date with today's trends.
The content of materials should also be embedded by interesting materials outside the English for the students (Pam: L25-26) It is clear that from the interview above that the interesting materials perhaps can be one of the solutions to attract another students to learn and more focus on the English subject.When the learning activities more interesting, more comfortable, and easier to absorb its materials, the enthusiasm will come and drag the students to put their attention more to English subject.
More comprehensively, Olive (L24-28) also strengthen that many modifications should be made to give some brand new packages of English materials to the nursing students.Games activity and "hot" discussion should be included on the classroom learning activities so that the obligation to fulfill 4 (four) credit hours in the classroom will not make them feel tired and bored because of the lesson.In addition, another adjustments in the learning process can be done by inserting in the four skills activities such as listening to the songs the try to fill in the gaps from its lyric or guessing out the meaning behind the songs.Movie discussion from many aspects related to the topic, and reading comprehension which also still embedded with the nursing stuff as well.It is not merely about abstract things about grammar and structure which has been stated from the textbook, but more about practical things in how English is used and applied in daily activity, and nursing environment in particular.Nevertheless, some lecturers were given up-to-date learning activities with engage through classroom fun learning by using multimodalities such us pictures to help nursing students' visualize some tools, videos to encourage students to understand more about particular activities, and games to refresh students' cognitive to be more creative in thinking which also stated by Solak & bayar (2015) on their research about challenges in EFL students.

Nursing Students Positive Attitude and Perception toward Leaning English
Another finding which is interesting to be discussed is about nursing students' positive attitude and their perception toward learning English which can be a consideration for further research to be analyzed.
It has been a common that English subject which is taught in nursing institute somehow become the second priority or complementary subject for some students and become secondary consideration sometimes by the institutions' stakeholders.English subject is put the same as another complementary subjects such as Indonesian, civics, religion, etc.Some nursing students are not feeling passionate to pursue the importance of classroom activities, the benefits of English subjects, and tend to ignore the class session.As said by Pam (L26-30) that even though, right now English is not very important to learn in the institution, but it will give a long term effect for a professional nurse compete in ASEAN Free Trade and ASEAN Economic Society from the others job seekers around the ASEAN region.From this situation, Pam believes that English will play its role to raise the value of the people who master and having a good ability in English.So, English is not merely for today's necessity when the assumption of being learned English only for adding some scores in the GPA.Olive (L10-11) mentioned that learning English is not just for making the GPA score better and everything is counted by the score.Somehow, learning English will give value for future investment.

Discussion
The research finding in this study is separated into two main points; nursing students' obstacles in learning English subject and their expectations toward English lesson implementation in the nursing institute.Generally, nursing students are feeling difficult to adapt and manage themselves in mastering English vocabularies, grammar and tenses.In addition, students' cultural background influence their performance in learning English in the classroom.In line with the finding, Müller, 2011;Hou, 2013;Khan, 2011;Solak & Bayar, 2015 strengthen that EFL nursing students' obstacles in learning English are difficult in acquiring vocabulary stuffs, having jammed in spoken language both making statement and giving feedback, having anxiety to communicate and do English performances, grammar, structure, and tenses understanding difficulties, having less motivation and attitude toward Indonesian Journal of English Language Teaching and Applied Linguistics, 2(2), 2018 English language learning.Harmer (2007) also mentioned that adult students may still have anxiety and feeling demotivated if their action or classroom experiences are not going as smooth as they thoughts.Sometimes, they will do "critics" and try to comment on what should be fixed in the learning process as well.
Furthermore, suitable topic, materials, and contents in mastering English language especially for professional nurse should be fit with the reality, today's era of globalization, etc.In addition, some overlaps situation among curriculum nursing stakeholders to determine materials that should be taught because of lecturer's shifting which happen almost all the time (discussed more deeply in proceeding subtheme) can give more obstacle in determining better English language materials which are should be embedded with the needs for professional nurse.
Then, it is clear that from four language skills, nursing students were so difficult to comprehend English language both in theoretical body framework in mastering listening skill and practical use of English because of insufficient of vocabularies which influence on their writing, speaking, and reading skills.The same tone also resulted in Müller (2011) that nursing students were lack in four language skills practices; slower intonation and speed of speaking, difficult to understand textbooks, and devastated and stuck with communication among the others.Solak & Bayar (2015) also felt that four language skills are more challenging than grammar, structure and tense because the four language skills are the comprehensive accumulation from all basic skills of mastering English language.it would be a little bit harder for the teachers to teach four language skills materials, if the students are not quite familiar with vocabularies, terms, basic information about grammar and tenses which require in depth understanding of making meaning of phrases, clauses, sentences, or even paragraphs.
However, it is quite relaxing that the representative respondent realized that the four skills management truly came from their lacks of practice.Susan (L17-20) stated that: "Actually, as a student we have to improve English in our daily activity.Honestly, we rarely use English in our daily conversation." It is clear that the students actually know their weaknesses toward English skill management.The habitual of English activities should be increased.TOEFL test basic purpose stated that there should not a dominant skill on the test.The test takers should masters all the four skills of English.There is not a priority or secondary, or even tertiary skills in taking the test.Moreover, Alaraj (2016) also stated that EFL students are lack of productive language skills (writing and speaking) rather than receptive language skills (listening and reading).EFL students difficult to respond some daily communication contexts, understand the instructions and procedures.Less time of practice and accommodate English material development in the classroom may reduce students' opportunity to learn and study the lesson.
Moreover, the importance of communication before teaching between the curriculum development authorities and the recent lecturer to make a clear pathway of teaching and learning process in the classroom should be highlighted further.
Lecturer should communicate with the students before he/she transfer the materials.It will make the students feel comfortable during the learning process.They may negotiate the activities, materials development, and schedule with the classroom members to make the teaching and learning process smoothly.The syllabus, lesson plans, and the students' needs should be determined and described in detail to find some correlation and chemistry between the new lecturer and the students.Besides, Khan (2011) also emphasized that the obstacles were not only from the students, materials, circumstances, or lecturers, but also the management staffs could also give involvement to the learning process.Lack of using technology, rigid form of regulations, and somehow ignore learners' complaints were also made the nursing students' more complicated to manage and adapt with the learning situation both inside and outside the classroom.

Conclusions
Indeed, to create the best result in particular contexts, the bottom up analysis and check should be done as well.Further, the investigation from experiences, technical problems, positive and negative effects should also be examined to contribute to the perfect result.It is also te same in the educational context that it is not an easy play to construct a smooth teaching and learning process in the classroom, for instance.Many processes, individuals, groups, and systems involve in this learning cycle.Therefore, to produce better understanding and "comfortable" learning process on the private nursing institution need some data to provide comprehensive information.
The data showed that nursing students' obstacle during learning English in the classroom were about classical obstacles related to the grammar, structure, and tense in the form of theoretical foundation in building communication through spoken and written.Meanwhile, from the practical obstacles came from the insufficient to master four skills in English.Students' lack in vocabularies to write stories, understanding text and reading books, difficult to communicate with English, and have issues to understand the content in listening comprehension.
Then, from the non-technical obstacles were derived from the lecturers' shifting which interfered the students' momentum to learner and adapt deeper about the lecturer, materials, and his/her teaching style.Further, the problems of managerial of the time, schedule, and dividing of the material contents by the curriculum staffs were also one of the major obstacles for nursing students to develop their English learning in the classroom.However, the students should also manage themselves to have quick response toward the problems that they have felt and tried to figure it out directly to the problem solvers.Additionally, nursing students should have high initiative to learn by themselves also through group discussion, reading books from library, watch movies, listening to the news or western songs, and communicate with English both spoken and written.
As recommendation for further research, it is better to modify and analyze more about nursing students' obstacles and their expectations into pedagogical implication for the sake of educational preferences for better constructing a syllabus that will be

Table 1 :
General obstacles

Table 2 :
Four language skills obstacles