PICTURE SERIES: A STRATEGY TO ASSIST NURSING STUDENTS TO SPEAK ENGLISH

Speaking is an important skill among other. It can be used to measure the language learner’s ability. However, many language learners are reluctant to speak in English class. One of the reasons is the students do not know the way how to express their idea properly. Then teaching learning process should be designed to assist them to speak. This study will try at investigating the use of pictures to enhance students in speaking class. This is a class action research (CAR) which consists of two cycles. Each cycle involves some activities; plan, action, observation, and reflection. The subject of the study is the third semester of S1 nursing in academic year 2017/2018 that consist of 34. The instruments are in the form of observation and speaking test. The result of the study is expected to be beneficial for students in speaking class, especially to motivate students to speak, to make easier the students in expressing the theme provided by the pictures, and to create interesting environment.


Introduction
English for Specific Purposes (ESP) is an approach to teach a language in which all decisions such as content and method are constructed based on the learner's reason for learning (Hutchinson and Waters, 1987: 19).This definition places learners' need or reason for learning English as basic determination of the learning.
The graduated of S1 nursing should be professional in nursing skills and other compe-tences such as: able to cooperate with the team, have high motivation, able to communicate well etc.The ability to have good communication is related to language skill.Then teaching and learning in should be designed to meet the students' specific need.
The teaching learning English for nursing students is categorized as English for Specific Purposes (ESP).It highlights on the language in context rather than the structure or grammar.So far, the aim is to prepare the students to be able to communicate in English in nursing field of work, such as in communication with foreign patient or foreign doctor, and getting job overseas.
ESP in nursing class deals with the terms that are commonly used in medical situation.This indicates that teaching and learning process should focus on the development of students' ability in oral communication between patient and nurse or doctor.By having ability to communicate in English, students will be ready to face their future career.
Speaking is the most important skill in learning English since it can be used to measure a successful learning of the target language (Nunan, 2000).This indicates that speaking is essential skill among other as it represents the learners' ability in mastering the language.Other experts explain that speaking is an interactive process of constructing meaning that involves producing and receiving and processing information (Brown, 1994;Burns & Joyce, 1997).Nunan (1999) point out that it consists of producing systematic verbal utterances to convey meaning.
This can be affirmed that speaking is a productive skill that requires the speakers to produce words or sentences with particular meaning that can be received and comprehended by the listeners both verbal and nonverbal.Unfortunately, many students are lack of willingness to speak in English class.They are unmotivated to communicate in English not because they do not know how to, but they lack of self-confidence to do so.They consider that the language is difficult to be learnt especially to articulate the words.Students do not know the way how to express their idea correctly.As a result, they are reluctant to speak up in English class.
There are many reason why students' are lack of motivation to speak in English class such as: lack of vocabulary, do not know the structure and lack of motivation.This becomes more problematic when it happens to older learners since they are afraid of making mistakes in front of the class.This is another lecturers' responsibility to motivate the students to be actively speak up.The lecturers should help them to reduce their fears and to provide a comfortable learning environment.
The writer chooses pictures series as a technique to stimulate students in speaking class.The use of pictures is important because it gives a significant impact in language learning process.It creates an interesting learning situation and activate students' motivation to speak.The students are promoted to speak through the picture.The writer is interested to conduct a classroom action research to help the students in communicating body temperature measurement through picture series.
This study was conducted in Nahdlatul Ulama University of Surabaya A campus at Jl. SMEA 57 Surabaya.The subjects of this study was students of S1 Nursing of UNUSA.They are all the third semester students in the academic year 2016-2017.There were four classes, however the writer only took C class consists of 34 students as the subjects of the study.This study was conducted on November 22, 2017 to January 10, 2018 in English for Nursing 1 class.

Literature Review
Speaking in a second language is the most challenging skill between other abilities.This involves a complex process of constructing meaning (Celce Murcia and Olshtain in Gruyter, 2006:139).This means that speaking has very significant role in language learning because it involves a process of constructing meaning which covers almost all of language components.Through speaking someone can express their mind and ideas freely and spontaneously.In addition, the purpose of teaching speaking is to guide the students to use the target language as in the daily life.Brown (2004: 140) describes that speaking is a productive skill that directly and empirically observed.Those observations are highlighted by accuracy and effectiveness of a test which is necessary compromises the reliability and validity of an oral production test.This indicates that speaking has influential position in language learning as a device to determine the learners' attainment.
Speaking is a complicated skill among others.This involves more than just pronouncing the words.There are many aspects in speaking such as: vocabulary grammar, pronunciation, fluency and comprehension (Harris, 1969:81).Vocabulary is essential factor for speaker to share information to the listener.The speaker should have adequate vocabularies so that the process of delivering messages can be done effectively.Grammar is a valuable entity in speaking since this can provide well-definition of a sentence.Moreover, mastering a grammatical function can assist to signify the message being intended by a sentence.Other components of speaking is pronunciation.A speaker who has a good pronunciation will inhibit misinterpretation of the message.In addition, an acceptable pronunciation describes a prerequisite of a skillful language learner.The next element of speaking is fluency that refers to a state of smoothness in spoken interaction.The fluency is an indicator of a speaker's competence in delivering information.The last com-ponent is comprehension namely a speaker ability to grasp the main point of a conversation.When a speaker comprehend a material, the process in communication can be done successfully.These elements are required to establish a good communication between speaker and listener.
Many strategies can be applied to assist students to speak up in speaking class.One of them is the used of media for teaching nursing procedure namely picture series.Picture is a valuable resource for teaching (Raimes, 1983:27).It provides a shared experience for students in the class, a fundamental aspect that leads to a variety of four language activities.In addition, picture gives contribution to students' interest and motivation, the use of a language in context, and stimulate students' ideas (Wright, 1989:2).This means that the used of picture promote the students to articulate the ideas being intended.In other word, the application of picture encourages the students to recognize the ideas deals with the aspects they want to describe.
The types of picture used in this study is picture series.Picture series are number of related pictures which are linked to form a series sequence (Yunus, 1981:50).In addition, Bowen (1991) explains that picture series are a sequence of pictures on a single subject.They expose story or theme, like a strip cartoon.
The pictures used to present the subject matter because they tell the students activities from beginning to the end.It is like a story presented in chronological order.Harmer (1991) points out that picture series can be used to stimulate the students to produce oral compositions, miming a story, or playing them a tape recorder with a series of sound.Wright (1989) describes that pictures encourage and provide information to be referred to in conversation and discussion as in storytelling.This means that the picture series is valuable way in promoting students in speaking class.
There are many the advantages of picture series, such as: they are easy to use, even by experienced teachers.This indicates that the pictures can be prepared quickly and easily at relatively little expenses.They are flexible and can be employed at different stages of instruction, for drilling on new items and also for review of old material.They can be arranged in structural grouping or in areas to meet different needs.They are easily portable no small consideration for teachers and event school.
Nursing students learn English for specifics purposes.This indicates that there is particular goal that should be achieved from teaching learning process, namely oral communication in nursing field.The students have to be familiar with terms and useful expressions that are commonly used in nursing area.Besides, the students should also master several topics such as: hospital admission, nursing profession, a doctor -a patient appointment, consultation, family planning, feeding patient, vital signs, bed making, and patient's personal hygiene, etc.
From the topics, we know that those deal with nursing procedures.Nursing procedures are standardized process used by nurses to achieve a high level of patient care.This involves several stages that should be done by the nurses in order to provide accurate services to the patients.Mostly, the subject matters of English nursing consist of procedures in the field of nursing, then teaching learning process should emphasizes on the way how to activate students in the class.This means that they should be able to communicate the process of nursing intervention.
This study chooses one of the nursing procedure in vital signs measurement namely body temperature.There are several types of body temperature measurement, such as: oral, rectal, and axilla.There are two different types for measuring; digital and manual thermometer.This study emphasized on the students' communication in axilla body temperature measurement by using digital thermometer.

Method
This study applied Classroom Action Research (CAR) to assist the students to speak a nursing procedure through the use of pictures.It was an approach employed by a lecturer and conducted by one or more researchers to improve the quality of education by evaluation from the unsuccessful of the previous study (Susanto, 2010).It is used to solve problems in teaching learning process by applying new strategy in the classroom.In this study, the writer uses tests (pre-test and post-test) to know the students' improvement in speaking.
The procedure of the research consisted of five main steps, they are: planning, action, implementation, observation, and reflection (Burns, 2010).The study focuses on the application of picture series as teaching learning medium to improve students' speaking ability.In cycle I the writer employed three meetings, the first meeting was a preliminary or pretest, the second meeting was the implementation of the daily teaching learning method, and the third meeting was doing the test.In cycle II, the writer conducted two meeting, the first meeting to implement the new method namely the use of picture series and the second meeting for evaluation (posttest).
There are some steps in teaching nursing procedure by using picture series.The lec-turer applied a new technique by asking the students to describe the activities based on the picture series.Firstly, the writer divided the students into groups consist of at least 4-5 students.Secondly, the writer provided picture series and they had to make a conversation and performed it in front of the class.When the students found difficulties, the writer helped them by giving the similar word or the synonymy.
The description of the research procedure can be seen below: 1. Cycle of Action Research a. First cycle (1st meeting) 1) Planning a) The writer prepared the material and media needed for the study b) The writer discussed about the implementation of media in the classroom.c) The writer made a lesson plan for the first meeting.

2) Acting
This step many activities to be done.The writer gave students material about procedure how to perform body's temperature measurement.
There are as follow: a) Lecturer greeted the students.b) Lecturer mentioned some key words deals with body's temperature measurement.c) Lecturer modeled the pronunciation of the key words.d) Students repeated after lecturer mentioned the key words.e) Lecturer taught the procedure of how to perform body's temperature measurement to the students by using pictures f) Students expressed their idea about procedure how to do body's temperature measurement based on the pictures and the key words given previously.g) Students practiced how to do body's temperature measurement in a pair.

3) Observing
The lecturer observed students' activities in teaching learning process.There are many aspects to be observed by the writer such as: students' attention and respond, students' ability to mention the vocabularies, students' ability to express the procedures of body's temperature based on pictures.The writer noted all the information from the observation in the class in observation sheet.

4) Reflecting
After doing the first cycle the writer analyzed the weakness and strength of the implementation of pictures.Then made reflection and conclusion of the first cycle.This study found that the result of the first cycle was good.However, the writer wanted to observe more on the students' aspects' of speaking.Then the second cycle needed to be conducted.b.Second cycle 1) Revised Planning a) The writer evaluated the result of reflection and discussion of the first cycle in order to have better result for the next meeting.b) The writer revised the material and media needed.c) The writer made a lesson plan for the second meeting.

2) Acting
In the second cycle the writer still used the pictures with some modification namely by stating the key words related to the procedure of how to measure body temperature.There were many activities here as follow: a) The lecturer greeted the students.
b) The lecturer explained the topic by using pictures with some modification.c) The students were asked to find out the synonymy or the similar words provided by the pictures.d) The lecturer explained the steps of how to measure body temperature.f) The lecturer modeled the pronunciation of the keywords.g) The students repeated after the lecturer.h) Student came in front of the class and practiced a conversation of how to measure body temperature with their partner.

3) Observing
Similar to the first cycle, in this stage the writer observed the students activity.They are: students' attention and respond, students' ability in mention some keywords based on the pictures, students' ability in constructing sentences based on the pictures given.

4) Reflecting
The writer evaluated and concluded the result of the second cycle by calculating score of students test.From that score the writer concluded that the second cycle was successful then the stages of CAR ended.Since, the prob-lem of teaching learning had been answered from the application of picture series provided with key words.Then, the students' improvement on speaking ability was considered satisfied.

Data Collection Technique
The writer observed the teaching learning process in classroom and noted the situation in observation sheet.This involved any kind of students' activities and responds in teaching learning process.She gave a speaking test to identify the students' ability before and after giving a new strategy of learning.

Data Analysis
The writer identified the aspects of speaking into four.These are: vocabulary, grammar, fluency, and pronunciation.After observing the students' performance, the writer calculated the students' speaking score and it was categorized by using the following criteria:

Finding and Discussion
The Finding of the First Cycle The writer describes the application of the first cycle.This based on the procedures of the research that has been explained in previous section.The explanation can be seen below:

a. Plan
In the first stage of the cycle, the writer prepared the lesson plan deciding the basic competence and the learning media namely picture series.The lesson plan for the first cycle is same with the previous one that was used by the lecturer in orientation section.The changes were made in instructional objectives, learning material, learning steps and resources.The writer decided picture series as the learning media as an alternative mean to help the students to narrate the nursing procedure.

b. Action
The use of picture series was observed and documented in the observation checklist and field notes.Based on the lesson plan, the writer introduced the topic by showing the picture, students were asked to note some keywords and their meaning such as: place, observe, measure, perform, result, increase, low, high.The writer gave example how to explain the body temperature measurement based on the picture.The students gave five minutes to practice and describe the body temperature measurement procedure in front of the class.

c. Observation
The writer observed the result of the students' speaking test.The aspects of speaking skill that were examined were fluency, grammar, vocabulary, and pronunciation.

Grammar
In the aspect of grammar, some students used incorrect sentences when narrating the pictures.This can be seen in the following description: 1. "After greet patient, I confirm his identity" (student 13).It should be greeting.It should be result 3. "The purpose of this is to identify your body" (student 29).It should be progress or development.

Fluency
The student' looked nervous in narrating body temperature measurement based on the picture.Many causes can affect to students' fluency such as: less confidence, lack of vocabulary and difficulties in constructing sentences (observation notes).

d. Reflection
After observing the students, the writer analyzed the data and got the score.The result was simplified into the following diagram.

Finding of Second Cycle a. Revised Plan
Before conducting the second cycle, the writer revised the previous plan based on the students' difficulties found in the first cycle.The students got difficulties in using appropriate vocabulary.Some students told to the lecturer that they understood the pictures, but sometimes it was hard for them to find the proper words.The writer decided to revise lesson plan was made used and the activity before the pictures showed as learning media.
In the first cycle, the researcher only showed the picture series related to the body measurement.However, in the second cycle the writer modified them by adding the keywords on them.Then, the writer explained to the students that they should find similar words or synonymy.Next, the lecturer modeled the way how to narrate the pictures.After that the students were given five minutes to prepare for performing in front of the class.

b. Action
The application of picture series were observed and recorded in the observation checklist and field notes which were also used in cycle 1.The result was described as follows: The second cycle was conducted the writer used revised picture series, namely picture provided with key words.The students were asked to retell the nursing procedure of body temperature measurement based on the picture.1) The writer introduced the topic by showing the picture 2) The students were asked to note some keywords and their meaning such as: place, observe, measure, perform, result, increase, low, high.The result shows that the highest score was in the aspect of fluency, and the lowest score was vocabulary.The problem found in cycle I is in the area of vocabulary, the students still got difficulties in finding appropriate words to narrate the nursing procedure based on the picture.
Regarding to the result obtained in this cycle, it was considered that the first cycle was successful.This can be seen from students score (39.62) or in good level.However, the writer considered to perform the second cycle in c.
3) The writer gave example of narrating the pictures.4) The students gave five minutes to practice and describe the body temperature measurement procedure in front of the class.5) Students practice how to do body's temperature measurement in a pair.

c. Observation
In the second cycle, the writer observed the result of the students' speaking test.The aspects of speaking skills that were examined were the same as in the previous cycle.The writer also used the same rubric for scoring the students' speaking ability.
The average score of students' speaking ability in cycle II was 56.89 or in Good level.
The following is the explanation on aspect of students' speaking ability:
It should be: "Your temperature is normal"

Pronunciation
The same condition was also found in pronunciation aspect.Some students still pronounced some words improperly, such as: 1. Temperature was pronounced /temperatur/ it should be pronounced/ tempre+∫ə/

d. Reflection
After observing the students' performance in cycle II, the writer got identified the students' score.The result can be simplified into following diagram.The result shows that after being taught by using picture series with some modification, the students' score increased.There is improvement in all aspects of the speaking.The highest average score was vocabulary (14.66%).Thus it can be affirmed that the problem found in cycle I can be resolved.The second cycle was considered successful.This can be seen from students score namely 56.89 or in good level.

Discussion
The use of picture series In this section the writer is going to discuss the results of the study.By using picture series in speaking class, the writer recognizes the students' speaking ability from several aspects: fluency, grammar, pronunciation, and vocabulary.The writer also encourages the students' to cooperate with their friends to share ideas in the conversation and performed it in front of the class.
Each cycle of the study had different problem, then it made the application of picture series was also different in pre cycle, cycle I and cycle II.In pre cycle, students were taught by using without picture series, the lecturer employed Power Point Template (PPT) contained the steps of having measurement of body temperature.The students were provided with several vocabularies and their meaning.They also asked to memorize the procedure of body temperature measurement.As a result, many of the students were failed in explaining the procedure.The writer decided to apply different learning media to help the students in narrating axilla body temperature measurement.
The cycle I was applied.The used of picture series in this cycle had helped the students to explain the nursing procedure.Students' speaking skills were better than before.They were able to narrate the nursing procedure based on the picture series.However, from four aspects of students' ability, (fluency, grammar, vocabulary, and pronunciation), students still had problems in finding the correct vocabulary.Then, it was identified that in the first cycle many students had difficulties in finding vocabulary related to the picture properly.Thus, the writer decided to continue this study by conducting the second cycle.
In the cycle II, students got difficulties in understanding the picture because the lecturer did not give vocabularies related to the picture.Then the writer modified the picture series by adding the key words on them.The writer explained the keywords to assist the students in narrating the picture.The changes were made to solve the problem in cycle I and to improve the students' speaking ability.As a result, the students' were able to find out the vocabularies properly.The problems in cycle I were solved and the students' speaking ability was improved.
The writer simplified that the used of picture series in enhancing students' speaking ability in narrating nursing procedure was valuable in several ways: they are: First, the application of picture series as learning media in cycle I and cycle II supported the students' ability in speaking.This can be seen from their ability in explaining axilla body temperature measurement were better than the application of PPT in pre cycle.The procedure of teaching speaking by using picture series in this research was narrating the picture, the lecturer showed the picture then asked the students to narrate the procedure.The students should be familiar with the nursing procedure so that they were easy to narrate the picture fluently.The procedure that was simplified into picture series was easier to be memorized than in the form of procedural text.This made the use of picture series in cycle I and cycle II were more valuable in assisting students' in speaking rather than the use of procedural text in pre cycle.
Second, the picture series that were used in this study was provided with key words.By paying attention to the key words, the students learned about the vocabulary.Even, they had to find out the similar words, this encouraged the students' to learn new vocabulary more.
Third, the activities before narrating the picture helped the students in understanding the nursing procedure.The students' were asked to share with friends their ideas based on the picture.In this case, transforming the picture into their sentences.This leads the students to learn how to construct a correct sentences.When students are able to construct correct sentences, this also give positive effect on their fluency of speaking.The fluency in narrating the picture was one of criteria in speaking rubric.

The Students' Speaking Ability after being taught by using picture series
The result of students' speaking test showed that there were improvements in their speaking ability.The progress in cycle I and cycle II can be seen in the diagram of students' speaking score below: From the diagram above, it can be seen that students' ability in speaking improved in all aspects.The progress of average score of students' speaking involves fluency, pronunciation, grammar, and vocabulary.The vocabulary has the highest score (7.62), and the lowest score was in grammar aspect (2.4).The average score of students' speaking ability after using picture series in cycle II (56.89) was better than the previous cycle (39.62).This followed by the improvement in the level of students' speaking ability in cycle I and cycle II.Thus, the study is considered successful.

Conclusion
Picture series is an appropriate strategy to be implemented nursing class.The result of the study shows significant progress on students' speaking ability, especially in vocabulary aspect.Narrating a nursing procedure based on the picture series building up their motivation to speak.The pictures help them to activate their memory to find out appropriate vocabularies, and organize them into good sentences.Besides, they guide the students to stay on specific theme, since the pictures exclude other material and explain merely the steps illustrated by the picture series.
The use of pictures series bring fun and enjoy learning situation.When the students learn in enjoyable atmosphere they are more confident and more actively participated in speaking.This situation influences on their fluency of speaking as they are able to produce a good sentences.Moreover, the picture series could break from monotonous activity.Some activities can be set up such as: telling a story, role play, and small group discussion etc.The English lecturer should design it in order to meet the students' need in this case the English for specific purposes (ESP).Picture series materials should be appropriate with student's real life.This related to the students' prospective career in nursing field.

Suggestion
The results of the study show that the use of picture series improves the students' competence in speaking a nursing procedure.Some suggestions are directed to: a. the English lecturers are recommended to use picture series as a media in speaking class because this media activate students' language aspects such as: vocabulary, grammar, pronunciation and fluency.b. the students should be more confidence in exploring their ability and ideas in speaking.c.Other researchers are suggested to carry out more in-depth analysis on the use of picture series in improving students' speaking ability in narrating a procedure text by using picture series.
Diagram 4.2 The Students' Speaking Score of Cycle II Diagram 4.3 Students' Progress in Cycle I and Cycle II