English For Nursing 2 TB

 

English for

Nursing

2 Vocational English Teacher’s Book 

 A2-B1

Ros Wright

 

  Pearson Education Limited 

Edinburgh Gate Harlow Essex CM20 2JE England and Associated Companies throughout the world. www.pearsonlongman.com © Pearson Education Limited 2011 The right of Ros Wright to be identified as author of this Work has been asserted  by her in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved; no part of this  publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without  without the prior written  permission of the Publishers. Photocopying: The Publisher grants  permission for the photocopying of those  pages marked ‘photocopiable’ according to the following conditions. Individual  purchasers may make copies for their own use or for use by the classes they teach. Institutional purchasers may make copies for use by their staff and students,  but this permission does not extend to additional institutions or branches. Under no circumstances may any part of this  book be photocopied for resale. First published 2011 ISBN: 978-1-4082-5212-3 Set in Palatino The publisher would like to thank the following for their kind permission to reproduce their photographs: Cover images: Front: Photolibrary.com: Comstock c, Corbis l, David Trainor Background, Photodisc r

 

 

Contents

Unit 1 Patie Patient nt admis sion s

page 3 

Unit 2 Pain Pain

page 12 

Unit 3 Vital Vital signs sig ns

page 22 

Unit 4 Symp Symptoms toms

page 31 

Unit 5 Food and nutrit ion

page 41 

Unit 6 Pers Person onal al care

page 50 

Unit 7 Elimi Elimination nation

page 59 

Unit 8 Patient Patient discharge disc harge

page 70 

 

1

Patient admissions

Briefing This unit begins by introducing hospital personnel and departments and then deals with the admissions process, i.e. checking in a patient and welcoming them onto the ward/into the room.

Hospital jobs and personnel Nurses work as part of an extensive team, especially within the context of a hospital and this first section presents a variety of personnel and their roles. It makes the distinction between several key nursing personnel; the triage nurse who is responsible for  making sure the most urgent cases are treated as a priority, the sister or charge nurse (male equivalent) who runs the ward/department, deals with the budget and staff employment and the scrub nurse, who looks after patients during and after surgery. Students then look in more detail at the responsibilities of a practice nurse working in a doctor’s surgery (USA: doctor’s office) and an agency nurse (employed on short-term contracts through a nursing employment agency), specialising in renal care (kidney diseases). Students focus on usage of the present the present simple and the present continuous simple and the present continuous   to describe nursing roles and responsibilities as well as daily routines. 

Hospital departments and facilities The main aim of Section 2 is to develop lexis of specific hospital departments – Casualty  (UK/Ireland), Dermatology, Pathology, etc. – and facilities waiting room, that bank, etc. It should be noted vending including machines,canteen, emergency care is also offered in the Emergency Department (UK/Ireland) and Emergency Room or ER (USA). Appropriate word stress greatly facilitates communication with patients and colleagues. Students will work on stress patterns of the various hospital departments. This section also reviews language of place and movement and provides an opportunity for students to practise directing patients and visitors around a hospital.

through waiting in a cubicle to their assessment. A discussion activity invites students to draw on their experience to use the triage process to prioritise a series of patients presenting at ER. Later, this section seeks to develop a set of requests that a nurse might make with a patient newly arrived in ER: Could you take a seat in the waiting room, please? Could I ask you a few questions, please? Could you tell me what happened? The happened? The admissions process requires nurses to be accurate when taking patient details. A review of how to pronounce letters of the alphabet by encouraging students to group letters with the same sound completes this section of the unit.

Checking in a patient After familiarising themselves with terms and expressions that typically appear in the Patient Details section of an admissions form, students will then go on to develop a set of questions used to complete the form. Questions are related to the patient – full name, DOB (date of birth), gender, marital status and occupation – as well as contact details of their next of kin (family member, carer, even neighbour). There are also questions about smoking and allergies. It is important to ask for the patient’s preferred name, as it helps develop a stronger relationship with the patient. Some patients feel more comfortable if medical staff use their first name, preferring the more informal contact, while others like to maintain a more formal relationship and might ask staff to use their  title (Mr/Ms, etc.) and surname. As the patient is shown into their room/ward (a large room for up to six same-sex patients – very common in the UK/Ireland), it is up to the nurse to inform them about the facilities available to them – buzzer, locker, etc.

Admissions Section 3 looks at admitting the patient to hospital. An extract from a (USA) patient educational leaflet explains the triage process, describing the patient  journey from their arrival at the reception desk, Patient admissions  admissions 

1 

3

 

Teache Te acher’s r’s notes not es Hospital jobs and personnel Vocabulary 1  Before you open the book, ask students to

introduce themselves and say a little about why they are attending the course. Experienced nurses: Ask students to explain what they hope to improve during the course. Pre-experience nurses: Ask students to explain which area(s) of nursing they find the most interesting. Then draw a pyramid on the board and write one of the following at each point of the triangle: nursing/English/my nursing/En glish/my future. future. Encourage students (individually) to write or draw words/sentences/objects to represent how they feel about each topic. Ask students to discuss their ideas with a partner. Then ask students to introduce their partner to the rest of the group, explaining the points on their pyramid. Open the book on page 4 and ask students to look at the picture at the top of the page. Ask: What department do you think it is? (Emergency Room/ER or Casualty/Accident & Emergency/A&E). If necessary, pre-teach/elicit and surgery. triage room and  surgery.   Ask students, individually or in pairs, to match the job titles with the hospital personnel they see in the picture. a 8 b  1 c  4 d  2 e 7 f  3  3 g  9 h  5 i  6

2  Ask students, individually or in pairs, to match

the job titles in 1 with the descriptions. If necessary, encourage them to deduce the meanings from the picture. Come together as a group to check answers. For further language practice, draw two columns on the board. In column 1, write: carry, In   deal, give treatment, look, responsible, specialise. In column 2, write: after, for, in, out, to, with. with. Ask students to match the verbs to the correct preposition. Then choose one of the activities for further practice of the target language.   1 b 2 d 3 f 4 c 5 h 6 i 7 e 8 a 9 g

Extra activity On the board, write all the phrasal verbs from Exercise 2. Divide your group into two teams. Ask students to cover the page and using the phrasal verbs on the board, take turns to describe one of the job titles on page 4 to the opposite team. The team with the most correct answers wins the game.

Language Depending on your group, you may wish to ask students to complete 3 before  going through the before going Language box. This will serve as a ‘diagnostic test’ to check their current understanding of the target structures for this unit.

Present simple v present continuous Refer students back to the picture and 2 on page 4. On the board, write: 1 What does the scrub nurse do? 2 What is the scrub nurse doing now? Elicit answers: 1 She looks after patients during surgery. 2 She is pushing a patient p atient trolley through the    Admissions area.  area. Ask students to compare the two forms and ask: When do we use the present simple? When do we use the present continuous?  continuous?  Suggested answer: We use the present simple to talk about routines and things that happen all the time. We use the present continuous to talk about things that take place at the time of speaking/things that are not permanent. Give students time to assimilate the points covered in the Language box. If necessary, review present simple and present continuous forms in more detail.

Reading 3  Tell students they are going to read an interview

with practice nurse Reena Chaudry. Ask them to read and underline the correct verb forms in the text. If necessary, ask a stronger learner to select the best answer in the first sentence. 1 work 2 like 3 carry out 4 change 5 treat 6 am 7 give 8 are running 9 ’m learning 10 10 don’t  don’t have 11 11 like  like going 12 12 play  play

Patient admissions  admissions 

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4

 

Listening 4

► 

02 Tell students they are now going to hear an interview with agency nurse Carlos da Silva. Ask them to listen and answer the question. Check students understand: agency nurse, renal care, paediatrics, emergency medicine. medicine.  a renal care

5

Refer students to the beginnings of sentences 1– 8. Tell them to listen again and complete the sentences about Carlos. Play the recording again if necessary.  For further language practice, ask students to turn to the audio script 02 on page 70 and underline the examples of the present simple and circle the examples of the present continuous. (Present simple: I work, I specialise, I spend, I carry out, administer, play, do I like?, I don’t like, there is, can be, I want, I hope, I go climbing;  climbing;  Present continuous: I’m continuous: I’m working, I’m looking after, is waiting, I’m teaching) teaching) Students may be confused with the examples of verbs followed by -ing -ing:: like like  + -ing,  -ing, go   go + -ing, that appear in this audio script. Check their understanding of these after the above activity. Explain both examples will be covered later in the course. 1 renal care. 2 a transplant unit in Auckland. 3 a little girl who is waiting for a kidney transplant. 4 carries out her tests, administers her medication and plays games. 5 teaching her how to play dominoes. 6 likes dealing with children./doesn’t like dealing with paperwork. 7 qualify as an advanced practice nurse. 8 he goes climbing in the mountains.

Speaking 6  In pairs, students take turns to interview each

other using questions in 5. Students should then introduce their partner to the rest of the group.

Patient admissions  admissions 

1 

5

 

Hospital departments and facilities

  Renal 

Vocabulary 1  Tell students to look at the hospital plan taken

from a patient educational leaflet. Ask: Which department names do you recognise? Ask recognise? Ask students, individually or in pairs, to complete the definitions using the words in the box. Alternatively, do this activity as a group chorus and then give students time to complete the definitions in writing to reinforce the target language. Come together as a group to check answers. Check students understand: nervous system, skin disorder, midwife/midwives, recover . 1 emergency cases 2 operations 3 kidney 4 skin disorders 5 elderly 6 test results 7 babies 8 children 9 heart 10 10 X-rays  X-rays 11 11 nervous  nervous system 12 12 exercises  exercises

Pronunciation 2 

write renal.. Ask how many 03 On the board, write renal syllables there are in the word and then elicit the correct stress pattern. Ask a stronger student to write the stress pattern above the word on the board (see key opposite). If necessary, check the stress pattern of dermatology dermatology.. ► 

Ask students, individually or in pairs, to put the names of the hospital departments in 1 into the correct box according to their stress pattern. Avoid correcting at this stage. Students then listen to the recording and check answers. Play the recording again and ask students to repeat the stress patterns they hear. Play the recording several times until you are happy students are able to reproduce the same/approximate pronunciation and stress pattern. Reassure them that some terms are difficult to pronounce even for a native speaker.

  Casualty Surgery

  Pathology Maternity Neurology



  Geriatrics Paediatrics





  Dermatology Cardiology Radiology 

  Physiotherapy 

Extra activity On the board, write: facilities, write: facilities,  orthopaedics,  pharmacy, registration, registration, patient, entrance, toilets, information, coffee, hospital, emergency (these emergency (these words all appear on the hospital plan on page 6). Ask students to add these words to the correct column in the table in 2 according to their stress pattern. See answers below. 

  patient entrance toilets coffee



  pharmacy hospital



  facilities emergency

  orthopaedics registration information 

Speaking If students need to review prepositions of place, they could do 4 and 5 before 3. 3  Refer students to the speech bubbles at the

bottom of the page. Using the hospital floor plan, ask students (in pairs) to take turns asking and answering questions about the location of facilities and departments in the hospital. Encourage the correct stress pattern.

Note: Follow the table opposite for correct pronunciation patterns. Note: Students may recognise these words from their own language but will tend to place the stress in the wrong place in English. Ask them to compare stress patterns in their L1.

Patient admissions  admissions 

1 

6

 

Vocabulary 4  Ask students, individually or in pairs, to choose

the correct prepositions of place to complete the explanations. Come together as a group to check answers. 1 between, and 2 on, the left of 3 on, opposite 4 in, at 5 next to, on 6 in front of 5  Ask students, individually or in pairs, to match

the symbols to the facilities. Ask: Which facilities can you find in hospitals in your country? Which  facilities would you like to see see in hospitals in your your country? Why is it important to provide p rovide facilities such as these in hospitals? Do we really need to  provide these facilities in hospitals? hospitals? a 6 b  9 c  7 d  8 e 4 f  5  5 g  2 h  3 i  1

Listening 6 

► 

04 Depending on your students, you may

wish to review prepositions of movement before you start this activity. Tell students they are going to hear three nurses giving visitors directions to different hospital facilities. Ask them to listen and complete the instructions. Come together as a group to check answers.  

Extra activity Dictate these scenarios to the group (or prepare as a handout) and then put students into pairs and ask them to roleplay four or more of the situations to practise giving directions using the hospital floor plan on page 6. 1 You want to visit your sister who has just had her first baby. You are at the main entrance. 2 You are looking for a shop to buy your wife some flowers. She’s in room 202. You are next n ext to the bank. 3 You are late for your X-ray and lost. You are on the second floor in front of the Neurology Ne urology Department. 4 You hear an announcement that your eightyear-old son is waiting for you at the registration desk. You are on the 5 th floor visiting your mother after her hip operation. 5 You arrived 20 minutes late for your appointment with the dermatologist. You are at the main entrance. 6 You are leaving hospital today. The consultant gave you a prescription for painkillers. You are still in your room on the 4 th  floor but want to know where the pharmacy is located.

1 straight on, front of, at, end 2 second, left, turn, of, turn right 3 turn left, go, next to 7 

05 Ask students to look at statements 1 and 2. Then refer them back to the hospital plan on page 6. Explain they are situated at the main entrance and that they are going to hear directions being given by a nurse. As they listen, students should follow the directions on the hospital plan with their finger, then circle the correct answer.

► 

8  Ask students to check their answers by turning to the audio script on page 70.  1 main entrance 2 4th

Patient admissions  admissions 

1 

7

 

Admissions

Extra activity Ask: Why is it a good idea to explain the triage  process to patients? In patients? In small groups, students brainstorm ideas and then come together as a group to share their ideas. Suggested answers It helps patients better understand the order of care; helps reduce levels of patient anxiety and possible frustration. Note: Some students may have difficulty expressing these ideas effectively in English. Reassure them that for this activity accuracy is not important – just encourage students to discuss their opinions.

Reading going to read a patient patient 1  Tell students they are going educational leaflet from a hospital in Phoenix, Arizona (USA). Ask them to scan the text and find answers to questions 1 and 2. If necessary, reassure them that they don’t need to understand the whole text, which has been adapted from an authentic patient educational leaflet. Ask: What is the average waiting time in ER in your  place of work/country? work/country? Are waiting times in ER a  problem? What can hospitals do to reduce waiting times? How can they make waiting times more bearable for patients? 1 2.5 hours 2 4.5 hours 2  Ask students to read the leaflet again. As they

read, they should complete the gaps in the ‘When you arrive’ section using the words in the box. Ask students, in pairs, to compare their answers, then come together as a group to check. Encourage students to visualise the admissions process in their place of work/country to help them complete the activity. If your students are pre-experience nurses, ask them to visualise what happened the last time they attended the Emergency Room as a patient/carer. Check students understand: assessment, cubicle,  priority.    priority. 1 reception desk 2 date of birth 3 cubicle 4 triage nurse 5 assessment 6 priority 7 cubicle 3  Ask students to look at the medical problems (a–

c) and ask: Which problems are the most serious? serious?   Then ask them to match the problems to the gaps 8–10 in ‘The Order of Care’ section on the patient leaflet. In pairs, students can then compare their answers before coming together as a group to check. If your students are experienced nurses, ask them to brainstorm other medical problems for 8–10. 8 c 9 a 10 10 b  b

Listening 4 

► 

06 Tell students they are going to hear a 06 Tell triage nurse talking to four new patients. Before they listen, ask students, in pairs or small groups, to ‘observe’ the patients a–d in the picture. Note that observation is an authentic task for a triage nurse and will also serve to prepare students for the interventions they are about to hear. Ask students to listen and decide which patient is speaking in each case. 1 d 2 b 3 a 4 c

5  Ask students to listen again and complete the

sentences using the words in the box. 1 leg 2 bleeding 3 hurts 4 worried, baby 5 eye

pairs, to put the four patients 6  Ask students, in pairs, into order of priority to see the doctor. Ask students to compare their answers with another pair before coming together as a group to check. If your students are experienced nurses, ask them to explain the reasons behind their thei r order of priority for a–d. Answers: d has been brought in by ambulance from a car accident and will have priority, a the patient is 23 weeks pregnant and has some bleeding so needs to see a doctor urgently, b and c are not priority cases but the child (b) would probably be seen by a medical professional before c. d a b c

Patient admissions  admissions 

1 

8

 

7  Ask students to match the sentence halves to

make six requests. If necessary, review the use of modals (can (can/ /could could)) for polite requests. Remind students that the use of modals can and could for polite requests is interchangeable. 1 e 2 d 3 a 4 f 5 b 6 c 8  Tell students they are going to listen to the

conversations with patients a–d once again. As they listen, students should match the requests to the correct patient. Allow them to compare answers in pairs before coming to together as a group to check. Patient 1 – Could you fill in this form, please? Patient 2 – Could you show me your head? Patient 3 – Could you lie back and try to relax? Patient 4 – Could you take a seat in the waiting room, please?

Extra activity In pairs, students use the audio script 06 on page 70 to practise roleplaying the dialogues. Variation: Ask students to change the medical problems in the dialogues before roleplaying the activity. 

Pronunciation 9 

► 

07 Ask students, individually or in pairs, to 07 Ask complete the groups with letters of the same sound. Encourage them to say the letters aloud or in their heads in order to ‘hear’ the differences in pronunciation. Play the recording to enable them to check their answers. B, C, D, E, G, P, T, V, Z F, L, M, N, S, X, Z  A, H, J, K, Q, U, W I, Y O R

10  Elicit the request: Could you spell your name,

 please? In pairs, ask students to write down names of four people they know and then take it it in turns to spell the names to each other. For further practice, students could spell the hospital departments, facilities and personnel from pages 4, 6 and 7.

Patient admissions  admissions 

1 

9

 

Checking in a patient Vocabulary 1  Refer students to the Patient Details form and

ask them, individually or in pairs, to find words in the form with the meanings 1–13. Elicit/Pre-teach: n/a.  Check understanding of: n/a. Check next of kin and kin and ask students for more examples (any family member, friend, carer or neighbour).  neighbour).   Experienced nurses: Ask: Do all patients want  (Some feel medical staff to use their first name? name? (Some more comfortable if the medical staff use their first name. Others prefer a more formal relationship and ask staff use their title (Mr/Ms, etc.) and family name.) 1 surname 2 occupation 3 title 4 GP (General Practitioner) 5 first name(s) 6 next of kin 7 country of origin 8 gender 9 marital status 10 10 reason  reason for admission 11 11 DOB  DOB 12 12 intake  intake 13 13 allergies  allergies

Listening 2 

► 

08 Tell students they are going to hear a nurse interviewing a patient from page 9. If necessary, refer them back to the picture of the waiting room on page 9 first, to familiarise themselves with the different patients present. Ask students to listen and answer the question: Which patient is the nurse talking to?  to?  

3  Ask students to listen again and complete the

nurse’s questions. Alternatively, to make the task more challenging, ask students to complete the nurse’s questions first and then listen and a nd check their answers, making any necessary corrections. 1 name 2 spell 3 call 4 date, birth 5 job 6 allergies 4  Ask students, individually or in pairs, to write

questions for the remaining admissions questions. Encourage them to make use of the terms in the admissions form to help them design their questions. Ask them to check their thei r answers on page 70 of the audio script. If necessary, play recording 08 again for students to check their answers. 1 do you come from (originally) 2 your marital status 3 is your next of kin

Vocabulary 5  Ask students to brainstorm items they would

find in a typical patient room in their place of work/country. Ask them, individually or in pairs, to look at the picture of the patient room and label the items using the words in the box. Check understanding of: buzzer  and locker.  and locker.   1 light 2 buzzer 3 TV 4 chair 5 table 6 bed 7 locker 8 drawer  

Check they have the correct answer before moving on to the next stage. Ask students to listen again and fill in the admissions form for the patient. Ask students, in pairs or small groups, to compare their answers before coming together as a group to check. The nurse is talking to the pregnant woman. Title: Mrs First name(s): Rosanna Surname: Cameron Gender: F Preferred name: Rosanna Marital status: married Date of birth: 20/01/1981 Country of origin: Italy Occupation: international marketing manager Tel (home): 02 831 9476 Next of kin: Daniel Cameron Mobile: 0779 706 7517  Allergies: none

Patient admissions  admissions 

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10

 

Listening 6 

► 

09 Tell students they are now going to hear a nurse showing Rosanna the facilities in her room. As they listen, they should write down the names of the objects they hear. shelf, locker, bed, buzzer, light, chair, TV, drawer

7  Ask students to look at the picture again in

detail and complete the information about the facilities in the room. If necessary, refer ref er students back to the prepositions of place on page 7. Play the recording again if necessary for students to complete the answers. 1 light, chair 2 TV 3 drawer 4 pharmacy, waiting area 5 ground 6 hall, lift

Speaking 8  Tell students they are now going to roleplay

admitting a patient, showing the patient to their room and explaining the facilities. Put them into pairs and refer them to the list in 8. Ask them to invent details for their respective patient. They should then make a copy of the admissions form on page 10 and carry out the interview. They then swap roles.

Preparing for the next unit In preparation for Unit 2, suggest the following to your students: •

Compile a list of body parts you already know in English.

•

Think about ways patients in your country

•

describe pain – adjectives, common expressions. Do some (online) research into different types of pain relief (commonly used in your country).

Patient admissions  admissions 

1 

11

 

2

Pain

Briefing

appropriate questions to gain a better understanding of their patients’ needs.

This unit deals predominantly with the topic of

Building and maintaining a good patient relationship is an essential aspect of the treatment and healing process. Effective communication skills are a key part of this. These include employing a patient-friendly intonation pattern and putting the patient at ease. The text titled Putting your Patient at  on page 17 provides more detail on this aspect Ease on Ease of successful communication.

pain; understanding patient incorporating descriptions ofsuccessful pain, carrying out an assessment, communication skills, and discussing different forms of pain relief. This is arguably the most important unit in the coursebook.

Locating and describing pain This first section of the unit provides an opportunity to develop patient language for the major body parts. Students will be asked to complete a pain map, a diagram representing front and back views of the body, used by medical staff to indicate location and movement of pain. Comparatives and superlatives of simple adjectives (stronger, ( stronger, better, the worst)) are also covered in this section to describe worst changes and improvements to pain.

Pain assessment Section 2 draws students’ attention to collocations and expressions patients commonly use to describe pain – a burning sensation, a shooting pain, a tingling feeling, it’s itchy. The section then moves on to describing intensity of pain using different types of pain scale. The 1–10: nurses ask patients to give a number between 1 and 10 (0 = no pain) to describe how much pain they feel. In the case of children or those who have difficulty expressing themselves, nurses will ask them to point to the face that describes how they are feeling. The section goes on to develop a set of questions, based on simple Wh- words – what, where, when, how, used by nurses to assess their patients’ pain. Using patient case histories, students put these skills into practice.

Successful communication Nursing is not just about treating the disease – nurses also have to consider the economic, social, psychological and even environmental aspects that impact on the patient, their symptoms and their treatment and recovery. Pain is not just physical and patients express their pain in various ways – anger, depression, loss of appetite or sleep, etc. A nurse needs to be able to look behind the words (or lack of them) and interpret what their patient is feeling. The initial pain assessment tool enables nurses to ask

Pain relief Increasingly, patients turn to the internet for advice on general health matters and nurses need to be familiar with this medium and the approach used. An online article provides the backdrop for the first part of this section, which encourages students to discuss different methods of painback relief. It considers pain relief for sufferers of lower pain, from painkillers and anti-inflammatory drugs to heat patches and ice packs. Students are then asked to give advice on specific patient questions linked to back pain as well as rate the article in i n terms of its suitability as a patient reference. Nurses may also be asked for advice on complementary and alternative medicine or CAM as a means of pain relief. The last page of the unit looks at some examples of these, including aromatherapy (use of natural oils to help control pain) hydrotherapy  (underwater exercise), chiropractic therapy (manipulation of bones in the spine) and herbal therapy (use of herbs and plants to help treat muscle ache). Finally, students s tudents are asked to consider the difference between chronic  and acute pain. Chronic pain is that suffered over a long period of time, e.g. lower back pain, arthritis; while acute pain can be mild or severe but lasts l asts no longer than six months, e.g. broken bone, labour pains, a burn, etc.

Pain   Pain

2 

12

 

Teache Te acher’s r’s notes not es

2

Warm-up 1  Dictate the names of hospital departments and

Pre-teach/elicit: throat, gum, lower (back). Refer students to the vocabulary table and ask them, individually or in pairs, to change sentences 1–6, using different words from the table.  If necessary, work through the first sentence as a group.

facilities from Unit 1. Then ask students to group them according to their stress pattern. This can be done as a team game – the first team to group all the words successfully is the winner. 2  Ask students to refer to the Patient Details form on page 10 and ask them to take it in turns to roleplay interviewing the patient at admissions.

Remind students we say I’ve got toothache/stomach ache/earache. BUT I’ve got a headache.

Locating and describing pain

Suggested answers 1 My throat hurts. 2 My ankle hurts, it’s very sore. 3 Does your head hurt? 4 Her gums are really sore. 5 His stomach hurts. 6 My lower back aches and it’s really painful.

Vocabulary 1  If students are experienced nurses, ask: What

not, ask: type of chart is this? What is it used for? If not,  What do you think this chart is used for? Who fills it in? (Pain map, used by nurses and doctors to mark the exact location of the patient’s pain.)  pain.)  

3

1 head 2 face 3 neck 4 shoulder 5 chest 6 stomach 7 hip 8 arm 9 hand 10 10 leg  leg 11 11 knee  knee 12 12 ankle  ankle 13 13 foot  foot 14 14 back  back 15 15 buttocks  buttocks

Suggested answers 1 My knee is really sore. 2 I’ve got a pain in my shoulder, it’s really painful. 3 My chest hurts.

Extra activity

the body. Alternatively, askresearch students, individually or in pairs, to the above and deliver their findings during the next class. Suggested answers Arm: hand, finger, thumb, elbow, wrist, palm Leg: foot, ankle, calf, toe, thigh, knee, shin, heel, sole Torso: stomach, hip, shoulder, buttocks, back, chest, waist, navel Head: face, neck, eye, nose, mouth, ear, cheek, forehead, eyebrow, lip, eyelid, throat

Elicit a general opening question: How do you  feel?/How are you feeling feeling today?  today?  Refer students back to the pain map. Ask them to write one or more sentences for each of the red arrows to answer this question.

Ask students, or ininpairs, to label the pain map, individually using the words the box. Tell them to ignore the red arrows for the moment. Come together as a group to check answers.

Divide the class into four groups. Give each group a different area of the body: arm arm,, leg leg,,  (elicit/pre-teach this) head  and ask them to torso (elicit/pre-teach torso head and brainstorm the parts related to that section of

Patients often talk about their pain in simple terms. Mime a patient with a headache. Elicit expressions from the table in 1 to describe how you are feeling.

Listening 4

► 10  10 Tell  Tell

students they are going to hear three patients (James, Godfrey and Alma) describing where they feel pain. As they listen, students should put a cross (x) on the pain map for each patient. Play the recording again if necessary. 1 stomach/chest 2 forehead 3 hip/leg

5

Ask students to listen to the three dialogues again and complete the descriptions and the nurse’s question. If necessary, review prepositions of place. Play the recording again for students to check their answers. 1 between, stomach 2 right, above 3 back, hip, down 4 Where, feel

Pain   Pain

2 

13

 

Extra activity

7

In pairs, students should take turns asking and answering the nurse’s question: Where do you  feel the pain? Encourage pain? Encourage students to recycle parts of the body from 1.

On the board write: bad, good, severe, strong. strong. Ask students to complete the patient descriptions using the comparative and superlative forms of these adjectives. They can then use the table as a means of checking their answers.

write: good/bad.. Ask students to 6  On the board write: good/bad give the comparative form of these adjectives (better/worse ). Ask them, individually or in pairs, better/worse). to put the words in the correct order to form sentences that patients might use to describe changes to their pain.  For further language practice, ask students to underline the word that makes a comparison stronger – much much.. Remind them that we don’t say more worse/better.  worse/better.  1 The pain is much better now. 2 I feel better today. 3 It’s worse than yesterday. 4 The pain in my leg is much worse.

Language Comparatives and superlatives

If necessary, review comparatives and adjectives before starting this exercise.

1 1 stronger 1 stronger 2 better 3 better 4 most severe 5 the worst 2 1 worse 1 worse 2 worst 3 best 4 better 8

Ask students to look again at the descriptions in 7 and choose the correct medical problem for each. Check understanding of: painkillers, of: painkillers, darkened darkened room, forehead, cheekbones, nasal spray, face pack. For further language practice, on the board write: headache, stomach ache, toothache. toothache. In pairs, students should choose one condition and take turns to describe their pain in detail using comparative and superlative adjectives. If necessary, students can write notes first. 1 migraine 2 sinusitis

and painful.  Ask 1 On the board, write: strong and  painful. Ask students to count the syllables in each word. Elicit the comparative and superlative forms of each and then ask: What is the rule for adjectives with one syllable? What is the rule for adjectives with two or more syllables? One syllable: add -er  add -er   (comparative), add the +  (superlative) est est (superlative) Two syllables: add more (comparative), add the  (superlative) most (superlative) most of good and  and bad 2 Elicit the superlative forms of good bad.. (the best, the worst) worst ) 3 Ask students to look at 6 and find an example of comparison of two ideas/things. (It’s worse than yesterday.)  Then refer students  yesterday.) Then to the two examples in the table to reinforce the usage. Give students time to assimilate the points covered in the Language box.

Pain   Pain

2 

14

 

Point out that these adjective phrases are used with certain parts of the body. To help them remember, ask students to think about how the equivalent adjectives are used in their L1.

Pain assessment Listening 1

► 11

Tell students they are going to hear five patients talking about their pain in detail. Ask them to listen and write down exactly where the patient feels the pain under each name.

1 e 2 h 3 g 4 b 5 f 6 a 7 d 8 c

Extra activity Ask: Which adjectives can be used to refer to the  (tingling, stinging, itchy) skin? (tingling, skin? On the board write: head, eye, shoulder, chest, limb (leg/arm), stomach and stomach and ask students in small groups to match the parts of the body to the most appropriate adjective. Alternatively, ask students, individually or in pairs, to research the above and deliver their findings as an informal presentation during the next class. Suggested answers head: dull, throbbing, shooting eye: burning, stinging, itchy shoulder: stabbing, throbbing chest: shooting, stabbing, dull limb: dull, shooting, stabbing, tingling stomach: throbbing, burning

Alternatively, to offer students more support, write the answers in a different order on the board: chest, hands, head, lower back. Then back. Then play the recording. This will give students the chance to concentrate on the patient’s description. 1 head 2 lower back 3 chest/stomach (patient doesn’t give specific area but says she gets a burning feeling after eating food) 4 hands 5 chest 2

Ask students to listen to the dialogues again and complete the patients’ descriptions using the adjectives in the box. Encourage students to deduce the meaning of the adjectives from the descriptions and the body parts they refer to. Ask students, in pairs, to compare their answers before coming together as a group to check. Point out that initially nurses often ask a very ver y general question to encourage the patient to talk about their pain. Either ask students to turn to the audio script on page 71 and find two general questions the nurses use to ask about pain, or elicit these questions: Can you describe the pain? What does the pain feel like?  like?  1 throbbing 2 dull, shooting 3 burning 4 tingling 5 stabbing

3

Vocabulary

Refer students to the table and ask them, individually or in pairs, to match the adjective phrases to the correct description. Encourage students to use their knowledge of English to deduce the meanings.  Depending on your group, you may wish to use illustrations (arrow = shooting, drum = throbbing, knife = stabbing, bee = stinging, pincushion = pins and needles) to reinforce the meanings of these words.

Extra activity In pairs, students take turns asking and answering the nurse’s questions: Where do you  feel the pain? and Can you describe the pain?/What does the pain feel like?  like?   4

If your students are pre-experience nurses, ask: What do you think these charts are used for? When do you think nurses use the chart with faces? If faces? If they are experienced nurses, ask: What are these charts called? How do nurses use these charts? Which pain scales areof used scale you prefer and why? (Pain why?  (Pain the with do patients to assess/measure level their pain. The 1–10 pain scale is generally ge nerally used with adults and the faces pain scale with children or people who have difficulty expressing themselves/their feelings. Nurses ask patients to give a number between 1 and 10, where 0 = no pain, to describe how much pain they feel. Nurses ask children to point to the face that describes how they are feeling.)

Pain   Pain

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15

 

Tell students they are going to look at vocabulary to describe the degree/level of pain. Refer them to the chart and ask them, individually or in pairs, to match the expressions in the box to the faces and the numbers. If necessary, do the first one as a group. Elicit the question a nurse would ask when using these scales: On a scale of 1 to 10, how bad is the pain/how much pain are you in? Can you point to the face that shows how you are feeling? 1 no pain 2 mild pain 3 moderate pain 4 severe pain 5 very severe pain 6 unbearable pain

1 labour: location – lower stomach/hip area; type – dull ache, contractions (strong waves of pain) 2 appendicitis: location  –  – middle of stomach (belly button), moves to lower right side of abdomen; type  –  – stabbing pains 3 severe migraine: location – head, behind eye, neck; type – throbbing 4  broken shoulder: type – stabbing, aching, throbbing 5 kidney stones: location – middle back, groin; type – ache/spasms (or waves) of pain 6 tonsillitis: location  –  – throat, (glands) in neck; type  –  – burning sensation

Speaking 5

Tell students they are going to develop a set of basic questions to assess pain. Ask them to add  words to complete the questions. Wh- words WhIf necessary, elicit Wh (who, Wh-- question words (who, where, what, when and when and how how)) before completing the exercise. Tell students they will be looking at question techniques in more detail in Unit 4. 1 Where 2 How 3 When 4 How 5 Where 6 Where 7 What 8 Where/When

6

Give students adequate time to read through their patient cases. Refer Student Bs to page 68. Check understanding of: unbearable, unbearable,  spicy food.  Student As should interview their patient (Student Bs) and complete the pain map and pain scale. Students should swap roles. Ask pairs to compare their pain maps and pain scales, before checking answers. Student A: Pain A:  Pain map with cross on chest with arrow across to right arm; Pain Scale with cross on 9 (moving down to 7) Student B: Pain B:  Pain map with cross on stomach; Pain scale with cross on 7 

7

On the board write: Where does it hurt? From 1 to 10, how  how bad is the pain? In pain? In pairs, ask students to look at the conditions 1–6 and answer these questions for each condition. Ask them to compare their ideas with another pair before coming together as a group to check answers.   If your students are pre-experience nurses, check understanding of: appendicitis  and kidney stones. appendicitis and stones.

Pain   Pain

2 

16

 

Ask: Why is it important to ask these questions?  questions?  (Pain is not just physical; it can also have an impact on other areas of the patient’s life – social, economic, psychological, and environmental. It is important that the nurse considers the patient as a whole – a holistic approach – so that they can propose an effective treatment.)

Successful communication Listening 1

► 12

Ask students to ‘observe’ the patient Dina Guyader (28) by looking at the photo. Ask them to answer or just think about questions 1 and 2. Avoid providing corrections at this point.

Some students may have difficulty expressing these ideas effectively in English. Reassure them that for this activity accuracy is not important –  just encourage them to discuss their opinions.

Tell students they are now going to hear practice nurse David Taylor interviewing Dina. As they listen to Part 1, students should check the answers to questions 1 and 2. If necessary, play the recording of Part 1 again.

Ask students, individually or in pairs, to answer questions 1 and 2. You may wish to check the answers to these questions before moving on to question 3.

1 lower back – below the waist, across the back 2 dull ache and a shooting pain, like an electric shock 2

Ask students, in pairs or small groups, to match the symptoms in the box to the correct sections in question 7.

► 13

Tell students to listen to Part 2 and put a cross and the letter N on the pain scale to indicate how Dina feels now and a cross and an M to indicate how she feels in the morning.

Point out that questions 1–6 of the initial pain assessment tool are similar to those covered in 5 on page 15.

1 2 2 7 or 8 3

1 What makes it better? 2 What makes it worse? 3 Sleep – insomnia  Appetite – can’t eat Physical activity – can’t climb stairs easily, can’t do sports, can’t stand even for short periods Emotions – anger, suicidal feelings, crying

Ask students to listen to Part 2 again and circle the correct answers. If necessary, allow students to read through the questions before listening. 1 b 2 a 3 b

Writing 4

Extra activity

If your students are experienced nurses, refer them to the initial pain assessment tool and ask: Have you ever used a form like this? What is it used  for? Who carries out out pain assessment assessment in your country/place of work? (Nurses use the assessment tool as a guide to ask more detailed questions about the patient’s pain. Depending on the country, nurses are more or less involved in carrying out pain assessment; this may be the responsibility of the doctor.)  doctor.) 

Ask students to add one more example to each section of the initial pain assessment tool. Suggested answers Accompanying symptoms: stomach cramps, headaches Sleep: feeling overtired Appetite: smaller, reduced appetite Physical activity: difficulty lifting heavy objects Relationships with others: feeling suspicious of family members Emotions: feeling depressed

Pre-experience nurses will understand how the tool is used once they have worked through questions 1–3.

Listening 5

► 14

Before listening to Part 3, ask students to brainstorm possible answers for questions 5 and 6 for Dina. Then ask them to listen and complete these two questions.

Pain   Pain

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17

 

Play the recording again and ask students, in pairs, to complete question 7. Explain that some points are referred to indirectly. If necessary,   allow them to read through the audio script on page 72 to check their answers.

Extra activity Refer students to pictures A and B and ask them to imagine themselves as the patient in each case. On the board write: How do you feel? What do you think about the t he nurse? Would you like this nurse to take care of you? Why (not)? Students may wish to write down their answers before

5 lying down, taking a hot shower 6 lifting heavy objects, carrying her daughter 7 Accompanying symptoms Sleep – she doesn’t sleep well, she is often very tired  Appetite – she has no time to eat properly Physical activity – she is unable to lift heavy objects/her daughter Relationships with others – she has problems getting along with her husband (mentioned indirectly) Emotions – she feels angry, she feels emotional (cries during the interview)

discussing in pairs then group to share theirand ideas. ideas.    come together as a

Reading 7

Ask students to complete the description using the words in the box. Encourage them make use of pictures A and B to help them complete the text.

Speaking 6

If your students are pre-experience nurses, you may wish to do 7 before 6. The pictures will then

Check understanding of: close member, expression, eye contact, rush, takefamily an interest in, aggressive, roughly.

serve to reinforce the examples in the description. Tell students they are going to talk about good communication in nursing. Ask them, individually or in pairs, to write down or think about between three and five things that demonstrate good communication, e.g. smiling when talking to a patient. 

If necessary, reinforce the meanings of the important aspects by asking students to point to examples of each in pictures A and B. 1 ease 2 relaxed 3 sit 4 smile 5 eye 6 quickly 7 friendly 8 name 9 questions 10 10 open  open 11 11 questions  questions

Then, ask students, in pairs, to look at pictures A and B. Ask: What are the nurses doing or not doing to facilitate communication with the patient? Check understanding of: facilitate. of: facilitate.  

Extra activity For further discussion, ask: What kind of questions could/do you ask patients to show interest? Suggested answers ask questions about the patient’s family/friends; ask about what the patient is doing (programme they are watching on TV, music they are listening to); the weather; current events; etc.

Some students may have difficulty expressing their ideas; reassure them that for this activity accuracy is not important – just encourage them to discuss their opinions.  A  A:: The patient looks relaxed/at ease and is responding to the nurse. The nurse is smiling and making eye contact with the patient. His posture is open and he is leaning slightly forward. He is engaging directly with the patient. This shows a very positive communication technique. B:  The patient does not feel listened to, feels unimportant. The nurse demonstrates very poor communication technique. Standing over the patient as opposed to putting himself at the same level and having his arms behind his back gives the impression he is not interested. He is not looking at the patient when speaking to her.

Tell students they are now going to read a description of good communication practice. Before they read, ask them to explain the title of the article or give it an alternative title (e.g. How to make your patient feel comfortable). comfortable).

Pronunciation 8

 15 Tell  Tell ► 15

students they are going to listen to four nurses greeting their patients. Ask them to listen and decide if the nurses sound friendly or unfriendly by ticking () the correct box. Ask them to listen to the first one as an example.  

Pain   Pain

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18

 

If necessary, play the recording two or three times to allow students to hear the difference. Reassure them that it is sometimes difficult for non-native speakers to hear the difference. However, reiterate (as in 7) that a friendly tone of voice is very important in developing and maintaining a good patient relationship. 1 friendly 2 unfriendly 3 unfriendly 4 friendly 9

► 16

Ask students, individually or in pairs, to complete the ‘rule’ about the intonation pattern used for a friendly welcome. Play the recording again and ask students to repeat the stress pattern they hear. Do this several times until you are happy students are able to reproduce the same/approximate pronunciation and stress pattern.

Extra activity In pairs, ask students to choose two patients from page 14. Refer them to audio script 11 on page 71 and ask them to invent information for these patients and complete questions 5–7 in the initial pain assessment tool on page 16. Students should continue the conversation, using the new information. Encourage use patient-friendly intonation patternsthem and to questions to put the patient at ease and show interest. They then swap roles. If necessary , brainstorm the patient details as a group before asking students to roleplay.

 A friendly welcome usually uses an intonation pattern that rises and falls.

Speaking 10 Tell students they are going to look for examples

of how the nurse tries to put Dina at ease. Refer students to the audio scripts 12–14 on pages 71– 72 and ask them to underline examples of points 1–6 in the nurse’s dialogue. Ask them to write down exactly what he says in each case. If necessary, go through the first question as a group. 1 Hello Dina. Come in …/I understand it’s not easy for you Dina. 2 And how’s the little one today? 3 I hope the baby is OK? 4 It’s OK. Take your time. 5 I understand it’s not easy for you Dina. 6 I just want to ask you a few questions. Is that OK?/I want to ask you a few more questions.

Extra activity Refer students to audio scripts 12–14 on pages 71–72. In pairs, students take turns roleplaying the dialogue between the practice nurse and Dina Guyader. Encourage them to use patientfriendly intonation patterns.

Pain   Pain

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19

 

Pain relief

5  In small groups, ask students to discuss the

question. Reassure students that accuracy is not important for this activity – just encourage them to discuss their ideas.

Speaking 1

Ask students, in pairs, to brainstorm different types of pain relief suitable for lower back pain, then answer the questions. Come together as a group to share.

Vocabulary 6  Refer students to the pictures at the top of the

page ask: (Complementary What kind of treatment do these and alternative imagesand show? show? (Complementary medicine.) Explain that the abbreviation CAM is now commonly used.

Suggested answers bed rest, shower, gentle walking, ice pack, swimming 

Ask students, individually or in pairs, to match the different examples of CAM to the correct description. Check understanding of: improve, mental well-being, therapy, therapist, manipulate, influence.   influence.

Reading 2  Tell students they are going to read an article

from a health website aimed at sufferers of lower back pain. If necessary, pre-teach/elicit the items in the box before doing the exercise. As they read, students should complete the text using the words in the box. Come together as a group to check answers.

1 e 2 c 3 b 4 d 5 f 6 a

Listening 7 

herbal therapy, hypnotherapy, hydrotherapy, chiropractic therapy, music therapy

3  Tell students they are going to be giving advice

1 Don’t 2 Do 3 Do 4 Don’t 5 Do

students they are now going to hear

friends, Angie and Carlos, talking about their experiences using CAM. Ask students to listen and tick the examples of CAM they hear.

1 comfortable position 2 pillow 3 shower 4 painkillers 5 anti-inflammatory 6 hot-water bottle 7 heat patches 8 ice pack 9 muscles 10 10 swimming  swimming

to patients suffering from lower back pain. Refer them to the statements 1–5, then ask them to reread the article and complete the pieces of advice by adding Do  or Don’t  to the beginning of Do or Don’t to each one. If necessary, go through the first item as an example as a group. g roup.

 17 Tell  Tell ► 17

8

Refer students to the statements 1–5 and ask them to listen and decide if the statements are true (T) or false (F). Ask students, individually or in pairs, to correct the false statements. Come together as a group to check answers. 1 T

Speaking 4

Refer students, in pairs, to the patient’s questions 1–3 and ask them to roleplay possible answers. If necessary, pre-teach/elicit expressions for giving advice: Why don’t you + you + infinitive …; You  + infinitive … (for tentative suggestions); sugges tions); could + could You should + should + infinitive (for strong advice).

2  F (Carlos thinksand ginger is onlyache.) used as a remedy for colds stomach 3 T 4 F (Angie thinks chiropractic therapy sounds more painful than the backache itself. She doesn’t give the impression she wishes to try it out.) 5 F (Carlos believes CAM is more effective for acute pain.)

Suggested answers: 1 You could use a hot-water bottle. 2 You could go swimming/use an exercise bike. 3 You should make an appointment to see your GP/family doctor.

Pain   Pain

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20

 

Speaking

Extra activity Ask students (in small groups) to brainstorm more examples of CAM and write short descriptions for a health website or patient educational leaflet. Suggested answers acupuncture – uses very fine needles to regulate the flow of energy through the body. If the energy in the body is balanced, then the person is in good health. homeopathy – uses very small doses of a substance that causes symptoms to stimulate the body's self-healing response massage – squeezes/stretches parts of the body to make someone relax or to reduce pain visualisation – uses positive mental images to reduce pain or relax someone

Extra activity Ask students, in pairs, to look at audio

two 10  In small groups, ask students to discuss the two questions. Ask them to feed back to the rest of the group and share their thoughts. If necessary, give students time to write notes first. If your students are pre-experience nurses, ask them to prepare a short informal presentation for the next class.

Preparing for the next unit In preparation for Unit 3, suggest the following to your students: •

Compile a list of words related to giving instructions you already know in English.

•

Familiarise yourselves with general nursing statistics, e.g. height, weight, temperature, blood pressure.

•

Do some (online) research into the heart and heart disease.

script 17 on page 72. Say: Carlos believes chiropractic therapy is the best treatment for back pain. Do you agree or disagree? Tell them to explain their answer to another pair. Students may wish to write notes before discussing their ideas.

Vocabulary 9

On the board write: acute pain and and chronic  chronic pain  pain  and ask: What is the difference between the two  Brainstorm ideas. Then ask students, in terms? Brainstorm terms? pairs, to complete the definitions. Come together as a group to check answers. Experienced nurses may already be aware of these terms, although some may have difficulty expressing their ideas in English. Suggested answers 1 Chronic pain continues over a longer period of time; i.e. longer than six months. It can be caused by lower back pain, headaches, arthritis, cancer pain, neurogenic pain. 2 Acute pain can be mild or severe but doesn’t last longer than six months. Examples include: dental work, labour and childbirth, surgery, broken bones, burns and cuts.

Pain   Pain

2 

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3

Vital signs

Briefing

Describing readings

This unit deals predominantly with procedures that

This section draws students’ attention to the

form an important part of a nurse’s daily routine: tasks of high-level frequency that introduce students to language of equally high frequency.

language used to describe the readings. This differs depending on the vital sign: respiration (beats or breaths per minute), temperature (thirty-six point  four) blood pressure (one thirty over eighty). Students become acquainted with lexis to enable them to describe variations in readings, e.g. stable, up and down, increase, decrease, etc.

Statistics and vital signs Vital signs are measurements of the most basic functions of the body. These are recorded initially on the patient’s admission form and then throughout their stay in hospital on observation (or obs) charts. Each time a nurse adds a new recording to the observation chart or admissions form, he/she must sign it to show who is responsible.

Normal respiratory rates (RR) for adults are 15–20 breaths per minute and for children (5–12 years) 20–

Students are also asked to discuss factors that can affect such readings: environmental (climate, humidity), social (lifestyle, alcohol), psychological (stress, anxiety) and physical (age, gender). See answer to 5 for more detailed information.

Taking vital signs Taking vital signs involves giving patient-friendly instructions and making polite requests. In Section 3, students will look at language used for these as well as the future using will,  which serves to keep the will, which patient informed about what is about to happen and helps reduce their anxiety.

25. These are measured either with a stethoscope or by the nurse placing their hand on the patient’s chest. The heart rate is usually assessed by calculating the patient’s pulse (P), detected by placing two fingers over the artery in the wrist. Normal rates for adults are 60–100 beats per minute  and for children (5–12 years), 80–100. Normal body temperature (T), taken using a thermometer, can vary between 36.5°C and 37.2°C. There are various types of thermometer and the one most commonly used in UK and US hospitals is the tympanic thermometer. Blood pressure (BP) is measured using a sphygmomanometer  (or sphyg) or a digital blood pressure monitor. Normal blood pressure ranges from 110 to 150 millimeters (as the heart

As nurses spend a lot of time taking vital signs and therefore giving instructions or making polite

beats) over 60 to 80 millimeters (as the heart relaxes). relaxes) .  Finally, oxygen saturation (0² sats) relates to the percentage (%) of oxygen in the blood and is measured using a pulse oximeter.

requests, this section includes high-frequency language that is vital to the development and maintenance of nurse-patient relations at a time when patients feel vulnerable.

On admission, nurses will also measure the patient’s height and weight. Nurses are also expected to observe their patient as this too may have a bearing on the patient’s diagnosis and treatment. They note the following: pallor, colour and texture of the skin; general appearance (Are they well groomed and appropriately dressed?); expression (Do they appear in pain/look their age?); movement (posture, gait, co-ordination); and mental alertness of the patient. Where possible, it is suggested teachers exploit the images of the patients provided in the unit to encourage students to do this.

It is assumed that students at this level will be familiar with the modals can/could can/could.. Here, guidance is given on the importance of how to give patientfriendly instructions and make requests, using appropriate intonation patterns and reassuring expressions.

Circulation and the heart This section introduces students to medical terms for the heart and its functioning commonly used amongst colleagues and sometimes with patients. It then considers the link between smoking and cardiovascular disease. Section 4 reviews words to describe readings within the context of smoking. These constitute authentic tasks which show how how nurses are required to to explain medical conditions, etc. using patient leaflets.

Vital signs  signs 

3 

22

 

Refer students to the information in the height/weight chart. Explain that Imperial measurements (pounds/lbs) are used in the USA and also with older patients in the UK and a nd Ireland (pounds/lbs and stones).

Teache Te acher’s r’s notes not es Warm-up 1  On the board write: head, eye, shoulder, chest, limb,

stomach, skin and skin and then ask students to brainstorm adjectives that can be used to describe pain for each. This can be done as a team game – the team with the most correct adjectives in a given time is the winner.

1 c 2 d 3 a 4 b 3

2  Ask students, in pairs, to brainstorm different

ways to put a patient at ease. Tell students to use the patient case on page 15 and take it in turns to assess the patient, making sure the patient is at ease.

1 underweight 2 normal weight 3 overweight 4

Statistics and vital signs Listening 1

On the board, write: 65 m, 56 kg, 1.74 m, 25.5 kg, 81 cm, 153 cm, 66.25 kg. kg. Elicit the correct

1 Can you, first? 2 are you 3 height 4 stand, scales 5 much, weigh 5

Tell students they are going to hear a practice nurse weighing and measuring six patients. They should circle the correct number.

Extra activity

Depending on your group, students may prefer to work in single-sex pairs for this activity. In pairs, ask students to practise weighing and measuring each other (they can guess). Encourage students to use the questions 1–5 in 4. Remind them to swap partners.

Point out they will hear: one point three four  or one metre thirty-four  and  and twenty-two metres or metres  point two five kilos, kilos, but no t  twenty two point twenty-five kilos. 1 1.60 m 2 72 kg 3 1.34 m 4 89.5 kg 5 22.25 kg 6 1.40 m

Ask students, individually or in pairs, to complete the nurse’s questions and requests. If necessary, play dialogue 1 again. Come together as a group to check. Check understanding of: bladder, to empty, scales.

► 18

way to say figures. If necessary, review weights andthese measures and/or numbers in more detail.

Tell students they are going to listen to the dialogues again and ask them to plot the statistics for patients 1–3 on the height and weight chart. They should also decide if the patients are normal, overweight or underweight.

Less confident students may wish to keep the phrases uncovered initially. 6

Ask students to match the vital signs to the correct definition. 1 d 2 c 3 a 4 b

Ask students, in pairs or small groups, to write the height and weight of three people – a child/older person/person the same age – and then take turns to dictate the statistics to each other. 2

 19 Tell  Tell ► 19

students they will hear Nurse McMaster weighing and measuring four patients. Before they listen, ask students to observe the patients a–d. Then ask them to listen and match the dialogues to the correct patient.  Remind students we don’t say How high are you? or What’s your tall?  tall? 

signs  Vital signs 

3 

23

 

Extra activity

Extra activity

On the board, write: A write: A high/low … means that the  patient … Ask students, in pairs or small groups, to discuss what a) a very high and b) a very low reading of each of the vital signs shows about the health of a patient.

1 On the board draw a spidergram (temperature temperature)) and elicit different types of equipment for taking temperature. Students may not know the name in English, but ask them to explain how it is used/what it looks like.

Suggested answers A high pulse indicates infection, stress, anaemia or exercise. A very low pulse rate indicates hypothermia, certain drugs (for example beta-blockers) and certain heart conditions. A high blood pressure indicates anxiety or stress. A low blood pressure indicates hypotension. A high temperature indicates fever. A very low temperature indicates hypothermia. A low respiratory rate indicates over-sedation, opiate poisoning or the presence of a cerebral lesion. A high respiratory rate indicates asthma, heart

2 Ask: What are the different methods of taking a temperature?/Whatt type of thermometer is used for temperature?/Wha each method?  method?  Answers  1 tympanic, electronic, mercury (now rarely used), oral 2 axillary/under the arm: mercury, electronic ear: tympanic oral/mouth: mercury, electronic, oral rectal: glass, electronic

problems. 7  Ask students to look at the pictures and label the

equipment with the words in the box. If your students are pre-experience nurses, check the answers are correct before moving on to the next stage of the activity. Ask students to write sentences using the expression: A/An expression: A/An … is used used to measure … Tell them not to worry too much about their pronunciation at this stage. a blood pressure monitor b  thermometer c  pulse oximeter d  stethoscope e sphygmomanometer 1 A digital blood pressure monitor is used to measure a patient’s blood pressure. 2 A thermometer is used to measure a patient’s body temperature. 3 A pulse oximeter is used to measure how much oxygen there is in a patient’s blood – the oxygen saturation. 4 A stethoscope is used to listen to heart sounds and respiration rate  (and bowel sounds).  5 A sphygmomanometer is used to measure a patient’s blood pressure.

Pronunciation 8

► 20

Ask students to listen and check their answers to 7. Then on the board, write: digital digital.. Ask how many syllables there are in the word and then elicit the stressed syllable. Ask students to underline the stressed syllable in each word. Avoid correcting at this stage. 1 digital blood pressure monitor 2 thermometer 3 pulse oximeter 4 stethoscope 5 sphygmomanometer

9  Play the recording again until you are happy

students are able to reproduce the same/approximate pronunciation and stress pattern. Reassure students that some of these terms are difficult to pronounce even for a native speaker. Students know of these terms from theirmay ownalready language butsome will tend to place the stress in the wrong place. Ask them to compare stress patterns in their L1.

Speaking 10 Refer students to the chart (the ‘vital signs’

section of the admission form). Ask: When is this section completed? Who completes the information? Why/When is it necessary to sign?  sign?  Ask students in pairs to match the abbreviations to the words in the box. If your students are preexperience nurses, check that they have the correct abbreviations before moving on to the next part of the activity. Ask students to explain the terms to each other.

signs  Vital signs 

3 

24

 

Suggested answers BP stands for blood pressure. We use a digital blood pressure monitor or a sphygmomanometer to measure this. P means pulse. We use a pulse oximeter to measure this. (The nurse can also use his/her finger to measure the pulse.) RR stands for respiration rate. We use a

Listening 3

Point out that short forms are often used in spoken English: Pulse 60, Resps 120, Temp 35.2, BP 120. 1 P 128 RR RR 33  33 T 37 2 BP BP 89  89 / 66 P 78 RR RR 20  20 T 37.5 4 

complete the summary, summary, then 11  Ask students to complete compare their answers with a partner. Come together as a group to check. 1 take 2 vital signs 3 record 4 observation chart 5 sign 6 monitor 7 high 8 low

Extra activity Ask: What other observations do nurses carry out?  out?  Suggested answer Nurses should always take time to look carefully at their patient and note: pallor; colour and texture of the skin; the general appearance (Is he/she well groomed and appropriately dressed?); expression (Does he/she appear in pain, look his/her age?); movement (posture, gait, coordination) and mental alertness of the patient.

students they are going to hear nurses giving readings of vital signs for two patients. Before they listen, ask students to look at the current readings for the two patients. Ask: What do you already know about these patients? If necessary, play the recording again. Students should compare answers with a partner, then come together as a group to check.  

stethoscope to measure this. T means temperature . We use a thermometer to measure this. Wt stands for weight. 0² Sats means oxygen saturation. We use a pulse oximeter to measure this. kg means kilograms. O2 means oxygen.  % means percentage.  

Vocabulary

 21 Tell  Tell ► 21

► 22

Ask students to look carefully at the vital signs for Anja Wellington. Ask: What do you learn about the patient from her vital signs? (According signs? (According to the chart, we know her age and that she weighs 32 kg. Her sats and resps are normal (for a child), but her pulse is at the maximum rate for a child of her age, and her BP seems low.) Explain to students that the information on the chart is incorrect. They are going to hear a nurse giving the correct readings for this patient. Tell students to listen and correct the mistakes. If necessary, play the recording again.  again.  BP 100 BP  100 / 65 P 130 RR RR 25  25 T 37.5

Describing readings Vocabulary 1

Ask students, individually or in pairs, to complete the table. RR 130/85 36.8 79 20

BP  

P

T  

   

2  Ask students to complete the descriptions of the

vital signs using the words in the box. 1 one, over 2 at, per 3 point 4 per signs  Vital signs 

3 

25

 

Speaking 5

7  Depending on your group, you may wish to do

8 before 7. The statements in 7 will then further reinforce the meaning of the language items.

On the board, write: Environmen Environmental, tal, Social, Psychological, Physical. Physical. 

Explain that nurses use different words and expressions to describe readings.

Ask students to brainstorm one example for each category of something that can affect a patient’s vital signs. Check understanding of the

Tell students they will hear the same conversation again. They should listen and match the correct patient to each statement. Check the answers before moving on to the next stage of the activity. Then ask students to use expressions from the box to complete the statements.

categories before continuing. Then ask students to match the other factors in the box to the correct category. Environmental: humidity, temperature Environmental: humidity, Social: lifestyle, Social:  lifestyle, caffeine, tobacco Psychological: anxiety, Psychological:  anxiety, anger, stress Physical: age, Physical:  age, gender, infection Your students may mention some of the following points. Humidity can raise respiration rate. Tobacco and caffeinated drinks should be avoided for 30 minutes prior to recording as these can increase BP and P rates. Blood pressure may be affected by anxiety.  Anger can affect can affect blood pressure and the pulse, causing them to rise.  Stress can increase the pulse rate. Rates differ with age, gender and as a result of infection. Note also: Pulse also:  Pulse can be increased due to: exercise, fear, excitement, loss of blood or fluids, certain drugs and heart conditions. Pulse can be decreased due to: hypothermia, certain drugs (e.g. beta-blockers) and heart conditions. Temperature may be affected by: fever, exercise, ill health, hypothermia.

1 up and down (P) 2 down (R) 3 vary, and (P) 4 up (D) 5 stable (D)

Vocabulary 8

Brainstorm words and expressions to describe readings. them later.Tell students you will be checking Draw the five line types on the board and ask students to match the correct arrow to the sentences in Exercise 7.  Ar row : 1 1 sentence  sentence 4 2 sentence 2 3 sentence 3 4 sentence 5 5 sentence 1

Extra activity Ask students, individually or in pairs, to research effects of these factors on vital signs andthe deliver their information as an informal presentation during the next class.   6

 23 Ask  Ask students to first observe the three ► 23 patients Davina, Rose and Pilar, at the top of the page. If your students are pre-experience nurses, check that they are familiar with an observation chart. Ask: What do the three charts show? show?   Tell students they are going to hear staff nurse Debbie giving her colleagues an update on the three patients. They should listen and label the observation charts with the correct patient name. a Rose b  Davina c  Pilar

3 

Vital signs  signs 

 

Taking vital signs

Extra activity On the board write: Could you relax your arm,  Elicit an appropriate intonation pattern,  please? Elicit  please? then play the recording again to check. Alternatively, model two examples – one with a flat intonation pattern and one with a rise and fall. Ask: Which is more polite? Why?  Why?  

Listening It is important students take time to grasp how to give patient-friendly instructions and requests as this is vital in developing and maintaining nurse-patient relations. If necessary, review and usage of modals . Students canform then can/could. can/could concentrate on ensuring their instructions/requests are patient-friendly.

Answer A flat intonation pattern sounds impolite/uncaring/not patient-friendly. 

Tell students they are now going to work on giving instructions and making polite requests. On the board, write: Relax your arm. Elicit a ‘softer’, more patient-friendly instruction:  instruction:  Can/Could you relax your arm, please?

Extra activity Ask students to underline one word in sentences 1 and 3 that makes them more patient-friendly. Ask: What does this do to the  (Including just makes instruction/request? (Including instruction/request?  just makes the instruction/request sound softer.) Ask students to practise giving instructions 2, 4, 5 and 6 adding the word just. word  just.   Note that intonation rises slightly on just. on  just.  

Check understanding of: roll up, sleeve, straight.  straight.  Encourage students to deduce the meaning from the context/images. 1

 24   ► 24

Refer students to the images a–f and ask them, individually or in pairs, to match them to instructions 1–6. You may wish to correct the first part of the activity before continuing. Then ask students to choose the correct piece of equipment for each instruction.

2

Remind them that the use of modals can  and can and  for instructions and polite requests is could for could interchangeable. Ask students to practise the instructions/polite requests in pairs. Encourage them to use can and could.. Tell them that intonation is very important could when giving patient-friendly instructions. A gentle rise and fall pattern will help to soften the instruction (make it sound less direct) and as a result relax the patient. Ask students to practise the instructions/ requests again, this time focusing on the intonation pattern. 1 a 2 b 3 e 4 d 5 c 6 f 1 temperature (thermometer) 2 temperature (in ear with tympanic thermometer) 3 blood pressure/pulse (digital blood pressure or a sphygmomanometer) 4 pulse (finger) 5 respiration rate (stethoscope) 6 blood pressure (digital blood pressure or a sphygmomanometer)

Tell students that charge nurse Stefano is going to take Mr Daniels’ pulse rate. Before they listen, ask students to visualise taking a patient’s pulse; this will help them to concentrate on the language input as opposed to the task itself. Then ask students, individually or in pairs, to put the words in order to form a sentence and then put the sentences in the correct order. If necessary, go through one answer with the students first. 1 I’ll take your pulse now, Mr Daniels, if I can? 2 Can you give me your palm, please? 3 I’ll put my fingers on your wrist. 4 That’s ninety-five beats per minute.

3

► 25

Play the recording to check answers to 2. Then play the recording again to answer the question. Mr Daniels was late for his appointment and rushed to arrive on time. The reading was not accurate.

4

► 26

Tell students they are now going to listen to the same nurse taking Cameron’s pulse. Ask them to read through the questions, then listen and answer. If necessary, play the recording again. Ask students to compare answers with their partner, then come together as a group to check.

26

Vital signs  signs 

3 

 

1 pulse oximeter 2 110 beats per minute 3 Around ten years old. His pulse rate is higher than a mature adult/His voice/His anxiety about the pain.

1 ’ll (just) roll 2 ’ll put 3 hold 4 ’ll wrap 5 won’t feel 6 ’ll (just) be 7 ’ll (just) take 8 eat 9 see

Extra activity Ask: How do you usually take blood pressure?  pressure?  Which piece of equipment does the staff nurse use?

Language  Will +

Which method do you prefer? Tell students to read audio script 28 on page 73 to check their answers. Answer: sphygmomanometer Students may mention the difficulty in hearing the heart sounds using a sphygmomanometer/ that it is less practical compared with a digital blood pressure monitor.

infinitive for future

On the board, write: You will feel better soon. and soon. and I’ll take your temperature now. Elicit now. Elicit when the future with will with will + infinitive infinitive  is used. Some students may already know this. Most students of this level will know how to form the structure. (You’ll feel better soon.) Answer: for predictions (You’ll and to talk about decisions made at the time of speaking (I’ll (I’ll take your temperature now.) Ask: Why do nurses talk about decisions? Answer: Nurses should always keep patients informed of what they are about to do to reduce patient anxiety.

8

together as a group to check. For further language practice, ask students to underline other examples of future with will in audio script 26 on page 73 to further reinforce usage. Ask students to circle examples where speakers are making predictions and underline examples where speakers are talking about decisions.

Ask students to complete the examples from dialogues with nurse Stefano using will  and will and verbs from the box. Come together as a group to check.

(Predictions – Will it hurt?, No it won’t, It will be very quick. Decisions quick. Decisions – I’ll just clip, I’ll just write this down., We’ll take your temperature.) temperature.)

1 ’ll put 2 ’ll take 3 ’ll, clip 4 Will, hurt 5 won’t, ’ll be 6 ’ll, write 6

Tell students they are going to hear a staff nurse interview Ana Leogardo during her morning rounds (visit of patients in the ward). Ask students to read the questions and then listen to the recording and answer.

► 27

1 not bad, hungry 2 She uses a pulse oximeter. 3 She thinks Ana’s temperature is still high. 7  Before they listen to the recording, ask students

to complete the staff nurse’s dialogue, using will and the correct form of the verbs in the box. Encourage them to use their nursing knowledge to help them complete the dialogue. Check understanding of: cuff, lap, pillow, tight.  tight.  Encourage pre-experience nurses to deduce meaning from the context/images. Do not check answers until students listen to the recording in 8.

Ask students to listen to the recording, check the answers to 7, and then complete as many of Ana’s vital signs as possible. They then look at audio script 27 on page 73 and complete the rest of the vital signs. Ask them to compare their answers with a partner, before coming  

Give students time to assimilate the points covered in the Language box. If necessary, review future with will,  including will, including contracted forms. 5

► 28

BP 130 BP  130 / 85 P 80 RR RR 17  17 T 38

Writing 9

Ask students to choose one piece of equipment from page 21. Tell them they are going to write five lines (at least) explaining to a patient how they will take one set of vital signs. Before they write, elicit expressions from 7 that give encouragement to the patient – e.g. that’s also fine, you’re doing well.   good/that’s right, right, also fine, well.  Encourage students to include patient-friendly instructions. If students lack confidence, put them into pairs or small groups for collaborative writing. They could use the text in 7 as a model. Ask students to practise giving their explanations in pairs. Encourage them to use patient-friendly intonation patterns.  patterns. 

27

Vital signs  signs 

3 

 

Circulation and the heart

1 pumps 2 circulates 3 returns 4 atria 5 ventricles 6 circulatory system 7 vena cava 8 pulmonary artery 9 aorta

Vocabulary the diagram diagram of the heart. If 1  Ask students to label the they are pre-experience nurses, you may wish to give them the first letter of each word.

Speaking 4  In pairs, ask students to cover the diagram and

explain how the heart functions (as if speaking to a student nurse). Encourage students to use terms from the text, check their partner’s comprehension, and ask if he/she has any questions. With less confident students, you could suggest they write notes first.

1 aorta 2 vena cava 3 pulmonary artery 4 right atrium 5 pulmonary vein 6 right ventricle 7 left atrium 8 left ventricle

Pronunciation 2

► 29

Ask students to underline the syllables that are stressed.

Extra activity Students imagine they are explaining the function of the heart to an adult patient with a suspected heart condition.

If you feel they need more support, elicit the first example from the group. Alternatively, ask:  – the stress is on Which is the odd one out? (1 out? (1 aorta aorta – the second syllable, all the others are stressed on the first syllable.)

Extra activity Students imagine they are explaining the

Play the recording several times until you are happy that students are able to reproduce the same/approximate pronunciation and stress pattern. Reassure them that some of these terms are difficult to pronounce even for a native speaker. Students may already know some of these terms from L1, but will tend to place the stress in the wrong place. Ask them to compare stress patterns in their L1.

function of the heart to one of the following: a child aged ten, the carer or family member of a patient with a chronic heart condition.

Reading 5

Ask students to scan the text to find the answer to the question. Reassure them that they don’t have to understand every word on first reading. 

1 aorta 2 artery 3 vena cava 4 atrium 5 ventricle 6 pulmonary

If necessary, pre-teach/elicit the meaning of: risk, to narrow, nicotine, several, significant.  significant. 

Reading 3

Tell students they are going to read part of a reference text that explains the function of the heart. As they read, they should use the words in the boxes to complete the information. Encourage them to deduce the meaning of new words from the context and their own nursing knowledge. With less confident students, you could check their answers stage by stage. Students compare their answers in small groups, then come together as a group to check. Check understanding of: circulate, pump, chamber, oxygen-rich blood.  blood. 

Ask: Which age group is most affected by smoking in your country? What can the health service do to encourage people to stop smoking?  smoking? 

Smoking causes the heart rate to increase and the blood pressure to rise. The arteries narrow and the blood flow decreases. 6

As they read again, ask students, individually or in pairs, to decide if the statements 1–5 are true or false. They should then correct the false statements. Come together as a group to check. 1 T 2 F, Nicotine causes your blood flow to decrease and your blood pressure to increase. 3 T 4 F, After a few years the risk of heart disease for an ex-smoker is the same as a nonsmoker. 5 F, It is never too late to stop smoking.

7  Ask students to cover the leaflet and complete

the summary, individually or in pairs. Tell them there may be more than one possible answer.

28

Vital signs  signs 

 

Suggested answers 1 increases 2 goes up/rises/increases, goes up/rises/increases 3 reduces/falls/drops 4 goes up/rises/increases, reduces/falls/drops 5 reduces/falls/drops/decreases

Speaking 8  Tell students they are going to advise a patient

who is a heavy smoker. Ask them, them , in pairs, to take turns to play the role of the patient and the nurse, following the instructions 1–5. Students may want to write notes on each point first.

Preparing for the next unit In preparation for Unit 4, suggest the following to your students: •

Compile a list of common symptoms you already know in English.

•

Think about the last time you were ill. What were your symptoms and how did they start?

•

Do some (online) research into respiratory problems.

3 

29

Vital signs  signs 

3 

 

4

Symptoms

Briefing This unit looks at developing language for common symptoms and injuries, as well as encouraging patients to describe how these came about. It also deals with the symptoms of asthma and giving instructions in an emergency situation. Finally, it provides an introduction to understanding and writing simple SOAP notes.

Symptoms and injuries Triage nurses working in an emergency emerg ency room (or doctor’s surgery/office) will be called upon to assess patients suffering from a whole variety of symptoms   and injuries; the most common of these being sprains or contusions (the medical term for bruise). Chest and abdominal pain and respiratory problems are also common reasons for presenting to ER. Nurses will hear the terms signs  and symptoms signs and symptoms.. Signs Signs   are objective – what you can see with the eye (bruise, swelling , redness) or with medical equipment (e.g. vital signs). Symptoms  are subjective Symptoms are – these are what the patient feels (headache, nausea, etc.). Students will be given the opportunity to build word forms (noun, verb, adjective) of the vocabulary most commonly used by patients to describe their symptoms and injuries. They also focus on the past simple and past continuous  continuous as a means of understanding patients’ descriptions of how their symptoms and injuries came about.

Asking about symptoms and injuries Section 2 provides a framework of basic questions that a (triage) nurse might use to find out about their patient’s symptoms and complete the patient record. Students focus on question types. Closed questions are those requiring one-word answers and are used when requesting factual information from a patient or when there is a need to narrow down options to make an accurate diagnosis. The disadvantage is that it might take some time to find out all the important information. Open questions encourage the patient to describe their symptoms in their own words, without the nurse guiding the patient in a particular direction. Answers tend to be more detailed than closed questions. The nurse could find out important information that he/she may not think to ask about. The disadvantage is that the

patient could start giving information that is not relevant to the case. This type of questioning could waste valuable time. The cone technique is the most effective means of questioning – it involves asking open questions to allow the patients to express themselves followed by closed questions to request specific details.

Asthma emergency – giving instructions In this section, students are asked to read an article from the World Health Organization providing data on the global issue of asthma, before they are introduced to some basic medical terms related to the respiratory system. They also develop key words to describe the symptoms and causes of asthma, such as mucus, pollen, wheeze, etc. In emergency situations, instructions must be simple and clear while remaining patient-friendly. Students will look not only at how to form instructions using imperatives but also how to include staging words –  first, then, next, finally – finally – and pausing to ensure their patients are able to follow the instructions more easily and in turn replicate the procedures more accurately.

SOAP notes The final section deals with SOAP notes: a (US) nursing document used to record information about the patient, their symptoms, the assessment and the proposed nursing plan. The acronym SOAP stands for subjective – what the patient actually says about the problem (often written verbatim); objective – what the nurse observes, either physical symptoms or vital signs; assessment – the nurse’s summary of the patient’s medical problem; and plan – how the nurse intends to treat the patient. Students will also be introduced to some commonly used medical abbreviations, including NKA (no known allergies), IBP (ineffective breathing pattern) and p.o. from the Latin pe Latin  pe os (by os (by mouth).

30

Symptoms   Symptoms

4 

 

Teache Te acher’s r’s notes not es

2

Warm-up 1  On the board, draw five arrows/patterns as in 7

on page 23. Ask students to brainstorm words to describe these patterns. Then ask students, in

Some students may have difficulty expressing their ideas effectively in English. Reassure them that for this activity accuracy is not important –  just encourage students to discuss their opinions.

pairs, to draw charts similar page 23 and practise describing themto asthose if to aon colleague or patient. students, udents, in pairs, pairs, to the patient on page 24 2  Refer st

If your students are experienced nurses, ask them to explain the reason for their order of care.

and ask them to take it in turns to practise taking the patient’s vital signs, using similar instructions. Remind students to use patientfriendly intonation patterns.

1 (Suggested answers) a Difficult to give anything specific from the picture. Common problems for infants: colic, teething b  black eye, cuts, grazes and bruising c  mild asthma attack d  sprained shoulder, bruising e cut finger

Symptoms and injuries Vocabulary 1  Ask students, in pairs or small groups, to think about emergency room(s) in their place of

work/country and ask them to brainstorm the kind of symptoms patients generally present with. Then ask them, individually or in pairs, to read the text about emergency rooms in the USA and complete it using the words in the box. Check understanding of: contusion (bruise), abdominal, respiratory, sprain.  sprain. 

f  chest  chest pains, asthma, angina 2 f, c, d, b, a, e

Listening 3

Ask students to compare their ideas with the information in the text. Ask: What can chest pains be a symptom of? (heart attack, angina, asthma, allergies, anxiety, pain, fever, infection, diseases of heart and lung, stroke, head injuries, certain medications such as beta-blockers, aspirin, etc.) Explain that nurses will hear the terms signs,  and injuries  are objective – what symptoms and symptoms injuries.. Signs Signs are you can see with the eye (bruise, swelling, redness) or with medical equipment (e.g. vital signs). Symptoms  are subjective – these are what Symptoms are the patient feels (headache, nausea, etc.). Injury Injury   is the patient term for the physical damage to the body (cut, broken bone). 1 injury 2 contusion/sprain 3 sprain/contusion 4 abdominal/chest 5 chest/abdominal 6 respiratory

Ask students to look at the picture of the patients sitting in the Emergency Room. If necessary, check meaning of triage triage.. Ask them, in pairs or small groups, to discuss questions 1 and 2. Come together as a group to check.

30 Tell students they are going to listen to the six patients in the picture describing their problems. As they listen, students should label the pictures a–f in the order they hear them.

► 

a 5 b  2 c  1 d  4 e 3 f   6 6

4

Ask the students to listen again and write the description of the problem next to each person. Check understanding of: colic, nauseous. Play the recording again if necessary.  necessary.  a colic b  black eye, contusion c  asthma d  broken wrist, nausea e bleeding, infection f  heart  heart problem

Vocabulary 5

Tell students they are now going to look at terms patients frequently use to describe their symptoms. Ask students, individually or in pairs, to complete the sentences about the symptoms and injuries of each of the six patients using the words in the box. Point out they will need to change the form of the word in some cases.

31

Symptoms   Symptoms

 

Ask students to indentify the symptoms  and the symptoms and  in the sentences. (injuries: cut, banged injuries in injuries head, bruise; symptoms: cough, difficulty breathing, dizziness, infection, nausea.) 1 coughing, breathing 2 pain, dizzy 3 bleeding, infection 4 pain, sick 5 swollen, dizzy 6 bruises

6

If you have confident students, you may do 7 first which will serve as a diagnostic test of the target structures. Students can then go through the Language box to reinforce their knowledge. Ask students, individually or in pairs, to complete the table with the correct word forms. Explain there are no ‘rules’ to follow for these particular language items, but they are frequently used by patients and therefore important to grasp. Encourage them to search for the answers in 5. Point out that in the USA/Canada sick  is a sick is general term for feeling unwell. In US English the word vomit  is used to mean sick vomit is sick.. 1 bleed 2 breathless/breathy 3 bruise 4 cough 5 dizzy 6 infect 7 pain 8 swell 9 sick

Extra activity Ask: Find synonyms for more formal medical words.. words Answers: shortness of breath – dyspnoea dyspnoea,, dizziness – vertigo vertigo,, swelling – mass mass,, bruise – contusion contusion,, breathing – respiration respiration   Variation: On the board, write: dyspnoea, vertigo, mass, contusion. Then contusion. Then ask students to match the medical term to the patient term. Pre-experience nurses: You may wish to give this task to students as homework/self-study to present during the next class.

4 

32

Symptoms   Symptoms

4 

 

Language

Extra activity

Past simple v past continuous Refer students to the picture of the Emergency Room on page 28. On the board, write: 1 What did Jason do? He ______ off his bike. 2 What was be doing d oing before he fell? He ______ ______ his bike.  bike.  Ask a stronger learner to fill in the gaps. On the board draw:  past

 

 

→

now

 Jason was riding his bike.   ↓   Jason fell off his bike. Refer students to the example in the Language box. Ask: Did the person stop coughing or was it a continuous action? (continuous action? (continuous action) Ask: When do nurses use these two forms? (To understand how the patient arrived at their symptoms.) Give students time to assimilate the points covered in the Language box.

→

7

→

Ask students, individually or pairs, to use the Language box as a reference to help them complete the sentences with the correct form of the verb in brackets. Go through the first answer together if necessary. Come together as a group to check. Elicit/Pre-teach: soccer, pull a muscle, suffer from, trip, dose.  dose.  For further practice of the target structure, refer students to audio script 30 on pages 73–74 and ask them to underline all examples of the past simple and circle all examples of the past continuous. This will allow them to see the structures in context as well as serve to reinforce rein force usage.seem, (pastbrought, (past   simple –ran, started, said, felt, didn’t wasn’t, had to,took, camedidn’t, off, cut, didn’t hurt, wasn’t, was, fell, banged, fell, had,  gave, was, started, felt, was, was, was, started, fell down, called;; past continuous – was playing, was called coughing, was just coming up, wasn’t going, was working, was painting, was getting out). out). 1 was playing, fell over, pulled 2 was coughing, phoned, told 3 was running, brought 4 didn’t stop, took, were not 5 presented, was suffering 6 were doing, started 7 was having, tripped, fell 8 didn’t think/wasn’t thinking, gave

Refer students to the patients on page 28 and audio script 30 on pages 73–74. Ask students to write at least three sentences about each of the patients, using the past continuous and the past simple tenses. In pairs, students take turns asking the patients about their symptoms. Suggest students use questions such as these to interview their patients: Can you tell me what happened? What were you doing when …?

33

Symptoms   Symptoms

4 

 

Asking about symptoms and injuries Speaking 1  Ask students, in pairs, to observe the patient and discuss questions 1–3. Encourage them to explain their reasoning. Wait until students

listen to the recording in 2 to check the answers.

Listening 2

31 Tell students they are going to hear a nurse interviewing the patient, Mr Daniels. Ask them to listen and check their answers to 1. Play the recording again if necessary.

► 

1 shortness of breath, pains in chest, pain in left arm 2 diagnosis not given (but possibly a heart attack/angina) 3 carrying a heavy object

3  Refer students to the patient record. If necessary,

allow them to familiarise themselves with the contents of the patient record before they listen again. Elicit/Pre-teach: located, radiate, condition.  condition.  1 chest 2 shortness 3 centre 4 arm 5 face 6 three 7 was carrying heavy things 8 two 9 third 10 10 breathing  breathing 11 11 very  very worried 12 12 worse  worse

Vocabulary now going to develop a set 4  Tell students they are now of questions that nurses might use to assess their patient’s symptoms. Ask them, individually or in pairs, to match the beginnings 1–8 and the endings a–h to complete the nurse’s questions. Remind them that they have already come across some of these in Unit 2. If necessary, do the first one as a group. Ask pairs to compare answers. Wait until 5 to check. 1 d 2 g 3 a 4 b 5 h 6 c 7 e 8 f

Extra activity In pairs, students should take turns asking and answering the nurse’s questions in 4, using the patient record. This will serve to reinforce the target language items. Students may wish to read the dialogue on page 74 before doing this. 5

Refer students to audio script 31 on page 74 to read the nurse’s questions and check their answers to 4. Encourage them to underline the

questions as they read. On the board, write: 1 Does the pain move at all? 2 How would you describe the pain? Elicit the answers: 1 Yes, it does. 2 The  pain moves down the arm arm and up to the chest. chest. It lasts  for around three minutes minutes each time … Ask: … Ask: What is the difference between the two answers? (1 The answer is Yes/No Yes/No.. 2 This answer is more detailed.) On the board, write: Open question/Closed question.. Ask the group to match these terms to 1 question and 2.  2. (1 closed question, 2 open question)  question)  Ask students, individually or in pairs, to look at the audio script 31 on page 74 and circle all the closed questions and underline all the open questions. Come together as a group to check. Ask students, in pairs or small groups, to discuss questions 2 and 3. Come together as a group to check.  Pre-experience nurses may not yet have come across this communication technique, but should be able to identify some of the above. Some students may have difficulty expressing these ideas effectively in English. Reassure them that for this activity accuracy is not important –  just encourage students to discuss their opinions. 1 open questions: 1, 6, 7, 8 closed questions: 2, 3, 4, 5 2 (Suggested answers)  Advantages: Open questions encourage the patient to describe their symptoms in their own words, without the nurse guiding the patient in a particular direction. Answers tend to be more detailed than ‘closed’ questions. The nurse could find out important information that he/she may not think to ask about. Disadvantages: The patient could start giving information that is not relevant to the case. This type of questioning could waste valuable time. 3 (Suggested answers)  Advantages: Closed questions are useful when requesting factual information from a patient or when there is a need to narrow down the options in order to make an accurate diagnosis. Disadvantages: It takes time to find out all the important information.

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Symptoms   Symptoms

4 

 

Speaking

Extra activity You could develop appropriate intonation for question forms before students roleplay the patient interview. On the board, write: Does the  pain move at all? Elicit all? Elicit the correct intonation pattern. Go through each question as a group chorus to ensure students are able to reproduce/approximate the pattern. Answer: Intonation rises at the end of polite requests. 6

Ask students to look at question 1 and ask: Why do you think this is an ‘open’ question? (It encourages the patient to express themselves/does not require a Yes/No  or oneYes/No or word answer.) Ask students, individually or in pairs, to decide if questions 1–10 are open or closed. Tell them to write ‘O’ for open questions and ‘C’ for closed questions. Do not confirm answers yet. 1 open 2 open 3 closed 4 closed 5 open 6 open 7 closed 8 open 9 open 10 10 closed  closed

7

Ask students, in pairs or small groups, to compare their answers to 6 before coming together as a group to check. As a group, answer the question. Point out that in terms of medical communications the most effective method is the ‘cone’ technique. The cone technique involves asking open questions to allow patients to express themselves followed by closed questions to ask for specific details. Both question types are necessary.

8  Ask students to observe the two patients, Ahmed and Vicky, and try to build up a picture of the patients before starting the exercise. Ask: What are the patients suffering from? What were these patients doing before? Can you describe their  pain?    pain?

Then ask students, individually or in pairs, to complete the dialogues using question forms from 4 and 6. If necessary, do the first few questions as a group. Do not confirm the answers yet.

9

32 Tell students they are now going to hear the two dialogues. Ask them to listen and check their answers to 8.  ► 

Some of their answers may differ from those in the recording. Check the different possibilities before moving on to the next stage of the exercise. Ask students (in pairs) to practise the dialogues. 1 how it happened 2 I slipped and fell 3 has this happened 4 I touch here 5 really sore 6 of one to ten, how bad is the pain 7 Five, I guess 8 what happened 9 I was just doing my kickboxing class at the gym 10 10 Dizziness  Dizziness or nausea 11 11 I  I feel a little sick

Extra activity Refer students back to the patients on page 28. In pairs, ask them to prepare a dialogue using the question forms in 4 and 6 based one of these patients.

35

Symptoms   Symptoms

4 

 

Ask students to brainstorm ideas for the following question: What advice might nurses give to asthma sufferers about how to enjoy a good quality of life? (Take moderate exercise, don’t allow smoking in the house or car, keep ke ep a diary of the patient’s symptoms/peak flow diary to record the differences in the patient’s breathing, don’t

Asthma emergency – giving instructions Speaking 1  Tell students they are going to read an article from the World Health Organization (WHO) about asthma. Ask: What is your experience of asthma?   asthma?

have pets in dust free.)  free.)   the house, make sure the house is 1 windpipe 2 right lung 3 diaphragm 4 bronchial tubes 5 normal bronchiole 6 asthmatic bronchiole 7 left lung

Pre-experience nurses may not have treated asthma patients, but it is likely they know someone who suffers from the condition. Ask students, in pairs or small groups, to discuss the question. Tell them they will have a chance to check their answers later. Alternatively, you could give them the suggested answers below before moving on to 2.

Extra activity In order to check their understanding of the text, ask students the following comprehension questions (either pre- or post-reading). 1 What generally happens when a patient has an asthma attack? 2 Which countries have the highest levels of asthma in the world?

Suggested answers Symptoms: coughing, breathlessness, wheezing (noisy breathing), tight feeling in the

 Where do most of the deaths in asthma take 3 place? 4 Who is more likely to suffer from asthma? 5 What is the cure for asthma?

chest, trouble sleeping due to breathing difficulties Causes: colds and flu, cigarette smoke, animals/pets, house dust mites (in carpets, etc.), physical activity, emotions, allergies, family history, certain medications such as beta-blockers, aspirin

Extra activity Ask students to deliver a short presentation on asthma, using the diagram on page 32.

Vocabulary 2  Ask students, individually or in pairs, to match the words related to asthma to the correct definition. 1 c 2 a 3 f 4 b 5 d 6 e

Reading 3

Ask students to read the text and check their answers to 1. Tell them the vocabulary in 2 will help them follow the text. Once they have read the text, ask students to label the diagram with the words in the box. With less confident students, you could check the answers to 1 before labelling the diagram. Then check answers to 3.

Listening 4

33 Ask students to look at the picture on the right of the page and ask: What is the nurse doing?

► 

 (She’s What typeher of inhaler youtothink) is this? (She’s this? teaching patient(do how use his in haler. inhaler. It’s a Ventolin inhaler which is used in emergencies. Note that Becotide inhalers are used as preventative medication.) Tell students they are going to listen to Practice Nurse Nina talking to her patient Kyle Jenkins and his father during an asthma clinic. Ask students to listen to Part 1 and decide if the sentences 1–5 are true or false. If necessary, allow students to read the sentences before playing the recording. Ask students, individually or in pairs, to correct the false answers. Play the recording again if necessary. 1 T 2 F, football with his dad

36

Symptoms   Symptoms

4 

 

3 F, seven minutes 4 F, his cousin 5 T

going to develop a set of 5  Tell students they are going instructions for using an inhaler. Ask them, individually or in pairs, to put the sentences a–e into the correct order. If your students are experienced nurses, encourage them to visualise the process first, to allow them to concentrate on the language. a Take a puff on your inhaler at the same time but don’t breathe out immediately. 3 b  Remove the inhaler and hold your breath for 10 seconds. 4 c  Place the mouthpiece between your lips and breathe in as deeply as possible. 2 d  Breathe out slowly and repeat if necessary. 5 e Breathe out gently and tilt your head back slightly. 1

Language The imperative

1 Refer students to the examples in the Language box, then ask them to underline the imperatives in 5. It is important to point out that imperatives are only used for giving clear, simple instructions. 2 On the board, write: First, breathe out. Then, blow into the mouthpiece. mouthpiece. Ask students to read the sentence aloud, pausing very slightly after each comma. Then ask: What effect do the underlined words and the pausing have on the instruction?   instruction? Answer: Staging words and pausing help nurses to divide up the instructions and make them easier for the patient to follow. 6

Tell the students they are now going to complete the set of instructions. Ask them, individually or in pairs, to complete the instructions for Kyle using the verbs in the box. Come together as a group to check. 1 Sit 2 lie down 3 Lean 4 put 5 Take 6 Call 7 Continue 8 Repeat

Speaking 7

34 Ask the students, individually or in pairs, to rewrite the instructions in 6, using staging words.

► 

In pairs, students then take it in turns to practise reading the instructions aloud. Encourage them to pause after each staging word. Then play the recording so they can check. If necessary, ask them to roleplay the instructions again to replicate the recording. Suggested answer First, sit down at a table. Don’t lie down. Then, lean forward slightly and put your arms on the table. Next, take up to six puffs of your inhaler. Call an ambulance after six minutes if your symptoms don’t improve. Then, continue to take your inhaler every six minutes, for a maximum of six puffs. Finally, repeat these steps, if your symptoms begin again.

Extra activity Ask students to write simple patient instructions for two pieces of medical equipment, using the prompts below. If your students are pre-experience nurses, first ask: 1  What is a peak flow meter? 2 What is a nebulizer? What is a portable p ortable nebulizer? (A peak flow meter measures lung capacity. A nebulizer pumps medication into the lungs to help the patient breathe more easily. Portable nebulizers may be used in the home by the patient.  patient.  1 Peak flow meter: blow out/sit up straight/hard and fast/three times/record the reading 2 (Portable) nebulizer: fill/put on/breathe in/turn on/wash with soap/slowly and deeply/medication Then ask students, in pairs, to take it in turns to roleplay giving instructions to their patient for this medical equipment.

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Symptoms   Symptoms

4 

 

Reading

SOAP notes 4

Reading 1  If your students are pre-experience nurses, write SOAP notes on notes on the board and ask: What do you think SOAP stands for? What do you think SOAP

notes are used for? Avoid for?  Avoid correcting at this stage. Ask students, individually or in pairs, to read the text about SOAP notes. As they read, students should complete the text with the words in the box. If necessary, pre-teach/elicit the words in the box first.

Tell students they are now going to read SOAP notes for two new patients, Nancy and Massimo. Ask them to read the patient information first and ask: What do you know about the patients?  patients?   (Point out that the photos would not normally be attached to the SOAP notes – they are included here to support the students.) Ask students, individually or in pairs, to read the SOAP notes and answer the questions. Come together as a group to check. If necessary, reassure students that they may not understand all the abbreviations at this stage, but that they will work on these in the next activity. Encourage them to ‘get the gist’.

If your students are experienced nurses, ask: What is your experience of using SOAP notes? Do you use another form of notes when you assess a  patient? How do they differ from from SOAP notes? notes?

1 Massimo 2 Nancy 3 Nancy 4 Massimo 5 both of them 6 Nancy

1 documents 2 symptoms 3 measure 4 summary 5 treat 6 help

Vocabulary Vocabulary 2

5

Refer students back to the SOAP note written for Kyle and ask them, individually or in pairs, to find expressions or abbreviations with the meanings given in 1–8. Come together as a group to check.

Note: the following abbreviations come from Latin but are used in medical English as standard: t.id. ter in die – die – three times a day; p.o.  pe os – os – by mouth; b.i.d. bis in die – die – twice a day; p.r.n. pro p.r.n.  pro re nata – as required.

1 meds 2 pt 3 r/t 4 SOB 5 abdominal exertion 6 administer 7 RR 8 nebulizer

Extra activity You may wish to check students’ understanding by asking concept questions about the note for Kyle, What e.g. What  patient saySOAP about his sym symptoms? ptoms? does does the the nurse observe? What is the nurse’s diagnosis of the  patient’s condition? How does does the nurse decide decide to treat the patient?  patient? 

Speaking 3  Refer students to the diagram and ask them to discuss the questions in pairs or small groups. It is a position where the patient sits upright at 90°. This position helps the patient to breathe more easily. Sit upright at 90°.

Refer students to the abbreviations key and ask them, in pairs, to practise saying the abbreviations as complete words.

Speaking 6

Dictate the following abbreviations from Unit 3 and ask students, in pairs, to note the terms in full: BP, RR, T, Ht, kg, DOB, Wt, P, O² Sats. The first pair with all the correct terms wins the game. Answers: blood pressure, respiratory rate, temperature, height, kilogram, date of birth, weight, pulse, oxygen saturation Refer Student Bs to page 68. Ask Student As to add two more terms that can be abbreviated to the list on page 35. They should then dictate the abbreviations 1–8 to Student B, who must write the terms in full. Students then swap roles. Student A  A  1 p.o. 2 Chol 3 R/O 4 mg 5 NKA 6 IAC 7 IBW 8 UA Student B 1 R 1 R 2 BS 3 t.i.d. 4 p.r.n. 5 L 6 ROM 7 NKDA 8 PA

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Symptoms   Symptoms

 

Extra activity In pairs, refer students back to the patients on page 31 and audio script 32 on page 74. Ask them to write a SOAP note for one or both of the patients.

Extra activity Ask students to research another 10–15 common medical abbreviations in English and present them to the rest of the group during the next class.

Preparing for the next unit In preparation for Unit 5, suggest the following to your students: •

Compile a list of words related to food and nutrition you already know in English.

•

Write a diary of your food intake for the week.

•

Do some (online) research into Type 1 and Type 2 diabetes.

4 

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Symptoms   Symptoms

4 

 

5

Food and nutrition

Briefing This unit and seeksfood to develop key language related to nutrition before looking at skills to carry out a nutritional assessment and offering advice on improved diet. It also develops understanding of conditions related to food intake – food allergies and diabetes.

Nutrition A healthy diet comprises roughly one-third fruit and vegetables, one-third starchy foods and one-third meat, dairy and oily, fatty and sugary foods. The food pyramid (a graphic representation of the different food groups and the proportions advised for a healthy diet) is an authentic way of presenting the key words for this first section of the unit. Students are asked to draw on their general knowledge of foodstuffs and nutrients – carbohydrates, proteins, fats, vitamins, minerals, fibre (and water) – and label the pyramid, indicating dairy products, fresh fruit and vegetables, cereals, etc. They will then go on to compile definitions of the food groups, highlighting which of these fights  disease, repairs the body and helps digest food. Describing quantities is necessary for a better understanding of a patient’s diet and this unit provides ample practice of countable and uncountable nouns for this purpose.

Nutritional status Good nutritional status is essential to the health and well-being of the patient. Extra demands placed on the body due to illness mean the need for nutrients is increased. Poor nutrition can be associated with delayed recovery; adequate nutrition not only promotes tissue repair, but also aids recovery from surgery and disease. Assessing nutritional status involves taking measurements (see Unit 3) and calculating the BMI or Body Mass Index. A patient weighing 50 kg at 1.68 m would have a BMI of 50/1.68 x 1.68 = 17.7. A BMI of less than 18.5 indicates the patient is underweight while a BMI of 30+ is an indication of obesity. Nurses also ask questions to determine the patient’s food intake. In this section students will have the chance to analyse a patient’s food journal to check if he/she is eating a balanced diet.

Food allergies and intolerances In the USA,population nearly 4 percent of food allergies the general and affect it is estimated that such allergic reactions cause 30,000 emergency room visits and 150 to 200 deaths every year. 90 percent of these are caused by milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat; and are often lifelong conditions. There is no cure for a food allergy and minute amounts of a food can cause a reaction in a highly sensitive patient. Strict avoidance of the allergy-causing food is the key to preventing allergic alle rgic reactions. A food allergy  allergy is an immune system  response to a food that the body mistakenly believes is harmful. Once this happens, the patient experiences an adverse reaction and the body creates specific antibodies against the food. The next time thereleases individual eats that food,of the immune system massive amounts chemicals, including histamine, in order to protect the body. These chemicals trigger allergic symptoms that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system. Food intolerance does not involve the immune system and is not life-threatening. Lactose intolerance – trouble digesting the milk sugar lactose – is a common example. Symptoms may include abdominal cramps, bloating and diarrhoea.

The second part of this section provides discussion on diabetes and takes students through the different stages of administering a blood sugar test. Refer to the text on page 41 for an explanation of Type 1 and Type 2 diabetes.

Advice on diet This section begins by reviewing key words used to describe quantities and containers for food stuffs, including carton, packet, segment. Students listen to a school nurse giving government advice on portions, focusing on the five-a-day campaign. The section then moves to develop students’ skills in giving suggestions and advice in a way that involves the patient in the decision-making process and is personalised/ adapted to the needs or lifestyle of the patient. Use of tentative suggestions, How about + -ing?, Can I suggest you + infinitive compared with strong suggestionsto based on medical evidence: Patient case It is advisable/important + infinitive. histories are then presented to allow students to put

40

their skills into practice.  Food and nutrition  nutrition 

5 

 

Teache Te acher’s r’s notes not es Warm-up and Open 1  On the board, write: Closed questions and  Open questions. Ask students, in small groups, to select questions. one of the patients from page 28 and brainstorm five questions for each heading to assess the patient’s symptoms. This can be done as a team game – the first team with ten correct questions in a given time is the winner. 2  Ask students, in pairs, to take turns to roleplay

an assessment with their patient from page 28.

Nutrition Vocabulary 1  Refer students to the food pyramid and ask

them, in pairs or small groups, to brainstorm names of food stuffs they see. Depending on your group, you may wish to add a competitive element and divide the group in two. The winning group is the one that finds the most food items in a given time. Depending on your group, they may know certain food stuffs as opposed to others. Ask students, individually or in pairs, to label the sections 1–4 of the pyramid with the words from column 3 of the table. Ask them to compare their ideas with a partner, then come together as a group to check. If your students are experienced nurses, ask: When might a nurse use the pyramid with patients? What is your experience of this type of chart? What other types of diagram might be used instead?  instead?   (Nurses use food pyramids to give advice to patients on diet, to show them the proportion of each food group they should be eating. Other examples: eat-well food plate/a pie chart.) Ask students to add typical food stuffs/dishes from their own culture to the sections of the pyramid. Come together as a group to exchange ideas. 1 fats, oils, sweets 2 meat, fish, dairy products, beans, eggs 3 fruit and vegetables 4 potatoes, rice, cereal, pasta, bread 2

Refer students to the table and ask them, individually or in pairs, to use the words in the box to complete the statements in column 2

about the different food groups. Come together as a group to check. If your students are pre-experience nurses, encourage them to make use of the information in the third column to help them complete the table. 1 energy 2 build 3 digest 4 bones 5 fight 6 repair 7 skin

Language More confident students can complete 3 (and 4) before referring to the Language box. They can then use this as a means of checking their existing knowledge of the target structures. For less confident students,  students, write headings: a and an and  on the board and ask them to brainstorm  an on food stuffs for each column. Ask: When do we use ‘a’ and when do we use ‘an’? ‘ an’? (  A is A is used in front of countable nouns beginning with a consonant, an  an  with countable nouns beginning with a vowel.)

Countable and uncountable nouns Draw a two-column table on the board. Do not label the columns but write in column 1 biscuit, egg and in column 2 water, sugar. Ask sugar. Ask students to add two more food items to each column and ask a stronger student to give each column a title (Countable (Countable and and Uncountable ). Ask: What is  Uncountable). the difference? (It difference? (It is possible to count the nouns in column 1 but not those in column 2.) On the board, write: some, a lot of, How much?, How many? many? Ask students to put these into the correct columns. (Some (Some and a lot of  appear  appear in both columns. How much? in much? in column 2 and How  instudents column 1.) many? many? in Remind they can say a piece  piece of  of cheese, a  – the phrases in bold are bottle of bottle  of water  – countable. Give students time to assimilate the points covered in the Language box. 3  Ask students, individually or in pairs, to refer

back to the pyramid and add foods to the two columns.

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Food and nutrition  nutrition 

5 

 

Suggested answers Countable: some sweets, some crisps, some sausages, a yoghurt, a chicken, some nuts, some eggs, some peppers, some carrots, some tomatoes, a lettuce, a cucumber, an aubergine, some mushrooms, an orange, an apple, a bunch of bananas, a pineapple, some grapes, some some potatoes, biscuits Uncountable: olivesome oil, some chocolate, some fish, a glass of milk, some cheese, some bacon, some broccoli, a bunch of celery, some rice, some pasta, some cereal, some bread 4

Refer students to the photos of the four women and ask them to read the texts and match the photos to the correct text. a3 b4

c1 d2

5  Ask students, individually or in pairs, to reread

the texts and underline the best word in each case. If necessary,  necessary, do the first answer as a group. Encourage students to make use of the information in the Language box if they are unsure. Check students understand: fussy, understand: fussy, tofu, spicy,  papaya, pineapple, shellfish.  shellfish.  1 1 a 2 any 3 a lot of 2 1 a 1 a 2 much 3 many 3 1 any 1 any 2 any 3 some 4 1 an 1 an 2 much 3 any

4 much 5 a lot of 4 a 5 some 4 a lot of 4 any 5 a lot

Writing 6

Ask students to write a short paragraph to describe their own diet and eating habits. Encourage them to use the target language and structures. Encourage less confident students to use the texts in 5 as a model. Students may wish to work in pairs or small groups for collaborative writing.

Extra activity Ask students to prepare a brief presentation to deliver during the next class. Ask them to find a food pyramid or something similar that reflects typical eating habits of a patient/a child/a culture that they don’t know well. Alternatively, they research and design a food pyramid to represent typical food intake and quantities for one of the above. They present the information on PowerPoint slides, if possible, as a case study during the next class.

Variation Ask students, in small groups, to discuss the following questions: Why (do you think) is it important to understand the dietary habits of your  patient? Give examples of the dietary habits of a culture/religious group that you know well.

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Food and nutrition  nutrition 

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Nutritional status

c  last night, 10pm, bowl of soup and toast 3

Vocabulary 1  If your students are experienced nurses, ask:

What is the Body Mass Index used for? How is it measured? (The Body Mass Index or BMI is used

1 slightly underweight 2 gain weight 3 normal weight 4 doesn’t eat enough

to decide if a patient’s weight is healthy, compared with their height squared.) Elicit/Pre-teach adjectives that nurses might use to describe a patient’s weight: overweight, obese, underweight.. underweight

Speaking 4  Refer students to Alain’s food journal and ask:

What do you think a food journal is used for? Who  fills in the journal? (Patients journal? (Patients suffering from weight problems may be asked to fill in a food  journal so that the nurse or nutritionist can advise them on a weight loss/gain plan if necessary.)

It is important to point out that the adjective fat adjective fat is not used in a medical context – use of  or obese and variations of these  these are overweight or overweight used instead. Ask students, individually or in pairs, to read the text about BMI and complete the statements using the words in the box.

Ask students, individually or in pairs, to read through Alain’s food journal and answer questions 1 and 2. Come together as a group to

Remind students that numbers with decimal points are pronounced like this: twenty-five point a comma is  is used instead  five. (In some languages a comma  five. of a point a point.) .) Ask: How do you think nurses might calculate the BMI of a patient who is not able to stand? Is the BMI suitable for measuring children/a baby?  Answers: Ask the patient to open their arms outstretched at shoulder height and measure the distance between the tips of the middle fingers – this measures the height of the patient. Use mid upper arm circumference (MUAC) measurement. If the MUAC is less than 23.5 cm, the BMI is likely to be less than 20 kg/m2  (patient is likely to be underweight). If MUAC is more than 32.0 cm, the BMI is likely to be more than 30 kg/m2 (patient is likely to be obese). The BMI and MUAC measurements are only suitable for adults.  1 underweight 2 overweight 3 obese

Listening 2

► 

35 Tell students they are going to hear Nurse Sam McCarthy assessing Alain’s nutritional status. Ask students to listen and complete the Nursing Assessment form. If necessary,  necessary, ask them to familiarise themselves with the assessment form before listening. Check understanding of: allergies. allergies.   a 22.4 b  peanuts

Ask students to read Alain’s food journal and then complete the statements about his nutritional status based on this and the information in the assessment form.

5

check. See 5 below for complete answers. 36 Tell students they are now going to hear Nurse Sam assessing Alain’s food intake. Ask them to listen and compare her advice with their own.   own.

► 

Less confident students could complete 6 before listening to the audio. Suggested answer  As ses sment sm ent and advic adv ic e: Bad points: calorie intake is very low; it’s not a balanced diet; lacks sufficient protein, carbohydrates and fibre; he’s skipping breakfast (after eight to ten hours without food, the body needs energy); he drinks too much coffee Good points: brown bread is a good source of fibre; he eats three portions of fruit and vegetables a day; his only snack was a piece of fruit 6  Ask students, individually or in pairs, to

complete the sentences using the words in the box. Play the recording again. Come together as a group and check. Check understanding of: snack, balanced, skip, source. 1 intake 2 balanced 3 lack 4 skipping 5 energy 6 source 7 snack

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Food and nutrition  nutrition 

 

7

► 

37 Ask students to listen to the final part of the assessment and complete the statements about Alain. If your students are experienced nurses, ask: Do you find it difficult to follow a good diet at work? What kind of food do you eat while at work/on shift? nurse, fruit/vegetables/yoghurts/avocados

Reading 8

Ask students to read through the case history and food journal for patient Annabelle Driver. Ask some comprehension questions: What kind of surgery did Annabelle have recently? What is her job? What do we learn about her family life? What is her general health like? Ask students, individually or in pairs, to write six sentences about her food intake. If necessary, elicit/pre-teach: varicose vein (surgery), deprived area, recover, depression, single  parent.    parent. Suggested answers  answers   1 Her calorie intake is very high and most of the calories come from fat and sugar sources or complex carbohydrates. 2 She has a very unbalanced diet. She eats too many high-calorie and high-fat foods and sugary, carbonated drinks. Her servings are also larger than average. She does eat three portions of fruit but no vegetables (except potatoes in the form of chips). Her diet also lacks sufficient protein. 3 The patient often snacks on high-calorie and high-fat foods. Her calorie intake for these snacks is also very high. 4 She skips breakfast which is the most important meal of the day. 5 She lacks sufficient fibre in her diet. 6 The patient should eat more fibre, vegetables and protein.

Speaking 9

Ask students to write their own food journal and then present an assessment of their food intake to the rest of the group, using the same headlines as for Annabelle. Students may wish to write notes before presenting to the rest of the group.

5 

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Food and nutrition  nutrition 

5 

 

Food allergies and intolerances

Extra activity In small groups, students answer these questions:   questions: 1 Name two ways that a food allergy can be diagnosed.   diagnosed. work?  2 How do these tests work? 

Speaking 1  Ask students, in pairs, to discuss the questions.

Come together as a group to brainstorm possible answers. Avoid correcting at this stage as answers will be supplied in 4. Ask: Who suffers  from allergies, other than food allergies? What are the symptoms?   symptoms?

 What advice give  a patient 3 suffering from would a food you allergy? allergy?  e.g. It might be a good idea to …, to …, Can I suggest  …   you … you

If your students are experienced nurses, ask: What is your experience of dealing with patients with (food) allergies?

Pronunciation 5

Reading going to read a patient patient 2  Tell students they are going education leaflet about food allergies. Before they read, ask them, individually or in pairs, to match the words 1–4 to the correct definitions a–d. Come together as a group to check.

Depending on your group, you may wish to read out the first sentence aloud as a group chorus, to discourage embarrassment. Avoid checking at this stage. On the board write: allergy  and allergic allergy and allergic.. Ask a stronger student to underline the stress in each case (allergy / allergic).

Alternatively, could ask more confident students to do you 3 first, without correcting at this stage – allow them to read the target language in context first and encourage them to deduce the meaning from context. 1 c 2 a 3 d 4 b   b  3

Ask students, individually or in pairs, to complete the first part of the patient leaflet using the words in 2. Check comprehension of: release, histamine, gastrointestinal tract.  tract.  1 adverse 2 immune system 3 harmful 4 antibodies

4  Before students read the second part of the

leaflet, write two additional questions on the board: When do symptoms typically appear? When should a patient call the doctor? Remind doctor? Remind them of the questions in 1, then ask them to read and correct their responses to 1. Come together as a group to check. Check understanding of: rash, eczema, consciousness,, disappear.  consciousness disappear.  Most common foo d allergies: allergies: fish,  fish, shellfish, peanuts, milk, eggs, wheat, nuts, soy Symptoms: tingling Symptoms:  tingling sensation in the mouth, rash, swelling, eczema, abdominal cramps, diarrhoea, vomiting, swelling of the tongue and throat, wheezing,loss breathing difficulties, fall in blood pressure, of consciousness, death

Ask students, in pairs, to read the sentences out loud and then underline the stressed syllable in the words in bold. Encourage them to divide each of the words in bold into syllables first firs t as this may help them distinguish the sounds.

6

► 

38 Ask students to listen to the recording and check their answers. Then play the recording again, asking them to listen and repeat the stress pattern they hear. Play the recording several times until you are happy students are able to reproduce the same/approximate stress pattern. Students may already know some of these words from their own language, but will tend to place the stress in the wrong place in English. Ask them to compare stress patterns in their L1. 1 allergies 2 allergic 3 abdomen 4 abdominal 5 respiratory 6 respiration

Extra activity Ask students to practise reading the patient leaflet in 3 aloud as a group for controlled practice of the stressed words. Then one by one, ask students to read the leaflet aloud. Explain that when you say ‘Stop’ the next student should continue. Make sure that all the students are given an opportunity to practise the target word stress. If necessary, repeat the activity to ensure this takes place.

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5 

 

Speaking If your students are pre-experience nurses, you may prefer to set 7 and 8 as selfstudy/homework. It is not necessary for students to have completed 7 and 8 in order to carry out the rest of the activities in i n this section. 7

Ask students, in pairs, to discuss questions 1–3. Ask them to join up with another pair to compare their answers. Avoid correcting their ideas at this point. Pre-experience nurses may find this activity a little challenging. Reassure them that this is not a test. If your students are experienced nurses, you   could ask: What are the symptoms of diabetes? What is the difference between Type 1 and Type 2 diabetes?

Reading now going to read a 8  Tell students they are now

questions. Ask them to compare their answers in pairs, then come together as a group to check.   Note that the answer to 4 is contained in the illustration, not in the audio script. 1 the patient’s blood sugar level 2 top of the finger (any) 3 test strip 4 106, this shows the level of glucose in the blood

Extra activity Refer students to audio script 39 on page 75 and ask them, in pairs, to practise the dialogue. This allows them to ‘see’ the target language in context, thus reinforcing what they have just heard.

Speaking 11 Ask students, in pairs, to take turns to practise

taking their partner’s glucose level using the prompts 1–6. Tell them they can also make use  

definition of diabetes takenAsk from a reference book for nursing students. them to read and find the answers to the questions in 7. Check understanding of: hormone, pancreas, respond, thirsty, link.  link.  1 Diabetes is a condition where the body is unable to produce glucose, a sugar which the body uses for energy. The body has a very high blood sugar. The level of glucose is usually controlled by the hormone insulin. 2 Type 1 diabetes is caused when the pancreas doesn’t create enough insulin. Type 2 diabetes is caused because the body is not able to respond to the insulin in the body. 3 Type 1 diabetes can be controlled with insulin. Type 2 diabetes can be controlled with diet and exercise.

Listening 9

►  39 Tell students they are going to listen to a student nurse, Joely Thomas, learning how to administer a blood sugar test. Ask students, individually or in pairs, to label the diagram using the words in the box. Point out there are two answers required for c.

a screen b  finger c  drop of blood, lancet d  test strip e plaster f  glucometer  glucometer g  blood glucose chart 10 Refer students to questions 1–4. Ask them to

listen to the recording again and answer the

of the images in 9 to help them structure their roleplay.   Encourage them to use staging words from Unit 4. On the board write: firstly, write: firstly, then, next, finally. finally.   Ask students to brainstorm other staging words that could be used when explaining a medical process to a patient. Ask: Why are staging words useful?  What else is important when explaining a useful?  process to a patient? (Always keep patients informed before carrying out the process. Pause slightly after each staging word. This makes it easier for the patient to follow the information provided by the nurse – it divides up the information into manageable chunks. It is also important to use patient-friendly intonation.)  intonation.)   Students may wish to make notes first before practising their dialogue.

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Food and nutrition  nutrition 

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Advice on diet

Extra activity On the board, write the following list: carbonated/sugary drinks  drinks  sugary snacks: chocolate, cookies, sweets, etc. salty snacks: crisps, peanuts, pretzels, etc. ready-made meals, takeaway foods

Vocabulary pairs, to look at 1  Ask students, individually or in pairs, the containers and quantities and match them to the correct word. Encourage students to use their knowledge of general English to help them. them . Ask them to compare answers with another pair before coming together as a group to check.

high-calorie desserts: chocolate mousse, carrot cake red meat  fried food: chips, fried fish, etc. skipping breakfast snacking between meals eating after 8pm 1= easy to stop  2 =  2 = a little difficult, but I could stop 3 = very difficult to stop Ask students, individually, to look at the list and, using the scale 1–3, decide which dietary habit(s) they would find difficult to change. On the board, write: … are cheaper/more practical than … I want to stop eating ..., but it’s not easy. I’ve tried to stop, but …

Ask students to brainstorm two or three examples for each of these, e.g. bottle bottle of  of tomato etc. sauce, slice slice of  of bread, etc. 1 can 2 carton 3 glass 4 tablespoon 5 packet 6 slice 7 piece 8 stick 9 bottle 10 10 segment  segment

Listening 2

► 

40 Ask: What is a school school nurse? What do you think their role is? Does this post exist in your country/place of work? Tell students they are going to hear Maggie, a school nurse, giving advice on nutrition to a group of adolescents. Ask students to listen and tick the quantities/containers they hear. Reassure them it is not necessary to understand the whole recording on first hearing as they will have a chance to listen to the recording again later. slice, segment, portion, carton, stick, a lot of, packet

3  Refer students to the questions 1–5. Ask them to

listen and answer the questions. Encourage students to take notes as they listen. 1 Eat five portions of fruit and vegetables a day. 2 one apple, fourteen cherries, two slices of mango, eight segments of canned grapefruit, one tablespoon of raisins, two figs, 150 ml of fruit juice 3 three sticks of celery, three tablespoons of cooked/canned/frozen vegetables 4 These do not count as a portion of vegetables. 5 Be careful of them because they only count as one portion of vegetables and contain a lot of salt and sugar.

 My and it makes it more difficult to stop.partner loves … and Ask students, in pairs, to discuss their responses, using these phrases. 4

► 

41 Tell students they are now going to listen to nurse Brad Tyler giving advice to three of his patients, Lena, Frank and Edith. Refer students to statements 1–3 and ask them to listen and complete the statement for each patient. Encourage students to use the information in the statements to help them guess the rest. Play the recording again if necessary. 1 gain weight, build up her appetite 2 improve his diet 3 lose weight/take exercise

5  Ask students to listen to the recording again and

complete the nurse’s suggestions. Students should then match each suggestion to the correct patient, Edith, Lena or Frank. Ask them to compare their answers with a partner, before coming together as a group to check. 1 walking, dog 2 eat, often 3 eating fish 4 exercise, lose weight 5 drink, water

E L F E L

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Language

Extra activity Ask students, in pairs, to write three or four f our more pieces of advice using should  + infinitive. should + Ask them to pass their suggestions to another pair, who rewrite them in the appropriate form – tentative or strong.

Giving suggestions and advice Refer students, in small groups, to the Language box and ask them to note the form in each case. Answers: should (not) + (not) +  infinitive ; How about + -ing; Can I suggest you + you +  infinitive; infinitive   It’s advisable/important to + to +  infinitive Refer students back to 5 and ask them to indicate what type of advice is being given in each case (tentative or strong suggestion). Answers: 1 tentative 2 tentative 3 tentative 4 strong 5 strong Still focusing on 5, ask: When do we use the three t hree ways of giving suggestions and advice? Answer: should (not) + (not) +  infinitive: to give a strong opinion; How about + -ing/Can I suggest  +  infinitive infinitive:: to encourage the patient to take you + you responsibility and/or take part in the decisionmaking process; It’s advisable/important to + to +  

on cards. Variation: each small Write groupthe intoadvice two teams. EachDivide player turns over a card and reads out the piece of advice to another team member, who then offers their own stronger/tentative version. Teams win a point for each correct answer.

Writing 7

Speaking 8  Put students in pairs and refer Student Bs to

infinitive: to give strong advice in an impersonal way – this makes it sound less threatening to the patient.  patient.  Give students time to assimilate the points covered in the Language box. 6

page 68. Ask the pairs to read through their instructions and the relevant case history and food journal carefully and then carry out the roleplay. If necessary, go through the case histories and food journals in detail first as a group before asking students to roleplay the scenarios. Students then swap roles.

Ask students, individually or in pairs, to rewrite the suggestions 1–6 by replacing should  with should with another expression from the Language box.   Alternatively, you may wish to ask a stronger student to decide if the pieces of advice require tentative or strong suggestions. Check this first before asking the students (individually or in pairs) to carry out the activity. Come together as a group to check. Suggested answers 1 It’s advisable to only eat red meat once a month, according to government advice. 2 It’s advisable to eat breakfast: it’s the most important meal of the day. 3 Why don’t you play football with your kids in the park? 4 It is important not to drink more than one cup of coffee at night. 5 How about going swimming if this is your favourite sport? 6 Can I suggest you reduce the number of complex carbohydrates in your diet?

Refer students back the three patients in 5. Ask them to write two pieces of advice for each of the three patients.

Preparing for the next unit In preparation for Unit 6, suggest the following to your students: •

Compile a list of words related to patient care that you already know in English, e.g. e.g .  toothbrush. toothbrush.

•

Think about all the different ways a nurse may be required to assist a patient on a daily basis.

•

Do some (online) research into how to treat and dress minor wounds.

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Food and nutrition  nutrition 

5 

 

6

Personal care

Briefing

prepositions with/without  is covered in this section of with/without is the unit: He hates using the commode., Do you need help

This unit focuses on developing language and skills related to caring for the patient’s basic personal hygiene needs as well as wound care management. It also seeks to further improve effective communication skills, particularly the demonstration of empathy in situations that patients might find embarrassing or frustrating.

with putting on your tights? Finally, in situations such as these, nurses need to be able to distinguish between offers, requests or refusals of help: What do you need help with? Could you give me a hand with …? I want to try and do it myself.

Patient hygiene Personal hygiene involves far more than just the physical act of cleaning the patient to reduce potential infection; indeed it is more about caring for the overall well-being of the patient. It is therefore essential that nurses help provide a conducive environment as well as the necessary assistance required for their patients to carry out these basic tasks as independently as possible.

Empathy Empathy is the ability to perceive and understand another person’s emotions, a key aspect of nursepatient communication. However, it is not one that is easy to replicate, as emotions can be hidden or displayed through behaviour that contradicts how a person actually feels. A patient complaint about the mistreatment of a geriatric patient suffering from early dementia provides the context to this section. Students are required to analyse the case and then offer advice on how the nurse might improve his communication with the patient.

Students begin this section by familiarising themselves with vocabulary related to personal hygiene, including not only washing and dressing   but also grooming   ((shaving , basic nail and hair care, make-up) and oral hygiene. Keeping the patient informed of intentions is important when providing such assistance, as this is essential in terms of maintaining patient dignity. Focus is therefore given to the use of be going to + infinitive to talk about intentions: I’m going to explain the procedure to you  and events that are planned: We’re going to  first.; and  first.; discharge Mr Singh later this afternoon.

Patients can find loss of independence frustrating, embarrassing, even humiliating and depressing . In the second half of this section, students look at ways to improve communication in such situations. They learn to recognise examples of empathy through tone of voice, before developing expressions, not only to show empathy (I understand how you must be ), but also to demonstrate both reassurance   feeling.),  feeling. (Don’t be embarrassed, it can happen to anyone.) anyone.) and respect for patient privacy (Do you want me to come back later?) later?) The unit then looks at how patients use

It should be noted that depending on the country of origin, nurses may or may not carry out the personal hygiene duties mentioned above.

adjective endings -ing -ing or -ed to inform the nurse about how they themselves feel (depressed ( depressed)) or what they think about the situation (humiliating (humiliating). ).

ADLs – activities of daily living ADLs or activities of daily living consist of routine everyday activities people carry out without assistance – bathing, dressing, oral hygiene and toileting (walking/eating are not covered in this unit). Nurses refer to the ability or inability to perform basic ADLs as a measurement of the functional status of a patient. Students complete an  ADL checklist to assess their patient’s ability to carry these out either independently or with assistance, and acquire vocabulary for items used to help patients with their ADLs: bed pan , urinal

Wound management Wound management refers to assessing, treating ,  and dressing  a  a wound. This final section seeks to develop key language items – saline solution, absorbent dressing, tape and disposable gloves – before working on skills for changing a dressing. The Wound Assessment and Treatment Chart is completed by the nurse when first assessing the patient’s wound. The chart includes a description of the wound type – traumatic, pressure ulcer (bed sore), the wound closure – open, sutured (stitches) or clipped, the kind of dressing  required  required and how often it should be changed, as well as an assessment

49

-ing form after bottle, walking frame, etc. Use of the -ing certain verbs love/hate/finish  and following love/hate/finish and

of the level of pain the patient is feeling. Personal care  care 

6 

 

Teache Te acher’s r’s notes not es

Extra activity Show students pictures of patients (from magazines, online sources) or describe patients – woman, heavily made up; a man with a five o’clock shadow, for example; and ask students to identify the items needed for washing and

Warm-up 1  On the board, write up your food journal for the

week and ask students to analyse and advise you on your food intake.

grooming of these Then ask them to come up with theirpatients. own examples.

2  Divide the group into three and allocate one of

the following to each group: carbohydrates, fats, group to prepare a one proteins. Then ask each group  minute presentation on their topic.

Extra activity  Ask: Why is grooming important for patients?  patients?  (Patients should be encouraged to live as normally as possible while in hospital and to regain their routine and daily tasks as quickly as possible. The nurse is responsible for encouraging this from the outset.)

Patient hygiene Vocabulary going to listen to a charge 1  Tell students they are going nurse helping two patients with washing and grooming. Ask them to scan the pictures and find an example each of an item used for washing and grooming. Then ask them, in pairs or small groups, to label the items a–w.

Listening 3

Depending on your group, you may wish to add a competitive element and divide the group in two. The winning group is the one that is able to label all the items in a given time. Encourage students to use their knowledge of general English to help them.

42 If you have less confident students, you may wish to ask them to do 4 before 3 as it only requires gist understanding. Tell students they are now going to hear a nurse helping the two patients, Mrs Turner and Mary, with washing and grooming. Refer them to the statements 1–7 and ask them to listen and mark the statements true (T) or false (F).

a washbowl b  disposable wipes c  comb d  brush e nail brush f  hand  hand cream g  soap h  toothbrush i  kidney basin  j shampoo  j  shampoo k  nightdress l  dressing gown m  towel n  washcloth o  blanket p  deodorant q  mirror r  swab  swab s  toothpaste t   razor u  shaving cream v  make-up w  pyjamas

Play the recording again and ask students, individually or in pairs, to correct the false statements. 1 F, She’s not totally independent – she needs some assistance – e.g. she cannot go to the bathroom to clean her teeth.

2  Elicit/Pre-teach: oral hygiene. Refer hygiene. Refer students to

2 F, Mrs Turner is breathless, Mary has no energy. 3 F, She says, ‘I can do that by myself.’ 4 T 5 T 6 F, The nurse encourages the patients go slowly and take a rest when necessary. 7 T

the table and ask them, individually or in pairs, to put the items a–w into the correct column. Ask them to look at the examples first. Point out that some items might go into more than one column. Washing:  washbowl, blanket, disposable wipes, soap, shampoo, towel, washcloth, swab Grooming: nail Grooming:  nail brush, comb, brush, hand cream, deodorant, mirror, razor, shaving cream, make-up Oral hygiene: toothpaste, hygiene:  toothpaste, kidney basin, mirror, swab, toothbrush, towel Pa Patient tient clothi ng: nightdress, ng:  nightdress, dressing gown, pyjamas

► 

4

Play the recording again and ask students to tick the items that correspond to the correct patient, either Mrs Turner or Mary. Mrs Turner: kidney Turner:  kidney basin, swab Mary: hairbrush, Mary:  hairbrush, mirror, towel, washcloth

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Writing

Extra activity Ask: Why is it important to encourage the patient to be independent? How can nurses encourage  (A nurse’s job is  patients to be more independent? independent? (A to encourage independence as quickly as possible. Patients find loss of independence frustrating and daily embarrassing. Offer to help patient in their routine, but don’t do the things for them unless they ask the nurse to do so.) Note that some students may have difficulty expressing these ideas effectively in English. Reassure them that for this activity accuracy is not important – just encourage them to discuss their opinions.

Language  Be going to + infinitive for future If necessary, review the form be going to first. to first. Refer students to audio script 42 on pages 75– 76 and ask them, individually or in pairs, to underline examples of be be  going  going to + to + infinitive. Ask: Why does the nurse use be going to + to + infinitive in infinitive  in these situations? (The situations? (The nurse uses this form to keep the patient informed of what is about to happen.) Ask: Why is it important to keep patients  (So that patients understand what is informed? (So informed? happening/going to happen to them. It is also an important aspect of maintaining patient dignity.) Give students time to assimilate the points covered in the Language box. 5

Elicit/Pre-teach: bed bath, as we go along, discharge, procedure.  procedure.  Ask students to read through the situations 1–6 and think about the intention of the nurse or doctor in each case. Then ask them, in pairs, to complete the sentences and questions using the correct form of be going to and to and the verbs in the box. Ask them to compare their answers with another pair before coming together as group to check. 1 is going to help 2 am not going to give 3 Are (you) going to check 4 is not going to discharge 5 are going to explain 6 Are (you) going to take

6

Refer students to the prompts 1–4 and the example. Ask them, in pairs, to think of a patient they know or refer them back to the patients in 3. Ask them to write three questions they could ask their ‘patients’ about the future, using the prompts and be going to. to. Ask them to compare their ideas with another pair.

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Language

ADLs – activities of daily living

-ing  form  form

Vocabulary

On the board write: I  write: I  like/love/hate … Ask students to come to the board and write something about themselves using one of these verbs. Check that they use the -ing -ing form.  form. Point out that the following verbs can also be followed by -ing: -ing: begin, start, stop, finish. Brainstorm prepositions that also take -ing take -ing   (with, without). without). Tell students they will come across examples of these in the next activity.

1  Ask students, individually or in pairs, to label

the aids using the words in the box. Encourage them to use their existing knowledge of English to deduce meaning. Come together as a group to check. Ask students, in pairs or small groups, to answer the questions: What are the main ADLs? (Washing, toileting, dressing, oral hygiene, grooming. Also eating and walking.) Which walking.) Which  ADLs would this equipment equipment help patients with? (Toileting: commode/urinal bottle/bed pan. Washing: shower chair. Walking/Moving around: walker/walking frame/walking stick.) Come together as a group to check.

3

Ask students to listen to the dialogues again and complete the responses to the questions. Ask students, in pairs, to compare their answers,

1 commode 2 shower chair 3 walker/walking frame 4 walking stick 5 urinal bottle 6 bed pan

before coming together as group to check.   You may wish to suggest students check their answers by reading through audio script 43 on page 76. This will serve to reinforce the target structures and language covered in this section.

Listening 2

► 

43 On the board write: independent, needs help and dependent. and  Check understanding of these  dependent. Check terms. Tell students they are going to hear a nurse assessing four patients, Mr Karam, Elaine, Samson and Mr Bates. Ask them to listen and write one of these assessments against the appropriate ADL for each patient.

1 it’s difficult to hold the razor still without cutting himself. 2 she can’t put her tights on without bending down. 3 washing her hair.  hair.  4 He doesn’t want help with either cleaning his teeth or getting dressed. 5 He doesn’t need help with going to the toilet (although he may need to use a walker) and he hates using the commode.

If necessary, play the first part of the dialogue with Mr Karam and check students understand the example answer. Play the recording again if necessary. Ask students to compare answers before coming together as a group to check. 1 Mr Karam: washing Karam:  washing = independent, grooming = dependent 2 Elaine: washing = needs help, dressing = needs help, grooming = needs help 3 Samson Samson :  dressing = independent, oral hygiene = independent 4 Mr Bates: toileting Bates:  toileting = needs help

Refer students to the questions 1–5 and then ask them to listen to the dialogues again. Check understanding of: shaving, shaky, tights, need a hand with.  with. 

4

Ask students, individually or in pairs, to reorder the words to form sentences. If necessary, do the first one as a group. You may wish to check the phrases are in the correct order before students do the next part of the activity. Ask students to decide if the sentences represent offers of help, requests for help or refusals of help. Refer students to the example first.

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Personal care  care 

 

1 What do you need help with Elaine? Offer 2 Do you need help with anything else? Offer 3 Could you give me a hand washing my hair? Request 4 Do you need help with cleaning your teeth? Offer 5 I want to try to do everything by myself today. Refusal 6 Can you help me? I need help getting to the toilet. Request

Extra activity This can be used as preparation for the speaking activity in 5. Refer students to audio script 43 on page 76 and ask them to underline possible responses that the nurse might give to the patient requests in 4. (Of ( Of course, Yes, no problem, I can help you with that, Not to worry.) worry.) Ask students to underline more examples of patient refusals of help. (I’m (I’m OK with [the shower/ showering], I’m OK thanks, It’s OK, I can do it) it)

Speaking 5

Elicit/Pre-teach: fetch, get. Elicit/Pre-teach: fetch, get. Refer students to the scenarios 1–3 and ask them, in pairs, to write three short dialogues based on the scenarios. Remind them to use the -ing  form. Ask them to -ing form. practise reading their dialogues aloud, or pass their dialogues to another pair for peer correction and/or to read aloud. Depending on your group, you may wish to ask them to roleplay one of their dialogues to the rest of the group. 

6

Ask students to work with a different partner for this activity. Student As use the ADL checklists on page 47 and Student Bs to turn to page 69. Explain that Student As will take the role of the nurse who asks their patient (Student B) questions to complete ADL checklist 1. Once they have finished, Student As should use the information in ADL checklist 2 to reply to Student B’s questions.

Extra activity Ask students, in pairs, to copy an empty ADL checklist and complete it based on a patient they know/someone they know well following an operation/hospital stay. They then take turns to roleplay the scenario with a partner,

6 

53

using expressions and target language from the unit.   unit. Personal care  care 

6 

 

Empathy

1 Toileting, washing, grooming, eating and other simple tasks (not specified in text). 2 The poor care of her father by Nurse Jones during his stay in St Marc’s Ward. 3 Nurse Jones seems unhappy with his job in general, and does not feel his salary is high enough.

Reading 1  Tell students they are going to read a complaint

form. Refer them to the form and the photo of the patient.

4 She wants the department to investigate her father’s case. 5 Suggested answer : He needs be more caring towards his patients and show some empathy. He should imagine he was caring for a close family member or friend. He should consider going on a communications course.

Explain the photo would not usually be attached to a complaint form – this is to support students in this activity. Ask students, individually or in pairs, to read sections 1 and 2 and answer questions 1 and 2. Then ask them to compare their answers with a partner, before coming together as a group to check.

Extra activity Ask experienced nurses: What is your experience of working with geriatric patients? Why might it be difficult for nurses working in this kind of department in general? Why might it be difficult to assist patients with dementia with their ADLs? 

You may wish to ask students more structured comprehension questions to facilitate the reading process: What is the patient’s name? How old is he? What is his ethnic origin? Who is making the complaint? When did the incident take place?

Pronunciation

Who is Ms Hynd and what did she do? When did the complaint take place? 1 Patient is Winston Miller, 88 years old, of Afro Caribbean origin. His consultant is Dr Hew Jones from the Geriatrics department. The patient stayed in St Marc’s Ward between 15 and 20 May 2010. The patient’s daughter, Ms Deidre Hynd, has made a formal complaint to the hospital patient relations department. 2 Suggested answers: racism, poor treatment by the consultant, the medical procedure, incorrect diagnosis, (if students are looking at the photo, they might speculate that nobody assisted the patient in getting around).

3

► 

44 On the board write: empathy empathy.. Explain to students that Nurse Jones has been criticised by the Complaints Board because he didn’t show empathy towards his patient. Ask students, individually or in pairs, to read the definition on the right of the page. If your students are experienced nurses, put them into pairs or small groups to brainstorm their own definition of ‘empathy’. If your students are pre-experience nurses, they may wish to check the translation in a good bilingual dictionary.

2

Elicit/Pre-teach: dementia, geriatrics, impolite, treat someone like a child, confused, unacceptable, investigate, case.  case. 

Tell students they are going to hear three nurses talking to their patients. Ask them to listen and complete the table to show how much empathy each nurse demonstrates.

Refer students to questions 1–5 and ask them to read Section 3 of the complaint form. Ask them, in pairs, to compare their answers before coming together as a group to check.

Play the recording again if necessary. Reassure students that they may need to listen a few times to hear the differences. Do not check the answers at this stage. 4

Ask students, in pairs, to compare their ideas in 3 before coming together as a group to check. Ask: How do the two nurses (nurses 1 and 3) show empathy? What other ways can nurses demonstrate/show empathy? (Touch: arm/shoulder/hand, if appropriate; eye contact and a ‘warm’ facial expression.)

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Pre-experience nurses may find it difficult to indentify expressions of empathy, but reassure them they will be looking at this in more detail in 6.

Extra activity Ask students, in pairs, to read audio script 44 on page 76 aloud. Ask them to ‘feel’/notice the difference between dialogues 1 and 3 and dialogue 2. Swap roles. Ask students to take turns to roleplay

1 a lot of empathy 2 no empathy 3 a little empathy

dialogues 1 and 3 again, this time encouraging them to use patient-friendly intonation patterns, touch, ‘warm’ facial expression, etc. Ask them to feed back to the class about the experience. Some students may have difficulty expressing these ideas effectively in English. Reassure them that for this activity accuracy is not important – just encourage students to discuss their opinions.

Tone of voice, expressions, e.g. I understand how you must be feeling., I can see it’s difficult for you.

Extra activity Ask experienced nurses: On a scale of 1–5 (1 = very easy), how easy is it to show empathy to  Ask students to explain their rating.    patients? Ask  patients? 5

Ask students to listen to the three dialogues again and complete the summaries about each patient using the words in the box. Elicit/Preteach: chemotherapy.  Avoid pre-teaching the chemotherapy. Avoid words in the box to encourage students to deduce the meaning from the context. 1 feeding himself, humiliating 2 washing her hair, embarrassed 3 sickness, depressing

Vocabulary 6

Tell students they are now going to develop expressions they can use to improve communication with their patients. On the board write: show empathy, reassure the patient, respect the patient’s privacy. privacy. Check understanding of: reassure, privacy. Ask privacy. Ask students to reorder the words in 1–7 to form expressions for each of the headings on the board. Remind students of the patient-friendly intonation covered in Unit 2, (gentle rise and fall). Ask students, in pairs, to practise saying these expressions as if to a patient, using patientfriendly intonation patterns. If necessary, ask a stronger student to model an appropriate intonation pattern for the first example. 1 I understand how you must be feeling. 2 I can see it’s difficult for you. 3 Please don’t worry Josh. Let me clean you up and you’ll feel much better. 4 Don’t be embarrassed Sheila. It can happen to anyone. 5 I’m used to it; it’s part of my job.

7

On the board write: feelings write: feelings and and situations  situations.. Ask students to decide which adjectives from the box go under each heading. (Feelings: (Feelings: depressed, Situations:   embarrassed, frustrated, humiliated. Situations: depressing, embarrassing, frustrating, humiliating.) humiliating.) Check students understand: adjectives ending in  describe the patient’s feelings while -ing describe -ing adjectives ending in -ed in -ed describe  describe the situation. Ask students, individually or in pairs, to complete the sentences, using an appropriate adjective from the box. Point out that more than one answer is sometimes possible. Come together as a group to check. 1 humiliating/embarrassing 2 humiliated/frustrated/embarrassed 3 embarrassed/humiliated 4 depressed 5 frustrating/embarrassing 6 embarrassing/humiliating

Extra activity Ask students to think about a patient they know/someone they know who has been in hospital and ask them to write three or more sentences about their ‘patients’ using the adjectives in 7.

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6 Do you want me to come back later? 7 I’ll bring a screen to put round the bed. You can have a little privacy. Personal care  care 

6 

 

Wound management

Additional activity Refer students to audio script 45 on pages 76– 77. In pairs, ask them to take turns roleplaying the dialogue between the nurse and Una Hagans to help reinforce the target language items. Encourage students to use patient-

Listening 1  Ask: What does the term t erm ‘wound management’

mean? (assessing, treating, dressing and changing a wound) What is your experience of wound management (of a patient/your own)?  own)?  Refer students to the pictures at the top of the page and ask them, individually or in pairs, to number the pictures 1–6 in the correct order for cleaning a wound. a 2 b 3 c 4 d 1 e 5 f 6 2

► 

45 Elicit/Pre-teach: heal, hardly, remove, odour, secure. Tell secure. Tell students they are going to hear a nurse treating her patient, Una Hagans. Refer them to the dialogue and ask them, individually or in pairs, to complete the nurse’s half of the dialogue using the words in the box. You may wish to ask students to label the pictures with the words in the box first. This will help them complete the nurse’s dialogue. Point out they only need to use eight of the twelve words in the box to label the pictures – the other words in the box will be used to complete the dialogue. Note also that some words are used both to label the pictures and to complete the dialogue. Explain that nurses should always confirm the patient’s name first before beginning wound care. Experienced nurses will already be aware of this. Brainstorm suitable questions a nurse might ask for this. (Can you just confirm your name for me (please)? Can you give me your full name please?) Play the recording and ask students to listen and check. Play the recording again if necessary. Ask students, individually or in pairs, to label the pictures using the words in the box. This will help reinforce the target language. Dialogue: 1 wound 1 wound 2 antibiotics 3 disposable gloves 4 sutures 5 dressing 6 bin 7 pus 8 edges 9 saline solution 10 10 absorbent  absorbent dressing 11 11 tape  tape 12 12 wound  wound assessment Pictures: 1 bin 1 bin 2 sutures 3 wound 4 saline solution 5 disposable gloves 6 absorbent dressing 7 tape

friendly intonation patterns.

Writing 3

Refer students to the chart and ask: What is it for? Who completes it? When?  When?  (The Wound Assessment and Treatment Chart is completed by the nurse when he/she first assesses the patient. It includes a description of the type of wound, the type of dressing required and how often it should be changed, as well as an assessment of the level of pain the patient is feeling.) Pre-experience nurses may not yet be aware of this chart, but reassure them that they will have a better understanding at the end of this section of the unit. Ask students, in pairs, to read the Wound Assessment and Treatment Chart for Una Hagans. Encourage them to use a bilingual dictionary to check any of the terms they are unsure of. Point out that this is a slightly simplified version ve rsion of the Wound Assessment and Treatment Chart. Experienced nurses may notice some omissions. Ask students, individually or in pairs, to fill as much of the chart as they can from f rom memory. Then play the recording to allow them to add additional information. If necessary play the recording again. Refer the students back to the dialogue in 2 and come together as a group to check. Type of wound: surgical Infection: no Infection:  no Dressing Dre ssing frequency: daily frequency: daily  An ti bi ot otic ic s:  no Odour: no Odour:  no Pain assessment: 2 assessment:  2 Wound closure: sutures closure:  sutures Wound dressing: absorbent dressing:  absorbent Comments: wound Comments:  wound feels itchy

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8 wound assessment chart

Personal care  care 

6 

 

Extra activity

Extra activity

Ask students, in pairs, to explain the meanings of different sections of the chart (location/type of wound, etc.) to the rest of the group. Ask them to choose or allocate a section to each pair.

Ask students, individually or in pairs, to write a SOAP note for either/both patients in this section of the unit.

Alternatively, you could ask students to do this for homework/self-study for informal presentation during the next class. 4

Refer students to the photo on the right of the page and ask: What type of wound do you think it is? If is? If your students are experienced nurses, you can also ask: How would you manage this type of  Avoid correcting at this stage. wound? Avoid wound? Ask students to read through the case history for the patient, Mia Fox. Check understanding of: inflamed, moderate, antimicrobial dressing. Then ask students, individually or in pairs, to complete the Wound Assessment and Treatment Chart for the patient. Ask students to compare their charts, before coming together as a group to check. Name: Mia Fox DOB: we DOB:  we know she is 19  19  Type of wound: burn Location of wound: arm wound:  arm Infection: yes Infection:  yes Dressing Dre ssing frequency: frequency: every  every third day  An ti biot bi ot ic s:  oral  oral   Odour: no Odour:  no Pain assessment: 3 assessment:  3 Wound closure: open closure:  open wound Wound dressing: antimicrobial dressing:  antimicrobial dressing Comments: patient Comments:  patient burned arm in kitchen accident

Speaking 5  Tell students they are going to roleplay a nurse

assessing the patient, Mia Fox. One student takes the role of the patient, and the other the nurse. Refer students (in pairs) to the prompts (1–4) and ask them to use these to carry out the roleplay. They then swap roles. If necessary, start by brainstorming possible expressions for each stage of the procedure as a whole group activity. You can refer students back to relevant units for each stage: 1 – unit 1, 2 – units 2 and 4, 3 – this unit, 4 – this unit. Students may wish to write notes first before

Preparing for the next unit In preparation for Unit 7, suggest the following to your students: •

Think about how you  feel talking about you feel problems of elimination/bodily functions with others/medical professionals.

•

Do some (online) research into the treatment of problems related to patient elimination, e.g. constipation.

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carrying out the roleplay. They could use the dialogue on page 50 as a model.

Personal care  care 

6 

 

7

Elimination

Briefing This unit deals with the sensitive subject of elimination, concentrating on bowel waste and the related conditions of diarrhoea and constipation. Students are made aware of the benefits of active listening, an important aspect of effective communication, and learn how to give a simple patient case presentation.

Assessing patient elimination Elimination is a fundamental human process that includes elimination of urine, faeces – the waste products of digestion, excreted through the bowel – and menstrual waste. Being able to meet the patient’s elimination needs, in a manner that is sensitive and respects their dignity, is an essential function of nursing. Assessing a patient’s elimination pattern can be challenging, as patients often feel very uncomfortable discussing this aspect of their health and information is often misinterpreted. It is therefore very important that nurses have a general understanding of colloquial expressions so as to avoid asking patients to repeat themselves, thus creating further embarrassment. Section 1 seeks to build target lexis, making the distinction between the more formal or medical terms – incontinence, bowel movement, bladder control, defecate, urinate – and those used more commonly by the adult patient – go to the toilet (UK)/bathroom (USA) – as well as those of the child – pooh and wee. Students will in this section start to develop a series of assessment questions relative to this area, using the past simple and present perfect tenses, beginning with a review of past participles.

Describing bodily functions Section 2 continues work on assessment for this sensitive topic by developing students’ active listening skills; demonstrating that the nurse is really listening to their patient. This can be done either through verbal expressions: I see, go on, anything else? or else? or sounds: uh-huh? uh-huh?,, or by using nonverbal signals such as nodding or smiling warmly. Silence and repetition of the patient’s words are also effective listening techniques. The aim is to put the patient at ease, confirm understanding of what the

teachers carry out these same techniques with their students.) Students are asked to analyse part of an assessment in terms of the active listening skills employed by the nurse, before being given the chance to practise the skills themselves. The section continues to build on suitable language structures (present perfect  perfect and and  past simple) for assessing patient elimination – determining the period of time the patient has suffered the condition (constipation). Usage and form of these structures is consolidated through the writing up of a nursing assessment.

Diarrhoea Abnormal bowel habits result in constipation and  and  diarrhoea; the latter characterised by the excess of water in the stool and the marked frequency of defecation; anywhere from three per day. Students are asked to consider the significance of this condition in the developing world where diarrhoeal disease is second only to pneumonia as the main cause of death in children under five. (Read the article on page 56 for more detail about this condition.) Students are then asked to listen to the experience of one particular nurse working East Africa as she describes the treatment of   dehydration, a side effect of diarrhoea.

Presenting a patient case As in many other disciplines, nurses are required to deliver presentations. Patient case presentations generally take place during the nursing handover and constitute semi-formal presentations of the patient’s current situation. A complete case presentation might include an introduction, history of the present illness, physical examination, diagnostic studies, differential diagnosis, management and summary of the case. This section deals only with the introduction, providing students first with a model and then asking them to create their own based on a nursing assessment, tying all the various elements of the unit together. Mention is made of the Bristol stool chart, a medical tool designed at the University of Bristol, UK (1997), to categorise faeces into seven ‘types’.  Types 1–2 indicate constipation, Types 3–4 are the easiest to

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patient is saying, and demonstrate that you are interested in what he/she is saying. The result being that it facilitates the elicitation process. (ELT

pass, while Types 5–6 may indicate diarrhoea. Type 7 may be a sign of serious food poisoning or even cholera and therefore fatal.  Elimination   Elimination

 

The abuse of laxatives as a means of losing or controlling weight is also referred to in this final f inal section. Often used by people suffering from eating disorders, the individual mistakenly believes that laxatives will work to rush food and calories through the gut and bowels before they can be absorbed. This can result in a variety of health complications – dehydration, dependency, internal organ damage – which can sometimes even be lifethreatening. Overcoming laxative abuse requires working with a team of health professionals who have expertise in treating eating disorders, including a GP, a psychiatrist or psychologist and a registered dietician. Support from close friends and family is also crucial.

7 

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Elimination   Elimination

7 

 

Teache Te acher’s r’s notes not es Warm-up 1  Students work in small groups. Ask each

member of the group to write five objects used in patient washing and grooming on a piece of paper. Refer students to the items on page 44, if necessary. Then ask students in pairs to take it in turns to describe the objects for their partner to guess. This can be done as a team game. 2  Refer students to the ADL checklist for Sophie

Mellors on page 47 and ask students in pairs to take it in turns to ask questions to provide the answers given in the chart.

If your students are experienced nurses, ask: Please explain the rationale for your diagnostic. (Sample answer: The patient is suffering from altered bowel elimination/change in bowel habit. This may be as a result of lack of exercise and poor diet, not enough foods high in fibre. Passing small hard stools every three or four days and the resulting abdominal pain are all signs of constipation. Patient feels lonely and maybe suffers from a lack of appetite; consequently she does not maintain a suitable diet.)   diet.) Suggested answers: The patient is most likely suffering from constipation. Causes include undernourishment, poor diet and patient’s current psychological state.

Assessing patient elimination Reading 1

Vocabulary 2  Depending on your group, ask: How do you feel

Refer students to the title of the unit and ask: a sk:

about discussing bodily functions/going to the toilet

(Issues related to What elimination refer to?urinating, bodilydoes functions, including defecating and the menstrual cycle. It is also related to conditions such as incontinence, constipation and diarrhoea and abnormal bowel movements.)

with a nurse/another nurse/another person? Tell students they are going to learn some of the expressions that patients use in English to describe elimination/bodily functions. Ask them to complete the sentences 1–8, using the words in the box. Encourage them to use a monolingual dictionary to help them.

Note that students are unlikely to know all these terms in English, so reassure them they will be covering relevant language items in the unit. Ask students to look at the photo and ‘observe’ their patient, Mrs Eileen Ashton. Ask: What Ask:  What do you learn about the patient on observation? (Students should  should consider: age, physical condition, psychological state.) Elicit/Pre-teach: widow, active, previously, bowel movement, abdominal, stool, lump. Ask students, in pairs, to read the nursing assessment and answer the questions. Come together as a group to check. With less confident students, you may wish to ask more structured questions: How old is Mrs  Ashton? What is her home home life like? Where does the rest of her family live? Can you describe her diet and exercise?

1 bathroom 2 wee 3 Urine, urinate 4 waterworks, incontinent 5 bowel 6 pooh, defecate 7 diarrhoea, constipation 8 runs

Extra activity  Ask students to draw four circles, labelled as follows: Medical, follows:  Medical, Formal, Children, Children, Informal. Informal. Then ask them, in pairs, to add lexical items from 2 to the correct circle. Encourage them to update their lists as they go through the unit. Sample answers: medical – bowel, constipation, defecate, diarrhoea, incontinent, urinate, urine; formal – to go to the bathroom/toilet, waterworks; children – wee, pooh; informal – the runs

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Elimination   Elimination

7 

 

Listening 3

► 

46 Ask students to ‘observe’ the three patients, Toni, Leah and Dave, in the photos at the top of the page. Ask: What do you learn about the patients? Tell them they are going to hear a nurse assessing thethe three patients. to listen and write problem for Ask eachstudents patient under the correct photo, using the words in the box.   box. Toni:  problem with urinating Toni: problem Leah: constipation Dave: diarrhoea Dave:  diarrhoea

4

Ask students to listen again and complete the expressions used by the patients and the nurse. 1 with my waterworks again 2 do a poo 3 wee wee 4 the runs

5

Ask students, individually or in pairs, to rewrite sentences from 1–4 using the more language 2. Ask them to formal/medical compare with another pair, before coming together as a group to check. Suggested answers: 1 I’ve had problems urinating. 2 Leah, did you have a bowel movement this morning? 3 I urinated. 4 Well, basically, I’ve had diarrhoea ever since I came back from holiday.

Grammar 6  If necessary, review the form of regular and

irregular verbs in the past simple first. Ask students to identify the regular verbs in the list (notice, open, pass) pass). Ask: What is the ending for the  past participle of these verbs? Ask students to brainstorm past participles for the irregular verbs in the box. Ask students, individually or in pairs, to look at the box and write the past participle for each verb. Explain to students they will be looking at this structure in more detail later in the unit. be – been, catch – caught, come – come, do – done, eat – eaten, go – been/gone,

7

Ask students, individually or in pairs, to complete the nurse’s questions using four of the past participles from 6. Point out they need to use two of the participles twice. Come together as a group to check. If necessary, students can listen to the recording again to check before moving on to 8. 1 been 2 passed 3 noticed 4 been 5 had 6 had

8  Now ask students, individually or in pairs, to

match the questions 1–6 in 7 to the answers a–f. Then ask them to write the name of the patient they refer to. Look at the first one together as a group. Ask students to listen to the dialogues to check. If necessary , , play  play the recording again. Check understanding of: drop. a 3, Leah b  4, Leah c  6, Dave d  2, Toni e 5, Dave f  1  1 Toni

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have had, notice pass – passed

noticed, open

opened,

Elimination   Elimination

7 

 

Check understanding of: non-verbal signals, nod, repeat.

Describing bodily functions

Tell students they are now going to read a dialogue where Staff Nurse Paul is checking up on his patient, Ms Sonoda. Refer them to the expressions in the box and ask them,

Vocabulary 1

Ask: Do patients use different expressions to describe bodily functions, depending on their age, gender,

individually or in pairs, to complete the dialogue using these expressions. Ask students to listen and check.

ethnicity? Is it better a nurse use familiar  formal language whenfor when talking to to a child? Why? or When do children generally start to use ‘adult’ terms  for bodily functions?  functions? 

Check understanding of: anything else?, look worried, go on, runny.  runny. 

Refer students to the sentences 1–6 and ask them, individually or in pairs, to rewrite them using the familiar terms in the box. Tell students there is more than one possible answer in each case.

Ask: Why might Ms Sonoda find it difficult to talk to Staff Nurse Paul? (Many Paul? (Many patients prefer talking to a nurse of the same gender; they are less embarrassed, especially when talking about bodily functions, for example. Age – if the nurse is younger than the patient, this also may be an issue.)

Point out that patients often use a neutral expression to talk about elimination: elimination: I go to the toilet/bathroom. This is either out of politeness or embarrassment. The nurse will then have to ask closed questions to find out exactly what he/she is referring to.

Ask students, in pairs or small groups, to underline examples of the active listening techniques Staff Nurse Paul uses with his patient. Explain that the ‘actors’ instructions’ in brackets will give them information about the non-verbal techniques the nurse uses. Come together as a group to check. Remind students that patient-friendly intonation also plays an important role in active listening. You may wish to play the recording again to demonstrate this.

Explain also that waterworks  takes a possessive waterworks takes pronoun – my/his/her waterworks, waterworks, etc. Children will very often use these expressions: to  (urinate) and number two   go for a/do a number  number  one one (urinate) two  (defecate). 1 Does it hurt to do a pooh/go to the toilet? 2 Do you often have to get up in the night to wee/go to the toilet? 3 Have you noticed any blood when you wee? 4 How many times a day do you pooh/go to the toilet? 5 She’s been having problems with her waterworks/going to the toilet.

Verbal techniques: take techniques:  take your time, could you explain what you mean? (open question), pain (repetition), can you describe your bowel movements (open question), I understand it isn’t an easy thing to talk about (empathy) Non-verbal techniques: smiles techniques:  smiles warmly,

6  Do have hard poohs?/Is it hard when you go to you the toilet?

pausing, nodding

Speaking Listening 2

47 On the board, write: active listening. listening. Tell students they are now going to learn about an important skills for nurses – active listening.

Ask students, in pairs, to practise the dialogue. Tell them to pay attention to their active listening skills and use patient-friendly intonation.

If your students are experienced nurses, ask: What is active listening? Why is it such an important skill for nurses? When do nurses use this skill?  skill? 

Depending on your group you may ask students to roleplay their dialogues to the rest of the group.

► 

Ask students, individually or in pairs, to read the definition of ‘active listening’ that appears in the first line of the box.

3

62

Ask students to brainstorm how nurses demonstrate active listening. Then ask students to read the rest of the text to find the answers.

Elimination   Elimination

7 

 

Extra activity Ask students to create a checklist of the active listening techniques mentioned in the text. They then add a rating (1–3) for each technique. (ratings: 1 = needs improvement, 2 = OK, 3 = effective) Ask one pair to observe another as they roleplay their dialogue and use the checklist to comment on their active listening skills. They then swap roles. Give pairs time to feed back to each other. Each pair should be given the chance to repeat their roleplay to improve their skills.

Listening 4

► 

48 Refer students to the photo on the right of the page and ask: Why is the patient in hospital? What type of elimination problems could he be suffering from? from? Avoid correction at this stage. Tell students they are going to listen to Staff Nurse Paulawho Willis an assessment of leg Christophe, is giving recovering from a broken after a motorcycle accident. Ask students to listen to Part 1 and answer questions 1–3. Come together as a group to check. 1 regular 2 he’s not been active since his operation 3 since his operation/for one week

Language Present perfect v past simple 1 On the board draw:

2 weeks H o s p i t a l

past

now ↑  accident (5th May)

Then write: a) I came to hospital on 5th May. b) I have been in hospital for two weeks. 1 present perfect 2 past simple Ask a stronger student to match the examples a) and b) with the tenses 1 and 2. (a) 2, b) 1). If necessary, review shortened forms: I’ve, haven’t,  haven’t,  etc. Elicit: How long have you + past participle?  participle?  th 2 Dictate these items: since items: since 5  May, yesterday, for two days, five days ago, couple of days, last night. Ask students to circle the expressions of time that are followed by theby present perfect and(present underline those followed the past simple. perfect – since 5th May, for two days; days; past simple– yesterday,  five days ago, last night) night) 3 Ask students to write three columns titled since, and ago  for and  ago.. Dictate different expressions of time and ask them to write them under the correct column. Explain that some of them may go into more than one column. Give students time to assimilate the points covered in the Language box. 5  Ask students to complete the nurse’s assessment

questions. Ask students to listen to Part 1 again and check. Ask: Which questions are in the past simple? Which questions are in the present perfect? (past simple: 3;  present perfect: 1, 2 and and 4)  4)  1 have, felt 2 Have, opened 3 did, open 4 have, been 6  Ask students, individually or in pairs, to take the

role of Christophe and write answers to the questions in 5. Remind them they may have to use expressions of time: since, for, ago. ago. Encourage them to write full answers. If necessary, do the first one as a group.   Refer students to audio script 48 on page 77 to reinforce the target structures in context.

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1 I’ve felt/been bloated/like this for a couple of days. 2 No, I haven’t opened my bowels today. 3 I last opened my bowels before my operation. th 4 I’ve been in hospital since 5  May, for a week. 7

► 

49 Tell students they are now going to listen to Part 2 of the staff nurse’s assessment. Refer students to the statements 1–6 and as they listen, ask them to underline the correct verb form in brackets – the past simple or present perfect. Encourage students to look at the time expression to guide them to the correct structure. Ask students to compare their answers with another student before coming together as a group to check. 1 has been 2 hasn’t been 3 has felt 4 had 5 didn’t eat 6 hasn’t eaten

Writing 8

Tell students they are going to read a patient summary for Christophe. Ask them, individually or in pairs, to read the summary and then correct the five mistakes that appear in the text. Look at the first one together as a group. Come together as a group to check. Christophe has not eaten anything since yesterday and has only drunk juice for breakfast. His stools have been small and hard and he needs to push to defecate. He has not experienced pain going to the toilet and has not suffered abdominal pain this morning/he suffered bloating this morning.

9

Refer students to the questions 1–5 and ask them to write the whole assessment, answering the five questions and including the corrected information from 8. Either ask students to complete the activity individually, or write collaboratively in pairs. The pairs then pass their text to another pair for peer correction. You may wish to brainstorm a correct version as a group activity on the board.

Suggested answer Christophe was in a motorbike accident and had an operation to repair a broken femur/leg. th He’s been in hospital since 5  May, and it is a week since his operation. He has not opened his bowels since before the operation. For the last two days he has felt bloated. He hasn’t eaten anything for the last three days except a glass of orange juice. His stools have been small and hard. He needs to push to defecate but has not experienced any pain when going to the toilet or any abdominal pain.

Extra activity Ask: What is important to remember when writing a patient summary? Why is it important to write  (Always sign the document, write clearly? (Always clearly? clearly, only use standard medical abbreviations – see Unit 4. Other medical professionals need to be able to understand the content. It is also necessary to know who has written the summary, just in case there is need for further clarification.)

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Vocabulary

Diarrhoea 3

Speaking 1

On the board write: Diarrhoea write: Diarrhoea – developing world, v. developed world. world. Ask students, individually or in pairs, to write a definition of the condition ‘diarrhoea’. Ask them to compare their definition with a partner/another pair before coming together as a group to check.

You may wish to correct students’ answers for the table before asking them to complete the sentences.

If your students are pre-experience nurses, reassure them this is not a test and that they will learn more about the condition in this section of the unit. Suggested answer: Diarrhoea is an infection of the intestine caused by bacteria, a virus or a parasite. It can be dangerous because it can cause dehydration which means loss of water and electrolytes (essential chemicals – sodium, chloride, bicarbonate). Diarrhoeapotassium, can be treated with antibiotics if it is a fairly mild form and all patients should try to replace fluids.

now going to read an 2  Tell students they are now article about diarrhoea. Ask students to read the first two sentences of the article and compare this with their own definition of diarrhoea. Elicit/Pre-teach: intestine, virus, parasite, dehydrated, fluid, restless, irritable, sunken, severe, malnutrition.   malnutrition. Refer students to sentences 1–4. Ask them, individually or in pairs, to read the article and complete the sentences using words from the article as they read. Come together as a group to check. Encourage students to use the sentences as a guideline for reading and comprehending the article. Reassure them that this is a fairly fai rly difficult text but that it is not necessary to understand every word in order to gain an understanding of the main points. 1 result 2 cause 3 causes 4 result

Ask students, individually or in pairs, to complete the word-building table before completing the sentences about diarrhoea. Refer students back to the text on page 56 if they are having difficulties filling in the table.

Table: 1 diarrhoeal 1 diarrhoeal 2 dehydration 3 intestine 4 to replace 5 to lose Sentences: 1 dehydration 1 dehydration 2 loss 3 intestine 4 replacement 5 Diarrhoeal

Listening 4

► 

50 Tell students they are now going to hear Femi Lwanga talking about how she treats children with diarrhoea. Refer students to questions 1 and 2 and then ask them to listen and answer the questions. This is a fairly long recording, but reassure students that it is not necessary to understand every word to answer the questions. Ask students to compare their answers with a partner before coming together as a group to check. If necessary, play the recording again. 1 a refugee camp in North East Africa, lack of clean drinking water that leads to sickness and diarrhoea 2 moderate dehydration

Vocabulary 5  Elicit/Pre-teach: severely, moderate, save lives,

limited, absorb, intravenous.  intravenous.  Tell students they are going to read part of Femi’s explanation. Ask them, individually or in pairs, to complete the text with the words in the box. You could also to ask some comprehension questions to facilitate the process: 1 How do they treat patients with severe diarrhoea? (Patients are taken to hospital and fed through an intravenous drip.) 2 drip.) 2 What is ORS made of? (ORS is made of water, salt and sugar.) 3 sugar.)  3 How does ORS work? (The work? (The small intestine absorbs the ORS and it replaces the water and electrolytes that the patient has lost.)  lost.)  

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Ask students to listen to the text again and check their answers. Point out that they will hear the whole text, not just the section that appears in 5. 1 rehydrate 2 fluids 3 drip 4 sugar 5 cheap 6 dehydration 7 replaces 8 faeces

Extra activity Tell students they are going to participate in a spelling bee. Explain the rules – a word is read out twice. The student must spell the word correctly to stay in the game. If they spell the word incorrectly they are knocked out of the game. The last student is the winner. Choose words from the texts on pages 56 and 57. You may need to use words more than once depending on the size of your group.

7 

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Elimination   Elimination

7 

 

Language

Refer students to the prompts 1–6 and ask them, individually or in pairs, to write Part 2 of David’s presentation. You may wish to do the first sentence as a group.

Ask: What is a case presentation? When do they take t ake  place? What is included in a case presentation? presentation? What

If necessary, encourage students to use the nursing assessment of the patient on page 52 for

is your experience of presenting a patient case/giving a presentation in front of other students? (It students? (It is a formal or informal presentation of the patient’s current situation, including an introduction, i ntroduction, history of the present illness, physical examination, diagnostic studies, differential diagnosis, management and summary of the case. Patient case presentations generally take place during a handover.)

additional guidance. Come together as a group to check.

Presenting a patient case

1

Tell students they are going to read a case presentation of the patient from page 52, Mrs Eileen Ashton, given by Charge Nurse David

1 On admission, Eileen complained of abdominal pain. 2 Dr Insulza saw her at 16.00 and she rated the pain seven out of ten on the pain scale. 3 She had her last bowl movement four days ago. 4 She has opened her bowels every three or four days since the beginning of May. 5 She described her stools as hard lumps, which is Type 1 on the Bristol Stool Chart. 6 Eileen has experienced some pain but no blood or mucus.

Amani.  Ask: What do you remember about Mrs  Ashton?  Ashton? 

Extra activity

On the board write: age, presenting complaint, social situation, diet, diet, etc. Encourage students to brainstorm their ideas.

Ask students to prepare an oral presentation using Part 1 and 2 of the case presentation. Encourage them to add spaces for pausing during the delivery to facilitate understanding. Ask them to take turns to practise their presentation in front of their partner. Variation: Students work together first to add pausing in the most appropriate places. Ask students to deliver the case presentation as a group chorus.

Point out that the example used in this unit deals with the introductory part of a case presentation.

Ask students, individually or in pairs, to complete Part 1 of David’s presentation using the correct form of the verbs in brackets. You may wish to use this as a mini test to check students’ understanding of the target structures – past simple v present perfect. Ask students to compare their answers with another pair before coming together as a group to check. 1 presented 2 became 3 hasn’t cooked 4 has been 5 was 6 hasn’t taken 7 has suffered

Writing 2

If your students are experienced nurses, ask: What is the Bristol Stool Chart? (The Chart? (The chart is a medical aid, developed at the University of Bristol, UK, which classifies faeces into seven types depending on the length of time they have spent in the colon. Type 1–2 indicates constipation, Type 5–6 indicates diarrhoea.) Depending on your group, students may or may not have come across the Bristol Stool Chart.

Listening 3

► 

51 Tell students they are going to hear Triage Nurse Magda Nowak assessing her patient, Anita Blasky. Refer students to the photo at the bottom right of the page and ask them to ‘observe’ her. Ask: What do you learn about the patient on observation? (Students might mention that the patient is unhappy/tired/ bored. She is 15–20 years of age. She is slightly overweight.) Refer students to the questions 1–3 and ask them to listen to Part 1 of the dialogue and circle the correct response to each question. If necessary play the recording again. 1 stomach ache, frequent bowel movement

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2 embarrassed 3 diarrhoea

Elimination   Elimination

7 

 

Speaking

Suggested answers:  answers:   The patient abuses laxatives that she uses to try and lose weight. The patient is suffering from constipation but experiences bouts of diarrhoea and cramping as a result of taking laxatives. Treatment means working with a team of health professionals with expertise in eating disorders (GP, psychiatrist or psychologist, dietician). Support from close friends and family is also crucial.

4  Refer students to the nursing assessment of the

patient. Ask them to read and then, individually or in pairs, write five assessment questions, based on the information in the assessment. You may wish to use the example to create one of the questions. As a whole group, brainstorm a possible assessment question: How long have you suffered from diarrhoea?  diarrhoea?  Remind students that they will be required to use more patient-friendly/informal terms for the assessment.

Extra activity Ask students, in pairs, to take it in turns to carry out a complete assessment of Anita Blasky, using the information in the nursing assessment. Encourage them to use patientfriendly terms for bodily functions and to practise employing active listening skills as they interview their patient. Variation: Students work in pairs to compile a

If necessary, check students’ questions for accuracy before carrying out the roleplay. Suggested answers: How long have you suffered from diarrhoea?/When did the symptoms begin? How often do you visit the toilet on a typical day? How many times a day do you need to go to the toilet? Can you describe your stools for me? Do you suffer from any other symptoms?

checklist to evaluate active listening skills/patient-friendly terms, using ratings (1 = needs improvement, 2 = OK, 3 = effective), and use this to assess another pair. Students swap roles. Give pairs time to feed back to each other. Each pair should be given the chance to repeat their roleplay to improve their skills.

Listening 5

► 

52 Refer students to the second half of the nursing assessment. Ask them to listen to Part 2 of the dialogue and complete the assessment using the words in the box. If necessary, ne cessary, replay the recording.

8

1 allergies 2 spicy 3 weight 4 kilos 5 overweight 6 angry 7 laxatives 8 embarrassed

Speaking

Depending on the group, you may want to ask students to present their case to the rest of the group. Otherwise this can be done in small groups.

pairs to discuss the patient case 6  Ask students in pairs and answer the questions. Reassure them that for this activity accuracy is not important – just encourage them to discuss their opinions. If your students are pre-experience nurses, they may not yet have come across laxative abuse in their training. Encourage them to brainstorm as a group and give suitable suggestions for the treatment.

Ask students, in pairs, to chose one of the patients from page 53, Toni, Leah or Dave, and prepare a patient case for presentation. Ask them to include the information at the bottom of the page for their patient. Tell students to invent the details if necessary. Encourage students to use pausing techniques and staging words ( firstly,  firstly, secondly, then, finally finally)) from Unit 4 to facilitate understanding.

Preparing for the next unit In preparation for Unit 8, suggest the following to your students: •

Compile a list of expressions for making an appointment by phone that you already know in English.

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Become familiar with the hospital discharge practice in your country/place of work.

7  Ask students to compare their ideas with the rest

of the group.

•

Do some (online) research into mobility aids that assist patients around the house. Elimination   Elimination

7 

 

8

Patient discharge

Briefing This unit looks at the discharge plan and making a final assessment of levels of patient independence  just prior to their leaving the hospital environment. It also deals with medications and explaining dosages. Finally, it provides an opportunity to develop telephone skills, in particular when making follow-up appointments on behalf of patients.

Evaluating levels of independence The discharge lounge provides a quiet area for patients to relax while waiting for their transportation after being discharged from hospital. While waiting, they might also receive assistance with follow-up appointments, arranging pick up of their prescriptions from the pharmacy, receive instruction on medications, etc. A registered nurse is assigned to the discharge lounge to address any concerns and oversee patient safety. One of the advantages of the discharge lounge is that it frees f rees up ward beds, thus decreasing the length of time new patients are required to wait for bed placement. Levels of independence are evaluated constantly during the patient journey with the final assessment carried out just before the patient is discharged. Students will develop structures to help them assess levels of patient independence: How do you feel about …? Is there anything you are worried about? Mobility about? Mobility aids to assist the patient’s walking – leg brace, well as those thatmat, can be crutches, wheelchair the home –– as installed in grab bar, non-slip shower chair – might be recommended to increase levels of independence and therefore allow the patient to return to their home environment.

A patient discharge plan In Section 2, students begin by reading through an authentic patient educational leaflet that explains the Patient Discharge Plan. Prepared by the different healthcare providers involved in the patient’s treatment, the discharge plan provides information to the patient and their carers about prescriptions, follow-up appointments, support groups, even therapists, if necessary. The

will need community services, but also the type and frequency of those services. Depending on the country, patients and/or their carers may be more or less involved in the discharge process. One of the most important elements of the Discharge Plan is patient education regarding medications. Drug therapy can only be effective when patients co-operate with the drug regime. In hospital this is closely supervised, but once discharged, many patients fail to continue with their treatment. Reasons for this include: forgetfulness, inconvenience, lack of understanding of the illness/drug, unclear instructions, a confusing cocktail of medications, side effects and fear of addiction.

Explaining medication Nurses are sometimes called upon to explain overthe-counter medications or OTCs. This section of the unit provides plenty of practice of language related to types of medication, including capsules, cough syrup and ointment, as well as expressions of time used to explain dosages: three times a day, two every six hours, at mealtimes. mealtimes. It is very important that the information patients receive concerning any form of medication is accurate, so in addition, students will spend time acquiring expressions commonly used in direction sheets: do not exceed, do not chew, according to the severity of the t he symptoms and symptoms and may cause drowsiness.. Patients must be advised to take caution drowsiness with andsame supplements as they may not beOTCs, safe tovitamins take at the time as their prescription drugs.

Making appointments on the phone It is just as important for nurses as it is for other professionals to develop effective telephone skills; maybe more so, considering the stressful situations in which many nurses work. This final section of the unit deals with making appointments with another hospital service or perhaps a local GP or practice nurse. It is important to signal the beginning and closing of a telephone conversation. Nurses are encouraged

69

Independence Assessment, including a final evaluation of ADLs, including ambulation (patient’s ability to get around on foot) and transferring (by vehicle) will determine not only whether the patient

therefore to open or byunit: identifying themselves and their department This is Nurse Akif Altundas  from Paediatrics. Their speech should be clear and coherent: I want to make an appointment for one of our  patients, please. It should make possibilities for Patient discharge  discharge 

 

clarification: Good, so that’s 1.15 on Monday 24th   To ensure students are able to handle such February. To February. calls with ease, the unit provides a simple checklist for making appointments to guide the student through the process. With regard to pronunciation, students will concentrate on word and syllable stress for emphasis, a skill that is particularly important to ensure clarity and accuracy when taking and providing information over the phone. Finally, this section offers an opportunity for students to discuss their concerns about speaking over the phone in English. The lack of visual information to complement face-to-face conversation is one such concern. Even if the caller is unable to see you, using non-verbal communication, such as smiling (to dissipate any anger or stress) and showing warmth with the eyes is proved to have a very positive effect on maintaining a good relationship with the caller, even during difficult In terms of position,and a standing up cansituations. lead to a rushed conversation feeling of superiority, while lounging back in a chair might lead to the nurse being more casual and less attentive.

8 

70

Patient discharge  discharge 

8 

 

which are being used by the patients in the picture.

Teache Te acher’s r’s notes not es Warm-up

1 crutches 2 wheelchair 3 leg brace 4 walking frame 5 walking stick

1  Divide the group into two teams and ask

students to brainstorm ten terms or expressions

4  Refer students to the photos a–e of mobility aids

for the home (and hospital) at the bottom of the page. Ask them, individually or in pairs, to label them using the words in the box.

used to discuss elimination in a formal context (with another medical professional, during a student presentation). The first team to reach ten and spell them correctly wins.

a shower chair b  bath lift c  grab bar d  non-slip mat e raised toilet seat

2  Refer students to the information for Mrs Eileen

Ashton on pages 52 and 58. Ask students, in pairs, to take it in turns to roleplay the nurse’s patient assessment, employing appropriate active listening skills. You may wish to elicit eli cit the active listening skills covered in the unit (page 54) first.

Extra activity Dictate the following: leg brace, walking frame, walking stick, shower chair, grab bar, bath lift, nonslip mat.  mat.  Ask students to underline the main stress for each phrase. Come together as a group to check. Point out that for grab for grab bar  the  the speaker doesn't differentiate between the two words – it is pronounced as one word. As you point to each phrase, ask students as a group to practise saying them aloud, checking they have the right word stress. Ask: What is the ‘rule‘? (The main stress appears on the first word of the phrase, except in non-slip mat where mat where it is on the word mat ). mat).

Evaluating levels of independence Listening 1

► 

53 Refer students to the picture at the top of the page. Ask: What is a discharge lounge? When do patients go there? (Discharge lounges can be found in larger hospitals and provide a quiet area for patients to relax while waiting for their transportation after being discharged from hospital. A registered nurse is assigned to give assistance with follow-up appointments, arrange pick up of prescriptions from the pharmacy, give instruction on medications, etc.)

5

Ask students to look at patients a–d and tell them they are going to hear a nurse explaining each case. Ask them to listen and an d label the

With more confident students, you could ask them to supply their own definitions, perhaps brainstorming the first one as a group first. Then

patients with the correct name.

ask them to compare with definitions a–e.

1 Jim 2 Mrs Ridley 3 Elin 4 Mr Aziz 2

Ask students to listen again and answer questions 1–6. Ask them, in pairs, to compare their answers before coming together as a group to check. 1 Elin 2 Mr Aziz 3 Jim 4 Mrs Ridley 5 Elin 6 Mrs Ridley

Vocabulary 3

Ask students to match the definitions a–e to the mobility aids in Exercise 4. Come together as a group to check.

On the board write: mobility aid. aid. Ask: What are mobility aids?  aids? Give an example. (Equipment example. (Equipment that

a non-slip mat b  raised toilet seat c  bath lift d  shower chair e grab bar

Listening 6

► 

54 Tell students they are going to hear Nurse Denis Astorga preparing the patients from page 60 for discharge. Point out that in some cases he is speaking to a carer. Ask students to listen to the three dialogues, then ask them to write the name of the patient Denis is talking to or about in each case.

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1 Mrs Ridley 2 Elin 3 Jim

enables the patient to be more independent , e.g. e.g.   walking stick.) stick.) Ask students, individually or in pairs, to match the words in the box to the mobility aids 1–5 Patient discharge  discharge 

 

7  Elicit/Pre-teach: bathing, toileting, dressing. dressing. Ask:

What kind of tasks are these? (Activities these?  (Activities of Daily Living or ADLs – see Unit 6.) Ask students s tudents to listen again and circle the ADL that each patient/carer is worried about. Then students tofor write mobility aid the nurseask recommends eachthe patient. 1 toileting, raised toilet seat 2 bathing, grab bars, non-slip mat 3 bathing, shower chair 8  Ask students, individually or in pairs, to match

the sentence beginnings 1–6 to the correct endings a–f. 1 f 2 c 3 d 4 e 5 a 6 b 9

Ask students to listen again to the dialogues to check their answers to 8. Then ask students, in small groups, to decide which of the expressions are suggestions/recommendations from the nurse (four expressions), questions the nurse asks the patient (one expression) or worries or concerns expressed by the patient or carer (one expression). Ask: Why does the nurse offer recommendations recommenda tions or suggestions? (This suggestions? (This is more likely to encourage the patient than using must must   for obligation. Also the patient should be encouraged to be part of the decision-making process.) Refer students back to Unit 5, if necessary. 1 3, 4, 5, 6 2 1 32

Speaking 10 Refer students to situations 1–6. Check

understanding of: stiff, nervous, slip. slip. Then ask them, in pairs, to take turns to play the nurse who is giving advice about mobility aids. Tell students to start their dialogues using the prompt and encourage them to use the language from 5–7. Depending on your group, you may wish to ask students to roleplay their scenario in front of the rest of the group.

8 

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Patient discharge  discharge 

8 

 

Listening

A patient discharge plan 4

Speaking 1

Ask students in pairs to discuss the question. Come together as a group to compare answers. Ask: What is the role of the patient/carer in the discharge process? (Depending process? (Depending on the country, patients and/or their carers may be more or less involved in the discharge process.) Some students may have difficulty expressing their ideas effectively in English. Reassure them that for this activity accuracy is not important – just encourage them to discuss their opinions. Come together as a group to compare ideas.

Tell students they are going to read a patient educational leaflet that explains the discharge process. Refer them to the titles a–e and ask as k them to read the leaflet, thecompare titles to the relevant paragraph. Askmatching students to their ideas with a partner before coming together as a group to check.

1 F – she’s a bit worried about leaving 2 F – she lives alone 3T 4 F – the neighbour could help with the shopping/her sister will help with cooking

2 e 3 a 4 c 6 b 8 d 3  Ask students, individually or in pairs, to match

the definitions to the words highlighted in yellow in the text. Point out the following: give following: give a shot (USA) shot (USA) give  give an  (UK). injection (UK). injection 1 over-the-counter drugs 2 prescription drugs 3 supplements 4 side effects 5 giving a shot 6 support groups 7 therapist 8 healthcare provider

Extra activity Ask students, individually or in pairs, to think about a patient they know well and write down a list of the different members of the medical team (within the hospital and aftercare services) involved in devising the patient’s discharge plan. Then ask students to present their ideas to the rest of the group.

55 Refer students to the photo on the right of the page. Ask: What kind of worries do patients have just before they leave hospital? (Patients might wonder how they are going to manage to take care of themselves, especially if they live alone or, if they have dependents, how they will be able to take care of the whole family fa mily while still in recovery. After a long period in hospital patients may have become slightly institutionalised.) Tell students they are going to hear a nurse going through a discharge plan with her patient, Nancy Lorenz. Refer students to the statements 1–4 and ask them to listen to the recording and decide if the statements are true or false. Ask students to correct the false statements. If necessary, play the recording again. Ask students, in pairs, to compare their answers, before coming together as a group to check.

Reading 2

► 

5

On the board write:  ADLs. ADLs. Ask students to brainstorm a list of these, and refer them back to Unit 6, page 47 if necessary. Then add: ambulation, transferring and transferring and ask: What do you think  – getting around these ADLs refer to? (ambulation ambulation – on foot, transferring  – getting around by vehicle) transferring – They are both indicators of levels of independence and could indicate a need for assistance. Pre-experience nurses may not have come across these terms. Ask students to look at the independence assessment form and ask them to listen to the dialogue with Nancy Lorenz again and complete the form, ticking the correct boxes. If necessary, play the recording again. Bathing – needs assistance  Ambulation – independent Toileting – independent Transferring – dependent Eating – needs assistance Dressing – needs assistance

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Patient discharge  discharge 

8 

 

Language 6

On the board write: If ... With confident students who prefer a more inductive method, ask them, individually or in pairs, to cover the Language box and complete the exercise. Explain that these are sentences taken from the dialogue between the nurse and Nancy Lorenz. Ask students to check their usage by reading through the ‘rule’ for the first conditional, allowing them to make any necessary changes to their answers. For less confident students, ask them to read the ‘rule’ for the first conditional. Tell them to use this information to help them complete sentences 1–4. If necessary, dictate the verbs needed to complete each sentence (help, ( help, fall, tired, ). help). help Come together as a group to check. 1 will help me 2 I’ll fall 3 I feel tired 4 will help me

7

You can carry out this activity in the same way. It is important to ensure students understand the difference in usage between the two conditionals. On the board, write Zero Conditional, First Conditional. Conditional. Ask: Which one refers to the future? (first) Which one is used to give  general instructions instructions or solutions to a problem (in a nursing context)? (zero) context)? (zero) Which one describes a situation and its possible result? (first) It is also important they understand how to form the two conditionals. Explain that it is possible to reverse the order of the sentences. On the board write: My write: My sister will be angry if I’m late. or If or If I’m late, my sister will be angry. Point out that it is not possible to use if  followed  followed by will/won’t will/won’t.. On the board, write: If I will be late, my sister will be angry. Put angry. Put a line through the first  in the example – this will serve to reiterate will in will the point, especially for students where this occurs in their L1. Allow students sufficient time to assimilate the information in the Language box. 1 buy a non-slip mat and some grab bars to put in the shower. 2 just ask.

8  Ask students to check their answers to Exercise 6

and Exercise 7 by looking at audio script 55 on pages 78–79. This will allow students to see the target structures in context. Come together as a group to discuss any concerns students might have with the two conditionals – it could prove a little confusing for some students.

Extra activity Refer students back to the patient leaflet on page 62. On the board, write: 1 Do you know what to do if you need help with …? 2 Do you know who to contact if …? 3 What do you do if …? Ask students, individually or in pairs, to use the information to write five questions they could ask their patient to check understanding of their discharge plan. Ask students to use information in the checklist to write five questions their patient might ask at discharge. On the board, write: Who can I call if I need help changing a bandage? What can I do if …? Ask students, in pairs, to take turns to ask and answer the questions they prepared above.

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3 you re worried about feeling tired. 4 you start feeling tired. 5 ask your neighbour.

Patient discharge  discharge 

8 

 

Reading

Explaining medication 4

Listening 1

► 

56 If your students are experienced nurses , ask: What is your experience of explaining medications to patients? What problems have you experienced? What advice would you give to new nurses?

Elicit/Pre-teach: post-discharge care. Elicit/Pre-teach: post-discharge care. Tell students that they are going to hear a second conversation between the nurse and Nancy Lorenz. Explain that the nurse is talking to the patient about her medication and post-discharge care. You may wish to refer students to questions 1–6 first to facilitate the listening process and help set the scene. Ask students to listen and circle the best answer in each case. If necessary, play the recording again. Ask students to compare their answers in small groups before coming together as a group to check. 1 b 2 a 3 b 4 b 5 b 6 b

Vocabulary students ents to cover the word word box and try to 2  Ask stud label the different types of medication a–f. Students may already know many of these items. Refer them to the word box if necessary. ne cessary. Come together as a group to check. Point out that these terms are also used: cough medicine/mixture, medicine/mixtur e, tube of cream, nose spray, a bottle the contraceptive pill is known of pills. However the  as the Pill. Pill. Refer students to the note on the left of the pictures –1 tablespoon is a common measurement in the UK/Ireland/Australia, but the quantities are different. a bottle of tablets b  nasal spray c  tube of ointment d  eye drops and a dropper e capsules f  cough  cough syrup

Listening 3  Elicit/Pre-teach: apply, area, mealtimes. mealtimes. Ask

students to listen to the recording again and complete the instructions as they listen. If

Tell students they are going to practise explaining over-the-counter medications to a patient. Allow them time to familiarise themselves with the directions for the three medications. asktothem, individually or in pairs, to find Then phrases match meanings 1–5. Ask pairs to compare their answers with another pair, before coming together as a group to check. 1 Do not give more than four doses in 24 hours. (Do not exceed eight capsules in 24 hours.) 2 May cause drowsiness. Avoid driving … when taking this medicine. 3 Do not chew. 4 To be taken … as required according to the severity of the symptoms. 5 For oral use (only).

Writing 5  You may wish to review usage and form of

imperatives for simple instructions (see Unit 4) before asking students to carry out this activity. On the board write: take, don’t take, you need to. to . Brainstorm the first instruction as a group, before asking students to write instructions for patients 2–4. Encourage them to write in their own words. Less confident students may prefer to write collaboratively. Point out to students that for situations 2 and 5, they will need nee d to write the instruction for the parent/carer.

75

necessary, play the recording again. Come together as a group to correct. 1 two, mealtimes 2 pain, two 3 hours, day 4 put 5 stitches 6 tablespoonful Patient discharge  discharge 

 

Suggested answers 1 You need to take Dicalm for your diarrhoea. Take two tablets every two to four hours according to how bad you feel. It’s important not to take more than six doses a day. Chew the tablets and then drink a glass of water. 2  You or can give Give Kold her Karma children of sixfour years more. onetocapsule every hours with water. Do not let her chew the capsules. She should have no more than four capsules in 24 hours. 3 Take Kold Karma for the flu symptoms: two capsules every four hours, but not more than eight capsules a day. Take the capsules with water, do not chew them. And for your cough, take Coffalix. Take two 1.5 ml spoonfuls four times a day. You shouldn’t take more than four doses a day. Don’t drive or operate machinery while you are taking Coffalix. 4 For your cold, take two Kold Karma capsules with water every four hours. Do not chew the capsules. Don’t exceed the recommended dose – eight capsules a day. 5 Give him one Dicalm tablet every two to four hours while his symptoms continue. He needs to chew the tablets and then drink a glass of water. Don’t give him more than six tablets in the space of 24 hours.

Extra activity Ask students, in pairs, to write two more scenarios like the ones on 5 and swap them with those of another pair. The pair should write out the instructions and then take it in turns to roleplay the scenarios.

Speaking 6

Tell students they are going to practise a set of basic questions a nurse might use when asking about the patient’s medication (with the patient/carer or other medical professionals). Ask students, individually or in pairs, to match the questions 1–3 to the correct answers a–c. For more confident students, write on the board: every four hours, two 80 mg tablets, Oxcycontin for  pain relief . Then elicit the correct question for each one. 1 c 2 a 3 b

8 

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pairs, to take it in turns turns to 7  Ask students, in pairs, practise asking and answering similar questions using the directions for over-the-counter medications in 4.

Patient discharge  discharge 

8 

 

Making appointments on the phone

4  Ask students, individually or in pairs, to

complete the patient’s appointment card. Then play the recording again to allow them to make any necessary corrections. Come together as a group to check. If necessary, play the recording once more.

Speaking 1

Explain to students they are going to work on developing a set of useful expressions that they can use when making an appointment for a patient over the phone. Tell them they are going to hear Orthopaedic Nurse, Zafar Hussein, making an appointment for his patient with another medical service. Refer students to the information about the patient 1–4. On the board write: Identify yourself and department. department. Elicit a suitable telephone expression from the group for this and then ask students to compare with the one on the Appointment Checklist. Ask students, in pairs or small groups, to use the information about the patient as a basis to brainstorm expressions for each point on the checklist. Avoid correcting at this stage.

Patient Name: Name:  Geoff Pattern  Ap po poin in tm ent w ith: it h:  occupational therapist Day: Tuesday Day:  Tuesday th Date: 17 Date:  17  June Time: 17:00 Time:  17:00 1 Occupational Therapy 2 Tuesdays and Thursdays 3 3.30 in the afternoon 5

► 

57 Tell students they are going to hear Zafar’s telephone call. Ask them to listen and compare what he says with their expressions in 1. If necessary, play the recording again. Variations of these may also be acceptable. 1 Good afternoon. (Hello.) 2 This is Zafar from Orthopaedics. 3 I’d like to make an appointment with the Practice Nurse for one of our patients, please. rd 4 How about 23 ?, Do you have any appointments in the morning? th 5 Good, so that’s 10.15 on the 24  of January. 6 Let me give you the patient’s details. It’s Mr Ernesto Chavaz, that’s C-H-A-V-A-Z. 7 Thank you for your help. Goodbye.

3

► 

58 Tell students they are now going to hear Zafar making an appointment for another patient. Ask students to listen and tick the points in the checklist as they hear them. Reassure them they don’t have to understand everything on first hearing; they will have the opportunity to listen for detail later. Ticked items: greet person, identify self and department/unit, give reason for calling, suggest day and time, give patient details

59 Tell students they are now going to hear Zafar change Mr Pattern’s appointment. Refer them to points 1–3. As they listen, tell students to transcribe expressions they hear for each point. For less confident students, you may wish to give them the first letter of each word in the expressions.

Listening 2

► 

1 (Sorry to disturb you but) can I reschedule Mr Pattern’s first appointment? 2 What time was his appointment?/Sorry, did you say Tuesday or Thursday? 3 Can you just hang on a moment?

Pronunciation 6

On the board write: Sorry, did you say Tuesday or Thursday? Ask students to translate this expression into their own language. Ask: How do you make the caller understand which day is important? Languages differ, but some will follow the same rule as English. Ask students: How do we do this in English? (In English? (In English, speakers stress the words or syllables to emphasise important information.) More confident students may already be aware of this. Ask a more confident student to underline the stressed words/syllables. Avoid correcting at this stage. Ask students to listen to examples 1–4 from the recording in 5 and underline the stressed words or syllables in each sentence as they listen. You may wish to go over the first one as a group.

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Patient discharge  discharge 

8 

 

7  Ask students to listen again and make any

Extra activity 

corrections, before coming together as a group to check. Play the recording again and ask students to repeat the stress patterns they hear. Play the recording several times until you are happy that they are able to reproduce the

Ask students in pairs to take turns reading audio script 59 (page 79) aloud to practise the stress patterns in context. Encourage them to employ effective communication strategies for the phone.on Ask another to for listen and then comment their use ofpair stress emphasis and communication strategies.

same/approximate stress pattern.  1 Sorry did you say Tuesday or Thursday? 2 Tuesday, Tuesday afternoon. 3 No, not 10.15, 10.50. 4 Oh, OK 10:50, sorry.

Speaking 8

Ask students: What is your experience of speaking on the phone with other medical professionals in English? Ask students in small groups to discuss question 1, encouraging them to use the prompt, I find it difficult because ... ... Some students may have difficulty expressing their ideas effectively in English. Reassure them that for this activity accuracy is not important – just encourage students to discuss their opinions. If necessary, brainstorm opinions first as a group, writing their ideas on the board. Then ask students, in pairs, to discuss. Refer students to question 2. Ask them to visualise an effective phone conversation (in their L1). Then ask them to note down strategies they use to ensure the conversation is effective. Refer students back to the checklist from page 66 and ask: Does ask: Does it help to use a checklist like the one on  page 66? Why/Why not? (It not? (It helps to structure the call/the caller doesn’t forget what he or she needs to say/it gives prompts for expressions in English.) You may wish to suggest to students they keep a copy of their checklist close to the phone for future calls. Suggested answers: smile, sit down, speak at moderate speed, speak clearly, ask for clarification, repeat if necessary, stress important words

9

Put students into pairs and tell them that they are going to practise making appointments over the phone. Refer Student Bs to page 69. Ask Students A and B to read the information for roleplays 1 and 2. Point out that all the vocabulary presented in 1–4 has already appeared earlier in the course. Allow them adequate time to review if necessary. Encourage students to use the checklist on page 66 as well as their newly acquired skills for emphasis and telephone communication strategies. Ask students to carry out roleplays 3 and 4 in the same way. Depending on your group, you may wish to ask students to roleplay their conversations in front of the rest of the group or in small groups. Encourage ‘observers’ to provide constructive feedback.

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