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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
ISBN: 978-1-4082-5212-3
Set in Palatino
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 1 3
Teacher’s notes Extra activity
On the board, write all the phrasal verbs from
Hospital jobs and personnel Exercise 2. Divide your group into two teams.
Ask students to cover the page and using the
Vocabulary phrasal verbs on the board, take turns to
describe one of the job titles on page 4 to the
1 Before you open the book, ask students to opposite team. The team with the most correct
introduce themselves and say a little about why answers wins the game.
they are attending the course. Experienced
nurses: Ask students to explain what they hope
to improve during the course. Pre-experience Language
nurses: Ask students to explain which area(s) of Depending on your group, you may wish to ask
nursing they find the most interesting. students to complete 3 before going through the
Then draw a pyramid on the board and write Language box. This will serve as a ‘diagnostic
one of the following at each point of the triangle: test’ to check their current understanding of the
nursing/English/my future. Encourage students target structures for this unit.
(individually) to write or draw
words/sentences/objects to represent how they Present simple v present continuous
feel about each topic. Ask students to discuss Refer students back to the picture and 2 on
their ideas with a partner. Then ask students to page 4. On the board, write:
introduce their partner to the rest of the group, 1 What does the scrub nurse do?
explaining the points on their pyramid. 2 What is the scrub nurse doing now?
Elicit answers:
Open the book on page 4 and ask students to
1 She looks after patients during surgery.
look at the picture at the top of the page. Ask:
2 She is pushing a patient trolley through the
What department do you think it is? (Emergency Admissions area.
Room/ER or Casualty/Accident & Ask students to compare the two forms and
Emergency/A&E). If necessary, pre-teach/elicit ask: When do we use the present simple? When do
triage room and surgery. we use the present continuous?
Ask students, individually or in pairs, to match Suggested answer: We use the present simple
the job titles with the hospital personnel they see to talk about routines and things that happen
in the picture. all the time. We use the present continuous to
talk about things that take place at the time of
a8 b1 c4 d2 e7 f3 g9 h5 i6 speaking/things that are not permanent.
Give students time to assimilate the points
covered in the Language box.
2 Ask students, individually or in pairs, to match If necessary, review present simple and present
the job titles in 1 with the descriptions. If continuous forms in more detail.
necessary, encourage them to deduce the
meanings from the picture. Come together as a
group to check answers. Reading
For further language practice, draw two 3 Tell students they are going to read an interview
columns on the board. In column 1, write: carry, with practice nurse Reena Chaudry. Ask them to
deal, give treatment, look, responsible, specialise. In read and underline the correct verb forms in the
column 2, write: after, for, in, out, to, with. Ask text.
students to match the verbs to the correct If necessary, ask a stronger learner to select the
preposition. Then choose one of the activities for best answer in the first sentence.
further practice of the target language.
1 work 2 like 3 carry out 4 change 5 treat
1b 2d 3f 4c 5h 6i 7e 8a 9g 6 am 7 give 8 are running 9 ’m learning
10 don’t have 11 like going 12 play
Patient admissions 1 4
Listening
a renal care
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 1 5
Hospital departments and facilities zy zyy yzyy
Renal Casualty Pathology
Surgery Maternity
Vocabulary Neurology
1 Tell students to look at the hospital plan taken
from a patient educational leaflet. Ask: Which yyzy yyzyy
Geriatrics Dermatology
department names do you recognise? Ask students,
Paediatrics Cardiology
individually or in pairs, to complete the Radiology
definitions using the words in the box.
Alternatively, do this activity as a group chorus yyzyy
and then give students time to complete the Physiotherapy
definitions in writing to reinforce the target
language. Extra activity
Come together as a group to check answers. On the board, write: facilities, orthopaedics,
Check students understand: nervous system, skin pharmacy, registration, patient, entrance, toilets,
disorder, midwife/midwives, recover. information, coffee, hospital, emergency (these
words all appear on the hospital plan on page
1 emergency cases 2 operations 3 kidney 6). Ask students to add these words to the
4 skin disorders 5 elderly 6 test results correct column in the table in 2 according to
7 babies 8 children 9 heart 10 X-rays their stress pattern.
11 nervous system 12 exercises See answers below.
Patient admissions 1 6
Vocabulary
Extra activity
4 Ask students, individually or in pairs, to choose Dictate these scenarios to the group (or prepare
the correct prepositions of place to complete the as a handout) and then put students into pairs
explanations. Come together as a group to check and ask them to roleplay four or more of the
answers. situations to practise giving directions using
the hospital floor plan on page 6.
1 between, and 2 on, the left of 1 You want to visit your sister who has just had
3 on, opposite 4 in, at 5 next to, on her first baby. You are at the main entrance.
6 in front of 2 You are looking for a shop to buy your wife
some flowers. She’s in room 202. You are next
5 Ask students, individually or in pairs, to match
to the bank.
the symbols to the facilities. Ask: Which facilities
3 You are late for your X-ray and lost. You are
can you find in hospitals in your country? Which
on the second floor in front of the Neurology
facilities would you like to see in hospitals in your
Department.
country? Why is it important to provide facilities
such as these in hospitals? Do we really need to 4 You hear an announcement that your eight-
provide these facilities in hospitals? year-old son is waiting for you at the
registration desk. You are on the 5th floor
a6 b9 c7 d8 e4 f5 g2 h3 i1 visiting your mother after her hip operation.
5 You arrived 20 minutes late for your
appointment with the dermatologist. You are at
Listening the main entrance.
6 ► 04 Depending on your students, you may 6 You are leaving hospital today. The
wish to review prepositions of movement before consultant gave you a prescription for
you start this activity. Tell students they are painkillers. You are still in your room on the 4th
going to hear three nurses giving visitors floor but want to know where the pharmacy is
directions to different hospital facilities. Ask located.
them to listen and complete the instructions.
Come together as a group to check answers.
Patient admissions 1 7
Admissions Extra activity
Ask: Why is it a good idea to explain the triage
Reading process to patients? In small groups, students
brainstorm ideas and then come together as a
1 Tell students they are going to read a patient group to share their ideas.
educational leaflet from a hospital in Phoenix, Suggested answers
Arizona (USA). Ask them to scan the text and It helps patients better understand the order of
find answers to questions 1 and 2. If necessary, care; helps reduce levels of patient anxiety and
reassure them that they don’t need to possible frustration.
understand the whole text, which has been Note: Some students may have difficulty
adapted from an authentic patient educational expressing these ideas effectively in English.
leaflet. Reassure them that for this activity accuracy is
Ask: What is the average waiting time in ER in your not important – just encourage students to
place of work/country? Are waiting times in ER a discuss their opinions.
problem? What can hospitals do to reduce waiting
times? How can they make waiting times more
Listening
bearable for patients?
4 ► 06 Tell students they are going to hear a
1 2.5 hours 2 4.5 hours triage nurse talking to four new patients. Before
they listen, ask students, in pairs or small
2 Ask students to read the leaflet again. As they
groups, to ‘observe’ the patients a–d in the
read, they should complete the gaps in the
picture. Note that observation is an authentic
‘When you arrive’ section using the words in the
task for a triage nurse and will also serve to
box. Ask students, in pairs, to compare their
prepare students for the interventions they are
answers, then come together as a group to check.
about to hear.
Encourage students to visualise the admissions
process in their place of work/country to help Ask students to listen and decide which patient
them complete the activity. is speaking in each case.
If your students are pre-experience nurses, ask 1d 2b 3a 4c
them to visualise what happened the last time
they attended the Emergency Room as a 5 Ask students to listen again and complete the
patient/carer. sentences using the words in the box.
Check students understand: assessment, cubicle, 1 leg 2 bleeding 3 hurts 4 worried, baby
priority. 5 eye
1 reception desk 2 date of birth 3 cubicle 6 Ask students, in pairs, to put the four patients
4 triage nurse 5 assessment 6 priority into order of priority to see the doctor. Ask
7 cubicle
students to compare their answers with another
3 Ask students to look at the medical problems (a– pair before coming together as a group to check.
c) and ask: Which problems are the most serious? If your students are experienced nurses, ask
Then ask them to match the problems to the them to explain the reasons behind their order of
gaps 8–10 in ‘The Order of Care’ section on the priority for a–d.
patient leaflet. In pairs, students can then
compare their answers before coming together Answers: d has been brought in by ambulance
as a group to check. from a car accident and will have priority, a the
patient is 23 weeks pregnant and has some
If your students are experienced nurses, ask bleeding so needs to see a doctor urgently, b and
them to brainstorm other medical problems for c are not priority cases but the child (b) would
8–10. probably be seen by a medical professional
before c.
8 c 9 a 10 b
d a b c
Patient admissions 1 8
7 Ask students to match the sentence halves to
make six requests. If necessary, review the use of
modals (can/could) for polite requests. Remind
students that the use of modals can and could for
polite requests is interchangeable.
1e 2d 3a 4f 5b 6c
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
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
Patient admissions 1 9
Checking in a patient 3 Ask students to listen again and complete the
nurse’s questions. Alternatively, to make the
task more challenging, ask students to complete
Vocabulary the nurse’s questions first and then listen and
1 Refer students to the Patient Details form and check their answers, making any necessary
ask them, individually or in pairs, to find words corrections.
in the form with the meanings 1–13.
1 name 2 spell 3 call 4 date, birth 5 job
Elicit/Pre-teach: n/a. Check understanding of: 6 allergies
next of kin and ask students for more examples
(any family member, friend, carer or neighbour). 4 Ask students, individually or in pairs, to write
questions for the remaining admissions
Experienced nurses: Ask: Do all patients want questions. Encourage them to make use of the
medical staff to use their first name? (Some feel terms in the admissions form to help them
more comfortable if the medical staff use their design their questions. Ask them to check their
first name. Others prefer a more formal answers on page 70 of the audio script. If
relationship and ask staff use their title (Mr/Ms, necessary, play recording 08 again for students
etc.) and family name.) to check their answers.
1 surname 2 occupation 3 title 4 GP 1 do you come from (originally)
(General Practitioner) 5 first name(s) 2 your marital status 3 is your next of kin
6 next of kin 7 country of origin 8 gender
9 marital status 10 reason for admission
11 DOB 12 intake 13 allergies Vocabulary
5 Ask students to brainstorm items they would
Listening find in a typical patient room in their place of
work/country. Ask them, individually or in
2 ► 08 Tell students they are going to hear a
pairs, to look at the picture of the patient room
nurse interviewing a patient from page 9. If
and label the items using the words in the box.
necessary, refer them back to the picture of the
waiting room on page 9 first, to familiarise Check understanding of: buzzer and locker.
themselves with the different patients present.
1 light 2 buzzer 3 TV 4 chair 5 table
Ask students to listen and answer the question: 6 bed 7 locker 8 drawer
Which patient is the nurse talking to?
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.
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 1 10
Listening
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.
Patient admissions 1 11
2 Pain
Pain 2 12
2 Patients often talk about their pain in simple
Teacher’s notes terms. Mime a patient with a headache. Elicit
expressions from the table in 1 to describe how
Warm-up
you are feeling.
1 Dictate the names of hospital departments and Pre-teach/elicit: throat, gum, lower (back). Refer
facilities from Unit 1. Then ask students to group students to the vocabulary table and ask them,
them according to their stress pattern. This can individually or in pairs, to change sentences 1–6,
be done as a team game – the first team to group using different words from the table. If
all the words successfully is the winner. necessary, work through the first sentence as a
2 Ask students to refer to the Patient Details form group.
on page 10 and ask them to take it in turns to Remind students we say I’ve got
roleplay interviewing the patient at admissions. toothache/stomach ache/earache. BUT I’ve got
a headache.
Locating and describing pain
Suggested answers
Vocabulary 1 My throat hurts.
2 My ankle hurts, it’s very sore.
1 If students are experienced nurses, ask: What 3 Does your head hurt?
type of chart is this? What is it used for? If not, ask: 4 Her gums are really sore.
What do you think this chart is used for? Who fills it 5 His stomach hurts.
in? (Pain map, used by nurses and doctors to 6 My lower back aches and it’s really painful.
mark the exact location of the patient’s pain.)
3 Elicit a general opening question: How do you
Ask students, individually or in pairs, to label feel?/How are you feeling today?
the pain map, using the words in the box. Tell
them to ignore the red arrows for the moment. Refer students back to the pain map. Ask them
Come together as a group to check answers. to write one or more sentences for each of the
red arrows to answer this question.
1 head 2 face 3 neck 4 shoulder 5 chest
6 stomach 7 hip 8 arm 9 hand 10 leg Suggested answers
11 knee 12 ankle 13 foot 14 back 1 My knee is really sore.
15 buttocks 2 I’ve got a pain in my shoulder, it’s really
painful.
3 My chest hurts.
Extra activity
Divide the class into four groups. Give each
group a different area of the body: arm, leg,
Listening
torso (elicit/pre-teach this) head and ask them to 4 ► 10 Tell students they are going to hear three
brainstorm the parts related to that section of patients (James, Godfrey and Alma) describing
the body. Alternatively, ask students, where they feel pain. As they listen, students
individually or in pairs, to research the above should put a cross (x) on the pain map for each
and deliver their findings during the next class. patient. Play the recording again if necessary.
Suggested answers
Arm: hand, finger, thumb, elbow, wrist, palm 1 stomach/chest 2 forehead 3 hip/leg
Leg: foot, ankle, calf, toe, thigh, knee, shin,
heel, sole 5 Ask students to listen to the three dialogues
Torso: stomach, hip, shoulder, buttocks, back, again and complete the descriptions and the
chest, waist, navel nurse’s question. If necessary, review
Head: face, neck, eye, nose, mouth, ear, cheek, prepositions of place. Play the recording again
forehead, eyebrow, lip, eyelid, throat for students to check their answers.
Pain 2 13
7 If necessary, review comparatives and adjectives
Extra activity
before starting this exercise.
In pairs, students should take turns asking and
answering the nurse’s question: Where do you On the board write: bad, good, severe, strong. Ask
feel the pain? Encourage students to recycle students to complete the patient descriptions
parts of the body from 1. using the comparative and superlative forms of
these adjectives. They can then use the table as a
6 On the board write: good/bad. Ask students to means of checking their answers.
give the comparative form of these adjectives
(better/worse). Ask them, individually or in pairs, 1 1 stronger 2 better 3 better 4 most severe
to put the words in the correct order to form 5 the worst
sentences that patients might use to describe 2 1 worse 2 worst 3 best 4 better
changes to their pain.
8 Ask students to look again at the descriptions in
For further language practice, ask students to 7 and choose the correct medical problem for
underline the word that makes a comparison each.
stronger – much. Remind them that we don’t say
Check understanding of: painkillers, darkened
more worse/better.
room, forehead, cheekbones, nasal spray, face pack.
1 The pain is much better now. For further language practice, on the board
2 I feel better today. write: headache, stomach ache, toothache. In pairs,
3 It’s worse than yesterday. students should choose one condition and take
4 The pain in my leg is much worse. turns to describe their pain in detail using
comparative and superlative adjectives. If
Language necessary, students can write notes first.
Pain 2 14
Pain assessment 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
Listening equivalent adjectives are used in their L1.
1 ► 11 Tell students they are going to hear five
1e 2h 3g 4b 5f 6a 7d 8c
patients talking about their pain in detail. Ask
them to listen and write down exactly where the
patient feels the pain under each name. Extra activity
Ask: Which adjectives can be used to refer to the
Alternatively, to offer students more support,
skin? (tingling, stinging, itchy)
write the answers in a different order on the
On the board write: head, eye, shoulder, chest,
board: chest, hands, head, lower back. Then play the
limb (leg/arm), stomach and ask students in small
recording. This will give students the chance to
groups to match the parts of the body to the
concentrate on the patient’s description.
most appropriate adjective. Alternatively, ask
1 head 2 lower back 3 chest/stomach students, individually or in pairs, to research
(patient doesn’t give specific area but says she the above and deliver their findings as an
gets a burning feeling after eating food) informal presentation during the next class.
4 hands 5 chest Suggested answers
head: dull, throbbing, shooting
2 Ask students to listen to the dialogues again and eye: burning, stinging, itchy
complete the patients’ descriptions using the shoulder: stabbing, throbbing
adjectives in the box. Encourage students to chest: shooting, stabbing, dull
deduce the meaning of the adjectives from the limb: dull, shooting, stabbing, tingling
descriptions and the body parts they refer to. stomach: throbbing, burning
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 Extra activity
general question to encourage the patient to talk
In pairs, students take turns asking and
about their pain. Either ask students to turn to
answering the nurse’s questions: Where do you
the audio script on page 71 and find two general
feel the pain? and Can you describe the pain?/What
questions the nurses use to ask about pain, or does the pain feel like?
elicit these questions: Can you describe the pain?
What does the pain feel like? 4 If your students are pre-experience nurses, ask:
What do you think these charts are used for? When
1 throbbing 2 dull, shooting 3 burning
do you think nurses use the chart with faces? If they
4 tingling 5 stabbing
are experienced nurses, ask: What are these charts
called? How do nurses use these charts? Which pain
Vocabulary scale do you prefer and why? (Pain scales are used
with patients to assess/measure the level of their
3 Refer students to the table and ask them,
pain. The 1–10 pain scale is generally used with
individually or in pairs, to match the adjective
adults and the faces pain scale with children or
phrases to the correct description. Encourage
people who have difficulty expressing
students to use their knowledge of English to
themselves/their feelings. Nurses ask patients to
deduce the meanings.
give a number between 1 and 10, where 0 = no
Depending on your group, you may wish to use pain, to describe how much pain they feel.
illustrations (arrow = shooting, drum = Nurses ask children to point to the face that
throbbing, knife = stabbing, bee = stinging, describes how they are feeling.)
pincushion = pins and needles) to reinforce the
meanings of these words.
Pain 2 15
Tell students they are going to look at 1 labour: location – lower stomach/hip area;
vocabulary to describe the degree/level of pain. type – dull ache, contractions (strong waves of
Refer them to the chart and ask them, pain)
individually or in pairs, to match the expressions 2 appendicitis: location – middle of stomach
in the box to the faces and the numbers. If (belly button), moves to lower right side of
necessary, do the first one as a group. abdomen; type – stabbing pains
3 severe migraine: location – head, behind eye,
Elicit the question a nurse would ask when neck; type – throbbing
using these scales: On a scale of 1 to 10, how bad is 4 broken shoulder: type – stabbing, aching,
the pain/how much pain are you in? Can you point to throbbing
the face that shows how you are feeling? 5 kidney stones: location – middle back, groin;
type – ache/spasms (or waves) of pain
1 no pain 2 mild pain 3 moderate pain 6 tonsillitis: location – throat, (glands) in neck;
4 severe pain 5 very severe pain type – burning sensation
6 unbearable pain
Speaking
5 Tell students they are going to develop a set of
basic questions to assess pain. Ask them to add
Wh- words to complete the questions.
If necessary, elicit Wh- question words (who,
where, what, when and how) before completing the
exercise.
Tell students they will be looking at question
techniques in more detail in Unit 4.
Pain 2 16
Successful communication Ask: Why is it important to ask these questions?
(Pain is not just physical; it can also have an
impact on other areas of the patient’s life –
Listening social, economic, psychological, and
1 ► 12 Ask students to ‘observe’ the patient Dina environmental. It is important that the nurse
Guyader (28) by looking at the photo. Ask them considers the patient as a whole – a holistic
to answer or just think about questions 1 and 2. approach – so that they can propose an effective
Avoid providing corrections at this point. treatment.)
Tell students they are now going to hear practice Some students may have difficulty expressing
nurse David Taylor interviewing Dina. As they these ideas effectively in English. Reassure them
listen to Part 1, students should check the that for this activity accuracy is not important –
answers to questions 1 and 2. If necessary, play just encourage them to discuss their opinions.
the recording of Part 1 again. Ask students, individually or in pairs, to answer
questions 1 and 2. You may wish to check the
1 lower back – below the waist, across the answers to these questions before moving on to
back
question 3.
2 dull ache and a shooting pain, like an electric
shock Ask students, in pairs or small groups, to match
the symptoms in the box to the correct sections
2 ► 13 Tell students to listen to Part 2 and put a in question 7.
cross and the letter N on the pain scale to
indicate how Dina feels now and a cross and an Point out that questions 1–6 of the initial pain
M to indicate how she feels in the morning. assessment tool are similar to those covered in 5
on page 15.
1 2 2 7 or 8
1 What makes it better?
3 Ask students to listen to Part 2 again and circle 2 What makes it worse?
the correct answers. If necessary, allow students 3 Sleep – insomnia
to read through the questions before listening. Appetite – can’t eat
Physical activity – can’t climb stairs easily, can’t
1b 2a 3b do sports, can’t stand even for short periods
Emotions – anger, suicidal feelings, crying
Writing
Extra activity
4 If your students are experienced nurses, refer Ask students to add one more example to each
them to the initial pain assessment tool and ask: section of the initial pain assessment tool.
Have you ever used a form like this? What is it used Suggested answers
for? Who carries out pain assessment in your Accompanying symptoms: stomach cramps,
country/place of work? (Nurses use the assessment headaches
tool as a guide to ask more detailed questions Sleep: feeling overtired
about the patient’s pain. Depending on the Appetite: smaller, reduced appetite
country, nurses are more or less involved in Physical activity: difficulty lifting heavy objects
carrying out pain assessment; this may be the Relationships with others: feeling suspicious of
responsibility of the doctor.) family members
Pre-experience nurses will understand how the Emotions: feeling depressed
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 2 17
Play the recording again and ask students, in
Extra activity
pairs, to complete question 7. Explain that some
points are referred to indirectly. If necessary, Refer students to pictures A and B and ask
allow them to read through the audio script on them to imagine themselves as the patient in
page 72 to check their answers. each case. On the board write: How do you feel?
What do you think about the nurse? Would you like
5 lying down, taking a hot shower this nurse to take care of you? Why (not)? Students
6 lifting heavy objects, carrying her daughter may wish to write down their answers before
7 Accompanying symptoms discussing in pairs and then come together as a
Sleep – she doesn’t sleep well, she is often group to share their ideas.
very tired
Appetite – she has no time to eat properly
Physical activity – she is unable to lift heavy Reading
objects/her daughter 7 Tell students they are now going to read a
Relationships with others – she has problems
description of good communication practice.
getting along with her husband (mentioned
indirectly) Before they read, ask them to explain the title of
Emotions – she feels angry, she feels the article or give it an alternative title (e.g. How
emotional (cries during the interview) to make your patient feel comfortable).
Ask students to complete the description using
Speaking the words in the box. Encourage them make use
of pictures A and B to help them complete the
6 If your students are pre-experience nurses, you text.
may wish to do 7 before 6. The pictures will then
serve to reinforce the examples in the Check understanding of: close family member,
description. expression, eye contact, rush, take an interest in,
aggressive, roughly.
Tell students they are going to talk about good
communication in nursing. Ask them, If necessary, reinforce the meanings of the
individually or in pairs, to write down or think important aspects by asking students to point to
about between three and five things that examples of each in pictures A and B.
demonstrate good communication, e.g. smiling
1 ease 2 relaxed 3 sit 4 smile 5 eye
when talking to a patient.
6 quickly 7 friendly 8 name 9 questions
Then, ask students, in pairs, to look at pictures A 10 open 11 questions
and B. Ask: What are the nurses doing or not
doing to facilitate communication with the Extra activity
patient? Check understanding of: facilitate. For further discussion, ask: What kind of
Some students may have difficulty expressing questions could/do you ask patients to show
their ideas; reassure them that for this activity interest?
accuracy is not important – just encourage them Suggested answers
to discuss their opinions. ask questions about the patient’s
family/friends; ask about what the patient is
A: The patient looks relaxed/at ease and is doing (programme they are watching on TV,
responding to the nurse. The nurse is smiling music they are listening to); the weather;
and making eye contact with the patient. His current events; etc.
posture is open and he is leaning slightly
forward. He is engaging directly with the
patient. This shows a very positive Pronunciation
communication technique.
8 ► 15 Tell students they are going to listen to
B: The patient does not feel listened to, feels
four nurses greeting their patients. Ask them to
unimportant. The nurse demonstrates very
poor communication technique. Standing over listen and decide if the nurses sound friendly or
the patient as opposed to putting himself at the unfriendly by ticking (9) the correct box. Ask
same level and having his arms behind his them to listen to the first one as an example.
back gives the impression he is not interested.
He is not looking at the patient when speaking
to her.
Pain 2 18
If necessary, play the recording two or three
Extra activity
times to allow students to hear the difference.
Reassure them that it is sometimes difficult for In pairs, ask students to choose two patients
non-native speakers to hear the difference. from page 14. Refer them to audio script 11 on
However, reiterate (as in 7) that a friendly tone page 71 and ask them to invent information for
of voice is very important in developing and these patients and complete questions 5–7 in
maintaining a good patient relationship. the initial pain assessment tool on page 16.
Students should continue the conversation,
1 friendly 2 unfriendly 3 unfriendly 4 friendly using the new information. Encourage them to
use patient-friendly intonation patterns and
9 ► 16 Ask students, individually or in pairs, to questions to put the patient at ease and show
complete the ‘rule’ about the intonation pattern interest. They then swap roles.
used for a friendly welcome. If necessary, brainstorm the patient details as a
group before asking students to roleplay.
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.
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.
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 patient-
friendly intonation patterns.
Pain 2 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
Speaking to discuss their ideas.
1 Ask students, in pairs, to brainstorm different
types of pain relief suitable for lower back pain, Vocabulary
then answer the questions. Come together as a 6 Refer students to the pictures at the top of the
group to share.
page and ask: What kind of treatment do these
images show? (Complementary and alternative
Suggested answers
bed rest, shower, gentle walking, ice pack, medicine.) Explain that the abbreviation CAM is
swimming now commonly used.
Ask students, individually or in pairs, to match
Reading the different examples of CAM to the correct
description. Check understanding of: improve,
2 Tell students they are going to read an article mental well-being, therapy, therapist, manipulate,
from a health website aimed at sufferers of lower influence.
back pain. If necessary, pre-teach/elicit the items
in the box before doing the exercise. 1e 2c 3b 4d 5f 6a
As they read, students should complete the text
using the words in the box. Come together as a Listening
group to check answers.
7 ► 17 Tell students they are now going to hear
1 comfortable position 2 pillow 3 shower friends, Angie and Carlos, talking about their
4 painkillers 5 anti-inflammatory experiences using CAM. Ask students to listen
6 hot-water bottle 7 heat patches 8 ice pack and tick the examples of CAM they hear.
9 muscles 10 swimming
herbal therapy, hypnotherapy, hydrotherapy,
3 Tell students they are going to be giving advice chiropractic therapy, music therapy
to patients suffering from lower back pain. Refer
them to the statements 1–5, then ask them to 8 Refer students to the statements 1–5 and ask
reread the article and complete the pieces of them to listen and decide if the statements are
advice by adding Do or Don’t to the beginning of true (T) or false (F).
each one. If necessary, go through the first item Ask students, individually or in pairs, to correct
as an example as a group. the false statements. Come together as a group
to check answers.
1 Don’t 2 Do 3 Do 4 Don’t 5 Do
1T
Speaking 2 F (Carlos thinks ginger is only used as a
remedy for colds and stomach ache.)
4 Refer students, in pairs, to the patient’s 3T
questions 1–3 and ask them to roleplay possible 4 F (Angie thinks chiropractic therapy sounds
answers. more painful than the backache itself. She
doesn’t give the impression she wishes to try it
If necessary, pre-teach/elicit expressions for out.)
giving advice: Why don’t you + infinitive …; You 5 F (Carlos believes CAM is more effective for
could + infinitive … (for tentative suggestions); acute pain.)
You should + infinitive (for strong advice).
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 2 20
Extra activity Speaking
Ask students (in small groups) to brainstorm 10 In small groups, ask students to discuss the two
more examples of CAM and write short questions. Ask them to feed back to the rest of
descriptions for a health website or patient the group and share their thoughts. If necessary,
educational leaflet. give students time to write notes first.
Suggested answers If your students are pre-experience nurses, ask
acupuncture – uses very fine needles to them to prepare a short informal presentation
regulate the flow of energy through the body. If for the next class.
the energy in the body is balanced, then the
person is in good health. Preparing for the next unit
homeopathy – uses very small doses of a
substance that causes symptoms to stimulate In preparation for Unit 3, suggest the following to
the body's self-healing response your students:
massage – squeezes/stretches parts of the body • Compile a list of words related to giving
to make someone relax or to reduce pain instructions you already know in English.
visualisation – uses positive mental images to
reduce pain or relax someone • Familiarise yourselves with general nursing
statistics, e.g. height, weight, temperature,
blood pressure.
• Do some (online) research into the heart and
Extra activity
heart disease.
Ask students, in pairs, to look at audio
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 chronic pain
and ask: What is the difference between the two
terms? Brainstorm ideas. Then ask students, in
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 2 21
3 Vital signs
Vital signs 3 22
Refer students to the information in the
Teacher’s notes height/weight chart. Explain that Imperial
measurements (pounds/lbs) are used in the
Warm-up
USA and also with older patients in the UK and
1 On the board write: head, eye, shoulder, chest, limb, Ireland (pounds/lbs and stones).
stomach, skin and then ask students to brainstorm
adjectives that can be used to describe pain for 1c 2d 3a 4b
each. This can be done as a team game – the
3 Tell students they are going to listen to the
team with the most correct adjectives in a given
dialogues again and ask them to plot the
time is the winner.
statistics for patients 1–3 on the height and
2 Ask students, in pairs, to brainstorm different weight chart. They should also decide if the
ways to put a patient at ease. Tell students to use patients are normal, overweight or underweight.
the patient case on page 15 and take it in turns to
assess the patient, making sure the patient is at 1 underweight 2 normal weight 3 overweight
ease.
4 Ask students, individually or in pairs, to
Statistics and vital signs complete the nurse’s questions and requests. If
necessary, play dialogue 1 again. Come together
as a group to check.
Listening
Check understanding of: bladder, to empty, scales.
1 ► 18 On the board, write: 65 m, 56 kg, 1.74 m,
25.5 kg, 81 cm, 153 cm, 66.25 kg. Elicit the correct 1 Can you, first? 2 are you 3 height
way to say these figures. If necessary, review 4 stand, scales 5 much, weigh
weights and measures and/or numbers in more
detail. 5 Depending on your group, students may prefer
to work in single-sex pairs for this activity.
Tell students they are going to hear a practice
nurse weighing and measuring six patients. In pairs, ask students to practise weighing and
They should circle the correct number. measuring each other (they can guess).
Encourage students to use the questions 1–5 in 4.
Point out they will hear: one point three four Remind them to swap partners.
metres or one metre thirty-four and twenty-two
point two five kilos, but not twenty two point Less confident students may wish to keep the
twenty-five kilos. phrases uncovered initially.
6 Ask students to match the vital signs to the
1 1.60 m 2 72 kg 3 1.34 m 4 89.5 kg
5 22.25 kg 6 1.40 m correct definition.
1d 2c 3a 4b
Extra activity
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.
Vital signs 3 23
Extra activity Extra activity
On the board, write: A high/low … means that the 1 On the board draw a spidergram
patient … (temperature) and elicit different types of
Ask students, in pairs or small groups, to equipment for taking temperature. Students
discuss what a) a very high and b) a very low may not know the name in English, but ask
reading of each of the vital signs shows about them to explain how it is used/what it looks
the health of a patient. like.
Suggested answers 2 Ask: What are the different methods of taking a
A high pulse indicates infection, stress, temperature?/What type of thermometer is used for
anaemia or exercise. each method?
A very low pulse rate indicates hypothermia, Answers
certain drugs (for example beta-blockers) and 1 tympanic, electronic, mercury (now rarely
certain heart conditions. used), oral
A high blood pressure indicates anxiety or 2 axillary/under the arm: mercury, electronic
stress. ear: tympanic
A low blood pressure indicates hypotension. oral/mouth: mercury, electronic, oral
A high temperature indicates fever. rectal: glass, electronic
A very low temperature indicates hypothermia.
A low respiratory rate indicates over-sedation, Pronunciation
opiate poisoning or the presence of a cerebral
lesion. 8 ► 20 Ask students to listen and check their
A high respiratory rate indicates asthma, heart answers to 7. Then on the board, write: digital.
problems. Ask how many syllables there are in the word
and then elicit the stressed syllable. Ask students
7 Ask students to look at the pictures and label the to underline the stressed syllable in each word.
equipment with the words in the box. If your Avoid correcting at this stage.
students are pre-experience nurses, check the
answers are correct before moving on to the next 1 digital blood pressure monitor
stage of the activity. Ask students to write 2 thermometer 3 pulse oximeter
4 stethoscope 5 sphygmomanometer
sentences using the expression: A/An … is used to
measure …
9 Play the recording again until you are happy
Tell them not to worry too much about their students are able to reproduce the
pronunciation at this stage. same/approximate pronunciation and stress
pattern. Reassure students that some of these
a blood pressure monitor b thermometer terms are difficult to pronounce even for a native
c pulse oximeter d stethoscope speaker.
e sphygmomanometer
Students may already know some of these terms
1 A digital blood pressure monitor is used to from their own language but will tend to place
measure a patient’s blood pressure. the stress in the wrong place. Ask them to
2 A thermometer is used to measure a patient’s compare stress patterns in their L1.
body temperature.
3 A pulse oximeter is used to measure how Speaking
much oxygen there is in a patient’s blood – the
oxygen saturation. 10 Refer students to the chart (the ‘vital signs’
4 A stethoscope is used to listen to heart section of the admission form). Ask: When is this
sounds and respiration rate (and bowel section completed? Who completes the information?
sounds). Why/When is it necessary to sign?
5 A sphygmomanometer is used to measure a
patient’s blood pressure. Ask students in pairs to match the abbreviations
to the words in the box. If your students are pre-
experience 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.
Vital signs 3 24
Suggested answers Listening
BP stands for blood pressure. We use a digital
3 ► 21 Tell students they are going to hear nurses
blood pressure monitor or a
sphygmomanometer to measure this. giving readings of vital signs for two patients.
P means pulse. We use a pulse oximeter to Before they listen, ask students to look at the
measure this. (The nurse can also use his/her current readings for the two patients. Ask: What
finger to measure the pulse.) do you already know about these patients?
RR stands for respiration rate. We use a If necessary, play the recording again. Students
stethoscope to measure this.
should compare answers with a partner, then
T means temperature. We use a thermometer
come together as a group to check.
to measure this.
Wt stands for weight. Point out that short forms are often used in
0² Sats means oxygen saturation. We use a spoken English: Pulse 60, Resps 120, Temp 35.2,
pulse oximeter to measure this. BP 120.
kg means kilograms.
O2 means oxygen. 1 P 128 RR 33 T 37
% means percentage. 2 BP 89 / 66 P 78 RR 20 T 37.5
Describing readings
Vocabulary
1 Ask students, individually or in pairs, to
complete the table.
RR BP P T
130/85 9
36.8 9
79 9
20 9
Vital signs 3 25
Speaking 7 Depending on your group, you may wish to do
8 before 7. The statements in 7 will then further
5 On the board, write: Environmental, Social, reinforce the meaning of the language items.
Psychological, Physical. Explain that nurses use different words and
Ask students to brainstorm one example for each expressions to describe readings.
category of something that can affect a patient’s Tell students they will hear the same
vital signs. Check understanding of the conversation again. They should listen and
categories before continuing. Then ask students match the correct patient to each statement.
to match the other factors in the box to the Check the answers before moving on to the next
correct category. stage of the activity. Then ask students to use
expressions from the box to complete the
Environmental: humidity, temperature
statements.
Social: lifestyle, caffeine, tobacco
Psychological: anxiety, anger, stress
1 up and down (P)
Physical: age, gender, infection
2 down (R)
3 vary, and (P)
Your students may mention some of the
4 up (D)
following points.
5 stable (D)
Humidity can raise respiration rate.
Tobacco and caffeinated drinks should be
avoided for 30 minutes prior to recording as Vocabulary
these can increase BP and P rates.
Blood pressure may be affected by anxiety. 8 Brainstorm words and expressions to describe
Anger can affect can affect blood pressure and readings. Tell students you will be checking
the pulse, causing them to rise. them later.
Stress can increase the pulse rate.
Draw the five line types on the board and ask
Rates differ with age, gender and as a result of
students to match the correct arrow to the
infection.
Note also: Pulse can be increased due to: sentences in Exercise 7.
exercise, fear, excitement, loss of blood or
fluids, certain drugs and heart conditions. Pulse Arrow: 1 sentence 4 2 sentence 2
can be decreased due to: hypothermia, certain 3 sentence 3 4 sentence 5 5 sentence 1
drugs (e.g. beta-blockers) and heart conditions.
Temperature may be affected by: fever,
exercise, ill health, hypothermia.
Extra activity
Ask students, individually or in pairs, to
research the effects of these factors on vital
signs and deliver their information as an
informal presentation during the next class.
Vital signs 3 26
Taking vital signs Extra activity
On the board write: Could you relax your arm,
Listening please? Elicit an appropriate intonation pattern,
then play the recording again to check.
It is important students take time to grasp how Alternatively, model two examples – one with
to give patient-friendly instructions and requests a flat intonation pattern and one with a rise and
as this is vital in developing and maintaining fall. Ask: Which is more polite? Why?
nurse-patient relations. If necessary, review form Answer
and usage of modals can/could. Students can then A flat intonation pattern sounds
concentrate on ensuring their impolite/uncaring/not patient-friendly.
instructions/requests are patient-friendly.
Tell students they are now going to work on
giving instructions and making polite requests. Extra activity
On the board, write: Relax your arm. Elicit a Ask students to underline one word in
‘softer’, more patient-friendly instruction: sentences 1 and 3 that makes them more
Can/Could you relax your arm, please? patient-friendly. Ask: What does this do to the
instruction/request? (Including just makes the
Check understanding of: roll up, sleeve, straight.
instruction/request sound softer.)
Encourage students to deduce the meaning from
Ask students to practise giving instructions 2,
the context/images.
4, 5 and 6 adding the word just.
1 ► 24 Refer students to the images a–f and ask Note that intonation rises slightly on just.
them, individually or in pairs, to match them to
instructions 1–6. You may wish to correct the 2 Tell students that charge nurse Stefano is going
first part of the activity before continuing. Then to take Mr Daniels’ pulse rate. Before they listen,
ask students to choose the correct piece of ask students to visualise taking a patient’s pulse;
equipment for each instruction. this will help them to concentrate on the
language input as opposed to the task itself.
Remind them that the use of modals can and
Then ask students, individually or in pairs, to
could for instructions and polite requests is
put the words in order to form a sentence and
interchangeable.
then put the sentences in the correct order. If
Ask students to practise the instructions/polite necessary, go through one answer with the
requests in pairs. Encourage them to use can and students first.
could. Tell them that intonation is very important
when giving patient-friendly instructions. A 1 I’ll take your pulse now, Mr Daniels, if I can?
gentle rise and fall pattern will help to soften the 2 Can you give me your palm, please?
3 I’ll put my fingers on your wrist.
instruction (make it sound less direct) and as a
4 That’s ninety-five beats per minute.
result relax the patient.
Ask students to practise the instructions/ 3 ► 25 Play the recording to check answers to 2.
requests again, this time focusing on the Then play the recording again to answer the
intonation pattern. question.
Vital signs 3 27
1 pulse oximeter 1 ’ll (just) roll 2 ’ll put 3 hold 4 ’ll wrap
2 110 beats per minute 5 won’t feel 6 ’ll (just) be 7 ’ll (just) take
3 Around ten years old. His pulse rate is higher 8 eat 9 see
than a mature adult/His voice/His anxiety about
the pain. Extra activity
Ask: How do you usually take blood pressure?
Language Which piece of equipment does the staff nurse use?
Which method do you prefer?
Will + infinitive for future Tell students to read audio script 28 on page 73
On the board, write: You will feel better soon. and to check their answers.
I’ll take your temperature now. Elicit when the Answer: sphygmomanometer
future with will + infinitive is used. Some Students may mention the difficulty in hearing
students may already know this. Most students the heart sounds using a sphygmomanometer/
of this level will know how to form the that it is less practical compared with a digital
structure. blood pressure monitor.
Answer: for predictions (You’ll feel better soon.)
and to talk about decisions made at the time of 8 ► 28 Ask students to listen to the recording,
speaking (I’ll take your temperature now.) check the answers to 7, and then complete as
Ask: Why do nurses talk about decisions? many of Ana’s vital signs as possible. They then
Answer: Nurses should always keep patients look at audio script 27 on page 73 and complete
informed of what they are about to do to the rest of the vital signs. Ask them to compare
reduce patient anxiety. their answers with a partner, before coming
Give students time to assimilate the points together as a group to check.
covered in the Language box. For further language practice, ask students to
If necessary, review future with will, including underline other examples of future with will in
contracted forms. audio script 26 on page 73 to further reinforce
usage. Ask students to circle examples where
5 Ask students to complete the examples from speakers are making predictions and underline
dialogues with nurse Stefano using will and examples where speakers are talking about
verbs from the box. Come together as a group to decisions.
check.
(Predictions – Will it hurt?, No it won’t, It will be
1 ’ll put 2 ’ll take 3 ’ll, clip 4 Will, hurt very quick. Decisions – I’ll just clip, I’ll just write
5 won’t, ’ll be 6 ’ll, write this down., We’ll take your temperature.)
Check understanding of: cuff, lap, pillow, tight. If students lack confidence, put them into pairs
Encourage pre-experience nurses to deduce or small groups for collaborative writing. They
meaning from the context/images. Do not check could use the text in 7 as a model.
answers until students listen to the recording in Ask students to practise giving their
8. explanations in pairs. Encourage them to use
patient-friendly intonation patterns.
Vital signs 3 28
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
1 Ask students to label the diagram of the heart. If Speaking
they are pre-experience nurses, you may wish to
give them the first letter of each word. 4 In pairs, ask students to cover the diagram and
explain how the heart functions (as if speaking
1 aorta 2 vena cava 3 pulmonary artery to a student nurse). Encourage students to use
4 right atrium 5 pulmonary vein terms from the text, check their partner’s
6 right ventricle 7 left atrium 8 left ventricle comprehension, and ask if he/she has any
questions. With less confident students, you
Pronunciation could suggest they write notes first.
3 Tell students they are going to read part of a Smoking causes the heart rate to increase and
reference text that explains the function of the the blood pressure to rise. The arteries narrow
heart. As they read, they should use the words and the blood flow decreases.
in the boxes to complete the information.
Encourage them to deduce the meaning of new 6 As they read again, ask students, individually or
words from the context and their own nursing in pairs, to decide if the statements 1–5 are true
knowledge. or false. They should then correct the false
statements. Come together as a group to check.
With less confident students, you could check
their answers stage by stage. 1 T 2 F, Nicotine causes your blood flow to
decrease and your blood pressure to increase.
Students compare their answers in small groups, 3 T 4 F, After a few years the risk of heart
then come together as a group to check. disease for an ex-smoker is the same as a non-
Check understanding of: circulate, pump, chamber, smoker. 5 F, It is never too late to stop
oxygen-rich blood. smoking.
Vital signs 3 29
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, 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.
Vital signs 3 30
4 Symptoms
Symptoms 4 31
Teacher’s notes 2 Ask students to look at the picture of the
patients sitting in the Emergency Room. If
Warm-up necessary, check meaning of triage. Ask them, in
pairs or small groups, to discuss questions 1 and
1 On the board, draw five arrows/patterns as in 7 2. Come together as a group to check.
on page 23. Ask students to brainstorm words to
describe these patterns. Then ask students, in Some students may have difficulty expressing
pairs, to draw charts similar to those on page 23 their ideas effectively in English. Reassure them
and practise describing them as if to a colleague that for this activity accuracy is not important –
or patient. just encourage students to discuss their
opinions.
2 Refer students, in pairs, to the patient on page 24
and ask them to take it in turns to practise taking If your students are experienced nurses, ask
the patient’s vital signs, using similar them to explain the reason for their order of
instructions. Remind students to use patient- care.
friendly intonation patterns.
1 (Suggested answers)
Symptoms and injuries a Difficult to give anything specific from the
picture. Common problems for infants: colic,
teething
Vocabulary b black eye, cuts, grazes and bruising
c mild asthma attack
1 Ask students, in pairs or small groups, to think
d sprained shoulder, bruising
about emergency room(s) in their place of e cut finger
work/country and ask them to brainstorm the f chest pains, asthma, angina
kind of symptoms patients generally present 2 f, c, d, b, a, e
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. Listening
Check understanding of: contusion (bruise), 3 ► 30 Tell students they are going to listen to the
abdominal, respiratory, sprain. six patients in the picture describing their
problems. As they listen, students should label
Ask students to compare their ideas with the the pictures a–f in the order they hear them.
information in the text.
a5 b2 c1 d4 e3 f6
Ask: What can chest pains be a symptom of? (heart
attack, angina, asthma, allergies, anxiety, pain, 4 Ask the students to listen again and write the
fever, infection, diseases of heart and lung, description of the problem next to each person.
stroke, head injuries, certain medications such as Check understanding of: colic, nauseous. Play the
beta-blockers, aspirin, etc.) recording again if necessary.
Explain that nurses will hear the terms signs,
symptoms and injuries. Signs are objective – what a colic b black eye, contusion c asthma
you can see with the eye (bruise, swelling, d broken wrist, nausea e bleeding, infection
f heart problem
redness) or with medical equipment (e.g. vital
signs). Symptoms are subjective – these are what
the patient feels (headache, nausea, etc.). Injury Vocabulary
is the patient term for the physical damage to the
5 Tell students they are now going to look at terms
body (cut, broken bone).
patients frequently use to describe their
1 injury 2 contusion/sprain symptoms. Ask students, individually or in
3 sprain/contusion 4 abdominal/chest pairs, to complete the sentences about the
5 chest/abdominal 6 respiratory 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.
Symptoms 4 32
Ask students to indentify the symptoms and the
injuries in the sentences. (injuries: cut, banged
head, bruise; symptoms: cough, difficulty
breathing, dizziness, infection, nausea.)
Extra activity
Ask: Find synonyms for more formal medical
words.
Answers: shortness of breath – dyspnoea,
dizziness – vertigo, swelling – mass,
bruise – contusion, breathing – respiration
Variation: On the board, write: dyspnoea,
vertigo, mass, 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.
Symptoms 4 33
Language Extra activity
Refer students to the patients on page 28 and
Past simple v past continuous audio script 30 on pages 73–74. Ask students to
Refer students to the picture of the Emergency write at least three sentences about each of the
Room on page 28. On the board, write: patients, using the past continuous and the past
1 What did Jason do? He ______ off his bike. simple tenses.
2 What was be doing before he fell? He ______ ______ In pairs, students take turns asking the patients
his bike. about their symptoms. Suggest students use
Ask a stronger learner to fill in the gaps. questions such as these to interview their
On the board draw: patients: Can you tell me what happened? What
past → now were you doing when …?
→ 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)
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.
Symptoms 4 34
Asking about symptoms and injuries 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
Speaking pain moves down the arm and up to the chest. It lasts
1 Ask students, in pairs, to observe the patient and for around three minutes each time … Ask: What is
discuss questions 1–3. Encourage them to the difference between the two answers? (1 The
explain their reasoning. Wait until students answer is Yes/No. 2 This answer is more
listen to the recording in 2 to check the answers. detailed.)
On the board, write: Open question/Closed
Listening question. Ask the group to match these terms to 1
and 2. (1 closed question, 2 open question)
2 ► 31 Tell students they are going to hear a
nurse interviewing the patient, Mr Daniels. Ask Ask students, individually or in pairs, to look at
them to listen and check their answers to 1. Play the audio script 31 on page 74 and circle all the
the recording again if necessary. closed questions and underline all the open
questions. Come together as a group to check.
1 shortness of breath, pains in chest, pain in
left arm Ask students, in pairs or small groups, to discuss
2 diagnosis not given (but possibly a heart questions 2 and 3. Come together as a group to
attack/angina) check.
3 carrying a heavy object Pre-experience nurses may not yet have come
3 Refer students to the patient record. If necessary, across this communication technique, but should
allow them to familiarise themselves with the be able to identify some of the above.
contents of the patient record before they listen Some students may have difficulty expressing
again. Elicit/Pre-teach: located, radiate, condition. these ideas effectively in English. Reassure them
that for this activity accuracy is not important –
1 chest 2 shortness 3 centre 4 arm 5 face just encourage students to discuss their
6 three 7 was carrying heavy things 8 two opinions.
9 third 10 breathing 11 very worried
12 worse 1 open questions: 1, 6, 7, 8
closed questions: 2, 3, 4, 5
Vocabulary 2 (Suggested answers)
Advantages: Open questions encourage the
4 Tell students they are now going to develop a set patient to describe their symptoms in their own
of questions that nurses might use to assess their words, without the nurse guiding the patient in
patient’s symptoms. Ask them, individually or a particular direction. Answers tend to be more
in pairs, to match the beginnings 1–8 and the detailed than ‘closed’ questions. The nurse
endings a–h to complete the nurse’s questions. could find out important information that he/she
Remind them that they have already come may not think to ask about.
Disadvantages: The patient could start giving
across some of these in Unit 2. If necessary, do
information that is not relevant to the case. This
the first one as a group. Ask pairs to compare
type of questioning could waste valuable time.
answers. Wait until 5 to check. 3 (Suggested answers)
Advantages: Closed questions are useful when
1d 2g 3a 4b 5h 6c 7e 8f requesting factual information from a patient or
when there is a need to narrow down the
Extra activity options in order to make an accurate diagnosis.
In pairs, students should take turns asking and Disadvantages: It takes time to find out all the
answering the nurse’s questions in 4, using the important information.
patient record. This will serve to reinforce the
target language items.
Students may wish to read the dialogue on
page 74 before doing this.
Symptoms 4 35
Extra activity Speaking
You could develop appropriate intonation for 9 ► 32 Tell students they are now going to hear
question forms before students roleplay the the two dialogues. Ask them to listen and check
patient interview. On the board, write: Does the their answers to 8.
pain move at all? Elicit the correct intonation
Some of their answers may differ from those in
pattern. Go through each question as a group
the recording. Check the different possibilities
chorus to ensure students are able to
before moving on to the next stage of the
reproduce/approximate the pattern.
exercise.
Answer: Intonation rises at the end of polite
requests. Ask students (in pairs) to practise the dialogues.
Symptoms 4 36
Asthma emergency – giving Ask students to brainstorm ideas for the
following question: What advice might nurses give
instructions to asthma sufferers about how to enjoy a good quality
of life? (Take moderate exercise, don’t allow
Speaking smoking in the house or car, keep a diary of the
patient’s symptoms/peak flow diary to record
1 Tell students they are going to read an article the differences in the patient’s breathing, don’t
from the World Health Organization (WHO) have pets in the house, make sure the house is
about asthma. Ask: What is your experience of dust free.)
asthma?
Pre-experience nurses may not have treated 1 windpipe 2 right lung 3 diaphragm
4 bronchial tubes 5 normal bronchiole
asthma patients, but it is likely they know
6 asthmatic bronchiole 7 left lung
someone who suffers from the condition.
Ask students, in pairs or small groups, to discuss Extra activity
the question. Tell them they will have a chance
In order to check their understanding of the
to check their answers later. Alternatively, you
text, ask students the following comprehension
could give them the suggested answers below
questions (either pre- or post-reading).
before moving on to 2.
1 What generally happens when a patient has
Suggested answers an asthma attack?
Symptoms: coughing, breathlessness, 2 Which countries have the highest levels of
wheezing (noisy breathing), tight feeling in the asthma in the world?
chest, trouble sleeping due to breathing 3 Where do most of the deaths in asthma take
difficulties place?
Causes: colds and flu, cigarette smoke, 4 Who is more likely to suffer from asthma?
animals/pets, house dust mites (in carpets, 5 What is the cure for asthma?
etc.), physical activity, emotions, allergies,
family history, certain medications such as
beta-blockers, aspirin
Extra activity
Vocabulary Ask students to deliver a short presentation on
asthma, using the diagram on page 32.
2 Ask students, individually or in pairs, to match
the words related to asthma to the correct
definition. Listening
4 ► 33 Ask students to look at the picture on the
1c 2a 3f 4b 5d 6e
right of the page and ask: What is the nurse doing?
What type of inhaler (do you think) is this? (She’s
Reading teaching her patient how to use his inhaler. It’s a
Ventolin inhaler which is used in emergencies.
3 Ask students to read the text and check their
Note that Becotide inhalers are used as
answers to 1. Tell them the vocabulary in 2 will
preventative medication.)
help them follow the text.
Tell students they are going to listen to Practice
Once they have read the text, ask students to
Nurse Nina talking to her patient Kyle Jenkins
label the diagram with the words in the box.
and his father during an asthma clinic. Ask
With less confident students, you could check
students to listen to Part 1 and decide if the
the answers to 1 before labelling the diagram.
sentences 1–5 are true or false. If necessary,
Then check answers to 3.
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.
Symptoms 4 37
3 F, seven minutes 4 F, his cousin 5 T In pairs, students then take it in turns to practise
reading the instructions aloud. Encourage them
5 Tell students they are going to develop a set of to pause after each staging word. Then play the
instructions for using an inhaler. Ask them, recording so they can check. If necessary, ask
individually or in pairs, to put the sentences a–e them to roleplay the instructions again to
into the correct order. replicate the recording.
Speaking
7 ► 34 Ask the students, individually or in pairs,
to rewrite the instructions in 6, using staging
words.
Symptoms 4 38
SOAP notes Reading
4 Tell students they are now going to read SOAP
Reading notes for two new patients, Nancy and Massimo.
Ask them to read the patient information first
1 If your students are pre-experience nurses, write
and ask: What do you know about the patients?
SOAP notes on the board and ask: What do you
(Point out that the photos would not normally
think SOAP stands for? What do you think SOAP
be attached to the SOAP notes – they are
notes are used for? Avoid correcting at this stage.
included here to support the students.)
Ask students, individually or in pairs, to read
Ask students, individually or in pairs, to read
the text about SOAP notes. As they read,
the SOAP notes and answer the questions. Come
students should complete the text with the
together as a group to check.
words in the box. If necessary, pre-teach/elicit
the words in the box first. If necessary, reassure students that they may not
understand all the abbreviations at this stage,
If your students are experienced nurses, ask:
but that they will work on these in the next
What is your experience of using SOAP notes? Do
activity. Encourage them to ‘get the gist’.
you use another form of notes when you assess a
patient? How do they differ from SOAP 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 5 Refer students to the abbreviations key and ask
them, in pairs, to practise saying the
2 Refer students back to the SOAP note written for
abbreviations as complete words.
Kyle and ask them, individually or in pairs, to
find expressions or abbreviations with the Note: the following abbreviations come from
meanings given in 1–8. Come together as a Latin but are used in medical English as
group to check. standard: t.id. ter in die – three times a day; p.o.
pe os – by mouth; b.i.d. bis in die – twice a day;
1 meds 2 pt 3 r/t 4 SOB p.r.n. pro re nata – as required.
5 abdominal exertion 6 administer 7 RR
8 nebulizer
Speaking
Extra activity 6 Dictate the following abbreviations from Unit 3
and ask students, in pairs, to note the terms in
You may wish to check students’
full: BP, RR, T, Ht, kg, DOB, Wt, P, O² Sats. The
understanding by asking concept questions
first pair with all the correct terms wins the
about the SOAP note for Kyle, e.g. What does the
patient say about his symptoms? What does the game.
nurse observe? What is the nurse’s diagnosis of the Answers: blood pressure, respiratory rate,
patient’s condition? How does the nurse decide to temperature, height, kilogram, date of birth,
treat the patient? weight, pulse, oxygen saturation
Refer Student Bs to page 68. Ask Student As to
Speaking add two more terms that can be abbreviated to
3 Refer students to the diagram and ask them to the list on page 35. They should then dictate the
discuss the questions in pairs or small groups. abbreviations 1–8 to Student B, who must write
the terms in full. Students then swap roles.
It is a position where the patient sits upright at
90°. Student A 1 p.o. 2 Chol 3 R/O 4 mg
This position helps the patient to breathe more 5 NKA 6 IAC 7 IBW 8 UA
easily. Student B 1 R 2 BS 3 t.i.d. 4 p.r.n. 5 L
Sit upright at 90°. 6 ROM 7 NKDA 8 PA
Symptoms 4 39
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.
Symptoms 4 40
5 Food and nutrition
a3 b4 c1 d2
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.
a 22.4 b peanuts
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.
Suggested 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.
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.
3 Refer students to the questions 1–5. Ask them to 1 gain weight, build up her appetite
listen and answer the questions. Encourage 2 improve his diet
students to take notes as they listen. 3 lose weight/take exercise
1 Eat five portions of fruit and vegetables a 5 Ask students to listen to the recording again and
day. complete the nurse’s suggestions. Students
2 one apple, fourteen cherries, two slices of should then match each suggestion to the correct
mango, eight segments of canned grapefruit, patient, Edith, Lena or Frank. Ask them to
one tablespoon of raisins, two figs, 150 ml of compare their answers with a partner, before
fruit juice coming together as a group to check.
3 three sticks of celery, three tablespoons of
cooked/canned/frozen vegetables 1 walking, dog E
4 These do not count as a portion of 2 eat, often L
vegetables. 3 eating fish F
5 Be careful of them because they only count 4 exercise, lose weight E
as one portion of vegetables and contain a lot 5 drink, water L
of salt and sugar.
Personal care 6 50
Teacher’s notes Extra activity
Show students pictures of patients (from
Warm-up magazines, online sources) or describe patients
– woman, heavily made up; a man with a five
1 On the board, write up your food journal for the
o’clock shadow, for example; and ask students
week and ask students to analyse and advise
to identify the items needed for washing and
you on your food intake.
grooming of these patients. Then ask them to
2 Divide the group into three and allocate one of come up with their own examples.
the following to each group: carbohydrates, fats,
proteins. Then ask each group to prepare a one-
minute presentation on their topic.
Extra activity
Patient hygiene Ask: Why is grooming important for patients?
(Patients should be encouraged to live as
normally as possible while in hospital and to
Vocabulary
regain their routine and daily tasks as quickly
1 Tell students they are going to listen to a charge as possible. The nurse is responsible for
nurse helping two patients with washing and encouraging this from the outset.)
grooming. Ask them to scan the pictures and
find an example each of an item used for Listening
washing and grooming. Then ask them, in pairs
or small groups, to label the items a–w. 3 ► 42 If you have less confident students, you
may wish to ask them to do 4 before 3 as it only
Depending on your group, you may wish to add
requires gist understanding.
a competitive element and divide the group in
two. The winning group is the one that is able to Tell students they are now going to hear a nurse
label all the items in a given time. Encourage helping the two patients, Mrs Turner and Mary,
students to use their knowledge of general with washing and grooming. Refer them to the
English to help them. 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 cream g soap Play the recording again and ask students,
h toothbrush i kidney basin j shampoo individually or in pairs, to correct the false
k nightdress l dressing gown m towel statements.
n washcloth o blanket p deodorant q mirror
r swab s toothpaste t razor u shaving 1 F, She’s not totally independent – she needs
cream v make-up w pyjamas some assistance – e.g. she cannot go to the
bathroom to clean her teeth.
2 Elicit/Pre-teach: oral hygiene. Refer students to 2 F, Mrs Turner is breathless, Mary has no
the table and ask them, individually or in pairs, energy.
to put the items a–w into the correct column. 3 F, She says, ‘I can do that by myself.’
Ask them to look at the examples first. Point out 4T
5T
that some items might go into more than one
6 F, The nurse encourages the patients go
column.
slowly and take a rest when necessary.
7T
Washing: washbowl, blanket, disposable
wipes, soap, shampoo, towel, washcloth, swab
4 Play the recording again and ask students to tick
Grooming: nail brush, comb, brush, hand
the items that correspond to the correct patient,
cream, deodorant, mirror, razor, shaving
cream, make-up either Mrs Turner or Mary.
Oral hygiene: toothpaste, kidney basin, mirror,
Mrs Turner: kidney basin, swab
swab, toothbrush, towel
Patient clothing: nightdress, dressing gown, Mary: hairbrush, mirror, towel, washcloth
pyjamas
Personal care 6 51
Extra activity Writing
Ask: Why is it important to encourage the patient 6 Refer students to the prompts 1–4 and the
to be independent? How can nurses encourage example. Ask them, in pairs, to think of a patient
patients to be more independent? (A nurse’s job is they know or refer them back to the patients in
to encourage independence as quickly as 3. Ask them to write three questions they could
possible. Patients find loss of independence ask their ‘patients’ about the future, using the
frustrating and embarrassing. Offer to help the prompts and be going to. Ask them to compare
patient in their daily routine, but don’t do their ideas with another pair.
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
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
Personal care 6 52
ADLs – activities of daily living Language
-ing form
Vocabulary
On the board write: I like/love/hate … Ask
1 Ask students, individually or in pairs, to label students to come to the board and write
the aids using the words in the box. Encourage something about themselves using one of these
them to use their existing knowledge of English verbs. Check that they use the -ing form. Point
to deduce meaning. Come together as a group to out that the following verbs can also be
check. followed by -ing: begin, start, stop, finish.
Ask students, in pairs or small groups, to answer Brainstorm prepositions that also take -ing
the questions: What are the main ADLs? (with, without).
(Washing, toileting, dressing, oral hygiene, Tell students they will come across examples of
grooming. Also eating and walking.) Which these in the next activity.
ADLs would this equipment help patients with?
3 Refer students to the questions 1–5 and then ask
(Toileting: commode/urinal bottle/bed pan.
them to listen to the dialogues again. Check
Washing: shower chair. Walking/Moving
understanding of: shaving, shaky, tights, need a
around: walker/walking frame/walking stick.)
hand with.
Come together as a group to check.
Ask students to listen to the dialogues again and
1 commode 2 shower chair complete the responses to the questions. Ask
3 walker/walking frame 4 walking stick students, in pairs, to compare their answers,
5 urinal bottle 6 bed pan before coming together as group to check.
You may wish to suggest students check their
Listening answers by reading through audio script 43 on
2 ► 43 On the board write: independent, needs help page 76. This will serve to reinforce the target
and dependent. Check understanding of these structures and language covered in this section.
terms. Tell students they are going to hear a
nurse assessing four patients, Mr Karam, Elaine, 1 it’s difficult to hold the razor still without
cutting himself.
Samson and Mr Bates. Ask them to listen and
2 she can’t put her tights on without bending
write one of these assessments against the down.
appropriate ADL for each patient. 3 washing her hair.
If necessary, play the first part of the dialogue 4 He doesn’t want help with either cleaning his
with Mr Karam and check students understand teeth or getting dressed.
the example answer. 5 He doesn’t need help with going to the toilet
(although he may need to use a walker) and he
Play the recording again if necessary. Ask hates using the commode.
students to compare answers before coming
together as a group to check. 4 Ask students, individually or in pairs, to reorder
the words to form sentences. If necessary, do the
1 Mr Karam: washing = independent, first one as a group. You may wish to check the
grooming = dependent phrases are in the correct order before students
2 Elaine: washing = needs help, do the next part of the activity.
dressing = needs help, grooming = needs help
3 Samson: dressing = independent, oral Ask students to decide if the sentences represent
hygiene = independent offers of help, requests for help or refusals of
4 Mr Bates: toileting = needs help help. Refer students to the example first.
Personal care 6 53
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 course, Yes, no problem, I can
help you with that, Not to worry.)
Ask students to underline more examples of
patient refusals of help. (I’m OK with [the
shower/ showering], I’m OK thanks, It’s OK, I can
do it)
Speaking
5 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
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,
using expressions and target language from the
unit.
Personal care 6 54
Empathy 1 Toileting, washing, grooming, eating and
other simple tasks (not specified in text).
2 The poor care of her father by Nurse Jones
Reading during his stay in St Marc’s Ward.
1 Tell students they are going to read a complaint 3 Nurse Jones seems unhappy with his job in
form. Refer them to the form and the photo of general, and does not feel his salary is high
the patient. enough.
4 She wants the department to investigate her
Explain the photo would not usually be attached father’s case.
to a complaint form – this is to support students 5 Suggested answer: He needs be more caring
in this activity. towards his patients and show some empathy.
He should imagine he was caring for a close
Ask students, individually or in pairs, to read family member or friend. He should consider
sections 1 and 2 and answer questions 1 and 2. going on a communications course.
Then ask them to compare their answers with a
partner, before coming together as a group to Extra activity
check.
Ask experienced nurses: What is your experience
You may wish to ask students more structured of working with geriatric patients? Why might it be
comprehension questions to facilitate the difficult for nurses working in this kind of
reading process: What is the patient’s name? How department in general? Why might it be difficult to
old is he? What is his ethnic origin? Who is making assist patients with dementia with their ADLs?
the complaint? When did the incident take place?
Who is Ms Hynd and what did she do? When did the
complaint take place?
Pronunciation
3 ► 44 On the board write: empathy. Explain to
1 Patient is Winston Miller, 88 years old, of Afro students that Nurse Jones has been criticised by
Caribbean origin. His consultant is Dr Hew
the Complaints Board because he didn’t show
Jones from the Geriatrics department. The
empathy towards his patient. Ask students,
patient stayed in St Marc’s Ward between 15
and 20 May 2010. The patient’s daughter, Ms individually or in pairs, to read the definition on
Deidre Hynd, has made a formal complaint to the right of the page.
the hospital patient relations department. If your students are experienced nurses, put
2 Suggested answers: racism, poor treatment them into pairs or small groups to brainstorm
by the consultant, the medical procedure,
their own definition of ‘empathy’.
incorrect diagnosis, (if students are looking at
the photo, they might speculate that nobody If your students are pre-experience nurses, they
assisted the patient in getting around). 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, Tell students they are going to hear three nurses
investigate, case. talking to their patients. Ask them to listen and
complete the table to show how much empathy
Refer students to questions 1–5 and ask them to each nurse demonstrates.
read Section 3 of the complaint form. Ask them,
in pairs, to compare their answers before coming Play the recording again if necessary. Reassure
together as a group to check. 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.)
Personal care 6 55
Pre-experience nurses may find it difficult to
Extra activity
indentify expressions of empathy, but reassure
them they will be looking at this in more detail Ask students, in pairs, to read audio script 44
in 6. on page 76 aloud. Ask them to ‘feel’/notice the
difference between dialogues 1 and 3 and
1 a lot of empathy 2 no empathy dialogue 2. Swap roles.
3 a little empathy Ask students to take turns to roleplay
Tone of voice, expressions, e.g. I understand dialogues 1 and 3 again, this time encouraging
how you must be feeling., I can see it’s difficult them to use patient-friendly intonation
for you. patterns, touch, ‘warm’ facial expression, etc.
Ask them to feed back to the class about the
Extra activity experience.
Ask experienced nurses: On a scale of 1–5 (1 = Some students may have difficulty expressing
very easy), how easy is it to show empathy to these ideas effectively in English. Reassure
patients? Ask students to explain their rating. them that for this activity accuracy is not
important – just encourage students to discuss
5 Ask students to listen to the three dialogues their opinions.
again and complete the summaries about each
patient using the words in the box. Elicit/Pre- 7 On the board write: feelings and situations. Ask
teach: chemotherapy. Avoid pre-teaching the students to decide which adjectives from the box
words in the box to encourage students to go under each heading. (Feelings: depressed,
deduce the meaning from the context. embarrassed, frustrated, humiliated. Situations:
depressing, embarrassing, frustrating, humiliating.)
1 feeding himself, humiliating Check students understand: adjectives ending in
2 washing her hair, embarrassed
-ing describe the patient’s feelings while
3 sickness, depressing
adjectives ending in -ed describe the situation.
Personal care 6 56
Wound management Additional activity
Refer students to audio script 45 on pages 76–
Listening 77. In pairs, ask them to take turns roleplaying
the dialogue between the nurse and Una
1 Ask: What does the term ‘wound management’ Hagans to help reinforce the target language
mean? (assessing, treating, dressing and changing a
items. Encourage students to use patient-
wound) What is your experience of wound
friendly intonation patterns.
management (of a patient/your own)?
Refer students to the pictures at the top of the
Writing
page and ask them, individually or in pairs, to
number the pictures 1–6 in the correct order for 3 Refer students to the chart and ask: What is it for?
cleaning a wound. Who completes it? When?
Personal care 6 57
Extra activity Extra activity
Ask students, in pairs, to explain the meanings Ask students, individually or in pairs, to write
of different sections of the chart (location/type a SOAP note for either/both patients in this
of wound, etc.) to the rest of the group. Ask section of the unit.
them to choose or allocate a section to each
pair. Preparing for the next unit
Alternatively, you could ask students to do this
for homework/self-study for informal In preparation for Unit 7, suggest the following to
presentation during the next class. your students:
• Think about how you feel talking about
4 Refer students to the photo on the right of the
problems of elimination/bodily functions
page and ask: What type of wound do you think it
with others/medical professionals.
is? If your students are experienced nurses, you
can also ask: How would you manage this type of • Do some (online) research into the treatment
wound? Avoid correcting at this stage. of problems related to patient elimination, e.g.
constipation.
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.
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
carrying out the roleplay. They could use the
dialogue on page 50 as a model.
Personal care 6 58
7 Elimination
Elimination 7 59
The abuse of laxatives as a means of losing or
controlling weight is also referred to in this final
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 life-
threatening. 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.
Elimination 7 60
If your students are experienced nurses, ask:
Teacher’s notes Please explain the rationale for your diagnostic.
(Sample answer: The patient is suffering from
Warm-up
altered bowel elimination/change in bowel
1 Students work in small groups. Ask each habit. This may be as a result of lack of exercise
member of the group to write five objects used and poor diet, not enough foods high in fibre.
in patient washing and grooming on a piece of Passing small hard stools every three or four
paper. Refer students to the items on page 44, if days and the resulting abdominal pain are all
necessary. Then ask students in pairs to take it in signs of constipation. Patient feels lonely and
turns to describe the objects for their partner to maybe suffers from a lack of appetite;
guess. This can be done as a team game. consequently she does not maintain a suitable
diet.)
2 Refer students to the ADL checklist for Sophie
Mellors on page 47 and ask students in pairs to Suggested answers: The patient is most likely
take it in turns to ask questions to provide the suffering from constipation. Causes include
answers given in the chart. undernourishment, poor diet and patient’s
current psychological state.
Assessing patient elimination
Vocabulary
Reading
2 Depending on your group, ask: How do you feel
1 Refer students to the title of the unit and ask: about discussing bodily functions/going to the toilet
What does elimination refer to? (Issues related to with a nurse/another person?
bodily functions, including urinating, defecating
Tell students they are going to learn some of the
and the menstrual cycle. It is also related to
expressions that patients use in English to
conditions such as incontinence, constipation
describe elimination/bodily functions. Ask them
and diarrhoea and abnormal bowel movements.)
to complete the sentences 1–8, using the words
Note that students are unlikely to know all these in the box. Encourage them to use a monolingual
terms in English, so reassure them they will be dictionary to help them.
covering relevant language items in the unit.
1 bathroom 2 wee 3 Urine, urinate
Ask students to look at the photo and ‘observe’ 4 waterworks, incontinent 5 bowel
their patient, Mrs Eileen Ashton. Ask: What do 6 pooh, defecate 7 diarrhoea, constipation
you learn about the patient on observation? 8 runs
(Students should consider: age, physical
condition, psychological state.)
Extra activity
Elicit/Pre-teach: widow, active, previously, bowel Ask students to draw four circles, labelled as
movement, abdominal, stool, lump. Ask students, in follows: Medical, Formal, Children, Informal.
pairs, to read the nursing assessment and Then ask them, in pairs, to add lexical items
answer the questions. Come together as a group from 2 to the correct circle. Encourage them to
to check. update their lists as they go through the unit.
With less confident students, you may wish to Sample answers: medical – bowel,
ask more structured questions: How old is Mrs constipation, defecate, diarrhoea, incontinent,
Ashton? What is her home life like? Where does the urinate, urine; formal – to go to the
rest of her family live? Can you describe her diet and bathroom/toilet, waterworks; children – wee,
exercise? pooh; informal – the runs
Elimination 7 61
Listening 7 Ask students, individually or in pairs, to
complete the nurse’s questions using four of the
3 ► 46 Ask students to ‘observe’ the three past participles from 6. Point out they need to
patients, Toni, Leah and Dave, in the photos at use two of the participles twice. Come together
the top of the page. Ask: What do you learn about as a group to check.
the patients? Tell them they are going to hear a If necessary, students can listen to the recording
nurse assessing the three patients. Ask students again to check before moving on to 8.
to listen and write the problem for each patient
under the correct photo, using the words in the 1 been 2 passed 3 noticed 4 been 5 had
box. 6 had
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). 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.
Elimination 7 62
Describing bodily functions Check understanding of: non-verbal signals, nod,
repeat.
Elimination 7 63
Extra activity Language
Ask students to create a checklist of the active
Present perfect v past simple
listening techniques mentioned in the text.
They then add a rating (1–3) for each technique. 1 On the board draw: 2 weeks
(ratings: 1 = needs improvement, 2 = OK, 3 = H o s p i t a l
effective) Ask one pair to observe another as past now
they roleplay their dialogue and use the ↑
checklist to comment on their active listening accident (5th May)
skills. They then swap roles. Give pairs time to Then write:
feed back to each other. Each pair should be a) I came to hospital on 5th May.
b) I have been in hospital for two weeks.
given the chance to repeat their roleplay to
1 present perfect
improve their skills.
2 past simple
Ask a stronger student to match the examples a)
Listening and b) with the tenses 1 and 2. (a) 2, b) 1).
If necessary, review shortened forms: I’ve, haven’t,
4 ► 48 Refer students to the photo on the right of
etc.
the page and ask: Why is the patient in hospital?
Elicit: How long have you + past participle?
What type of elimination problems could he be
2 Dictate these items: since 5th May, yesterday, for two
suffering from? Avoid correction at this stage.
days, five days ago, couple of days, last night. Ask
Tell students they are going to listen to Staff students to circle the expressions of time that are
Nurse Paula Willis giving an assessment of followed by the present perfect and underline
Christophe, who is recovering from a broken leg those followed by the past simple. (present perfect
after a motorcycle accident. Ask students to – since 5th May, for two days; past simple– yesterday,
listen to Part 1 and answer questions 1–3. Come five days ago, last night)
together as a group to check. 3 Ask students to write three columns titled since,
for and ago. Dictate different expressions of time
1 regular and ask them to write them under the correct
2 he’s not been active since his operation column. Explain that some of them may go into
3 since his operation/for one week more than one column.
Give students time to assimilate the points covered
in the Language box.
Elimination 7 64
1 I’ve felt/been bloated/like this for a couple of Suggested answer
days. Christophe was in a motorbike accident and
2 No, I haven’t opened my bowels today. had an operation to repair a broken femur/leg.
3 I last opened my bowels before my operation. He’s been in hospital since 5th May, and it is a
4 I’ve been in hospital since 5th May, for a week since his operation. He has not opened
week. his bowels since before the operation. For the
last two days he has felt bloated. He hasn’t
7 ► 49 Tell students they are now going to listen eaten anything for the last three days except a
to Part 2 of the staff nurse’s assessment. Refer glass of orange juice. His stools have been
students to the statements 1–6 and as they listen, small and hard. He needs to push to defecate
ask them to underline the correct verb form in but has not experienced any pain when going
brackets – the past simple or present perfect. to the toilet or any abdominal pain.
Elimination 7 65
Diarrhoea Vocabulary
3 Ask students, individually or in pairs, to
Speaking complete the word-building table before
completing the sentences about diarrhoea. Refer
1 On the board write: Diarrhoea – developing world,
students back to the text on page 56 if they are
v. developed world. Ask students, individually or
having difficulties filling in the table.
in pairs, to write a definition of the condition
‘diarrhoea’. Ask them to compare their You may wish to correct students’ answers for
definition with a partner/another pair before the table before asking them to complete the
coming together as a group to check. sentences.
If your students are pre-experience nurses, Table: 1 diarrhoeal 2 dehydration 3 intestine
reassure them this is not a test and that they will 4 to replace 5 to lose
learn more about the condition in this section of Sentences: 1 dehydration 2 loss 3 intestine
the unit. 4 replacement 5 Diarrhoeal
Suggested answer:
Diarrhoea is an infection of the intestine caused Listening
by bacteria, a virus or a parasite. 4 ► 50 Tell students they are now going to hear
It can be dangerous because it can cause
Femi Lwanga talking about how she treats
dehydration which means loss of water and
children with diarrhoea. Refer students to
electrolytes (essential chemicals – sodium,
chloride, potassium, bicarbonate). questions 1 and 2 and then ask them to listen
Diarrhoea can be treated with antibiotics if it is and answer the questions. This is a fairly long
a fairly mild form and all patients should try to recording, but reassure students that it is not
replace fluids. necessary to understand every word to answer
the questions.
2 Tell students they are now going to read an
Ask students to compare their answers with a
article about diarrhoea. Ask students to read the
partner before coming together as a group to
first two sentences of the article and compare
check. If necessary, play the recording again.
this with their own definition of diarrhoea.
Elicit/Pre-teach: intestine, virus, parasite, 1 a refugee camp in North East Africa, lack of
dehydrated, fluid, restless, irritable, sunken, severe, clean drinking water that leads to sickness and
malnutrition. diarrhoea
2 moderate dehydration
Refer students to sentences 1–4. Ask them,
individually or in pairs, to read the article and
complete the sentences using words from the Vocabulary
article as they read. Come together as a group to 5 Elicit/Pre-teach: severely, moderate, save lives,
check. limited, absorb, intravenous.
Encourage students to use the sentences as a Tell students they are going to read part of
guideline for reading and comprehending the Femi’s explanation. Ask them, individually or in
article. Reassure them that this is a fairly difficult pairs, to complete the text with the words in the
text but that it is not necessary to understand box. You could also to ask some comprehension
every word in order to gain an understanding of questions to facilitate the process:
the main points.
1 How do they treat patients with severe diarrhoea?
1 result 2 cause 3 causes 4 result (Patients are taken to hospital and fed through
an intravenous drip.) 2 What is ORS made of?
(ORS is made of water, salt and sugar.) 3 How
does ORS work? (The small intestine absorbs the
ORS and it replaces the water and electrolytes
that the patient has lost.)
Elimination 7 66
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.
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.
Elimination 7 67
Presenting a patient case 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
Language first sentence as a group.
1 Ask: What is a case presentation? When do they take If necessary, encourage students to use the
place? What is included in a case presentation? What nursing assessment of the patient on page 52 for
is your experience of presenting a patient case/giving additional guidance.
a presentation in front of other students? (It is a
formal or informal presentation of the patient’s Come together as a group to check.
current situation, including an introduction,
1 On admission, Eileen complained of
history of the present illness, physical
abdominal pain.
examination, diagnostic studies, differential
2 Dr Insulza saw her at 16.00 and she rated the
diagnosis, management and summary of the pain seven out of ten on the pain scale.
case. Patient case presentations generally take 3 She had her last bowl movement four days
place during a handover.) ago.
Point out that the example used in this unit deals 4 She has opened her bowels every three or
four days since the beginning of May.
with the introductory part of a case presentation.
5 She described her stools as hard lumps,
Tell students they are going to read a case which is Type 1 on the Bristol Stool Chart.
presentation of the patient from page 52, Mrs 6 Eileen has experienced some pain but no
Eileen Ashton, given by Charge Nurse David blood or mucus.
Amani. Ask: What do you remember about Mrs
Ashton? Extra activity
On the board write: age, presenting complaint, Ask students to prepare an oral presentation
social situation, diet, etc. Encourage students to using Part 1 and 2 of the case presentation.
brainstorm their ideas. Encourage them to add spaces for pausing
during the delivery to facilitate understanding.
Ask students, individually or in pairs, to Ask them to take turns to practise their
complete Part 1 of David’s presentation using presentation in front of their partner.
the correct form of the verbs in brackets. Variation: Students work together first to add
You may wish to use this as a mini test to check pausing in the most appropriate places. Ask
students’ understanding of the target structures students to deliver the case presentation as a
– past simple v present perfect. Ask students to group chorus.
compare their answers with another pair before
coming together as a group to check. Listening
1 presented 2 became 3 hasn’t cooked 3 ► 51 Tell students they are going to hear
4 has been 5 was 6 hasn’t taken Triage Nurse Magda Nowak assessing her
7 has suffered patient, Anita Blasky. Refer students to the
photo at the bottom right of the page and ask
Writing them to ‘observe’ her. Ask: What do you learn
about the patient on observation? (Students might
2 If your students are experienced nurses, ask: mention that the patient is unhappy/tired/
What is the Bristol Stool Chart? (The chart is a bored. She is 15–20 years of age. She is slightly
medical aid, developed at the University of overweight.)
Bristol, UK, which classifies faeces into seven
types depending on the length of time they have Refer students to the questions 1–3 and ask them
spent in the colon. Type 1–2 indicates to listen to Part 1 of the dialogue and circle the
constipation, Type 5–6 indicates diarrhoea.) correct response to each question. If necessary
Depending on your group, students may or may play the recording again.
not have come across the Bristol Stool Chart.
1 stomach ache, frequent bowel movement
2 embarrassed 3 diarrhoea
Elimination 7 68
Speaking Suggested answers:
The patient abuses laxatives that she uses to
4 Refer students to the nursing assessment of the try and lose weight. The patient is suffering
patient. Ask them to read and then, individually from constipation but experiences bouts of
or in pairs, write five assessment questions, diarrhoea and cramping as a result of taking
based on the information in the assessment. You laxatives.
may wish to use the example to create one of the Treatment means working with a team of health
questions. As a whole group, brainstorm a professionals with expertise in eating disorders
(GP, psychiatrist or psychologist, dietician).
possible assessment question: How long have you
Support from close friends and family is also
suffered from diarrhoea?
crucial.
Remind students that they will be required to
use more patient-friendly/informal terms for the Extra activity
assessment.
Ask students, in pairs, to take it in turns to
If necessary, check students’ questions for carry out a complete assessment of Anita
accuracy before carrying out the roleplay. Blasky, using the information in the nursing
assessment. Encourage them to use patient-
Suggested answers: friendly terms for bodily functions and to
How long have you suffered from practise employing active listening skills as
diarrhoea?/When did the symptoms begin? they interview their patient.
How often do you visit the toilet on a typical Variation: Students work in pairs to compile a
day?
checklist to evaluate active listening
How many times a day do you need to go to
skills/patient-friendly terms, using ratings (1 =
the toilet?
Can you describe your stools for me? needs improvement, 2 = OK, 3 = effective), and
Do you suffer from any other symptoms? 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
Listening repeat their roleplay to improve their skills.
5 ► 52 Refer students to the second half of the
8 Ask students, in pairs, to chose one of the
nursing assessment. Ask them to listen to Part 2
patients from page 53, Toni, Leah or Dave, and
of the dialogue and complete the assessment
prepare a patient case for presentation. Ask
using the words in the box. If necessary, replay
them to include the information at the bottom of
the recording.
the page for their patient. Tell students to invent
1 allergies 2 spicy 3 weight 4 kilos the details if necessary. Encourage students to
5 overweight 6 angry 7 laxatives use pausing techniques and staging words
8 embarrassed (firstly, secondly, then, finally) from Unit 4 to
facilitate understanding.
Speaking Depending on the group, you may want to ask
students to present their case to the rest of the
6 Ask students in pairs to discuss the patient case group. Otherwise this can be done in small
and answer the questions. groups.
Reassure them that for this activity accuracy is
not important – just encourage them to discuss Preparing for the next unit
their opinions.
In preparation for Unit 8, suggest the following to
If your students are pre-experience nurses, they your students:
may not yet have come across laxative abuse in
• Compile a list of expressions for making an
their training. Encourage them to brainstorm as
appointment by phone that you already know
a group and give suitable suggestions for the
in English.
treatment.
• Become familiar with the hospital discharge
7 Ask students to compare their ideas with the rest
practice in your country/place of work.
of the group.
• Do some (online) research into mobility aids
that assist patients around the house.
Elimination 7 69
8 Patient discharge
Patient discharge 8 70
clarification: Good, so that’s 1.15 on Monday 24th
February. To ensure students are able to handle such
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 situations. In terms of position,
standing up can lead to a rushed conversation and a
feeling of superiority, while lounging back in a chair
might lead to the nurse being more casual and less
attentive.
Patient discharge 8 71
which are being used by the patients in the
Teacher’s notes picture.
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
used to discuss elimination in a formal context for the home (and hospital) at the bottom of the
(with another medical professional, during a page. Ask them, individually or in pairs, to label
student presentation). The first team to reach ten them using the words in the box.
and spell them correctly wins.
2 Refer students to the information for Mrs Eileen a shower chair b bath lift c grab bar
Ashton on pages 52 and 58. Ask students, in d non-slip mat e raised toilet seat
pairs, to take it in turns to roleplay the nurse’s
patient assessment, employing appropriate Extra activity
active listening skills. You may wish to elicit the Dictate the following: leg brace, walking frame,
active listening skills covered in the unit (page walking stick, shower chair, grab bar, bath lift, non-
54) first. slip mat.
Ask students to underline the main stress for
Evaluating levels of independence each phrase. Come together as a group to
check. Point out that for grab bar the speaker
Listening doesn't differentiate between the two words – it
is pronounced as one word. As you point to
1 ► 53 Refer students to the picture at the top of each phrase, ask students as a group to practise
the page. Ask: What is a discharge lounge? When saying them aloud, checking they have the
do patients go there? (Discharge lounges can be right word stress. Ask: What is the ‘rule‘? (The
found in larger hospitals and provide a quiet main stress appears on the first word of the
area for patients to relax while waiting for their phrase, except in non-slip mat where it is on the
transportation after being discharged from word mat).
hospital. A registered nurse is assigned to give
assistance with follow-up appointments, arrange 5 Ask students to match the definitions a–e to the
pick up of prescriptions from the pharmacy, give mobility aids in Exercise 4. Come together as a
instruction on medications, etc.) group to check.
Ask students to look at patients a–d and tell With more confident students, you could ask
them they are going to hear a nurse explaining them to supply their own definitions, perhaps
each case. Ask them to listen and label the 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 a non-slip mat b raised toilet seat c bath lift
d shower chair e grab bar
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 Listening
to check. 6 ► 54 Tell students they are going to hear Nurse
Denis Astorga preparing the patients from page
1 Elin 2 Mr Aziz 3 Jim 4 Mrs Ridley 5 Elin
60 for discharge. Point out that in some cases he
6 Mrs Ridley
is speaking to a carer. Ask students to listen to
the three dialogues, then ask them to write the
Vocabulary name of the patient Denis is talking to or about
in each case.
3 On the board write: mobility aid. Ask: What are
mobility aids? Give an example. (Equipment that 1 Mrs Ridley 2 Elin 3 Jim
enables the patient to be more independent, e.g.
walking stick.)
Ask students, individually or in pairs, to match
the words in the box to the mobility aids 1–5
Patient discharge 8 72
7 Elicit/Pre-teach: bathing, toileting, dressing. Ask:
What kind of tasks are these? (Activities of Daily
Living or ADLs – see Unit 6.) Ask students to
listen again and circle the ADL that each
patient/carer is worried about.
Then ask students to write the mobility aid the
nurse recommends for each patient.
1f 2c 3d 4e 5a 6b
1 3, 4, 5, 6
21
32
Speaking
10 Refer students to situations 1–6. Check
understanding of: stiff, nervous, 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.
Patient discharge 8 73
A patient discharge plan Listening
4 ► 55 Refer students to the photo on the right of
Speaking the page. Ask: What kind of worries do patients
have just before they leave hospital? (Patients might
1 Ask students in pairs to discuss the question.
wonder how they are going to manage to take
Come together as a group to compare answers.
care of themselves, especially if they live alone
Ask: What is the role of the patient/carer in the
or, if they have dependents, how they will be
discharge process? (Depending on the country,
able to take care of the whole family while still
patients and/or their carers may be more or less
in recovery. After a long period in hospital
involved in the discharge process.) Some
patients may have become slightly
students may have difficulty expressing their
institutionalised.)
ideas effectively in English. Reassure them that
for this activity accuracy is not important – just Tell students they are going to hear a nurse
encourage them to discuss their opinions. Come going through a discharge plan with her patient,
together as a group to compare ideas. Nancy Lorenz. Refer students to the statements
1–4 and ask them to listen to the recording and
Reading decide if the statements are true or false. Ask
students to correct the false statements. If
2 Tell students they are going to read a patient necessary, play the recording again. Ask
educational leaflet that explains the discharge students, in pairs, to compare their answers,
process. Refer them to the titles a–e and ask before coming together as a group to check.
them to read the leaflet, matching the titles to the
relevant paragraph. Ask students to compare 1 F – she’s a bit worried about leaving
their ideas with a partner before coming 2 F – she lives alone
together as a group to check. 3T
4 F – the neighbour could help with the
2e 3a 4c 6b 8d shopping/her sister will help with cooking
3 Ask students, individually or in pairs, to match 5 On the board write: ADLs. Ask students to
the definitions to the words highlighted in brainstorm a list of these, and refer them back to
yellow in the text. Unit 6, page 47 if necessary. Then add:
ambulation, transferring and ask: What do you think
Point out the following: give a shot (USA) give an
these ADLs refer to? (ambulation – getting around
injection (UK).
on foot, transferring – getting around by vehicle)
1 over-the-counter drugs 2 prescription drugs They are both indicators of levels of
3 supplements 4 side effects 5 giving a shot independence and could indicate a need for
6 support groups 7 therapist assistance. Pre-experience nurses may not have
8 healthcare provider come across these terms.
Ask students to look at the independence
Extra activity assessment form and ask them to listen to the
Ask students, individually or in pairs, to think dialogue with Nancy Lorenz again and complete
about a patient they know well and write down the form, ticking the correct boxes. If necessary,
a list of the different members of the medical play the recording again.
team (within the hospital and aftercare
services) involved in devising the patient’s Bathing – needs assistance
discharge plan. Then ask students to present Ambulation – independent
Toileting – independent
their ideas to the rest of the group.
Transferring – dependent
Eating – needs assistance
Dressing – needs assistance
Patient discharge 8 74
Language 8 Ask students to check their answers to Exercise 6
and Exercise 7 by looking at audio script 55 on
6 On the board write: If ... With confident students pages 78–79. This will allow students to see the
who prefer a more inductive method, ask them, target structures in context. Come together as a
individually or in pairs, to cover the Language group to discuss any concerns students might
box and complete the exercise. Explain that these have with the two conditionals – it could prove a
are sentences taken from the dialogue between little confusing for some students.
the nurse and Nancy Lorenz. Ask students to
check their usage by reading through the ‘rule’ Extra activity
for the first conditional, allowing them to make Refer students back to the patient leaflet on
any necessary changes to their answers. page 62. On the board, write:
1 Do you know what to do if you need help with …?
For less confident students, ask them to read the
2 Do you know who to contact if …?
‘rule’ for the first conditional. Tell them to use 3 What do you do if …?
this information to help them complete Ask students, individually or in pairs, to use
sentences 1–4. If necessary, dictate the verbs the information to write five questions they
needed to complete each sentence (help, fall, tired, could ask their patient to check understanding
help). of their discharge plan.
Come together as a group to check. Ask students to use information in the checklist
to write five questions their patient might ask
1 will help me 2 I’ll fall 3 I feel tired at discharge.
4 will help me On the board, write:
Who can I call if I need help changing a bandage?
7 You can carry out this activity in the same way. What can I do if …?
It is important to ensure students understand Ask students, in pairs, to take turns to ask and
the difference in usage between the two answer the questions they prepared above.
conditionals. On the board, write Zero
Conditional, First Conditional. Ask: Which one
refers to the future? (first) Which one is used to give
general instructions or solutions to a problem (in a
nursing 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 sister will be angry if I’m late. or If
I’m late, my sister will be angry.
Point out that it is not possible to use if followed
by will/won’t. On the board, write: If I will be late,
my sister will be angry. Put a line through the first
will in the example – this will serve to reiterate
the point, especially for students where this
occurs in their L1.
Allow students sufficient time to assimilate the
information in the Language box.
Patient discharge 8 75
Explaining medication Reading
4 Tell students they are going to practise
Listening explaining over-the-counter medications to a
patient. Allow them time to familiarise
1 ► 56 If your students are experienced nurses,
themselves with the directions for the three
ask: What is your experience of explaining
medications. Then ask them, individually or in
medications to patients? What problems have you
pairs, to find phrases to match meanings 1–5.
experienced? What advice would you give to new
Ask pairs to compare their answers with another
nurses?
pair, before coming together as a group to check.
Elicit/Pre-teach: post-discharge care. Tell students
that they are going to hear a second conversation 1 Do not give more than four doses in 24
between the nurse and Nancy Lorenz. Explain hours. (Do not exceed eight capsules in 24
that the nurse is talking to the patient about her hours.)
medication and post-discharge care. 2 May cause drowsiness. Avoid driving …
when taking this medicine.
You may wish to refer students to questions 1–6 3 Do not chew.
first to facilitate the listening process and help 4 To be taken … as required according to the
set the scene. Ask students to listen and circle severity of the symptoms.
the best answer in each case. If necessary, play 5 For oral use (only).
the recording again. Ask students to compare
their answers in small groups before coming Writing
together as a group to check.
5 You may wish to review usage and form of
1b 2a 3b 4b 5b 6b 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.
Vocabulary
Brainstorm the first instruction as a group,
2 Ask students to cover the word box and try to before asking students to write instructions for
label the different types of medication a–f. patients 2–4. Encourage them to write in their
Students may already know many of these own words. Less confident students may prefer
items. Refer them to the word box if necessary. to write collaboratively. Point out to students
Come together as a group to check. that for situations 2 and 5, they will need to
write the instruction for the parent/carer.
Point out that these terms are also used: cough
medicine/mixture, tube of cream, nose spray, a bottle
of pills. However the contraceptive pill is known
as the 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.
Listening
3 Elicit/Pre-teach: apply, area, mealtimes. Ask
students to listen to the recording again and
complete the instructions as they listen. If
necessary, play the recording again. Come
together as a group to correct.
Patient discharge 8 76
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 can give Kold Karma to children of six
years or more. Give her one capsule every four
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.
1c 2a 3b
Patient discharge 8 77
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
Speaking any necessary corrections. Come together as a
1 Explain to students they are going to work on group to check. If necessary, play the recording
developing a set of useful expressions that they once more.
can use when making an appointment for a
Patient Name: Geoff Pattern
patient over the phone. Tell them they are going
Appointment with: occupational therapist
to hear Orthopaedic Nurse, Zafar Hussein, Day: Tuesday
making an appointment for his patient with Date: 17th June
another medical service. Refer students to the Time: 17:00
information about the patient 1–4. On the board 1 Occupational Therapy
write: Identify yourself and department. Elicit a 2 Tuesdays and Thursdays
suitable telephone expression from the group for 3 3.30 in the afternoon
this and then ask students to compare with the
one on the Appointment Checklist. Ask 5 ► 59 Tell students they are now going to hear
students, in pairs or small groups, to use the Zafar change Mr Pattern’s appointment. Refer
information about the patient as a basis to them to points 1–3. As they listen, tell students
brainstorm expressions for each point on the to transcribe expressions they hear for each
checklist. Avoid correcting at this stage. point.
For less confident students, you may wish to
Listening give them the first letter of each word in the
2 ► 57 Tell students they are going to hear expressions.
Zafar’s telephone call. Ask them to listen and
1 (Sorry to disturb you but) can I reschedule Mr
compare what he says with their expressions in Pattern’s first appointment?
1. If necessary, play the recording again. 2 What time was his appointment?/Sorry, did
Variations of these may also be acceptable. you say Tuesday or Thursday?
3 Can you just hang on a moment?
1 Good afternoon. (Hello.)
2 This is Zafar from Orthopaedics.
3 I’d like to make an appointment with the Pronunciation
Practice Nurse for one of our patients, please.
4 How about 23rd?, Do you have any 6 On the board write: Sorry, did you say Tuesday or
appointments in the morning? Thursday? Ask students to translate this
5 Good, so that’s 10.15 on the 24th of January. expression into their own language. Ask: How do
6 Let me give you the patient’s details. It’s Mr you make the caller understand which day is
Ernesto Chavaz, that’s C-H-A-V-A-Z. important? Languages differ, but some will
7 Thank you for your help. Goodbye. follow the same rule as English. Ask students:
How do we do this in English? (In English,
3 ► 58 Tell students they are now going to hear speakers stress the words or syllables to
Zafar making an appointment for another emphasise important information.) More
patient. Ask students to listen and tick the points confident students may already be aware of this.
in the checklist as they hear them. Reassure them Ask a more confident student to underline the
they don’t have to understand everything on stressed words/syllables. Avoid correcting at
first hearing; they will have the opportunity to this stage.
listen for detail later.
Ask students to listen to examples 1–4 from the
Ticked items: greet person, identify self and recording in 5 and underline the stressed words
department/unit, give reason for calling, or syllables in each sentence as they listen. You
suggest day and time, give patient details may wish to go over the first one as a group.
Patient discharge 8 78
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 Ask students in pairs to take turns reading
to repeat the stress patterns they hear. Play the audio script 59 (page 79) aloud to practise the
recording several times until you are happy that stress patterns in context. Encourage them to
they are able to reproduce the employ effective communication strategies for
same/approximate stress pattern. the phone. Ask another pair to listen and then
comment on their use of stress for emphasis
1 Sorry did you say Tuesday or Thursday? and communication strategies.
2 Tuesday, Tuesday afternoon.
3 No, not 10.15, 10.50. 9 Put students into pairs and tell them that they
4 Oh, OK 10:50, sorry. 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
Speaking
roleplays 1 and 2. Point out that all the
8 Ask students: What is your experience of speaking vocabulary presented in 1–4 has already
on the phone with other medical professionals in appeared earlier in the course. Allow them
English? Ask students in small groups to discuss adequate time to review if necessary. Encourage
question 1, encouraging them to use the prompt, students to use the checklist on page 66 as well
I find it difficult because ... Some students may as their newly acquired skills for emphasis and
have difficulty expressing their ideas effectively telephone communication strategies.
in English. Reassure them that for this activity
Ask students to carry out roleplays 3 and 4 in
accuracy is not important – just encourage
the same way.
students to discuss their opinions.
Depending on your group, you may wish to ask
If necessary, brainstorm opinions first as a
students to roleplay their conversations in front
group, writing their ideas on the board. Then
of the rest of the group or in small groups.
ask students, in pairs, to discuss.
Encourage ‘observers’ to provide constructive
Refer students to question 2. Ask them to feedback.
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 it help to use a checklist like the one on
page 66? Why/Why 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
Patient discharge 8 79