English For Nursing 2 TB

English
for
Nursin
2
Vocational English
Teacher’s Book
g
A2-B1
Ros Wright
Pearson Education Limited
Edinburgh Gate
Harlow
Essex CM20 2JE
England
and Associated Companies throughout
the world.
www.pearsonlongman.com
© Pearson Education Limited 2011
The right of Ros Wright to be identified

as author of this Work has been asserted
by her in accordance with the Copyright,
Designs and Patents Act 1988.
All rights reserved; no part of this

publication may be reproduced, stored in
a retrieval system, or transmitted in any
form or by any means, electronic,
mechanical, photocopying, recording, or
otherwise without the prior written
permission of the Publishers.
Photocopying: The Publisher grants

permission for the photocopying of those
pages marked ‘photocopiable’ according
to the following conditions. Individual
purchasers may make copies for their
own use or for use by the classes they
teach. Institutional purchasers may make
copies for use by their staff and students,
but this permission does not extend to
additional institutions or branches. Under
no circumstances may any part of this
book be photocopied for resale.
First published 2011
ISBN: 978-1-4082-5212-3
Set in Palatino
The publisher would like to thank the

following for their kind permission to
reproduce their photographs:
Cover images: Front: Photolibrary.com:

Comstock c, Corbis l, David Trainor
Background, Photodisc r
Contents
Unit 1 Patient admissions page 3
Unit 2 Pain page 12
Unit 3 Vital signs page 22
Unit 4 Symptoms page 31
Unit 5 Food and nutrition page 41
Unit 6 Personal care page 50
Unit 7 Elimination page 59
Unit 8 Patient discharge page 70

1 Patient admissions
Briefing through waiting in a cubicle to their assessment. A

discussion activity invites students to draw on their
This unit begins by introducing hospital personnel experience to use the triage process to prioritise a
and departments and then deals with the series of patients presenting at ER.
admissions process, i.e. checking in a patient and
welcoming them onto the ward/into the room. Later, this section seeks to develop a set of requests
that a nurse might make with a patient newly
Hospital jobs and personnel arrived in ER: Could you take a seat in the waiting
room, please? Could I ask you a few questions, please?
Nurses work as part of an extensive team, especially Could you tell me what happened? The admissions
within the context of a hospital and this first section process requires nurses to be accurate when taking
presents a variety of personnel and their roles. It patient details. A review of how to pronounce letters
makes the distinction between several key nursing of the alphabet by encouraging students to group
personnel; the triage nurse who is responsible for letters with the same sound completes this section of
making sure the most urgent cases are treated as a the unit.
priority, the sister or charge nurse (male
equivalent) who runs the ward/department, deals Checking in a patient
with the budget and staff employment and the scrub
nurse, who looks after patients during and after After familiarising themselves with terms and
surgery. expressions that typically appear in the Patient
Students then look in more detail at the Details section of an admissions form, students will
responsibilities of a practice nurse working in a then go on to develop a set of questions used to
doctor’s surgery (USA: doctor’s office) and an complete the form. Questions are related to the
agency nurse (employed on short-term contracts patient – full name, DOB (date of birth), gender,
through a nursing employment agency), specialising marital status and occupation – as well as contact
in renal care (kidney diseases). Students focus on details of their next of kin (family member, carer,
usage of the present simple and the present even neighbour). There are also questions about
continuous to describe nursing roles and smoking and allergies. It is important to ask for the
responsibilities as well as daily routines. patient’s preferred name, as it helps develop a
stronger relationship with the patient. Some patients
Hospital departments and facilities feel more comfortable if medical staff use their first
name, preferring the more informal contact, while
The main aim of Section 2 is to develop lexis of others like to maintain a more formal relationship
specific hospital departments – Casualty and might ask staff to use their title (Mr/Ms, etc.)
(UK/Ireland), Dermatology, Pathology, etc. – and and surname. As the patient is shown into their
facilities including canteen, waiting room, bank, room/ward (a large room for up to six same-sex
vending machines, etc. It should be noted that patients – very common in the UK/Ireland), it is up
emergency care is also offered in the Emergency to the nurse to inform them about the facilities
Department (UK/Ireland) and Emergency Room or available to them – buzzer, locker, etc.
ER (USA). Appropriate word stress greatly
facilitates communication with patients and
colleagues. Students will work on stress patterns of
the various hospital departments. This section also
reviews language of place and movement and
provides an opportunity for students to practise
directing patients and visitors around a hospital.
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 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
What department do you think it is? (Emergency the 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
the job titles with the hospital personnel they see simple to talk about routines and things that
in the picture. happen all the time. We use the present
continuous to talk about things that take
a8 b1 c4 d2 e7 f3 g9 h5 i6 place at the time of speaking/things that are
not permanent.
Give students time to assimilate the points
2 Ask students, individually or in pairs, to match covered in the Language box.
the job titles in 1 with the descriptions. If If necessary, review present simple and present
necessary, encourage them to deduce the continuous forms in more detail.
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
preposition. Then choose one of the activities If necessary, ask a stronger learner to select the best
for further practice of the target language. answer in the first sentence.
1b 2d 3f 4c 5h 6i 7e 8a 9g 1 work 2 like 3 carry out 4 change 5 treat

6 am 7 give 8 are running 9 ’m learning
10 don’t have 11 like going 12 play
Patient 1 4
Listening
4 ► 02 Tell students they are now going to hear

an interview with agency nurse Carlos da Silva.
Ask them to listen and answer the question.
Check students understand: agency nurse, renal
care, paediatrics, emergency medicine.
a renal care
5 Refer students to the beginnings of sentences 1–

8. Tell them to listen again and complete the
sentences about Carlos. Play the recording again
if necessary.
For further language practice, ask students to
turn to the audio script 02 on page 70 and
underline the examples of the present simple
and circle the examples of the present
continuous. (Present simple: I work, I specialise, I
spend, I carry out, administer, play, do I like?, I
don’t like, there is, can be, I want, I hope, I go
climbing; Present continuous: I’m working, I’m
looking after, is waiting, I’m teaching)
Students may be confused with the examples of
verbs followed by -ing: like + -ing, go + -ing,
that appear in this audio script. Check their
understanding of these after the above activity.
Explain both examples will be covered later in
the course.
1 renal care.
2 a transplant unit in Auckland.
3 a little girl who is waiting for a
kidney transplant.
4 carries out her tests, administers her
medication and plays games.
5 teaching her how to play dominoes.
6 likes dealing with children./doesn’t
like dealing with paperwork.
7 qualify as an advanced practice nurse.
8 he goes climbing in the mountains.
Speaking
6 In pairs, students take turns to interview each
other using questions in 5. Students should then
introduce their partner to the rest of the group.
Patient admissions 1 5
Hospital departments and facilities   
Renal Casualty Pathology
Surgery Maternity
Vocabulary Neurology
1 Tell students to look at the hospital plan taken from a
patient educational leaflet. Ask: Which department names  
Geriatrics Dermatology
do you recognise? Ask students, individually or in pairs, to
Paediatrics Cardiology
complete the definitions using the words in the box.
Radiology
Alternatively, do this activity as a group chorus and then give
students time to complete the definitions in writing to reinforce 
the target language. Physiotherapy
Extra activity
Come together as a group to check answers. Check students
understand: nervous system, skin disorder, midwife/midwives, On the board, write: facilities, orthopaedics,
recover. pharmacy, registration, patient, entrance,
toilets, information, coffee, hospital, emergency
1 emergency cases 2 operations 3 kidney (these words all appear on the hospital plan on
4 skin disorders 5 elderly 6 test results page 6). Ask students to add these words to the
7 babies 8 children 9 heart 10 X-rays correct column in the table in 2 according to
11 nervous system 12 exercises their stress pattern.
See answers below.
Pronunciation
Speaking
2 ► 03 On the board, write renal. Ask how
many syllables there are in the word and then If students need to review prepositions of place,
elicit the correct stress pattern. Ask a stronger they could do 4 and 5 before 3.
student to write the stress pattern above the 3 Refer students to the speech bubbles at the
word on the board (see key opposite). If bottom of the page. Using the hospital floor
necessary, check the stress pattern of plan, ask students (in pairs) to take turns
dermatology. asking and answering questions about the
Ask students, individually or in pairs, to put the location of facilities and departments in the
names of the hospital departments in 1 into the hospital. Encourage the correct stress pattern.
correct box according to their stress pattern.
Avoid correcting at this stage.
Students then listen to the recording and check
answers. Play the recording again and ask
students to repeat the stress patterns they hear.
Play the recording several times until you are
happy students are able to reproduce the
same/approximate pronunciation and stress
pattern. Reassure them that some terms are
difficult to pronounce even for a native speaker.
Note: Follow the table opposite for correct
pronunciation patterns.
Note: Students may recognise these words from
their own language but will tend to place the
stress in the wrong place in English. Ask them to
compare stress patterns in their L1.
  
patient pharmacy facilities
entrance hospital emergency
toilets
coffee

orthopaedics
registration
information
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
5 Ask students, individually or in pairs, to match
next to the bank.
the symbols to the facilities. Ask: Which facilities
3 You are late for your X-ray and lost. You
can you find in hospitals in your country? Which
facilities would you like to see in hospitals in your are on the second floor in front of the
country? Why is it important to provide facilities Neurology Department.
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
going to hear three nurses giving visitors 4th floor but want to know where the pharmacy
directions to different hospital facilities. Ask is located.
them to listen and complete the instructions.
Come together as a group to check answers.
1 straight on, front of, at, end 2 second, left,

turn, of, turn right 3 turn left, go, next to
7 ► 05 Ask students to look at statements 1 and

2. Then refer them back to the hospital plan on
page 6. Explain they are situated at the main
entrance and that they are going to hear
directions being given by a nurse. As they listen,
students should follow the directions on the
hospital plan with their finger, then circle the
correct answer.
8 Ask students to check their answers by turning
to the audio script on page 70.
1 main entrance 2 4th
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 care; helps reduce levels of patient anxiety and
necessary, reassure them that they don’t need possible frustration.
to 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 triage
1 2.5 hours 2 4.5 hours nurse talking to four new patients. Before they
listen, ask students, in pairs or small groups, to
2 Ask students to read the leaflet again. As they ‘observe’ the patients a–d in the picture. Note that
read, they should complete the gaps in the observation is an authentic task for a triage nurse
‘When you arrive’ section using the words in the and will also serve to prepare students for the
box. Ask students, in pairs, to compare their interventions they are about to hear.
answers, then come together as a group to check.
Encourage students to visualise the admissions Ask students to listen and decide which patient
process in their place of work/country to help is speaking in each case.
them complete the activity.
1d 2b 3a 4c
If your students are pre-experience nurses, ask
them to visualise what happened the last time 5 Ask students to listen again and complete the
they attended the Emergency Room as a sentences using the words in the box.
patient/carer.
1 leg 2 bleeding 3 hurts 4 worried, baby
Check students understand: assessment, cubicle, 5 eye
priority.
6 Ask students, in pairs, to put the four patients
1 reception desk 2 date of birth 3 cubicle into order of priority to see the doctor. Ask
4 triage nurse 5 assessment 6 priority students to compare their answers with another
7 cubicle pair before coming together as a group to check.
3 Ask students to look at the medical problems (a– If your students are experienced nurses, ask
c) and ask: Which problems are the most serious? them to explain the reasons behind their order of
Then ask them to match the problems to the priority for a–d.
gaps 8–10 in ‘The Order of Care’ section on the
Answers: d has been brought in by ambulance
patient leaflet. In pairs, students can then
from a car accident and will have priority, a the
compare their answers before coming together
patient is 23 weeks pregnant and has some
as a group to check.
bleeding so needs to see a doctor urgently, b and
If your students are experienced nurses, ask c are not priority cases but the child (b) would
them to brainstorm other medical problems for probably be seen by a medical professional
8–10. before c.
8 c 9 a 10 b d a b c
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
8 Tell students they are going to listen to the

conversations with patients a–d once again. As
they listen, students should match the requests
to the correct patient. Allow them to compare
answers in pairs before coming to together as a
group to check.
Patient 1 – Could you fill in this form, please?

Patient 2 – Could you show me your head?
Patient 3 – Could you lie back and try to relax?
Patient 4 – Could you take a seat in the waiting
room, please?
Extra activity
In pairs, students use the audio script 06 on
page 70 to practise roleplaying the dialogues.
Variation: Ask students to change the
medical problems in the dialogues before
roleplaying the activity.
Pronunciation
9 ► 07 Ask students, individually or in pairs, to
complete the groups with letters of the same
sound. Encourage them to say the letters aloud
or in their heads in order to ‘hear’ the differences
in pronunciation. Play the recording to enable
them to check their answers.
B, C, D, E, G, P, T, V, Z
F, L, M, N, S, X, Z
A, H, J, K, Q, U, W
I, Y
O
R
10 Elicit the request: Could you spell your name,

please? In pairs, ask students to write down
names of four people they know and then take
it in turns to spell the names to each other. For
further practice, students could spell the hospital
departments, facilities and personnel from pages
4, 6 and 7.
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.
Ask students to listen and answer the question:
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.
Patient 1 10
1 light 2 buzzer 3 TV 4 chair 5 table
6 bed 7 locker 8 drawer
The nurse is talking to the pregnant woman.
Title: Mrs
First name(s): Rosanna
Surname: Cameron
Gender: F
Preferred name: Rosanna
Marital status: married
Date of birth: 20/01/1981
Country of origin: Italy
Occupation: international marketing manager
Tel (home): 02 831 9476
Next of kin: Daniel Cameron
Mobile: 0779 706 7517
Allergies: none
Patient 1 11
Listening

a nurse showing Rosanna the facilities in her
room. As they listen, they should write down
the names of the objects they hear.
shelf, locker, bed, buzzer, light, chair, TV,

drawer
7 Ask students to look at the picture again in

detail and complete the information about the
facilities in the room. If necessary, refer
students back to the prepositions of place on
page 7. Play the recording again if necessary for
students to complete the answers.
1 light, chair 2 TV 3 drawer

4 pharmacy, waiting area 5 ground 6 hall, lift
Speaking
8 Tell students they are now going to roleplay
admitting a patient, showing the patient to their
room and explaining the facilities. Put them into
pairs and refer them to the list in 8. Ask them to
invent details for their respective patient. They
should then make a copy of the admissions form
on page 10 and carry out the interview. They
then swap roles.
Preparing for the next unit
In preparation for Unit 2, suggest the following to

your students:
• Compile a list of body parts you already know
in English.
• Think about ways patients in your country
describe pain – adjectives, common
expressions.
• Do some (online) research into different types
of pain relief (commonly used in your country).
Patient 1 12
2 Pain
Briefing appropriate questions to gain a better understanding

of their patients’ needs.
This unit deals predominantly with the topic of
pain; understanding patient descriptions of pain, Building and maintaining a good patient
carrying out an assessment, incorporating successful relationship is an essential aspect of the treatment
communication skills, and discussing different and healing process. Effective communication skills
forms of pain relief. This is arguably the most are a key part of this. These include employing a
important unit in the coursebook. patient-friendly intonation pattern and putting
the patient at ease. The text titled Putting your
Locating and describing pain Patient at Ease on page 17 provides more detail on
this aspect of successful communication.
This first section of the unit provides an opportunity
to develop patient language for the major body Pain relief
parts. Students will be asked to complete a pain
map, a diagram representing front and back views Increasingly, patients turn to the internet for advice
of the body, used by medical staff to indicate on general health matters and nurses need to be
location and movement of pain. Comparatives and familiar with this medium and the approach used.
superlatives of simple adjectives (stronger, better, the An online article provides the backdrop for the first
worst) are also covered in this section to describe part of this section, which encourages students to
changes and improvements to pain. discuss different methods of pain relief. It considers
pain relief for sufferers of lower back pain, from
Pain assessment painkillers and anti-inflammatory drugs to heat
patches and ice packs. Students are then asked to
Section 2 draws students’ attention to collocations give advice on specific patient questions linked to
and expressions patients commonly use to describe back pain as well as rate the article in terms of its
pain – a burning sensation, a shooting pain, a suitability as a patient reference.
tingling feeling, it’s itchy. The section then moves
on to describing intensity of pain using different Nurses may also be asked for advice on
types of pain scale. The 1–10: nurses ask patients to complementary and alternative medicine or
give a number between 1 and 10 (0 = no pain) to CAM as a means of pain relief. The last page of the
describe how much pain they feel. In the case of unit looks at some examples of these, including
children or those who have difficulty expressing aromatherapy (use of natural oils to help control
themselves, nurses will ask them to point to the face pain) hydrotherapy (underwater exercise),
that describes how they are feeling. The section chiropractic therapy (manipulation of bones in the
goes on to develop a set of questions, based on spine) and herbal therapy (use of herbs and plants
simple Wh- words – what, where, when, how, used to help treat muscle ache). Finally, students are
by nurses to assess their patients’ pain. Using asked to consider the difference between chronic
patient case histories, students put these skills into and acute pain. Chronic pain is that suffered over
practice. a long period of time, e.g. lower back pain, arthritis;
while acute pain can be mild or severe but lasts no
Successful communication longer than six months, e.g. broken bone, labour
pains, a burn, etc.
Nursing is not just about treating the disease –
nurses also have to consider the economic, social,
psychological and even environmental aspects that
impact on the patient, their symptoms and their
treatment and recovery. Pain is not just physical and
patients express their pain in various ways – anger,
depression, loss of appetite or sleep, etc. A nurse
needs to be able to look behind the words (or lack of
them) and interpret what their patient is feeling. The
initial pain assessment tool enables nurses to ask
Pa 2 13
Teacher’s notes 2 Patients often talk about their pain in simple
terms. Mime a patient with a headache. Elicit
Warm-up expressions from the table in 1 to describe
how you are feeling.
1 Dictate the names of hospital departments and
facilities from Unit 1. Then ask students to Pre-teach/elicit: throat, gum, lower (back). Refer
group them according to their stress pattern. This students to the vocabulary table and ask them,
can be done as a team game – the first team to individually or in pairs, to change sentences 1–6,
group all the words successfully is the winner. using different words from the table. If
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
roleplay interviewing the patient at admissions. Remind students we say I’ve got
toothache/stomach ache/earache. BUT I’ve got
Locating and describing pain a headache.
Suggested answers
Vocabulary 1 My throat hurts.
1 If students are experienced nurses, ask: What 2 My ankle hurts, it’s very sore.
type of chart is this? What is it used for? If not, 3 Does your head hurt?
ask: What do you think this chart is used for? Who 4 Her gums are really sore.
fills it in? (Pain map, used by nurses and doctors 5 His stomach hurts.
to mark the exact location of the patient’s pain.) 6 My lower back aches and it’s really painful.
Ask students, individually or in pairs, to label 3 Elicit a general opening question: How do you
the pain map, using the words in the box. Tell feel?/How are you feeling today?
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 4 ► 10 Tell students they are going to hear three
to 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.
1 between, stomach 2 right, above

3 back, hip, down 4 Where, feel
Pa 2 14
Extra activity 7 If necessary, review comparatives and adjectives
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 1 1 stronger 2 better 3 better 4 most severe
pairs, to put the words in the correct order to 5 the worst
form sentences that patients might use to 2 1 worse 2 worst 3 best 4 better
describe 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
3 It’s worse than yesterday. pairs, students should choose one condition and
4 The pain in my leg is much worse.
take turns to describe their pain in detail using
comparative and superlative adjectives. If
Language necessary, students can write notes first.
Comparatives and superlatives 1 migraine 2 sinusitis

1 On the board, write: strong and painful. Ask
students to count the syllables in each word.
Elicit the comparative and superlative forms of
each and then ask:
What is the rule for adjectives with one syllable?
What is the rule for adjectives with two or more
syllables?
One syllable: add -er (comparative), add the + -
est (superlative)
Two syllables: add more (comparative), add the
most (superlative)
2 Elicit the superlative forms of good and bad.
(the best, the worst)
3 Ask students to look at 6 and find an example
of comparison of two ideas/things.
(It’s worse than yesterday.) Then refer students
to the two examples in the table to reinforce the
usage.
covered in the Language box.
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 patients
1e 2h 3g 4b 5f 6a 7d 8c
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, write the answers
skin? (tingling, stinging, itchy)
in a different order on the board: chest, hands, head, lower back.
On the board write: head, eye, shoulder, chest,
Then play the recording. This will give students the chance to
limb (leg/arm), stomach and ask students in
concentrate on the patient’s description.
small groups to match the parts of the body to
1 head 2 lower back 3 chest/stomach the most appropriate adjective. Alternatively,
(patient doesn’t give specific area but says ask students, individually or in pairs, to
she gets a burning feeling after eating food) research the above and deliver their findings as
4 hands 5 chest an informal presentation during the next class.
Suggested answers
2 Ask students to listen to the dialogues again and head: dull, throbbing, shooting
complete the patients’ descriptions using the eye: burning, stinging, itchy
adjectives in the box. Encourage students to shoulder: stabbing, throbbing
deduce the meaning of the adjectives from the chest: shooting, stabbing, dull
descriptions and the body parts they refer to. limb: dull, shooting, stabbing, tingling
Ask students, in pairs, to compare their answers stomach: throbbing, burning
before coming together as a group to check.
Point out that initially nurses often ask a very general question Extra activity
to encourage the patient to talk about their pain. Either ask
students to turn to the audio script on page 71 and find two In pairs, students take turns asking and
general questions the nurses use to ask about pain, or elicit answering the nurse’s questions: Where do you
these questions: Can you describe the pain? What does the pain feel the pain? and Can you describe the
feel like? pain?/What does the pain feel like?
4 If your students are pre-experience nurses, ask:

1 throbbing 2 dull, shooting 3 burning What do you think these charts are used for? When
4 tingling 5 stabbing do you think nurses use the chart with faces? If they
are experienced nurses, ask: What are these charts
Vocabulary called? How do nurses use these charts? Which pain
3 Refer students to the table and ask them, scale do you prefer and why? (Pain scales are used
individually or in pairs, to match the adjective with patients to assess/measure the level of their
phrases to the correct description. Encourage pain. The 1–10 pain scale is generally used with
students to use their knowledge of English to adults and the faces pain scale with children or
deduce the meanings. people who have difficulty expressing
themselves/their feelings. Nurses ask patients to
Depending on your group, you may wish to use give a number between 1 and 10, where 0 = no
illustrations (arrow = shooting, drum = pain, to describe how much pain they feel.
throbbing, knife = stabbing, bee = stinging, Nurses ask children to point to the face that
pincushion = pins and needles) to reinforce the describes how they are feeling.)
meanings of these words.
Pain 2 15
Tell students they are going to look at vocabulary to describe 1 labour: location – lower stomach/hip area;
the degree/level of pain. Refer them to the chart and ask them, type – dull ache, contractions (strong waves of
individually or in pairs, to match the expressions in the box to pain)
the faces and the numbers. If necessary, do the first one as a 2 appendicitis: location – middle of stomach
group. (belly button), moves to lower right side of
abdomen; type – stabbing pains
Elicit the question a nurse would ask when using these scales: 3 severe migraine: location – head, behind eye,
On a scale of 1 to 10, how bad is the pain/how much pain are you neck; type – throbbing
in? Can you point to the face that shows how you are feeling? 4 broken shoulder: type – stabbing, aching,
throbbing
1 no pain 2 mild pain 3 moderate pain 5 kidney stones: location – middle back,
4 severe pain 5 very severe pain groin; type – ache/spasms (or waves) of pain
6 unbearable pain 6 tonsillitis: location – throat, (glands) in neck;
type – burning sensation
Speaking
5 Tell students they are going to develop a set of
basic questions to assess pain. Ask them to add
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.
1 Where 2 How 3 When 4 How 5 Where

6 Where 7 What 8 Where/When
6 Give students adequate time to read through

their patient cases. Refer Student Bs to page
68. Check understanding of: unbearable, spicy
food.
Student As should interview their patient
(Student Bs) and complete the pain map and
pain scale. Students should swap roles. Ask
pairs to compare their pain maps and pain
scales, before checking answers.
Student A: Pain map with cross on chest with

arrow across to right arm; Pain Scale with
cross on 9 (moving down to 7)
Student B: Pain map with cross on stomach;
Pain scale with cross on 7
7 On the board write: Where does it hurt? From 1

to 10, how bad is the pain? In pairs, ask students
to look at the conditions 1–6 and answer these
questions for each condition. Ask them to
compare their ideas with another pair before
coming together as a group to check answers.
If your students are pre-experience nurses, check
understanding of: appendicitis and kidney stones.
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 environmental. It is important that the nurse
Dina Guyader (28) by looking at the photo. Ask considers the patient as a whole – a holistic
them to answer or just think about questions 1 approach – so that they can propose an effective
and 2. 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 answers to these
1 lower back – below the waist, across questions before moving on to question 3.
the back
2 dull ache and a shooting pain, like an Ask students, in pairs or small groups, to match the
electric shock symptoms in the box to the correct sections in question 7.
2 ► 13 Tell students to listen to Part 2 and put a Point out that questions 1–6 of the initial pain assessment
cross and the letter N on the pain scale to tool are similar to those covered in 5 on page 15.
indicate how Dina feels now and a cross and an
M1 to
2 indicate
2 7 or 8how she feels in the morning.
1 What makes it better?

3 Ask students to listen to Part 2 again and circle the correct 2 What makes it worse?
answers. If necessary, allow students to read through the 3 Sleep – insomnia
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
Suggested answers
used for? Who carries out pain assessment in your
Accompanying symptoms: stomach cramps,
country/place of work? (Nurses use the
headaches
assessment tool as a guide to ask more detailed
Sleep: feeling overtired
questions about the patient’s pain. Depending on
the country, nurses are more or less involved in Appetite: smaller, reduced appetite
carrying out pain assessment; this may be the Physical activity: difficulty lifting heavy
responsibility of the doctor.) objects Relationships with others: feeling
suspicious of 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 pairs, to complete
Extra activity
question 7. Explain that some points are referred to indirectly.
If necessary, allow them to read through the audio script on Refer students to pictures A and B and ask
page 72 to check their answers. them to imagine themselves as the patient in
each case. On the board write: How do you feel?
What do you think about the nurse? Would you
5 lying down, taking a hot shower like this nurse to take care of you? Why (not)?
6 lifting heavy objects, carrying her daughter Students may wish to write down their answers
7 Accompanying symptoms before discussing in pairs and then come together
Sleep – she doesn’t sleep well, she is often as a group to share their ideas.
very tired
Appetite – she has no time to eat properly Reading
Physical activity – she is unable to lift heavy 7 Tell students they are now going to read a
objects/her daughter description of good communication practice.
Relationships with others – she has problems
Before they read, ask them to explain the title of
getting along with her husband (mentioned
indirectly) the article or give it an alternative title (e.g. How
Emotions – she feels angry, she feels to make your patient feel comfortable).
emotional (cries during the interview) 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 their ideas; questions could/do you ask patients to show
reassure them that for this activity accuracy is not important – interest?
just encourage them to discuss their opinions. Suggested answers
ask questions about the patient’s
family/friends; ask about what the patient
A: The patient looks relaxed/at ease and is is doing (programme they are watching on
responding to the nurse. The nurse is smiling TV, music they are listening to); the
and making eye contact with the patient. His weather; 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
unimportant. The nurse demonstrates very
poor communication technique. Standing over to listen and decide if the nurses sound friendly
the patient as opposed to putting himself at or unfriendly by ticking () the correct box.
the same level and having his arms behind his Ask them to listen to the first one as an
back gives the impression he is not interested. example.
He is not looking at the patient when speaking
to her.
Pain 2 18
If necessary, play the recording two or three times to allow
Extra activity
students to hear the difference. Reassure them that it is
sometimes difficult for non-native speakers to hear the In pairs, ask students to choose two patients
difference. from page 14. Refer them to audio script 11 on
However, reiterate (as in 7) that a friendly tone of voice is very page 71 and ask them to invent information for
important in developing and maintaining a good patient these patients and complete questions 5–7 in
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
Play the recording again and ask students to group before asking students to roleplay.
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.
A friendly welcome usually uses an intonation

pattern that rises and falls.
Speaking
10 Tell students they are going to look for examples
of how the nurse tries to put Dina at ease. Refer
students to the audio scripts 12–14 on pages 71–
72 and ask them to underline examples of points
1–6 in the nurse’s dialogue. Ask them to write
down exactly what he says in each case. If
necessary, go through the first question as a
group.
1 Hello Dina. Come in …/I understand it’s

not easy for you Dina.
2 And how’s the little one today?
3 I hope the baby is OK?
4 It’s OK. Take your time.
5 I understand it’s not easy for you Dina.
6 I just want to ask you a few questions. Is
that OK?/I want to ask you a few more
questions.
Extra activity
Refer students to audio scripts 12–14 on pages
71–72. In pairs, students take turns roleplaying
the dialogue between the practice nurse and
Dina Guyader. Encourage them to use 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 Vocabulary
pain, then answer the questions. Come together
6 Refer students to the pictures at the top of the page
as a group to share.
and ask: What kind of treatment do these images
Suggested answers show? (Complementary and alternative medicine.)
bed rest, shower, gentle walking, ice pack, Explain that the abbreviation CAM is now commonly
swimming used.
Ask students, individually or in pairs, to match the
Reading different examples of CAM to the correct description.
Check understanding of: improve, mental well-being,
2 Tell students they are going to read an article therapy, therapist, manipulate, influence.
from a health website aimed at sufferers of lower
back pain. If necessary, pre-teach/elicit the items 1e 2c 3b 4d 5f 6a
in the box before doing the exercise.
As they read, students should complete the text Listening
using the words in the box. Come together as a
group to check answers.
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 and
6 hot-water bottle 7 heat patches 8 ice pack 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
Speaking
4 Refer students, in pairs, to the patient’s
questions 1–3 and ask them to roleplay possible
answers.
If necessary, pre-teach/elicit expressions for
giving advice: Why don’t you + infinitive …; You
could + infinitive … (for tentative suggestions);
You should + infinitive (for strong advice).
Pa 2 20
1T
2 F (Carlos thinks ginger is only used as
a remedy for colds and stomach ache.)
3T
4 F (Angie thinks chiropractic therapy sounds
more painful than the backache itself. She
doesn’t give the impression she wishes to try
it out.)
5 F (Carlos believes CAM is more effective
for acute pain.)
Suggested answers:
1 You could use a hot-water bottle.
2 You could go swimming/use an exercise
bike. 3 You should make an appointment to
see your GP/family doctor.
Pa 2 21
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 the
descriptions for a health website or patient group and share their thoughts. If necessary, give
educational leaflet. students time to write notes first.
Suggested answers If your students are pre-experience nurses, ask them to
acupuncture – uses very fine needles to prepare a short informal presentation for the next class.
regulate the flow of energy through the body. If
the energy in the body is balanced, then the Preparing for the next unit
person is in good health.
homeopathy – uses very small doses of a In preparation for Unit 3, suggest the following to
substance that causes symptoms to stimulate your students:
the body's self-healing response
• Compile a list of words related to giving
massage – squeezes/stretches parts of the
instructions you already know in English.
body to make someone relax or to reduce
pain visualisation – uses positive mental • Familiarise yourselves with general nursing
images to reduce pain or relax someone statistics, e.g. height, weight, temperature,
blood pressure.
• Do some (online) research into the heart and heart
Extra activity
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.
Pa 2 22
3 Vital signs
unit to encourage students to do this.

Briefing
This unit deals predominantly with procedures that
form an important part of a nurse’s daily routine:
tasks of high-level frequency that introduce students
to language of equally high frequency.
Statistics and vital signs

Vital signs are measurements of the most basic
functions of the body. These are recorded initially on
the patient’s admission form and then throughout
their stay in hospital on observation (or obs) charts.
Each time a nurse adds a new recording to the
observation chart or admissions form, he/she must
sign it to show who is responsible.
Normal respiratory rates (RR) for adults are 15–20
breaths per minute and for children (5–12 years) 20–
25. These are measured either with a stethoscope or
by the nurse placing their hand on the patient’s
chest. The heart rate is usually assessed by
calculating the patient’s pulse (P), detected by
placing two fingers over the artery in the wrist.
Normal rates for adults are 60–100 beats per
minute and for children (5–12 years), 80–100.
Normal body temperature (T), taken using a
thermometer, can vary between 36.5°C and
37.2°C. There are various types of thermometer and
the one most commonly used in UK and US
hospitals is the tympanic thermometer. Blood
pressure (BP) is measured using a
sphygmomanometer (or sphyg) or a digital blood
pressure monitor. Normal blood pressure ranges
from 110 to 150 millimeters (as the heart beats) over
60 to 80 millimeters (as the heart relaxes). Finally,
oxygen saturation (0² sats) relates to the
percentage (%) of oxygen in the blood and is
measured using a pulse oximeter.
On admission, nurses will also measure the patient’s
height and weight.
Nurses are also expected to observe their patient
as this too may have a bearing on the patient’s
diagnosis and treatment. They note the following:
pallor, colour and texture of the skin; general
appearance (Are they well groomed and
appropriately dressed?); expression (Do they appear
in pain/look their age?); movement (posture, gait,
co-ordination); and mental alertness of the
patient. Where possible, it is suggested teachers
exploit the images of the patients provided in the
Vital 3 23
Describing readings
This section draws students’ attention to the
language used to describe the readings. This
differs depending on the vital sign: respiration
(beats or breaths per minute), temperature
(thirty-six point four) blood pressure (one
thirty over eighty).
Students become acquainted with lexis to
enable them to describe variations in readings,
e.g. stable, up and down, increase, decrease,
etc.
Students are also asked to discuss factors that
can affect such readings: environmental
(climate, humidity), social (lifestyle, alcohol),
psychological (stress, anxiety) and physical
(age, gender). See answer to 5 for more detailed
information.
Taking vital signs

Taking vital signs involves giving patient-
friendly instructions and making polite requests.
In Section 3, students will look at language used
for these as well as the future using will, which
serves to keep the patient informed about what is
about to happen and helps reduce their anxiety.
It is assumed that students at this level will be
familiar with the modals can/could. Here,
guidance is given on the importance of how to
give patient- friendly instructions and make
requests, using appropriate intonation patterns
and reassuring expressions.
As nurses spend a lot of time taking vital signs
and therefore giving instructions or making
polite requests, this section includes high-
frequency language that is vital to the
development and maintenance of nurse-patient
relations at a time when patients feel vulnerable.
Circulation and the heart

This section introduces students to medical terms
for the heart and its functioning commonly used
amongst colleagues and sometimes with patients.
It then considers the link between smoking and
cardiovascular disease.
Section 4 reviews words to describe readings
within the context of smoking. These constitute
authentic tasks which show how nurses are
required to explain medical conditions, etc.
using patient leaflets.
Vital 3 24
Teacher’s notes Refer students to the information in the
height/weight chart. Explain that Imperial
Warm-up measurements (pounds/lbs) are used in the
USA and also with older patients in the UK and
1 On the board write: head, eye, shoulder, chest, Ireland (pounds/lbs and stones).
limb, stomach, skin and then ask students to
brainstorm adjectives that can be used to 1c 2d 3a 4b
describe pain for each. This can be done as a
team game – the team with the most correct 3 Tell students they are going to listen to the
adjectives in a given time is the winner. dialogues again and ask them to plot the
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
the patient case on page 15 and take it in turns to
underweight.
assess the patient, making sure the patient is at
ease. 1 underweight 2 normal weight 3 overweight
Statistics and vital signs 4 Ask students, individually or in pairs, to
complete the nurse’s questions and requests. If
Listening necessary, play dialogue 1 again. Come together
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 Check understanding of: bladder, to empty, scales.
way to say these figures. If necessary, review
1 Can you, first? 2 are you 3 height
weights and measures and/or numbers in more
4 stand, scales 5 much, weigh
detail.
Tell students they are going to hear a practice 5 Depending on your group, students may prefer
nurse weighing and measuring six patients. to work in single-sex pairs for this activity.
They should circle the correct number. In pairs, ask students to practise weighing and
Point out they will hear: one point three four measuring each other (they can guess).
metres or one metre thirty-four and twenty- Encourage students to use the questions 1–5 in 4.
two point two five kilos, but not twenty two Remind them to swap partners.
point twenty-five kilos. Less confident students may wish to keep the
phrases uncovered initially.
1 1.60 m 2 72 kg 3 1.34 m 4 89.5 kg
5 22.25 kg 6 1.40 m 6 Ask students to match the vital signs to the
correct definition.
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.
2 ► 19 Tell students they will hear Nurse

McMaster weighing and measuring four
patients. Before they listen, ask students to
observe the patients a–d. Then ask them to listen
and match the dialogues to the correct patient.
Remind students we don’t say How high are you?
or What’s your tall?
1d 2c 3a 4b
Vital 3 25
Extra activity
Extra activity
1 On the board draw a spidergram
On the board, write: A high/low … means that the (temperature) and elicit different types of
patient … equipment for taking temperature. Students
Ask students, in pairs or small groups, to may not know the name in English, but ask
discuss what a) a very high and b) a very low them to explain how it is used/what it looks
reading of each of the vital signs shows about like.
the health of a patient. 2 Ask: What are the different methods of taking
Suggested answers a temperature?/What type of thermometer is used
A high pulse indicates infection, stress, for each method?
anaemia or exercise. Answers
A very low pulse rate indicates hypothermia, 1 tympanic, electronic, mercury (now rarely
certain drugs (for example beta-blockers) and used), oral
certain heart conditions. 2 axillary/under the arm: mercury, electronic
A high blood pressure indicates anxiety or ear: tympanic
stress. oral/mouth: mercury, electronic, oral
A low blood pressure indicates hypotension. rectal: glass, electronic
A high temperature indicates fever.
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 answers
A high respiratory rate indicates asthma, heart to 7. Then on the board, write: digital. Ask how many
problems. syllables there are in the word and then elicit the
stressed syllable. Ask students to underline the stressed
7 Ask students to look at the pictures and label the syllable in each word. Avoid correcting at this stage.
equipment with the words in the box. If your
students are pre-experience nurses, check the 1 digital blood pressure monitor
answers are correct before moving on to the next 2 thermometer 3 pulse oximeter
stage of the activity. Ask students to write 4 stethoscope 5 sphygmomanometer
sentences using the expression: A/An … is used
9 Play the recording again until you are happy students
to measure …
are able to reproduce the same/approximate
Tell them not to worry too much about their pronunciation and stress pattern. Reassure students that
pronunciation at this stage. some of these terms are difficult to pronounce even for
a blood pressure monitor b thermometer a native speaker.
c pulse oximeter d stethoscope
e sphygmomanometer Students may already know some of these terms from their
own language but will tend to place the stress in the wrong
1 A digital blood pressure monitor is used place. Ask them to compare stress patterns in their L1.
to measure a patient’s blood pressure.
2 A thermometer is used to measure a Speaking
patient’s body temperature.
3 A pulse oximeter is used to measure how 10 Refer students to the chart (the ‘vital signs’
much oxygen there is in a patient’s blood – section of the admission form). Ask: When is this
the oxygen saturation. section completed? Who completes the information?
4 A stethoscope is used to listen to Why/When is it necessary to sign?
heart sounds and respiration rate (and
bowel sounds). Ask students in pairs to match the abbreviations
5 A sphygmomanometer is used to measure to the words in the box. If your students are pre-
a patient’s blood pressure. 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 giving readings of vital signs for two patients.
sphygmomanometer to measure this.
Before they listen, ask students to look at the
P means pulse. We use a pulse oximeter to
current readings for the two patients. Ask: What
measure this. (The nurse can also use his/her
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
Vocabulary 4 ► 22 Ask students to look carefully at the vital

signs for Anja Wellington. Ask: What do you
11 Ask students to complete the summary, then
learn about the patient from her vital signs?
compare their answers with a partner. Come
(According to the chart, we know her age and
together as a group to check.
that she weighs 32 kg. Her sats and resps are
1 take 2 vital signs 3 record normal (for a child), but her pulse is at the
4 observation chart 5 sign 6 monitor 7 high maximum rate for a child of her age, and her BP
8 low seems low.)
Explain to students that the information on the
Extra activity chart is incorrect. They are going to hear a nurse
Ask: What other observations do nurses carry out? giving the correct readings for this patient. Tell
Suggested answer students to listen and correct the mistakes. If
Nurses should always take time to look necessary, play the recording again.
carefully at their patient and note: pallor;
colour and texture of the skin; the general BP 100 / 65 P 130 RR 25 T 37.5
appearance (Is he/she well groomed and
appropriately dressed?); expression (Does
he/she appear in pain, look his/her age?);
movement (posture, gait, coordination) and
mental alertness of the patient.
Describing readings
Vocabulary
1 Ask students, individually or in pairs, to
complete the table.
RR BP P T
130/85 
36.8 
79 
20 
2 Ask students to complete the descriptions of the

vital signs using the words in the box.
1 one, over 2 at, per 3 point 4 per
25
Vital signs 3
Speaking 7 Depending on your group, you may wish to do
8 before 7. The statements in 7 will then
5 On the board, write: Environmental, further reinforce the meaning of the language
Social, Psychological, Physical. items.
Ask students to brainstorm one example for each Explain that nurses use different words and
category of something that can affect a patient’s expressions to describe readings.
vital signs. Check understanding of the Tell students they will hear the same
categories before continuing. Then ask students conversation again. They should listen and
to match the other factors in the box to the match the correct patient to each statement.
correct category. Check the answers before moving on to the next
stage of the activity. Then ask students to use
Environmental: humidity, temperature
expressions from the box to complete the
Social: lifestyle, caffeine, tobacco
Psychological: anxiety, anger, stress statements.
Physical: age, gender, infection
1 up and down (P)
Your students may mention some of the 2 down (R)
3 vary, and (P)
following points.
4 up (D)
Humidity can raise respiration rate.
Tobacco and caffeinated drinks should be 5 stable (D)
avoided for 30 minutes prior to recording
as these can increase BP and P rates. Vocabulary
Blood pressure may be affected by anxiety.
Anger can affect can affect blood pressure and 8 Brainstorm words and expressions to describe
the pulse, causing them to rise. readings. Tell students you will be checking
Stress can increase the pulse rate. them later.
Rates differ with age, gender and as a result of
Draw the five line types on the board and ask
infection.
Note also: Pulse can be increased due to: students to match the correct arrow to the
exercise, fear, excitement, loss of blood or sentences in Exercise 7.
fluids, certain drugs and heart conditions. Pulse
can be decreased due to: hypothermia, certain Arrow: 1 sentence 4 2 sentence 2
drugs (e.g. beta-blockers) and heart conditions. 3 sentence 3 4 sentence 5 5 sentence 1
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.
6 ► 23 Ask students to first observe the three

patients Davina, Rose and Pilar, at the top of the
page. If your students are pre-experience nurses,
check that they are familiar with an observation
chart. Ask: What do the three charts show?
Tell students they are going to hear staff nurse
Debbie giving her colleagues an update on the
three patients. They should listen and label the
observation charts with the correct patient name.
a Rose b Davina c Pilar
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,
It is important students take time to grasp how then play the recording again to check.
to give patient-friendly instructions and requests Alternatively, model two examples – one with
as this is vital in developing and maintaining a flat intonation pattern and one with a rise and
nurse-patient relations. If necessary, review form fall. Ask: Which is more polite? Why?
Answer
and usage of modals can/could. Students can
A flat intonation pattern sounds
then 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
Check understanding of: roll up, sleeve, straight. the instruction/request? (Including just makes
Encourage students to deduce the meaning from the instruction/request sound softer.)
the context/images. Ask students to practise giving instructions 2,
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
first part of the activity before continuing. Then
going to take Mr Daniels’ pulse rate. Before
ask students to choose the correct piece of
they listen, ask students to visualise taking a
equipment for each instruction.
patient’s pulse; this will help them to
Remind them that the use of modals can and concentrate on the language input as opposed
could for instructions and polite requests is to the task itself. Then ask students,
interchangeable. individually or in pairs, to put the words in
order to form a sentence and then put the
Ask students to practise the instructions/polite
sentences in the correct order. If necessary, go
requests in pairs. Encourage them to use can and
through one answer with the 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?
instruction (make it sound less direct) and as a 3 I’ll put my fingers on your wrist.
result relax the patient. 4 That’s ninety-five beats per minute.
Ask students to practise the instructions/
3 ► 25 Play the recording to check answers to
requests again, this time focusing on the
2. Then play the recording again to answer the
intonation pattern.
question.
1a 2b 3e 4d 5c 6f
Mr Daniels was late for his appointment and
1 temperature (thermometer)
rushed to arrive on time. The reading was not
2 temperature (in ear with tympanic
accurate.
thermometer)
3 blood pressure/pulse (digital blood pressure 4 ► 26 Tell students they are now going to
or a sphygmomanometer) listen to the same nurse taking Cameron’s
4 pulse (finger)
pulse. Ask them to read through the questions,
5 respiration rate (stethoscope)
6 blood pressure (digital blood pressure or then listen and answer. If necessary, play the
a sphygmomanometer) recording again. Ask students to compare
answers with their partner, then come together
Vital signs 3 27
1 pulse oximeter
2 110 beats per minute
3 Around ten years old. His pulse rate is higher 1
than a mature adult/His voice/His anxiety about
the pain. ’ll (just)
Extra roll 2 ’ll put 3 hold 4 ’ll wrap
activity
5 won’t feel 6 ’ll (just) be 7 ’ll (just) take
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. to check their answers.
and I’ll take your temperature now. Elicit when Answer: sphygmomanometer
the 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 8 ► 28 Ask students to listen to the recording,
time of speaking (I’ll take your temperature check the answers to 7, and then complete as
now.) many of Ana’s vital signs as possible. They
Ask: Why do nurses talk about decisions? then look at audio script 27 on page 73 and
Answer: Nurses should always keep patients complete the rest of the vital signs. Ask them to
informed of what they are about to do to compare their answers with a partner, before
reduce patient anxiety. coming together as a group to check.
Give students time to assimilate the points For further language practice, ask students to underline
covered in the Language box. other examples of future with will in audio script 26 on
If necessary, review future with will, including page 73 to further reinforce usage. Ask students to circle
contracted forms. examples where speakers are making predictions and
5 Ask students to complete the examples from underline examples where speakers are talking about
dialogues with nurse Stefano using will and decisions.
verbs from the box. Come together as a group to
check. (Predictions – Will it hurt?, No it won’t, It will be very quick.
1 ’ll put 2 ’ll take 3 ’ll, clip 4 Will, hurt Decisions – I’ll just clip, I’ll just write this down., We’ll take
5 won’t, ’ll be 6 ’ll, write your temperature.)
BP 130 / 85 P 80 RR 17 T 38
staff nurse interview Ana Leogardo during her
Writing
morning rounds (visit of patients in the ward).
Ask students to read the questions and then 9 Ask students to choose one piece of equipment from
listen to the recording and answer. page 21. Tell them they are going to write five lines
1 not bad, hungry (at least) explaining to a patient how they will take
2 She uses a pulse oximeter. one set of vital signs.
3 She thinks Ana’s temperature is still high.
Before they write, elicit expressions from 7 that give
encouragement to the patient – e.g. that’s good/that’s right,
7 Before they listen to the recording, ask students also fine, you’re doing well.
to complete the staff nurse’s dialogue, using
Encourage students to include patient-friendly
will and the correct form of the verbs in the box.
instructions.
Encourage them to use their nursing knowledge
to help them complete the dialogue. If students lack confidence, put them into pairs
or small groups for collaborative writing. They
Check understanding of: cuff, lap, pillow, tight.
could use the text in 7 as a model.
Encourage pre-experience nurses to deduce
meaning from the context/images. Do not check Ask students to practise giving their
answers until students listen to the recording in explanations in pairs. Encourage them to use
8. 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
Vocabulary 8 pulmonary artery 9 aorta
1 Ask students to label the diagram of the heart. If they are

pre-experience nurses, you may wish to give them the first Speaking
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
6 right ventricle 7 left atrium 8 left ventricle terms from the text, check their partner’s
comprehension, and ask if he/she has any
questions. With less confident students, you
Pronunciation could suggest they write notes first.
2 ► 29 Ask students to underline the
syllables that are stressed. Extra activity
Students imagine they are explaining the
If you feel they need more support, elicit the first
function of the heart to an adult patient with a
example from the group. Alternatively, ask:
suspected heart condition.
Which is the odd one out? (1 aorta – the stress is
on the second syllable, all the others are stressed
on the first syllable.) Extra activity
Play the recording several times until you are Students imagine they are explaining the
happy that students are able to reproduce the function of the heart to one of the following: a
same/approximate pronunciation and stress child aged ten, the carer or family member of a
pattern. Reassure them that some of these terms patient with a chronic heart condition.
are difficult to pronounce even for a native
speaker. Reading
Students may already know some of these terms from L1, but
5 Ask: Which age group is most affected by smoking
will tend to place the stress in the wrong place. Ask them to
in your country? What can the health service do to
compare stress patterns in their L1.
encourage people to stop smoking?
Ask students to scan the text to find the
1 aorta 2 artery 3 vena cava 4 atrium answer to the question. Reassure them that
5 ventricle 6 pulmonary they don’t have to understand every word on
Reading first reading.
3 Tell students they are going to read part of a If necessary, pre-teach/elicit the meaning of:
reference text that explains the function of the risk, to narrow, nicotine, several, significant.
heart. As they read, they should use the words
Smoking causes the heart rate to increase
in the boxes to complete the information.
and the blood pressure to rise. The arteries
Encourage them to deduce the meaning of new
narrow and the blood flow decreases.
words from the context and their own nursing
knowledge. 6 As they read again, ask students, individually or
With less confident students, you could check in pairs, to decide if the statements 1–5 are true
their answers stage by stage. or false. They should then correct the false
statements. Come together as a group to check.
Students compare their answers in small groups,
then come together as a group to check. 1 T 2 F, Nicotine causes your blood flow to
decrease and your blood pressure to increase.
Check understanding of: circulate, pump, chamber, 3 T 4 F, After a few years the risk of heart
oxygen-rich blood. disease for an ex-smoker is the same as a
non- smoker. 5 F, It is never too late to stop
smoking.
7 Ask students to cover the leaflet and complete

the summary, individually or in pairs. Tell them
Vital 3 29
there may be more than one possible
answer.
Vital 3 30
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.

your students:
• Compile a list of common symptoms you
already know in English.
• Think about the last time you were ill.
What were your symptoms and how did
they start?
• Do some (online) research into respiratory
problems.
Vital 3 31
4 Symptoms
Briefing patient could start giving information that is not

relevant to the case. This type of questioning could
This unit looks at developing language for common waste valuable time. The cone technique is the most
symptoms and injuries, as well as encouraging effective means of questioning – it involves asking
patients to describe how these came about. It also open questions to allow the patients to express
deals with the symptoms of asthma and giving themselves followed by closed questions to request
instructions in an emergency situation. Finally, it specific details.
provides an introduction to understanding and
writing simple SOAP notes.
Symptoms and injuries about. The disadvantage is that the
Triage nurses working in an emergency room (or

doctor’s surgery/office) will be called upon to assess
patients suffering from a whole variety of
symptoms and injuries; the most common of
these being sprains or contusions (the medical term
for bruise). Chest and abdominal pain and
respiratory problems are also common reasons for
presenting to ER. Nurses will hear the terms signs
and symptoms. Signs are objective – what you can
see with the eye (bruise, swelling, redness) or
with medical equipment (e.g. vital signs).
Symptoms are subjective
– these are what the patient feels (headache, nausea,
etc.).
Students will be given the opportunity to build
word forms (noun, verb, adjective) of the vocabulary
most commonly used by patients to describe their
symptoms and injuries. They also focus on the past
simple and past continuous as a means of
understanding patients’ descriptions of how their
symptoms and injuries came about.
Asking about symptoms and injuries
Section 2 provides a framework of basic questions

that a (triage) nurse might use to find out about
their patient’s symptoms and complete the patient
record. Students focus on question types. Closed
questions are those requiring one-word answers
and are used when requesting factual information
from a patient or when there is a need to narrow
down options to make an accurate diagnosis. The
disadvantage is that it might take some time to
find out all the important information. Open
questions encourage the patient to describe their
symptoms in their own words, without the nurse
guiding the patient in a particular direction.
Answers tend to be more detailed than closed
questions. The nurse could find out important
information that he/she may not think to ask
Sympto 4 32
Asthma emergency – giving
instructions
In this section, students are asked to read an

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

(US) nursing document used to record
information about the patient, their symptoms,
the assessment and the proposed nursing plan.
The acronym SOAP stands for subjective –
what the patient actually says about the
problem (often written verbatim); objective –
what the nurse observes, either physical
symptoms or vital signs; assessment – the
nurse’s summary of the patient’s medical
problem; and plan – how the nurse intends to
treat the patient. Students will also be
introduced to some commonly used medical
abbreviations, including NKA (no known
allergies), IBP (ineffective breathing pattern)
and p.o. from the Latin pe os (by mouth).
Sympto 4 33
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
1 On the board, draw five arrows/patterns as in
and
7 on page 23. Ask students to brainstorm words
2. Come together as a group to check.
to describe these patterns. Then ask students,
in pairs, to draw charts similar to those on Some students may have difficulty expressing
page 23 and practise describing them as if to a their ideas effectively in English. Reassure
colleague or patient. them that for this activity accuracy is not
important – just encourage students to discuss
2 Refer students, in pairs, to the patient on page 24
their opinions.
and ask them to take it in turns to practise taking
the patient’s vital signs, using similar If your students are experienced nurses, ask
instructions. Remind students to use patient- them to explain the reason for their order of
friendly intonation patterns. care.
Symptoms and injuries 1 (Suggested answers)

a Difficult to give anything specific from the
picture. Common problems for infants: colic,
Vocabulary teething
1 Ask students, in pairs or small groups, to think b black eye, cuts, grazes and bruising
about emergency room(s) in their place of c mild asthma attack
work/country and ask them to brainstorm the d sprained shoulder, bruising
kind of symptoms patients generally present e cut finger
f chest pains, asthma, angina
with. Then ask them, individually or in pairs, to
2 f, c, d, b, a, e
read the text about emergency rooms in the USA
and complete it using the words in the box.
Listening
Check understanding of: contusion (bruise),
abdominal, respiratory, sprain. 3 ► 30 Tell students they are going to listen to
the six patients in the picture describing their
Ask students to compare their ideas with the
problems. As they listen, students should label
information in the text.
the pictures a–f in the order they hear them.
Ask: What can chest pains be a symptom of?
(heart attack, angina, asthma, allergies, anxiety, a5 b2 c1 d4 e3 f6
pain, fever, infection, diseases of heart and lung,
4 Ask the students to listen again and write the
stroke, head injuries, certain medications such as
description of the problem next to each
beta-blockers, aspirin, etc.)
person. Check understanding of: colic, nauseous.
Explain that nurses will hear the terms signs, Play the recording again if necessary.
symptoms and injuries. Signs are objective – what
you can see with the eye (bruise, swelling, a colic b black eye, contusion c asthma
redness) or with medical equipment (e.g. vital d broken wrist, nausea e bleeding, infection
signs). Symptoms are subjective – these are what f heart problem
the patient feels (headache, nausea, etc.). Injury
is the patient term for the physical damage to the Vocabulary
body (cut, broken bone).
5 Tell students they are now going to look at terms
patients frequently use to describe their symptoms.
1 injury 2 contusion/sprain Ask students, individually or in pairs, to complete the
3 sprain/contusion 4 abdominal/chest sentences about the symptoms and injuries of each of
5 chest/abdominal 6 respiratory the six patients using the words in the box. Point out
they will need to change the form of the word in some
cases.
Sympto 4 34
Ask students to indentify the symptoms and the injuries in the
sentences. (injuries: cut, banged head, bruise; symptoms: cough,
difficulty breathing, dizziness, infection, nausea.)
1 coughing, breathing 2 pain, dizzy

3 bleeding, infection 4 pain, sick
5 swollen, dizzy 6 bruises
6 If you have confident students, you may do 7

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

4 cough 5 dizzy 6 infect 7 pain 8 swell
9 sick
Extra activity
Ask: Find synonyms for more formal
medical words.
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 Room on page 28. On the board,
write write:
at least three sentences about each of the
What did Jason do? He off his bike. patients, using the past continuous and the past
What was be doing before he fell? He his bike. simple tenses.
Ask a stronger learner to fill in the gaps. On the board draw: In pairs, students take turns asking the patients
about their symptoms. Suggest students use
questions such as these to interview their
patients: Can you tell me what happened? What
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 ac
Ask: When do nurses use these two forms? (To understand how the patient arrived at their symptoms.) Give students time to ass
7 Ask students, individually or pairs, to use the

Language box as a reference to help them
complete the sentences with the correct form of
the verb in brackets. Go through the first answer
together if necessary. Come together as a group
to check.
Elicit/Pre-teach: soccer, pull a muscle, suffer from,
trip, dose.
For further practice of the target structure, refer
students to audio script 30 on pages 73–74 and
ask them to underline all examples of the past
simple and circle all examples of the past
continuous. This will allow them to see the
structures in context as well as serve to reinforce
usage. (past simple – started, said, felt, took,
didn’t, didn’t seem, brought, ran, wasn’t, had to,
came off, cut, didn’t hurt, wasn’t, was, fell,
banged, fell, had, gave, was, started, felt, was, was,
started, fell down, called; past continuous – was
playing, was coughing, was just coming up,
wasn’t going, was working, was painting, was
getting out).
1 was playing, fell over, pulled
2 was coughing, phoned, told
3 was running, brought
4 didn’t stop, took, were
not 5 presented, was
suffering 6 were doing,
started
7 was having, tripped, fell
8 didn’t think/wasn’t thinking, gave
Sympto 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.
Speaking 2 The pain moves down the arm and up to the
1 Ask students, in pairs, to observe the patient and chest. It lasts for around three minutes each time …
discuss questions 1–3. Encourage them to Ask: What is the difference between the two
explain their reasoning. Wait until students answers? (1 The answer is Yes/No. 2 This answer
listen to the recording in 2 to check the answers. is more 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)
nurse interviewing the patient, Mr Daniels. Ask Ask students, individually or in pairs, to look at the audio
them to listen and check their answers to 1. Play script 31 on page 74 and circle all the closed questions
the recording again if necessary. 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 questions
2 diagnosis not given (but possibly a 2 and 3. Come together as a group to check.
heart attack/angina) Pre-experience nurses may not yet have come
3 carrying a heavy object
across this communication technique, but should
3 Refer students to the patient record. If necessary, be able to identify some of the above.
allow them to familiarise themselves with the Some students may have difficulty expressing these ideas
contents of the patient record before they listen effectively in English. Reassure them that for this activity
again. Elicit/Pre-teach: located, radiate, condition. accuracy is not important – just encourage students to
1 chest 2 shortness 3 centre 4 arm 5 face discuss their opinions.
6 three 7 was carrying heavy things 8 two
9 third 10 breathing 11 very worried 1 open questions: 1, 6, 7, 8
12 worse 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.
across some of these in Unit 2. If necessary, do Disadvantages: The patient could start giving
the first one as a group. Ask pairs to compare information that is not relevant to the case.
This type of questioning could waste valuable
answers. Wait until 5 to check.
time. 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
In pairs, students should take turns asking and diagnosis. Disadvantages: It takes time to find
answering the nurse’s questions in 4, using the out all 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.
5 Refer students to audio script 31 on page 74

to read the nurse’s questions and check their
answers to 4. Encourage them to underline
Sympto 4 35
Then ask students, individually or in pairs, to
Extra activity complete the dialogues using question forms from
You could develop appropriate intonation for 4 and 6. If necessary, do the first few questions as a
question forms before students roleplay the group. Do not confirm the answers yet.
patient interview. On the board, write: Does the
pain move at all? Elicit the correct intonation
pattern. Go through each question as a group
chorus to ensure students are able to
reproduce/approximate the pattern.
Answer: Intonation rises at the end of polite
requests.
6 Ask students to look at question 1 and ask:

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

6 open 7 closed 8 open 9 open 10 closed
7 Ask students, in pairs or small groups, to

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

Ahmed and Vicky, and try to build up a picture
of the patients before starting the exercise. Ask:
What are the patients suffering from? What were
these patients doing before? Can you describe their
pain?
Speaking
9 ► 32 Tell students they are now going to
hear the two dialogues. Ask them to listen
and check their answers to 8.
Some of their answers may differ from those
in the recording. Check the different
possibilities before moving on to the next
stage of the exercise.
Ask students (in pairs) to practise the dialogues.
1 how it happened
2 I slipped and fell
3 has this happened
4 I touch here
5 really sore
6 of one to ten, how bad is the pain
7 Five, I guess
8 what happened
9 I was just doing my kickboxing class at
the gym
10 Dizziness or nausea
11 I feel a little sick
Extra activity
Refer students back to the patients on page 28.
In pairs, ask them to prepare a dialogue using
the question forms in 4 and 6 based one of
these patients.
Asthma emergency – giving instructions Ask students to brainstorm ideas for the
following question: What advice might nurses
give to asthma sufferers about how to enjoy a good
quality of life? (Take moderate exercise, don’t
Speaking allow smoking in the house or car, keep a diary
of the patient’s symptoms/peak flow diary to
1 Tell students they are going to read an article record the differences in the patient’s breathing,
from the World Health Organization (WHO) don’t have pets in the house, make sure the
about asthma. Ask: What is your experience of house is dust free.)
asthma?
1 windpipe 2 right lung 3 diaphragm
Pre-experience nurses may not have treated
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
to check their answers later. Alternatively, you In order to check their understanding of the
could give them the suggested answers below text, ask students the following comprehension
before moving on to 2. questions (either pre- or post-reading).
1 What generally happens when a patient
Suggested answers has an asthma attack?
Symptoms: coughing, breathlessness, 2 Which countries have the highest levels
wheezing (noisy breathing), tight feeling in the of 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
2 Ask students, individually or in pairs, to match the words asthma, using the diagram on page 32.
related to asthma to the correct definition.
Listening
1c 2a 3f 4b 5d 6e 4 ► 33 Ask students to look at the picture on the right of
the page and ask: What is the nurse doing? What type of
Reading
inhaler (do you think) is this? (She’s teaching her patient
3 Ask students to read the text and check their how to use his inhaler. It’s a Ventolin inhaler which is
answers to 1. Tell them the vocabulary in 2 used in emergencies. Note that Becotide inhalers are
will help them follow the text. used as preventative medication.)
Once they have read the text, ask students to Tell students they are going to listen to Practice
label the diagram with the words in the box. Nurse Nina talking to her patient Kyle Jenkins
With less confident students, you could check and his father during an asthma clinic. Ask
the answers to 1 before labelling the diagram. students to listen to Part 1 and decide if the
Then check answers to 3. sentences 1–5 are true or false. If necessary,
allow students to read the sentences before
playing the recording.
Ask students, individually or in pairs, to correct
the false answers. Play the recording again if
necessary.
1 T 2 F, football with his dad
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.
If your students are experienced nurses, Suggested answer
encourage them to visualise the process first, to First, sit down at a table. Don’t lie down. Then,
allow them to concentrate on the language. lean forward slightly and put your arms on the
table. Next, take up to six puffs of your inhaler.
a Take a puff on your inhaler at the same time Call an ambulance after six minutes if your
but don’t breathe out immediately. 3 symptoms don’t improve. Then, continue to
b Remove the inhaler and hold your breath for take your inhaler every six minutes, for a
10 seconds. 4 maximum of six puffs. Finally, repeat these
c Place the mouthpiece between your lips and steps, if your symptoms begin again.
breathe in as deeply as possible. 2
d Breathe out slowly and repeat if necessary. 5
e Breathe out gently and tilt your head back
slightly. 1
Language
The imperative
1 Refer students to the examples in the
Language box, then ask them to underline the
imperatives in 5.
It is important to point out that imperatives are
only used for giving clear, simple instructions.
2 On the board, write: First, breathe out. Then,
blow into the mouthpiece. Ask students to read
the sentence aloud, pausing very slightly after
each comma. Then ask: What effect do the
underlined words and the pausing have on the
instruction?
Answer: Staging words and pausing help
nurses to divide up the instructions and make
them easier for the patient to follow.
6 Tell the students they are now going to complete

the set of instructions. Ask them, individually or
in pairs, to complete the instructions for Kyle
using the verbs in the box. Come together as a
group to check.
1 Sit 2 lie down 3 Lean 4 put 5 Take

6 Call 7 Continue 8 Repeat
Speaking
7 ► 34 Ask the students, individually or in pairs,
to rewrite the instructions in 6, using staging
words.
Extra activity
Ask students to write simple patient
instructions for two pieces of medical
equipment, using the prompts below. If your
students are pre-experience nurses, first ask: 1
What is a peak flow meter? 2 What is a
nebulizer? What is a portable nebulizer? (A peak
flow meter measures lung capacity. A nebulizer
pumps medication into the lungs to help the
patient breathe more easily. Portable
nebulizers may be used in the home by the
patient.
1 Peak flow meter: blow out/sit up
straight/hard and fast/three times/record
the reading
2 (Portable) nebulizer: fill/put
on/breathe in/turn on/wash with
soap/slowly and deeply/medication
Then ask students, in pairs, to take it in turns to
roleplay giving instructions to their patient for
this medical equipment.
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
the text about SOAP notes. As they read,
the SOAP notes and answer the questions. Come
students should complete the text with the
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, but that
If your students are experienced nurses, ask: What is your
they will work on these in the next activity. Encourage
experience of using SOAP notes? Do you use another form of notes
them to ‘get the gist’.
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
2 Refer students back to the SOAP note written them, in pairs, to practise saying the
for Kyle and ask them, individually or in pairs, abbreviations as complete words.
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
You may wish to check students’ 3 and ask students, in pairs, to note the terms in
understanding by asking concept questions full: BP, RR, T, Ht, kg, DOB, Wt, P, O² Sats. The
about the SOAP note for Kyle, e.g. What does first pair with all the correct terms wins the
the patient say about his symptoms? What does game.
the nurse observe? What is the nurse’s diagnosis of Answers: blood pressure, respiratory rate,
the patient’s condition? How does the nurse decide temperature, height, kilogram, date of birth,
to 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.

your students:
• Compile a list of words related to food and
nutrition you already know in English.
• Write a diary of your food intake for the
week.
• Do some (online) research into Type 1
and Type 2 diabetes.
Symptoms 4 40
5 Food and nutrition
Briefing Food allergies and intolerances

This unit seeks to develop key language related to In the USA, food allergies affect nearly 4 percent of
nutrition and food before looking at skills to carry the general population and it is estimated that such
out a nutritional assessment and offering advice on allergic reactions cause 30,000 emergency room
improved diet. It also develops understanding of visits and 150 to 200 deaths every year. 90 percent
conditions related to food intake – food allergies and of these are caused by milk, eggs, peanuts, tree nuts,
diabetes. fish, shellfish, soy and wheat; and are often lifelong
Nutrition conditions. There is no cure for a food allergy and
minute amounts of a food can cause a reaction in a
A healthy diet comprises roughly one-third fruit and highly sensitive patient. Strict avoidance of the
vegetables, one-third starchy foods and one-third allergy-causing food is the key to preventing allergic
meat, dairy and oily, fatty and sugary foods. The reactions. A food allergy is an immune system
food pyramid (a graphic representation of the response to a food that the body mistakenly believes
different food groups and the proportions advised is harmful. Once this happens, the patient
for a healthy diet) is an authentic way of presenting experiences an adverse reaction and the body
the key words for this first section of the unit. creates specific antibodies against the food. The
Students are asked to draw on their general next time the individual eats that food, the immune
knowledge of foodstuffs and nutrients – system releases massive amounts of chemicals,
carbohydrates, proteins, fats, vitamins, minerals, including histamine, in order to protect the body.
fibre (and water) – and label the pyramid, indicating These chemicals trigger allergic symptoms that
dairy products, fresh fruit and vegetables, cereals, can affect the respiratory system, gastrointestinal
etc. They will then go on to compile definitions of tract, skin or cardiovascular system.
the food groups, highlighting which of these fights Food intolerance does not involve the immune
disease, repairs the body and helps digest food. system and is not life-threatening. Lactose
Describing quantities is necessary for a better intolerance – trouble digesting the milk sugar lactose
understanding of a patient’s diet and this unit – is a common example. Symptoms may include
provides ample practice of countable and abdominal cramps, bloating and diarrhoea.
uncountable nouns for this purpose.
The second part of this section provides discussion
Nutritional status on diabetes and takes students through the different
stages of administering a blood sugar test. Refer to
Good nutritional status is essential to the health the text on page 41 for an explanation of Type 1
and well-being of the patient. Extra demands and Type 2 diabetes.
placed on the body due to illness mean the need
for nutrients is increased. Poor nutrition can be Advice on diet
associated with delayed recovery; adequate This section begins by reviewing key words used to
nutrition not only promotes tissue repair, but also describe quantities and containers for food stuffs,
aids recovery from surgery and disease. including carton, packet, segment. Students listen to
Assessing nutritional status involves taking a school nurse giving government advice on
measurements (see Unit 3) and calculating the portions, focusing on the five-a-day campaign. The
BMI or Body Mass Index. A patient weighing 50 section then moves to develop students’ skills in
kg at 1.68 m would have a BMI of 50/1.68 x 1.68 giving suggestions and advice in a way that involves
= 17.7. A BMI of less than 18.5 indicates the the patient in the decision-making process and is
patient is underweight while a BMI of 30+ is an personalised/ adapted to the needs or lifestyle of the
indication of obesity. patient. Use of tentative suggestions, How about +
Nurses also ask questions to determine the patient’s -ing?, Can I suggest you + infinitive compared with
food intake. In this section students will have the strong suggestions based on medical evidence: It is
chance to analyse a patient’s food journal to check if advisable/important to + infinitive. Patient case
he/she is eating a balanced diet. histories are then presented to allow students to put
their skills into practice.
Food and 5 41
Teacher’s notes about the different food groups. Come together
Warm-up If your students are pre-experience nurses,
1 On the board, write: Closed questions and Open encourage them to make use of the information
questions. Ask students, in small groups, to in the third column to help them complete the
select one of the patients from page 28 and table.
brainstorm five questions for each heading to
assess the patient’s symptoms. This can be done 1 energy 2 build 3 digest 4 bones 5 fight
6 repair 7 skin
as a team game – the first team with ten correct
questions in a given time is the winner.
Language
2 Ask students, in pairs, to take turns to roleplay
an assessment with their patient from page 28. More confident students can complete 3 (and 4)
before referring to the Language box. They can
Nutrition then use this as a means of checking their
existing knowledge of the target structures.
Vocabulary For less confident students, write headings: a
1 Refer students to the food pyramid and ask and an on the board and ask them to brainstorm
them, in pairs or small groups, to brainstorm food stuffs for each column. Ask: When do we use
names of food stuffs they see. Depending on ‘a’ and when do we use ‘an’? (A is used in front of
your group, you may wish to add a competitive countable nouns beginning with a consonant, an
element and divide the group in two. The with countable nouns beginning with a vowel.)
winning group is the one that finds the most
food items in a given time. Countable and uncountable nouns
Draw a two-column table on the board. Do not
Depending on your group, they may know
label the columns but write in column 1
certain food stuffs as opposed to others.
biscuit, egg and in column 2 water, sugar. Ask
Ask students, individually or in pairs, to label students to add two more food items to each
the sections 1–4 of the pyramid with the words column and ask a stronger student to give each
from column 3 of the table. Ask them to column a title (Countable and Uncountable). Ask:
compare their ideas with a partner, then come What is the difference? (It is possible to count
together as a group to check. the nouns in column 1 but not those in column
2.)
If your students are experienced nurses, ask:
On the board, write: some, a lot of, How much?,
When might a nurse use the pyramid with
How many? Ask students to put these into the
patients? What is your experience of this type of
correct columns. (Some and a lot of appear in
chart? What other types of diagram might be used
both columns. How much? in column 2 and How
instead? (Nurses use food pyramids to give advice
many? in column 1.)
to patients on diet, to show them the proportion of
Remind students they can say a piece of cheese,
each food group they should be eating. Other
a bottle of water – the phrases in bold are
examples: eat-well food plate/a pie chart.)
countable.
Ask students to add typical food stuffs/dishes Give students time to assimilate the points
from their own culture to the sections of the covered in the Language box.
pyramid. Come together as a group to exchange
3 Ask students, individually or in pairs, to refer
ideas.
back to the pyramid and add foods to the two
1 fats, oils, sweets columns.
2 meat, fish, dairy products, beans, eggs
3 fruit and vegetables
4 potatoes, rice, cereal, pasta, bread
2 Refer students to the table and ask them,

individually or in pairs, to use the words in the
box to complete the statements in column 2
Food and 5 42
Suggested answers
Countable: some sweets, some crisps, some
sausages, a yoghurt, a chicken, some nuts,
some eggs, some peppers, some carrots,
some tomatoes, a lettuce, a cucumber, an
aubergine, some mushrooms, an orange, an
apple, a bunch of bananas, a pineapple, some Variation
grapes, some potatoes, some biscuits
Uncountable: some olive oil, some chocolate,
some fish, a glass of milk, some cheese, some
bacon, some broccoli, a bunch of celery, some
rice, some pasta, some cereal, some bread
4 Refer students to the photos of the four women and ask

them to read the texts and match the photos to the
correct text.
a3 b4 c1 d2
5 Ask students, individually or in pairs, to reread

the texts and underline the best word in each
case. If necessary, do the first answer as a
group. Encourage students to make use of the
information in the Language box if they are
unsure.
Check students understand: fussy, tofu, spicy,
papaya, pineapple, shellfish.
1 1 a 2 any 3 a lot of 4 much 5 a lot of

2 1 a 2 much 3 many 4 a 5 some
3 1 any 2 any 3 some 4 a lot of
4 1 an 2 much 3 any 4 any 5 a lot
Writing
6 Ask students to write a short paragraph to
describe their own diet and eating habits.
Encourage them to use the target language
and structures.
Encourage less confident students to use the
texts in 5 as a model. Students may wish to
work in pairs or small groups for collaborative
writing.
Extra activity
Ask students to prepare a brief presentation
to deliver during the next class. Ask them to
find a food pyramid or something similar
that reflects typical eating habits of a
patient/a child/a culture that they don’t know
well.
Alternatively, they research and design a food
pyramid to represent typical food intake and
quantities for one of the above. They present
the information on PowerPoint slides, if
possible, as a case study during the next class.
Food and nutrition 5 43

Nutritional status c last night, 10pm, bowl of soup and toast
Vocabulary 3 Ask students to read Alain’s food journal and

then complete the statements about his
nutritional status based on this and the
1 If your students are experienced nurses, ask:
information in the assessment form.
What is the Body Mass Index used for? How is it
measured? (The Body Mass Index or BMI is used 1 slightly underweight 2 gain weight
to decide if a patient’s weight is healthy, 3 normal weight 4 doesn’t eat enough
compared with their height squared.)
Elicit/Pre-teach adjectives that nurses might use Speaking
to describe a patient’s weight: overweight, obese,
underweight. 4 Refer students to Alain’s food journal and ask:
What do you think a food journal is used for?
It is important to point out that the adjective fat Who fills in the journal? (Patients suffering
is not used in a medical context – use of from weight problems may be asked to fill in a
overweight or obese and variations of these are food journal so that the nurse or nutritionist can
used instead. advise them on a weight loss/gain plan if
Ask students, individually or in pairs, to read necessary.)
the text about BMI and complete the statements Ask students, individually or in pairs, to read
using the words in the box. through Alain’s food journal and answer
Remind students that numbers with decimal questions 1 and 2. Come together as a group to
points are pronounced like this: twenty-five point check. See 5 below for complete answers.
five. (In some languages a comma is used instead 5 ► 36 Tell students they are now going to hear
of a point.) Nurse Sam assessing Alain’s food intake. Ask
Ask: How do you think nurses might calculate the them to listen and compare her advice with their
BMI of a patient who is not able to stand? Is the BMI own.
suitable for measuring children/a baby? Less confident students could complete 6 before
Answers: Ask the patient to open their arms listening to the audio.
outstretched at shoulder height and measure the
distance between the tips of the middle fingers – Suggested answer
this measures the height of the patient. Use mid Assessment and advice: Bad points: calorie
intake is very low; it’s not a balanced diet; lacks
upper arm circumference (MUAC)
sufficient protein, carbohydrates and fibre; he’s
measurement. If the MUAC is less than 23.5 cm,
skipping breakfast (after eight to ten hours
the BMI is likely to be less than 20 kg/m2 without food, the body needs energy); he drinks
(patient is likely to be underweight). If MUAC too much coffee
is more than 32.0 cm, the BMI is likely to be Good points: brown bread is a good source of
more than 30 kg/m2 (patient is likely to be fibre; he eats three portions of fruit and
obese). The BMI and MUAC measurements are vegetables a day; his only snack was a piece of
only suitable for adults. fruit
1 underweight 2 overweight 3 obese 6 Ask students, individually or in pairs, to complete

the sentences using the words in the box. Play the
recording again. Come together as a group and
Listening
check. Check understanding of: snack, balanced,
2 ► 35 Tell students they are going to hear skip, source.
Nurse Sam McCarthy assessing Alain’s
nutritional status. Ask students to listen and 1 intake 2 balanced 3 lack 4 skipping
complete the Nursing Assessment form. If 5 energy 6 source 7 snack
necessary, ask them to familiarise themselves
with the assessment form before listening.
Check understanding of: allergies.
a 22.4 b peanuts

7 ► 37 Ask students to listen to the final part
of the assessment and complete the statements
about Alain.
If your students are experienced nurses, ask: Do
you find it difficult to follow a good diet at work?
What kind of food do you eat while at work/on shift?
nurse, fruit/vegetables/yoghurts/avocados
Reading
8 Ask students to read through the case history
and food journal for patient Annabelle Driver.
Ask some comprehension questions: What kind
of surgery did Annabelle have recently? What is
her job? What do we learn about her family
life? What is her general health like?
Ask students, individually or in pairs, to write
six sentences about her food intake.
If necessary, elicit/pre-teach: varicose vein
(surgery), deprived area, recover, depression, single
parent.
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.

Food allergies and intolerances
Extra activity
In small groups, students answer these
Speaking questions:
1 Name two ways that a food allergy can be
1 Ask students, in pairs, to discuss the questions. diagnosed.
Come together as a group to brainstorm possible 2 How do these tests work?
answers. Avoid correcting at this stage as
3 What advice would you give a patient
answers will be supplied in 4. Ask: Who suffers
suffering from a food allergy?
from allergies, other than food allergies? What are the
e.g. It might be a good idea to …, Can I suggest
symptoms?
you …
If your students are experienced nurses, ask:
What is your experience of dealing with patients with
Pronunciation
(food) allergies?
5 Ask students, in pairs, to read the sentences out loud
Reading and then underline the stressed syllable in the
words in bold. Encourage them to divide each of
2 Tell students they are going to read a patient
the words in bold into syllables first as this may
education leaflet about food allergies. Before
help them distinguish the sounds.
they read, ask them, individually or in pairs, to
match the words 1–4 to the correct definitions Depending on your group, you may wish to
a–d. Come together as a group to check. read out the first sentence aloud as a group
chorus, to discourage embarrassment. Avoid
Alternatively, you could ask more confident
checking at this stage.
students to do 3 first, without correcting at this
stage – allow them to read the target language in On the board write: allergy and allergic. Ask a
context first and encourage them to deduce the stronger student to underline the stress in each
meaning from context. case (allergy / allergic).
1c 2a 3d 4b 6 ► 38 Ask students to listen to the recording

and check their answers. Then play the
3 Ask students, individually or in pairs, to recording again, asking them to listen and repeat
complete the first part of the patient leaflet using the stress pattern they hear.
the words in 2. Check comprehension of:
Play the recording several times until you are
release, histamine, gastrointestinal tract.
happy students are able to reproduce the
1 adverse 2 immune system 3 harmful same/approximate stress pattern.
4 antibodies Students may already know some of these
words from their own language, but will tend to
4 Before students read the second part of the
place the stress in the wrong place in English.
leaflet, write two additional questions on the
Ask them to compare stress patterns in their L1.
board: When do symptoms typically appear?
When should a patient call the doctor? Remind 1 allergies 2 allergic 3 abdomen
them of the questions in 1, then ask them to 4 abdominal 5 respiratory 6 respiration
read and correct their responses to 1. Come
Extra activity
Check understanding of: rash, eczema, Ask students to practise reading the patient
consciousness, disappear. leaflet in 3 aloud as a group for controlled
practice of the stressed words.
Most common food allergies: fish, shellfish,
Then one by one, ask students to read the
peanuts, milk, eggs, wheat, nuts, soy
Symptoms: tingling sensation in the mouth, leaflet aloud. Explain that when you say
rash, swelling, eczema, abdominal cramps, ‘Stop’ the next student should continue.
diarrhoea, vomiting, swelling of the tongue Make sure that all the students are given an
and throat, wheezing, breathing difficulties, fall opportunity to practise the target word stress.
in blood pressure, loss of consciousness, If necessary, repeat the activity to ensure this
death takes place.
46
Food and nutrition 5
Speaking questions. Ask them to compare their answers in
If your students are pre-experience nurses, you pairs, then come together as a group to check.
may prefer to set 7 and 8 as self- Note that the answer to 4 is contained in the
study/homework. It is not necessary for illustration, not in the audio script.
students to have completed 7 and 8 in order to
carry out the rest of the activities in this section. 1 the patient’s blood sugar level 2 top of the
finger (any) 3 test strip 4 106, this shows the
7 Ask students, in pairs, to discuss questions 1–3. level of glucose in the blood
Ask them to join up with another pair to
compare their answers. Avoid correcting their
ideas at this point.
Extra activity
Refer students to audio script 39 on page 75
Pre-experience nurses may find this activity a and ask them, in pairs, to practise the dialogue.
little challenging. Reassure them that this is not a This allows them to ‘see’ the target language
test. in context, thus reinforcing what they have just
If your students are experienced nurses, you heard.
could ask: What are the symptoms of diabetes?
What is the difference between Type 1 and Type 2 Speaking
diabetes?
11 Ask students, in pairs, to take turns to practise
Reading taking their partner’s glucose level using the
prompts 1–6. Tell them they can also make
8 Tell students they are now going to read a use of the images in 9 to help them structure
definition of diabetes taken from a reference their roleplay.
book for nursing students. Ask them to read and
find the answers to the questions in 7. Encourage them to use staging words from Unit
4. On the board write: firstly, then, next, finally.
Check understanding of: hormone, Ask students to brainstorm other staging words
pancreas, respond, thirsty, link. that could be used when explaining a medical
process to a patient. Ask: Why are staging words
1 Diabetes is a condition where the body is
useful? What else is important when explaining a
unable to produce glucose, a sugar which the
process to a patient? (Always keep patients
body uses for energy. The body has a very
high blood sugar. The level of glucose is informed before carrying out the process. Pause
usually controlled by the hormone insulin. slightly after each staging word. This makes it
2 Type 1 diabetes is caused when the easier for the patient to follow the information
pancreas doesn’t create enough insulin. Type provided by the nurse – it divides up the
2 diabetes is caused because the body is not information into manageable chunks. It is also
able to respond to the insulin in the body. important to use patient-friendly intonation.)
3 Type 1 diabetes can be controlled with
Students may wish to make notes first before
insulin. Type 2 diabetes can be controlled
with diet and exercise. practising their dialogue.
Listening
9 ► 39 Tell students they are going to listen to
a student nurse, Joely Thomas, learning how to
administer a blood sugar test. Ask students,
individually or in pairs, to label the diagram
using the words in the box. Point out there are
two answers required for c.
a screen b finger c drop of blood, lancet

d test strip e plaster f glucometer
g blood glucose chart
10 Refer students to questions 1–4. Ask them

to listen to the recording again and answer
the

Advice on diet
Extra activity
On the board, write the following list:
Vocabulary carbonated/sugary drinks
1 Ask students, individually or in pairs, to look at the sugary snacks: chocolate, cookies, sweets, etc.
containers and quantities and match them to the correct salty snacks: crisps, peanuts, pretzels, etc.
word. Encourage students to use their knowledge of ready-made meals, takeaway foods
general English to help them. Ask them to compare answers high-calorie desserts: chocolate mousse, carrot cake
with another pair before coming together as a group to red meat
check. fried food: chips, fried fish, etc.
skipping breakfast
Ask students to brainstorm two or three snacking between meals
examples for each of these, e.g. bottle of eating after 8pm
tomato sauce, slice of bread, etc. 1= easy to stop 2 = a little difficult, but I could stop
3 = very difficult to stop
1 can 2 carton 3 glass 4 tablespoon Ask students, individually, to look at the list
5 packet 6 slice 7 piece 8 stick 9 bottle and, using the scale 1–3, decide which dietary
10 segment habit(s) they would find difficult to change.
On the board, write:
Listening … are cheaper/more practical than …
I want to stop eating ..., but it’s not easy.
2 ► 40 Ask: What is a school nurse? What do you I’ve tried to stop, but …
think their role is? Does this post exist in your My partner loves … and it makes it more difficult to
country/place of work? stop.
Tell students they are going to hear Maggie, a Ask students, in pairs, to discuss their
school nurse, giving advice on nutrition to a responses, using these phrases.
group of adolescents. Ask students to listen and
tick the quantities/containers they hear. 4 ► 41 Tell students they are now going to listen
Reassure them it is not necessary to understand the whole to nurse Brad Tyler giving advice to three of his
recording on first hearing as they will have a chance to listen patients, Lena, Frank and Edith. Refer students
to the recording again later. to statements 1–3 and ask them to listen and
complete the statement for each patient.
Encourage students to use the information in the
slice, segment, portion, carton, stick, a lot of, statements to help them guess the rest. Play the
packet recording again if necessary.
3 Refer students to the questions 1–5. Ask them
to listen and answer the questions. Encourage 1 gain weight, build up her appetite
students to take notes as they listen. 2 improve his diet
3 lose weight/take exercise
1 Eat five portions of fruit and vegetables 5 Ask students to listen to the recording again and
a day. complete the nurse’s suggestions. Students should then
2 one apple, fourteen cherries, two slices of match each suggestion to the correct patient, Edith,
mango, eight segments of canned Lena or Frank. Ask them to compare their answers with
grapefruit, one tablespoon of raisins, two a partner, before coming together as a group to check.
figs, 150 ml of fruit juice
3 three sticks of celery, three tablespoons of 1 walking, dog E
cooked/canned/frozen vegetables 2 eat, often L
4 These do not count as a portion of 3 eating fish F
vegetables. 4 exercise, lose weight E
5 Be careful of them because they only count 5 drink, water L
as one portion of vegetables and contain a
lot of salt and sugar.
Food and 5 48
Language Extra activity
Ask students, in pairs, to write three or four
Giving suggestions and advice more pieces of advice using should +
Refer students, in small groups, to the infinitive. Ask them to pass their suggestions to
Language box and ask them to note the form in another pair, who rewrite them in the
each case. appropriate form
Answers: should (not) + infinitive; – tentative or strong.
How about + -ing; Can I suggest you + infinitive; Variation: Write the advice on cards. Divide
It’s advisable/important to + infinitive each small group into two teams. Each player
Refer students back to 5 and ask them to turns over a card and reads out the piece of
indicate what type of advice is being given in advice to another team member, who then
each case (tentative or strong suggestion). offers their own stronger/tentative version.
Answers: 1 tentative 2 tentative 3 tentative Teams win a point for each correct answer.
4 strong 5 strong Writing
Still focusing on 5, ask: When do we use the three
ways of giving suggestions and advice? 7 Refer students back the three patients in 5. Ask them
Answer: should (not) + infinitive: to give a to write two pieces of advice for each of the three
strong opinion; How about + -ing/Can I patients.
suggest you + infinitive: to encourage the
patient to take responsibility and/or take part in Speaking
the decision- making process; It’s
8 Put students in pairs and refer Student Bs to
advisable/important to + infinitive: to give
strong advice in an impersonal way – this page 68. Ask the pairs to read through their
makes it sound less threatening to the patient. instructions and the relevant case history and
Give students time to assimilate the points food journal carefully and then carry out the
covered in the Language box. roleplay.
If necessary, go through the case histories and
6 Ask students, individually or in pairs, to rewrite food journals in detail first as a group before
the suggestions 1–6 by replacing should with asking students to roleplay the scenarios.
another expression from the Language box. Students then swap roles.
Alternatively, you may wish to ask a stronger Preparing for the next unit
student to decide if the pieces of advice require
tentative or strong suggestions. Check this first In preparation for Unit 6, suggest the following to
before asking the students (individually or in your students:
pairs) to carry out the activity. Come together as
a group to check. • Compile a list of words related to patient care that
you already know in English, e.g. toothbrush.
Suggested answers
• Think about all the different ways a nurse may be
1 It’s advisable to only eat red meat once
required to assist a patient on a daily basis.
a month, according to government advice.
2 It’s advisable to eat breakfast: it’s the • Do some (online) research into how to treat
most important meal of the day. and dress minor wounds.
3 Why don’t you play football with your kids
in the park?
4 It is important not to drink more than one
cup of coffee at night.
5 How about going swimming if this is
your favourite sport?
6 Can I suggest you reduce the number
of complex carbohydrates in your diet?
Food and 5 49
6 Personal care
Briefing prepositions with/without is covered in this section of

the unit: He hates using the commode., Do you need help
This unit focuses on developing language and skills with putting on your tights? Finally, in situations such
related to caring for the patient’s basic personal as these, nurses need to be able to distinguish
hygiene needs as well as wound care management. between offers, requests or refusals of help: What do
It also seeks to further improve effective you need help with? Could you give me a hand with …? I
communication skills, particularly the want to try and do it myself.
demonstration of empathy in situations that patients
might find embarrassing or frustrating. Empathy
Patient hygiene Empathy is the ability to perceive and understand
another person’s emotions, a key aspect of nurse-
Personal hygiene involves far more than just the patient communication. However, it is not one that
physical act of cleaning the patient to reduce is easy to replicate, as emotions can be hidden or
potential infection; indeed it is more about caring for displayed through behaviour that contradicts how a
the overall well-being of the patient. It is therefore person actually feels. A patient complaint about the
essential that nurses help provide a conducive mistreatment of a geriatric patient suffering from
environment as well as the necessary assistance early dementia provides the context to this section.
required for their patients to carry out these basic Students are required to analyse the case and then
tasks as independently as possible. offer advice on how the nurse might improve his
Students begin this section by familiarising communication with the patient.
themselves with vocabulary related to personal Patients can find loss of independence frustrating,
hygiene, including not only washing and dressing embarrassing, even humiliating and depressing. In
but also grooming (shaving, basic nail and hair care, the second half of this section, students look at ways
make-up) and oral hygiene. Keeping the patient to improve communication in such situations. They
informed of intentions is important when providing learn to recognise examples of empathy through
such assistance, as this is essential in terms of tone of voice, before developing expressions, not
maintaining patient dignity. Focus is therefore given only to show empathy (I understand how you must
to the use of be going to + infinitive to talk about be feeling.), but also to demonstrate both reassurance
intentions: I’m going to explain the procedure to you (Don’t be embarrassed, it can happen to anyone.) and
first.; and events that are planned: We’re going to respect for patient privacy (Do you want me to
discharge Mr Singh later this afternoon. come back later?) The unit then looks at how patients
It should be noted that depending on the country of use adjective endings -ing or -ed to inform the nurse
origin, nurses may or may not carry out the personal about how they themselves feel (depressed) or what
hygiene duties mentioned above. they think about the situation (humiliating).
ADLs – activities of daily living Wound management
ADLs or activities of daily living consist of routine Wound management refers to assessing, treating,
everyday activities people carry out without and dressing a wound. This final section seeks to
assistance – bathing, dressing, oral hygiene and develop key language items – saline solution,
toileting (walking/eating are not covered in this absorbent dressing, tape and disposable gloves –
unit). Nurses refer to the ability or inability to before working on skills for changing a dressing.
perform basic ADLs as a measurement of the The Wound Assessment and Treatment Chart is
functional status of a patient. Students complete an completed by the nurse when first assessing the
ADL checklist to assess their patient’s ability to patient’s wound. The chart includes a description of
carry these out either independently or with the wound type – traumatic, pressure ulcer (bed
assistance, and acquire vocabulary for items used to sore), the wound closure – open, sutured (stitches)
help patients with their ADLs: bed pan, urinal or clipped, the kind of dressing required and how
bottle, walking frame, etc. Use of the -ing form often it should be changed, as well as an assessment
after certain verbs love/hate/finish and following of the level of pain the patient is feeling.
Personal 6 50
Teacher’s notes Extra activity
Show students pictures of patients (from
Warm-up magazines, online sources) or describe patients
1 On the board, write up your food journal for the – woman, heavily made up; a man with a five
week and ask students to analyse and advise o’clock shadow, for example; and ask students
you on your food intake. to identify the items needed for washing and
grooming of these patients. Then ask them to
2 Divide the group into three and allocate one of the come up with their own examples.
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
washing and grooming. Then ask them, in pairs Listening
or small groups, to label the items a–w. 3 ► 42 If you have less confident students,
Depending on your group, you may wish to add you may wish to ask them to do 4 before 3 as it
a competitive element and divide the group in only requires gist understanding.
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 the table 2 F, Mrs Turner is breathless, Mary has
and ask them, individually or in pairs, to put the items a–w no energy.
into the correct column. Ask them to look at the examples 3 F, She says, ‘I can do that by myself.’
first. Point out that some items might go into more than one 4T
column. 5T
6 F, The nurse encourages the patients
go slowly and take a rest when necessary.
Washing: washbowl, blanket, disposable 7T
wipes, soap, shampoo, towel, washcloth, swab
Grooming: nail brush, comb, brush, hand 4 Play the recording again and ask students to tick
cream, deodorant, mirror, razor, shaving the items that correspond to the correct patient,
cream, make-up either Mrs Turner or Mary.
Oral hygiene: toothpaste, kidney basin, mirror,
swab, toothbrush, towel Mrs Turner: kidney basin, swab
Patient clothing: nightdress, dressing gown, Mary: hairbrush, mirror, towel, washcloth
pyjamas
Personal 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
Be going to + infinitive for future

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

discharge, procedure.
Ask students to read through the situations 1–6
and think about the intention of the nurse or
doctor in each case. Then ask them, in pairs, to
complete the sentences and questions using the
correct form of be going to and the verbs in the
box. Ask them to compare their answers with
another pair before coming together as group to
check.
1 is going to help
2 am not going to give
3 Are (you) going to
check 4 is not going to
discharge 5 are going to
explain
6 Are (you) going to take
Personal care 6 52
ADLs – activities of daily living Language
Vocabulary -ing form

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?
(Toileting: commode/urinal bottle/bed pan. 3 Refer students to the questions 1–5 and then ask
Washing: shower chair. Walking/Moving them to listen to the dialogues again. Check
around: walker/walking frame/walking stick.) understanding of: shaving, shaky, tights, need a
Come together as a group to check. hand with.
Ask students to listen to the dialogues again and complete
1 commode 2 shower chair the responses to the questions. Ask students, in pairs, to
3 walker/walking frame 4 walking stick
compare their answers, before coming together as group
5 urinal bottle 6 bed pan
to check.
Listening You may wish to suggest students check their answers

by reading through audio script 43 on page 76. This
2 ► 43 On the board write: independent, needs will serve to reinforce the target structures and language
help and dependent. Check understanding of covered in this section.
these terms. Tell students they are going to hear
a nurse assessing four patients, Mr Karam, 1 it’s difficult to hold the razor still
Elaine, Samson and Mr Bates. Ask them to without cutting himself.
listen and write one of these assessments against 2 she can’t put her tights on without
bending down.
the 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
with Mr Karam and check students understand his 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
Play the recording again if necessary. Ask he 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
Reading text).
2 The poor care of her father by Nurse
1 Tell students they are going to read a complaint form. Jones during his stay in St Marc’s Ward.
Refer them to the form and the photo of the patient. 3 Nurse Jones seems unhappy with his job
in general, and does not feel his salary is
Explain the photo would not usually be attached
high enough.
to a complaint form – this is to support students 4 She wants the department to investigate her
in this activity. father’s case.
Ask students, individually or in pairs, to read 5 Suggested answer: He needs be more
sections 1 and 2 and answer questions 1 and 2. caring towards his patients and show some
empathy. He should imagine he was caring for
Then ask them to compare their answers with a
a close family member or friend. He should
partner, before coming together as a group to
consider going on a communications course.
check.
Extra activity
You may wish to ask students more structured
Ask experienced nurses: What is your experience
comprehension questions to facilitate the
of working with geriatric patients? Why might it
reading process: What is the patient’s name?
be difficult for nurses working in this kind of
How old is he? What is his ethnic origin? Who is
department in general? Why might it be difficult
making the complaint? When did the incident take
to assist patients with dementia with their ADLs?
place?
Who is Ms Hynd and what did she do? When did the complaint take
place? Pronunciation
1 Patient is Winston Miller, 88 years old, of 3 ► 44 On the board write: empathy. Explain to
Afro Caribbean origin. His consultant is Dr Hew students that Nurse Jones has been criticised by
Jones from the Geriatrics department. The the Complaints Board because he didn’t show
patient stayed in St Marc’s Ward between 15 empathy towards his patient. Ask students,
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.
2 Suggested answers: racism, poor treatment If your students are experienced nurses, put
by the consultant, the medical procedure, them into pairs or small groups to brainstorm
incorrect diagnosis, (if students are looking at their own definition of ‘empathy’.
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
2 Elicit/Pre-teach: dementia, geriatrics, impolite, treat bilingual dictionary.
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
Refer students to questions 1–5 and ask them to complete the table to show how much empathy
read Section 3 of the complaint form. Ask them, each nurse demonstrates.
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 indentify
Extra activity
expressions of empathy, but reassure them they will be looking
at this in more detail in 6. Ask students, in pairs, to read audio script 44
on page 76 aloud. Ask them to ‘feel’/notice the
1 a lot of empathy 2 no empathy difference between dialogues 1 and 3 and
3 a little empathy dialogue 2. Swap roles.
Tone of voice, expressions, e.g. I understand Ask students to take turns to roleplay
how you must be feeling., I can see it’s difficult dialogues 1 and 3 again, this time encouraging
for you. them to use patient-friendly intonation
patterns, touch, ‘warm’ facial expression, etc.
Extra activity Ask them to feed back to the class about the
Ask experienced nurses: On a scale of 1–5 (1 = experience.
very easy), how easy is it to show empathy to Some students may have difficulty expressing
patients? Ask students to explain their rating. these ideas effectively in English. Reassure
them that for this activity accuracy is not
5 Ask students to listen to the three dialogues important – just encourage students to discuss
again and complete the summaries about each their opinions.
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
2 washing her hair, embarrassed Check students understand: adjectives ending in
3 sickness, depressing -ing describe the patient’s feelings while
adjectives ending in -ed describe the situation.
Vocabulary Ask students, individually or in pairs, to

complete the sentences, using an appropriate
6 Tell students they are now going to develop adjective from the box. Point out that more than
expressions they can use to improve one answer is sometimes possible. Come
communication with their patients. On the board together as a group to check.
write: show empathy, reassure the patient, respect
the patient’s privacy. 1 humiliating/embarrassing
2 humiliated/frustrated/embarrassed
Check understanding of: reassure, privacy. Ask
3 embarrassed/humiliated
students to reorder the words in 1–7 to form 4 depressed
expressions for each of the headings on the 5 frustrating/embarrassing
board. 6 embarrassing/humiliating
Remind students of the patient-friendly
intonation covered in Unit 2, (gentle rise and Extra activity
fall). Ask students, in pairs, to practise saying Ask students to think about a patient they
these expressions as if to a patient, using patient- know/someone they know who has been in
friendly intonation patterns. If necessary, ask a hospital and ask them to write three or more
stronger student to model an appropriate sentences about their ‘patients’ using the
intonation pattern for the first example. adjectives in 7.
1 I understand how you must be feeling.

2 I can see it’s difficult for you.
3 Please don’t worry Josh. Let me clean you
up and you’ll feel much better.
4 Don’t be embarrassed Sheila. It can happen
to anyone.
5 I’m used to it; it’s part of my job.
6 Do you want me to come back later?
7 I’ll bring a screen to put round the bed.
You can have a little privacy.
Personal care 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
1 Ask: What does the term ‘wound management’ the dialogue between the nurse and Una
mean? (assessing, treating, dressing and changing a Hagans to help reinforce the target language
wound) What is your experience of wound items. Encourage students to use patient-
management (of a patient/your own)? friendly intonation patterns.
Refer students to the pictures at the top of the page and ask
them, individually or in pairs, to number the pictures 1–6 in Writing
the correct order for cleaning a wound.
3 Refer students to the chart and ask: What is it for? Who
completes it? When?
a2 b3 c4 d1 e5 f6 (The Wound Assessment and Treatment Chart is
2 ► 45 Elicit/Pre-teach: heal, hardly, remove, completed by the nurse when he/she first
odour, secure. Tell students they are going to assesses the patient. It includes a description of
hear a nurse treating her patient, Una Hagans. the type of wound, the type of dressing required
Refer them to the dialogue and ask them, and how often it should be changed, as well as
individually or in pairs, to complete the nurse’s an assessment of the level of pain the patient is
half of the dialogue using the words in the box. feeling.)
You may wish to ask students to label the Pre-experience nurses may not yet be aware
pictures with the words in the box first. This will of this chart, but reassure them that they will
help them complete the nurse’s dialogue. Point have a better understanding at the end of this
out they only need to use eight of the twelve section of the unit.
words in the box to label the pictures – the other
words in the box will be used to complete the Ask students, in pairs, to read the Wound
dialogue. Note also that some words are used Assessment and Treatment Chart for Una
both to label the pictures and to complete the Hagans. Encourage them to use a bilingual
dialogue. dictionary to check any of the terms they are
unsure of.
Explain that nurses should always confirm the
patient’s name first before beginning wound Point out that this is a slightly simplified version
care. Experienced nurses will already be aware of the Wound Assessment and Treatment Chart.
of this. Experienced nurses may notice some omissions.
Brainstorm suitable questions a nurse might ask Ask students, individually or in pairs, to fill as much of
for this. (Can you just confirm your name for me the chart as they can from memory. Then play the
(please)? Can you give me your full name recording to allow them to add additional information. If
please?) necessary play the recording again. Refer the students
back to the dialogue in 2 and come together as a group to
Play the recording and ask students to listen and check.
check. Play the recording again if necessary.
Ask students, individually or in pairs, to label
the pictures using the words in the box. This Type of wound: surgical
will help reinforce the target language. Infection: no
Dressing frequency: daily
Dialogue: 1 wound 2 antibiotics Antibiotics: no
3 disposable gloves 4 sutures 5 dressing Odour: no
6 bin 7 pus 8 edges 9 saline solution Pain assessment: 2
10 absorbent dressing 11 tape Wound closure: sutures
12 wound assessment Wound dressing: absorbent
Pictures: 1 bin 2 sutures 3 wound Comments: wound feels itchy
4 saline solution 5 disposable gloves
6 absorbent dressing 7 tape
8 wound assessment chart
Personal 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 page and ask:
problems of elimination/bodily functions
What type of wound do you think it is? If your students are
with others/medical professionals.
experienced nurses, you can also ask: How would you
manage this type of wound? Avoid correcting at this stage. • Do some (online) research into the treatment
of problems related to patient elimination, e.g.
Ask students to read through the case history for the patient,
constipation.
Mia Fox. Check understanding of: inflamed, moderate,
antimicrobial dressing. Then ask students, individually or in pairs,
to complete the Wound Assessment and Treatment Chart for
the patient. Ask students to compare their charts, before
coming together as a group to check.
Name: Mia Fox

DOB: we know she is 19
Type of wound: burn
Location of wound: arm
Infection: yes
Dressing frequency: every third day
Antibiotics: oral
Odour: no
Pain assessment: 3
Wound closure: open wound
Wound dressing: antimicrobial dressing
Comments: patient burned arm in kitchen
accident
Speaking
5 Tell students they are going to roleplay a nurse
assessing the patient, Mia Fox. One student takes
the role of the patient, and the other the nurse.
Refer students (in pairs) to the prompts (1–4)
and ask them to use these to carry out the
roleplay. They then swap roles.
If necessary, start by brainstorming possible
expressions for each stage of the procedure as a
whole group activity. You can refer students
back to relevant units for each stage: 1 – unit 1,
2
– units 2 and 4, 3 – this unit, 4 – this unit.
Students may wish to write notes first before
carrying out the roleplay. They could use the
dialogue on page 50 as a model.
Personal 6 58
7 Elimination
Briefing teachers carry out these same techniques with their

students.) Students are asked to analyse part of an
This unit deals with the sensitive subject of assessment in terms of the active listening skills
elimination, concentrating on bowel waste and the employed by the nurse, before being given the
related conditions of diarrhoea and constipation. chance to practise the skills themselves.
Students are made aware of the benefits of active
listening, an important aspect of effective The section continues to build on suitable language
communication, and learn how to give a simple structures (present perfect and past simple) for
patient case presentation. assessing patient elimination – determining the
period of time the patient has suffered the condition
Assessing patient elimination (constipation). Usage and form of these structures
is consolidated through the writing up of a nursing
Elimination is a fundamental human process that assessment.
includes elimination of urine, faeces – the waste
products of digestion, excreted through the bowel – Diarrhoea
and menstrual waste. Being able to meet the
patient’s elimination needs, in a manner that is Abnormal bowel habits result in constipation and
sensitive and respects their dignity, is an essential diarrhoea; the latter characterised by the excess of
function of nursing. Assessing a patient’s water in the stool and the marked frequency of
elimination pattern can be challenging, as patients defecation; anywhere from three per day. Students
often feel very uncomfortable discussing this aspect are asked to consider the significance of this
of their health and information is often condition in the developing world where diarrhoeal
misinterpreted. It is therefore very important that disease is second only to pneumonia as the main
nurses have a general understanding of colloquial cause of death in children under five. (Read the
expressions so as to avoid asking patients to repeat article on page 56 for more detail about this
themselves, thus creating further embarrassment. condition.) Students are then asked to listen to the
Section 1 seeks to build target lexis, making the experience of one particular nurse working East
distinction between the more formal or medical Africa as she describes the treatment of
terms – incontinence, bowel movement, bladder dehydration, a side effect of diarrhoea.
control, defecate, urinate – and those used more
commonly by the adult patient – go to the toilet Presenting a patient case
(UK)/bathroom (USA) – as well as those of the As in many other disciplines, nurses are required to
child deliver presentations. Patient case presentations
– pooh and wee. Students will in this section start to generally take place during the nursing handover
develop a series of assessment questions relative to and constitute semi-formal presentations of the
this area, using the past simple and present perfect patient’s current situation. A complete case
tenses, beginning with a review of past participles. presentation might include an introduction, history
Describing bodily functions of the present illness, physical examination,
diagnostic studies, differential diagnosis,
Section 2 continues work on assessment for this management and summary of the case. This section
sensitive topic by developing students’ active deals only with the introduction, providing students
listening skills; demonstrating that the nurse is first with a model and then asking them to create
really listening to their patient. This can be done their own based on a nursing assessment, tying all
either through verbal expressions: I see, go on, the various elements of the unit together.
anything else? or sounds: uh-huh?, or by using non- Mention is made of the Bristol stool chart, a medical
verbal signals such as nodding or smiling warmly. tool designed at the University of Bristol, UK
Silence and repetition of the patient’s words are also (1997), to categorise faeces into seven ‘types’.
effective listening techniques. The aim is to put Types 1–2 indicate constipation, Types 3–4 are the
the patient at ease, confirm understanding of what easiest to pass, while Types 5–6 may indicate
the patient is saying, and demonstrate that you are diarrhoea. Type 7 may be a sign of serious food
interested in what he/she is saying. The result poisoning or even cholera and therefore fatal.
being that it facilitates the elicitation process.
(ELT
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
Teacher’s notes If your students are experienced nurses, ask:
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
member of the group to write five objects used exercise and poor diet, not enough foods high
in patient washing and grooming on a piece of in fibre. Passing small hard stools every three
paper. Refer students to the items on page 44, if or four days and the resulting abdominal pain
necessary. Then ask students in pairs to take it in are all signs of constipation. Patient feels lonely
turns to describe the objects for their partner to and maybe suffers from a lack of appetite;
guess. This can be done as a team game. consequently she does not maintain a suitable
2 Refer students to the ADL checklist for Sophie diet.)
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
and the menstrual cycle. It is also related to Tell students they are going to learn some of
conditions such as incontinence, constipation the expressions that patients use in English to
and diarrhoea and abnormal bowel movements.) describe elimination/bodily functions. Ask them
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.
Ask students to look at the photo and ‘observe’ 1 bathroom 2 wee 3 Urine, urinate
their patient, Mrs Eileen Ashton. Ask: What do 4 waterworks, incontinent 5 bowel
you learn about the patient on observation? 6 pooh, defecate 7 diarrhoea, constipation
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 bathroom/toilet, waterworks; children – wee,
and 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 as a group to check.
about the patients? Tell them they are going to If necessary, students can listen to the recording
hear a nurse assessing the three patients. Ask again to check before moving on to 8.
students to listen and write the problem for
each patient under the correct photo, using the 1 been 2 passed 3 noticed 4 been 5 had
words in the box. 6 had
Toni: problem with urinating

Leah: constipation
8 Now ask students, individually or in pairs, to
Dave: diarrhoea
match the questions 1–6 in 7 to the answers a–f.
4 Ask students to listen again and complete the Then ask them to write the name of the patient
expressions used by the patients and the nurse. they refer to. Look at the first one together as a
group. Ask students to listen to the dialogues to
1 with my waterworks again 2 do a poo check. If necessary, play the recording again.
3 wee wee 4 the runs
Check understanding of: drop.
5 Ask students, individually or in pairs, to rewrite
sentences 1–4 using the more formal/medical a 3, Leah b 4, Leah c 6, Dave d 2, Toni
e 5, Dave f 1 Toni
language from 2. Ask them to compare with
another pair, before coming together as a
group to check.
Suggested answers:
1 I’ve had problems urinating.
2 Leah, did you have a bowel movement
this morning?
3 I urinated.
4 Well, basically, I’ve had diarrhoea ever
since I came back from holiday.
Grammar
6 If necessary, review the form of regular and
irregular verbs in the past simple first. Ask
students to identify the regular verbs in the list
(notice, open, pass). Ask: What is the ending for
the past participle of these verbs? Ask students
to brainstorm past participles for the irregular
verbs in the box.
Ask students, individually or in pairs, to look at
the box and write the past participle for each
verb.
Explain to students they will be looking at this
structure in more detail later in the unit.
be – been, catch – caught, come – come,

do – done, eat – eaten, go – been/gone,
have – had, notice – noticed, open – opened,
pass – passed
Elimination 7 62
Describing bodily functions Check understanding of: non-verbal signals, nod,
repeat.
Vocabulary Tell students they are now going to read a

dialogue where Staff Nurse Paul is checking up
1 Ask: Do patients use different expressions to describe on his patient, Ms Sonoda. Refer them to the
bodily functions, depending on their age, gender, expressions in the box and ask them,
ethnicity? Is it better for a nurse to use familiar or individually or in pairs, to complete the
formal language when talking to a child? Why? dialogue using these expressions. Ask students
When do children generally start to use ‘adult’ to listen and check.
terms for bodily functions?
Check understanding of: anything else?, look
Refer students to the sentences 1–6 and ask worried, go on, runny.
them, individually or in pairs, to rewrite them
using the familiar terms in the box. Tell students Ask: Why might Ms Sonoda find it difficult to talk to
there is more than one possible answer in each Staff Nurse Paul? (Many patients prefer talking
case. to a nurse of the same gender; they are less
embarrassed, especially when talking about
Point out that patients often use a neutral bodily functions, for example. Age – if the nurse
expression to talk about elimination: I go to the is younger than the patient, this also may be an
toilet/bathroom. This is either out of politeness or issue.)
embarrassment. The nurse will then have to ask
closed questions to find out exactly what he/she Ask students, in pairs or small groups, to underline
is referring to. examples of the active listening techniques Staff Nurse
Paul uses with his patient. Explain that the ‘actors’
Explain also that waterworks takes a possessive instructions’ in brackets will give them information about
pronoun – my/his/her waterworks, etc. the non-verbal techniques the nurse uses. Come together
Children will very often use these expressions: to as a group to check. Remind students that patient-friendly
go for a/do a number one (urinate) and number two intonation also plays an important role in active listening.
(defecate). You may wish to play the recording again to demonstrate
this.
1 Does it hurt to do a pooh/go to the toilet?
2 Do you often have to get up in the night Verbal techniques: take your time, could you
to wee/go to the toilet? explain what you mean? (open question), pain
3 Have you noticed any blood when you wee? (repetition), can you describe your bowel
4 How many times a day do you pooh/go to the movements (open question), I understand it
toilet? isn’t an easy thing to talk about (empathy)
5 She’s been having problems with her Non-verbal techniques: smiles warmly,
waterworks/going to the toilet. pausing, nodding
6 Do you have hard poohs?/Is it hard when
you go to the toilet?
Speaking
Listening
3 Ask students, in pairs, to practise the dialogue.
2 ► 47 On the board, write: active listening. Tell them to pay attention to their active
Tell students they are now going to learn listening skills and use patient-friendly
about an important skills for nurses – active intonation.
listening.
Depending on your group you may ask
If your students are experienced nurses, ask: students to roleplay their dialogues to the rest
What is active listening? Why is it such an of the group.
important skill for nurses? When do nurses use this
skill?
the definition of ‘active listening’ that appears
in the first line of the box.
Ask students to brainstorm how nurses
demonstrate active listening. Then ask students
to read the rest of the text to find the answers.
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 1 On the board draw: 2 weeks
technique. (ratings: 1 = needs improvement, 2 = H o s p i t a l
OK, 3 = effective) Ask one pair to observe past now
another as they roleplay their dialogue and use ↑
the checklist to comment on their active accident (5th May)
listening skills. They then swap roles. Give Then write:
pairs time to feed back to each other. Each pair a) I came to hospital on 5th May.
should be given the chance to repeat their b) I have been in hospital for two weeks.
roleplay to improve their skills. 1 present perfect
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).
4 ► 48 Refer students to the photo on the right of If necessary, review shortened forms: I’ve, haven’t,
the page and ask: Why is the patient in hospital? etc.
What type of elimination problems could he be Elicit: How long have you + past participle?
suffering from? Avoid correction at this stage. 2 Dictate these items: since 5th May, yesterday, for
two days, five days ago, couple of days, last night.
Tell students they are going to listen to Staff Ask 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.
5 Ask students to complete the nurse’s assessment

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

4 have, been
6 Ask students, individually or in pairs, to take the

role of Christophe and write answers to the
questions in 5. Remind them they may have to
use expressions of time: since, for, ago. Encourage
them to write full answers. If necessary, do the
first one as a group.
Refer students to audio script 48 on page 77 to
reinforce the target structures in context.
Elimination 7 64
1 I’ve felt/been bloated/like this for a couple Suggested answer
of 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 He’s been in hospital since 5th May, and it is a
operation. 4 I’ve been in hospital since 5th May, week since his operation. He has not opened
for a 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 to Part 2 eaten anything for the last three days except a
of the staff nurse’s assessment. Refer students to the glass of orange juice. His stools have been
statements 1–6 and as they listen, ask them to underline the small and hard. He needs to push to defecate
correct verb form in brackets – the past simple or present but has not experienced any pain when going
perfect. to the toilet or any abdominal pain.
Encourage students to look at the time expression to

Extra activity
guide them to the correct structure.
Ask: What is important to remember when
Ask students to compare their answers with another writing a patient summary? Why is it important
student before coming together as a group to check. to write clearly? (Always sign the document,
write clearly, only use standard medical
1 has been 2 hasn’t been 3 has felt abbreviations – see Unit 4. Other medical
4 had 5 didn’t eat 6 hasn’t eaten
professionals need to be able to understand the
content. It is also necessary to know who has
Writing written the summary, just in case there is need
for further clarification.)
8 Tell students they are going to read a patient
summary for Christophe. Ask them,
individually or in pairs, to read the summary
and then correct the five mistakes that appear in
the text. Look at the first one together as a
group.
Come together as a group to check.
Christophe has not eaten anything since

yesterday and has only drunk juice for
breakfast. His stools have been small and hard
and he needs to push to defecate. He has not
experienced pain going to the toilet and has not
suffered abdominal pain this morning/he
suffered bloating this morning.
9 Refer students to the questions 1–5 and ask them

to write the whole assessment, answering the
five questions and including the corrected
information from 8.
Either ask students to complete the activity
individually, or write collaboratively in pairs.
The pairs then pass their text to another pair for
peer correction.
You may wish to brainstorm a correct version as
a group activity on the board.
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 Femi
It can be dangerous because it can cause
Lwanga talking about how she treats children with
dehydration which means loss of water and
diarrhoea. Refer students to questions 1 and 2 and
electrolytes (essential chemicals – sodium,
chloride, potassium, bicarbonate). then ask them to listen and answer the questions.
Diarrhoea can be treated with antibiotics if it is This is a fairly long recording, but reassure students
a fairly mild form and all patients should try to that it is not necessary to understand every word to
replace fluids. answer the questions.
Ask students to compare their answers with a
2 Tell students they are now going to read an
partner before coming together as a group to
article about diarrhoea. Ask students to read the
check. If necessary, play the recording again.
first two sentences of the article and compare
this with their own definition of diarrhoea. 1 a refugee camp in North East Africa, lack of
Elicit/Pre-teach: intestine, virus, parasite, clean drinking water that leads to sickness and
dehydrated, fluid, restless, irritable, sunken, severe, diarrhoea
malnutrition. 2 moderate dehydration
Refer students to sentences 1–4. Ask them,

individually or in pairs, to read the article and
Vocabulary
complete the sentences using words from the 5 Elicit/Pre-teach: severely, moderate, save lives,
article as they read. Come together as a group to limited, absorb, intravenous.
check.
Tell students they are going to read part of
Encourage students to use the sentences as a Femi’s explanation. Ask them, individually or in
guideline for reading and comprehending the pairs, to complete the text with the words in the
article. Reassure them that this is a fairly box. You could also to ask some comprehension
difficult text but that it is not necessary to questions to facilitate the process:
understand every word in order to gain an
1 How do they treat patients with severe diarrhoea? (Patients
understanding of the main points.
1 result 2 cause 3 causes 4 result 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.
1 rehydrate 2 fluids 3 drip 4 sugar 5 cheap

6 dehydration 7 replaces 8 faeces
Extra activity
Tell students they are going to participate in
a spelling bee. Explain the rules – a word is
read out twice. The student must spell the
word correctly to stay in the game. If they
spell the word incorrectly they are knocked
out of the game. The last student is the
winner. Choose words from the texts on
pages 56 and 57. You may need to use
words more than once depending on the size
of your group.
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 If necessary, encourage students to use the
take place? What is included in a case presentation? nursing assessment of the patient on page 52 for
What is your experience of presenting a patient additional guidance.
case/giving a presentation in front of other
students? (It is a formal or informal presentation Come together as a group to check.
of the patient’s current situation, including an
1 On admission, Eileen complained of
introduction, history of the present illness,
abdominal pain.
physical examination, diagnostic studies,
2 Dr Insulza saw her at 16.00 and she rated
differential diagnosis, management and summary the pain seven out of ten on the pain scale.
of the case. Patient case presentations generally 3 She had her last bowl movement four
take place during a handover.) days ago.
Point out that the example used in this unit deals 4 She has opened her bowels every three
with the introductory part of a case presentation. or four days since the beginning of May.
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 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
medical aid, developed at the University of
slightly 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 to listen
spent in the colon. Type 1–2 indicates to Part 1 of the dialogue and circle the correct response to
constipation, Type 5–6 indicates diarrhoea.) each question. If necessary play the recording again.
Depending on your group, students may or may
not have come across the Bristol Stool Chart.
1 stomach ache, frequent bowel movement
2 embarrassed 3 diarrhoea
Eliminati 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
possible assessment question: How long have you (GP, psychiatrist or psychologist, dietician).
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 assessment. Extra activity
If necessary, check students’ questions for accuracy before Ask students, in pairs, to take it in turns to
carrying out the roleplay. carry out a complete assessment of Anita
Blasky, using the information in the nursing
Suggested answers: assessment. Encourage them to use patient-
How long have you suffered from friendly terms for bodily functions and to
diarrhoea?/When did the symptoms begin? practise employing active listening skills as
How often do you visit the toilet on a typical they interview their patient.
day?
Variation: Students work in pairs to compile a
How many times a day do you need to go to
checklist to evaluate active listening
the toilet?
Can you describe your stools for me? skills/patient-friendly terms, using ratings (1 =
Do you suffer from any other symptoms? needs improvement, 2 = OK, 3 = effective),
and use this to assess another pair. Students
swap roles. Give pairs time to feed back to
Listening each other. Each pair should be given the
5 ► 52 Refer students to the second half of the nursing chance to repeat their roleplay to improve their
assessment. Ask them to listen to Part 2 of the dialogue 8 skills.
Ask students, in pairs, to chose one of the
and complete the assessment using the words in the box. If patients from page 53, Toni, Leah or Dave,
necessary, replay the recording. and prepare a patient case for presentation.
Ask them to include the information at the
bottom of the page for their patient. Tell
1 allergies 2 spicy 3 weight 4 kilos students to invent the details if necessary.
5 overweight 6 angry 7 laxatives Encourage students to use pausing techniques
8 embarrassed and staging words (firstly, secondly, then,
Speaking finally) from Unit 4 to facilitate understanding.
6 Ask students in pairs to discuss the patient case Depending on the group, you may want to ask
and answer the questions. students to present their case to the rest of the
group. Otherwise this can be done in small
Reassure them that for this activity accuracy is groups.
not important – just encourage them to discuss
their opinions. Preparing for for
In preparation theUnit
next8,unit
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.
Eliminati 7 69
8 Patient discharge
Briefing will need community services, but also the type and
frequency of those services. Depending on the
This unit looks at the discharge plan and making a country, patients and/or their carers may be more
final assessment of levels of patient independence or less involved in the discharge process.
just prior to their leaving the hospital environment.
It also deals with medications and explaining One of the most important elements of the
dosages. Finally, it provides an opportunity to Discharge Plan is patient education regarding
develop telephone skills, in particular when making medications. Drug therapy can only be effective
follow-up appointments on behalf of patients. when patients co-operate with the drug regime. In
hospital this is closely supervised, but once
Evaluating levels of independence discharged, many patients fail to continue with their
treatment. Reasons for this include: forgetfulness,
The discharge lounge provides a quiet area for inconvenience, lack of understanding of the
patients to relax while waiting for their illness/drug, unclear instructions, a confusing
transportation after being discharged from hospital. cocktail of medications, side effects and fear of
While waiting, they might also receive assistance addiction.
with follow-up appointments, arranging pick up of
their prescriptions from the pharmacy, receive Explaining medication
instruction on medications, etc. A registered nurse is
assigned to the discharge lounge to address any Nurses are sometimes called upon to explain over-
concerns and oversee patient safety. One of the the-counter medications or OTCs. This section of the
advantages of the discharge lounge is that it frees up unit provides plenty of practice of language related
ward beds, thus decreasing the length of time new to types of medication, including capsules, cough
patients are required to wait for bed placement. syrup and ointment, as well as expressions of time
used to explain dosages: three times a day, two every
Levels of independence are evaluated constantly six hours, at mealtimes. It is very important that the
during the patient journey with the final assessment information patients receive concerning any form of
carried out just before the patient is discharged. medication is accurate, so in addition, students will
Students will develop structures to help them assess spend time acquiring expressions commonly used in
levels of patient independence: How do you feel about direction sheets: do not exceed, do not chew,
…? Is there anything you are worried about? Mobility according to the severity of the symptoms and may
aids to assist the patient’s walking – leg brace, cause drowsiness. Patients must be advised to take
crutches, wheelchair – as well as those that can be caution with OTCs, vitamins and supplements as
installed in the home – grab bar, non-slip mat, they may not be safe to take at the same time as their
shower chair – might be recommended to increase prescription drugs.
levels of independence and therefore allow the
patient to return to their home environment. Making appointments on the phone
A patient discharge plan It is just as important for nurses as it is for other
professionals to develop effective telephone skills;
In Section 2, students begin by reading through an maybe more so, considering the stressful situations
authentic patient educational leaflet that explains in which many nurses work. This final section of the
the Patient Discharge Plan. Prepared by the unit deals with making appointments with another
different healthcare providers involved in the hospital service or perhaps a local GP or practice
patient’s treatment, the discharge plan provides nurse.
information to the patient and their carers about
prescriptions, follow-up appointments, support It is important to signal the beginning and closing of
groups, even therapists, if necessary. The a telephone conversation. Nurses are encouraged
therefore to open by identifying themselves and
Independence Assessment, including a final
their department or unit: This is Nurse Akif Altundas
evaluation of ADLs, including ambulation
from Paediatrics. Their speech should be clear and
(patient’s ability to get around on foot) and
coherent: I want to make an appointment for one of our
transferring (by vehicle) will determine not only
patients, please. It should make possibilities for
whether the patient
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.
Teacher’s notes which are being used by the patients in the
picture.
Warm-up 1 crutches 2 wheelchair 3 leg brace
1 Divide the group into two teams and ask 4 walking frame 5 walking stick
students to brainstorm ten terms or expressions
4 Refer students to the photos a–e of mobility aids for
used to discuss elimination in a formal context
the home (and hospital) at the bottom of the page. Ask
(with another medical professional, during a
them, individually or in pairs, to label them using the
student presentation). The first team to reach ten
words in the box.
and spell them correctly wins.
2 Refer students to the information for Mrs a shower chair b bath lift c grab bar
Eileen Ashton on pages 52 and 58. Ask d non-slip mat e raised toilet seat
students, in pairs, to take it in turns to roleplay
the nurse’s patient assessment, employing Extra activity
appropriate active listening skills. You may Dictate the following: leg brace, walking frame,
wish to elicit the active listening skills covered walking stick, shower chair, grab bar, bath lift, non-
in the unit (page 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
transportation after being discharged from the 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 to
them they are going to hear a nurse explaining supply their own definitions, perhaps brainstorming the
each case. Ask them to listen and label the first one as a group first. Then ask them to compare with
patients with the correct name. 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
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
1 Mrs Ridley 2 Elin 3 Jim
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.
1 toileting, raised toilet seat

2 bathing, grab bars, non-slip mat
3 bathing, shower chair
8 Ask students, individually or in pairs, to match

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

check their answers to 8.
Then ask students, in small groups, to decide
which of the expressions are
suggestions/recommendations from the nurse
(four expressions), questions the nurse asks the
patient (one expression) or worries or concerns
expressed by the patient or carer (one
expression). Ask: Why does the nurse offer
recommendations or suggestions? (This is more
likely to encourage the patient than using must
for obligation. Also the patient should be
encouraged to be part of the decision-making
process.) Refer students back to Unit 5, if
necessary.
1 3, 4, 5, 6
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.
students to roleplay their scenario in front of the
rest of the group.
A patient discharge plan Listening
4 ► 55 Refer students to the photo on the right
Speaking of the page. Ask: What kind of worries do
patients have just before they leave hospital?
1 Ask students in pairs to discuss the question.
(Patients might wonder how they are going to
Come together as a group to compare answers.
manage to take care of themselves, especially if
Ask: What is the role of the patient/carer in the
they live alone or, if they have dependents, how
discharge process? (Depending on the country,
they will be able to take care of the whole
patients and/or their carers may be more or less
family while still in recovery. After a long
involved in the discharge process.) Some
period in hospital patients may have become
students may have difficulty expressing their
slightly 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 going through
encourage them to discuss their opinions. Come a discharge plan with her patient, Nancy Lorenz. Refer
together as a group to compare ideas. students to the statements 1–4 and ask them to listen to
the recording and decide if the statements are true or false.
Reading Ask students to correct the false statements. If necessary,
play the recording again. Ask students, in pairs, to
2 Tell students they are going to read a patient compare their answers, before coming together as a group
educational leaflet that explains the discharge to check.
process. Refer them to the titles a–e and ask
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:
Point out the following: give a shot (USA) give an ambulation, transferring and ask: What do you
injection (UK). think these ADLs refer to? (ambulation – getting
around on foot, transferring – getting around by
1 over-the-counter drugs 2 prescription drugs vehicle) 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
their ideas to the rest of the group. Toileting – independent
Transferring – dependent
Eating – needs assistance
Dressing – needs assistance
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 have with the two conditionals – it could prove a
these are sentences taken from the dialogue little confusing for some students.
between the nurse and Nancy Lorenz. Ask
students to check their usage by reading through Extra activity
the ‘rule’ for the first conditional, allowing them Refer students back to the patient leaflet on
to make 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.
1 buy a non-slip mat and some grab bars to

put in the shower.
2 just ask.
3 you’re worried about feeling tired.
4 you start feeling tired.
5 ask your neighbour.
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 to patients? What problems have you medications. Then ask them, individually or in
experienced? What advice would you give to new pairs, to find phrases to match meanings 1–5.
nurses? Ask pairs to compare their answers with another
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– 3 Do not chew.
6 first to facilitate the listening process and help 4 To be taken … as required according to
set the scene. Ask students to listen and circle the 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
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
Vocabulary the board write: take, don’t take, you need to.
Brainstorm the first instruction as a group, before
2 Ask students to cover the word box and try to asking students to write instructions for patients 2–4.
label the different types of medication a–f. Encourage them to write in their own words. Less
Students may already know many of these confident students may prefer to write
items. Refer them to the word box if collaboratively. Point out to students that for
necessary. Come together as a group to check. situations 2 and 5, they will need to write the
Point out that these terms are also used: cough instruction for the parent/carer.
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.
a bottle of tablets b nasal spray

c tube of ointment d eye drops and a dropper
e capsules f cough syrup
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.
1 two, mealtimes 2 pain, two 3 hours, day

4 put 5 stitches 6 tablespoonful
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
7 Ask students, in pairs, to take it in turns to

practise asking and answering similar questions
using the directions for over-the-counter
medications in 4.
Making appointments on the phone
4 Ask students, individually or in pairs, to complete
the patient’s appointment card. Then play the
recording again to allow them to make any
Speaking necessary corrections. Come together as a group to
1 Explain to students they are going to work on check. If necessary, play the recording once more.
developing a set of useful expressions that
Patient Name: Geoff Pattern
they can use when making an appointment for
Appointment with: occupational therapist
a patient over the phone. Tell them they are Day: Tuesday
going to hear Orthopaedic Nurse, Zafar Date: 17th June
Hussein, making an appointment for his Time: 17:00
patient with another medical service. Refer 1 Occupational Therapy
students to the information about the patient 2 Tuesdays and Thursdays
1–4. On the board write: Identify yourself and 3 3.30 in the afternoon
department. Elicit a suitable telephone
expression from the group for this and then ask 5 ► 59 Tell students they are now going to
students to compare with the one on the hear Zafar change Mr Pattern’s appointment.
Appointment Checklist. Ask students, in pairs Refer them to points 1–3. As they listen, tell
or small groups, to use the information about students to transcribe expressions they hear for
the patient as a basis to brainstorm expressions each point.
for each point on the checklist. Avoid For less confident students, you may wish to give them
correcting at this stage. the first letter of each word in the expressions.
Listening
1 (Sorry to disturb you but) can I reschedule
2 ► 57 Tell students they are going to hear
Mr Pattern’s first appointment?
Zafar’s telephone call. Ask them to listen and 2 What time was his appointment?/Sorry,
compare what he says with their expressions in did you say Tuesday or Thursday?
1. If necessary, play the recording again. 3 Can you just hang on a moment?
Variations of these may also be acceptable.
1 Good afternoon. (Hello.)

2 This is Zafar from Orthopaedics.
3 I’d like to make an appointment with the 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
6 Let me give you the patient’s details. It’s Mr do 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 speakers stress the words or syllables to
hear Zafar making an appointment for another emphasise important information.) More
patient. Ask students to listen and tick the confident students may already be aware of this.
points in the checklist as they hear them. Ask a more confident student to underline the
Reassure them they don’t have to understand stressed words/syllables. Avoid correcting at
everything on first hearing; they will have the this stage.
opportunity to 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.
7 Ask students to listen again and make any corrections,
Extra activity
before coming together as a group to check. Play the
recording again and ask students to repeat the stress Ask students in pairs to take turns reading
patterns they hear. Play the recording several times until audio script 59 (page 79) aloud to practise the
you are happy that they are able to reproduce the stress patterns in context. Encourage them to
same/approximate stress pattern. employ effective communication strategies for
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. 9 Put students into pairs and tell them that they
3 No, not 10.15, 10.50. are going to practise making appointments over
4 Oh, OK 10:50, sorry. 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 vocabulary presented in 1–4 has already
speaking on the phone with other medical appeared earlier in the course. Allow them
professionals in English? Ask students in small adequate time to review if necessary. Encourage
groups to discuss question 1, encouraging them students to use the checklist on page 66 as well
to use the prompt, I find it difficult because ... as their newly acquired skills for emphasis and
Some students may have difficulty expressing telephone communication strategies.
their ideas effectively in English. Reassure them
Ask students to carry out roleplays 3 and 4 in
that for this activity accuracy is not important –
the same way.
just encourage students to discuss their opinions.
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

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English

© Pearson Education Limited 2011

The right of Ros Wright to be identified

All rights reserved; no part of this

Photocopying: The Publisher grants

First published 2011

The publisher would like to thank the

Cover images: Front: Photolibrary.com:

Unit 1 Patient admissions page 3

Unit 2 Pain page 12

Unit 3 Vital signs page 22

Unit 4 Symptoms page 31

Unit 5 Food and nutrition page 41

Unit 6 Personal care page 50

Unit 7 Elimination page 59

Unit 8 Patient discharge page 70

Briefing through waiting in a cubicle to their assessment. A

1b 2d 3f 4c 5h 6i 7e 8a 9g 1 work 2 like 3 carry out 4 change 5 treat

4 ► 02 Tell students they are now going to hear

5 Refer students to the beginnings of sentences 1–

1 straight on, front of, at, end 2 second, left,

7 ► 05 Ask students to look at statements 1 and

1 main entrance 2 4th

8 Tell students they are going to listen to the

Patient 1 – Could you fill in this form, please?

10 Elicit the request: Could you spell your name,

The nurse is talking to the pregnant woman.

6 ► 09 Tell students they are now going to hear

shelf, locker, bed, buzzer, light, chair, TV,

7 Ask students to look at the picture again in

1 light, chair 2 TV 3 drawer

Preparing for the next unit

In preparation for Unit 2, suggest the following to

Briefing appropriate questions to gain a better understanding

1 between, stomach 2 right, above

Comparatives and superlatives 1 migraine 2 sinusitis

4 If your students are pre-experience nurses, ask:

1 Where 2 How 3 When 4 How 5 Where

6 Give students adequate time to read through

Student A: Pain map with cross on chest with

7 On the board write: Where does it hurt? From 1

1 What makes it better?

A friendly welcome usually uses an intonation

1 Hello Dina. Come in …/I understand it’s

unit to encourage students to do this.

Statistics and vital signs

Taking vital signs

Circulation and the heart

2 ► 19 Tell students they will hear Nurse

Vocabulary 4 ► 22 Ask students to look carefully at the vital

2 Ask students to complete the descriptions of the

1 one, over 2 at, per 3 point 4 per

6 ► 23 Ask students to first observe the three

a Rose b Davina c Pilar

1 Ask students to label the diagram of the heart. If they are

7 Ask students to cover the leaflet and complete

Preparing for the next unit

In preparation for Unit 4, suggest the following to

Briefing patient could start giving information that is not