English for

Nursing 2
Vocational English
Teacher’s Book

A2-B1

Ros Wright
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First published 2011

ISBN: 978-1-4082-5212-3

Set in Palatino

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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
This unit begins by introducing hospital personnel
and departments and then deals with the
admissions process, i.e. checking in a patient and
welcoming them onto the ward/into the room.
Hospital jobs and personnel
Nurses work as part of an extensive team, especially
within the context of a hospital and this first section
presents a variety of personnel and their roles. It
makes the distinction between several key nursing
personnel; the triage nurse who is responsible for
making sure the most urgent cases are treated as a
priority, the sister or charge nurse (male equivalent)
who runs the ward/department, deals with the
budget and staff employment and the scrub nurse,
who looks after patients during and after surgery.
Students then look in more detail at the
responsibilities of a practice nurse working in a
doctor’s surgery (USA: doctor’s office) and an
agency nurse (employed on short-term contracts
through a nursing employment agency), specialising
in renal care (kidney diseases). Students focus on
usage of the present simple and the present continuous
to describe nursing roles and responsibilities as well
as daily routines.
Hospital departments and facilities
The main aim of Section 2 is to develop lexis of
specific hospital departments – Casualty
(UK/Ireland), Dermatology, Pathology, etc. – and
facilities including canteen, waiting room, bank,
vending machines, etc. It should be noted that
emergency care is also offered in the Emergency
Department (UK/Ireland) and Emergency Room or
ER (USA). Appropriate word stress greatly
facilitates communication with patients and
colleagues. Students will work on stress patterns of
the various hospital departments. This section also
reviews language of place and movement and
provides an opportunity for students to practise
directing patients and visitors around a hospital.
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,
through waiting in a cubicle to their assessment. A
discussion activity invites students to draw on their
experience to use the triage process to prioritise a
series of patients presenting at ER.
Later, this section seeks to develop a set of requests
that a nurse might make with a patient newly
arrived in ER: Could you take a seat in the waiting
room, please? Could I ask you a few questions, please?
Could you tell me what happened? The admissions
process requires nurses to be accurate when taking
patient details. A review of how to pronounce letters
of the alphabet by encouraging students to group
letters with the same sound completes this section of
the unit.
Checking in a patient
After familiarising themselves with terms and
expressions that typically appear in the Patient
Details section of an admissions form, students will
then go on to develop a set of questions used to
complete the form. Questions are related to the
patient – full name, DOB (date of birth), gender,
marital status and occupation – as well as contact
details of their next of kin (family member, carer,
even neighbour). There are also questions about
smoking and allergies. It is important to ask for the
patient’s preferred name, as it helps develop a
stronger relationship with the patient. Some patients
feel more comfortable if medical staff use their first
name, preferring the more informal contact, while
others like to maintain a more formal relationship
and might ask staff to use their title (Mr/Ms, etc.)
and surname. As the patient is shown into their
room/ward (a large room for up to six same-sex
patients – very common in the UK/Ireland), it is up
to the nurse to inform them about the facilities
available to them – buzzer, locker, etc.
Patient admissions 1 3
Teacher’s notes
Hospital jobs and personnel
Vocabulary
1 Before you open the book, ask students to
introduce themselves and say a little about why
they are attending the course. Experienced
nurses: Ask students to explain what they hope
to improve during the course. Pre-experience
nurses: Ask students to explain which area(s) of
nursing they find the most interesting.
Then draw a pyramid on the board and write
one of the following at each point of the triangle:
nursing/English/my future. Encourage students
(individually) to write or draw
words/sentences/objects to represent how they
feel about each topic. Ask students to discuss
their ideas with a partner. Then ask students to
introduce their partner to the rest of the group,
explaining the points on their pyramid.
Open the book on page 4 and ask students to
look at the picture at the top of the page. Ask:
What department do you think it is? (Emergency
Room/ER or Casualty/Accident &
Emergency/A&E). If necessary, pre-teach/elicit
triage room and surgery.
Ask students, individually or in pairs, to match
the job titles with the hospital personnel they see
in the picture.
a8 b1 c4 d2 e7 f3 g9 h5 i6
2 Ask students, individually or in pairs, to match
the job titles in 1 with the descriptions. If
necessary, encourage them to deduce the
meanings from the picture. Come together as a
group to check answers.
For further language practice, draw two
columns on the board. In column 1, write: carry,
deal, give treatment, look, responsible, specialise. In
column 2, write: after, for, in, out, to, with. Ask
students to match the verbs to the correct
preposition. Then choose one of the activities for
further practice of the target language.
1b 2d 3f 4c 5h 6i 7e 8a 9g
Extra activity
On the board, write all the phrasal verbs from
Exercise 2. Divide your group into two teams.
Ask students to cover the page and using the
phrasal verbs on the board, take turns to
describe one of the job titles on page 4 to the
opposite team. The team with the most correct
answers wins the game.
Language
Depending on your group, you may wish to ask
students to complete 3 before going through the
Language box. This will serve as a ‘diagnostic
test’ to check their current understanding of the
target structures for this unit.
Present simple v present continuous
Refer students back to the picture and 2 on
page 4. On the board, write:
1 What does the scrub nurse do?
2 What is the scrub nurse doing now?
Elicit answers:
1 She looks after patients during surgery.
2 She is pushing a patient trolley through the
Admissions area.
Ask students to compare the two forms and
ask: When do we use the present simple? When do
we use the present continuous?
Suggested answer: We use the present simple
to talk about routines and things that happen
all the time. We use the present continuous to
talk about things that take place at the time of
speaking/things that are not permanent.
Give students time to assimilate the points
covered in the Language box.
If necessary, review present simple and present
continuous forms in more detail.
Reading
3 Tell students they are going to read an interview
with practice nurse Reena Chaudry. Ask them to
read and underline the correct verb forms in the
text.
If necessary, ask a stronger learner to select the
best answer in the first sentence.
1 work 2 like 3 carry out 4 change 5 treat
6 am 7 give 8 are running 9 ’m learning
10 don’t have 11 like going 12 play
Patient admissions 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 zy zyy yzyy
Renal Casualty Pathology
Surgery Maternity
Vocabulary Neurology
1 Tell students to look at the hospital plan taken
from a patient educational leaflet. Ask: Which yyzy yyzyy
Geriatrics Dermatology
department names do you recognise? Ask students,
Paediatrics Cardiology
individually or in pairs, to complete the Radiology
definitions using the words in the box.
Alternatively, do this activity as a group chorus yyzyy
and then give students time to complete the Physiotherapy
definitions in writing to reinforce the target
language. Extra activity
Come together as a group to check answers. On the board, write: facilities, orthopaedics,
Check students understand: nervous system, skin pharmacy, registration, patient, entrance, toilets,
disorder, midwife/midwives, recover. information, coffee, hospital, emergency (these
words all appear on the hospital plan on page
1 emergency cases 2 operations 3 kidney 6). Ask students to add these words to the
4 skin disorders 5 elderly 6 test results correct column in the table in 2 according to
7 babies 8 children 9 heart 10 X-rays their stress pattern.
11 nervous system 12 exercises See answers below.

Pronunciation zy zyy yzyy

patient pharmacy facilities
2 ► 03 On the board, write renal. Ask how many entrance hospital emergency
syllables there are in the word and then elicit the toilets
correct stress pattern. Ask a stronger student to coffee
write the stress pattern above the word on the
board (see key opposite). If necessary, check the yyzy
stress pattern of dermatology. orthopaedics
registration
Ask students, individually or in pairs, to put the information
names of the hospital departments in 1 into the
correct box according to their stress pattern. Speaking
Avoid correcting at this stage.
If students need to review prepositions of place,
Students then listen to the recording and check
they could do 4 and 5 before 3.
answers. Play the recording again and ask
students to repeat the stress patterns they hear. 3 Refer students to the speech bubbles at the
Play the recording several times until you are bottom of the page. Using the hospital floor
happy students are able to reproduce the plan, ask students (in pairs) to take turns asking
same/approximate pronunciation and stress and answering questions about the location of
pattern. Reassure them that some terms are facilities and departments in the hospital.
difficult to pronounce even for a native speaker. Encourage the correct stress pattern.
Note: Follow the table opposite for correct
pronunciation patterns.
Note: Students may recognise these words from
their own language but will tend to place the
stress in the wrong place in English. Ask them to
compare stress patterns in their L1.

Patient admissions 1 6
 Vocabulary
4 Ask students, individually or in pairs, to choose
the correct prepositions of place to complete the
explanations. Come together as a group to check
answers.
1 between, and 2 on, the left of
3 on, opposite 4 in, at 5 next to, on
6 in front of
5 Ask students, individually or in pairs, to match
the symbols to the facilities. Ask: Which facilities
can you find in hospitals in your country? Which
facilities would you like to see in hospitals in your
country? Why is it important to provide facilities
such as these in hospitals? Do we really need to
provide these facilities in hospitals?
a6 b9 c7 d8 e4 f5 g2 h3 i1
Listening
6 ► 04 Depending on your students, you may
wish to review prepositions of movement before
you start this activity. Tell students they are
going to hear three nurses giving visitors
directions to different hospital facilities. Ask
them to listen and complete the instructions.
Come together as a group to check answers.
Extra activity
Dictate these scenarios to the group (or prepare
as a handout) and then put students into pairs
and ask them to roleplay four or more of the
situations to practise giving directions using
the hospital floor plan on page 6.
1 You want to visit your sister who has just had
her first baby. You are at the main entrance.
2 You are looking for a shop to buy your wife
some flowers. She’s in room 202. You are next
to the bank.
3 You are late for your X-ray and lost. You are
on the second floor in front of the Neurology
Department.
4 You hear an announcement that your eight-
year-old son is waiting for you at the
registration desk. You are on the 5th floor
visiting your mother after her hip operation.
5 You arrived 20 minutes late for your
appointment with the dermatologist. You are at
the main entrance.
6 You are leaving hospital today. The
consultant gave you a prescription for
painkillers. You are still in your room on the 4th
floor but want to know where the pharmacy is
located.

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

turn, of, turn right 3 turn left, go, next to

7 ► 05 Ask students to look at statements 1 and

2. Then refer them back to the hospital plan on
page 6. Explain they are situated at the main
entrance and that they are going to hear
directions being given by a nurse. As they listen,
students should follow the directions on the
hospital plan with their finger, then circle the
correct answer.
8 Ask students to check their answers by turning
to the audio script on page 70.

1 main entrance 2 4th

Patient admissions 1 7
 Admissions
Reading
1 Tell students they are going to read a patient
educational leaflet from a hospital in Phoenix,
Arizona (USA). Ask them to scan the text and
find answers to questions 1 and 2. If necessary,
reassure them that they don’t need to
understand the whole text, which has been
adapted from an authentic patient educational
leaflet.
Ask: What is the average waiting time in ER in your
place of work/country? Are waiting times in ER a
problem? What can hospitals do to reduce waiting
times? How can they make waiting times more
bearable for patients?
1 2.5 hours 2 4.5 hours
2 Ask students to read the leaflet again. As they
read, they should complete the gaps in the
‘When you arrive’ section using the words in the
box. Ask students, in pairs, to compare their
answers, then come together as a group to check.
Encourage students to visualise the admissions
process in their place of work/country to help
them complete the activity.
If your students are pre-experience nurses, ask
them to visualise what happened the last time
they attended the Emergency Room as a
patient/carer.
Check students understand: assessment, cubicle,
priority.
1 reception desk 2 date of birth 3 cubicle
4 triage nurse 5 assessment 6 priority
7 cubicle
3 Ask students to look at the medical problems (a–
c) and ask: Which problems are the most serious?
Then ask them to match the problems to the
gaps 8–10 in ‘The Order of Care’ section on the
patient leaflet. In pairs, students can then
compare their answers before coming together
as a group to check.
If your students are experienced nurses, ask
them to brainstorm other medical problems for
8–10.
8 c 9 a 10 b
Extra activity
Ask: Why is it a good idea to explain the triage
process to patients? In small groups, students
brainstorm ideas and then come together as a
group to share their ideas.
Suggested answers
It helps patients better understand the order of
care; helps reduce levels of patient anxiety and
possible frustration.
Note: Some students may have difficulty
expressing these ideas effectively in English.
Reassure them that for this activity accuracy is
not important – just encourage students to
discuss their opinions.
Listening
4 ► 06 Tell students they are going to hear a
triage nurse talking to four new patients. Before
they listen, ask students, in pairs or small
groups, to ‘observe’ the patients a–d in the
picture. Note that observation is an authentic
task for a triage nurse and will also serve to
prepare students for the interventions they are
about to hear.
Ask students to listen and decide which patient
is speaking in each case.
1d 2b 3a 4c
5 Ask students to listen again and complete the
sentences using the words in the box.
1 leg 2 bleeding 3 hurts 4 worried, baby
5 eye
6 Ask students, in pairs, to put the four patients
into order of priority to see the doctor. Ask
students to compare their answers with another
pair before coming together as a group to check.
If your students are experienced nurses, ask
them to explain the reasons behind their order of
priority for a–d.
Answers: d has been brought in by ambulance
from a car accident and will have priority, a the
patient is 23 weeks pregnant and has some
bleeding so needs to see a doctor urgently, b and
c are not priority cases but the child (b) would
probably be seen by a medical professional
before c.
d a b c
Patient admissions 1 8
7 Ask students to match the sentence halves to
make six requests. If necessary, review the use of
modals (can/could) for polite requests. Remind
students that the use of modals can and could for
polite requests is interchangeable.

1e 2d 3a 4f 5b 6c

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.

Patient admissions 1 9
 Checking in a patient
Vocabulary
1 Refer students to the Patient Details form and
ask them, individually or in pairs, to find words
in the form with the meanings 1–13.
Elicit/Pre-teach: n/a. Check understanding of:
next of kin and ask students for more examples
(any family member, friend, carer or neighbour).
Experienced nurses: Ask: Do all patients want
medical staff to use their first name? (Some feel
more comfortable if the medical staff use their
first name. Others prefer a more formal
relationship and ask staff use their title (Mr/Ms,
etc.) and family name.)
1 surname 2 occupation 3 title 4 GP
(General Practitioner) 5 first name(s)
6 next of kin 7 country of origin 8 gender
9 marital status 10 reason for admission
11 DOB 12 intake 13 allergies
Listening
2 ► 08 Tell students they are going to hear a
nurse interviewing a patient from page 9. If
necessary, refer them back to the picture of the
waiting room on page 9 first, to familiarise
themselves with the different patients present.
Ask students to listen and answer the question:
Which patient is the nurse talking to?
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.
3 Ask students to listen again and complete the
nurse’s questions. Alternatively, to make the
task more challenging, ask students to complete
the nurse’s questions first and then listen and
check their answers, making any necessary
corrections.
1 name 2 spell 3 call 4 date, birth 5 job
6 allergies
4 Ask students, individually or in pairs, to write
questions for the remaining admissions
questions. Encourage them to make use of the
terms in the admissions form to help them
design their questions. Ask them to check their
answers on page 70 of the audio script. If
necessary, play recording 08 again for students
to check their answers.
1 do you come from (originally)
2 your marital status 3 is your next of kin
Vocabulary
5 Ask students to brainstorm items they would
find in a typical patient room in their place of
work/country. Ask them, individually or in
pairs, to look at the picture of the patient room
and label the items using the words in the box.
Check understanding of: buzzer and locker.
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 admissions 1 10
 Listening

6 ► 09 Tell students they are now going to hear a

nurse showing Rosanna the facilities in her
room. As they listen, they should write down
the names of the objects they hear.

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

drawer

7 Ask students to look at the picture again in

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

1 light, chair 2 TV 3 drawer

4 pharmacy, waiting area 5 ground 6 hall, lift

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

Preparing for the next unit

In preparation for Unit 2, suggest the following to
your students:
• Compile a list of body parts you already know
in English.
• Think about ways patients in your country
describe pain – adjectives, common expressions.
• Do some (online) research into different types of
pain relief (commonly used in your country).

Patient admissions 1 11
 2 Pain
Briefing
This unit deals predominantly with the topic of
pain; understanding patient descriptions of pain,
carrying out an assessment, incorporating successful
communication skills, and discussing different
forms of pain relief. This is arguably the most
important unit in the coursebook.
Locating and describing pain
This first section of the unit provides an opportunity
to develop patient language for the major body
parts. Students will be asked to complete a pain
map, a diagram representing front and back views
of the body, used by medical staff to indicate
location and movement of pain. Comparatives and
superlatives of simple adjectives (stronger, better, the
worst) are also covered in this section to describe
changes and improvements to pain.
Pain assessment
Section 2 draws students’ attention to collocations
and expressions patients commonly use to describe
pain – a burning sensation, a shooting pain, a
tingling feeling, it’s itchy. The section then moves
on to describing intensity of pain using different
types of pain scale. The 1–10: nurses ask patients to
give a number between 1 and 10 (0 = no pain) to
describe how much pain they feel. In the case of
children or those who have difficulty expressing
themselves, nurses will ask them to point to the face
that describes how they are feeling. The section goes
on to develop a set of questions, based on simple
Wh- words – what, where, when, how, used by
nurses to assess their patients’ pain. Using patient
case histories, students put these skills into practice.
Successful communication
Nursing is not just about treating the disease –
nurses also have to consider the economic, social,
psychological and even environmental aspects that
impact on the patient, their symptoms and their
treatment and recovery. Pain is not just physical and
patients express their pain in various ways – anger,
depression, loss of appetite or sleep, etc. A nurse
needs to be able to look behind the words (or lack of
them) and interpret what their patient is feeling. The
initial pain assessment tool enables nurses to ask
appropriate questions to gain a better understanding
of their patients’ needs.
Building and maintaining a good patient
relationship is an essential aspect of the treatment
and healing process. Effective communication skills
are a key part of this. These include employing a
patient-friendly intonation pattern and putting the
patient at ease. The text titled Putting your Patient at
Ease on page 17 provides more detail on this aspect
of successful communication.  
Pain relief
Increasingly, patients turn to the internet for advice
on general health matters and nurses need to be
familiar with this medium and the approach used.
An online article provides the backdrop for the first
part of this section, which encourages students to
discuss different methods of pain relief. It considers
pain relief for sufferers of lower back pain, from
painkillers and anti-inflammatory drugs to heat
patches and ice packs. Students are then asked to
give advice on specific patient questions linked to
back pain as well as rate the article in terms of its
suitability as a patient reference.
Nurses may also be asked for advice on
complementary and alternative medicine or CAM
as a means of pain relief. The last page of the unit
looks at some examples of these, including
aromatherapy (use of natural oils to help control
pain) hydrotherapy (underwater exercise),
chiropractic therapy (manipulation of bones in the
spine) and herbal therapy (use of herbs and plants
to help treat muscle ache). Finally, students are
asked to consider the difference between chronic
and acute pain. Chronic pain is that suffered over a
long period of time, e.g. lower back pain, arthritis;
while acute pain can be mild or severe but lasts no
longer than six months, e.g. broken bone, labour
pains, a burn, etc.
Pain 2 12

Teacher’s notes
Warm-up
1 Dictate the names of hospital departments and
facilities from Unit 1. Then ask students to group
them according to their stress pattern. This can
be done as a team game – the first team to group
all the words successfully is the winner.
2 Ask students to refer to the Patient Details form
on page 10 and ask them to take it in turns to
roleplay interviewing the patient at admissions.
Locating and describing pain
Vocabulary
1 If students are experienced nurses, ask: What
type of chart is this? What is it used for? If not, ask:
What do you think this chart is used for? Who fills it
in? (Pain map, used by nurses and doctors to
mark the exact location of the patient’s pain.)
Ask students, individually or in pairs, to label
the pain map, using the words in the box. Tell
them to ignore the red arrows for the moment.
Come together as a group to check answers.
1 head 2 face 3 neck 4 shoulder 5 chest
6 stomach 7 hip 8 arm 9 hand 10 leg
11 knee 12 ankle 13 foot 14 back
15 buttocks
Extra activity
Divide the class into four groups. Give each
group a different area of the body: arm, leg,
torso (elicit/pre-teach this) head and ask them to
brainstorm the parts related to that section of
the body. Alternatively, ask students,
individually or in pairs, to research the above
and deliver their findings during the next class.
Suggested answers
Arm: hand, finger, thumb, elbow, wrist, palm
Leg: foot, ankle, calf, toe, thigh, knee, shin,
heel, sole
Torso: stomach, hip, shoulder, buttocks, back,
chest, waist, navel
Head: face, neck, eye, nose, mouth, ear, cheek,
forehead, eyebrow, lip, eyelid, throat
2 Patients often talk about their pain in simple
terms. Mime a patient with a headache. Elicit
expressions from the table in 1 to describe how
you are feeling.
Pre-teach/elicit: throat, gum, lower (back). Refer
students to the vocabulary table and ask them,
individually or in pairs, to change sentences 1–6,
using different words from the table. If
necessary, work through the first sentence as a
group.
Remind students we say I’ve got
toothache/stomach ache/earache. BUT I’ve got
a headache.
Suggested answers
1 My throat hurts.
2 My ankle hurts, it’s very sore.
3 Does your head hurt?
4 Her gums are really sore.
5 His stomach hurts.
6 My lower back aches and it’s really painful.
3 Elicit a general opening question: How do you
feel?/How are you feeling today?
Refer students back to the pain map. Ask them
to write one or more sentences for each of the
red arrows to answer this question.
Suggested answers
1 My knee is really sore.
2 I’ve got a pain in my shoulder, it’s really
painful.
3 My chest hurts.
Listening
4 ► 10 Tell students they are going to hear three
patients (James, Godfrey and Alma) describing
where they feel pain. As they listen, students
should put a cross (x) on the pain map for each
patient. Play the recording again if necessary.
1 stomach/chest 2 forehead 3 hip/leg
5 Ask students to listen to the three dialogues
again and complete the descriptions and the
nurse’s question. If necessary, review
prepositions of place. Play the recording again
for students to check their answers.
1 between, stomach 2 right, above
3 back, hip, down 4 Where, feel
Pain 2 13
 7 If necessary, review comparatives and adjectives
Extra activity
In pairs, students should take turns asking and
answering the nurse’s question: Where do you
feel the pain? Encourage students to recycle
parts of the body from 1.
6 On the board write: good/bad. Ask students to
give the comparative form of these adjectives
(better/worse). Ask them, individually or in pairs,
to put the words in the correct order to form
sentences that patients might use to describe
changes to their pain.
8 Ask students to look again at the descriptions in
For further language practice, ask students to
underline the word that makes a comparison
stronger – much. Remind them that we don’t say
more worse/better.
1 The pain is much better now.
2 I feel better today.
3 It’s worse than yesterday.
4 The pain in my leg is much worse.
Language
before starting this exercise.
On the board write: bad, good, severe, strong. Ask
students to complete the patient descriptions
using the comparative and superlative forms of
these adjectives. They can then use the table as a
means of checking their answers.
1 1 stronger 2 better 3 better 4 most severe
5 the worst
2 1 worse 2 worst 3 best 4 better
7 and choose the correct medical problem for
each.
Check understanding of: painkillers, darkened
room, forehead, cheekbones, nasal spray, face pack.
For further language practice, on the board
write: headache, stomach ache, toothache. In pairs,
students should choose one condition and take
turns to describe their pain in detail using
comparative and superlative adjectives. If
necessary, students can write notes first.

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.
Give students time to assimilate the points
covered in the Language box.

Pain 2 14
 Pain assessment
Listening
1 ► 11 Tell students they are going to hear five
patients talking about their pain in detail. Ask
them to listen and write down exactly where the
patient feels the pain under each name.
Alternatively, to offer students more support,
write the answers in a different order on the
board: chest, hands, head, lower back. Then play the
recording. This will give students the chance to
concentrate on the patient’s description.
1 head 2 lower back 3 chest/stomach
(patient doesn’t give specific area but says she
gets a burning feeling after eating food)
4 hands 5 chest
2 Ask students to listen to the dialogues again and
complete the patients’ descriptions using the
adjectives in the box. Encourage students to
deduce the meaning of the adjectives from the
descriptions and the body parts they refer to.
Ask students, in pairs, to compare their answers
before coming together as a group to check.
Point out that initially nurses often ask a very
general question to encourage the patient to talk
about their pain. Either ask students to turn to
the audio script on page 71 and find two general
questions the nurses use to ask about pain, or
elicit these questions: Can you describe the pain?
What does the pain feel like?
1 throbbing 2 dull, shooting 3 burning
4 tingling 5 stabbing
Vocabulary
3 Refer students to the table and ask them,
individually or in pairs, to match the adjective
phrases to the correct description. Encourage
students to use their knowledge of English to
deduce the meanings.
Depending on your group, you may wish to use
illustrations (arrow = shooting, drum =
throbbing, knife = stabbing, bee = stinging,
pincushion = pins and needles) to reinforce the
meanings of these words.
Point out that these adjective phrases are used
with certain parts of the body. To help them
remember, ask students to think about how the
equivalent adjectives are used in their L1.
1e 2h 3g 4b 5f 6a 7d 8c
Extra activity
Ask: Which adjectives can be used to refer to the
skin? (tingling, stinging, itchy)
On the board write: head, eye, shoulder, chest,
limb (leg/arm), stomach and ask students in small
groups to match the parts of the body to the
most appropriate adjective. Alternatively, ask
students, individually or in pairs, to research
the above and deliver their findings as an
informal presentation during the next class.
Suggested answers
head: dull, throbbing, shooting
eye: burning, stinging, itchy
shoulder: stabbing, throbbing
chest: shooting, stabbing, dull
limb: dull, shooting, stabbing, tingling
stomach: throbbing, burning
Extra activity
In pairs, students take turns asking and
answering the nurse’s questions: Where do you
feel the pain? and Can you describe the pain?/What
does the pain feel like?
4 If your students are pre-experience nurses, ask:
What do you think these charts are used for? When
do you think nurses use the chart with faces? If they
are experienced nurses, ask: What are these charts
called? How do nurses use these charts? Which pain
scale do you prefer and why? (Pain scales are used
with patients to assess/measure the level of their
pain. The 1–10 pain scale is generally used with
adults and the faces pain scale with children or
people who have difficulty expressing
themselves/their feelings. Nurses ask patients to
give a number between 1 and 10, where 0 = no
pain, to describe how much pain they feel.
Nurses ask children to point to the face that
describes how they are feeling.)
Pain 2 15
 Tell students they are going to look at
vocabulary to describe the degree/level of pain.
Refer them to the chart and ask them,
individually or in pairs, to match the expressions
in the box to the faces and the numbers. If
necessary, do the first one as a group.
Elicit the question a nurse would ask when
using these scales: On a scale of 1 to 10, how bad is
the pain/how much pain are you in? Can you point to
the face that shows how you are feeling?
1 no pain 2 mild pain 3 moderate pain
4 severe pain 5 very severe pain
6 unbearable pain
1 labour: location – lower stomach/hip area;
type – dull ache, contractions (strong waves of
pain)
2 appendicitis: location – middle of stomach
(belly button), moves to lower right side of
abdomen; type – stabbing pains
3 severe migraine: location – head, behind eye,
neck; type – throbbing
4 broken shoulder: type – stabbing, aching,
throbbing
5 kidney stones: location – middle back, groin;
type – ache/spasms (or waves) of pain
6 tonsillitis: location – throat, (glands) in neck;
type – burning sensation

Speaking
5 Tell students they are going to develop a set of
basic questions to assess pain. Ask them to add
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
Listening
1 ► 12 Ask students to ‘observe’ the patient Dina
Guyader (28) by looking at the photo. Ask them
to answer or just think about questions 1 and 2.
Avoid providing corrections at this point.
Tell students they are now going to hear practice
nurse David Taylor interviewing Dina. As they
listen to Part 1, students should check the
answers to questions 1 and 2. If necessary, play
the recording of Part 1 again.
1 lower back – below the waist, across the
back
2 dull ache and a shooting pain, like an electric
shock
2 ► 13 Tell students to listen to Part 2 and put a
cross and the letter N on the pain scale to
indicate how Dina feels now and a cross and an
M to indicate how she feels in the morning.
1 2 2 7 or 8
3 Ask students to listen to Part 2 again and circle
the correct answers. If necessary, allow students
to read through the questions before listening.
1b 2a 3b
Writing
4 If your students are experienced nurses, refer
them to the initial pain assessment tool and ask:
Have you ever used a form like this? What is it used
for? Who carries out pain assessment in your
country/place of work? (Nurses use the assessment
tool as a guide to ask more detailed questions
about the patient’s pain. Depending on the
country, nurses are more or less involved in
carrying out pain assessment; this may be the
responsibility of the doctor.)
Pre-experience nurses will understand how the
tool is used once they have worked through
questions 1–3.
5 ► 14 Before listening to Part 3, ask students to
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 –
social, economic, psychological, and
environmental. It is important that the nurse
considers the patient as a whole – a holistic
approach – so that they can propose an effective
treatment.)
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.
Ask students, individually or in pairs, to answer
questions 1 and 2. You may wish to check the
answers to these questions before moving on to
question 3.
Ask students, in pairs or small groups, to match
the symptoms in the box to the correct sections
in question 7.
Point out that questions 1–6 of the initial pain
assessment tool are similar to those covered in 5
on page 15.
1 What makes it better?
2 What makes it worse?
3 Sleep – insomnia
Appetite – can’t eat
Physical activity – can’t climb stairs easily, can’t
do sports, can’t stand even for short periods
Emotions – anger, suicidal feelings, crying
Extra activity
Ask students to add one more example to each
section of the initial pain assessment tool.
Suggested answers
Accompanying symptoms: stomach cramps,
headaches
Sleep: feeling overtired
Appetite: smaller, reduced appetite
Physical activity: difficulty lifting heavy objects
Relationships with others: feeling suspicious of
family members
Emotions: feeling depressed
Listening
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 question 7. Explain that some
points are referred to indirectly. If necessary,
allow them to read through the audio script on
page 72 to check their answers.
5 lying down, taking a hot shower
6 lifting heavy objects, carrying her daughter
7 Accompanying symptoms
Sleep – she doesn’t sleep well, she is often
very tired
Appetite – she has no time to eat properly
Physical activity – she is unable to lift heavy
objects/her daughter
Relationships with others – she has problems
getting along with her husband (mentioned
indirectly)
Emotions – she feels angry, she feels
emotional (cries during the interview)
Speaking
6 If your students are pre-experience nurses, you
may wish to do 7 before 6. The pictures will then
serve to reinforce the examples in the
description.
Tell students they are going to talk about good
communication in nursing. Ask them,
individually or in pairs, to write down or think
about between three and five things that
demonstrate good communication, e.g. smiling
when talking to a patient.
Then, ask students, in pairs, to look at pictures A
and B. Ask: What are the nurses doing or not
doing to facilitate communication with the
patient? Check understanding of: facilitate.
Some students may have difficulty expressing
their ideas; reassure them that for this activity
accuracy is not important – just encourage them
to discuss their opinions.
A: The patient looks relaxed/at ease and is
responding to the nurse. The nurse is smiling
and making eye contact with the patient. His
posture is open and he is leaning slightly
forward. He is engaging directly with the
patient. This shows a very positive
communication technique.
B: The patient does not feel listened to, feels
unimportant. The nurse demonstrates very
poor communication technique. Standing over
the patient as opposed to putting himself at the
same level and having his arms behind his
back gives the impression he is not interested.
He is not looking at the patient when speaking
to her.
Extra activity
Refer students to pictures A and B and ask
them to imagine themselves as the patient in
each case. On the board write: How do you feel?
What do you think about the nurse? Would you like
this nurse to take care of you? Why (not)? Students
may wish to write down their answers before
discussing in pairs and then come together as a
group to share their ideas.
Reading
7 Tell students they are now going to read a
description of good communication practice.
Before they read, ask them to explain the title of
the article or give it an alternative title (e.g. How
to make your patient feel comfortable).
Ask students to complete the description using
the words in the box. Encourage them make use
of pictures A and B to help them complete the
text.
Check understanding of: close family member,
expression, eye contact, rush, take an interest in,
aggressive, roughly.
If necessary, reinforce the meanings of the
important aspects by asking students to point to
examples of each in pictures A and B.
1 ease 2 relaxed 3 sit 4 smile 5 eye
6 quickly 7 friendly 8 name 9 questions
10 open 11 questions
Extra activity
For further discussion, ask: What kind of
questions could/do you ask patients to show
interest?
Suggested answers
ask questions about the patient’s
family/friends; ask about what the patient is
doing (programme they are watching on TV,
music they are listening to); the weather;
current events; etc.
Pronunciation
8 ► 15 Tell students they are going to listen to
four nurses greeting their patients. Ask them to
listen and decide if the nurses sound friendly or
unfriendly by ticking (9) the correct box. Ask
them to listen to the first one as an example.
Pain 2 18
 If necessary, play the recording two or three
times to allow students to hear the difference.
Reassure them that it is sometimes difficult for
non-native speakers to hear the difference.
However, reiterate (as in 7) that a friendly tone
of voice is very important in developing and
maintaining a good patient relationship.
1 friendly 2 unfriendly 3 unfriendly 4 friendly
9 ► 16 Ask students, individually or in pairs, to
complete the ‘rule’ about the intonation pattern
used for a friendly welcome.
Play the recording again and ask students to
repeat the stress pattern they hear. Do this
several times until you are happy students are
able to reproduce the same/approximate
pronunciation and stress pattern.
Extra activity
In pairs, ask students to choose two patients
from page 14. Refer them to audio script 11 on
page 71 and ask them to invent information for
these patients and complete questions 5–7 in
the initial pain assessment tool on page 16.
Students should continue the conversation,
using the new information. Encourage them to
use patient-friendly intonation patterns and
questions to put the patient at ease and show
interest. They then swap roles.
If necessary, brainstorm the patient details as a
group before asking students to roleplay.

A friendly welcome usually uses an intonation

pattern that rises and falls.

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

1 Hello Dina. Come in …/I understand it’s not

easy for you Dina.
2 And how’s the little one today?
3 I hope the baby is OK?
4 It’s OK. Take your time.
5 I understand it’s not easy for you Dina.
6 I just want to ask you a few questions. Is that
OK?/I want to ask you a few more questions.

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

Pain 2 19
 Pain relief
Speaking
1 Ask students, in pairs, to brainstorm different
types of pain relief suitable for lower back pain,
then answer the questions. Come together as a
group to share.
Suggested answers
bed rest, shower, gentle walking, ice pack,
swimming
Reading
2 Tell students they are going to read an article
from a health website aimed at sufferers of lower
back pain. If necessary, pre-teach/elicit the items
in the box before doing the exercise.
As they read, students should complete the text
using the words in the box. Come together as a
group to check answers.
1 comfortable position 2 pillow 3 shower
4 painkillers 5 anti-inflammatory
6 hot-water bottle 7 heat patches 8 ice pack
9 muscles 10 swimming
3 Tell students they are going to be giving advice
to patients suffering from lower back pain. Refer
them to the statements 1–5, then ask them to
reread the article and complete the pieces of
advice by adding Do or Don’t to the beginning of
each one. If necessary, go through the first item
as an example as a group.
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).
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.
5 In small groups, ask students to discuss the
question. Reassure students that accuracy is not
important for this activity – just encourage them
to discuss their ideas.
Vocabulary
6 Refer students to the pictures at the top of the
page and ask: What kind of treatment do these
images show? (Complementary and alternative
medicine.) Explain that the abbreviation CAM is
now commonly used.
Ask students, individually or in pairs, to match
the different examples of CAM to the correct
description. Check understanding of: improve,
mental well-being, therapy, therapist, manipulate,
influence.
1e 2c 3b 4d 5f 6a
Listening
7 ► 17 Tell students they are now going to hear
friends, Angie and Carlos, talking about their
experiences using CAM. Ask students to listen
and tick the examples of CAM they hear.
herbal therapy, hypnotherapy, hydrotherapy,
chiropractic therapy, music therapy
8 Refer students to the statements 1–5 and ask
them to listen and decide if the statements are
true (T) or false (F).
Ask students, individually or in pairs, to correct
the false statements. Come together as a group
to check answers.
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.)
Pain 2 20
 Extra activity
Ask students (in small groups) to brainstorm
more examples of CAM and write short
descriptions for a health website or patient
educational leaflet.
Suggested answers
acupuncture – uses very fine needles to
regulate the flow of energy through the body. If
the energy in the body is balanced, then the
person is in good health.
homeopathy – uses very small doses of a
substance that causes symptoms to stimulate
the body's self-healing response
massage – squeezes/stretches parts of the body
to make someone relax or to reduce pain
visualisation – uses positive mental images to
reduce pain or relax someone
Extra activity
Ask students, in pairs, to look at audio
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.
Speaking
10 In small groups, ask students to discuss the two
questions. Ask them to feed back to the rest of
the group and share their thoughts. If necessary,
give students time to write notes first.
If your students are pre-experience nurses, ask
them to prepare a short informal presentation
for the next class.
Preparing for the next unit
In preparation for Unit 3, suggest the following to
your students:
• Compile a list of words related to giving
instructions you already know in English.
• Familiarise yourselves with general nursing
statistics, e.g. height, weight, temperature,
blood pressure.
• Do some (online) research into the heart and
heart disease.

Vocabulary
9 On the board write: acute pain and chronic pain
and ask: What is the difference between the two
terms? Brainstorm ideas. Then ask students, in
pairs, to complete the definitions. Come together
as a group to check answers.
Experienced nurses may already be aware of
these terms, although some may have difficulty
expressing their ideas in English.

Suggested answers
1 Chronic pain continues over a longer period
of time; i.e. longer than six months. It can be
caused by lower back pain, headaches,
arthritis, cancer pain, neurogenic pain.
2 Acute pain can be mild or severe but doesn’t
last longer than six months. Examples include:
dental work, labour and childbirth, surgery,
broken bones, burns and cuts.

Pain 2 21
 3 Vital signs
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 unit to
encourage students to do this.
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 signs 3 22

Teacher’s notes
Warm-up
1 On the board write: head, eye, shoulder, chest, limb,
stomach, skin and then ask students to brainstorm
adjectives that can be used to describe pain for
each. This can be done as a team game – the
team with the most correct adjectives in a given
time is the winner.
2 Ask students, in pairs, to brainstorm different
ways to put a patient at ease. Tell students to use
the patient case on page 15 and take it in turns to
assess the patient, making sure the patient is at
ease.
Statistics and vital signs
Listening
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
way to say these figures. If necessary, review
weights and measures and/or numbers in more
detail.
Tell students they are going to hear a practice
nurse weighing and measuring six patients.
They should circle the correct number.
Point out they will hear: one point three four
metres or one metre thirty-four and twenty-two
point two five kilos, but not twenty two point
twenty-five kilos.
1 1.60 m 2 72 kg 3 1.34 m 4 89.5 kg
5 22.25 kg 6 1.40 m
Refer students to the information in the
height/weight chart. Explain that Imperial
measurements (pounds/lbs) are used in the
USA and also with older patients in the UK and
Ireland (pounds/lbs and stones).
1c 2d 3a 4b
3 Tell students they are going to listen to the
dialogues again and ask them to plot the
statistics for patients 1–3 on the height and
weight chart. They should also decide if the
patients are normal, overweight or underweight.
1 underweight 2 normal weight 3 overweight
4 Ask students, individually or in pairs, to
complete the nurse’s questions and requests. If
necessary, play dialogue 1 again. Come together
as a group to check.
Check understanding of: bladder, to empty, scales.
1 Can you, first? 2 are you 3 height
4 stand, scales 5 much, weigh
5 Depending on your group, students may prefer
to work in single-sex pairs for this activity.
In pairs, ask students to practise weighing and
measuring each other (they can guess).
Encourage students to use the questions 1–5 in 4.
Remind them to swap partners.
Less confident students may wish to keep the
phrases uncovered initially.
6 Ask students to match the vital signs to the
correct definition.

1d 2c 3a 4b
Extra activity
Ask students, in pairs or small groups, to write
the height and weight of three people – a
child/older person/person the same age – and
then take turns to dictate the statistics to each
other.

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?

Vital signs 3 23
 Extra activity
On the board, write: A high/low … means that the
patient …
Ask students, in pairs or small groups, to
discuss what a) a very high and b) a very low
reading of each of the vital signs shows about
the health of a patient.
Suggested answers
A high pulse indicates infection, stress,
anaemia or exercise.
A very low pulse rate indicates hypothermia,
certain drugs (for example beta-blockers) and
certain heart conditions.
A high blood pressure indicates anxiety or
stress.
A low blood pressure indicates hypotension.
A high temperature indicates fever.
A very low temperature indicates hypothermia.
A low respiratory rate indicates over-sedation,
opiate poisoning or the presence of a cerebral
lesion.
A high respiratory rate indicates asthma, heart
problems.
7 Ask students to look at the pictures and label the
equipment with the words in the box. If your
students are pre-experience nurses, check the
answers are correct before moving on to the next
stage of the activity. Ask students to write
sentences using the expression: A/An … is used to
measure …
Tell them not to worry too much about their
pronunciation at this stage.
a blood pressure monitor b thermometer
c pulse oximeter d stethoscope
e sphygmomanometer
1 A digital blood pressure monitor is used to
measure a patient’s blood pressure.
2 A thermometer is used to measure a patient’s
body temperature.
3 A pulse oximeter is used to measure how
much oxygen there is in a patient’s blood – the
oxygen saturation.
4 A stethoscope is used to listen to heart
sounds and respiration rate (and bowel
sounds).
5 A sphygmomanometer is used to measure a
patient’s blood pressure.
Extra activity
1 On the board draw a spidergram
(temperature) and elicit different types of
equipment for taking temperature. Students
may not know the name in English, but ask
them to explain how it is used/what it looks
like.
2 Ask: What are the different methods of taking a
temperature?/What type of thermometer is used for
each method?
Answers
1 tympanic, electronic, mercury (now rarely
used), oral
2 axillary/under the arm: mercury, electronic
ear: tympanic
oral/mouth: mercury, electronic, oral
rectal: glass, electronic
Pronunciation
8 ► 20 Ask students to listen and check their
answers to 7. Then on the board, write: digital.
Ask how many syllables there are in the word
and then elicit the stressed syllable. Ask students
to underline the stressed syllable in each word.
Avoid correcting at this stage.
1 digital blood pressure monitor
2 thermometer 3 pulse oximeter
4 stethoscope 5 sphygmomanometer
9 Play the recording again until you are happy
students are able to reproduce the
same/approximate pronunciation and stress
pattern. Reassure students that some of these
terms are difficult to pronounce even for a native
speaker.
Students may already know some of these terms
from their own language but will tend to place
the stress in the wrong place. Ask them to
compare stress patterns in their L1.
Speaking
10 Refer students to the chart (the ‘vital signs’
section of the admission form). Ask: When is this
section completed? Who completes the information?
Why/When is it necessary to sign?
Ask students in pairs to match the abbreviations
to the words in the box. If your students are pre-
experience nurses, check that they have the
correct abbreviations before moving on to the
next part of the activity. Ask students to explain
the terms to each other.
Vital signs 3 24
 Suggested answers
BP stands for blood pressure. We use a digital
3 ► 21 Tell students they are going to hear nurses
blood pressure monitor or a
sphygmomanometer to measure this.
P means pulse. We use a pulse oximeter to
measure this. (The nurse can also use his/her
finger to measure the pulse.)
RR stands for respiration rate. We use a
stethoscope to measure this.
T means temperature. We use a thermometer
to measure this.
Wt stands for weight.
0² Sats means oxygen saturation. We use a
pulse oximeter to measure this.
kg means kilograms.
O2 means oxygen.
% means percentage.
Listening
giving readings of vital signs for two patients.
Before they listen, ask students to look at the
current readings for the two patients. Ask: What
do you already know about these patients?
If necessary, play the recording again. Students
should compare answers with a partner, then
come together as a group to check. 
Point out that short forms are often used in
spoken English: Pulse 60, Resps 120, Temp 35.2,
BP 120.
1 P 128 RR 33 T 37
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 learn
11 Ask students to complete the summary, then about the patient from her vital signs? (According
compare their answers with a partner. Come to the chart, we know her age and that she
together as a group to check. weighs 32 kg. Her sats and resps are normal (for
a child), but her pulse is at the maximum rate for
1 take 2 vital signs 3 record a child of her age, and her BP seems low.)
4 observation chart 5 sign 6 monitor 7 high
8 low Explain to students that the information on the
chart is incorrect. They are going to hear a nurse
Extra activity giving the correct readings for this patient. Tell
students to listen and correct the mistakes. If
Ask: What other observations do nurses carry out? necessary, play the recording again.
Suggested answer
Nurses should always take time to look BP 100 / 65 P 130 RR 25 T 37.5
carefully at their patient and note: pallor;
colour and texture of the skin; the general
appearance (Is he/she well groomed and
appropriately dressed?); expression (Does
he/she appear in pain, look his/her age?);
movement (posture, gait, coordination) and
mental alertness of the patient.

Describing readings

Vocabulary
1 Ask students, individually or in pairs, to
complete the table.

RR BP P T
130/85 9
36.8 9
79 9
20 9

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

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

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
Listening
It is important students take time to grasp how
to give patient-friendly instructions and requests
as this is vital in developing and maintaining
nurse-patient relations. If necessary, review form
and usage of modals can/could. Students can then
concentrate on ensuring their
instructions/requests are patient-friendly.
Tell students they are now going to work on
giving instructions and making polite requests.
On the board, write: Relax your arm. Elicit a
‘softer’, more patient-friendly instruction:
Can/Could you relax your arm, please?
Check understanding of: roll up, sleeve, straight.
Encourage students to deduce the meaning from
the context/images.
1 ► 24 Refer students to the images a–f and ask
them, individually or in pairs, to match them to
instructions 1–6. You may wish to correct the
first part of the activity before continuing. Then
ask students to choose the correct piece of
equipment for each instruction.
Remind them that the use of modals can and
could for instructions and polite requests is
interchangeable.
Ask students to practise the instructions/polite
requests in pairs. Encourage them to use can and
could. Tell them that intonation is very important
when giving patient-friendly instructions. A
gentle rise and fall pattern will help to soften the
instruction (make it sound less direct) and as a
result relax the patient.
Ask students to practise the instructions/
requests again, this time focusing on the
intonation pattern.
1a 2b 3e 4d 5c 6f
1 temperature (thermometer)
2 temperature (in ear with tympanic
thermometer)
3 blood pressure/pulse (digital blood pressure
or a sphygmomanometer)
4 pulse (finger)
5 respiration rate (stethoscope)
6 blood pressure (digital blood pressure or a
sphygmomanometer)
Extra activity
On the board write: Could you relax your arm,
please? Elicit an appropriate intonation pattern,
then play the recording again to check.
Alternatively, model two examples – one with
a flat intonation pattern and one with a rise and
fall. Ask: Which is more polite? Why?
Answer
A flat intonation pattern sounds
impolite/uncaring/not patient-friendly.
Extra activity
Ask students to underline one word in
sentences 1 and 3 that makes them more
patient-friendly. Ask: What does this do to the
instruction/request? (Including just makes the
instruction/request sound softer.)
Ask students to practise giving instructions 2,
4, 5 and 6 adding the word just.
Note that intonation rises slightly on just.
2 Tell students that charge nurse Stefano is going
to take Mr Daniels’ pulse rate. Before they listen,
ask students to visualise taking a patient’s pulse;
this will help them to concentrate on the
language input as opposed to the task itself.
Then ask students, individually or in pairs, to
put the words in order to form a sentence and
then put the sentences in the correct order. If
necessary, go through one answer with the
students first.
1 I’ll take your pulse now, Mr Daniels, if I can?
2 Can you give me your palm, please?
3 I’ll put my fingers on your wrist.
4 That’s ninety-five beats per minute.
3 ► 25 Play the recording to check answers to 2.
Then play the recording again to answer the
question.
Mr Daniels was late for his appointment and
rushed to arrive on time. The reading was not
accurate.
4 ► 26 Tell students they are now going to listen
to the same nurse taking Cameron’s pulse. Ask
them to read through the questions, then listen
and answer. If necessary, play the recording
again. Ask students to compare answers with
their partner, then come together as a group to
check.
Vital signs 3 27
 1 pulse oximeter
2 110 beats per minute
3 Around ten years old. His pulse rate is higher
than a mature adult/His voice/His anxiety about
the pain.
Language
Will + infinitive for future
On the board, write: You will feel better soon. and
I’ll take your temperature now. Elicit when the
future with will + infinitive is used. Some
students may already know this. Most students
of this level will know how to form the
structure.
Answer: for predictions (You’ll feel better soon.)
and to talk about decisions made at the time of
speaking (I’ll take your temperature now.)
Ask: Why do nurses talk about decisions?
Answer: Nurses should always keep patients
informed of what they are about to do to
reduce patient anxiety.
Give students time to assimilate the points
covered in the Language box.
If necessary, review future with will, including
contracted forms.
5 Ask students to complete the examples from
dialogues with nurse Stefano using will and
verbs from the box. Come together as a group to
check.
1 ’ll put 2 ’ll take 3 ’ll, clip 4 Will, hurt
5 won’t, ’ll be 6 ’ll, write
6 ► 27 Tell students they are going to hear a staff
nurse interview Ana Leogardo during her
morning rounds (visit of patients in the ward).
Ask students to read the questions and then
listen to the recording and answer.
1 not bad, hungry
2 She uses a pulse oximeter.
3 She thinks Ana’s temperature is still high.
7 Before they listen to the recording, ask students
to complete the staff nurse’s dialogue, using will
and the correct form of the verbs in the box.
Encourage them to use their nursing knowledge
to help them complete the dialogue.
Check understanding of: cuff, lap, pillow, tight.
Encourage pre-experience nurses to deduce
meaning from the context/images. Do not check
answers until students listen to the recording in
8.
1 ’ll (just) roll 2 ’ll put 3 hold 4 ’ll wrap
5 won’t feel 6 ’ll (just) be 7 ’ll (just) take
8 eat 9 see
Extra activity
Ask: How do you usually take blood pressure?
Which piece of equipment does the staff nurse use?
Which method do you prefer?
Tell students to read audio script 28 on page 73
to check their answers.
Answer: sphygmomanometer
Students may mention the difficulty in hearing
the heart sounds using a sphygmomanometer/
that it is less practical compared with a digital
blood pressure monitor.
8 ► 28 Ask students to listen to the recording,
check the answers to 7, and then complete as
many of Ana’s vital signs as possible. They then
look at audio script 27 on page 73 and complete
the rest of the vital signs. Ask them to compare
their answers with a partner, before coming
together as a group to check.
For further language practice, ask students to
underline other examples of future with will in
audio script 26 on page 73 to further reinforce
usage. Ask students to circle examples where
speakers are making predictions and underline
examples where speakers are talking about
decisions.
(Predictions – Will it hurt?, No it won’t, It will be
very quick. Decisions – I’ll just clip, I’ll just write
this down., We’ll take your temperature.)
BP 130 / 85 P 80 RR 17 T 38
Writing
9 Ask students to choose one piece of equipment
from page 21. Tell them they are going to write
five lines (at least) explaining to a patient how
they will take one set of vital signs.
Before they write, elicit expressions from 7 that
give encouragement to the patient – e.g. that’s
good/that’s right, also fine, you’re doing well.
Encourage students to include patient-friendly
instructions.
If students lack confidence, put them into pairs
or small groups for collaborative writing. They
could use the text in 7 as a model.
Ask students to practise giving their
explanations in pairs. Encourage them to use
patient-friendly intonation patterns.
Vital signs 3 28
 Circulation and the heart
Vocabulary
1 Ask students to label the diagram of the heart. If
they are pre-experience nurses, you may wish to
give them the first letter of each word.
1 aorta 2 vena cava 3 pulmonary artery
4 right atrium 5 pulmonary vein
6 right ventricle 7 left atrium 8 left ventricle
Pronunciation
2 ► 29 Ask students to underline the syllables
that are stressed.
If you feel they need more support, elicit the first
example from the group. Alternatively, ask:
Which is the odd one out? (1 aorta – the stress is on
the second syllable, all the others are stressed on
the first syllable.)
Play the recording several times until you are
happy that students are able to reproduce the
same/approximate pronunciation and stress
pattern. Reassure them that some of these terms
are difficult to pronounce even for a native
speaker.
Students may already know some of these terms
from L1, but will tend to place the stress in the
wrong place. Ask them to compare stress
patterns in their L1.
1 aorta 2 artery 3 vena cava 4 atrium
5 ventricle 6 pulmonary
Reading
3 Tell students they are going to read part of a
reference text that explains the function of the
heart. As they read, they should use the words
in the boxes to complete the information.
Encourage them to deduce the meaning of new
words from the context and their own nursing
knowledge.
With less confident students, you could check
their answers stage by stage.
Students compare their answers in small groups,
then come together as a group to check.
Check understanding of: circulate, pump, chamber,
oxygen-rich blood.
1 pumps 2 circulates 3 returns 4 atria
5 ventricles 6 circulatory system 7 vena cava
8 pulmonary artery 9 aorta
Speaking
4 In pairs, ask students to cover the diagram and
explain how the heart functions (as if speaking
to a student nurse). Encourage students to use
terms from the text, check their partner’s
comprehension, and ask if he/she has any
questions. With less confident students, you
could suggest they write notes first.
Extra activity
Students imagine they are explaining the
function of the heart to an adult patient with a
suspected heart condition.
Extra activity
Students imagine they are explaining the
function of the heart to one of the following: a
child aged ten, the carer or family member of a
patient with a chronic heart condition.
Reading
5 Ask: Which age group is most affected by smoking in
your country? What can the health service do to
encourage people to stop smoking?
Ask students to scan the text to find the answer
to the question. Reassure them that they don’t
have to understand every word on first reading.
If necessary, pre-teach/elicit the meaning of:
risk, to narrow, nicotine, several, significant.
Smoking causes the heart rate to increase and
the blood pressure to rise. The arteries narrow
and the blood flow decreases.
6 As they read again, ask students, individually or
in pairs, to decide if the statements 1–5 are true
or false. They should then correct the false
statements. Come together as a group to check.
1 T 2 F, Nicotine causes your blood flow to
decrease and your blood pressure to increase.
3 T 4 F, After a few years the risk of heart
disease for an ex-smoker is the same as a 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
there may be more than one possible answer.
Vital signs 3 29
 Suggested answers
1 increases
2 goes up/rises/increases, goes
up/rises/increases
3 reduces/falls/drops
4 goes up/rises/increases, reduces/falls/drops
5 reduces/falls/drops/decreases

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

Preparing for the next unit

In preparation for Unit 4, suggest the following to
your students:
• Compile a list of common symptoms you
already know in English.
• Think about the last time you were ill. What
were your symptoms and how did they start?
• Do some (online) research into respiratory
problems.

Vital signs 3 30
 4 Symptoms
Briefing
This unit looks at developing language for common
symptoms and injuries, as well as encouraging
patients to describe how these came about. It also
deals with the symptoms of asthma and giving
instructions in an emergency situation. Finally, it
provides an introduction to understanding and
writing simple SOAP notes.
Symptoms and injuries
Triage nurses working in an emergency 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 about. The disadvantage is that the
patient could start giving information that is not
relevant to the case. This type of questioning could
waste valuable time. The cone technique is the most
effective means of questioning – it involves asking
open questions to allow the patients to express
themselves followed by closed questions to request
specific details.
Asthma emergency – giving
instructions
In this section, students are asked to read an article
from the World Health Organization providing data
on the global issue of asthma, before they are
introduced to some basic medical terms related to
the respiratory system. They also develop key
words to describe the symptoms and causes of
asthma, such as mucus, pollen, wheeze, etc. In
emergency situations, instructions must be simple
and clear while remaining patient-friendly. Students
will look not only at how to form instructions using
imperatives but also how to include staging words –
first, then, next, finally – and pausing to ensure their
patients are able to follow the instructions more
easily and in turn replicate the procedures more
accurately.
SOAP notes
The final section deals with SOAP notes: a (US)
nursing document used to record information about
the patient, their symptoms, the assessment and the
proposed nursing plan. The acronym SOAP stands
for subjective – what the patient actually says about
the problem (often written verbatim); objective –
what the nurse observes, either physical symptoms
or vital signs; assessment – the nurse’s summary of
the patient’s medical problem; and plan – how the
nurse intends to treat the patient. Students will also
be introduced to some commonly used medical
abbreviations, including NKA (no known allergies),
IBP (ineffective breathing pattern) and p.o. from the
Latin pe os (by mouth).
Symptoms 4 31
Teacher’s notes
Warm-up
1 On the board, draw five arrows/patterns as in 7
on page 23. Ask students to brainstorm words to
describe these patterns. Then ask students, in
pairs, to draw charts similar to those on page 23
and practise describing them as if to a colleague
or patient.
2 Refer students, in pairs, to the patient on page 24
and ask them to take it in turns to practise taking
the patient’s vital signs, using similar
instructions. Remind students to use patient-
friendly intonation patterns.
Symptoms and injuries
Vocabulary
1 Ask students, in pairs or small groups, to think
about emergency room(s) in their place of
work/country and ask them to brainstorm the
kind of symptoms patients generally present
with. Then ask them, individually or in pairs, to
read the text about emergency rooms in the USA
and complete it using the words in the box.
Check understanding of: contusion (bruise),
abdominal, respiratory, sprain.
Ask students to compare their ideas with the
information in the text.
Ask: What can chest pains be a symptom of? (heart
attack, angina, asthma, allergies, anxiety, pain,
fever, infection, diseases of heart and lung,
stroke, head injuries, certain medications such as
beta-blockers, aspirin, etc.)
Explain that nurses will hear the terms signs,
symptoms and injuries. 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.). Injury
is the patient term for the physical damage to the
body (cut, broken bone).
1 injury 2 contusion/sprain
3 sprain/contusion 4 abdominal/chest
5 chest/abdominal 6 respiratory
2 Ask students to look at the picture of the
patients sitting in the Emergency Room. If
necessary, check meaning of triage. Ask them, in
pairs or small groups, to discuss questions 1 and
2. Come together as a group to check.
Some students may have difficulty expressing
their ideas effectively in English. Reassure them
that for this activity accuracy is not important –
just encourage students to discuss their
opinions.
If your students are experienced nurses, ask
them to explain the reason for their order of
care.
1 (Suggested answers)
a Difficult to give anything specific from the
picture. Common problems for infants: colic,
teething
b black eye, cuts, grazes and bruising
c mild asthma attack
d sprained shoulder, bruising
e cut finger
f chest pains, asthma, angina
2 f, c, d, b, a, e
Listening
3 ► 30 Tell students they are going to listen to the
six patients in the picture describing their
problems. As they listen, students should label
the pictures a–f in the order they hear them.
a5 b2 c1 d4 e3 f6
4 Ask the students to listen again and write the
description of the problem next to each person.
Check understanding of: colic, nauseous. Play the
recording again if necessary.
a colic b black eye, contusion c asthma
d broken wrist, nausea e bleeding, infection
f heart problem
Vocabulary
5 Tell students they are now going to look at terms
patients frequently use to describe their
symptoms. Ask students, individually or in
pairs, to complete the sentences about the
symptoms and injuries of each of the six patients
using the words in the box. Point out they will
need to change the form of the word in some
cases.
Symptoms 4 32
 Ask students to indentify the symptoms and the
injuries in the sentences. (injuries: cut, banged
head, bruise; symptoms: cough, difficulty
breathing, dizziness, infection, nausea.)

1 coughing, breathing 2 pain, dizzy

3 bleeding, infection 4 pain, sick
5 swollen, dizzy 6 bruises

6 If you have confident students, you may do 7

first which will serve as a diagnostic test of the
target structures. Students can then go through
the Language box to reinforce their knowledge.
Ask students, individually or in pairs, to
complete the table with the correct word forms.
Explain there are no ‘rules’ to follow for these
particular language items, but they are
frequently used by patients and therefore
important to grasp.
Encourage them to search for the answers in 5.
Point out that in the USA/Canada sick is a
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 write at least three sentences about each of the
Room on page 28. On the board, write: patients, using the past continuous and the past
1 What did Jason do? He ______ off his bike. simple tenses.
2 What was be doing before he fell? He ______ ______ In pairs, students take turns asking the patients
his bike. about their symptoms. Suggest students use
Ask a stronger learner to fill in the gaps. questions such as these to interview their
On the board draw: patients: Can you tell me what happened? What
past → now were you doing when …?
→ Jason was riding his bike. →
↓
Jason fell off his bike.
Refer students to the example in the Language box.
Ask: Did the person stop coughing or was it a
continuous action? (continuous action)
Ask: When do nurses use these two forms? (To
understand how the patient arrived at their symptoms.)
Give students time to assimilate the points covered
in the Language box.

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

Symptoms 4 34
 Asking about symptoms and injuries
Speaking
1 Ask students, in pairs, to observe the patient and
discuss questions 1–3. Encourage them to
explain their reasoning. Wait until students
listen to the recording in 2 to check the answers.
Listening
2 ► 31 Tell students they are going to hear a
nurse interviewing the patient, Mr Daniels. Ask
them to listen and check their answers to 1. Play
the recording again if necessary.
1 shortness of breath, pains in chest, pain in
left arm
2 diagnosis not given (but possibly a heart
attack/angina)
3 carrying a heavy object
3 Refer students to the patient record. If necessary,
allow them to familiarise themselves with the
contents of the patient record before they listen
again. Elicit/Pre-teach: located, radiate, condition.
1 chest 2 shortness 3 centre 4 arm 5 face
6 three 7 was carrying heavy things 8 two
9 third 10 breathing 11 very worried
12 worse
Vocabulary
4 Tell students they are now going to develop a set
of questions that nurses might use to assess their
patient’s symptoms. Ask them, individually or
in pairs, to match the beginnings 1–8 and the
endings a–h to complete the nurse’s questions.
Remind them that they have already come
across some of these in Unit 2. If necessary, do
the first one as a group. Ask pairs to compare
answers. Wait until 5 to check.
1d 2g 3a 4b 5h 6c 7e 8f
Extra activity
In pairs, students should take turns asking and
answering the nurse’s questions in 4, using the
patient record. This will serve to reinforce the
target language items.
Students may wish to read the dialogue on
page 74 before doing this.
5 Refer students to audio script 31 on page 74 to
read the nurse’s questions and check their
answers to 4. Encourage them to underline the
questions as they read. On the board, write: 1
Does the pain move at all? 2 How would you describe
the pain? Elicit the answers: 1 Yes, it does. 2 The
pain moves down the arm and up to the chest. It lasts
for around three minutes each time … Ask: What is
the difference between the two answers? (1 The
answer is Yes/No. 2 This answer is more
detailed.)
On the board, write: Open question/Closed
question. Ask the group to match these terms to 1
and 2. (1 closed question, 2 open question)
Ask students, individually or in pairs, to look at
the audio script 31 on page 74 and circle all the
closed questions and underline all the open
questions. Come together as a group to check.
Ask students, in pairs or small groups, to discuss
questions 2 and 3. Come together as a group to
check.
Pre-experience nurses may not yet have come
across this communication technique, but should
be able to identify some of the above.
Some students may have difficulty expressing
these ideas effectively in English. Reassure them
that for this activity accuracy is not important –
just encourage students to discuss their
opinions.
1 open questions: 1, 6, 7, 8
closed questions: 2, 3, 4, 5
2 (Suggested answers)
Advantages: Open questions encourage the
patient to describe their symptoms in their own
words, without the nurse guiding the patient in
a particular direction. Answers tend to be more
detailed than ‘closed’ questions. The nurse
could find out important information that he/she
may not think to ask about.
Disadvantages: The patient could start giving
information that is not relevant to the case. This
type of questioning could waste valuable time.
3 (Suggested answers)
Advantages: Closed questions are useful when
requesting factual information from a patient or
when there is a need to narrow down the
options in order to make an accurate diagnosis.
Disadvantages: It takes time to find out all the
important information.
Symptoms 4 35
 Extra activity
You could develop appropriate intonation for
question forms before students roleplay the
patient interview. On the board, write: Does the
pain move at all? Elicit 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.
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.

6 Ask students to look at question 1 and ask: Why 1 how it happened

do you think this is an ‘open’ question? (It 2 I slipped and fell
encourages the patient to express 3 has this happened
themselves/does not require a Yes/No or one- 4 I touch here
word answer.) 5 really sore
6 of one to ten, how bad is the pain
Ask students, individually or in pairs, to decide 7 Five, I guess
if questions 1–10 are open or closed. Tell them to 8 what happened
write ‘O’ for open questions and ‘C’ for closed 9 I was just doing my kickboxing class at the
questions. Do not confirm answers yet. gym
10 Dizziness or nausea
1 open 2 open 3 closed 4 closed 5 open 11 I feel a little sick
6 open 7 closed 8 open 9 open 10 closed
Extra activity
7 Ask students, in pairs or small groups, to
Refer students back to the patients on page 28.
compare their answers to 6 before coming
In pairs, ask them to prepare a dialogue using
together as a group to check. As a group, answer
the question forms in 4 and 6 based one of
the question.
these patients.
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?
Then ask students, individually or in pairs, to
complete the dialogues using question forms
from 4 and 6. If necessary, do the first few
questions as a group. Do not confirm the
answers yet.

Symptoms 4 36
 Asthma emergency – giving
instructions
Speaking
1 Tell students they are going to read an article
from the World Health Organization (WHO)
about asthma. Ask: What is your experience of
asthma?
Pre-experience nurses may not have treated
asthma patients, but it is likely they know
someone who suffers from the condition.
Ask students, in pairs or small groups, to discuss
the question. Tell them they will have a chance
to check their answers later. Alternatively, you
could give them the suggested answers below
before moving on to 2.
Suggested answers
Symptoms: coughing, breathlessness,
wheezing (noisy breathing), tight feeling in the
chest, trouble sleeping due to breathing
difficulties
Causes: colds and flu, cigarette smoke,
animals/pets, house dust mites (in carpets,
etc.), physical activity, emotions, allergies,
family history, certain medications such as
beta-blockers, aspirin
Vocabulary
2 Ask students, individually or in pairs, to match
the words related to asthma to the correct
definition.
4 ► 33 Ask students to look at the picture on the
1c 2a 3f 4b 5d 6e
Reading
3 Ask students to read the text and check their
answers to 1. Tell them the vocabulary in 2 will
help them follow the text.
Once they have read the text, ask students to
label the diagram with the words in the box.
With less confident students, you could check
the answers to 1 before labelling the diagram.
Then check answers to 3.
Ask students to brainstorm ideas for the
following question: What advice might nurses give
to asthma sufferers about how to enjoy a good quality
of life? (Take moderate exercise, don’t allow
smoking in the house or car, keep a diary of the
patient’s symptoms/peak flow diary to record
the differences in the patient’s breathing, don’t
have pets in the house, make sure the house is
dust free.)
1 windpipe 2 right lung 3 diaphragm
4 bronchial tubes 5 normal bronchiole
6 asthmatic bronchiole 7 left lung
Extra activity
In order to check their understanding of the
text, ask students the following comprehension
questions (either pre- or post-reading).
1 What generally happens when a patient has
an asthma attack?
2 Which countries have the highest levels of
asthma in the world?
3 Where do most of the deaths in asthma take
place?
4 Who is more likely to suffer from asthma?
5 What is the cure for asthma?
Extra activity
Ask students to deliver a short presentation on
asthma, using the diagram on page 32.
Listening
right of the page and ask: What is the nurse doing?
What type of inhaler (do you think) is this? (She’s
teaching her patient how to use his inhaler. It’s a
Ventolin inhaler which is used in emergencies.
Note that Becotide inhalers are used as
preventative medication.)
Tell students they are going to listen to Practice
Nurse Nina talking to her patient Kyle Jenkins
and his father during an asthma clinic. Ask
students to listen to Part 1 and decide if the
sentences 1–5 are true or false. If necessary,
allow students to read the sentences before
playing the recording.
Ask students, individually or in pairs, to correct
the false answers. Play the recording again if
necessary.
1 T 2 F, football with his dad
Symptoms 4 37
 3 F, seven minutes 4 F, his cousin 5 T
5 Tell students they are going to develop a set of
instructions for using an inhaler. Ask them,
individually or in pairs, to put the sentences a–e
into the correct order.
If your students are experienced nurses,
encourage them to visualise the process first, to
allow them to concentrate on the language.
a Take a puff on your inhaler at the same time
but don’t breathe out immediately. 3
b Remove the inhaler and hold your breath for
10 seconds. 4
c Place the mouthpiece between your lips and
breathe in as deeply as possible. 2
d Breathe out slowly and repeat if necessary. 5
e Breathe out gently and tilt your head back
slightly. 1
Language
The imperative
1 Refer students to the examples in the
Language box, then ask them to underline the
imperatives in 5.
It is important to point out that imperatives are
only used for giving clear, simple instructions.
2 On the board, write: First, breathe out. Then,
blow into the mouthpiece. 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.
In pairs, students then take it in turns to practise
reading the instructions aloud. Encourage them
to pause after each staging word. Then play the
recording so they can check. If necessary, ask
them to roleplay the instructions again to
replicate the recording.
Suggested answer
First, sit down at a table. Don’t lie down. Then,
lean forward slightly and put your arms on the
table. Next, take up to six puffs of your inhaler.
Call an ambulance after six minutes if your
symptoms don’t improve. Then, continue to
take your inhaler every six minutes, for a
maximum of six puffs. Finally, repeat these
steps, if your symptoms begin again.
Extra activity
Ask students to write simple patient
instructions for two pieces of medical
equipment, using the prompts below. If your
students are pre-experience nurses, first ask: 1
What is a peak flow meter? 2 What is a nebulizer?
What is a portable 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
1 If your students are pre-experience nurses, write
SOAP notes on the board and ask: What do you
think SOAP stands for? What do you think SOAP
notes are used for? Avoid correcting at this stage.
Ask students, individually or in pairs, to read
the text about SOAP notes. As they read,
students should complete the text with the
words in the box. If necessary, pre-teach/elicit
the words in the box first.
If your students are experienced nurses, ask:
What is your experience of using SOAP notes? Do
you use another form of notes when you assess a
patient? How do they differ from SOAP notes?
1 documents 2 symptoms 3 measure
4 summary 5 treat 6 help
Vocabulary
2 Refer students back to the SOAP note written for
Kyle and ask them, individually or in pairs, to
find expressions or abbreviations with the
meanings given in 1–8. Come together as a
group to check.
1 meds 2 pt 3 r/t 4 SOB
5 abdominal exertion 6 administer 7 RR
8 nebulizer
Extra activity
You may wish to check students’
understanding by asking concept questions
about the SOAP note for Kyle, e.g. What does the
patient say about his symptoms? What does the
nurse observe? What is the nurse’s diagnosis of the
patient’s condition? How does the nurse decide to
treat the patient?
Speaking
3 Refer students to the diagram and ask them to
discuss the questions in pairs or small groups.
It is a position where the patient sits upright at
90°.
This position helps the patient to breathe more
easily.
Sit upright at 90°.
Reading
4 Tell students they are now going to read SOAP
notes for two new patients, Nancy and Massimo.
Ask them to read the patient information first
and ask: What do you know about the patients?
(Point out that the photos would not normally
be attached to the SOAP notes – they are
included here to support the students.)
Ask students, individually or in pairs, to read
the SOAP notes and answer the questions. Come
together as a group to check.
If necessary, reassure students that they may not
understand all the abbreviations at this stage,
but that they will work on these in the next
activity. Encourage them to ‘get the gist’.
1 Massimo 2 Nancy 3 Nancy 4 Massimo
5 both of them 6 Nancy
Vocabulary
5 Refer students to the abbreviations key and ask
them, in pairs, to practise saying the
abbreviations as complete words.
Note: the following abbreviations come from
Latin but are used in medical English as
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;
p.r.n. pro re nata – as required.
Speaking
6 Dictate the following abbreviations from Unit 3
and ask students, in pairs, to note the terms in
full: BP, RR, T, Ht, kg, DOB, Wt, P, O² Sats. The
first pair with all the correct terms wins the
game.
Answers: blood pressure, respiratory rate,
temperature, height, kilogram, date of birth,
weight, pulse, oxygen saturation
Refer Student Bs to page 68. Ask Student As to
add two more terms that can be abbreviated to
the list on page 35. They should then dictate the
abbreviations 1–8 to Student B, who must write
the terms in full. Students then swap roles.
Student A 1 p.o. 2 Chol 3 R/O 4 mg
5 NKA 6 IAC 7 IBW 8 UA
Student B 1 R 2 BS 3 t.i.d. 4 p.r.n. 5 L
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.

Preparing for the next unit

In preparation for Unit 5, suggest the following to
your students:
• Compile a list of words related to food and
nutrition you already know in English.
• Write a diary of your food intake for the
week.
• Do some (online) research into Type 1 and
Type 2 diabetes.

Symptoms 4 40
 5 Food and nutrition
Briefing
This unit seeks to develop key language related to
nutrition and food before looking at skills to carry
out a nutritional assessment and offering advice on
improved diet. It also develops understanding of
conditions related to food intake – food allergies and
diabetes.
Nutrition
A healthy diet comprises roughly one-third fruit and
vegetables, one-third starchy foods and one-third
meat, dairy and oily, fatty and sugary foods. The
food pyramid (a graphic representation of the
different food groups and the proportions advised
for a healthy diet) is an authentic way of presenting
the key words for this first section of the unit.
Students are asked to draw on their general
knowledge of foodstuffs and nutrients –
carbohydrates, proteins, fats, vitamins, minerals,
fibre (and water) – and label the pyramid, indicating
dairy products, fresh fruit and vegetables, cereals,
etc. They will then go on to compile definitions of
the food groups, highlighting which of these fights
disease, repairs the body and helps digest food.
Describing quantities is necessary for a better
understanding of a patient’s diet and this unit
provides ample practice of countable and
uncountable nouns for this purpose.
Nutritional status
Good nutritional status is essential to the health and
well-being of the patient. Extra demands placed on
the body due to illness mean the need for nutrients
is increased. Poor nutrition can be associated with
delayed recovery; adequate nutrition not only
promotes tissue repair, but also aids recovery from
surgery and disease. Assessing nutritional status
involves taking measurements (see Unit 3) and
calculating the BMI or Body Mass Index. A patient
weighing 50 kg at 1.68 m would have a BMI of
50/1.68 x 1.68 = 17.7. A BMI of less than 18.5
indicates the patient is underweight while a BMI of
30+ is an indication of obesity.
Nurses also ask questions to determine the patient’s
food intake. In this section students will have the
chance to analyse a patient’s food journal to check if
he/she is eating a balanced diet.
Food allergies and intolerances
In the USA, food allergies affect nearly 4 percent of
the general population and it is estimated that such
allergic reactions cause 30,000 emergency room
visits and 150 to 200 deaths every year. 90 percent of
these are caused by milk, eggs, peanuts, tree nuts,
fish, shellfish, soy and wheat; and are often lifelong
conditions. There is no cure for a food allergy and
minute amounts of a food can cause a reaction in a
highly sensitive patient. Strict avoidance of the
allergy-causing food is the key to preventing allergic
reactions. A food allergy is an immune system
response to a food that the body mistakenly believes
is harmful. Once this happens, the patient
experiences an adverse reaction and the body
creates specific antibodies against the food. The next
time the individual eats that food, the immune
system releases massive amounts of chemicals,
including histamine, in order to protect the body.
These chemicals trigger allergic symptoms that can
affect the respiratory system, gastrointestinal tract,
skin or cardiovascular system.
Food intolerance does not involve the immune
system and is not life-threatening. Lactose
intolerance – trouble digesting the milk sugar lactose
– is a common example. Symptoms may include
abdominal cramps, bloating and diarrhoea.
The second part of this section provides discussion
on diabetes and takes students through the different
stages of administering a blood sugar test. Refer to
the text on page 41 for an explanation of Type 1 and
Type 2 diabetes.
Advice on diet
This section begins by reviewing key words used to
describe quantities and containers for food stuffs,
including carton, packet, segment. Students listen to
a school nurse giving government advice on
portions, focusing on the five-a-day campaign. The
section then moves to develop students’ skills in
giving suggestions and advice in a way that involves
the patient in the decision-making process and is
personalised/ adapted to the needs or lifestyle of the
patient. Use of tentative suggestions, How about +
-ing?, Can I suggest you + infinitive compared with
strong suggestions based on medical evidence: It is
advisable/important to + infinitive. Patient case
histories are then presented to allow students to put
their skills into practice.
Food and nutrition 5 41

Teacher’s notes
Warm-up
1 On the board, write: Closed questions and Open
questions. Ask students, in small groups, to select
one of the patients from page 28 and brainstorm
five questions for each heading to assess the
patient’s symptoms. This can be done as a team
game – the first team with ten correct questions
in a given time is the winner.
2 Ask students, in pairs, to take turns to roleplay
an assessment with their patient from page 28.
Nutrition
Vocabulary
1 Refer students to the food pyramid and ask
them, in pairs or small groups, to brainstorm
names of food stuffs they see. Depending on
your group, you may wish to add a competitive
element and divide the group in two. The
winning group is the one that finds the most
food items in a given time.
Depending on your group, they may know
certain food stuffs as opposed to others.
Ask students, individually or in pairs, to label
the sections 1–4 of the pyramid with the words
from column 3 of the table. Ask them to compare
their ideas with a partner, then come together as
a group to check.
If your students are experienced nurses, ask:
When might a nurse use the pyramid with patients?
What is your experience of this type of chart? What
other types of diagram might be used instead?
(Nurses use food pyramids to give advice to
patients on diet, to show them the proportion of
each food group they should be eating. Other
examples: eat-well food plate/a pie chart.)
Ask students to add typical food stuffs/dishes
from their own culture to the sections of the
3 Ask students, individually or in pairs, to refer
pyramid. Come together as a group to exchange
ideas.
1 fats, oils, sweets
2 meat, fish, dairy products, beans, eggs
3 fruit and vegetables
4 potatoes, rice, cereal, pasta, bread
2 Refer students to the table and ask them,
individually or in pairs, to use the words in the
box to complete the statements in column 2
about the different food groups. Come together
as a group to check.
If your students are pre-experience nurses,
encourage them to make use of the information
in the third column to help them complete the
table.
1 energy 2 build 3 digest 4 bones 5 fight
6 repair 7 skin
Language
More confident students can complete 3 (and 4)
before referring to the Language box. They can
then use this as a means of checking their
existing knowledge of the target structures.
For less confident students, write headings: a
and an on the board and ask them to brainstorm
food stuffs for each column. Ask: When do we use
‘a’ and when do we use ‘an’? (A is used in front of
countable nouns beginning with a consonant, an
with countable nouns beginning with a vowel.)
Countable and uncountable nouns
Draw a two-column table on the board. Do not
label the columns but write in column 1 biscuit,
egg and in column 2 water, sugar. Ask students
to add two more food items to each column
and ask a stronger student to give each column
a title (Countable and Uncountable). Ask: What is
the difference? (It is possible to count the nouns
in column 1 but not those in column 2.)
On the board, write: some, a lot of, How much?,
How many? Ask students to put these into the
correct columns. (Some and a lot of appear in
both columns. How much? in column 2 and How
many? in column 1.)
Remind students they can say a piece of cheese, a
bottle of water – the phrases in bold are
countable.
Give students time to assimilate the points
covered in the Language box.
back to the pyramid and add foods to the two
columns.
Food and nutrition 5 42
 Suggested answers Variation
Countable: some sweets, some crisps, some Ask students, in small groups, to discuss the
sausages, a yoghurt, a chicken, some nuts, following questions: Why (do you think) is it
some eggs, some peppers, some carrots, important to understand the dietary habits of your
some tomatoes, a lettuce, a cucumber, an patient? Give examples of the dietary habits of a
aubergine, some mushrooms, an orange, an culture/religious group that you know well.
apple, a bunch of bananas, a pineapple, some
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
Vocabulary
1 If your students are experienced nurses, ask:
What is the Body Mass Index used for? How is it
measured? (The Body Mass Index or BMI is used
to decide if a patient’s weight is healthy,
compared with their height squared.)
Elicit/Pre-teach adjectives that nurses might use
to describe a patient’s weight: overweight, obese,
underweight.
It is important to point out that the adjective fat
is not used in a medical context – use of
overweight or obese and variations of these are
used instead.
Ask students, individually or in pairs, to read
the text about BMI and complete the statements
using the words in the box.
Remind students that numbers with decimal
points are pronounced like this: twenty-five point
five. (In some languages a comma is used instead
of a point.)
Ask: How do you think nurses might calculate the
BMI of a patient who is not able to stand? Is the BMI
suitable for measuring children/a baby?
Answers: Ask the patient to open their arms
outstretched at shoulder height and measure the
distance between the tips of the middle fingers –
this measures the height of the patient. Use mid
upper arm circumference (MUAC)
measurement. If the MUAC is less than 23.5 cm,
the BMI is likely to be less than 20 kg/m2
(patient is likely to be underweight). If MUAC is
more than 32.0 cm, the BMI is likely to be more
than 30 kg/m2 (patient is likely to be obese). The
BMI and MUAC measurements are only suitable
for adults.
1 underweight 2 overweight 3 obese
Listening
2 ► 35 Tell students they are going to hear Nurse
Sam McCarthy assessing Alain’s nutritional
status. Ask students to listen and complete the
Nursing Assessment form. If necessary, ask
them to familiarise themselves with the
assessment form before listening.
Check understanding of: allergies.
a 22.4 b peanuts
c last night, 10pm, bowl of soup and toast
3 Ask students to read Alain’s food journal and
then complete the statements about his
nutritional status based on this and the
information in the assessment form.
1 slightly underweight 2 gain weight
3 normal weight 4 doesn’t eat enough
Speaking
4 Refer students to Alain’s food journal and ask:
What do you think a food journal is used for? Who
fills in the journal? (Patients suffering from
weight problems may be asked to fill in a food
journal so that the nurse or nutritionist can
advise them on a weight loss/gain plan if
necessary.)
Ask students, individually or in pairs, to read
through Alain’s food journal and answer
questions 1 and 2. Come together as a group to
check. See 5 below for complete answers.
5 ► 36 Tell students they are now going to hear
Nurse Sam assessing Alain’s food intake. Ask
them to listen and compare her advice with their
own.
Less confident students could complete 6 before
listening to the audio.
Suggested answer
Assessment and advice: Bad points: calorie
intake is very low; it’s not a balanced diet; lacks
sufficient protein, carbohydrates and fibre; he’s
skipping breakfast (after eight to ten hours
without food, the body needs energy); he drinks
too much coffee
Good points: brown bread is a good source of
fibre; he eats three portions of fruit and
vegetables a day; his only snack was a piece of
fruit
6 Ask students, individually or in pairs, to
complete the sentences using the words in the
box. Play the recording again. Come together as
a group and check. Check understanding of:
snack, balanced, skip, source.
1 intake 2 balanced 3 lack 4 skipping
5 energy 6 source 7 snack
Food and nutrition 5 44
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 and nutrition 5 45

 Food allergies and intolerances
Speaking
1 Ask students, in pairs, to discuss the questions.
Come together as a group to brainstorm possible
answers. Avoid correcting at this stage as
answers will be supplied in 4. Ask: Who suffers
from allergies, other than food allergies? What are the
symptoms?
If your students are experienced nurses, ask:
What is your experience of dealing with patients with
(food) allergies?
5 Ask students, in pairs, to read the sentences out
Reading
2 Tell students they are going to read a patient
education leaflet about food allergies. Before
they read, ask them, individually or in pairs, to
match the words 1–4 to the correct definitions
a–d. Come together as a group to check.
Alternatively, you could ask more confident
students to do 3 first, without correcting at this
stage – allow them to read the target language in
context first and encourage them to deduce the
meaning from context.
6 ► 38 Ask students to listen to the recording
1c 2a 3d 4b
3 Ask students, individually or in pairs, to
complete the first part of the patient leaflet using
the words in 2. Check comprehension of: release,
histamine, gastrointestinal tract.
1 adverse 2 immune system 3 harmful
4 antibodies
4 Before students read the second part of the
leaflet, write two additional questions on the
board: When do symptoms typically appear? When
should a patient call the doctor? Remind them of
the questions in 1, then ask them to read and
correct their responses to 1. Come together as a
group to check.
Check understanding of: rash, eczema,
consciousness, disappear.
Most common food allergies: fish, shellfish,
peanuts, milk, eggs, wheat, nuts, soy
Symptoms: tingling sensation in the mouth,
rash, swelling, eczema, abdominal cramps,
diarrhoea, vomiting, swelling of the tongue and
throat, wheezing, breathing difficulties, fall in
blood pressure, loss of consciousness, death
Extra activity
In small groups, students answer these
questions:
1 Name two ways that a food allergy can be
diagnosed.
2 How do these tests work?
3 What advice would you give a patient
suffering from a food allergy?
e.g. It might be a good idea to …, Can I suggest
you …
Pronunciation
loud and then underline the stressed syllable in
the words in bold. Encourage them to divide
each of the words in bold into syllables first as
this may help them distinguish the sounds.
Depending on your group, you may wish to
read out the first sentence aloud as a group
chorus, to discourage embarrassment. Avoid
checking at this stage.
On the board write: allergy and allergic. Ask a
stronger student to underline the stress in each
case (allergy / allergic).
and check their answers. Then play the
recording again, asking them to listen and repeat
the stress pattern they hear.
Play the recording several times until you are
happy students are able to reproduce the
same/approximate stress pattern.
Students may already know some of these
words from their own language, but will tend to
place the stress in the wrong place in English.
Ask them to compare stress patterns in their L1.
1 allergies 2 allergic 3 abdomen
4 abdominal 5 respiratory 6 respiration
Extra activity
Ask students to practise reading the patient
leaflet in 3 aloud as a group for controlled
practice of the stressed words.
Then one by one, ask students to read the
leaflet aloud. Explain that when you say ‘Stop’
the next student should continue. Make sure
that all the students are given an opportunity
to practise the target word stress. If necessary,
repeat the activity to ensure this takes place.
Food and nutrition 5 46
 Speaking
If your students are pre-experience nurses, you
may prefer to set 7 and 8 as self-
study/homework. It is not necessary for
students to have completed 7 and 8 in order to
carry out the rest of the activities in this section.
7 Ask students, in pairs, to discuss questions 1–3.
Ask them to join up with another pair to
compare their answers. Avoid correcting their
ideas at this point.
Pre-experience nurses may find this activity a
little challenging. Reassure them that this is not a
test.
If your students are experienced nurses, you
could ask: What are the symptoms of diabetes? What
is the difference between Type 1 and Type 2 diabetes?
11 Ask students, in pairs, to take turns to practise
Reading
8 Tell students they are now going to read a
definition of diabetes taken from a reference
book for nursing students. Ask them to read and
find the answers to the questions in 7.
Check understanding of: hormone, pancreas,
respond, thirsty, link.
1 Diabetes is a condition where the body is
unable to produce glucose, a sugar which the
body uses for energy. The body has a very
high blood sugar. The level of glucose is
usually controlled by the hormone insulin.
2 Type 1 diabetes is caused when the
pancreas doesn’t create enough insulin. Type 2
diabetes is caused because the body is not
able to respond to the insulin in the body.
3 Type 1 diabetes can be controlled with
insulin. Type 2 diabetes can be controlled with
diet and exercise.
questions. Ask them to compare their answers in
pairs, then come together as a group to check.
Note that the answer to 4 is contained in the
illustration, not in the audio script.
1 the patient’s blood sugar level 2 top of the
finger (any) 3 test strip 4 106, this shows the
level of glucose in the blood
Extra activity
Refer students to audio script 39 on page 75
and ask them, in pairs, to practise the dialogue.
This allows them to ‘see’ the target language in
context, thus reinforcing what they have just
heard.
Speaking
taking their partner’s glucose level using the
prompts 1–6. Tell them they can also make use
of the images in 9 to help them structure their
roleplay.
Encourage them to use staging words from Unit
4. On the board write: firstly, then, next, finally.
Ask students to brainstorm other staging words
that could be used when explaining a medical
process to a patient. Ask: Why are staging words
useful? What else is important when explaining a
process to a patient? (Always keep patients
informed before carrying out the process. Pause
slightly after each staging word. This makes it
easier for the patient to follow the information
provided by the nurse – it divides up the
information into manageable chunks. It is also
important to use patient-friendly intonation.)
Students may wish to make notes first before
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

Food and nutrition 5 47

 Advice on diet
Vocabulary
1 Ask students, individually or in pairs, to look at
the containers and quantities and match them to
the correct word. Encourage students to use
their knowledge of general English to help them.
Ask them to compare answers with another pair
before coming together as a group to check.
Ask students to brainstorm two or three
examples for each of these, e.g. bottle of tomato
sauce, slice of bread, etc.
1 can 2 carton 3 glass 4 tablespoon
5 packet 6 slice 7 piece 8 stick 9 bottle
10 segment
Listening
2 ► 40 Ask: What is a school nurse? What do you
think their role is? Does this post exist in your
country/place of work?
Tell students they are going to hear Maggie, a
school nurse, giving advice on nutrition to a
group of adolescents. Ask students to listen and
tick the quantities/containers they hear.
Reassure them it is not necessary to understand
the whole recording on first hearing as they will
have a chance to listen to the recording again
later.
slice, segment, portion, carton, stick, a lot of,
packet
3 Refer students to the questions 1–5. Ask them to
listen and answer the questions. Encourage
students to take notes as they listen.
1 Eat five portions of fruit and vegetables a
day.
2 one apple, fourteen cherries, two slices of
mango, eight segments of canned grapefruit,
one tablespoon of raisins, two figs, 150 ml of
fruit juice
3 three sticks of celery, three tablespoons of
cooked/canned/frozen vegetables
4 These do not count as a portion of
vegetables.
5 Be careful of them because they only count
as one portion of vegetables and contain a lot
of salt and sugar.
Extra activity
On the board, write the following list:
carbonated/sugary drinks
sugary snacks: chocolate, cookies, sweets, etc.
salty snacks: crisps, peanuts, pretzels, etc.
ready-made meals, takeaway foods
high-calorie desserts: chocolate mousse, carrot cake
red meat
fried food: chips, fried fish, etc.
skipping breakfast
snacking between meals
eating after 8pm
1= easy to stop 2 = a little difficult, but I could stop
3 = very difficult to stop
Ask students, individually, to look at the list
and, using the scale 1–3, decide which dietary
habit(s) they would find difficult to change.
On the board, write:
… are cheaper/more practical than …
I want to stop eating ..., but it’s not easy.
I’ve tried to stop, but …
My partner loves … and it makes it more difficult to
stop.
Ask students, in pairs, to discuss their
responses, using these phrases.
4 ► 41 Tell students they are now going to listen
to nurse Brad Tyler giving advice to three of his
patients, Lena, Frank and Edith. Refer students
to statements 1–3 and ask them to listen and
complete the statement for each patient.
Encourage students to use the information in the
statements to help them guess the rest. Play the
recording again if necessary.
1 gain weight, build up her appetite
2 improve his diet
3 lose weight/take exercise
5 Ask students to listen to the recording again and
complete the nurse’s suggestions. Students
should then match each suggestion to the correct
patient, Edith, Lena or Frank. Ask them to
compare their answers with a partner, before
coming together as a group to check.
1 walking, dog E
2 eat, often L
3 eating fish F
4 exercise, lose weight E
5 drink, water L
Food and nutrition 5 48
 Language
Giving suggestions and advice
Refer students, in small groups, to the
Language box and ask them to note the form in
each case.
Answers: should (not) + infinitive;
How about + -ing; Can I suggest you + infinitive;
It’s advisable/important to + infinitive
Refer students back to 5 and ask them to
indicate what type of advice is being given in
each case (tentative or strong suggestion).
Answers: 1 tentative 2 tentative 3 tentative
4 strong 5 strong
Still focusing on 5, ask: When do we use the three
ways of giving suggestions and advice?
Answer: should (not) + infinitive: to give a
strong opinion; How about + -ing/Can I suggest
you + infinitive: to encourage the patient to take
responsibility and/or take part in the decision-
making process; It’s advisable/important to +
infinitive: to give strong advice in an
impersonal way – this makes it sound less
threatening to the patient.
Give students time to assimilate the points
covered in the Language box.
6 Ask students, individually or in pairs, to rewrite
the suggestions 1–6 by replacing should with
another expression from the Language box.
Alternatively, you may wish to ask a stronger
student to decide if the pieces of advice require
tentative or strong suggestions. Check this first
before asking the students (individually or in
pairs) to carry out the activity. Come together as
a group to check.
Suggested answers
1 It’s advisable to only eat red meat once a
month, according to government advice.
2 It’s advisable to eat breakfast: it’s the most
important meal of the day.
3 Why don’t you play football with your kids in
the park?
4 It is important not to drink more than one cup
of coffee at night.
5 How about going swimming if this is your
favourite sport?
6 Can I suggest you reduce the number of
complex carbohydrates in your diet?
Extra activity
Ask students, in pairs, to write three or four
more pieces of advice using should + infinitive.
Ask them to pass their suggestions to another
pair, who rewrite them in the appropriate form
– tentative or strong.
Variation: Write the advice on cards. Divide
each small group into two teams. Each player
turns over a card and reads out the piece of
advice to another team member, who then
offers their own stronger/tentative version.
Teams win a point for each correct answer.
Writing
7 Refer students back the three patients in 5. Ask
them to write two pieces of advice for each of
the three patients.
Speaking
8 Put students in pairs and refer Student Bs to
page 68. Ask the pairs to read through their
instructions and the relevant case history and
food journal carefully and then carry out the
roleplay.
If necessary, go through the case histories and
food journals in detail first as a group before
asking students to roleplay the scenarios.
Students then swap roles.
Preparing for the next unit
In preparation for Unit 6, suggest the following to
your students:
• Compile a list of words related to patient care
that you already know in English, e.g.
toothbrush.
• Think about all the different ways a nurse
may be required to assist a patient on a daily
basis.
• Do some (online) research into how to treat
and dress minor wounds.
Food and nutrition 5 49
 6 Personal care
Briefing
This unit focuses on developing language and skills
related to caring for the patient’s basic personal
hygiene needs as well as wound care management.
It also seeks to further improve effective
communication skills, particularly the
demonstration of empathy in situations that patients
might find embarrassing or frustrating.
Patient hygiene
Personal hygiene involves far more than just the
physical act of cleaning the patient to reduce
potential infection; indeed it is more about caring for
the overall well-being of the patient. It is therefore
essential that nurses help provide a conducive
environment as well as the necessary assistance
required for their patients to carry out these basic
tasks as independently as possible.
Students begin this section by familiarising
themselves with vocabulary related to personal
hygiene, including not only washing and dressing
but also grooming (shaving, basic nail and hair care,
make-up) and oral hygiene. Keeping the patient
informed of intentions is important when providing
such assistance, as this is essential in terms of
maintaining patient dignity. Focus is therefore given
to the use of be going to + infinitive to talk about
intentions: I’m going to explain the procedure to you
first.; and events that are planned: We’re going to
discharge Mr Singh later this afternoon.   back later?) The unit then looks at how patients use
It should be noted that depending on the country of
origin, nurses may or may not carry out the personal
hygiene duties mentioned above.
ADLs – activities of daily living
ADLs or activities of daily living consist of routine
everyday activities people carry out without
assistance – bathing, dressing, oral hygiene and
toileting (walking/eating are not covered in this
unit). Nurses refer to the ability or inability to
perform basic ADLs as a measurement of the
functional status of a patient. Students complete an
ADL checklist to assess their patient’s ability to
carry these out either independently or with
assistance, and acquire vocabulary for items used to
help patients with their ADLs: bed pan, urinal
bottle, walking frame, etc. Use of the -ing form after
certain verbs love/hate/finish and following
prepositions with/without is covered in this section of
the unit: He hates using the commode., Do you need help
with putting on your tights? Finally, in situations such
as these, nurses need to be able to distinguish
between offers, requests or refusals of help: What do
you need help with? Could you give me a hand with …? I
want to try and do it myself.
Empathy
Empathy is the ability to perceive and understand
another person’s emotions, a key aspect of nurse-
patient communication. However, it is not one that
is easy to replicate, as emotions can be hidden or
displayed through behaviour that contradicts how a
person actually feels. A patient complaint about the
mistreatment of a geriatric patient suffering from
early dementia provides the context to this section.
Students are required to analyse the case and then
offer advice on how the nurse might improve his
communication with the patient.
Patients can find loss of independence frustrating,
embarrassing, even humiliating and depressing. In
the second half of this section, students look at ways
to improve communication in such situations. They
learn to recognise examples of empathy through
tone of voice, before developing expressions, not
only to show empathy (I understand how you must be
feeling.), but also to demonstrate both reassurance
(Don’t be embarrassed, it can happen to anyone.) and
respect for patient privacy (Do you want me to come
adjective endings -ing or -ed to inform the nurse
about how they themselves feel (depressed) or what
they think about the situation (humiliating).
Wound management
Wound management refers to assessing, treating,
and dressing a wound. This final section seeks to
develop key language items – saline solution,
absorbent dressing, tape and disposable gloves –
before working on skills for changing a dressing.
The Wound Assessment and Treatment Chart is
completed by the nurse when first assessing the
patient’s wound. The chart includes a description of
the wound type – traumatic, pressure ulcer (bed
sore), the wound closure – open, sutured (stitches)
or clipped, the kind of dressing required and how
often it should be changed, as well as an assessment
of the level of pain the patient is feeling.
Personal care 6 50
Teacher’s notes
Warm-up
1 On the board, write up your food journal for the
week and ask students to analyse and advise
you on your food intake.
2 Divide the group into three and allocate one of
the following to each group: carbohydrates, fats,
proteins. Then ask each group to prepare a one-
minute presentation on their topic.
Patient hygiene
Vocabulary
1 Tell students they are going to listen to a charge
nurse helping two patients with washing and
grooming. Ask them to scan the pictures and
find an example each of an item used for
washing and grooming. Then ask them, in pairs
or small groups, to label the items a–w.
Depending on your group, you may wish to add
a competitive element and divide the group in
two. The winning group is the one that is able to
label all the items in a given time. Encourage
students to use their knowledge of general
English to help them.
a washbowl b disposable wipes c comb
d brush e nail brush f hand cream g soap
h toothbrush i kidney basin j shampoo
k nightdress l dressing gown m towel
n washcloth o blanket p deodorant q mirror
r swab s toothpaste t razor u shaving
cream v make-up w pyjamas
2 Elicit/Pre-teach: oral hygiene. Refer students to
the table and ask them, individually or in pairs,
to put the items a–w into the correct column.
Ask them to look at the examples first. Point out
that some items might go into more than one
column.
Washing: washbowl, blanket, disposable
wipes, soap, shampoo, towel, washcloth, swab
Grooming: nail brush, comb, brush, hand
cream, deodorant, mirror, razor, shaving
cream, make-up
Oral hygiene: toothpaste, kidney basin, mirror,
swab, toothbrush, towel
Patient clothing: nightdress, dressing gown,
pyjamas
Extra activity
Show students pictures of patients (from
magazines, online sources) or describe patients
– woman, heavily made up; a man with a five
o’clock shadow, for example; and ask students
to identify the items needed for washing and
grooming of these patients. Then ask them to
come up with their own examples.
Extra activity
Ask: Why is grooming important for patients?
(Patients should be encouraged to live as
normally as possible while in hospital and to
regain their routine and daily tasks as quickly
as possible. The nurse is responsible for
encouraging this from the outset.)
Listening
3 ► 42 If you have less confident students, you
may wish to ask them to do 4 before 3 as it only
requires gist understanding.
Tell students they are now going to hear a nurse
helping the two patients, Mrs Turner and Mary,
with washing and grooming. Refer them to the
statements 1–7 and ask them to listen and mark
the statements true (T) or false (F).
Play the recording again and ask students,
individually or in pairs, to correct the false
statements.
1 F, She’s not totally independent – she needs
some assistance – e.g. she cannot go to the
bathroom to clean her teeth.
2 F, Mrs Turner is breathless, Mary has no
energy.
3 F, She says, ‘I can do that by myself.’
4T
5T
6 F, The nurse encourages the patients go
slowly and take a rest when necessary.
7T
4 Play the recording again and ask students to tick
the items that correspond to the correct patient,
either Mrs Turner or Mary.
Mrs Turner: kidney basin, swab
Mary: hairbrush, mirror, towel, washcloth
Personal care 6 51
 Extra activity Writing
Ask: Why is it important to encourage the patient 6 Refer students to the prompts 1–4 and the
to be independent? How can nurses encourage example. Ask them, in pairs, to think of a patient
patients to be more independent? (A nurse’s job is they know or refer them back to the patients in
to encourage independence as quickly as 3. Ask them to write three questions they could
possible. Patients find loss of independence ask their ‘patients’ about the future, using the
frustrating and embarrassing. Offer to help the prompts and be going to. Ask them to compare
patient in their daily routine, but don’t do their ideas with another pair.
things for them unless they ask the nurse to do
so.)
Note that some students may have difficulty
expressing these ideas effectively in English.
Reassure them that for this activity accuracy is
not important – just encourage them to discuss
their opinions.

Language 

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.)
Give students time to assimilate the points
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
Vocabulary
1 Ask students, individually or in pairs, to label
the aids using the words in the box. Encourage
them to use their existing knowledge of English
to deduce meaning. Come together as a group to
check.
Ask students, in pairs or small groups, to answer
the questions: What are the main ADLs?
(Washing, toileting, dressing, oral hygiene,
grooming. Also eating and walking.) Which
ADLs would this equipment help patients with?
(Toileting: commode/urinal bottle/bed pan.
Washing: shower chair. Walking/Moving
around: walker/walking frame/walking stick.)
Come together as a group to check.
1 commode 2 shower chair
3 walker/walking frame 4 walking stick
5 urinal bottle 6 bed pan
Listening
2 ► 43 On the board write: independent, needs help
and dependent. Check understanding of these
terms. Tell students they are going to hear a
nurse assessing four patients, Mr Karam, Elaine,
Samson and Mr Bates. Ask them to listen and
write one of these assessments against the
appropriate ADL for each patient.
If necessary, play the first part of the dialogue
with Mr Karam and check students understand
the example answer.
Play the recording again if necessary. Ask
students to compare answers before coming
together as a group to check.
1 Mr Karam: washing = independent,
grooming = dependent
2 Elaine: washing = needs help,
dressing = needs help, grooming = needs help
3 Samson: dressing = independent, oral
hygiene = independent
4 Mr Bates: toileting = needs help
Language
-ing form
On the board write: I like/love/hate … Ask
students to come to the board and write
something about themselves using one of these
verbs. Check that they use the -ing form. Point
out that the following verbs can also be
followed by -ing: begin, start, stop, finish.
Brainstorm prepositions that also take -ing
(with, without).
Tell students they will come across examples of
these in the next activity.
3 Refer students to the questions 1–5 and then ask
them to listen to the dialogues again. Check
understanding of: shaving, shaky, tights, need a
hand with.
Ask students to listen to the dialogues again and
complete the responses to the questions. Ask
students, in pairs, to compare their answers,
before coming together as group to check.
You may wish to suggest students check their
answers by reading through audio script 43 on
page 76. This will serve to reinforce the target
structures and language covered in this section.
1 it’s difficult to hold the razor still without
cutting himself.
2 she can’t put her tights on without bending
down.
3 washing her hair.
4 He doesn’t want help with either cleaning his
teeth or getting dressed.
5 He doesn’t need help with going to the toilet
(although he may need to use a walker) and he
hates using the commode.
4 Ask students, individually or in pairs, to reorder
the words to form sentences. If necessary, do the
first one as a group. You may wish to check the
phrases are in the correct order before students
do the next part of the activity.
Ask students to decide if the sentences represent
offers of help, requests for help or refusals of
help. Refer students to the example first.
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
Reading
1 Tell students they are going to read a complaint
form. Refer them to the form and the photo of
the patient.
Explain the photo would not usually be attached
to a complaint form – this is to support students
in this activity.
Ask students, individually or in pairs, to read
sections 1 and 2 and answer questions 1 and 2.
Then ask them to compare their answers with a
partner, before coming together as a group to
check.
You may wish to ask students more structured
comprehension questions to facilitate the
reading process: What is the patient’s name? How
old is he? What is his ethnic origin? Who is making
the complaint? When did the incident take place?
Who is Ms Hynd and what did she do? When did the
complaint take place?
3 ► 44 On the board write: empathy. Explain to
1 Patient is Winston Miller, 88 years old, of Afro
Caribbean origin. His consultant is Dr Hew
Jones from the Geriatrics department. The
patient stayed in St Marc’s Ward between 15
and 20 May 2010. The patient’s daughter, Ms
Deidre Hynd, has made a formal complaint to
the hospital patient relations department.
2 Suggested answers: racism, poor treatment
by the consultant, the medical procedure,
incorrect diagnosis, (if students are looking at
the photo, they might speculate that nobody
assisted the patient in getting around).
2 Elicit/Pre-teach: dementia, geriatrics, impolite, treat
someone like a child, confused, unacceptable,
investigate, case.
Refer students to questions 1–5 and ask them to
read Section 3 of the complaint form. Ask them,
in pairs, to compare their answers before coming
together as a group to check.
4 Ask students, in pairs, to compare their ideas in
1 Toileting, washing, grooming, eating and
other simple tasks (not specified in text).
2 The poor care of her father by Nurse Jones
during his stay in St Marc’s Ward.
3 Nurse Jones seems unhappy with his job in
general, and does not feel his salary is high
enough.
4 She wants the department to investigate her
father’s case.
5 Suggested answer: He needs be more caring
towards his patients and show some empathy.
He should imagine he was caring for a close
family member or friend. He should consider
going on a communications course.
Extra activity
Ask experienced nurses: What is your experience
of working with geriatric patients? Why might it be
difficult for nurses working in this kind of
department in general? Why might it be difficult to
assist patients with dementia with their ADLs?
Pronunciation
students that Nurse Jones has been criticised by
the Complaints Board because he didn’t show
empathy towards his patient. Ask students,
individually or in pairs, to read the definition on
the right of the page.
If your students are experienced nurses, put
them into pairs or small groups to brainstorm
their own definition of ‘empathy’.
If your students are pre-experience nurses, they
may wish to check the translation in a good
bilingual dictionary.
Tell students they are going to hear three nurses
talking to their patients. Ask them to listen and
complete the table to show how much empathy
each nurse demonstrates.
Play the recording again if necessary. Reassure
students that they may need to listen a few times
to hear the differences. Do not check the answers
at this stage.
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 expressions of empathy, but reassure
them they will be looking at this in more detail
in 6.
1 a lot of empathy 2 no empathy
3 a little empathy
Tone of voice, expressions, e.g. I understand
how you must be feeling., I can see it’s difficult
for you.
Extra activity
Ask experienced nurses: On a scale of 1–5 (1 =
very easy), how easy is it to show empathy to
patients? Ask students to explain their rating.
5 Ask students to listen to the three dialogues
again and complete the summaries about each
patient using the words in the box. Elicit/Pre-
teach: chemotherapy. Avoid pre-teaching the
words in the box to encourage students to
deduce the meaning from the context.
1 feeding himself, humiliating
2 washing her hair, embarrassed
3 sickness, depressing
Vocabulary
6 Tell students they are now going to develop
expressions they can use to improve
communication with their patients. On the board
write: show empathy, reassure the patient, respect
the patient’s privacy.
Check understanding of: reassure, privacy. Ask
students to reorder the words in 1–7 to form
expressions for each of the headings on the
board.
Remind students of the patient-friendly
intonation covered in Unit 2, (gentle rise and
fall). Ask students, in pairs, to practise saying
these expressions as if to a patient, using patient-
friendly intonation patterns. If necessary, ask a
stronger student to model an appropriate
intonation pattern for the first example.
1 I understand how you must be feeling.
2 I can see it’s difficult for you.
3 Please don’t worry Josh. Let me clean you up
and you’ll feel much better.
4 Don’t be embarrassed Sheila. It can happen
to anyone.
5 I’m used to it; it’s part of my job.
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.
Extra activity
Ask students, in pairs, to read audio script 44
on page 76 aloud. Ask them to ‘feel’/notice the
difference between dialogues 1 and 3 and
dialogue 2. Swap roles.
Ask students to take turns to roleplay
dialogues 1 and 3 again, this time encouraging
them to use patient-friendly intonation
patterns, touch, ‘warm’ facial expression, etc.
Ask them to feed back to the class about the
experience.
Some students may have difficulty expressing
these ideas effectively in English. Reassure
them that for this activity accuracy is not
important – just encourage students to discuss
their opinions.
7 On the board write: feelings and situations. Ask
students to decide which adjectives from the box
go under each heading. (Feelings: depressed,
embarrassed, frustrated, humiliated. Situations:
depressing, embarrassing, frustrating, humiliating.)
Check students understand: adjectives ending in
-ing describe the patient’s feelings while
adjectives ending in -ed describe the situation.
Ask students, individually or in pairs, to
complete the sentences, using an appropriate
adjective from the box. Point out that more than
one answer is sometimes possible. Come
together as a group to check.
1 humiliating/embarrassing
2 humiliated/frustrated/embarrassed
3 embarrassed/humiliated
4 depressed
5 frustrating/embarrassing
6 embarrassing/humiliating
Extra activity
Ask students to think about a patient they
know/someone they know who has been in
hospital and ask them to write three or more
sentences about their ‘patients’ using the
adjectives in 7.
Personal care 6 56
 Wound management
Listening
1 Ask: What does the term ‘wound management’
mean? (assessing, treating, dressing and changing a
wound) What is your experience of wound
management (of a patient/your own)?
Refer students to the pictures at the top of the
page and ask them, individually or in pairs, to
number the pictures 1–6 in the correct order for
cleaning a wound.
a2 b3 c4 d1 e5 f6
2 ► 45 Elicit/Pre-teach: heal, hardly, remove,
odour, secure. Tell students they are going to hear
a nurse treating her patient, Una Hagans. Refer
them to the dialogue and ask them, individually
or in pairs, to complete the nurse’s half of the
dialogue using the words in the box.
You may wish to ask students to label the
pictures with the words in the box first. This will
help them complete the nurse’s dialogue. Point
out they only need to use eight of the twelve
words in the box to label the pictures – the other
words in the box will be used to complete the
dialogue. Note also that some words are used
both to label the pictures and to complete the
dialogue.
Explain that nurses should always confirm the
patient’s name first before beginning wound
care. Experienced nurses will already be aware
of this.
Brainstorm suitable questions a nurse might ask
for this. (Can you just confirm your name for me
(please)? Can you give me your full name please?)
Play the recording and ask students to listen and
check. Play the recording again if necessary.
Ask students, individually or in pairs, to label
the pictures using the words in the box. This will
help reinforce the target language.
Dialogue: 1 wound 2 antibiotics
3 disposable gloves 4 sutures 5 dressing
6 bin 7 pus 8 edges 9 saline solution
10 absorbent dressing 11 tape
12 wound assessment
Pictures: 1 bin 2 sutures 3 wound
4 saline solution 5 disposable gloves
6 absorbent dressing 7 tape
8 wound assessment chart
Additional activity
Refer students to audio script 45 on pages 76–
77. In pairs, ask them to take turns roleplaying
the dialogue between the nurse and Una
Hagans to help reinforce the target language
items. Encourage students to use patient-
friendly intonation patterns.
Writing
3 Refer students to the chart and ask: What is it for?
Who completes it? When?
(The Wound Assessment and Treatment Chart is
completed by the nurse when he/she first
assesses the patient. It includes a description of
the type of wound, the type of dressing required
and how often it should be changed, as well as
an assessment of the level of pain the patient is
feeling.)
Pre-experience nurses may not yet be aware of
this chart, but reassure them that they will have
a better understanding at the end of this section
of the unit.
Ask students, in pairs, to read the Wound
Assessment and Treatment Chart for Una
Hagans. Encourage them to use a bilingual
dictionary to check any of the terms they are
unsure of.
Point out that this is a slightly simplified version
of the Wound Assessment and Treatment Chart.
Experienced nurses may notice some omissions.
Ask students, individually or in pairs, to fill as
much of the chart as they can from memory.
Then play the recording to allow them to add
additional information. If necessary play the
recording again. Refer the students back to the
dialogue in 2 and come together as a group to
check.
Type of wound: surgical
Infection: no
Dressing frequency: daily
Antibiotics: no
Odour: no
Pain assessment: 2
Wound closure: sutures
Wound dressing: absorbent
Comments: wound feels itchy
Personal care 6 57
 Extra activity Extra activity
Ask students, in pairs, to explain the meanings Ask students, individually or in pairs, to write
of different sections of the chart (location/type a SOAP note for either/both patients in this
of wound, etc.) to the rest of the group. Ask section of the unit.
them to choose or allocate a section to each
pair. Preparing for the next unit
Alternatively, you could ask students to do this
for homework/self-study for informal In preparation for Unit 7, suggest the following to
presentation during the next class. your students:
• Think about how you feel talking about
4 Refer students to the photo on the right of the
problems of elimination/bodily functions
page and ask: What type of wound do you think it
with others/medical professionals.
is? If your students are experienced nurses, you
can also ask: How would you manage this type of • Do some (online) research into the treatment
wound? Avoid correcting at this stage. of problems related to patient elimination, e.g.
constipation.
Ask students to read through the case history for
the patient, Mia Fox. Check understanding of:
inflamed, moderate, antimicrobial dressing. Then ask
students, individually or in pairs, to complete
the Wound Assessment and Treatment Chart for
the patient. Ask students to compare their
charts, before coming together as a group to
check.

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 care 6 58
 7 Elimination
Briefing
This unit deals with the sensitive subject of
elimination, concentrating on bowel waste and the
related conditions of diarrhoea and constipation.
Students are made aware of the benefits of active
listening, an important aspect of effective
communication, and learn how to give a simple
patient case presentation.
Assessing patient elimination
Elimination is a fundamental human process that
includes elimination of urine, faeces – the waste
products of digestion, excreted through the bowel –
and menstrual waste. Being able to meet the
patient’s elimination needs, in a manner that is
sensitive and respects their dignity, is an essential
function of nursing. Assessing a patient’s
elimination pattern can be challenging, as patients
often feel very uncomfortable discussing this aspect
of their health and information is often
misinterpreted. It is therefore very important that
nurses have a general understanding of colloquial
expressions so as to avoid asking patients to repeat
themselves, thus creating further embarrassment.
Section 1 seeks to build target lexis, making the
distinction between the more formal or medical
terms – incontinence, bowel movement, bladder
control, defecate, urinate – and those used more
commonly by the adult patient – go to the toilet
(UK)/bathroom (USA) – as well as those of the child
– pooh and wee. Students will in this section start to
develop a series of assessment questions relative to
this area, using the past simple and present perfect
tenses, beginning with a review of past participles.
Describing bodily functions
Section 2 continues work on assessment for this
sensitive topic by developing students’ active
listening skills; demonstrating that the nurse is
really listening to their patient. This can be done
either through verbal expressions: I see, go on,
anything else? or sounds: uh-huh?, or by using non-
verbal signals such as nodding or smiling warmly.
Silence and repetition of the patient’s words are also
effective listening techniques. The aim is to put the
patient at ease, confirm understanding of what the
patient is saying, and demonstrate that you are
interested in what he/she is saying. The result being
that it facilitates the elicitation process. (ELT
teachers carry out these same techniques with their
students.) Students are asked to analyse part of an
assessment in terms of the active listening skills
employed by the nurse, before being given the
chance to practise the skills themselves.
The section continues to build on suitable language
structures (present perfect and past simple) for
assessing patient elimination – determining the
period of time the patient has suffered the condition
(constipation). Usage and form of these structures is
consolidated through the writing up of a nursing
assessment.
Diarrhoea
Abnormal bowel habits result in constipation and
diarrhoea; the latter characterised by the excess of
water in the stool and the marked frequency of
defecation; anywhere from three per day. Students
are asked to consider the significance of this
condition in the developing world where diarrhoeal
disease is second only to pneumonia as the main
cause of death in children under five. (Read the
article on page 56 for more detail about this
condition.) Students are then asked to listen to the
experience of one particular nurse working East
Africa as she describes the treatment of
dehydration, a side effect of diarrhoea.
Presenting a patient case
As in many other disciplines, nurses are required to
deliver presentations. Patient case presentations
generally take place during the nursing handover
and constitute semi-formal presentations of the
patient’s current situation. A complete case
presentation might include an introduction, history
of the present illness, physical examination,
diagnostic studies, differential diagnosis,
management and summary of the case. This section
deals only with the introduction, providing students
first with a model and then asking them to create
their own based on a nursing assessment, tying all
the various elements of the unit together.
Mention is made of the Bristol stool chart, a medical
tool designed at the University of Bristol, UK (1997),
to categorise faeces into seven ‘types’. Types 1–2
indicate constipation, Types 3–4 are the easiest to
pass, while Types 5–6 may indicate diarrhoea. Type
7 may be a sign of serious food poisoning or even
cholera and therefore fatal.
Elimination 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
Warm-up
1 Students work in small groups. Ask each
member of the group to write five objects used
in patient washing and grooming on a piece of
paper. Refer students to the items on page 44, if
necessary. Then ask students in pairs to take it in
turns to describe the objects for their partner to
guess. This can be done as a team game.
2 Refer students to the ADL checklist for Sophie
Mellors on page 47 and ask students in pairs to
take it in turns to ask questions to provide the
answers given in the chart.
Assessing patient elimination
Reading
2 Depending on your group, ask: How do you feel
1 Refer students to the title of the unit and ask:
What does elimination refer to? (Issues related to
bodily functions, including urinating, defecating
and the menstrual cycle. It is also related to
conditions such as incontinence, constipation
and diarrhoea and abnormal bowel movements.)
Note that students are unlikely to know all these
terms in English, so reassure them they will be
covering relevant language items in the unit.
Ask students to look at the photo and ‘observe’
their patient, Mrs Eileen Ashton. Ask: What do
you learn about the patient on observation?
(Students should consider: age, physical
condition, psychological state.)
Elicit/Pre-teach: widow, active, previously, bowel
movement, abdominal, stool, lump. Ask students, in
pairs, to read the nursing assessment and
answer the questions. Come together as a group
to check.
With less confident students, you may wish to
ask more structured questions: How old is Mrs
Ashton? What is her home life like? Where does the
rest of her family live? Can you describe her diet and
exercise?
If your students are experienced nurses, ask:
Please explain the rationale for your diagnostic.
(Sample answer: The patient is suffering from
altered bowel elimination/change in bowel
habit. This may be as a result of lack of exercise
and poor diet, not enough foods high in fibre.
Passing small hard stools every three or four
days and the resulting abdominal pain are all
signs of constipation. Patient feels lonely and
maybe suffers from a lack of appetite;
consequently she does not maintain a suitable
diet.)
Suggested answers: The patient is most likely
suffering from constipation. Causes include
undernourishment, poor diet and patient’s
current psychological state.
Vocabulary
about discussing bodily functions/going to the toilet
with a nurse/another person?
Tell students they are going to learn some of the
expressions that patients use in English to
describe elimination/bodily functions. Ask them
to complete the sentences 1–8, using the words
in the box. Encourage them to use a monolingual
dictionary to help them.
1 bathroom 2 wee 3 Urine, urinate
4 waterworks, incontinent 5 bowel
6 pooh, defecate 7 diarrhoea, constipation
8 runs
Extra activity
Ask students to draw four circles, labelled as
follows: Medical, Formal, Children, Informal.
Then ask them, in pairs, to add lexical items
from 2 to the correct circle. Encourage them to
update their lists as they go through the unit.
Sample answers: medical – bowel,
constipation, defecate, diarrhoea, incontinent,
urinate, urine; formal – to go to the
bathroom/toilet, waterworks; children – wee,
pooh; informal – the runs
Elimination 7 61
 Listening
3 ► 46 Ask students to ‘observe’ the three
patients, Toni, Leah and Dave, in the photos at
the top of the page. Ask: What do you learn about
the patients? Tell them they are going to hear a
nurse assessing the three patients. Ask students
to listen and write the problem for each patient
under the correct photo, using the words in the
box.
7 Ask students, individually or in pairs, to
complete the nurse’s questions using four of the
past participles from 6. Point out they need to
use two of the participles twice. Come together
as a group to check.
If necessary, students can listen to the recording
again to check before moving on to 8.
1 been 2 passed 3 noticed 4 been 5 had
6 had

Toni: problem with urinating

Leah: constipation
Dave: diarrhoea 8 Now ask students, individually or in pairs, to
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
a 3, Leah b 4, Leah c 6, Dave d 2, Toni
sentences 1–4 using the more formal/medical
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
Vocabulary
1 Ask: Do patients use different expressions to describe
bodily functions, depending on their age, gender,
ethnicity? Is it better for a nurse to use familiar or
formal language when talking to a child? Why?
When do children generally start to use ‘adult’ terms
for bodily functions?
Refer students to the sentences 1–6 and ask
them, individually or in pairs, to rewrite them
using the familiar terms in the box. Tell students
there is more than one possible answer in each
case.
Point out that patients often use a neutral
expression to talk about elimination: I go to the
toilet/bathroom. This is either out of politeness or
embarrassment. The nurse will then have to ask
closed questions to find out exactly what he/she
is referring to.
Explain also that waterworks takes a possessive
pronoun – my/his/her waterworks, etc.
Children will very often use these expressions: to
go for a/do a number one (urinate) and number two
(defecate).
1 Does it hurt to do a pooh/go to the toilet?
2 Do you often have to get up in the night to
wee/go to the toilet?
3 Have you noticed any blood when you wee?
4 How many times a day do you pooh/go to the
toilet?
5 She’s been having problems with her
waterworks/going to the toilet.
6 Do you have hard poohs?/Is it hard when you
go to the toilet?
Listening
3 Ask students, in pairs, to practise the dialogue.
2 ► 47 On the board, write: active listening. Tell
students they are now going to learn about an
important skills for nurses – active listening.
If your students are experienced nurses, ask:
What is active listening? Why is it such an important
skill for nurses? When do nurses use this skill?
Ask students, individually or in pairs, to read
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.
Check understanding of: non-verbal signals, nod,
repeat.
Tell students they are now going to read a
dialogue where Staff Nurse Paul is checking up
on his patient, Ms Sonoda. Refer them to the
expressions in the box and ask them,
individually or in pairs, to complete the
dialogue using these expressions. Ask students
to listen and check.
Check understanding of: anything else?, look
worried, go on, runny.
Ask: Why might Ms Sonoda find it difficult to talk to
Staff Nurse Paul? (Many patients prefer talking to
a nurse of the same gender; they are less
embarrassed, especially when talking about
bodily functions, for example. Age – if the nurse
is younger than the patient, this also may be an
issue.)
Ask students, in pairs or small groups, to
underline examples of the active listening
techniques Staff Nurse Paul uses with his
patient. Explain that the ‘actors’ instructions’ in
brackets will give them information about the
non-verbal techniques the nurse uses. Come
together as a group to check. Remind students
that patient-friendly intonation also plays an
important role in active listening. You may wish
to play the recording again to demonstrate this.
Verbal techniques: take your time, could you
explain what you mean? (open question), pain
(repetition), can you describe your bowel
movements (open question), I understand it
isn’t an easy thing to talk about (empathy)
Non-verbal techniques: smiles warmly,
pausing, nodding
Speaking
Tell them to pay attention to their active
listening skills and use patient-friendly
intonation.
Depending on your group you may ask students
to roleplay their dialogues to the rest of the
group.
Elimination 7 63
 Extra activity
Ask students to create a checklist of the active
listening techniques mentioned in the text.
They then add a rating (1–3) for each technique.
(ratings: 1 = needs improvement, 2 = OK, 3 =
effective) Ask one pair to observe another as
they roleplay their dialogue and use the
checklist to comment on their active listening
skills. They then swap roles. Give pairs time to
feed back to each other. Each pair should be
given the chance to repeat their roleplay to
improve their skills.
Listening
4 ► 48 Refer students to the photo on the right of
the page and ask: Why is the patient in hospital?
What type of elimination problems could he be
suffering from? Avoid correction at this stage.
Tell students they are going to listen to Staff
Nurse Paula Willis giving an assessment of
Christophe, who is recovering from a broken leg
after a motorcycle accident. Ask students to
listen to Part 1 and answer questions 1–3. Come
together as a group to check.
1 regular
2 he’s not been active since his operation
3 since his operation/for one week
5 Ask students to complete the nurse’s assessment
6 Ask students, individually or in pairs, to take the
Language
Present perfect v past simple
1 On the board draw: 2 weeks
H o s p i t a l
past now
↑
accident (5th May)
Then write:
a) I came to hospital on 5th May.
b) I have been in hospital for two weeks.
1 present perfect
2 past simple
Ask a stronger student to match the examples a)
and b) with the tenses 1 and 2. (a) 2, b) 1).
If necessary, review shortened forms: I’ve, haven’t,
etc.
Elicit: How long have you + past participle?
2 Dictate these items: since 5th May, yesterday, for two
days, five days ago, couple of days, last night. Ask
students to circle the expressions of time that are
followed by the present perfect and underline
those followed by the past simple. (present perfect
– since 5th May, for two days; past simple– yesterday,
five days ago, last night)
3 Ask students to write three columns titled since,
for and ago. Dictate different expressions of time
and ask them to write them under the correct
column. Explain that some of them may go into
more than one column.
Give students time to assimilate the points covered
in the Language box.
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
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 of
days.
2 No, I haven’t opened my bowels today.
3 I last opened my bowels before my operation.
4 I’ve been in hospital since 5th May, for a
week.
7 ► 49 Tell students they are now going to listen
to Part 2 of the staff nurse’s assessment. Refer
students to the statements 1–6 and as they listen,
ask them to underline the correct verb form in
brackets – the past simple or present perfect.
Suggested answer
Christophe was in a motorbike accident and
had an operation to repair a broken femur/leg.
He’s been in hospital since 5th May, and it is a
week since his operation. He has not opened
his bowels since before the operation. For the
last two days he has felt bloated. He hasn’t
eaten anything for the last three days except a
glass of orange juice. His stools have been
small and hard. He needs to push to defecate
but has not experienced any pain when going
to the toilet or any abdominal pain.

Encourage students to look at the time

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

Christophe has not eaten anything since

yesterday and has only drunk juice for
breakfast. His stools have been small and hard
and he needs to push to defecate. He has not
experienced pain going to the toilet and has not
suffered abdominal pain this morning/he
suffered bloating this morning.

9 Refer students to the questions 1–5 and ask them

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

Elimination 7 65
 Diarrhoea
Speaking
1 On the board write: Diarrhoea – developing world,
v. developed world. Ask students, individually or
in pairs, to write a definition of the condition
‘diarrhoea’. Ask them to compare their
definition with a partner/another pair before
coming together as a group to check.
If your students are pre-experience nurses,
reassure them this is not a test and that they will
learn more about the condition in this section of
the unit.
Suggested answer:
Diarrhoea is an infection of the intestine caused
by bacteria, a virus or a parasite.
It can be dangerous because it can cause
dehydration which means loss of water and
electrolytes (essential chemicals – sodium,
chloride, potassium, bicarbonate).
Diarrhoea can be treated with antibiotics if it is
a fairly mild form and all patients should try to
replace fluids.
2 Tell students they are now going to read an
article about diarrhoea. Ask students to read the
first two sentences of the article and compare
this with their own definition of diarrhoea.
Elicit/Pre-teach: intestine, virus, parasite,
dehydrated, fluid, restless, irritable, sunken, severe,
malnutrition.
Refer students to sentences 1–4. Ask them,
individually or in pairs, to read the article and
complete the sentences using words from the
article as they read. Come together as a group to
check.
Encourage students to use the sentences as a
guideline for reading and comprehending the
article. Reassure them that this is a fairly difficult
text but that it is not necessary to understand
every word in order to gain an understanding of
the main points.
1 result 2 cause 3 causes 4 result
Vocabulary
3 Ask students, individually or in pairs, to
complete the word-building table before
completing the sentences about diarrhoea. Refer
students back to the text on page 56 if they are
having difficulties filling in the table.
You may wish to correct students’ answers for
the table before asking them to complete the
sentences.
Table: 1 diarrhoeal 2 dehydration 3 intestine
4 to replace 5 to lose
Sentences: 1 dehydration 2 loss 3 intestine
4 replacement 5 Diarrhoeal
Listening
4 ► 50 Tell students they are now going to hear
Femi Lwanga talking about how she treats
children with diarrhoea. Refer students to
questions 1 and 2 and then ask them to listen
and answer the questions. This is a fairly long
recording, but reassure students that it is not
necessary to understand every word to answer
the questions.
Ask students to compare their answers with a
partner before coming together as a group to
check. If necessary, play the recording again.
1 a refugee camp in North East Africa, lack of
clean drinking water that leads to sickness and
diarrhoea
2 moderate dehydration
Vocabulary
5 Elicit/Pre-teach: severely, moderate, save lives,
limited, absorb, intravenous.
Tell students they are going to read part of
Femi’s explanation. Ask them, individually or in
pairs, to complete the text with the words in the
box. You could also to ask some comprehension
questions to facilitate the process:
1 How do they treat patients with severe diarrhoea?
(Patients are taken to hospital and fed through
an intravenous drip.) 2 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
Language
1 Ask: What is a case presentation? When do they take
place? What is included in a case presentation? What
is your experience of presenting a patient case/giving
a presentation in front of other students? (It is a
formal or informal presentation of the patient’s
current situation, including an introduction,
history of the present illness, physical
examination, diagnostic studies, differential
diagnosis, management and summary of the
case. Patient case presentations generally take
place during a handover.)
Point out that the example used in this unit deals
with the introductory part of a case presentation.
Tell students they are going to read a case
presentation of the patient from page 52, Mrs
Eileen Ashton, given by Charge Nurse David
Amani. Ask: What do you remember about Mrs
Ashton?
On the board write: age, presenting complaint,
social situation, diet, etc. Encourage students to
brainstorm their ideas.
Ask students, individually or in pairs, to
complete Part 1 of David’s presentation using
the correct form of the verbs in brackets.
You may wish to use this as a mini test to check
students’ understanding of the target structures
– past simple v present perfect. Ask students to
compare their answers with another pair before
coming together as a group to check.
1 presented 2 became 3 hasn’t cooked
4 has been 5 was 6 hasn’t taken
7 has suffered
Writing
2 If your students are experienced nurses, ask:
What is the Bristol Stool Chart? (The chart is a
medical aid, developed at the University of
Bristol, UK, which classifies faeces into seven
types depending on the length of time they have
spent in the colon. Type 1–2 indicates
constipation, Type 5–6 indicates diarrhoea.)
Depending on your group, students may or may
not have come across the Bristol Stool Chart.
Refer students to the prompts 1–6 and ask them,
individually or in pairs, to write Part 2 of
David’s presentation. You may wish to do the
first sentence as a group.
If necessary, encourage students to use the
nursing assessment of the patient on page 52 for
additional guidance.
Come together as a group to check.
1 On admission, Eileen complained of
abdominal pain.
2 Dr Insulza saw her at 16.00 and she rated the
pain seven out of ten on the pain scale.
3 She had her last bowl movement four days
ago.
4 She has opened her bowels every three or
four days since the beginning of May.
5 She described her stools as hard lumps,
which is Type 1 on the Bristol Stool Chart.
6 Eileen has experienced some pain but no
blood or mucus.
Extra activity
Ask students to prepare an oral presentation
using Part 1 and 2 of the case presentation.
Encourage them to add spaces for pausing
during the delivery to facilitate understanding.
Ask them to take turns to practise their
presentation in front of their partner.
Variation: Students work together first to add
pausing in the most appropriate places. Ask
students to deliver the case presentation as a
group chorus.
Listening
3 ► 51 Tell students they are going to hear
Triage Nurse Magda Nowak assessing her
patient, Anita Blasky. Refer students to the
photo at the bottom right of the page and ask
them to ‘observe’ her. Ask: What do you learn
about the patient on observation? (Students might
mention that the patient is unhappy/tired/
bored. She is 15–20 years of age. She is slightly
overweight.)
Refer students to the questions 1–3 and ask them
to listen to Part 1 of the dialogue and circle the
correct response to each question. If necessary
play the recording again.
1 stomach ache, frequent bowel movement
2 embarrassed 3 diarrhoea
Elimination 7 68
 Speaking
4 Refer students to the nursing assessment of the
patient. Ask them to read and then, individually
or in pairs, write five assessment questions,
based on the information in the assessment. You
may wish to use the example to create one of the
questions. As a whole group, brainstorm a
possible assessment question: How long have you
suffered from diarrhoea?
Remind students that they will be required to
use more patient-friendly/informal terms for the
assessment.
If necessary, check students’ questions for
accuracy before carrying out the roleplay.
Suggested answers:
How long have you suffered from
diarrhoea?/When did the symptoms begin?
How often do you visit the toilet on a typical
day?
How many times a day do you need to go to
the toilet?
Can you describe your stools for me?
Do you suffer from any other symptoms?
Listening
5 ► 52 Refer students to the second half of the
nursing assessment. Ask them to listen to Part 2
of the dialogue and complete the assessment
using the words in the box. If necessary, replay
the recording.
1 allergies 2 spicy 3 weight 4 kilos
5 overweight 6 angry 7 laxatives
8 embarrassed
Speaking
6 Ask students in pairs to discuss the patient case
and answer the questions.
Reassure them that for this activity accuracy is
not important – just encourage them to discuss
their opinions.
If your students are pre-experience nurses, they
may not yet have come across laxative abuse in
their training. Encourage them to brainstorm as
a group and give suitable suggestions for the
treatment.
7 Ask students to compare their ideas with the rest
of the group.
Suggested answers:
The patient abuses laxatives that she uses to
try and lose weight. The patient is suffering
from constipation but experiences bouts of
diarrhoea and cramping as a result of taking
laxatives.
Treatment means working with a team of health
professionals with expertise in eating disorders
(GP, psychiatrist or psychologist, dietician).
Support from close friends and family is also
crucial.
Extra activity
Ask students, in pairs, to take it in turns to
carry out a complete assessment of Anita
Blasky, using the information in the nursing
assessment. Encourage them to use patient-
friendly terms for bodily functions and to
practise employing active listening skills as
they interview their patient.
Variation: Students work in pairs to compile a
checklist to evaluate active listening
skills/patient-friendly terms, using ratings (1 =
needs improvement, 2 = OK, 3 = effective), and
use this to assess another pair. Students swap
roles. Give pairs time to feed back to each
other. Each pair should be given the chance to
repeat their roleplay to improve their skills.
8 Ask students, in pairs, to chose one of the
patients from page 53, Toni, Leah or Dave, and
prepare a patient case for presentation. Ask
them to include the information at the bottom of
the page for their patient. Tell students to invent
the details if necessary. Encourage students to
use pausing techniques and staging words
(firstly, secondly, then, finally) from Unit 4 to
facilitate understanding.
Depending on the group, you may want to ask
students to present their case to the rest of the
group. Otherwise this can be done in small
groups.
Preparing for the next unit
In preparation for Unit 8, suggest the following to
your students:
• Compile a list of expressions for making an
appointment by phone that you already know
in English.
• Become familiar with the hospital discharge
practice in your country/place of work.
• Do some (online) research into mobility aids
that assist patients around the house.
Elimination 7 69
 8 Patient discharge
Briefing
This unit looks at the discharge plan and making a
final assessment of levels of patient independence
just prior to their leaving the hospital environment.
It also deals with medications and explaining
dosages. Finally, it provides an opportunity to
develop telephone skills, in particular when making
follow-up appointments on behalf of patients.
Evaluating levels of independence
The discharge lounge provides a quiet area for
patients to relax while waiting for their
transportation after being discharged from hospital.
While waiting, they might also receive assistance
with follow-up appointments, arranging pick up of
their prescriptions from the pharmacy, receive
instruction on medications, etc. A registered nurse is
assigned to the discharge lounge to address any
concerns and oversee patient safety. One of the
advantages of the discharge lounge is that it frees up
ward beds, thus decreasing the length of time new
patients are required to wait for bed placement.
Levels of independence are evaluated constantly
during the patient journey with the final assessment
carried out just before the patient is discharged.
Students will develop structures to help them assess
levels of patient independence: How do you feel about
…? Is there anything you are worried about? Mobility
aids to assist the patient’s walking – leg brace,
crutches, wheelchair – as well as those that can be
installed in the home – grab bar, non-slip mat,
shower chair – might be recommended to increase
levels of independence and therefore allow the
patient to return to their home environment.
A patient discharge plan
In Section 2, students begin by reading through an
authentic patient educational leaflet that explains
the Patient Discharge Plan. Prepared by the
different healthcare providers involved in the
patient’s treatment, the discharge plan provides
information to the patient and their carers about
prescriptions, follow-up appointments, support
groups, even therapists, if necessary. The
Independence Assessment, including a final
evaluation of ADLs, including ambulation (patient’s
ability to get around on foot) and transferring (by
vehicle) will determine not only whether the patient
will need community services, but also the type and
frequency of those services. Depending on the
country, patients and/or their carers may be more
or less involved in the discharge process.
One of the most important elements of the
Discharge Plan is patient education regarding
medications. Drug therapy can only be effective
when patients co-operate with the drug regime. In
hospital this is closely supervised, but once
discharged, many patients fail to continue with their
treatment. Reasons for this include: forgetfulness,
inconvenience, lack of understanding of the
illness/drug, unclear instructions, a confusing
cocktail of medications, side effects and fear of
addiction.
Explaining medication
Nurses are sometimes called upon to explain over-
the-counter medications or OTCs. This section of the
unit provides plenty of practice of language related
to types of medication, including capsules, cough
syrup and ointment, as well as expressions of time
used to explain dosages: three times a day, two every
six hours, at mealtimes. It is very important that the
information patients receive concerning any form of
medication is accurate, so in addition, students will
spend time acquiring expressions commonly used in
direction sheets: do not exceed, do not chew, according
to the severity of the symptoms and may cause
drowsiness. Patients must be advised to take caution
with OTCs, vitamins and supplements as they may
not be safe to take at the same time as their
prescription drugs.
Making appointments on the phone
It is just as important for nurses as it is for other
professionals to develop effective telephone skills;
maybe more so, considering the stressful situations
in which many nurses work. This final section of the
unit deals with making appointments with another
hospital service or perhaps a local GP or practice
nurse.
It is important to signal the beginning and closing of
a telephone conversation. Nurses are encouraged
therefore to open by identifying themselves and
their department or unit: This is Nurse Akif Altundas
from Paediatrics. Their speech should be clear and
coherent: I want to make an appointment for one of our
patients, please. It should make possibilities for
Patient discharge 8 70
clarification: Good, so that’s 1.15 on Monday 24th
February. To ensure students are able to handle such
calls with ease, the unit provides a simple checklist
for making appointments to guide the student
through the process.
With regard to pronunciation, students will
concentrate on word and syllable stress for
emphasis, a skill that is particularly important to
ensure clarity and accuracy when taking and
providing information over the phone.
Finally, this section offers an opportunity for
students to discuss their concerns about speaking
over the phone in English. The lack of visual
information to complement face-to-face
conversation is one such concern. Even if the caller
is unable to see you, using non-verbal
communication, such as smiling (to dissipate any
anger or stress) and showing warmth with the eyes
is proved to have a very positive effect on
maintaining a good relationship with the caller, even
during difficult situations. In terms of position,
standing up can lead to a rushed conversation and a
feeling of superiority, while lounging back in a chair
might lead to the nurse being more casual and less
attentive.

Patient discharge 8 71

Teacher’s notes
Warm-up
1 Divide the group into two teams and ask
students to brainstorm ten terms or expressions
used to discuss elimination in a formal context
(with another medical professional, during a
student presentation). The first team to reach ten
and spell them correctly wins.
2 Refer students to the information for Mrs Eileen
Ashton on pages 52 and 58. Ask students, in
pairs, to take it in turns to roleplay the nurse’s
patient assessment, employing appropriate
active listening skills. You may wish to elicit the
active listening skills covered in the unit (page
54) first.
Evaluating levels of independence
Listening
1 ► 53 Refer students to the picture at the top of
the page. Ask: What is a discharge lounge? When
do patients go there? (Discharge lounges can be
found in larger hospitals and provide a quiet
area for patients to relax while waiting for their
transportation after being discharged from
hospital. A registered nurse is assigned to give
assistance with follow-up appointments, arrange
pick up of prescriptions from the pharmacy, give
instruction on medications, etc.)
Ask students to look at patients a–d and tell
them they are going to hear a nurse explaining
each case. Ask them to listen and label the
patients with the correct name.
1 Jim 2 Mrs Ridley 3 Elin 4 Mr Aziz
2 Ask students to listen again and answer
questions 1–6. Ask them, in pairs, to compare
their answers before coming together as a group
to check.
1 Elin 2 Mr Aziz 3 Jim 4 Mrs Ridley 5 Elin
6 Mrs Ridley
Vocabulary
3 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
which are being used by the patients in the
picture.
1 crutches 2 wheelchair 3 leg brace
4 walking frame 5 walking stick
4 Refer students to the photos a–e of mobility aids
for the home (and hospital) at the bottom of the
page. Ask them, individually or in pairs, to label
them using the words in the box.
a shower chair b bath lift c grab bar
d non-slip mat e raised toilet seat
Extra activity
Dictate the following: leg brace, walking frame,
walking stick, shower chair, grab bar, bath lift, non-
slip mat.
Ask students to underline the main stress for
each phrase. Come together as a group to
check. Point out that for grab bar the speaker
doesn't differentiate between the two words – it
is pronounced as one word. As you point to
each phrase, ask students as a group to practise
saying them aloud, checking they have the
right word stress. Ask: What is the ‘rule‘? (The
main stress appears on the first word of the
phrase, except in non-slip mat where it is on the
word mat).
5 Ask students to match the definitions a–e to the
mobility aids in Exercise 4. Come together as a
group to check.
With more confident students, you could ask
them to supply their own definitions, perhaps
brainstorming the first one as a group first. Then
ask them to compare with definitions a–e.
a non-slip mat b raised toilet seat c bath lift
d shower chair e grab bar
Listening
6 ► 54 Tell students they are going to hear Nurse
Denis Astorga preparing the patients from page
60 for discharge. Point out that in some cases he
is speaking to a carer. Ask students to listen to
the three dialogues, then ask them to write the
name of the patient Denis is talking to or about
in each case.
1 Mrs Ridley 2 Elin 3 Jim
Patient discharge 8 72
7 Elicit/Pre-teach: bathing, toileting, dressing. Ask:
What kind of tasks are these? (Activities of Daily
Living or ADLs – see Unit 6.) Ask students to
listen again and circle the ADL that each
patient/carer is worried about.
Then ask students to write the mobility aid the
nurse recommends for each patient.

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.
Depending on your group, you may wish to ask
students to roleplay their scenario in front of the
rest of the group.

Patient discharge 8 73
 A patient discharge plan
Speaking
1 Ask students in pairs to discuss the question.
Come together as a group to compare answers.
Ask: What is the role of the patient/carer in the
discharge process? (Depending on the country,
patients and/or their carers may be more or less
involved in the discharge process.) Some
students may have difficulty expressing their
ideas effectively in English. Reassure them that
for this activity accuracy is not important – just
encourage them to discuss their opinions. Come
together as a group to compare ideas.
Reading
2 Tell students they are going to read a patient
educational leaflet that explains the discharge
process. Refer them to the titles a–e and ask
them to read the leaflet, matching the titles to the
relevant paragraph. Ask students to compare
their ideas with a partner before coming
together as a group to check.
2e 3a 4c 6b 8d
3 Ask students, individually or in pairs, to match
the definitions to the words highlighted in
yellow in the text.
Point out the following: give a shot (USA) give an
injection (UK).
1 over-the-counter drugs 2 prescription drugs
3 supplements 4 side effects 5 giving a shot
6 support groups 7 therapist
8 healthcare provider
Extra activity
Ask students, individually or in pairs, to think
about a patient they know well and write down
a list of the different members of the medical
team (within the hospital and aftercare
services) involved in devising the patient’s
discharge plan. Then ask students to present
their ideas to the rest of the group.
Listening
4 ► 55 Refer students to the photo on the right of
the page. Ask: What kind of worries do patients
have just before they leave hospital? (Patients might
wonder how they are going to manage to take
care of themselves, especially if they live alone
or, if they have dependents, how they will be
able to take care of the whole family while still
in recovery. After a long period in hospital
patients may have become slightly
institutionalised.)
Tell students they are going to hear a nurse
going through a discharge plan with her patient,
Nancy Lorenz. Refer students to the statements
1–4 and ask them to listen to the recording and
decide if the statements are true or false. Ask
students to correct the false statements. If
necessary, play the recording again. Ask
students, in pairs, to compare their answers,
before coming together as a group to check.
1 F – she’s a bit worried about leaving
2 F – she lives alone
3T
4 F – the neighbour could help with the
shopping/her sister will help with cooking
5 On the board write: ADLs. Ask students to
brainstorm a list of these, and refer them back to
Unit 6, page 47 if necessary. Then add:
ambulation, transferring and ask: What do you think
these ADLs refer to? (ambulation – getting around
on foot, transferring – getting around by vehicle)
They are both indicators of levels of
independence and could indicate a need for
assistance. Pre-experience nurses may not have
come across these terms.
Ask students to look at the independence
assessment form and ask them to listen to the
dialogue with Nancy Lorenz again and complete
the form, ticking the correct boxes. If necessary,
play the recording again.
Bathing – needs assistance
Ambulation – independent
Toileting – independent
Transferring – dependent
Eating – needs assistance
Dressing – needs assistance
Patient discharge 8 74
 Language 8 Ask students to check their answers to Exercise 6
and Exercise 7 by looking at audio script 55 on
6 On the board write: If ... With confident students pages 78–79. This will allow students to see the
who prefer a more inductive method, ask them, target structures in context. Come together as a
individually or in pairs, to cover the Language group to discuss any concerns students might
box and complete the exercise. Explain that these have with the two conditionals – it could prove a
are sentences taken from the dialogue between little confusing for some students.
the nurse and Nancy Lorenz. Ask students to
check their usage by reading through the ‘rule’ Extra activity
for the first conditional, allowing them to make Refer students back to the patient leaflet on
any necessary changes to their answers. page 62. On the board, write:
1 Do you know what to do if you need help with …?
For less confident students, ask them to read the
2 Do you know who to contact if …?
‘rule’ for the first conditional. Tell them to use 3 What do you do if …?
this information to help them complete Ask students, individually or in pairs, to use
sentences 1–4. If necessary, dictate the verbs the information to write five questions they
needed to complete each sentence (help, fall, tired, could ask their patient to check understanding
help). of their discharge plan.
Come together as a group to check. Ask students to use information in the checklist
to write five questions their patient might ask
1 will help me 2 I’ll fall 3 I feel tired at discharge.
4 will help me On the board, write:
Who can I call if I need help changing a bandage?
7 You can carry out this activity in the same way. What can I do if …?
It is important to ensure students understand Ask students, in pairs, to take turns to ask and
the difference in usage between the two answer the questions they prepared above.
conditionals. On the board, write Zero
Conditional, First Conditional. Ask: Which one
refers to the future? (first) Which one is used to give
general instructions or solutions to a problem (in a
nursing context)? (zero) Which one describes a
situation and its possible result? (first)
It is also important they understand how to form
the two conditionals. Explain that it is possible
to reverse the order of the sentences. On the
board write: My sister will be angry if I’m late. or If
I’m late, my sister will be angry.
Point out that it is not possible to use if followed
by will/won’t. On the board, write: If I will be late,
my sister will be angry. Put a line through the first
will in the example – this will serve to reiterate
the point, especially for students where this
occurs in their L1.
Allow students sufficient time to assimilate the
information in the Language box.

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.

Patient discharge 8 75
 Explaining medication Reading
4 Tell students they are going to practise
Listening explaining over-the-counter medications to a
patient. Allow them time to familiarise
1 ► 56 If your students are experienced nurses,
themselves with the directions for the three
ask: What is your experience of explaining
medications. Then ask them, individually or in
medications to patients? What problems have you
pairs, to find phrases to match meanings 1–5.
experienced? What advice would you give to new
Ask pairs to compare their answers with another
nurses?
pair, before coming together as a group to check.
Elicit/Pre-teach: post-discharge care. Tell students
that they are going to hear a second conversation 1 Do not give more than four doses in 24
between the nurse and Nancy Lorenz. Explain hours. (Do not exceed eight capsules in 24
that the nurse is talking to the patient about her hours.)
medication and post-discharge care. 2 May cause drowsiness. Avoid driving …
when taking this medicine.
You may wish to refer students to questions 1–6 3 Do not chew.
first to facilitate the listening process and help 4 To be taken … as required according to the
set the scene. Ask students to listen and circle severity of the symptoms.
the best answer in each case. If necessary, play 5 For oral use (only).
the recording again. Ask students to compare
their answers in small groups before coming Writing
together as a group to check.
5 You may wish to review usage and form of
1b 2a 3b 4b 5b 6b imperatives for simple instructions (see Unit 4)
before asking students to carry out this activity.
On the board write: take, don’t take, you need to.
Vocabulary
Brainstorm the first instruction as a group,
2 Ask students to cover the word box and try to before asking students to write instructions for
label the different types of medication a–f. patients 2–4. Encourage them to write in their
Students may already know many of these own words. Less confident students may prefer
items. Refer them to the word box if necessary. to write collaboratively. Point out to students
Come together as a group to check. that for situations 2 and 5, they will need to
write the instruction for the parent/carer.
Point out that these terms are also used: cough
medicine/mixture, tube of cream, nose spray, a bottle
of pills. However the contraceptive pill is known
as the Pill.
Refer students to the note on the left of the
pictures –1 tablespoon is a common
measurement in the UK/Ireland/Australia, but
the quantities are different.

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

Patient discharge 8 76
 Suggested answers
1 You need to take Dicalm for your diarrhoea.
Take two tablets every two to four hours
according to how bad you feel. It’s important
not to take more than six doses a day. Chew
the tablets and then drink a glass of water.
2 You can give Kold Karma to children of six
years or more. Give her one capsule every four
hours with water. Do not let her chew the
capsules. She should have no more than four
capsules in 24 hours.
3 Take Kold Karma for the flu symptoms: two
capsules every four hours, but not more than
eight capsules a day. Take the capsules with
water, do not chew them. And for your cough,
take Coffalix. Take two 1.5 ml spoonfuls four
times a day. You shouldn’t take more than four
doses a day. Don’t drive or operate machinery
while you are taking Coffalix.
4 For your cold, take two Kold Karma capsules
with water every four hours. Do not chew the
capsules. Don’t exceed the recommended
dose – eight capsules a day.
5 Give him one Dicalm tablet every two to four
hours while his symptoms continue. He needs
to chew the tablets and then drink a glass of
water. Don’t give him more than six tablets in
the space of 24 hours.

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

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

1c 2a 3b

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.

Patient discharge 8 77
 Making appointments on the phone
Speaking
1 Explain to students they are going to work on
developing a set of useful expressions that they
can use when making an appointment for a
patient over the phone. Tell them they are going
to hear Orthopaedic Nurse, Zafar Hussein,
making an appointment for his patient with
another medical service. Refer students to the
information about the patient 1–4. On the board
write: Identify yourself and department. Elicit a
suitable telephone expression from the group for
this and then ask students to compare with the
one on the Appointment Checklist. Ask
students, in pairs or small groups, to use the
information about the patient as a basis to
brainstorm expressions for each point on the
checklist. Avoid correcting at this stage.
Listening
2 ► 57 Tell students they are going to hear
Zafar’s telephone call. Ask them to listen and
compare what he says with their expressions in
1. If necessary, play the recording again.
Variations of these may also be acceptable.
1 Good afternoon. (Hello.)
2 This is Zafar from Orthopaedics.
3 I’d like to make an appointment with the
Practice Nurse for one of our patients, please.
4 How about 23rd?, Do you have any
appointments in the morning?
5 Good, so that’s 10.15 on the 24th of January.
6 Let me give you the patient’s details. It’s Mr
Ernesto Chavaz, that’s C-H-A-V-A-Z.
7 Thank you for your help. Goodbye.
3 ► 58 Tell students they are now going to hear
Zafar making an appointment for another
patient. Ask students to listen and tick the points
in the checklist as they hear them. Reassure them
they don’t have to understand everything on
first hearing; they will have the opportunity to
listen for detail later.
Ticked items: greet person, identify self and
department/unit, give reason for calling,
suggest day and time, give patient details
4 Ask students, individually or in pairs, to
complete the patient’s appointment card. Then
play the recording again to allow them to make
any necessary corrections. Come together as a
group to check. If necessary, play the recording
once more.
Patient Name: Geoff Pattern
Appointment with: occupational therapist
Day: Tuesday
Date: 17th June
Time: 17:00
1 Occupational Therapy
2 Tuesdays and Thursdays
3 3.30 in the afternoon
5 ► 59 Tell students they are now going to hear
Zafar change Mr Pattern’s appointment. Refer
them to points 1–3. As they listen, tell students
to transcribe expressions they hear for each
point.
For less confident students, you may wish to
give them the first letter of each word in the
expressions.
1 (Sorry to disturb you but) can I reschedule Mr
Pattern’s first appointment?
2 What time was his appointment?/Sorry, did
you say Tuesday or Thursday?
3 Can you just hang on a moment?
Pronunciation
6 On the board write: Sorry, did you say Tuesday or
Thursday? Ask students to translate this
expression into their own language. Ask: How do
you make the caller understand which day is
important? Languages differ, but some will
follow the same rule as English. Ask students:
How do we do this in English? (In English,
speakers stress the words or syllables to
emphasise important information.) More
confident students may already be aware of this.
Ask a more confident student to underline the
stressed words/syllables. Avoid correcting at
this stage.
Ask students to listen to examples 1–4 from the
recording in 5 and underline the stressed words
or syllables in each sentence as they listen. You
may wish to go over the first one as a group.
Patient discharge 8 78
7 Ask students to listen again and make any
Extra activity
corrections, before coming together as a group to
check. Play the recording again and ask students Ask students in pairs to take turns reading
to repeat the stress patterns they hear. Play the audio script 59 (page 79) aloud to practise the
recording several times until you are happy that stress patterns in context. Encourage them to
they are able to reproduce the employ effective communication strategies for
same/approximate stress pattern.   the phone. Ask another pair to listen and then
comment on their use of stress for emphasis
1 Sorry did you say Tuesday or Thursday? and communication strategies.
2 Tuesday, Tuesday afternoon.
3 No, not 10.15, 10.50. 9 Put students into pairs and tell them that they
4 Oh, OK 10:50, sorry. are going to practise making appointments over
the phone. Refer Student Bs to page 69. Ask
Students A and B to read the information for
Speaking
roleplays 1 and 2. Point out that all the
8 Ask students: What is your experience of speaking vocabulary presented in 1–4 has already
on the phone with other medical professionals in appeared earlier in the course. Allow them
English? Ask students in small groups to discuss adequate time to review if necessary. Encourage
question 1, encouraging them to use the prompt, students to use the checklist on page 66 as well
I find it difficult because ... Some students may as their newly acquired skills for emphasis and
have difficulty expressing their ideas effectively telephone communication strategies.
in English. Reassure them that for this activity
Ask students to carry out roleplays 3 and 4 in
accuracy is not important – just encourage
the same way.
students to discuss their opinions.
Depending on your group, you may wish to ask
If necessary, brainstorm opinions first as a
students to roleplay their conversations in front
group, writing their ideas on the board. Then
of the rest of the group or in small groups.
ask students, in pairs, to discuss.
Encourage ‘observers’ to provide constructive
Refer students to question 2. Ask them to feedback.
visualise an effective phone conversation (in
their L1). Then ask them to note down strategies
they use to ensure the conversation is effective.
Refer students back to the checklist from page 66
and ask: Does it help to use a checklist like the one on
page 66? Why/Why not? (It helps to structure the
call/the caller doesn’t forget what he or she
needs to say/it gives prompts for expressions in
English.)
You may wish to suggest to students they keep a
copy of their checklist close to the phone for
future calls.

Suggested answers:
smile, sit down, speak at moderate speed,
speak clearly, ask for clarification, repeat if
necessary, stress important words

Patient discharge 8 79