English for

Nursing 1
Vocational English
Teacher’s Book

A1-A2

Ros Wright
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First published 2012

ISBN: 978-1-4082-5215-4

Set in Palatino
Contents

Unit 1 Meeting colleagues page 3

Unit 2 Nursing assessment page 9

Unit 3 The patient ward page 16

Unit 4 Food and measurements page 24

Unit 5 The body and movement page 32

Unit 6 Medication page 40

Unit 7 The hospital team page 48

Unit 8 Recovery and assessing

the elderly page 56
 1 Meeting colleagues
Briefing
This unit deals with meeting people – nursing
colleagues, patients and their visitors – for the first
time. It introduces the idea of creating rapport and
reducing patient anxiety, especially prior to a
hospital test.
Introducing yourself to the team
Arriving in a hospital for the first time, whether it be
as a student nurse, an agency nurse (a temporary
nurse hired through an employment agency for
medical staff) or a new employee, can be daunting.
This section of the unit helps students carry out and
understand simple introductions. It also presents
some of the key personnel in a (UK) hospital: ward
sister (or ward manager) or charge nurse (male
equivalent), who run the ward/department; staff
nurse, a registered nurse; healthcare assistant
(HCA), whose role is to assist the patient with their
daily routine (eating, personal hygiene, dressing,
toileting, etc). Use of the present simple provides the
language tool to accomplish this.
Reading a nursing schedule
This section focuses on telling the time and the use
of prepositions of time to enable students to read
and ask about their nursing schedules. Use of the
24-hour clock is important for reading employee
time sheets and nursing schedules, and reporting
on medical documents and charts. Explanation of
visiting hours and patient mealtimes, as well as
hospital facilities (coffee shop, newsstand and gift
shop) are more likely to be communicated through
the 12-hour clock. This section also provides the
opportunity to review days of the week.
Meeting patients and their visitors
In this section students will learn expressions they
can use to introduce themselves to the patient on
their first meeting. 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 and surname.
Visiting hours are possibly the most important time
of the day for patients, as family and friends play an
essential role in the recovery process. By completing
a (medical) family tree, students will review/learn
vocabulary for family members. The final part of
this section deals with regulations for visitors in a
hospital situation. Students will be asked to read a
visitor’s code, which is followed by a chance to
discuss regulations in their place of work or country.
Escorting a patient for tests
In this section, students familiarise themselves with
the English terms for medical equipment used for
testing: X-ray machine, CT scanner, MRI scanner
and ECG machine. Previously known as a CAT
(computerised axial tomography) scanner, the CT
scanner takes computer images of the body’s organs.
The patient lies on a narrow table that slides into the
centre of the scanner, which can image the entire
body in less than 30 seconds. Similar in appearance,
the MRI (magnetic resonance imaging) scanner uses
a magnetic field and radio waves to produce
detailed pictures of the body’s organs and
structures, resulting in clear, cross-sectional, black
and white images of the body. It differs from the CT
scanner in that it does not use radiation. The MRI is
used to detect a variety of conditions, including
those of the brain, spinal cord, skeleton, chest, lungs,
abdomen, pelvis, wrists, hands, ankles and feet. In
some cases, it provides clearer images than those
produced by X-ray, CT scan, or ultrasound. The
ECG (electrocardiogram) is the most common
cardiac test. It is simple to perform, risk-free and
inexpensive. Ten electrodes (or leads) are attached to
the patient’s limbs and chest in order to detect
electrical impulses generated by the heart, which are
then transmitted to the ECG machine. The ECG
machine produces a graph (the ECG tracing) from
which the following information can be determined:
heart rate, heart rhythm, abnormalities, a prior or
possible future heart attack.
Students also practise taking appointments for the
Radiology Department and learn expressions to use
when escorting patients for tests. Nurses are
required to go through a process of identifying the
patient via their identity bracelet, to ensure they
have the correct patient, and then explaining what is
about to happen, therefore keeping the patient
informed at all times.
Preparing for this unit
Do the Entry test. For the Listening part of the test,
use track 02.
Meeting colleagues 1 3

Teacher’s notes
Warm-up
With books closed, write on the board: Hi/Hello,
I’m .../my name’s ... . I’m from ... and then introduce
yourself to the class. Ask: What’s your name? Point to
the expressions on the board and encourage
students to use these to introduce themselves. Then
write: I’m a(n) ... and the words teacher, student and
nurse, and ask students: What do you do? Point to the
relevant word/expression on the board to help
students answer the question if necessary. Then
elicit the expression nice to meet you and write it on
the board. Depending on your class, you may wish
to ask students to stand up and mingle, introducing
themselves to each other using the expressions on
the board.
Introducing yourself to the team
Listening
1 ► 02 Ask students to open their books and to
look at the notice board. Ask: How many new staff
members are there in Ward C? (five). Students can
work individually or in pairs to look at job titles
a–e and tick the ones they already know.
Tell students that they are going to hear three
conversations between hospital staff. Ask them
to listen and match the conversations to the job
titles. Play the recording. If necessary, play it a
second time, pausing after each conversation to
allow students time to write their answers.
Check answers as a class.
a 2, 3 b 2 c 1 d 1 e 3
Language
Depending on your class, you may wish to ask
questions about the nurses in 1 to check
students’ understanding of the target language.
On the board, write: What’s your name? What’s his
name? What’s her name? Point to a student and
ask: What’s your name? Are you [name]? Then
point to another student and ask: What’s his/her
name? Repeat with a few students. Check that
they are able to use the contracted forms of be.
Refer students to the Language box. On the
board, write teacher and a question mark (?).
Elicit from a stronger student: Is he/she a teacher?
Then elicit a short answer: Yes, he/she is./No,
he/she isn’t. Ask the same question about the
people in 1. Finally, do the same with the third
person plural. Ask students to read through the
Language box individually.
2 Ask students to complete conversations 1–3
individually, then check answers as a class. Then
ask them, in pairs, to practise reading the
conversations aloud. They can then swap roles
and repeat the activity.
1 am 2 Are 3 am 4 are 5 am 6 Is 7 isn’t
8 is 9 am 10 am
Speaking
3 You may wish to go through the model
conversation with a confident student first. Then
ask students to use the model to introduce
themselves to a partner.
Extra activity
Hand out character cards prepared in advance
with fictitious names, job titles from 1 and
countries of origin. Ask students to stand up,
mingle and introduce themselves to five
different people in the class using the identities
on their cards.
Language
On the board, write the days of the week,
putting a tick next to each one, and draw a stick
figure walking towards a hospital. Refer
students to the Language box and the sentence
He walks to the hospital every day. Ask: Where does
he work? (He works in the hospital.). Explain that
the present simple is used for things that happen
regularly and things that are usually true. Point
out the third person singular form and
encourage students to always pronounce the
final -s. Also draw their attention to the third
person does/doesn’t. Ask them to read the
Language box individually. Before attempting 4,
you could drill these forms using verbs students
have already come across (e.g. live, work, walk).
4 Depending on your class, you may wish to elicit
some (relevant) countries and their nationalities
before asking students to complete this activity.
Brainstorm countries and nationalities and write
them up on the board. Check students’
pronunciation of these, first chorally, then
individually. Ask students to complete the text
individually or in pairs and then check answers
as a class. Check that students understand
agency nurse, shift and night shift.
Meeting colleagues 1 4
 1 doesn’t live 2 lives 3 works 4 has
5 doesn’t work 6 have 7 work
Extra activity
Tell students that they are starting a new job
in a hospital. Ask them to write a short
introduction, including the following details:
name, country of origin, job title, where you
work, one thing you like about your job.
Encourage them to use expressions from the
unit. Then ask them, in small groups, to take
turns introducing themselves. Encourage other
students in the class to ask questions.
Reading a nursing schedule
Language
It is best to deal with the two sections of the
Language box separately, in order to allow
students to better assimilate the information.
On the board, draw clocks showing the
following times: 01.00, 04.30, 10.15 and 12.45,
and elicit the question What time is it? Ask
students around the class to ask and answer the
question. Depending on your class, you may
need to spend more time ensuring students
know how to say these basic times. With a
stronger class, you may prefer to ask students to
complete 1 before referring to the ‘Telling the
time’ section of the Language box. This will
allow you to gauge students’ prior knowledge of
the target items. Then ask students to read this
part of the Language box individually.
Vocabulary
1 Ask students to label the watches and clocks
individually using the words in the box. Check
answers as a class. Then refer students to the
words in the box again and ask: Which ones are
examples of the 24-hour clock? (20.00, 12.00 (both),
14.45, 23.30 and 24.00).
A 14.45 B 9.20 a.m. C 23.30 D 12.00
E 24.00 F 3 p.m. G 8.15 a.m. H 20.00
2 Tell students that they are now going to learn
expressions to tell the time. Ask them to work
individually to match expressions 1–8 to the
correct times in the box in 1. Ask them to
compare answers with a partner, then check as
a class.
On the board, write: in, at. Then ask students to
underline examples of in and at in the
expressions in 2.
On the board, write clock times + in/at and part of
the day + in/at. Ask a stronger student to come to
the board and circle the correct preposition in
each case. Point out that we say at night, not in
night. Refer students to the ‘Prepositions of time’
section of the Language box.
1 9.20 a.m. 2 20.00 3 12.00 4 14.45
5 23.30 6 3 p.m. 7 8.15 a.m. 8 24.00
Extra activity
For further practice, ask students to cover the
expressions in 2 and to practise saying aloud
the times in the box in 1.
Speaking
3 In pairs, students take turns asking and
answering questions 1–4.
Listening
4 ► 03 Depending on your class, you may need
to review the days of the week before asking
students to complete this activity. First ask them
to simply listen and note down the times they
hear. Play the recording. Then write on the
board: arrive/depart. Refer students to the
employee time sheet and ask them to find verbs
with a similar meaning (clock in, clock out). Play
the recording again and ask students to
complete Tyler’s time sheet. You may need to
play the recording a third time before checking
answers as a class. For weaker students, it may
be beneficial to play the recording again while
they read the audio script on page 72. Ask
experienced nurses: Do you have time sheets where
you work? What information do they give?
Tuesday: 16.45, 23.00
Wednesday: 15.30, 22.15
Thursday: 15.30, 22.15
Saturday: 6.00/6 a.m., 14.00/2 p.m.
Extra activity
For weaker students, bring in pictures of the
following: car, bank, restaurant, cup of coffee,
teddy bear, newspaper, plate of food. Ask
students, in pairs or small groups, to match the
pictures to the list of hospital facilities in 5.
Check answers as a class.
Meeting colleagues 1 5
 Speaking
5 Put students in pairs. Ask B Students to turn to
page 68 and refer the class to the example
questions. You could do the first question as an
example with a more confident student. Monitor
and assist students where necessary.
Student A
Car park: 7.30 a.m. – 9.00 p.m.; Bank: 10.00
a.m. – 12 noon and 1.00 p.m. – 3.00 p.m.;
Restaurant: 7.30 a.m. – 5.30 p.m.; Coffee
shop: 8.30 a.m. – 6.30 p.m.; Gift shop: 10.00
a.m. – 2.00 p.m. and 5.00 a.m. – 8.00 p.m.;
Newsstand: 12.00 noon – 8.00 p.m.; Patient
mealtimes: Breakfast: 7.30 a.m., Tea: 5.00 p.m.
Student B
Visiting hours: 2.00 p.m. – 4.00 p.m. daily and
6.30 p.m. – 8.00 p.m. daily; Restaurant: 10.00
a.m. – 5.00 p.m.; Coffee shop: 12.00 noon –
6.30 p.m.; Gift shop: 10.00 a.m. – 8.00 p.m.;
Newsstand: 10.00 a.m. – 8.00 p.m.; Patient
mealtimes: Dinner: 12.30 p.m., Beverages:
10.00 a.m. and 7.15 p.m.
Meeting patients and their visitors
Listening
1 ► 04 Tell students that they are going to hear
four nurses meeting their patients for the first
time and that they should tick the correct patient
name for each nurse. Play the recording, then
check answers as a class. Ask: Which nurse is
talking to a child? (Denny) What’s the child’s name?
(Kendra)
Anja: Ms Coxen Katya: Mr Williams
Max: Susie Arnold Denny: Kendra
2 Refer students to expressions 1–8, then replay
the recording section by section, allowing
students time to write their answers. Play the
recording again if necessary. Ask students to
compare answers with a partner, then check as
a class. Ask: Which expression does a patient use?
(5) When can a nurse use this expression? (when
speaking to new colleagues)
1 Can, in 2 course 3 isn’t 4 care 5 call
6 Sorry 7 after 8 are
3 ► 05 Play the recording and ask students to
tick the expressions in 2 that Denny uses.
Afterwards, ask: Who is Mr Willis? (Kendra’s
toy/teddy bear)
7, 8
Extra activities
1 Ask confident students to model each of the
expressions in 2. Give guidance as
necessary. On the board, write: Can I come
in? and I’m taking care of you. Above each
expression, draw an arrow to show the
correct intonation patterns for a question
and a statement. Then get students to
practise reading the expressions aloud, first
as a class and then in pairs, until you are
happy they sound natural.
2 With stronger classes, have a class
discussion about the use of first names and
surnames in the students’ own countries.
How well do they have to know someone
before they use their first name? Are there
any other factors (e.g. status, age) that play
a role in the choice of names? What about in
a hospital? Why do some patients prefer
nurses to use their first name/surname?
Vocabulary
4 Refer students to the family tree and ask: What
does it show? (family members). Go over the
examples, then ask them, in pairs or small
groups, to complete the family tree using the
underlined words in the box. Then ask them to
complete sentences a–e using the rest of the
words in the box. Check answers as a class.
1 grandfather 2 grandmother 3 father
4 mother 5 aunt 6 husband 7 brother
8 sister 9 cousin 10 cousin 11 son
a grandson b wife c granddaughter
d mother-in-law e father-in-law
Speaking
5 Ask students to draw a picture of their family –
they can invent the people if they wish – and
label it with words from 4. Students can draw
stick figures if necessary. Alternatively, ask them
to bring in photos of their family, or bring in
pictures of family groups for the students to use.
Then, ask students, in pairs, to turn to page 68
and roleplay meeting a patient for the first time.
Student A takes the role of nurse and asks
Student B questions about the family in his/her
picture. Go through the example with a stronger
student. When they have finished, ask them to
swap roles and repeat the activity.
Meeting colleagues 1 6
 Reading
6 Refer students to the illustration and ask: Where
is this? (a hospital ward). Point to visitor E and
ask: E is visiting a friend. Is it a good thing? Why
not? (No, she has a cold.). Ask students, in small
groups, to put a tick next to the visitors who are
doing the right thing and a cross next to the
visitors who are doing the wrong thing. Avoid
confirming answers at this stage.
A✓ B✓ C✓ Dx Ex Fx Gx Hx Ix
7 Now ask students to read the hospital visitor’s
code, checking their answers in 6 as they read.
Reassure them that they do not need to
understand every word at first. Help them
develop their vocabulary by asking them to
match words from the visitor’s code to items in
the illustration in 6. Check that they understand
touch, wound, vomiting, turn off and extinguish.
Speaking
8 Elicit/Pre-teach parent, guardian and overnight.
Then ask students, in small groups, to discuss
questions 1–4. Monitor and assist them where
necessary. Depending on your class, you may
wish to ask each group to give an informal
presentation of their answers to the rest of
the class.
9 On the board, write: Excuse me, please don’t ... ./
I’m sorry, you can’t ... . Refer students back to the
illustration in 6, point to visitor G and elicit
Excuse me, please don’t sit on the patient’s bed./
I’m sorry, you can’t sit on the patient’s bed. With
weaker classes, you may wish to elicit one or
two more examples, or elicit the correct verb for
each example.
Suggested answers
D ... give flowers to the patient/bring flowers
on the ward.
E ... visit the patient/hospital when you have
a cold/the flu.
F ... use a mobile phone on the ward.
G ... sit on the patient’s bed.
H ... touch the medical equipment.
I ... bring children under 12 to visit the
patient/visit more than two at a time.
Escorting a patient for tests
Vocabulary
1 Ask students, individually or in pairs, to label
the medical equipment with the letters in the
box. Pre-experience nurses may only be able to
label some of these. Ask them to make a guess.
A X B CT C MRI D ECG
Pronunciation
2 ► 06 Elicit pronunciation of the letters of the
alphabet by asking around the class. Then refer
students to the medical equipment in 1 and ask
them, in pairs, to guess the pronunciation of
each one. Avoid correction at this point. Ask
students to listen and repeat the names as they
hear them. Pause after each word and check
pronunciation, first chorally, then individually.
Language
Before you go through the Language box, write
the ordinal numbers for 1 to 20 on the board (1st,
2nd , 3rd, etc.). Review the numbers in order,
chorally and individually if necessary. Then
point randomly to the numbers and ask students
to say them aloud, paying attention to their
pronunciation. Add 21st and 22nd and do the
same up to 31st. Ask: When do we use ordinal
numbers? (for dates). Ask a student to write their
date of birth on the board (e.g. 19th January 1988)
and elicit the spoken form (the nineteenth of
January, nineteen eighty-eight). Remind students
that we do not usually write dates in words in
English. Then ask them to read the Language
box individually.
Listening
3 ► 07 Refer students to the appointments sheet
and ask: Why do patients go to the Radiology
Department? (for tests, X-rays, etc.). What does
DOB mean? (date of birth). Tell students that
they are going to hear a nurse taking three
patients to the Radiology Department. Give
them time to look at the information on the
appointments sheet first, then ask them to listen
and write the correct test for each patient. Play
the recording, then check answers as a class.
a ECG b CT scan c X-ray
Meeting colleagues 1 7
4 Ask students to listen again and complete each
patient’s name and date of birth in 1–6. If
necessary, pause the recording after each patient
to give students time to write their answers. Ask
them to compare answers with a partner, then
check as a class.
1 Khan 2 01.02.1956 3 Simpson
4 22.06.1932 5 Kadinska 6 16.04.1998
5 Refer students to the audio script on pages 72–73
and ask them to practise reading the dates of
birth in pairs. Then put them in new pairs and
ask them to dictate three dates of birth for their
new partner to write down.
Extra activity
Ask students to draw their own family tree, as
on page 8, labelling it with names and dates of
birth. Put them in pairs and ask them to explain
their family tree to their partner. Depending on
your class, you may wish to ask students to
prepare a PowerPoint slide and present their
family tree to the rest of the group.
Vocabulary
6 Ask students, individually or in pairs, to label
the illustration with the words in the box.
1 trolley 2 walking stick 3 blanket
4 wheelchair
7 Tell students that they are going to hear a
conversation between staff nurse Kelly and Jake,
her patient. Explain that before they listen, they
have to put the sentences and questions from
their conversation in the correct order. You may
wish to do the first item as an example with the
class. Avoid correction at this stage.
Listening
8 ► 08 Before students listen, check their
understanding of identity bracelet, swipe and code
(barcode). Ask them to listen to the first part of
the conversation between Kelly and Jake to
check their answers in 7. Play the recording,
then check answers as a class.
1 It’s time for your X-ray now.
2 Are you ready?
3 Can I just see your identity bracelet first,
please?
4 What’s your full name?
5 Can I swipe the code on your bracelet,
please?
9 ► 09 Give students time to read through
statements 1–5. Then ask them to listen to the
second part of the conversation between Kelly
and Jake and to choose the correct words in
italics. Play the recording, then check answers as
a class. Depending on your class, you may wish
to play the recording a second time.
1 wheelchair 2 cold, weak 3 blanket
4 Claire 5 10.30
10 Ask students, individually or in pairs, to
complete the expressions using the words in the
box. Then play track 09 again for students to
check their answers. They may have difficulty
understanding item 2 (Are you warm enough?);
encourage them to learn it as an expression and
not to break it down into individual words.
1 help 2 arm 3 Let 4 better
Speaking
11 Refer students to the audio script for tracks 08
and 09 on page 73 and ask them, in pairs, to
practise the conversation between Kelly and
Jake. When they have finished, ask them to swap
roles and repeat the activity.
12 Put students in new pairs. Tell them that they
are going to practise escorting a patient to the
Radiology Department. Depending on your
class, you may wish to ask students to write
their conversation out before carrying out the
roleplay. When they have finished, ask each pair
to join another pair. They then take turns
listening to each other’s conversations and
checking that they have followed all the steps.
Now do Unit test 1.
Preparing for the next unit
In preparation for Unit 2, suggest the following to
your students:
• Think about common symptoms and make a list.
• Do some (online) research into how to take a
blood sample.
Meeting colleagues 1 8
 2 Nursing assessment
Briefing
This unit focuses initially on checking patient
details. It then covers language to enable students to
understand and ask about patient symptoms for
common illnesses before moving on to those of
childhood diseases. It also seeks to develop effective
communication skills when taking a blood sample.
Checking patient details
It is common for patients in the UK to visit their GP
(general practitioner), or family doctor, when
symptoms present. Part of the job of a practice nurse
working in a GP/doctor’s surgery (AmE: doctor’s
office) is to keep accurate and up-to-date patient
records. This section draws students’ attention to the
patient details of a patient record. After familiarising
themselves with terms and expressions that
typically appear, students will go on to develop a
set of simple questions used to complete the patient
details. Questions are related to the patient: first
name and surname (family 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). Students will also
learn a simple strategy for checking the spelling of
words to help them record patient details.
Describing symptoms
Nurses are required to carry out patient assessments
which are often critical in the first step towards
establishing a care plan for the patient. Practice
nurses or those working for healthcare phone lines
are often the first point of contact for patients
suffering from common illnesses. This section looks
at developing key vocabulary for describing and
asking about patient symptoms, such as dizzy,
itchy, nauseous and swollen glands, along with the
related grammatical structures be/feel + adjective
and have + noun (e.g. I’m tired./He has a sore throat.).
Students will also discuss the most common patient
symptoms in their country. Nurses might use the
question How do you feel today? to open up
discussion with the patient and then follow up with
both open (What are your symptoms?) and closed (Do
you have a runny nose?) questions to encourage the
patient to express themselves while moving towards
a nursing diagnosis.
Assessing common childhood diseases
Patient education is an important aspect of nursing,
as is carrying out infant injections and vaccinations.
Students will be able to draw on their own
experience (as nurses, patients or parents/carers) to
work through this section of the unit, dealing with
common childhood diseases: rubella, (also known
by patients as German measles), measles and
mumps, which are all mild viral infections (refer to
the leaflet on page 16 of the course book for a
description). It should be noted that symptoms for
measles and rubella are very similar; these, along
with those for mumps, are presented in a patient
education leaflet about the MMR vaccine. The
introduction of adverbs of frequency enables
students to get to grips with explaining how often
symptoms occur when educating parents/carers
about these diseases. Finally, completing extracts
from similar leaflets about chickenpox (varicella)
and scarlet fever (scarletina) allows students to
further practise language from earlier in the section.
Taking a blood sample
This section takes students through the different
stages of taking a blood sample (or venipuncture),
while giving them the opportunity to acquire the
key language used to carry out this routine nursing
procedure: needle, syringe, tourniquet, etc. Note
that many nursing procedures need to be carried out
in a certain order. For example, labelling the
specimen tube at the beginning of the procedure
will avoid it being mistaken for that of another
patient. Students will also work on developing a set
of patient-friendly instructions for carrying out the
procedure, such as Please roll up your sleeve for me. In
the second part of this section, students listen to a
nurse reassuring a patient with a fear of needles.
An appropriate intonation pattern plays an essential
role in fully conveying reassurance to the patient.
Even at elementary level, it is important to raise
awareness of the importance of patient-friendly
intonation and encourage its development. A series
of scenarios at the end of this section provides
students with a means of further honing their
communication skills for carrying out this procedure
in English.
Nursing assessment 2 9

Teacher’s notes
Warm-up
1 On the board, draw a family tree of three
generations and ask students to complete it by
adding the different family members. This could
also be done as a team game; the first team to
complete the tree are the winners.
2 Put students in pairs and refer them back to 12
on page 11. Ask them to take turns roleplaying
escorting a patient for a test.
Checking patient details
Reading
1 With books closed, set the scene (doctor’s
surgery/office). Ask: What information does a
(practice) nurse need from a new patient? (name,
address, date of birth, name of doctor, etc.).
Experienced nurses may be able to provide more
ideas but may have difficulty expressing them
in English.
Ask students to open their books, refer them to
the patient details and review DOB (date of
birth) from Unit 1. Point out that GP stands for
general practitioner. Explain that in the UK and
Ireland, it is usual to consult a GP before being
referred to a specialist (see Briefing page). Ask:
Is this the same in your country?
Depending on your class, you may also wish to
ask the question: What is another word for ‘family
name’? (surname). Elicit other possible responses
for title (Ms, Miss, Dr, Professor, etc.), marital
status (married, divorced, separated, widowed)
and next of kin (husband, mother, father, sister,
etc.) Then ask students to read the patient details
and answer the questions.
1 a man 2 12.09.1982 3 construction worker
4 no 5 (Dr) Tanya Millet 6 his/the patient’s
mother
Extra activity
Reinforce the target language by asking
students to copy the form in 1 and complete it
as if they were a new patient. Monitor and
assist students where necessary.
Listening
2 ► 10 Tell students that they are now going to
listen to two conversations. Read through the
information in 1 and 2 with the class and check
understanding. Then ask students to listen and
tick the information the person asks for. Check
answers as a class.
1 name and surname, telephone number, next
of kin
2 name and surname, date of birth, address,
email address
3 Ask students to listen again and complete the
patient details requested for each patient. If
necessary, stop the recording after each
conversation to allow students to write their
answers. Ask students to compare answers with
a partner, then check as a class.
1 Herriot 2 Anna Herriot (mother) 3 775-932-
8053 4 Kamil 5 09.01.1973 6 Diouri
7 akamil
Language
On the board, write: Wh__? and elicit who, where
and what. Many students will also know how –
tell them this will appear later in the unit. Check
that students are able to form the contracted
forms (what’s, who’s, where’s). Ask them, in pairs,
to write down as many questions as they can in
a minute using these question words, then elicit
examples from the class. Ask students to read
through the Language box individually.
4 Draw students’ attention to question 1 and do
this one with the class as an example. Then ask
students, in pairs, to complete questions 2–8
using the correct question words. Check answers
as a class, then ask the pairs to practise asking
and answering questions 1–8.
1 What 2 Where 3 What 4 What 5 Who
6 Who 7 What
Extra activity
With books closed, ask students to write wh-
questions to find out the following information
from their patient: name of patient, DOB, email
address, country of origin, mobile phone
number, next of kin, mobile number for next
of kin.
Nursing assessment 2 10
 Speaking
5 On the board, write: B/P. Ask one half of the
class to say these letters aloud. Can the other
students hear the difference between the two
letters? Do the same with D/T. Then write on
the board: B for Bob/ P as in Peter. Refer students
to the model conversation in 5 and ask them to
repeat the question as a class several times until
it sounds natural. Brainstorm other letters
students have difficulties with (this will depend
on their L1). Then ask them, in pairs, to write
down names that could help them understand
these letters. Ask them to practise the
conversation using their own examples.
6 Ask students to swap partners and decide who
is Student A and who is Student B. B Students
should turn to page 69. Tell them that they are
going to take turns roleplaying an interview
between a nurse and a patient and complete the
patient details. Remind them to use the
techniques they learnt in 5 to help them with the
spelling of the names.
Extra activity
Ask students to copy a blank patient record as
in 6 (or prepare blank ones in advance). Ask
them to invent the patient details. Then, in
pairs, students practise asking and answering
questions to complete the patient records.
Describing symptoms
Vocabulary
1 Mime and elicit headache and stomachache. On the
board, write: headache/stomachache = symptoms.
Elicit other symptoms. Then refer students to the
illustrations and ask them to match them to
symptoms 1–14. They could do this individually
or in pairs.
A 8 B 5 C 11 D 1 E 4 F 6 G 9 H 10
I 3 J 13 K 14 L 12 M 2 N 7
Pronunciation
2 ► 11 Elicit I have a headache. Ask students to
give other examples using the illustrations in 1.
Avoid correcting their pronunciation at this
stage. Then ask them to listen and check their
answers in 1. Finally, play the recording again
and ask them to repeat what they hear.
Note: Depending on their L1, students may find
sore throat and nauseous difficult to pronounce.
Take time to focus on the pronunciation of the
ones that cause difficulties for your students.
Speaking
3 Refer students to the notice on the right of the
page and ask them, in small groups, to put the
symptoms in order (1–5), with 1 being the most
common. Students can check their answers at
the bottom of the page.
1 sore throat 2 cough 3 backache
4 earache 5 stomachache
4 Ask students to brainstorm the top 5 (or top 10)
reasons for visiting the GP/family doctor in
their country. Ask: Are there any differences from
the UK? Why?
Language
5 On the board, write: I have a headache./I feel
dizzy./I have a bad headache. Ask students to point
to the noun, the adjective and then to the
adjective + noun combination in the sentences.
Refer them to the symptoms in 1 on page 14 and
ask them, in pairs, to write A (adjective), N
(noun) or A+N (adjective + noun) next to each
one. Ask pairs to compare answers with another
pair before checking as a class.
Then write ? on the board. Point to a student
and demonstrate feeling itchy. Point to the
question mark and elicit Do you feel itchy? Point
to another student and elicit Does he/she feel
itchy? Demonstrate other symptoms from 1 and
elicit the relevant questions from the class. Ask
students to read the Language box individually.
1N 2A 3N 4N 5N 6A 7A 8A+N
9 N 10 A + N 11 N 12 A 13 A + N 14 A
6 Ask students, individually or in pairs, to match
1–5 to a–e to make questions about symptoms.
Check answers as a class. Then refer students to
the Language box and point out the use of Does
it feel itchy? Tell them that this is a very common
question form when asking about a spot or rash.
You may wish to get students, individually or
as a class, to practise asking these questions
before moving on to 7. Encourage them to use a
gentle rise and fall intonation (a patient-friendly
intonation).
1b 2a 3d 4c 5e
Nursing assessment 2 11
7 Elicit/Pre-teach anxious. Explain that an anxious
father is calling the doctor’s surgery to speak to
the practice nurse about his son. Give students
time to read through the father’s answers and
ask them, individually or in pairs, to write down
the nurse’s questions. Check answers as a class.
1 What is your son’s name?
2 How old is Saul/he?
3 What are Saul’s/his symptoms?
4 Does Saul/he have a fever/temperature?
5 Does Saul/he have any other symptoms?
Speaking
8 Explain that students are going to roleplay a
conversation between a nurse and a patient. Ask
B Students to turn to page 69. Student A is the
patient and Student B is the nurse. Refer them to
the model questions at the bottom of the page.
With stronger students, elicit/pre-teach other
openers: What brings you here today?/How can I
help you? For less confident students, ask pairs to
write out their conversation first. Encourage
students to use patient-friendly intonation.
Monitor and assist students where necessary.
Assessing common childhood diseases
Vocabulary
1 With books closed, ask students to think about
diseases/illnesses young children often suffer
from. Then ask them, in small groups, to look at
the three photos and match them to diseases 1–3.
Note that pre-experience nurses may not yet
have come across these diseases in their study
but reassure them that they will learn more
about these in the next activity. Note also that
the symptoms for rubella and measles are very
similar and students may give the same answer
for each of these. With experienced nurses, you
may wish to hold a short discussion about the
difficulty of diagnosing a patient. Point out that
these terms are used by patients but they are not
all medical terms (see Briefing). Depending on
their L1, it might help some students to give
them the medical terms.
A2 B3 C1
2 With experienced nurses, tell students that you
have mumps and ask: What are my symptoms?
Repeat the question, asking about rubella and
measles. With pre-experience nurses, ask
students, in pairs, to match the symptoms in the
box to the diseases in 1. Point out that some
symptoms appear in more than one disease.
Avoid correction at this stage.
Reading
3 Refer students to the patient education leaflet
and ask them to scan the text quickly and check
their answers in 2.
1 rubella (1): fever, headache, rash, runny
nose, sore throat, swollen glands
2 measles (2): cough, fever, rash, runny nose,
sore throat
3 mumps (3): fever, headache, nausea,
swollen glands
4 In pairs, ask students to read through the leaflet
in 3 again and answer questions 1–6. Check that
they understand highly infectious, appointment,
vaccine and injection area. Reassure them that
they have already met most of the vocabulary
items earlier in the unit but that it is not
necessary to understand every word.
1 parents (and carers)
2 measles, mumps, rubella
3 13 months old, 4–5 years old
4 fever, swollen or red area where nurse/
doctor gave the injection treatment
5 nothing; it’s free.
6 paracetamol or ibuprofen
Listening
5 ► 12 Tell students that they are going to listen
to three conversations between nurses and their
patients and/or parents. Ask them to listen and
tick the symptoms they hear for each patient. If
necessary, play the recording twice. Check
answers as a class.
Chelsea: headache, swollen glands
Milly: fever, rash, runny nose, sore throat,
swollen glands
Isabelle: cough, fever, rash, runny nose, sore
throat
6 In pairs, ask students to make a diagnosis of the
patients in 5. They should now have had
sufficient input to be able to carry out this
activity successfully. Check answers as a class.
Chelsea has mumps.
Milly has rubella.
Isabelle has measles.
Nursing assessment 2 12
 Extra activity
On the board, write the following questions
about the three patients in 5 or prepare as a
handout in advance. Ask students to complete
the nurses’ questions. Either play track 12 again
for them to check their answers or refer them to
the audio script on page 73. Then ask them to
practise asking and answering the questions
in pairs.
1 Hello, ________ name?
2 ________ hurt?
3 ________ any other symptoms?
4 ________ today, Isabelle?
5 ________ still nauseous?
Answers
1 what’s your (Milly) 2 Does this (Yes, it does.)
3 Does she have (She has a runny nose.)
4 How are you (I have a sore throat.) 5 Is she
(No, she isn’t.)
Language
On the board, copy the arrow that appears in the
Language box, omitting the adverbs of
frequency. Also write: What time do you get up on
Mondays? Point to the question and gesture for a
student to ask you the question. Use a calendar
to point to each Monday in the month. Answer:
I always get up at 7 a.m. on Mondays. Write the
word always at the end of the arrow (100%).
Point to Sundays and say: I never get up at 7 a.m.
on Sundays. Write the word never at the other
end of the arrow (0%). Give similar examples,
adding the adverbs of frequency to the arrow as
you go along. With a stronger class, brainstorm
the adverbs of frequency and ask one of the
students to write them in the correct place along
the arrow.
7 Ask students, individually or in pairs, to rewrite
sentences 1–4 putting the adverb of frequency in
the correct position. Go through the example
with the class. Encourage experienced nurses to
make use of their existing knowledge to help
them complete the activity. Ask students to
compare answers with a partner, then check as a
class. Depending on your students, you may
wish to go through each sentence in more detail.
1 My son is often feverish after a vaccine.
2 Most people never catch childhood diseases
more than once.
3 Babies sometimes have symptoms after the
MMR vaccine.
4 Patients with measles are not usually
infectious after the rash appears.
Writing
8 Ask experienced nurses to name two other
common childhood diseases (varicella,
scarletina). Depending on their L1, some
students may already know the medical terms
for these but may not know the patient terms in
English. Then ask: What are the symptoms? Refer
students to the extract from the patient leaflet
about chickenpox and ask them, in small groups,
to complete it with the words in the box. Check
answers as a class.
1 childhood disease 2 symptom 3 rash
4 itchy 5 hot 6 rest 7 stop 8 infectious
9 Refer students to the expressions in the box and
ask them to choose the correct words in italics.
Then ask them to read the leaflet about scarlet
fever and put the expressions in the correct
place. Ask them to compare answers with a
partner, then check as a class.
1 a common childhood disease 2 have a
fever, a sore throat 3 under their arm 4 are
infectious for three 5 treatment for scarlet
fever 6 school for five days
Extra activity
Ask stronger students to work in pairs to
investigate one of the childhood diseases and
prepare a presentation to be delivered during
the next lesson. Encourage them to use the
information in the unit, as well as find suitable
images to illustrate their presentation. They can
use PowerPoint if facilities are available.
Taking a blood sample
Vocabulary
1 Ask students to close their books. Either point to
the vein in the crook of your arm and ask them
to mime taking a blood sample, or ask them to
think about the different stages of taking a blood
sample. Encourage pre-experience nurses to use
their experience as patients to help them. This
will help students to think about the different
stages of the nursing procedure itself so that
they can then concentrate on acquiring the key
language. Then, ask students, in pairs, to match
1–7 in the illustrations to words a–g. Some
students may have difficulty with these
vocabulary items but encourage them to use the
illustrations to help them.
Nursing assessment 2 13
 a3 b7 c2 d6 e5 f4 g1
Reading
2 Ask students, individually or in pairs, to use the
words in 1 to complete the instructions for
taking a blood sample. For less confident
students, you may wish to elicit/review the use
of an with nouns that begin with a vowel before
they complete the activity. Again, encourage
students to make use of the illustrations in 1 to
help them. Check answers as a class.
i plaster ii cotton ball iii antiseptic wipe
iv specimen tube v tourniquet, needle
vi syringe
3 Refer students back to the instructions in 2 and
ask them to match these to the illustrations in 1.
This can be done as a group activity. Check that
students understand press hard, roll up, sleeve,
insert and fill. Ask: Why is it important to write the
name on the specimen tube at the beginning of the
procedure? (because it is important not to mistake
the tube for that of another patient)
i E, 5 ii F, 4 iii B, 2 iv D, 1 v A, 3 vi C, 6
(The correct order is: iv, iii, v, ii, i, vi)
Speaking
4 Ask students, in pairs, to put the words in 1–6 in
the correct order to make sentences about taking
a blood sample. Avoid correction at this stage.
5 ► 13 Tell students that they are now going to
listen to a nurse taking a blood sample. Ask
them to listen and check their answers in 4.
Check that they understand pin prick and bend.
1 Please roll up your sleeve for me.
2 Let me disinfect your arm first.
3 Let me tie the tourniquet round your arm.
4 You will feel a small pin prick.
5 Hold this cotton ball to your arm.
6 Press hard for a minute and bend your arm.
6 Refer students to sentences 1–4 and give them
time to read through them. Tell them that they
are going to listen to the recording again and
choose the correct words in italics. You may
wish to pause the recording after each answer to
allow students to complete the sentences.
1 blood 2 look out of the window 3 dizzy
4 some juice
Speaking
7 Ask students, in small groups, to answer
questions 2 and 4 in 6. Encourage pre-experience
nurses to think about their own experience as
patients or use their general knowledge to help
them answer the questions. Check answers as
a class.
Suggested answers
2 To relax the patient./The patient doesn’t like
blood or needles.
4 To give the patient some sugar./The patient
needs sugar
8 Ask students to change groups. On the board,
write: Some patients feel ____ during a blood test.
Ask groups to brainstorm possible symptoms to
complete the sentence on the board. You may
wish to carry out this activity with the whole
class for pre-experience nurses. If necessary, tell
students there are four possible answers and/or
refer them back to the symptoms on page 14.
Again, encourage them to use their general
knowledge or their own experience to help them
complete the activity. Ask experienced nurses:
Do you know patients who have these symptoms?
How do you help these patients? Do not insist on
accuracy, instead try to encourage fluency.
faint, weak, nauseous, hot
9 With books closed, write on the board: Tell me
about your ... and ask students to brainstorm
topics of conversation that a nurse could use to
try to relax a patient. Then refer students to 9
and ask them to compare their ideas with the
examples in the book. Then, ask them, in pairs,
to roleplay relaxing a patient using two or more
of the model conversation openers.
10 Ask students, in pairs, to take turns roleplaying
taking a blood sample. Refer them to the
information for this activity. Monitor and assist
students where necessary. For less confident
students, you may wish to ask them to write out
their conversations first.
Pronunciation
11 ► 14 Refer students to sentences 1–4 and ask
them to listen and complete. Then ask: Who is
speaking? (nurses). Check students understand
let me know and tell me.
1 faint 2 weak 3 nauseous 4 hot
Nursing assessment 2 14
12 On the board, draw a straight horizontal arrow
and then a wavy arrow indicating a gentle rise
and fall pattern. Then, next to the wavy arrow,
write: reassure. Depending on your class, either
ask students to check the meaning of the verb
in a good bilingual dictionary or brainstorm a
definition in their L1. Tell students that they are
going to listen to the sentences again and that
this time they must decide which nurses sound
reassuring – point to the wavy arrow on the
board. Ask them to circle Y (yes) if the nurse
sounds reassuring and N (no) if they do not.
You may wish to play the recording twice. Some
students may find this activity a little difficult.
Encourage them by suggesting they listen to the
rhythm of the nurses’ voices. Note that your
students may not achieve this immediately.
Explain that this is also difficult for some
native speakers.
After the activity, ask students to listen and
repeat the sentences as they hear them, first
chorally, then individually. Repeat until you are
confident that students sound reassuring.

1Y 2N 3N 4Y

Speaking
13 Refer students to scenarios 1–4. Check their
understanding by asking simple comprehension
questions for each one. Check they understand
taxi driver, actor, golf, maths, economics, online radio
station and retro.
Ask students, in pairs, to choose a scenario and
then roleplay taking a blood sample. Then ask
them to swap roles and repeat the activity.
Depending on your class, you may wish to ask
pairs to roleplay in front of the rest of the class.
Now do Unit test 2 and Progress test 1. For the
Listening part of the Progress test, use track 10,
conversation 2.

Preparing for the next unit

In preparation for Unit 3, suggest the following to
your students:
• Think about a hospital ward in your country and
list the names of the different rooms.
• Do some (online) research into hypothermia.

Nursing assessment 2 15
 3 The patient ward

for staff and visitor use. Hospitals in the UK and

Briefing Ireland are moving away from communal wards,
although individual patient rooms are still more
This unit first deals with monitoring body
common in private hospitals. The clean supply
temperature and then introduces key language for
room is where IV insertion kits, bandages, masks,
the different features of a patient ward. Finally, it
hospital gowns, sterile equipment, IV tubing, etc.
looks into the duties of a nurse before describing
are stocked, while the soiled utility room contains
the qualities of a responsible nurse.
waste bins as well as areas to dispose of bodily
fluids, etc. The nurses’ station is the administrative
Monitoring body temperature
centre for nursing care for a particular group of
The body requires a stable core temperature patients. Before going on duty, nurses usually meet
(ranging from 36.5°C to 37.2°C) to function there to receive daily assignments, review patient
efficiently and this can be affected by medication, charts and update files. The physicians’ area is
exercise, pregnancy, age, infection and emotions. reserved for charting and X-ray viewing, while the
Monitoring body temperature is one of the most conference room is where reports are delivered and
routine nursing procedures and measurements are assignments allocated. Finally, the nurses’ lounge,
taken regularly to assess variation that may indicate generally containing basic kitchen equipment, tables
disease, deterioration in condition, infection or and chairs, is where the staff can go to relax between
negative reaction to treatment. This section begins shifts. Prepositions of place are introduced to enable
by presenting four types of thermometer. Today, students to indicate the location of ward facilities
digital thermometers are preferred for their (e.g. visitors’ toilets).
accuracy and can be used for taking measurements
via oral, rectal or axillary (under the arm) sites. Nursing duties
Disposable thermometers are paper strips with
This section begins by introducing the present
temperature sensitive dots, used for oral or
continuous for actions happening at the moment of
skin/surface temperature measurements, often
speaking, in the context of describing the duties of
used with small children. When using an oral
a nurse. Duties specific to nursing include filling
thermometer, the nurse must ensure that the patient
in a form, taking a patient’s temperature and
has not eaten, drunk or smoked within the previous
changing an IV drip. This is then followed by the
15 minutes. Finally, the tympanic thermometer uses
presentation of the present continuous for
infrared sensors to sense temperature measurements
discussing future arrangements.
of the tympanic membrane in the ear.
Students then practise reading temperatures and The qualities of a responsible nurse
also study the language of polite requests. They
Call lights, also known as call bells or nurse-call
then investigate hypothermia (the opposite of
buttons, are the patient’s connection to the nurse.
hyperthermia), an extreme temperature deviation
The most frequent requests via call light are for
below 35°C, causing the metabolic rate to decrease,
positioning, pain medication and toileting
which can lead to body dysfunction such as
assistance. There are cases of misuse but nurses
convulsions and, in extreme cases, is fatal.
are obliged to attend to the patient, as otherwise
Hypothermia can be caused by exposure to cold,
could prove fatal.
blood transfusion, surgery or renal dialysis in the
critically ill. The final part of this unit concerns the qualities of
a responsible nurse and builds on students’
The patient ward knowledge of adjectives (attentive, friendly, caring,
polite), including the use of the prefixes in-, un- and
Orientation onto the patient ward is part of the
im-. Solid communication skills are a basic
admissions procedure. Students begin this section
foundation for any career but, for nurses, this is one
by familiarising themselves with the layout of a
of the most important aspects of the job.
typical (US) patient ward. In the US a patient either
shares a room with one other person or occupies an
individual room with a private bathroom and a sink

The patient ward 3 16


Teacher’s notes
Warm-up
1 Ask students to brainstorm a list of common
symptoms in pairs. They should then team up
with another pair and take turns miming their
symptoms for the other pair to guess. Encourage
students to use the correct form of be/feel +
adjective or have + (adjective +) noun.
2 Refer students to the blank patient record on
page 13. Ask them to invent details for the
patient. They should also list their symptoms.
Then, ask them, in pairs, to roleplay the
beginning of a patient interview, completing the
patient details and then asking about their
symptoms. When they have finished, ask them
to swap roles and repeat the activity.
Monitoring body temperature
Vocabulary
1 Refer students to the photos at the top of the
page and ask them to match these to words 1–4.
Check answers as a class.
A2 B3 C4 D1
2 Depending on your class, you may wish to
revise numbers and use of the decimal point
before this activity. Elicit the temperature in
question 1 from a confident student (thirty-six
point six degrees). Remind students to say point to
indicate the decimal. Explain that it is not usual
to say Celsius as this is understood. Ask them, in
pairs, to practise saying the temperatures in 1–6.
Monitor their pronunciation and assist where
necessary. Then ask the pairs to answer the
question in the rubric. Note that pre-experience
nurses may not know the exact temperature.
Check answers as a class.
Refer students to the box in the margin. Explain
that in the US the Fahrenheit scale is used to
measure temperature.
1 thirty-six point six degrees
2 thirty-five point two degrees
3 thirty-seven point four degrees
4 thirty-eight point three degrees
5 thirty-seven degrees
6 thirty-seven point nine degrees
Normal body temperature is between 36.5°C
and 37.2°C.
Extra activity
Ask experienced nurses:
1 Name three sites for taking temperature.
2 Which thermometer is used for babies:
disposable, oral or tympanic?
3 Which site(s) is/are the best: oral, tympanic or
axillary? Why?
Answers
1 oral (mouth), tympanic (ear), skin (forehead),
rectal 2 disposable 3 Tympanic is the most
accurate site.
Pronunciation
3 ► 15 Write oral on the board and ask: How
many syllables are there? (two). Demonstrate this
by holding up two fingers as you pronounce the
word. Ask a confident student to underline the
stressed syllable (oral). Ask students, in pairs, to
underline the stressed syllable in each word.
Encourage them to say the word aloud several
times to help them find the answers. Play the
recording for students to check their answers,
then play it a second time for them to repeat
the words.
Point out that for nouns ending in -ic and -able,
we place the stress on the penultimate syllable.
This is best demonstrated on the board.
Continue practising by pointing to the photos in
1 and asking: What kind of thermometer is it?
Which thermometer is the nurse using?
1 oral 2 tympanic 3 electronic
4 thermometer 5 temperature 6 disposable
Listening
4 ► 16 Tell students that they are going to hear a
nurse taking a patient’s temperature. Refer them
to the list of words and ask them to listen and
tick the words they hear. Reassure them that
they will be listening to the text again later
and that it is not important to understand
every word.
mouth, temperature chart, thermometer, tongue
5 Refer students to the illustrations of a nurse
taking a patient’s temperature and ask them,
individually or in pairs, to put the five stages in
the correct order. Avoid correcting at this stage.
A3 B1 C5 D2 E4
The patient ward 3 17
6 Ask students to listen again to check their
answers in 5. Play the recording and check
answers as a class. Then refer students to the
nurse’s requests 1–4 and explain that they are
going to listen again in order to complete them.
For some students the target structure may be
new. If this is the case, simply try to encourage
them to listen for the missing words. Play the
recording, then check answers as a class.
1 Can, open 2 Can, put 3 Could, close
4 Can, take
Language
On the board, write: Can you open your mouth?
Circle can and underline open your mouth. Ask a
confident student to come to the board. Write
could elsewhere on the board and ask the student
to rewrite the request using could. Explain that
can and could have a similar meaning and can
both be used for requests. Add please to the
requests on the board. Ask stronger students/
experienced nurses: Why do nurses use ‘could’ and
‘please’? (to soften the request/make the request
more polite). Do the same with the expression for
me, please? (used to personalise the request and
encourage the patient to carry it out – especially
with children). Finally, ask students to read the
Language box individually.
7 Ask students, individually or in pairs, to rewrite
the sentences to make polite requests. Remind
them to use please/for me, please. Go though
each request with the class to check students’
understanding of the target language.
1 Can/Could you put the thermometer under
your tongue (for me), please?
2 Can/Could you hold your arm up (for me),
please?
3 Can/Could you close your mouth (for me),
please?
4 Can/Could you put your head to one side
(for me), please?
5 Can/Could you take off your shirt (for me),
please?
Extra activities
1 Refer students to photos B–D in 1 on page
20. Ask them, individually or in pairs, to
match the thermometers to the following
sites: oral, ear, axillary (under the arm).
Answers
B oral C ear D axillary
2 Then ask students which site the nurse is
using for each request in 7. Ask them to
write O (oral), E (ear) or A (axillary) next to
each request. Alternatively, do this as a
whole class activity, orally.
Answers
1O 2A 3O 4E 5A
Speaking
8 Ask students to work in pairs. Using the
requests in 6 and 7 and the illustrations in 5,
they should roleplay taking a patient’s
temperature, then swap roles and repeat the
activity. Ask them to choose a different type of
thermometer each time.
Reading
9 Write hypothermia on the board and explain that
students are going to read an online advice page
about this condition. Ask experienced nurses:
What is hypothermia? (when a patient is very,
very cold; the patient can die from hypothermia).
Experienced nurses may recognise the condition
but may have difficulty expressing their ideas in
English. Refer students to statements 1–5 and
ask them to familiarise themselves with these
before reading. Check that they understand
blanket, fatal, emergency services, wet and turn up.
Then ask them, individually or in pairs, to read
through the text and decide if the statements are
true or false and correct the false statements.
1 F (The medical term is hypothermia.)
2 F (It is necessary to call the emergency
services immediately.)
3 T
4 T
5 T
Speaking
10 On the board, write: ____ ____ cover the patient
with a blanket, ____? and ask students to
complete the request (Can/Could you cover the
patient with a blanket, please?). Then, ask them, in
pairs, to roleplay a telephone conversation
between a nurse and someone who wants advice
on how to treat hypothermia. Encourage them to
use the advice in 9 and the language for making
polite requests in the Language box. When they
have finished, ask them to swap roles and repeat
the activity.
The patient ward 3 18
 The patient ward
Vocabulary
1 Refer students to the floor plan and ask: What is
this? (a patient ward). Ask them, in pairs, to
label the floor plan with the words in the box.
Less confident students may have difficulty with
some of these labels but encourage them to use
the illustrations and their existing knowledge of
English to help them. Ask students to compare
their ideas with another pair, then check
answers as a class.
Point out the use of the plural possessive in
nurses’ lounge. Then ask students to find more
examples of this in the words in the box (nurses’
station, physicians’ area and visitors’ toilet).
1 nurses’ station 2 clean supply room
3 soiled utility room 4 patient room 5 nurses’
lounge 6 physicians’ area 7 visitors’ toilet
8 conference room
Pronunciation
2 ► 17 Write conference room on the board and
ask a more confident student to underline the
stressed syllable (conference room). Then ask
students to underline the stressed syllables in
the rest of the words in 1. Avoid correction at
this stage. Play the recording for students to
check their answers.
Then play the recording again, asking students
to listen and repeat the words. Point out the
liaison in the following: nurses’ lounge, nurses’
station, physicians’ area and visitors’ toilet. You
may wish to demonstrate on the board by
drawing a curved arrow linking the two words
in each example.
clean supply room, conference room, nurses’
lounge, nurses’ station, patient room,
physicians’ area, soiled utility room, visitors’
toilet
Language
Depending on your class, you may like to ask
questions to elicit the target language using the
floor plan in 1. Ask students to find the
physicians’ area and the conference room. Ask:
Where is the physicians’ area? and elicit It’s next to
the conference room. Then elicit an example of on
the left, on the right and down the hall. Ask
students to read the Language box individually.
Extra activity
You may wish to do some further language
practice to reinforce the target structure before
tackling 3. On the board, write: Where is the ...?
I’m looking for the ... . Excuse me, can you tell me
where the ... is? Point to students at random
around the class to ask each other questions
using the floor plan in 1. Encourage them to
use different question openers each time.
3 Ask students, individually or in pairs, to choose
the correct prepositions in sentences 1–5. Check
answers as a class.
1 on 2 next 3 on 4 down, on 5 in
Language
Go through the examples in the Language box
with the class. Explain that with affirmative
plurals, we can give a precise number (e.g. There
are four thermometers.) or we can use some
without giving a number (e.g. There are some
books.). Point out the use of a and any in negative
sentences (There isn’t a bandage. There aren’t any
blankets.). Give students practice in using these
structures by asking about different items in the
classroom. Elicit short answers to some
questions (e.g. Are there any books in this
classroom?), then encourage students to make
their own statements (e.g. There are some desks.
There isn’t a drinks machine. There aren’t any
computers.). Point out the contracted forms isn’t,
aren’t and there’s.
4 Ask students to complete sentences 1–6 with the
correct form of there is or there are. Check
answers as a class.
1 There’s 2 There are 3 Is there 4 There
isn’t 5 Are there 6 There aren’t
Listening
5 ► 18 Tell students that they are going to listen
to student nurses Steve and Kelly talking about
the hospitals they work in. Refer them to the
table and then ask them to listen and tick the
rooms in each workplace. Play the recording,
then check answers as a class.
Kelly’s workplace: nurses’ station, patient room
Steve’s workplace: all
6 Ask students to first read through questions 1–5,
then play the recording again for them to answer
the questions. Pause the recording after each
The patient ward 3 19
 section if necessary to allow students to write
their answers. Ask students to compare answers
with a partner, then check as a class.
1 The people are friendly and it’s a good team.
2 more than 20 3 no 4 three 5 a TV,
a microwave, free tea and coffee, DVDs
Speaking
7 Ask students, in pairs, to ask and answer
questions about a patient ward they know.
Depending on your class, you may wish to go
through the model conversation at the bottom of
the page with a confident student. Monitor and
assist students where necessary.
Nursing duties
Speaking
1 Ask students to look at the illustrations and elicit
the following items: visitor, magazine, lunch,
bandage, X-ray and temperature chart. Then ask
them to work in pairs and describe what they
can see. Discuss answers with the class. Avoid
correcting students at this stage; just encourage
them to speak. This will serve as a ‘diagnostic
test’ to check students’ current knowledge of the
target structure.
Language
Pre-teach now and at the moment. Ask students:
What does a nurse do? (He/She looks after patients.)
Then refer them to illustration C in 1, point to
the nurse with the magazine and ask: What is this
nurse doing now? (She is reading a magazine.) Ask
similar questions around the class to practise the
different forms of the present continuous,
writing students’ answers on the board. Remind
them that they can also use the contracted form
of be. Ask students to read the Language box
individually.
2 Put students in new pairs and ask them to look
at the illustrations in 1 again. Using the verbs in
the box, they should describe what each person
is doing. This time, insist on more accurate
responses. Monitor and assist students where
necessary.
Suggested answers
A A visitor is talking to a nurse at the nurses’
station.
B A nurse is taking a patient’s temperature.
C Two nurses are eating lunch in the nurses’
lounge./A nurse is reading a magazine in
the nurses’ lounge.
D A nurse is looking for bandages in the clean
supply room.
E A doctor is looking at an X-ray (in the
consulting room).
F A nurse is filling in a patient’s temperature
chart.
Extra activity
Depending on your class, you may wish to ask
students to write out their descriptions of the
illustrations in 1. This may be especially useful
for those who are learning this structure for the
first time. You could also get students to ask
and answer questions about the illustrations, to
practise the question and negative forms (e.g. Is
he helping a patient? Yes he is./No he isn’t.)
3 Elicit/Pre-teach IV (intravenous drip), urgent, call
light, probably, complain, have trouble sleeping and
pain medication. You may wish to encourage
students to refer to a good bilingual dictionary.
Ask students, individually or in pairs, to
complete conversations 1–3 using the correct
form of the verbs in brackets. Check answers as
a class.
1 Are you doing 2 am changing 3 is probably
complaining 4 is having 5 are the nursing
assistants doing 6 are taking
4 Pre-teach/Elicit currently. Refer students back to
the illustrations in 1 and in pairs, ask them to ask
and answer questions about the people in each
illustration. Encourage them to use the verbs in
2 and at the moment, now and currently. Suggest
students begin with the example conversation.
Depending on your class, you may wish to go
through one or two examples first.
Language
On the board, write: 1 Mr Bates is seeing the
consultant now. Ask: What is Mr Bates doing now?
(He’s seeing the consultant.). Now write: 2 Mr
Bates is seeing the consultant at 5 p.m. and ask:
What is Mr Bates doing later? (He’s seeing the
consultant.) Ask: Which example is about the
future? (2). Explain that we can also use the
present continuous to talk about the future;
the time expression in the sentence indicates
The patient ward 3 20
 the present or future each time. You may wish
to brainstorm some other time expressions for
the future (e.g. tonight, later, later today). Ask
students to read the Language box individually.
5 Refer students to the email. Ask: Who is writing
the email? (Lisa). Who is she writing to? (Karen).
Check understanding of geriatric, treatment,
supervisor, feed, phone/telephone, insurance, IV
fluids and nonstop. You may wish to also point
out the use of sooo. Ask students, individually or
in pairs, to read the email and underline all the
verbs in the present continuous. Check answers
as a class.
I’m meeting, I’m seeing, I’m feeding,
I’m meeting, I’m checking, I’m phoning,
I’m checking
Extra activity
Ask comprehension questions to check
students’ understanding of the email in 5 and
use of the third person singular and plural of
the target structure. You may wish to ask them
to write down their answers. Some questions
you could ask are:
1 How long is Lisa’s shift today?
2 What is she doing at 9 a.m.?
3 What is she doing at lunchtime?
4 What are Lisa and the receptionist doing in the
afternoon?
Answers
1 12 hours
2 She’s meeting with the geriatric consultant.
3 She’s meeting Stefan in the nurses’ lounge
(for a quick sandwich).
4 They’re checking medical records.
6 Ask students, individually or in pairs, to go
through sentences 1–6 and write P for present or
F for future in each case. Depending on your
class, you may wish to do the first item as an
example with the class. Then, to check students’
understanding of the target structure, ask: How
do you know the sentence is about the present or the
future? (time expressions: 1 next week, 2 later
today, 3 currently, 4 at 5.20, 5 no time expression
= present, 6 at the moment)
1F 2F 3P 4F 5P 6P
Writing
7 Tell students that they are now going to write an
email similar to the one in 5. Encourage them to
use the verbs in 5–6 and the vocabulary in 1 on
page 22 to help them. Students may invent the
details if they wish. Monitor and assist them
where necessary. You may wish to give this as
a homework task.
Speaking
8 Elicit What are you doing later today/this
afternoon/at ...? and write it on the board. Ask
students to close their books and, in pairs,
describe their day to their partner. Encourage
them to ask each other questions and further
develop the conversation. Monitor and assist
students where necessary.
The qualities of a responsible nurse
Speaking
1 Elicit/Pre-teach call light. Pre-experience nurses
may not yet have come across call lights but they
should be able to use their general knowledge
and/or experience as patients to answer the
questions. Refer students to the illustration and
questions 1–3 and ask them to discuss in pairs.
Depending on your class, you may wish to put
them in small groups for this activity. When
they have finished, discuss answers as a class.
Suggested answers
1 She is talking to the patient./She is
answering the call light.
2 She wants a drink/an extra blanket/more
pain medication/to talk to someone, etc.
3 It may be serious, so nurses always have to
go and check on the patient.
Listening
2 ► 19 Tell students that they are going to hear
three conversations as nurses respond to call
lights for patients Mrs Azziza, Jerome and Mr
Patel. Ask them to listen and complete sentences
1–3 with the expressions in the box. Play the
recording, then check answers as a class.
1 to go to the toilet 2 some water, to turn off
the TV 3 more pain medication
3 Refer students to the nurses’ expressions 1–4.
Ask them to listen again and complete the
expressions. Depending on your class, you may
wish to replay the recording, pausing after each
conversation to allow students time to write
their answers. Ask students to compare answers
with a partner, then check as a class.
The patient ward 3 21
 1 How 2 What 3 Can, with 4 coming,
minutes
Vocabulary
4 Ask: What do you do to relax a patient? Students’
answers may vary, depending on the country.
Students may have difficulty expressing their
ideas in English; encourage them to use words
and gestures to describe their ideas. Explain that
they are going to match 1–5 to a–e to make
expressions to calm/relax a patient. Ask them
to complete the activity individually or in pairs,
then check answers as a class.
1c 2d 3a 4e 5b
Listening
5 ► 20 Tell students that they are going to listen
to Nurse Henshaw answering Mr Fredericks’
call light. Ask them to listen and tick the
expressions in 4 that she uses. Play the recording
twice if necessary. Ask students to compare
answers with a partner, then check as a class.
1, 2, 3, 5
6 Ask students to read through statements 1–4.
Explain that they are going to listen again and
underline the correct words in italics in each
case. Play the recording again, pausing after
each section to allow students time to complete
their answers. You may wish to refer them to the
audio script on page 75 to check their answers.
1 breathe 2 oxygen 3 relaxed 4 breathe
more easily
Extra activity
Remind students of the importance of patient-
friendly intonation when trying to relax a
patient. Model the nurses’ expressions in 3 and
4 and demonstrate the gentle rise and fall
intonation pattern with your hand as you do
so. Then ask students to say these expressions
aloud, first chorally, then individually.
Continue until you are happy that they sound
natural. Then refer students to the audio script
for track 20 on page 75 and ask them, in pairs,
to practise the conversation, paying attention
to intonation.
Language
Write the word friendly on the board. Ask a more
confident student to come to the board and write
a sentence about a nurse using this adjective
(e.g. The nurse is friendly.). Then write She’s a
_____ _____ . on the board and ask students to
complete the sentence (She’s a friendly nurse.).
Point out the position of the adjective in each
case. Do the same with the negative and plural
forms. Finally, write: _ _friendly on the board
and ask students to add two letters to form the
opposite (unfriendly). Tell them that to form the
opposite of other adjectives, we often use in-,
un- or im-. Ask students to read the Language
box individually.
7 Ask students, in pairs or small groups, to read
items 1–5, explaining that they are comments
patients made about their nurses. Ask them to
circle P if a comment is positive or N if it is
negative. You may wish to ask them to
underline the adjectives used to describe the
nurses before they complete the activity
(attentive, caring, patient, well-informed, unfriendly,
polite, flexible). Check answers as a class.
Depending on your class, you may wish to ask
students to then check the meanings in a good
bilingual dictionary.
1N 2P 3P 4N 5P
Extra activity
Ask students to write simple comments about
nurses (positive and negative) using the
adjectives in 7, in order to practise the form of
the target structure.
Vocabulary
8 Refer students back to the final point in the
Language box. Ask them, individually or in
pairs, to make adjectives 1–6 negative using the
prefixes in-, un- and im-.
1 inattentive 2 unfriendly 3 uncaring
4 uninformed 5 inflexible 6 impolite
9 Tell students that they are now going to read a
short article about the qualities of a responsible
(good) nurse. First check their understanding of
quality, responsible, contact, useful and busy.
Explain that, as they read the article, they have
to complete 1–6 using adjectives from 8. Tell
them that some of the adjectives will be in the
negative form. Give them time to complete the
article, then ask them to read it again and
The patient ward 3 22
 underline at least four more adjectives. Check
answers as a class. Depending on your class, you
may wish to ask students to then check the
meanings in a good bilingual dictionary.

1 informed 2 attentive 3 uncaring

4 impatient/unfriendly 5 friendly/polite
6 flexible
responsible, good, main, useful, important,
unhappy, busy, new

Speaking
10 Elicit/Pre-teach hedging expressions: maybe, it’s
possible, I think, etc. Refer students to the
illustration and ask them to imagine that they
are the patient looking at the scene in front of
them. Demonstrate the activity with a confident
student first. Then ask students to complete the
activity in pairs, using adjectives from 7, 8 and 9.
Monitor and assist them where necessary. For
less confident students, you may wish to stage
the activity as follows: individually, students
write down adjectives to describe each nurse
and then compare answers with a partner. Then,
in pairs, they write out their description, before
using it as a support for describing the
illustration orally.

Suggested answers
The nurse on the right is very busy but I think
he is unhappy and impolite. Maybe he isn’t very
friendly and maybe he is also uncaring but we
don’t know for sure. Maybe he is a very good
nurse. The nurse on the left is also busy but he
is caring, friendly and attentive. He is happy
and not impolite with his patients. He is flexible
and likes his important and useful job.

Extra activity
Ask students to write up their observations as a
short article. For experienced nurses, encourage
them to observe a scene in their workplace and
write a report.

Now do Unit test 3.

Preparing for the next unit

In preparation for Unit 4, suggest the following to
your students:
• Think about how to assist and encourage a patient
to eat while in hospital.
• Do some (online) research into clear liquid and
full liquid diets.

The patient ward 3 23

 4 Food and measurements
Briefing
Focusing on hospital food and beverages, this unit
also seeks to increase students’ understanding of
values for describing and calculating measurements.
It then goes on to develop language for assisting
patients effectively at mealtimes.
Hospital food and beverages
Patient recovery and overall well-being can be
attributed not only to the medical treatment they
receive but also to good nutrition. Hospital food
needs to be nutritionally balanced, varied, easy to
eat and presented in a way that is visually
appealing, thus encouraging the patient to increase
their food intake. In this section, an example of a
hospital menu provides a vehicle for students to
learn the names of food items that might be offered
in a hospital. Students hear patients selecting from
main dishes (e.g. cheese omelette) and side dishes
(e.g. mashed potatoes), as well as desserts (e.g.
apple purée) and hot and cold beverages, or drinks
(e.g. orange juice). Countable and uncountable
nouns with a/an and some are introduced, as well as
expressions for taking a patient’s order.
Measurements and quantities
This section introduces students to large numbers
used when describing quantities and calculating
measurements of liquids and solids. These include
calories, litres, kilograms and millilitres. It also
develops students’ use of how much and how many
via a conversation between a staff nurse and a
student discussing a clear liquid diet. A clear liquid
diet keeps the body hydrated during the first three
days following an operation or prior to certain tests
such as a colonoscopy. However, given that it does
not supply all the necessary nutrients, this diet
should not be continued for longer than a few days.
It consists of clear transparent liquid foods (e.g.
cranberry juice, black coffee, lemon tea and
bouillon (broth)). What follows is the full (or
strained) liquid diet, which includes both clear and
opaque liquid foods with a smooth consistency that
are easy to digest, such as vegetable soup, orange
juice, coffee or tea with milk, puréed foods or ice
cream that can be swallowed easily, before moving
back onto soft and then solid foods.
Helping a patient order from a hospital
menu
In this section, students are first encouraged to draw
on their own experience as a patient or nurse to
discuss the situation in their own country regarding
hospital menus and patient choice. Unlike in the
UK/Ireland and the US, in some countries the
responsibility for feeding the patient lies with the
relatives and not with the hospital. Some patients
require special diets: a soft diet for those suffering
problems swallowing, a restricted diet, a diabetic
diet or a vegetarian diet. The section then moves to
develop students’ skills in giving suggestions, with
expressions like how about and why not have + noun.
Assisting the patient at mealtimes
Patients will understandably suffer from a loss of
appetite while in hospital. Loss of taste, as well as
feelings of inadequacy and frustration, mean that
every effort should be made to ensure that the
environment is conducive to the patient having
optimum food and fluid intake. In some settings,
staff may even be encouraged to eat their meals with
patients to enhance the social function. To prepare
for mealtimes, nursing staff need to help the patient
sit upright and put their tray table at the right
height. Some patients may require a nurse to assist
them if they are too confused or weak to eat on their
own. Adapted utensils such as non-slip plates and
two-handled cups also encourage independence.
Nurses should not rush their patients but do need to
offer as much encouragement as possible (e.g. with
expressions like Can you just try a little more? or by
saying positive things about the food: It smells very
good.). Praising the patient is also important (e.g.
You’re doing well.) At the end of the section, students
are able to put their accumulated skills into practice
by taking the role of a nurse assisting a visually
impaired patient and using the ‘clock face’ to
describe the location of food on the plate. It should
be noted that, depending on the country of origin,
nurses may or may not carry out the duties
mentioned above. In the UK/Ireland these activities
may be conducted by a healthcare assistant (or
equivalent in the US).
Food and measurements 4 24

Teacher’s notes
Warm-up
1 If appropriate, bring in a photo of a nurse taking
a blood sample. Brainstorm the expressions used
for each stage of the procedure, then, in pairs,
ask students to roleplay taking a blood sample.
2 Brainstorm adjectives to describe negative and
positive qualities of a nurse. Then, ask students,
in small groups, to describe their ideal nurse and
present their ideas to the rest of the class.
Hospital food and beverages
Vocabulary
1 Ask students: What is hospital food like in your
country/place of work? Do you like hospital food in
your country/place of work? Why (not)? Avoid
correction at this stage to encourage fluency.
Ask students to brainstorm foods served in
their country/place of work.
Then refer students to the menu and ask them,
individually or in pairs, to label food items A–G
using the words in the box. Depending on your
class, students could check the items in a good
bilingual dictionary. Some of these may not be
familiar to your students and/or not appear on
a hospital menu in their country.
A grilled salmon B cheese omelette C pizza
D spaghetti bolognaise E turkey sandwich
F roast chicken G vegetable quiche
2 Refer students to the table and ask: When do we
eat side dishes? (with the main dish). When do we
eat dessert? (after the main dish). What is another
word for ‘beverage’? (drink). Then ask them, in
pairs, to complete the table with the food and
beverages in the box. You may wish to do an
example with the class first. Ask students to add
two more items to each group. Avoid correction
at this stage.
Side dishes: carrots, corn, mashed potatoes,
peas, peppers, rice
Desserts: apple, apple purée, banana, fruit
salad, orange, yoghurt
Beverages: apple juice, coffee, cola, cranberry
juice, orange juice, tea
3 Ask students to join another pair to compare
their answers and to then add another two items
to each group. These items can be food and
beverages eaten in their own country. Check
answers as a class.
Suggested answers
Side dishes: broccoli, cauliflower, couscous,
mushrooms
Desserts: ice cream, jelly, pancake, waffle
Beverages: hot chocolate, lemonade, mint tea,
grapefruit juice
Language
Write __ carrot and __ apple on the board and ask
a confident student to fill in the blanks. Ask:
When do we use ‘a’ and ‘an’? (We use them with
singular countable nouns. We use an before
nouns beginning with a vowel and a before
nouns beginning with a consonant). Ask: Can we
count apple juice? (no). Ask students to give you
another example of an uncountable noun. Elicit/
Pre-teach some for uncountable nouns. Point out
that we also use some with plural countable
nouns (e.g. some apples). Ask students to read
the Language box individually.
Listening
4 ► 21 Tell students that they are going to listen
to two patients ordering food from a hospital
menu. As they listen, they should tick the food
and beverages the patients want. Reassure
students that they do not need to understand
every word. You may wish to play the recording
twice, stopping after each patient to allow
students time to write their answers.
Then ask students, individually or in pairs, to
write a, an or some next to each item. Check
answers as a class.
1 coffee, mashed potatoes, orange, quiche
2 apple, cola, turkey sandwich
1 a cheese omelette, a coffee, some corn,
a fruit salad, some mashed potatoes, an
orange, some peas, some quiche
2 an apple, some apple juice, some apple
purée, a banana, some cola, some
cranberry juice, some salmon, some
spaghetti bolognaise, a turkey sandwich,
a yoghurt
Food and measurements 4 25
 Extra activity
Ask students to write a, an or some for the items
of food and beverages in 2 and 3. Monitor and
assist students where necessary. Finally, check
answers as a class.
Language
Refer students back to the menu on page 28.
Point to several items and demonstrate that you
like or dislike a particular food item. Elicit I like
and I don’t like from a confident student. On the
board, write: I like _____ but I don’t like _____ .
Using the menu and the items in 2, invite
students around the class to talk about their
likes and dislikes.
Then tell students that they are a patient
ordering from the menu. On the board, write:
What would you like to order? Elicit/Pre-teach I
would like _____ . Practise the target structure by
asking students around the class this question.
Encourage accurate use of a/an and some. Refer
students to the Language box and point out the
use of the contracted form I’d like. Finally, ask
them to read the Language box individually.
5 Tell students that they are now going to practise
like and would like. Ask them to complete the
questions and answers using the words in the
box. Ask them to compare answers with a
partner, then check as a class.
1 to order 2 like 3 for 4 What 5 Would
a would b please c would d do e Maybe
6 Now ask students to match the questions and
answers in 5. Check answers as a class.
1e 2d 3a 4b 5c
Speaking
7 Tell students that they are now going to practise
taking an order from a patient. Elicit/Pre-teach
Would you like to order your meal now? Yes, please.
/Yes, I would./Not right now, maybe later. Then
refer students to the model conversation at the
bottom of the page. Ask them, in pairs, to take
turns taking their patient’s order using the food
and beverages in 1, 2 and 4. Monitor and assist
students where necessary.
Measurements and quantities
Language
Depending on your class, you may wish to
review numbers before going through the
Language box. Write 2.45, 189 and 5,120 on the
board and ask: How do we say these numbers? Ask
students to write down their answers, then refer
them to the Language box to check. Write other
numbers on the board and ask them to say the
numbers aloud, first chorally, then individually.
Depending on your class, you may need to
highlight the use of the decimal point instead of
a comma in decimals, and the use of a comma in
numbers of 1,000 or more. Also point out that in
American English we say five thousand, one
hundred twenty (no and). Ask students to read
the Language box individually.
Listening
1 ► 22 Ask: When do nurses use numbers? (to talk
about age, calculate weight, height, temperature,
calories, etc.). If some students have difficulty
expressing their ideas in English, encourage
single word answers. Tell them that they are
going to hear some numbers and that they have
to circle the number they hear in each case. Play
the recording twice if necessary, then check
answers as a class.
1 160 2 119 3 1,050 4 1,200 5 18 6 1.25
2 Ask students, in pairs, to write out the numbers
in words. You may wish to do the first item as
an example with the class. Then ask students to
take turns saying the numbers in 1 and 2 aloud.
Monitor and assist students where necessary.
1 one thousand two hundred
2 two thousand five hundred
3 one point seven six
4 three thousand, four hundred and fifty
5 five point six six
6 eight point one seven
3 ► 23 Elicit/Pre-teach calories. Tell students that
they are going to hear four conversations.
Explain that they have to listen and write the
energy value (calories) they hear in each
conversation. Depending on your class, you may
wish to play the recording a second time,
pausing after each conversation to allow them to
write their answers. Reassure them that they
Food and measurements 4 26
 do not need to understand every word. Ask
them to compare answers with a partner, then
check as a class.
1 168 2 2,000 3 90 4 1,200
Extra activity
Refer students to the audio script for track 23
on page 75. Ask them, in pairs, to roleplay the
6 ► 24 Write kilo/kilo on the board. Say both
conversations. Then ask comprehension
questions to check their understanding of each
conversation. Write the following questions on
the board (or prepare a handout in advance):
1 How many calories are there in a glass of
orange juice?
2 How many calories can Nurse Webster’s patient
have a day?
3 How many calories are there in a cup of coffee
with fat-free milk?
4 How many calories are allowed in a low-calorie
diet?
Answers
1 168 calories 2 2,000 calories 3 90 calories
4 1,200 calories
Vocabulary
4 Refer students to the lists. Ask them to match
what nurses write to what they say and what
each measurement measures, as in the example.
Check answers as a class.
2 d, i 3 a, iii 4 b, ii 5 e, i 6 c, iii
5 To reinforce the terms and their meanings, ask
students, individually or in pairs, to write
sentences using the information in 4. Go through
the example with the class first, then ask
7 ► 23 Depending on your class, you may wish
students to complete the activity. Finally, check
answers as a class. Point out the plural forms of
measurements a–f.
Suggested answers
2 Nurses use kilos/kilograms to measure
weight. (e.g. a patient’s weight)
3 Nurses use kilojoules to measure energy.
(e.g. to check the energy value of a patient’s
menu)
4 Nurses use litres to measure liquids.
(e.g. the amount of fluids a patient drinks
per day)
5 Nurses use grams to measure weight.
(e.g. the weight of a newborn baby)
6 Nurses use calories to measure energy.
(e.g. the number of calories a patient eats
or uses)
Extra activity
Ask less confident students/pre-experience
nurses to do an online search for examples of
each measurement to tell the group at the
next class.
Pronunciation
versions aloud several times, placing the stress
in different places each time as indicated. Ask
students to decide which one is correct (kilo).
Point to the first syllable and tell them that this
is the stressed syllable. Then put them in pairs
and ask them to underline the stressed syllables
in words 1–6. Encourage them to say each word
aloud several times before they decide which
syllable is stressed. Play the recording for
students to check their answers, then play it a
second time for them to listen and repeat. For
weaker classes, ask students to mark the stress
as they listen.
1 kilo 2 calorie 3 litre 4 kilojoules
5 kilogram 6 millilitre
Language
Refer students to the Language box and tell
them that this is for their information, especially
for students working/hoping to work in the US.
Depending on your class, you may not need to
spend time on this – simply make students
aware of the differences.
Listening
to go through the Language box before asking
students to complete this activity. Alternatively,
you could use it as a ‘diagnostic test’, to check
students’ understanding and usage of the target
structure. Refer students to questions 1–4. Tell
them that they are going to listen to the
conversations in 3 again. Ask them to listen and
choose the correct words in italics. Play the
recording, pausing after each conversation to
allow students to complete their answers. You
may prefer to check answers after you have been
through the Language box with the class.
1 many 2 much 3 much 4 many
Food and measurements 4 27
 Language
Ask: When do we use ‘how many’? (to ask about
things we can count). When do we use ‘how much’?
(to ask about things we can’t count). Refer
students to the Language box and point out the
use of much and many in negative sentences. Ask
students to read the Language box individually.
8 Ask experienced nurses: What can patients eat on
a clear liquid diet? (They can’t eat anything. They
can only drink beverages such as clear soup, tea
or coffee without milk.). When are patients put on
a clear liquid diet? (after an operation, prior to
some tests or when they have difficulties
swallowing – see Briefing section). Tell students
that they are going to read a conversation
between a nurse and a student nurse talking
about the clear liquid diet. Ask them,
individually or in pairs, to complete it with much
or many as they read. Ask them to compare
answers with a partner, then check as a class.
1 much 2 many 3 many 4 much 5 many
9 Check that students understand explain, of course,
digest, operation, encourage, it depends, zero and
glass. You may wish to ask some comprehension
questions to check students’ understanding of
the conversation. Then ask them to practise the
conversation in pairs.
Speaking
10 Refer students to the diet sheet for patient Ivy
Manning and check understanding of bouillon
and popsicle. Ask them, in pairs, to put a cross
next to the items that are not part of the clear
liquid diet. Pre-experience nurses should now
have sufficient understanding to be able to
complete this activity successfully. Check
answers as a class.
ice cream, milk, orange juice, tea with milk,
tomato soup, vegetable soup
11 Elicit/Pre-teach nutritionist. Tell students that
they are going to talk about Ivy Manning’s clear
liquid diet. Ask them, in pairs, to roleplay a
conversation between a nurse (Student A) and a
nutritionist (Student B). Ask the pairs to choose
five items from the diet sheet. Model the first
part of the conversation with a confident student
first, then encourage students to begin their
conversation. Encourage them to use much,
many, a/an and some. Monitor and assist
students where necessary.
12 Brainstorm items that patients can eat on a full
liquid diet (all the items on the diet sheet in 10).
Tell students that four days later Ms Manning
begins a full liquid diet. Explain that Student A
is the nutritionist and Student B is the nurse.
First, they should choose another five items from
the diet sheet in 10. Student B should then ask
Student A what the patient can eat. Depending
on your class, you may wish to elicit What can
Ms Manning eat on the full liquid diet?/What is Ms
Manning allowed to eat? before they begin the
activity. Monitor and assist students where
necessary. You may wish to ask stronger pairs to
deliver their roleplay to the rest of the class.
Helping a patient order from a hospital
menu
Speaking
1 Ask students to read through questions 1–2.
Encourage them to take notes individually first
and then, in small groups, discuss their answers.
It is important to be aware that in some
countries the responsibility for feeding the
patient lies with the relatives and not with the
hospital. This is also the case for patient hygiene.
Depending on your class, you may need to
adapt questions 1 and 2 accordingly. Finally, ask
groups to present their ideas to the class. Some
students may have difficulty expressing their
ideas in English. Avoid correction; simply
encourage fluency.
Vocabulary
2 Ask students to look at the photos and complete
the sentences using the verbs in the box. Check
answers as a class.
1 breathe 2 chew, swallow 3 drink
Reading
3 Tell students that they are going to read a
hospital menu. As they read, they should tick
the things they would like to order. This will
help to personalise the activity. Then ask them,
in pairs, to tell their partner about their menu
choice. Remind them to use I’d like ... . Monitor
and assist students where necessary. Note that
students do not need to be concerned with the
codes at this stage.
Food and measurements 4 28
 Listening
4 ► 25 Tell students that they are going to hear
two patients, Cherif and Lydia, ordering from
the menu in 3. Read through the menu with the
class and check for understanding but reassure
students that at this stage they do not need to
understand every word. Ask them to listen and
write C for Cherif or L for Lydia next to the food
they order. If necessary, play the recording
again, pausing after each conversation to allow
students to write their answers. Check answers
as a class.
Cherif: vegetable lasagne, orange juice, fresh
fruit salad
Lydia: vegetable lasagne, yoghurt and honey
5 Ask students to read though sentences 1–5. Play
the first part of the first conversation (until What
do you suggest?) and go through the example
with the class. Then ask students to listen to the
two conversations again and correct the
sentences. You may wish to play the recording
again, pausing after each conversation to allow
students time to write their answers. Check
answers as a class.
1 The lasagne is made of tomatoes, peppers
and pasta with a cheese sauce.
2 Cherif would like fruit salad for dessert.
3 Lydia likes vegetables. She’s a vegetarian.
4 She orders vegetable lasagne for the main
course.
5 She would like yoghurt for dessert but she
doesn’t want a starter.
Language
6 Ask students, individually or in pairs, to put the
words in 1–4 in the correct order to make the
patient’s questions. Tell them that they will
correct these later in the unit. However, with less
confident students, you may wish to check
answers at this stage.
1 I have problems swallowing. What do you
suggest?
2 What’s the vegetable lasagne made of?
3 I'm a vegetarian, so what can I have today?
4 Am I allowed to eat the cherry tart?
7 Explain to students that they are now going to
complete the nurses’ answers to the questions
in 6. Ask them to listen to the recording again
and complete the answers. Then, as a class,
match the answers to the questions in 6.
1 Why not have 2 It’s a dish with 3 (Well,)
how about 4 I’m afraid
8 Refer students to the audio script on page 75 to
check their answers in 6 and 7.
Speaking
9 Ask: What is a vegetarian diet? (It is a diet for
patients who do not eat meat or meat products,
e.g. gelatine. However, they usually eat fish and
eggs.). Refer students to the box in the margin
about diabetes. Ask them to look at the menu in
3 and ask: Which foods can’t a diabetic patient eat?
(salad, mashed potatoes, cherry tart). Then refer
them to the marginal box about the soft diet and
go through it with the class. Refer them back to
the menu in 3 and ask them, in small groups, to
write S for soft diet next to the correct foods.
Finally, check answers as a class.
Soft diet: chicken soup, orange juice, cheese
omelette, mashed potatoes, ice cream, yoghurt
and honey
10 Point to Lara, a diabetic, in photo A and tell
students that they are going to complete her
conversation with a nurse about her diet. Tell
them that in some cases there is more than one
possible answer. Students could do this activity
individually or in pairs.
1 What would you like to 2 Would you like/
How about/Why not have 3 It’s a dish with
4 Would you like/How about/Why not have
5 Would you like/How about/Why not have
6 Would you like /How about
11 Put students in pairs and ask them to practise
the conversation in 10, then to swap roles and
repeat the activity.
12 Put students in new pairs and explain that they
are going to roleplay a conversation between a
nurse (Student A) and Jaroslav (Student B), who
is a vegetarian. Using the menu in 3, the nurse
takes Jaroslav’s lunch order. Monitor and assist
students where necessary.
Now ask pairs to swap roles. The nurse (Student
B) takes Wesley’s (Student A’s) lunch order.
Wesley is on a soft diet following an operation
on his throat. Again, monitor and assist students
where necessary.
Food and measurements 4 29
 Assisting the patient at mealtimes
Vocabulary
1 Elicit/Pre-teach cover, cup, plate and hold. Then
ask students, individually or in pairs, to match
definitions 1–5 to the words in the box. Check
answers as a class and then brainstorm other
utensils that a patient might use (fork, knife,
spoon, bowl, etc.).
1 plastic apron 2 straw 3 non-slip plate
4 non-slip mat 5 two-handled cup
Reading
2 Ask students to look at the title of the text and
give them a minute to think about how we can
help patients at mealtimes. In small groups,
students discuss their ideas and then share them
with the class. Avoid correction at this stage to
encourage fluency. Weaker students may have
difficulty expressing their ideas in English.
Depending on your class, you may wish to allow
students to respond in their L1.
Suggested answers
cut up food, smile, show warmth, encourage
and praise the patient, use special utensils
3 Refer students to the subheadings in the box.
Then ask them to read the text quickly and
choose the correct subheading for each section.
Reassure students that they do not need to
understand every word. Ask them to compare
answers with a partner, then check as a class.
Ask: Who is this text for? (student nurses,
healthcare assistants, carers). Finally, check
understanding of prepare and encourage.
A Preparing the patient to eat B Helping the
patient to eat C Encouraging the patient
4 Ask students, individually or in pairs, to match
the words in bold in the text in 2 to definitions
1–8. Check answers as a class.
Ask students to read the text again, then ask:
How can nurses help patients at mealtimes?
Encourage them to use the information in the
text to help them answer the question.
1 positive 2 recover 3 tray table 4 mouthful
5 nutrition 6 make eye contact 7 upright
8 assisting
Listening
5 Ask students, in pairs, to look at the photo and
discuss the question in the rubric: What is the
nurse doing? Elicit answers, then ask: Why do you
think the patient needs help? (She may not be able
to hold the knife and fork. She may be tired. She
could spill/drop her food.)
She is helping the patient to eat./She is feeding
the patient.
6 ► 26 Tell students that they are going to listen
to a conversation between Nurse Paula Minelli
and her patient, Mrs Taylor. Ask them to listen
and complete expressions 1–6. You may need to
play the recording a second time, pausing after
each expression to allow students to write their
answers. Ask students to compare answers with
a partner, then check as a class.
1 some help 2 a straw 3 doing 4 some
more 5 good 6 one more
7 Ask students, in pairs, to listen again in order to
answer questions 1–4. Depending on your class,
you may need to play the recording twice. Ask
students to compare answers with another pair,
then check as a class. Weaker students may have
difficulty answering question 4.
Suggested answers
1 Because her hands are shaking and she
doesn't want to spill her food.
2 chicken and vegetables
3 She's not very hungry.
4 The nurse says positive things about the
food, she encourages her to eat small
mouthfuls, she cuts up the vegetables, she
uses expressions to encourage and
congratulate the patient.
8 Ask students to look at the audio script for track
26 on pages 75–76 and find an example of
something positive the nurse says about the
food. Ask: What do you say to patients to encourage
them to eat? Encourage some whole class or small
group discussion around the subject. Avoid
correction; simply encourage fluency. Then ask
students to brainstorm other positive things that
the nurse could say about the food (e.g. It looks
good/tasty/fresh.).
It smells really good.
Food and measurements 4 30
 Language
9 Refer students to expressions 1–4 and ask them,
individually or in pairs, to write E if the
expression is used to encourage the patient or P
if it is used to praise the patient. You may wish
to do the first item as an example with the class.
For less confident students, you may wish to
begin by brainstorming an example of each
expression type in the L1 before asking them to
carry out the activity. Check answers as a class.
1E 2P 3P 4E
10 Refer students back to the expressions in 6 and
ask: Which expressions are used to encourage
patients? Which are used to praise them?
Encourage: 4, 6 Praise: 3, 5
11 Refer students to the audio script for track 26 on
pages 75–76 and ask them, in pairs or small
groups, to underline five expressions that Nurse
Minelli uses to encourage and praise the patient.
Ask them to group the expressions under P for
praise and E for encouragement. Check answers
as a class.
Praise: You're doing well. That's good.
Encourage: How about some more orange
juice? Can you just try a little? Just one more
potato?
Extra activities
1 Refer students to the audio script for track
26 on pages 75–76 and ask them, in pairs, to
practise the conversation. Monitor and assist
them with intonation patterns where
necessary. When they have finished, ask
them to swap roles and repeat the activity.
2 Ask students, in small groups, to brainstorm
three expressions of encouragement and
three expressions of praise. Then ask the
groups to imagine how the nurse would say
them (intonation pattern). Ask them to
practise saying the expressions aloud, then
get them to share their ideas with the rest of
the class. Tell students how important it is to
use patient-friendly intonation to encourage
and praise their patients.
Speaking
12 Elicit/Pre-teach visually impaired and hip
replacement operation. Ask: What problems can a
visually impaired patient have at mealtimes? (It is
difficult for them to find the food on the plate./
It is difficult for them to cut up the food.). Ask
students to work in small groups to read the
case study and answer the question. Note that
less confident students may have difficulty
expressing their ideas in English. Depending on
your class, you may wish to allow students to
respond in their L1. Check answers as a class.
Suggested answers
Always put the same food types in the same
place on the plate.
Describe the position of the food.
13 Ask experienced nurses: What expression do you
use in your language to help patients find food on the
plate?/What do you do to help patients find the food?
Ask students, individually or in pairs, to reorder
the words to make a useful expression to help a
patient find food on the plate. Ask them to
compare answers with a partner/another pair,
then check the answer as a class.
The potatoes/beans are at six/twelve o’clock
and the beans/potatoes are at twelve/six
o’clock.
14 Ask students, in pairs, to first choose items from
the hospital menu on page 32, taking note of the
information in the case study. Student A takes
the role of Anja and Student B the nurse. Ask the
pairs to roleplay the situation, where the nurse
assists Anja with her meal. Remind students to
use expressions from 6 and 9 to encourage and
praise the patient. Also encourage use of patient-
friendly intonation. Monitor and assist students
where necessary. When they have finished, ask
them to swap roles and repeat the activity.
Now do Unit test 4 and Progress test 2. For the
Listening part of the Progress test, use track 25,
conversation 2.
Preparing for the next unit
In preparation for Unit 5, suggest the following to
your students:
• Think about how to say different body parts in
English.
• Do some (online) research into ROM (Range of
Motion) exercises.
Food and measurements 4 31
 5 The body and movement
Briefing
This unit concentrates on patient terms for parts of
the body, as well as necessary structures for giving
simple but effective instructions. It trains students to
provide patients with the benefits of exercises for
recovery, as well as introducing medical
terminology for completing nursing documents.
The body: limbs and joints
The first section of this unit deals with patient (as
opposed to medical) terms for parts of the body: the
limbs (arms and legs), including thumb, foot, toe,
etc., and the main joints (where two bones meet),
such as knee and ankle. There are different types of
joints: the hip is an example of a ball and socket
joint, while the elbow is an example of a hinged
joint. Imperatives (e.g. lift your leg, rotate your hand)
enable students to give simple instructions to
establish levels of movement and for carrying out
exercises following surgery. The patient brochure
Exercises for recovery on page 37 provides students
with examples of exercise: leg lifts, knee bends and
ankle pumps, as well as opportunity to practise the
language taught in this section.
The body: torso and head
In this section students are asked to label a diagram
with patient terms for the head and torso areas of
the body: chest, buttocks, neck, waist, etc. ROM
(Range of Motion) exercises, used to help improve
movement of the joints after an operation or injury,
are introduced at this point. For more information
on ROM exercises, see the ‘Documenting ROM
exercises’ section. Language for prepositions of
place and movement followed by presentation of
verbs specific to the movement of limbs (tighten,
straighten, relax and lower) help students give
patient instructions for carrying out ROM exercises.
Setting goals and giving encouragement
Once the doctor writes an order of care and
treatment, members of the multi-disciplinary team
will need to decide on the goals of the care with the
patient. Goals may vary depending on the patient’s
condition, from being able to eat on their own or
climb the stairs safely to returning to work or
regaining body strength after a period of illness
and/or hospitalisation. Again, involving the patient
in the decision-making process is an important
aspect of gaining their consent and/or co-operation.
It is also a question of differentiating between long-
and short-term goals. What’s your long term goal? and
What can you do today? will help to ascertain the
patient’s capabilities. Working on word stress to
highlight the salient point of the question will also
help students set goals with their patients: What can
you do? Can you do this exercise three times a day?
The second part of this section, delivered via a
patient’s blog post, considers the use of comparative
adjectives to describe and ask about improvements
during the recovery period: The muscle in my back is
much stronger today. Finally, students develop
expressions to offer encouragement during the
exercise session (e.g. You’re doing well.).
Documenting ROM exercises
The final section of the unit helps students gain an
understanding of medical terms for body
movements, for completing nursing documents and
when talking to other medical professionals. In this
case, the ROM assessment form documents patient
progression. Abduction is moving a body part away
from the midline (the torso), while adduction means
the opposite, i.e. moving the body part towards the
midline. Rotation is moving the arm, for example,
around an axis; the head is rotated when moved
from side to side to indicate ‘no’. However,
circumduction is moving the arm in a complete
circle. Flexion is bending and extension is
straightening. There are three kinds of ROM
exercise. Active ROM: when the patient is able to do
full ROM for one or more parts of their body
without the physical help of another. The nurse (or
other healthcare member) watches the patient to
ensure that the exercises are done correctly. Active
Assistive ROM is when a patient needs some help
doing ROM exercises because their muscles are too
weak or stiff to do them independently. Finally,
passive ROM exercises are for patients who cannot
move one or more parts of their body at all. Patients
begin passive ROM exercises while in the hospital
bed, with the nurse (or healthcare member) moving
the patient’s legs and arms. A case study of a patient
in traction following a motor accident helps students
to develop skills in this area
The body and movement 5 32

Teacher’s notes
Warm-up
On the board, write: starters, main dishes, side dishes,
desserts and beverages. Divide the class into two
teams and ask students to brainstorm as many food
items as possible for each column in three minutes.
Allocate one point for each item. You may also wish
to ask your students to write C (countable) or U
(uncountable) next to each item. Give them extra
points for this. The winning team is the one with the
most points.
Refer students, in pairs, to the menu on page 32. Ask
them to roleplay a conversation between a nurse
(Student A) and an elderly patient (Student B)
whereby the nurse assists the patient to order and
eat their meal. Encourage A Students to employ
expressions using would like, as well as those used
to encourage and praise a patient. Also remind
them to use patient-friendly intonation. When they
have finished, ask them to swap roles and repeat
the activity.
The body: limbs and joints
Vocabulary
1 Read the section title and refer students to the
illustration. Ask: What are limbs? (arms and legs).
Explain to students they are going to learn the
names for parts of the body. Ask them to label
the parts of the body using the words in the box.
They could do this individually or in pairs. Ask
them to compare answers with a partner, then
check as a class.
1 arm 2 hand 3 finger 4 foot 5 thumb
6 leg 7 heel 8 toe
2 Point to your knee and then your elbow,
bending them as you do so and ask: Which word
do we use in English for these parts of the body?
(joint). Refer students to the title of the section if
they are unsure. Then ask them, individually or
in pairs, to label the joints in the illustration in 1.
Check answers as a class.
Check students have circled and correctly
labelled the following: ankle, elbow, hip, knee,
shoulder, wrist.
Listening
3 ► 27 Tell students that they are going to listen
to a conversation between a nurse and a patient,
Mr Dubois. Ask them to listen and tick the parts
of the body they hear. Reassure them that they
do not need to understand every word. Play the
recording twice if necessary. Check answers as
a class.
knee, foot, heel, leg, toe
4 On the board, write: push, rotate, lift, bend. Ask
students, in pairs, to practise demonstrating
each movement as if to a patient. Check answers
as a class.
Tell students that they are going to listen to the
conversation in 3 again. Ask them to listen and
write down the part of the body the nurse tells
the patient to push, rotate, lift or bend. For less
confident students, write the parts of the body
on the board first, then ask them to match these
to the correct verb. Students then listen and
check. Play the recording a second time, pausing
at intervals to allow students to write their
answers. You may wish to allow them to read
through the audio script on page 76 to enable
them to see the target language in context. Check
answers as a class.
1 toes and feet 2 foot 3 leg 4 knee
Extra activity
Write the following questions on the board (or
prepare a handout in advance):
1 Which other parts of the body can we push?
2 Which parts can we rotate?
3 Which parts can we lift?
Ask students to discuss these questions in
pairs, then compare ideas as a class.
Answers
1 arm, elbow, finger, hand, heel, hip, knee,
leg, shoulder, thumb, toe, wrist
2 ankle, arm, hand, leg, shoulder, thumb,
wrist
3 ankle, arm, elbow, finger, foot, hand, heel,
knee, leg, shoulder, thumb, toe
Language
Ask students to close their books. Point to a
confident student and say: Lift your arm. Then
tell another student: Please bend your left leg.
The body and movement 5 33
 Refer students to the examples in the Language
box. Explain that we use the imperative (the
infinitive without to) to give instructions to
patients. On the board, write: Please bend your left
leg. Please lift your right arm for me. Explain to
students that it is important that instructions to
patients do not sound like orders. Tell them that
to soften instructions, we can add the words
please or for me, and also use patient-friendly
intonation. Model each example in the Language
box, adding please/for me and employing
patient-friendly intonation. Ask students to
practise giving the instructions in the Language
box, first chorally, then individually. Finally, ask
them to read the Language box individually.
Speaking
5 Ask students, in pairs, to take turns giving
simple instructions to a patient using the verbs
in the Language box and the parts of the body
and joints in 1 and 2. Refer them to the example
sentences. If necessary, model these first with a
confident student. Monitor and assist students
where necessary.
Extra activity
In order to reinforce students’ understanding
of the use of the imperative, refer them to the
audio script for track 27 on page 76 and ask
them to underline all the imperative verbs.
Then ask them, in pairs, to practise the
conversation. Encourage them to use patient-
friendly intonation. When they have finished,
ask them to swap roles and repeat the activity.
Monitor and assist students where necessary.
Reading
6 Tell students that they are now going to read a
brochure about exercises. Refer them to the title
and ask them to read the introduction. Ask: Do
you think the brochure is for a nurse or a patient?
(a patient – after surgery). Then refer them to the
five illustrations on the left-hand side of the
brochure and ask: Do you know these exercises?
Can you do them? Ask students, individually or
in pairs, to read the brochure in detail and write
the correct exercise in each space. Depending on
your class, you may wish to do an example with
the class first. Ask students to compare answers
with a partner, then check as a class.
1 ankle pumps 2 knee bends 3 ankle
rotations 4 leg lifts 5 standing knee bends
7 Elicit/Pre-teach immediately, exercise session and
stressed syllable. Refer students to questions 1–3.
Ask them to read the brochure again and answer
the questions. Get them to compare answers
with a partner, then check as a class.
Check students’ understanding of recommend,
repeat, keep, straighten, circular motion, direction, as
far as you can, not too high and hold. Depending on
your class, you may wish to allow students to
check these items in a good bilingual dictionary.
1 ankle pumps 2 20 to 30 minutes
3 orthopaedic surgeon and physical therapist
Speaking
8 Ask students, in pairs, to practise giving
instructions to a patient. Student A should give
Student B instructions for exercises for their arm,
foot, leg and hand. Then students swap roles
and Student B gives instructions to Student A for
their ankle, hip, knee, shoulder and wrist.
Demonstrate the activity with a confident
student. Ask students to use the verbs in 6 and
the Language box on page 36. Encourage them
to use please/for me and patient-friendly
intonation. Depending on your class, you may
wish to allow students to write out their
instructions first. Monitor and assist students
where necessary.
The body: torso and head
Vocabulary
1 Ask experienced nurses: When do nurses use pain
maps? (They use them when asking the patient
about their pain. They mark the map with an X
to indicate where the patient feels pain and an
arrow to show where the pain moves to.). Ask:
What part of the body is the torso? (the upper part/
top of the body). Ask students, individually or in
pairs, to label the parts of the body on pain maps
A and B using the words in the box. Ask them to
compare answers in small groups, then check as
a class. Remind them that these are not medical
terms for parts of the body; they are words used
by and with patients.
1 face 2 shoulder 3 chest 4 stomach 5 hip
6 head 7 neck 8 back 9 waist 10 buttocks
The body and movement 5 34
 Language
Point to a chair in front of you in the classroom
and ask: Where is the chair? Elicit/Pre-teach in
front of. Refer students to the Language box and
explain that in front of is a preposition of place
(no movement). Then demonstrate the following
movements: lifting your arm above your head,
pushing down with your hand, moving your leg
to the side. Elicit/Pre-teach: lift up your arm, push
down and move your leg to the side. Explain that
up, down and to are prepositions of movement
and refer students to the Language box. Point
out that there are many more prepositions of
place (Unit 3) and movement but the examples
in the Language box are the ones commonly
used for exercise instructions. Ask students to
read the Language box individually.
2 Tell students that they are now going to read a
conversation between Nurse Naughton and the
patient, Ms Duggan. Ask them, individually or
in pairs, to complete the conversation using the
prepositions up, down, above and in front of.
5 Refer students to the three illustrations and ask
Check answers as a class.
1 in front of 2 up 3 above 4 down 5 down
Reading
3 Refer students to questions 1–4. Ask them to
read the conversation in 2 again and answer the
questions. Get them to compare answers with a
partner, then check as a class.
1 She feels (a little) tired.
2 They were (a little too) easy.
3 She starts with the right leg.
4 The exercises for the left leg are difficult but
she is getting stronger.
Extra activity
Put students in pairs and ask them to roleplay
the conversation in 2. Remind them to use
patient-friendly intonation. Monitor and assist
them where necessary.
Speaking
6 On the board, write: lift/your chest – your back.
4 Refer students to the Range of Motion exercise
record for Mr Ahmad. Write ROM on the board
and ask: What (do you think) are Range of Motion
exercises? (exercises to help improve movement
of the joints after an operation or injury). Point
out that these exercises are often referred to as
ROM exercises. Put students in pairs and ask
them to discuss the patient’s ROM exercise
programme. Depending on your class, you may
wish to first go through some telephone
expressions that would be useful for this
roleplay (e.g. Hello, is that ...? How are you? I’m
calling to discuss Mr Ahmad’s exercise programme.
Do you have a few minutes?). Ask A Students to
look at the information on page 39 and refer B
Students to the information on page 70. Explain
that Student A should call Student B and ask
questions to complete the ROM exercise record
for Mr Ahmad. Student B must use the
information in the completed record to answer
Student A’s questions. Refer A Students to the
example questions underneath the record. For
weaker students, you may wish to allow them
to write out their conversation first. Encourage
students to use patient-friendly intonation.
When they have finished, you may wish to ask
them to swap roles and repeat the activity.
Monitor and assist students where necessary.
Vocabulary
them to carry out the movements they see. Then
refer them to verbs 1–5 and a–e. Explain that
verbs a–e have the opposite meaning to 1–5. Ask
them, individually or in pairs, to match 1–5 to
their opposites, a–e. Get them to compare
answers with a partner, then check as a class.
1e 2c 3d 4a 5b
Extra activity
Put students in small groups. Ask them to
practise carrying out the movements in 5: one
student should call out the movement for the
others to carry out.
Language
Elicit/Pre-teach benefit. On the board, write:
When you bend your fingers, it helps ... . Ask
students, in small groups, to brainstorm ideas to
complete the sentence. Then refer them to the
Language box and ask them to read through the
example sentences.
Elicit the example sentence from the class. Then
ask students, individually or in pairs, to use the
prompts to write sentences about the benefits of
exercise. Check answers as a class.
The body and movement 5 35
 1 When you rotate your shoulder, it helps the
muscles in your neck.
2 When you bend your waist, it helps your
hips.
3 When you do your exercises, it helps you
recover from surgery faster.
4 When you hold a chair in front of you, it
helps you balance.
Speaking
7 Explain that students are going to practise using
when + clause + it helps in pairs. A Students
should help B Students to do exercises for the
waist, neck, shoulders and head. B Students
should then help A Students to do exercises for
the hips, chest and back. Ask students to use the
verbs in 5 and the information in the Language
box. Monitor and assist them where necessary.
Depending on your class, you may wish to allow
students to write out their conversation first.
Setting goals and giving encouragement
Speaking
1 Refer students to the three patients in
illustrations A–C, Patrick, Hugo and Juan. Point
to A and ask: What does Patrick want to do? Elicit
He wants to climb the stairs. On the board, write:
Patrick’s goal = to climb the stairs by himself. Refer
students to sentences 1–3. Point out the use of by
myself in 3. Elicit: by himself, by herself. Then ask
students, individually or in pairs, to match the
sentences to the illustrations. Check answers as a
class. Ask: What is Hugo’s goal? What is Juan’s
goal? (Hugo wants to be able to eat by himself.
Juan wants to put his clothes on by himself.).
Ask experienced nurses: Why is it important to ask
patients about their goals/set goals with the patient?
(to include patients in the decision-making
process; let patients decide what they can and
cannot do).
1B 2A 3C
2 Ask students, in pairs, to think of one or more
ROM exercise for each of the patients in 1. You
may want to encourage them to write down
their ideas. Then ask each pair to share their
ideas with the rest of the class.
Suggested answers
A Patrick wants to climb the stairs, so he
needs to exercise his legs and his hips.
B Hugo wants to eat by himself, so he needs
to exercise his wrists, hands and shoulders.
C Juan wants to put on his clothes by himself,
so he needs to exercise his shoulders, arms
and wrists.
Listening
3 ► 28 Tell students that they are going to listen
to conversations with the three patients in 1.
Before they listen, ask them, individually or in
pairs, to put the words in 1–6 in the correct order
to make sentences and questions. Do not confirm
answers at this stage. When they have finished,
ask them to listen to the recording to check their
answers. If necessary, play the recording a
second time, pausing at intervals to allow
students to write their answers. Depending on
your class, you may wish to refer students to the
audio script on page 76 to see the sentences and
questions in context.
1 What is your long-term goal?
2 What do you want to do today?
3 What can you do?
4 For today our goal is three sets of ten on
each arm.
5 Can you do that?
6 Can you do this exercise three times a day?
Pronunciation
4 ► 29 On the board, write: Please lift your left leg
for me. Read the instruction aloud two or three
times, exaggerating the stress on the word left.
Then write: Now lift your right leg. Read the
instruction aloud two or three times, this time
exaggerating the stress on the word right. Point
to each instruction and ask: Which words are the
most important? (left and right). Ask students to
repeat the instructions, first chorally, then
individually, until you are happy they sound
natural. Then ask them to listen to questions
1–4 and underline the stressed word in each
case. Check answers as a class. Depending on
your class, you may wish to go through each
question, asking: Why are these words important?
(1 today, not tomorrow; 2 three times, not twice;
3 can, not can’t; 4 that, not this). Finally, refer
students to the box in the margin and answer
any questions they may have.
The body and movement 5 36
 1 What do you want to do today?
2 Can you do this exercise three times a day?
3 What can you do?
4 Can you do that?
5 Refer students to the audio script for track 28
on page 76 and ask them, in pairs, to practise
the conversations. Remind them to stress the
underlined words and to use patient-friendly
intonation. Monitor and assist students where
necessary.
Language
Go through the Language box with the class.
Explain that we use comparative adjectives to
compare two people or things and that there are
differences between the forms of short adjectives
(which add -er than) and long adjectives (more ...
than). Draw students’ attention to the spelling
changes. Adjectives ending in -y change the -y to
-i and then add -er (e.g. easier, friendlier, happier).
Also explain that for one-syllable adjectives that
end in vowel + consonant, we double the final
consonant before -er (e.g. hotter, fatter). Point out
the irregular forms good–better and bad–worse.
Extra activity
For further language practice, refer students
back to the (positive) adjectives on page 27
(Unit 3) and ask them to write the comparative
form of each adjective.
Answers
more attentive, friendlier, more caring, more
informed, more flexible, more polite, more
useful, more important, busier
6 Tell students that they are now going to practise
forming comparative adjectives. Ask them,
individually or in pairs, to complete sentences
1–8 using the comparative form of the adjectives
in brackets. Depending on your class, you may
wish to do the first item as an example. Ask
students to compare answers with a partner,
then check as a class.
1 stronger 2 better 3 higher 4 worse
5 easier 6 more difficult 7 better 8 slower
Writing
7 Ask: Do you write a blog? Who reads your blog?
Refer students to the blog entry and explain that
this is a ‘pain diary’. Ask experienced nurses:
What is a pain diary? (Patients are encouraged to
write about their pain: e.g. Is it better? Worse?).
Then ask: Why do you think a patient might write a
blog? (to help them to understand their illness/
condition). Ask students, individually or in
pairs, to complete the blog entry using the
comparative form of the adjectives in the box.
Check answers as a class. Point out that it will get
easier is an expression. Finally, check students’
understanding of improvement and couple.
1 easier 2 easier 3 stronger 4 worse
5 more difficult 6 better
8 Refer students back to the blog in 7 and ask: Who
writes this blog?
Hugo
Listening
9 ► 30 Tell students that they are going to listen
to a conversation between a patient, Thelma, and
a nurse who is helping her with her recovery
exercises. Refer them to sentences 1–5 and ask
them to listen, decide if the sentences are true (T)
or false (F) and correct the false sentences. Play
the recording twice, pausing at intervals to allow
students to write their answers. Depending on
your class, you may prefer to ask students to
choose true or false on the first listening and then
listen again to correct the false sentences.
1 F (Her goal is three sets of ten on each leg.)
2 T
3 T
4 F (She repeats the exercise twice on the left
leg.)
5 T
Extra activity
For less confident students, you may wish to
ask them to first listen and answer the
following gist questions before they carry out
9 (write the questions on the board):
1 Which part of the body is Thelma exercising?
2 Are the exercises easy or difficult for Thelma?
Ask students to listen and answer the
questions. Reassure them that they do not need
to understand every word, simply to answer
the two questions.
Answers
1 her legs 2 (a little) difficult
10 Ask students to listen again and complete
expressions 1–4. Play the recording, pausing
after each expression to allow students to write
their answers. Ask them to compare answers
with a partner. Avoid correction at this stage.
The body and movement 5 37
 1 right 2 very well 3 it 4 That’s
11 Refer students to the audio script for track 30 on
page 76 and ask them to check their answers in
9 and 10. When they have finished, model the
expressions of encouragement in 10 and ask
students to practise saying the expressions, first
chorally, then individually, until you are happy
they sound natural.
Speaking
12 Refer students to the audio script for track 30 on
page 76 and ask them, in pairs, to practise the
conversation, paying attention to word stress.
When they have finished, ask them to swap roles
and repeat the activity. Monitor and assist
students where necessary.
13 Put students in new pairs and explain that they
are going to practise their conversations from 7
on page 39. First, refer them to steps 1–3 on page
41. Go through them with the class, then refer
students to 7 on page 39. Ask them to practise
their conversations following these steps. For
less confident students, you may wish to allow
them to write out their conversations first.
Monitor and assist students where necessary.
Documenting ROM exercises
Vocabulary
1 Refer students to illustrations A–F and ask them,
in small groups, to brainstorm words that a
nurse might use to ask a patient to make these
movements. Reassure them that they have
already come across these verbs earlier in the
unit. Check answers as a class.
Suggested answers
A Bend your knee. B Straighten your knee.
C Move your leg to the side. D Put your leg
down. E Rotate your arm. F Make circles
with your arm.
2 Tell students that they are now going to learn
the medical terms they will need to use when
filling in nursing documents and when talking
to other medical professionals. Ask them,
individually or in pairs, to label the illustrations
in 1 with the words in the box. Experienced
nurses may already know these and, depending
on the L1, you may wish to encourage them to
use their knowledge of Latin to help them. Also
encourage students to learn these in pairs, as
opposites. Reassure less confident students and
pre-experience nurses that this is not a test and
that they will learn these terms as they go
through this section of the unit.
A flexion (= bending)
B extension (= straightening)
C abduction (= moving (your arm/leg) out to
the side)
D adduction (= putting (your arm/leg) down
E rotation (= rotating)
F circumduction (= making (complete) circles
(with the arm/leg))
Extra activity
Write abduction on the board. Ask: How many
syllables are there? (3). Invite a confident student
to come to the board and underline the stressed
syllable. Model pronunciation and then ask
students to repeat the word, first chorally, then
individually, until you are happy that they are
able to pronounce it correctly. Then ask them,
in pairs, to underline the stress in each of the
other terms in 2. Check answers as a class.
Finally, ask confident students: What is the rule
for word stress in words ending in ‘-ion’? Elicit
and/or explain that in nouns ending in -ion, the
stress always comes in the penultimate syllable.
Answers
abduction, adduction, rotation, flexion,
extension, circumduction
Reading
3 Elicit/Pre-teach (be in) traction and road accident.
Tell students that they are going to read about a
patient, Joe Felicie, who is in traction following a
road accident. Refer them to definitions 1–8 and
explain that, as they read the ROM assessment,
they should match the words in bold to their
definitions. Ask students to compare answers
with a partner, then check as a class.
1 prior 2 unwilling 3 immobilised 4 active
ROM 5 mobile 6 discomfort 7 limited to
8 passive ROM
4 Ask students to look back at the assessment in 3
and find the abbreviation for the word patient.
pt
The body and movement 5 38
 Vocabulary
5 Refer students to the text and explain that a
nurse, Nurse Carter, is talking about Joe’s case to
a colleague. Ask them, individually or in pairs,
to complete his explanation using the words in
the box. Ask students to compare answers with a
partner, then check as a class.
Preparing for the next unit
In preparation for Unit 6, suggest the following to
your students:
• Make a list of types of medication.
• Do some (online) research into side effects of
common medications.

1 nauseous 2 medication 3 left 4 swollen

5 only 6 pain 7 normally 8 Before
9 doesn’t want

Listening
6 ► 31 Refer students to the flow sheet for Joe,
allowing them time to look through the different
sections. Point out the abbreviation WNL in the
box in the margin and check they understand it.
Then explain that they are going to hear Nurse
Carter explaining Joe’s exercise programme to a
senior nurse. Ask students to listen and tick the
ROM exercises Joe can do. Reassure them that
they do not need to understand every word,
simply get the gist. Depending on your class,
you may wish to play the recording twice. Check
answers as a class.

R shoulder flexion, R shoulder rotation, R hip

abduction, R hip extension, L shoulder flexion

7 Refer students to 1–4 in 6. Ask them to listen

again and underline the correct words in italics.
Play the recording (twice if necessary), stopping
at intervals to allow students to write their
answers. Check answers as a class.

1 some 2 some 3 100° 4 not able

Speaking
8 Put students in pairs and tell them that they are
going to roleplay a conversation between Nurse
Carter (Student A) and one of his nursing
colleagues (Student B). Refer A Students to the
flow sheet on page 43 and B Students to the one
on page 70. Explain that students should use the
information in their flow sheets to explain which
ROM exercises the patient can and cannot do.
Depending on your class, you may wish to
allow students to write out their conversation
first. Encourage appropriate word stress to
ensure understanding of the important word(s)
in a sentence. Monitor and assist students
where necessary.
Now do Unit test 5.

The body and movement 5 39

 6 Medication
Briefing
This unit deals predominantly with medications and
how they are administered, taking students through
the different stages of the process. It also provides
opportunity for students to practise their telephone
skills, in particular when talking with relatives.
Medication routes and forms
Administering medication is an important nursing
duty. Having first verified the prescription, a guide
to ensure patient safety is to check the ‘five rights’:
the right medication, the right dose (or dosage), the
right time, the right patient, the right route.
Right medication: medications from a container that
is unlabelled, defaced or illegible must never be
used. The nurse should read the instructions and
check the expiry date, and must never administer a
drug prepared by someone else. Right patient: it is
vital to check the identity of the patient before
administering medication; indeed medications
should never be administered if the nurse is unable
to confirm the patient’s name (For right dosage and
right time, see ‘Dosages and frequency’ below.).
Right route: medicines are produced in many forms
and for different routes. Forms include ointment
and suppository. Some medicines come in more
than one form and some can be administered via
more than one route. Capsules, drops, sprays,
syrups, tablets and inhalers can all be administered
orally (by mouth), while an injection is only ever
administered into the muscle and an IV drip into
a vein.
Dosages and frequency
Accuracy in calculations guarantees that the right
dosage is administered at all times. All medicines
have special dosages and/or dosage ranges for
adults and children. Some adult dosages may be
reduced for the older person; the effects of the aging
process mean they are more prone to side effects,
adverse reactions and overdose. Dosages for
children are generally based on weight, while, in
general, adolescents can safely take adult dosages.
Expressions of frequency (twice a day, every four
hours) then serve to ensure the right time is adhered
to, thus maximising the therapeutic effectiveness of
the medication concerned. Medical abbreviations
save time but they can also lead to deadly effects.
Originally written in Latin, some are still used
today: po for ‘by mouth’, pc for ‘before meals’ and
ac for ‘after meals’. However, there is a move
towards simplification to avoid error. Having read
through a wiki presenting proposed changes,
students then practise interpreting prescriptions
using the accepted abbreviations and symbols.
Side effects; assisting patients with
medication
All medicines have side effects, and nausea and
vomiting are the most common. But while some
side effects are troublesome, others can be life-
threatening. Nurses must therefore be aware of the
side effects, adverse drug reactions and the toxic
effects of the medication their patients are taking;
they must monitor patients and report side effects
immediately. This section provides an opportunity
to review symptoms from Unit 2, as well as learn
others that constitute common side effects, such as
constipation, depression and tremors. The modals
may and might are a means of explaining possible
side effects (e.g. She might suffer some swelling; it may
take a few days to heal.).
Students then look at how to educate patients in
managing their medication: checking the label,
reporting side effects and carrying a list of
medications in case of an emergency. By completing
a patient’s personal medication record, students
consolidate the language acquired in the first three
sections of the unit.
Communicating with relatives by phone
The final section of the unit puts forward a set of
recommendations for handling calls from relatives
(and friends). Medical staff are advised to answer a
call within four rings. Nurse should begin by giving
their name and department and offering assistance.
An initial greeting will put the caller at ease.
Expressions using will (e.g. I’ll check he is awake. He’ll
be out of surgery at 10 a.m.) are used to keep relatives
informed of the patient’s condition. However, it is
necessary for the nurse to admit their limitations, in
particular if it is a question of patient confidentiality
(e.g. You’ll need to speak to your sister’s doctor.).
Raising students’ awareness of linking words
enhances their effectiveness on the phone.
Medication 6 40
 4 Tell students that they are going to talk about
Teacher’s notes
Warm-up
1 On the board, write: head, torso, limbs, joints.
Divide the class into teams and give them two
minutes to come up with as many words for
each group as they can. The team with the most
when the time is up are the winners.
2 Refer students back to the patient blog post on
page 41. In pairs, students take turns giving the
patient goals and then giving instructions for his
ROM exercises.
Medication routes and forms
Speaking
1 Tell students that they are going to talk about
medication. With books closed, ask them to
brainstorm forms of medication. Ask a confident
student to write these on the board for reference
later or invite different students to come to the
board and draw pictures of different medication
forms. Provide an example first.
Then, write 5 rights on the board and ask
students, individually or in pairs, to match
illustrations A–E to the correct ‘right’ 1–5. Ask
experienced nurses: What do patients in your
country/place of work do to help remind them to take
their medication? Check answers as a class.
A3 B1 C5 D4 E2
5 ► 32 Elicit/Pre-teach heart problems and ear
2 Ask students, in small groups, to discuss
questions 1 and 2. Discuss answers as a class.
Suggested answers
1 To stop mistakes: in serious cases, the
patient could die. The patient might suffer
side effects.
2 muscle, eye, ear, nose, rectum, skin, vein,
mouth, tongue (under)
Vocabulary
6 Ask students to listen again and complete the
3 Refer students to illustrations A–J and ask them,
individually or in pairs, to label them with
words 1–10. Ask them to compare answers with
a partner, then check as a class.
A 6 B 1 C 2 D 5 E 4 F 3 G 8 H 10 I 9
J7
routes of medication. Refer them back to the
‘five rights’ in 1 if necessary. Depending on your
class, you may wish to do the extra activity
below before continuing with this exercise. Refer
students back to the forms of medication in 3.
Ask them, in pairs, to match these to routes 1–10.
Explain that they can use some words more than
once. You may wish to do the first item as an
example with the class. For pre-experience
nurses, you may wish to give them guidance: tell
them there are six possible answers for question
3 and three possible answers for question 9.
1 drops 2 drops 3 capsule, drops, spray,
syrup, tablets, inhaler 4 injection 5 spray
6 suppository 7 ointment 8 injection
9 drops, spray, tablets 10 IV drip
Extra activity
On the board, write: Put the drops ___ the eye.
Demonstrate a patient putting drops into their
eye and ask students to complete the sentence
(into). Note that some students may say in the
eye. Demonstrate the action again, insisting on
the idea of movement for the preposition into.
Write more expressions on the board (___ the
skin, ___ the tongue, etc.) and ask students to
complete them. Point out the use of by in by
mouth; it is unlikely students would be able to
guess this.
Listening
infection. Refer students to the patients in the
photos and medical problems 1–4. Tell them that
they are going to hear four nurses talking about
medication for these patients. Ask them to listen
and tick the correct medical problem for each
patient. Play the recording twice if necessary.
Check answers as a class.
1 nausea 2 ear infection 3 heart problems
4 skin rash
table. Ask them to compare answers with a
partner, then check as a class.
Katy: tablets, mouth Ted: drops, ear
Mrs Fox: capsules, mouth Ali: injection, vein
Medication 6 41
7 Elicit/Pre-teach administer and be confused. Refer
students to sentences 1–4. Ask them, in pairs, to
listen again, decide if the sentences are true or
false and correct the false sentences. Play the
recording (twice if necessary), then check
answers as a class.
1 F (She feels tired.) 2 F (Ted’s wife is going
to administer his medication.) 3 T
4 F (Student nurses can only watch.)
8 Refer students to sentences 1–4 and ask: Which
‘rights’ do these explanations refer to? (right dose,
right time). Tell students you will be looking at
these rights in more detail later in the unit. Ask
them, individually or in pairs, to complete the
explanations with the words in the box, then
play the recording again for them to check their
answers. Check answers as a class.
1 two, water 2 three, right 3 25mg,
lunchtime, go to bed 4 22.00 5 a lot better
Speaking
9 Refer students to the audio script for track 32 on
pages 76–77. Ask them to work in pairs and
practise reading the conversations aloud.
Monitor and correct their pronunciation and
word stress where necessary. Finally, check
understanding of have to, be able to, you’re
welcome, forget and antihistamine.
Dosages and frequency
Vocabulary
1 On the board, write: 1 + 1 = 2, 2 – 1 = 1, 1 x 2 = 2,
2 ÷2 = 1. Invite confident students to read these
aloud. This will serve as a ‘diagnostic’ test to
gauge understanding of students’ current
knowledge of the target language. Then ask
them to match the symbols in the box to terms
1–5. Check answers as a class.
1– 2+ 3x 4= 5÷
Listening
2 ► 33 Tell students that they are going to hear
three conversations between a senior nurse and
three student nurses about dosages. Ask them to
listen and complete calculations 1–3. Play the
recording, pausing after each conversation to
allow students to write their answers. Check
answers as a class. Then ask students, in pairs, to
practise reading the calculations aloud. Monitor
and assist with pronunciation where necessary.
1 60 mg ÷20 mg = 3 tablets
2 250 ml ÷ 2 hours = 125 ml per hour
3 28 kg x 1.5 mg = 42 mg
Vocabulary
3 Ask students, individually or in pairs, to write
calculations 1–4 in words. Check answers as a
class, then ask students to practise reading the
calculations aloud. Monitor and assist with
pronunciation where necessary.
1 One hundred milligrams plus/added to one
hundred and fifty milligrams equals/is two
hundred and fifty milligrams.
2 Eighty millilitres minus forty-five millilitres
equals/is thirty-five millilitres.
3 Sixty milligrams divided by five milligrams
equals/is twelve milligrams.
4 Three times/multiplied by five millilitres
equals/is fifteen millilitres.
Language
Depending on your class, you may wish to carry
out 4 before going through the Language box.
The Language box will then serve to consolidate
the target language.
If possible, bring in packaging of well-known
over-the-counter medications (headache tablets,
cough medicine, antiseptic ointment, etc.), or
refer students back to the illustrations on page
44. Use these to demonstrate the expressions of
frequency. Write 7.00 and 1 on the board. Then
ask: When do you take your medication? Invite a
confident student to answer, pointing to the time
and the number 1. Elicit/Pre-teach (I take my
medication) once a day. Repeat for twice a day.
Point out to students that from three onwards,
we say three times a day, four times a day, etc. Ask
students to read the Language box individually.
4 Ask students, individually or in pairs, to match
1–5 to a–e, then check answers as a class.
1b 2c 3d 4a 5e
Reading
5 Ask: What is a wiki? (a website that allows users
to change or add to the information it contains).
Do you use wikis? What kind of wikis do you use?
Write bd/6 hrly on the board and ask: What are
Medication 6 42
 they? (medical abbreviations). Tell students that
they are going to read a wiki entry written by
Australian nurses about medical abbreviations.
Refer them to questions 1–3. Before they read,
check understanding of Europe, ancient times,
Latin, list and prescription. Then ask them to read
the text and answer questions 1–3. Reassure
them that they do not need to understand every
word; encourage them to use the context to help
them understand the text. For experienced
nurses, ask students to predict the answers first,
then read to check/confirm. Ask students to
compare answers with a partner, then check as a
class. Finally, check understanding of western,
especially, handwritten, mistake, cause, safety issues,
commission and regularly.
1 Latin 2 when they write prescriptions 3 It is
difficult to read abbreviations written by hand
and medical professionals make mistakes. The
Commission wants to reduce the number of
mistakes in prescriptions.
Vocabulary
6 Ask students to cover the text in 5 and match
terms and abbreviations 1–4 to expressions of
frequency a–d. They should then use the text to
check their answers. Check answers as a class.
1b 2c 3a 4d
Writing
7 Refer students to the three prescriptions and
meanings 1–8. Ask: What is the abbreviation for
‘patient’? (Pt). Then ask: Which medication is Edna
taking? (Diovan). For experienced nurses, ask:
What is Diovan for? (blood pressure). Do the
same for the other medications (see Briefing
section). Then ask students, individually or in
pairs, to look at prescriptions 1–3 and find
abbreviations or symbols that match meanings
1–8. Refer them to the text in 5 for help. You may
wish to do this as a whole-class activity with
experienced nurses.
1 ac 2 hs 3 pc 4 caps 5 mg 6 # 7 tabs
8 bd
8 Ask students to read the prescriptions again and
explain that they are going to write out the
prescriptions in words. Go through the example
with the class, then ask students, individually or
in pairs, to complete items 2 and 3. Monitor and
assist them where necessary. Check answers as
a class.
2 (Diovan is for your blood pressure, Edna.)
One 40 milligram tablet a day after or before
meals for 90 days.
3 (For your cholesterol, your doctor has
prescribed Fluvastatin, Mr Khan. You need
to take) one 20 milligram capsule twice a
day for seven days.
Extra activity
Ask students to think of two examples of
medication dosages. Ask experienced nurses
to think about a patient they know and
pre-experience nurses to consider an over-the-
counter medication they use. Ask students to
write down the dosages and frequency of
these. Then ask them, in pairs, to explain the
dosages and frequency of the medication to
their partner.
Side effects; assisting patients with
medication
Speaking
1 Ask students, in pairs, to discuss questions 1 and
2. Note that some students may have difficulty
expressing their ideas in English; depending on
your class, you may wish to allow students to
discuss these questions in the L1 first. Before
checking answers as a class, encourage them to
share their ideas with another pair and/or write
them up on the board in preparation for the
next activity.
Suggested answers
1 symptoms that the patient sometimes
suffers after taking some types of
medication
2 nausea, swelling, dizziness, headaches,
skin rash, vomiting, high temperature,
constipation, drowsiness, tremors, loss of
appetite
Listening
2 ► 34 Tell students that they are going to listen
to Les, a senior nurse, talking about side effects
to a group of student nurses. Refer them to the
list of side effects, then ask them to listen and
tick the ones Les mentions. Reassure students
that they do not need to understand every word.
You may wish to play the recording a second
time, pausing after each side effect mentioned to
give them time to write their answers.
Medication 6 43
 Les mentions all of the side effects on the list.
3 Ask students, individually or in pairs, to put
the words in 1–5 in the correct order to make
sentences. Then play the recording again and
ask them to check their answers. Point out the
use of to suffer/experience a side effect and to cause
+ side effect. Finally, check understanding of
intravenously and Valium.
1 As you know, some patients suffer side
effects and others don’t.
2 Some people may suffer dizziness and
others might feel nauseous.
3 It’s also possible to have diarrhoea,
vomiting, even headaches.
4 Injecting drugs intravenously may cause
swelling at the injection site for some
patients.
5 Patients who take Valium may experience
drowsiness.
Language
On the board, write: Do patients always (100%)
experience side effects? (no; sometimes). Elicit an
answer, then write You _____ feel nauseous. Ask
students to complete the sentence. Tell them that
there are two possible answers (may/ might).
Explain, may and might are interchangeable in
this case. Finally, ask students to read the
Language box individually.
4 Elicit/Pre-teach abdominal pain, monitor, reduce,
dosage and heal. Ask students to use the prompts
in 1–6 to write sentences, using may or might and
putting the verbs in brackets in the correct place.
Do the first item as an example with the class.
Ask students to compare answers with a
partner, then check as a class.
1 You may/might feel a little dizzy after you
take your medication.
2 Some patients may/might experience
abdominal pains or sweating.
3 Your husband may/might suffer some side
effects but most patients don’t.
4 You may/might get some side effects to this
drug.
5 We’ll monitor him as we may/might need to
reduce his dosage.
6 It may/might take a few weeks for the wound
to heal completely.
Vocabulary
5 Refer students to the audio script for track 34 on
page 77. Ask them, individually or in pairs, to
find side effects that match definitions 1–5. For
confident students/experienced nurses, you
may wish to ask them to predict the answers
first, then check them against the audio script.
1 diarrhoea 2 constipation 3 drowsiness
4 loss of appetite 5 tremors
Extra activity
Use the packaging of well-known over-the-
counter medications (headache tablets, cough
medicine, antiseptic ointment, etc.) you have
brought in or refer students back to the
illustrations on page 44. Ask them to think
about possible side effects of these medications
and, in small groups, to make a list for each
one. Then put them in pairs and ask them to
take turns explaining the side effects of each
medication to a patient. Suggest they begin
with the opener Let me tell you about the possible
side effects of ... . Encourage them to use a soft,
reassuring tone so as not to alarm patients.
Speaking
6 Ask experienced nurses: Why do some patients
stop taking their medication when they leave
hospital? (They feel better. They get side effects.
They forget to take the medication.). Go through
the rubric and the example with the class, then
ask students to discuss in pairs. Encourage them
to take notes. Some students may find it difficult
to express their ideas in English, so you may
wish to allow them to discuss the question in
their L1 first. When they have finished, ask them
to share their ideas with the class.
Suggested answers
Learn the name of your medication, the dose
and the reason you are taking it.
Make a simple chart for your medications.
Update your chart as your medications change,
especially if you have been in hospital.
Set a regular routine for taking medications,
such as mealtime or bedtime.
Do not skip doses; if you miss a dose, do not
take two doses at once.
Set an alarm to remind you when to take your
medication.
Use a pill box to help you organise your daily
medication.
Medication 6 44
 Reading
7 Tell students that they are going to read a
patient brochure and ask them to look at the
title. Ask: What is the brochure about? Who is it for?
(It gives advice to patients on how to remember
9 Tell students that they are going to complete the
to take medications. It is for patients, especially
patients who have to take several medications at
once.). Ask students to read through questions
1–5 and then read the text to find the answers.
With experienced nurses, you may wish to ask
them to predict the answers first, then check/
confirm their ideas by reading the text. Ask
students to compare their answers with a
partner, then check as a class. Finally, check
understanding of label, avoid, in the dark, remedy,
herbal medicine, react and report.
1 to be sure you have the right medication and
the right dosage
2 You might make a mistake with the
medication and dosage.
3 (two of the following) vitamin tablets, herbal
medicine, aspirin
4 The doctor may decide to change the
dosage or give another medication.
5 It is useful for medical professionals to have
this information in an emergency.
Listening
8 ► 35 On the board, write: What is the personal
medication record for? (to help patients remember
information about their medication – name, the
medical condition, the form and route, dosage
and side effects). Refer students to the record for
Doris MacDonald and ask them to discuss the
question in small groups. Pre-experience nurses
should now be able to answer this question;
remind them of the ‘five rights’ if necessary. Ask
experienced nurses: Do patients in your country/
place of work use this type of record? If not, what do
you advise them to do?
Tell students that they are now going to listen to
a conversation between a nurse and Doris.
Explain that they have to listen and complete
1–6 in the medication record. Tell them not to
worry about the other gaps in the record for
now. They will be dealing with these in the next
activity. Play the recording, pausing at intervals
to allow students to write their answers. Ask
them to compare answers with a partner, then
check as a class. Depending on your class, you
may wish to refer students to the audio script on
page 77 in order to read the answers in context.
1 Azopt 2 diabetes 3 Metamucil
4 constipation 5 (bad cold) 6 multivitamins
Speaking
missing information in Doris’ medication record
by asking each other questions. Refer A Students
to the information on page 49 and B Students to
page 71. Go through the example questions with
the class. You might like to demonstrate the
activity with a confident student first, eliciting
answers to these before students begin (e.g. She
is taking Azopt because she has glaucoma. She’s
taking drops.). When they have finished, check
answers as a class.
Student A
Form: drops, syrup, capsules
Route: stomach, mouth
How much & when?: one drop, three times a
day; 15 mg, three times a day; 75 mg, two a
day for five days
Side effects: itching, mild pain, redness or
swelling at the injection site; nausea
Student B
Form: injection, tablets
Route: right + left eye, mouth, mouth
How much & when?: six units, every six hours;
1 mg a day
Side effects: headaches, itchy, red eyes –
temporary; diarrhoea; nausea, vomiting (take
with food)
Communicating with relatives by phone
Extra activities
1 On the board, write: How do you feel when you
speak on the phone in English? Ask students to
discuss the question in pairs. Encourage them to
take notes. Depending on your class, you may
wish to allow them to discuss in their L1 first.
When they have finished, discuss answers with
the class.
2 You may wish to carry out this activity before 1,
to set the context. Ask experienced nurses: Why
do relatives call the patient ward? How do they feel
when they call? What can nurses do to calm the
relatives when they call? Ask students to discuss
the questions in pairs. Encourage them to take
notes. Depending on your class, you may wish
to allow them to discuss in their L1 first.
When they have finished, discuss answers with
the class.
Medication 6 45
 Listening
1 Ask students to look at the two nurses in the
illustrations. Ask: What do you see? (The nurses
are talking on the phone. The one on the left is
unhappy/sad/angry. The one on the right is
smiling/is happy/likes her job.). Refer students
to the list of things nurses say and do on the
telephone and ask them to discuss the question
in pairs or small groups.
4, 8
2 ► 36 Tell students that they are going to listen
to the two nurses in 1 on the phone. Ask them to
listen to each conversation and tick the actions
for each nurse. Play the recording, pausing after
each conversation to allow students to select
their answers, then check answers as a class.
Depending on your class, you might like to ask
students to check their answers against the
audio script on page 77.
1 4, 5, 8
2 1, 2, 3, 5, 6, 7
Speaking
3 On the board, write: Why is conversation 1 a bad
example? Why is conversation 2 a good example?
Brainstorm answers for each question.
Alternatively, refer students to the examples and
ask them, in small groups, to make a list for each
conversation. Discuss answers with the class.
Depending on your class, you may wish to turn
this into a competition: the first group to provide
five answers wins.
Suggested answers
In conversation 1, the nurse is stressed. She is
not polite. She corrects the caller’s English.
She is impatient. She speaks to another person
at the same time.
In conversation 2, the nurse is polite. She
identifies the ward. She gives her name. She
apologises for the noise. She asks the caller to
repeat something.
Language
Refer students to the Language box, pointing out
that will is used to talk about the future. Read
the example sentences to the class or ask a
confident student to read them out. Point out
the contracted form of will. Elicit the contracted
forms (you’ll, he’ll, she’ll, we’ll, they’ll), then ask:
Will he be out of surgery at ten? Elicit No, he won’t.
He’ll be out of surgery at eleven. Refer students to
the audio script for track 36 on page 77 and ask
them, in pairs, to underline examples of will
(I’ll just check he’s awake and then I’ll transfer you.).
Drill questions and answers around the class
about the students’ future. These could be based
on the students’ own lives, work, nursing, etc.
4 Elicit/Pre-teach these check, transfer and wait.
Tell students that they are now going to read a
conversation between a nurse and a relative who
is calling to find out about her husband. Ask
them, individually or in pairs, to complete the
conversation using will and the verbs in the box.
You may wish to do the first item as an example
with the class. Check answers as a class.
1 will arrive 2 won’t come 3 will take 4 will,
be 5 will, check 6 will transfer 7 will wait
Listening
5 ► 37 Tell students that they are going to listen
to another phone conversation between a nurse
and a patient’s relative. Refer them to questions
1–4 and the choice of answers. Play the
recording, asking students to complete the task.
If necessary, play the recording a second time,
pausing at intervals to allow students to write/
select their answers. Check answers as a class.
1 General Central Hospital 2 Orthopaedics
Ward 3 She had an accident. 4 Westberry
Speaking
6 ► 38 Tell students that they are going to read
the second part of the conversation in 5. Explain
that, in pairs, they have to put the conversation
in the correct order. Go through the first two
items with the class and check understanding by
asking: Where is the patient? (in the ER). Who is
the caller? (the patient’s brother). Ask students to
compare answers with another pair, then play
the recording for them to check their answers.
The correct order is: 7, 12, 3, 10, 2, 11, 8, 5, 4,
1, 9, 6, 13. (See audio script for track 38 on
page 77 of the course book.)
7 Ask students to look at the conversation in 6
again and underline examples of will. You might
like to refer them to the audio script for track 38
on page 77 so they can see the conversation in
the correct order. Check answers as a class.
Medication 6 46
 You’ll need to speak to her doctor. to swap roles and repeat the activity. Depending
You’ll need to speak to her doctor when she’s on your class, you may wish to ask one pair to
out of surgery. observe another pair and check their use of the
Yes, I think I’ll do that. recommended elements, etc. Pairs should then
I’ll be there as soon as I can. feed back to each other. Monitor and assist
I’ll inform your sister’s doctor that you’re students where necessary.
coming.
Now do Unit test 6 and Progress test 3. For the
Listening part of the Progress test, use track 35.
Pronunciation
8 With books closed, write on the board: Could I
speak to Nurse Turner, please? Repeat the sentence Preparing for the next unit
several times, exaggerating the link between
Could and I. Then draw a line to link these two In preparation for Unit 7, suggest the following to
words on the board. Drill the question, first your students:
chorally, then individually, until you are happy • Think about how nurses move patients from one
students are pronouncing it correctly. Then hospital department to another and the type of
write the following sentence on the board: I’ll tell equipment they use to do this.
her doctor. Repeat it several times, exaggerating • Do some (online) research into safety issues in
the link between tell and her. Then invite a hospitals.
confident student to come to the board and draw
a line linking the correct
words together.
Ask students to open their books, refer them to
the box and give them time to assimilate the
information. Go through the example with the
class, asking students to repeat it, first chorally,
then individually. Then ask them, individually
or in pairs, to draw the links between the words
in sentences 1–4. Encourage them to read each
sentence aloud before drawing the link. Check
answers as a class.

1 I see you’re worried ͡ about ͡ her.

2 She’s ͡ in surgery at the moment.
3 I’ll help ͡ her when she’s ͡ out ͡ of surgery.
4 I’ll ͡ inform ͡ her doctor that you’re here.

9 Ask students, in pairs, to take turns reading the

conversation in 6, linking the correct words as
they do so. Depending on your class, you may
wish to ask students to draw the links in the
audio script for track 38 on page 77 before
practising the conversation. Monitor and assist
students where necessary.

Speaking
10 Put students in pairs and ask them to read the
scenario. Encourage them to include all the
recommended elements from 1 in their
conversations, and also to link the correct words
as they speak. Depending on your class, you
may wish to brainstorm ideas as a class first.
Ask pairs to practise their conversation and then

Medication 6 47
 7 The hospital team
Briefing
This unit aims to develop skills in team building
through English. Students will develop language
for communicating with colleagues by phone and
moving patients, as well as giving simple safety
instructions.
Moving and handling patients
When moving and handling patients, bear in mind
the patient’s weight, safety and comfort, as well as
their ability to function physically (including any
underlying conditions, e.g. arthritis in the elderly)
and mentally, not forgetting the nurses’ own health
and safety. There are legal issues involved in
manoeuvring patients; nurses are obliged to follow
official procedures and make use of specialised
equipment. The hoist is used to lift immobile or
heavy patients from or into bed. A rope ladder can
be used by the patient to pull him/herself up into a
sitting position, while a monkey pole will allow the
patient to lift up their buttocks. Patients can use
hand blocks to help to reposition themselves while
in bed. Banana boards can be used to slide the
patient onto another surface (e.g. from a wheelchair
to the bed), while slide sheets are used to roll over
the patient.
Keeping the patient informed and preparing them
for what is about to happen is important in gaining
their consent and co-operation. Will for decisions
taken at the moment of speaking and offers of help
is introduced in this section. After reading a training
brochure on procedure, students are provided with
opportunities to put the target language into
practice via a series of possible scenarios.
Communicating with team members
by phone
This section deals with effective telephone
communication between staff. Requesting assistance
or advice, ordering tests or medication, arranging
appointments and checking on test results are some
examples of telephone communication. Nurses
might also call to ask for a porter to transfer their
patient from the ward to the Orthopaedics
Department, for example. Depending on the
patient’s condition, a medical professional may also
need to accompany the patient. The staff nurse in
charge must also ensure the following documents
accompany the patient: medical notes, drug chart,
nursing documentation, as well as transfer
letter/forms and property, as appropriate.
Reporting back to colleagues is also important to
ensure the smooth running of the ward. The past
simple of be is introduced here to provide the
necessary structure for this.
Taking accurate telephone messages is another
essential skill for the nursing profession. Messages
not relayed accurately or within an appropriate
timeframe risk causing any number of problems,
some potentially fatal. Here, a training brochure
promoting effective telephone communication lays
out a simple framework from which to work; from
offering to take a message to reading it back, as
well as asking for confirmation and clarification of
any relevant details.
Ordering supplies
In a hospital supply room, supplies (gauze, surgical
tape, disinfectant, etc.) need to be readily available,
and ordering them when necessary ensures patients
are cared for promptly and safely. Supplies are often
stored in colour-coded bins which make it easier to
locate supplies quickly: red bins contain
intravenous/blood test items (e.g. specimen tubes
and IV bags); yellow bins contain urinary items
(e.g. catheter sets, sterile cups and bedpans); and
blue bins contain patient room items (e.g. pillows,
sheets and hospital gowns). A hand-held scanner
makes ordering the various packages and boxes of
supplies and maintaining a reliable inventory
simple and less time-consuming. A series of relevant
questions are developed here: Do we have enough ...?
How much/many ... do we have?
Giving simple safety instructions
Sharps constitute any item that may cut or penetrate
the skin (e.g. IV sets and knives). There is a need to
protect not only the person handling the equipment
from potential sharps injuries but also the staff
involved in the disposal of used equipment. In this
section, a case study demonstrates a policy to
eliminate sharps injuries in the Operating Room
(OR): having purchased sharps boxes and created
a specific ‘sharps zone’ the number of injuries
decreased. Students learn the structure always/
never + if clause to express obligation when giving
safety instructions.
The hospital team 7 48

Teacher’s notes
Warm-up
1 Ask students, in small groups, to write a list of
three over-the-counter medications. When they
have finished, ask groups to swap their lists and
then brainstorm the form, route, possible dosage
and side effects for each medication on their list.
Encourage students to take notes. Finally, ask
groups to present their ideas to the class.
2 Now put students in pairs and ask them to make
a list of recommendations for a new nurse when
using the phone to speak to relatives. Refer them
to the audio script for tracks 37 and 38 on page
77 and ask them to practise the conversations,
taking into consideration the recommendations.
When they have finished, they should swap
roles and repeat the activity. Encourage students
to use patient-friendly intonation and to link the
appropriate words as they speak.
Moving and handling patients
Speaking
1 Tell students that they are going to talk about
how to move patients safely. Explain that the
term used in hospitals and residential homes is
moving and handling. Refer students to the first
question and ask them, in small groups, to make
a list. Check answers as a class.
Refer experienced nurses to question 2 and ask
them, in small groups, to make a list. For pre-
experience nurses, refer them to the example,
then ask them, in small groups, to think of
another two examples. Check answers as a class.
Suggested answers
1 when the patient: changes department,
wants to go to the toilet, is not comfortable,
wants/needs to move from a bed to a chair/a
chair to a bed/a bed to a trolley/a bed to
standing position, etc.
2 the patient’s weight, the nurse’s health and
safety, the patient’s safety and comfort, the
patient’s ability to function physically and
mentally, any other conditions (e.g. arthritis
in the elderly, patients under the influence of
alcohol or drugs), the team work involved in
moving a patient, take all medical records if
the patient is being moved to another
department
Vocabulary
2 Refer students to the photos of equipment for
moving and handling patients (A–F) and ask
them, individually or in pairs, to label the
equipment with the words in the box. Note that
pre-experience nurses may not yet have come
across this equipment and experienced nurses
may not know the terms in English. At this level,
students will probably not be able to draw on
their knowledge of the L2 to be able to guess
these terms in English. Reassure them that they
will learn more about these words as they go
through the unit. Ask them to compare answers
with a partner, then check as a class. Finally, ask
experienced nurses: Do you have experience using
these pieces of equipment? Which ones? Are they easy
or difficult to use? Why?
A monkey pole B slide sheet C rope ladder
D hoist E banana board F hand blocks
Extra activity
Ask students, in pairs, to look at the photos in
2. Ask them to write P (patient) next to the
equipment the patient can use to move him/
herself and N (nurse) next to the equipment a
nurse uses to move the patient.
Answers
Patient: A, C, F Nurse: B, D, E
Listening
3 ► 39 Tell students that they are going to listen
to three conversations about moving patients.
Explain that, as they listen, they should write
down the piece of equipment the nurses use in
each case. Play the recording (twice if necessary),
pausing after each conversation to allow
students to write their answers. Check answers
as a class.
1 rope ladder 2 banana board 3 slide sheet
4 Refer students to the verbs in the box and
sentences 1–4. Ask them to listen again and
complete the sentences with the verbs in the box.
Ask them to compare answers with a partner,
then play the recording again for them to check.
Finally, check the answers as a class.
1 pull, up, sitting 2 swing, over 3 slide onto
4 roll, over
The hospital team 7 49

Extra activity
Use this whole-class activity to reinforce the
vocabulary in 4. Demonstrate pull up, then
write the verb on the board and ask: With which
piece(s) of equipment do we use this verb? (monkey
pole, rope ladder and hand blocks). Do the
same for roll over (slide sheet) and slide onto
(banana board).
Language
If necessary, review the present continuous for
future arrangements. Tell students that there are
two more ways of talking about the future in
English. On the board, write: Nurse Kendal is
going to help you. Underline is going to and circle
help. Above the example, write: be going to +
infinitive. Tell students that it is important for
nurses to explain an intention or a procedure to
a patient (e.g. moving him/her to another ward)
before they do it, thus keeping them informed.
To do this in English, we use be going to +
infinitive. Ask: What is Nurse Kendall going to do?
(She’s going to help the patient.). Then ask
questions about the students’ intentions (e.g.
What are you going to do after the class? What are
you going to eat for lunch? What is Sienna going to
eat for lunch?).
On the board, write: will + infinitive. Explain that
we often use will to offer to do something for
someone, or for decisions we make at the
moment of speaking. Then write the following
on the board:
1 Nurse: We need a wheelchair.
Nurse: I’ll go and find one.
2 Patient: It’s cold in here.
Nurse: I _____ the window. (close)/I _____ a
blanket for you. (get)
Invite a confident student to come to the board
and complete the nurse’s responses using the
verbs in brackets. Then write:
1 Patient: I’m thirsty.
Nurse: _____
2 Patient: I’m very hot.
Nurse: _____
Ask students, individually or in pairs, to
complete the nurses’ responses (e.g. I’ll bring you
some water. I’ll open the window a little.)
Now write I think/I’m sure on the board and
explain that we also use will to make predictions,
often with these expressions. Ask students to
read the Language box individually.
5 Tell students that they are going to read a
conversation between two nurses and their
patient. Get them to read the conversation
quickly and ask: Why are the nurses moving the
patient? (Abdel wants to watch the football game
in the TV room.). Ask students, individually or
in pairs, to complete the conversation using the
correct form of be going to or will and the verbs in
brackets. You may wish to do the first item as an
example with the class. Ask: Does Simin explain
an intention or offer help? (She explains an
intention.). Note that some students may find
this activity a little difficult; encourage them to
use the examples in the Language box to help
them decide which form to use in each case.
Check answers as a class.
1 are going to help 2 Will you be able 3 is
going to help 4 will go 5 am just going to
loosen 6 will bring 7 will help
Extra activity
Depending on your class, you may wish to go
through each item in 5 to reinforce the target
structures. Ask students, individually or in
pairs, to go through the items and write I
(intention), P (prediction), D (decision) or O (offer
of help) next to each one.
Answers
1I 2P 3I 4D 5I 6D 7O
6 Ask students, in groups of three, to practise the
conversation in 5. Encourage them to use
patient-friendly intonation. You may wish to
ask them to swap roles and repeat the activity
if there is time. Monitor and assist students
where necessary.
Reading
7 Tell students that they are going to read a
training brochure for medical professionals
about moving and handling patients safely.
Check understanding of co-operate, adjust, loosen
and level of independence. Ask students, in pairs,
to read the brochure and put the eight stages in
the correct order. Refer them to the first stage,
which is given as an example. When they have
finished, ask them to compare answers with
another pair, then check answers as a class.
Then ask students to go through the
conversation in 5 again and find examples for
each of the stages. Point out that one of the
stages (stage 5) is not covered in 5.
The hospital team 7 50
 1 Explain what you are going to do and the
reason for the move.
2 Give clear instructions to the patient at each
stage.
3 Check that the patient agrees.
4 Check the patient’s level of independence.
5 Adjust the height of the bed and/or loosen
bed linen if necessary.
6 Explain your actions as you are performing
them.
7 Encourage the patient to co-operate.
8 Check if the patient is comfortable after the
move.
Examples:
1 Phil and I are going to help you into a
wheelchair so you can go and sit in the
TV room.
2 Hold onto the handle with both hands.
Now hold onto me and I’ll help you into the
wheelchair.
3 What do you think?
4 Will you be able to use the monkey pole?
Now, can you pull yourself up?
5 (not covered)
6 Abdel, I’m just going to loosen the sheets on
your bed first.
7 Good; Good, good, well done.
That’s better.
8 How’s that now, Abdel?
Speaking
8 Put students in groups of three (Student A is the
patient; Students B and C are the nurses) and ask
them to read situation 1 and brainstorm the
equipment needed to move the patient. Refer
them back to the expressions in 4. Ask groups to
roleplay the scenario using these expressions
and the stages in 7. Then ask them to swap roles
and do the same for situations 2 and 3. Monitor
and assist students where necessary.
Extra activity
For experienced nurses, brainstorm other
situations where they might need to move
patients. Then ask them, in pairs, to choose two
of these situations and roleplay them. You may
wish to ask another pair to watch and then give
feedback. They should comment on students’
use of the eight stages for moving and handling
patients, their use of patient-friendly intonation
and correct use of future forms.
Communicating with team members
by phone
Speaking
1 On the board, write: Why do nurses need to
communicate with other medical staff by phone?
Ask students to discuss the question in pairs.
Encourage them to write a list. Encourage
pre-experience nurses to use their general
knowledge and/or experience as a patient.
Depending on your class, you may wish to allow
students to discuss this in their L1 first. Some
students may have difficulty expressing their
ideas in English; avoid correction to encourage
fluency. Discuss answers as a class.
Now ask: What other ways are there to communicate
with members of the team? Discuss as a whole
class. Pre-experience nurses may not be aware of
the different means of communication in a
hospital; reassure them that this is not a test and
encourage them to use their general knowledge
to answer the question.
Suggested answers
1 They may need to: ask another nurse for
assistance, order a porter to transfer a
patient, ask for a doctor to visit a patient,
ask for a doctor’s advice, order tests, ask for
test results, order medication, arrange an
appointment for a scan.
2 leave messages on the department/ward
whiteboard, by SMS (in some hospitals)
Listening
2 ► 40 Elicit/Pre-teach porter, paediatrics and
occupational therapy. Tell students that they are
going to listen to three nurses calling to ask for a
porter to transfer their patients. Refer them to
the patient information and ask them to
complete it as they listen. Play the recording,
pausing after each conversation to allow them to
write their answers. If necessary, play the
recording a second time. Reassure students that
they do not need to understand every word, just
get the gist. Check answers as a class.
1 211 2 992163 3 Maternity (Department)
3 Tell students that they are now going to read a
telephone conversation between Davy, a nurse,
and Susie, who works in the Porter’s Office.
Refer them to the conversation and the words
and phrases in the box and check understanding
of accompany, medical notes, Orthopaedics
The hospital team 7 51
 Department, double five and drug chart. Ask
students, individually or in pairs, to complete
the conversation with the words and phrases in
the box. Get them to compare answers with a
partner, then check as a class.
1 ask for 2 porter 3 transfer 4 ID number
5 spell 6 double five 7 accompany
8 medical notes
Speaking
4 Tell students that they are going to practise
calling a porter to transfer a patient. Put them in
pairs and ask them to choose one of the patients
in 2 each. Then refer them back to the
conversation in 3 and ask them to change the
underlined information for information about
their new patient. Monitor and assist them
where necessary. When they have finished, ask
them to swap roles and repeat the activity.
Language
Refer students back to the conversation in 3 and
ask: Where was Davy’s patient? Elicit/Pre-teach
She was in the ER. Write it on the board,
underlining was. Ask questions around the class
to practise forming the past simple of be (e.g.
Where were you yesterday afternoon/this morning?).
Then ask a student: Were you at work yesterday?
Elicit/Pre-teach: Yes, I was./No, I wasn’t. Point
out the use of were for you, we and they. Ask
students to read the Language box individually.
Extra activity
For further practice of the target structure,
write the following questions on the board (or
prepare a handout in advance):
1 Where were you yesterday?
2 Where were you this time last year?
3 What was the weather like yesterday?
4 Who were you with this morning at 9.00?
5 What was your lunch like yesterday?
6 Were you the first person in your department/
classroom today?
7 What was the name of your first English
teacher?
Students could ask and answer the questions in
pairs, or you could do this as a whole-class
activity, eliciting answers from different
students each time.
5 Ask two confident students to read out the
conversation between nurses Jenny and Pat,
who are discussing a patient in 2. Put students in
pairs and ask them to practise the conversation.
Then ask students, individually or in pairs,
to write four short conversations of their own
about the patients in 2 and 3 using the past
simple of be. Encourage them to invent some of
the information. You may wish to brainstorm
information about the patients with the whole
class first, before students write out their
conversations. Finally, ask students, in pairs, to
look at each other’s conversations and check
their partner’s use of the past simple of be.
Listening
6 ► 41 Tell students that they are going to listen
to a telephone conversation between Sam and
Glenda, two colleagues. Avoid giving too much
information about the conversation at this stage.
Simply ask students to listen and choose the
correct words in italics in 1 and 2. Check
answers as a class.
1 takes 2 leaves
7 Refer students to the training brochure about
how to use the telephone effectively and ask
them to read through stages 1–7. Check
understanding of read back, confirmation and
clarification. Ask students to listen to the
conversation again and tick the stages in the
brochure as they hear them.
8 Ask students to listen again and complete the
telephone message. Check answers as a class.
1 Nurse Wright 2 Glenda Davies 3 test
results 4 8391
9 Refer students to the audio script for track 41 on
page 78 and ask them, individually or in pairs,
to underline expressions for the different stages
in 7. Ask them to compare answers with a
partner, then check as a class.
1 Good afternoon, East Ward. Staff Nurse
Sam Turner speaking.
2 Can I take a message for her?
3 What’s your number?
4 OK, so if I can just check the message: ...
5 Nurse Wright to call Glenda Davies in
Pathology about Ms Shapiro’s test results
on extension 8391.
6 I’m sorry can you repeat your family name,
please?
7 Bye.
The hospital team 7 52
 Speaking
10 Put students in pairs and refer them to the
telephone message cards. Explain that Student A
is the caller and Student B receives the call. Ask
them to use the information on the first card to
roleplay the conversation with their partner.
Monitor and assist them where necessary. When
they have finished, ask them to swap roles and
do the same for the second message card.
3 Refer students to questions 1–3. Ask them to
Ordering supplies
Vocabulary
1 With books closed, ask students, in small
groups, to brainstorm a list of supplies they
might find in a clean supply room (refer them
back to Unit 3 if necessary). Some students may
not know the names of the items in English;
reassure them that they will learn these as they
go through the unit. Discuss ideas with the class
and write students’ suggestions on the board.
Then compare the list of items on the board to
illustrations A–L. Pre-experience nurses may not
have come across these in their studies but most
students will know these from their general
knowledge and/or experience as a patient.
Tell students that these items are often given a
colour. Ask experienced nurses: What colours are
used? Can you give an example for each colour? (red:
intravenous/blood test items, e.g. gauze; yellow:
urinary items, e.g. catheter set; blue: patient
room items, e.g. pillow). Refer students to the
table underneath the illustrations and the
examples provided and ask them, individually
or in pairs, to complete the table. Check answers
as a class.
Red: intravenous or blood test items:
disinfectant, surgical tape, specimen tube,
scissors, IV bag
Yellow: urinary items: sterile cup, bedpan
Blue: patient room items: hospital gown, sheet
Listening
2 ► 42 Pre-teach hand-held scanner and blood
donation campaign. Note that the scanner might
be easier to demonstrate using a picture. Tell
students they are going to listen to Cynthia and
Louis, two staff nurses, checking the inventory
and ordering supplies. Ask experienced nurses:
What do nurses in some hospitals use to make the
order? (a hand-held scanner). Do nurses use these
in your place of work/hospitals in your country?
Ask students to listen and tick the items in 1
that they hear. Reassure them that they do not
need to understand every word. Check answers
as a class.
hospital gown (I), sheet (L), bedpan (K), gauze
(B), surgical tape (E), specimen tube (G), IV
bag (J)
listen again and answer the questions. Play the
recording, pausing at intervals to allow students
to write their answers. Ask students to compare
answers with a partner, then check as a class.
1 He orders supplies for the patient rooms, for
the fourth floor.
2 He presses ‘Enter’ on the scanner.
3 They did a lot of blood tests this week.
Extra activity
On the board, write: pillow, catheter set, scissors,
disinfectant, towel, sterile cup. Point to pillow and
say it aloud, exaggerating the word stress. Ask:
How many syllables are there in ‘pillow’? (2).
Draw a dotted line to divide the two syllables.
Then invite a confident student to come to the
board and underline the stressed syllable
(pillow). Ask students, in pairs, to practise
saying the other words aloud, underlining the
stressed syllable in each word. When they have
finished, read out the words and ask students
to listen and check. Check answers as a class.
Answers
catheter set, scissors, disinfectant, towel,
sterile cup
Language
Review countable and uncountable nouns,
referring students back to the Language boxes
on pages 29 and 31 in Unit 4 if necessary. Write
countable/uncountable on the board. Refer
students back to the supplies in 1 and invite
different students to come to the board and
write the items under the correct heading. Then
review how much and how many by asking
questions about the illustrations in 1 (e.g. How
much gauze is there? How many rolls of surgical tape
are there?)
On the board, write: I can’t find any bedpans. Do
you have any disinfectant? Then, next to these
examples, write: positive, negative, question,
countable, uncountable. Ask: When do we use the
word ‘any’? Invite a confident student to come to
The hospital team 7 53
 the board and circle the correct words (negative,
question, countable, uncountable). Point to the
supplies in 1 and invite students around the
class to form questions or negative sentences
using any.
On the board, draw three stick figures, five
hospital gowns and a roll of gauze. Point to the
stick figures and the hospital gowns and ask: Are
there enough hospital gowns? Elicit/Pre-teach the
responses (Yes, there are./No, there aren’t.) and
write them up on the board. Then point to the
stick figures and the gauze and ask: Is there
enough gauze? Elicit/Pre-teach Yes, there is
(there’s) (enough)./No, there isn’t (enough). Write
these up on the board.
Ask students to read the definition of enough in
the Language box. You may also wish to ask
students to check the meaning of enough in a
good bilingual dictionary. Finally, ask students
to read the Language box individually.
4 Ask students, individually or in pairs, to
complete 1–6 with much, many, any and enough.
You may wish to do the first item as an example.
Check answers with the class.
1 any, enough, many 2 much 3 much,
enough 4 any, many 5 enough, enough,
much 6 much, enough
Vocabulary
5 Ask students to read through answers a–f.
Avoid explaining meaning at this stage; simply
encourage students to use the context to try to
understand the meaning of any words they do
not know. Ask them, individually or in pairs, to
match these answers to questions 1–6 in 4. Check
answers as a class, then ask students, in pairs, to
practise the conversations in 4 and 5.
a2 b6 c4 d3 e1 f5
6 Ask students to match 1–4 to a–d to make noun
phrases for hospital supplies. Check answers as
a class.
1c 2d 3b 4a
Speaking
7 Put students in pairs and tell them that they are
going to practise ordering supplies by phone.
Refer A Students to the information on page 57
and B Students to the information on page 71
and encourage them to begin their conversation
as in the example. Depending on your class, you
may wish to do an example with a confident
student first. Encourage confident students to
also use expressions for asking for repetition
(e.g. Sorry, can you repeat that, please?) and
confirmation (e.g. So you need X and Y?). Monitor
and assist students where necessary. Then ask
them to swap roles and repeat the activity.
Giving simple safety instructions
Vocabulary
1 Ask students, individually or in pairs, to match
the terms in the box to definitions 1–5 and to
then label the illustration using the words in the
box. Depending on your class, you may wish to
start by labelling the illustration and then ask
students to match the terms in the box to the
definitions. Ask students to compare answers
with a partner, then check as a class. Point out
that we also use the term (eye) goggles for eye
protection. Also refer students to the box in the
margin and tell them that medical professionals
often use the term sharps but this is not a term
used with patients.
1 mask 2 apron 3 sharps box 4 disposable
gloves 5 eye protection
a eye protection b mask c apron
d disposable gloves e sharps box
Language
Go through the Language box with the class and
get students to read out the example sentences.
Point out the use of the auxiliary did (the past
simple of do) in questions and short answers.
Explain that the past simple is often used with
time expressions. Ask a series of past tense
questions around the class about what students
did yesterday or last night. Invite a confident
student to write the responses on the board.
When a student answers correctly, encourage
them to ask the next question to another student.
Make sure students understand the concept of
regular verbs. Explain that you will look at past
simple questions in unit 8.
2 Tell students that they are going to read an
article from a hospital magazine. Before they
read, refer them to the title and ask: What do you
think sharps injuries are? Pre-experience nurses
should be able to answer this question from the
context though students may have difficulty
The hospital team 7 54
 expressing their ideas in English. Avoid
correction at this stage. Instead, ask students to
scan the text to check their ideas.
Then ask students to read the article again and,
individually or in pairs, complete it using the
past simple form of the verbs in brackets. Elicit/
Pre-teach organise, participate, review, decide,
include, purchase, create, pass, decrease, report
and continue. Check answers as a class.
A sharps injury is when someone gets hurt by
a sharp medical instrument, e.g. a needle.
1 organised 2 participated 3 reviewed
4 showed 5 decided 6 included 7 used
8 purchased 9 created 10 passed
11 decreased 12 reported 13 continued
Pronunciation
3 ► 43 With books closed, write the phonemic
symbols /d/, /t/and /ɪd/ on the board. Draw
students’ attention to the box in the margin and
explain that there are three different ways of
pronouncing the endings of regular past simple
verbs. On the board, write: ordered, worked,
disinfected. Read these aloud, exaggerating the
final sound in each one and ask: Which sounds
can you hear? Invite a confident student to the
board and ask them to draw an arrow to the
correct phonemic symbol to indicate the sound
they hear. Play the recording, asking students to
listen and repeat the verbs as they hear them,
paying close attention to the pronunciation.
4 ► 44 Refer students back to the past simple
verbs in 2. Ask them, individually or in pairs, to
write the verbs in the correct column in the table.
Encourage them to say the verbs aloud to enable
them to hear the difference in the endings. Tell
them that they are now going to hear each verb
pronounced and that they should listen and
check their answers.
/d/: organised, reviewed, showed, used,
continued
/t/: purchased, passed, decreased
/ɪd/: participated, decided, included, created,
reported
Language
Ask: What do nurses wear when they do a blood
test? (gloves). Refer students to the first example
in the Language box and point out the words in
bold (always and never). Then on the board,
write: If you want to move a patient, never lift them
on your own. Underline the words never and if.
Explain to students that these two sentences
express obligations – things the nurses must do –
and that for obligations we often use if + always/
never. Avoid going into too much detail about
forming if clauses; instead encourage students to
learn the two structures as chunks of language.
However, depending on your students’ L1, you
may wish to point out that we use the present
simple after if. Some students may be tempted to
wrongly use the future simple (e.g. Always wear
gloves if you will do a blood test.). Ask students to
read the Language box individually.
5 Elicit/Pre-teach throw, expensive and knife. Tell
students that they are now going to practise
using if + always/never for obligation. Ask them
to scan the conversation between Sarah, a senior
nurse and Anja, a student nurse, and answer the
question: What are they talking about? (The senior
nurse is giving advice to Anja about how to use
sharps in the OR.) Then ask them, individually
or in pairs, to read the conversation again and
circle the correct words in italics. For less
confident students, you may wish to do the first
item as an example with the class.
1 always 2 Never 3 never 4 always
5 never 6 Always
Speaking
6 Ask students to practise the conversation in 5 in
pairs. Monitor and assist them where necessary.
When they have finished, ask them to swap roles
and repeat the activity.
Now do Unit test 7.
Preparing for the next unit
In preparation for Unit 8, suggest the following to
your students:
• Think about how to remove sutures.
• Do some (online) research into caring for elderly
patients in your own country or the country you
are studying in.
The hospital team 7 55
 8 Recovery and assessing the elderly
Briefing
This unit considers the role of the nurse in the
recovery room and then moves to language for the
removal of sutures. The second half of the unit
discusses the concept of age before dealing with the
assessment of a new care home resident.
Caring for a patient in the recovery room
Patients are transferred to the recovery room
immediately after an operation carried out under
general anaesthetic. Observation of the patient’s
vital signs (measurement of the pulse, blood
pressure, temperature and respiration rate) occurs
every few minutes, and these are compared to the
anaesthesiologist’s report. Nurses should also look
out for possible problems caused by obstruction of
the airways (nose and mouth) and issues related to
the patient’s breathing or circulation, which might
include internal haemorrhaging as a result of the
surgery. On waking, patients often feel
disorientated; they may be in pain or feeling some
discomfort, as well as nausea and sickness due to
the anaesthetic. Pain levels are monitored as the
anaesthetic wears off. Patients are discharged back
onto the ward once their vital signs are stable and
they are able to respond to questions. Nurses
continue to observe them every 15 minutes for the
first hour and then hourly. Irregular past simple
verbs are introduced in this section, giving students
the chance to practise delivering a report at the
handover stage, providing updated information on a
patient’s condition.
Removing sutures
Sutures (stitches: patient term) are used to close the
wound to minimise scarring and reduce healing
time. This section presents related vocabulary such
as stitch cutter, sterile gloves and cleansing
solution. Sutures are generally removed within ten
days, although those on the face may be taken out
earlier to avoid possible scarring from the sutures
themselves. The use of sequencers (first, second,
etc.) to explain the procedure serves not only to gain
consent and co-operation but also to help alleviate
any anxiety the patient may feel. Patient stress can
be reduced further by use of the ‘softener’ just. For
an overview of the procedure, refer to the text
Removing sutures on page 62 of the course book.
Talking about old age
Psychologically, older people find their ability to
process information is slower and there are changes
in short-term memory recall. Socially, the older
generation experience a significant transition in
terms of their roles. Added to this, perceptions of
old age differ depending on the person’s culture,
age and gender. Elderly (geriatric) patients can
eventually be faced with the realities of not being
able to care for themselves and may be placed in a
care (or nursing) home. Medically-oriented care
homes today have a capacity for 10 to 30 residents
(not patients), comprising both private rooms and
communal areas such as a dining room and a TV
room. Other facilities might include a laundry room,
a library and a computer room, the aim of which is
to maintain a certain level of independence. Care
homes generally offer activities such as exercise
programmes and day trips to places of interest, even
aromatherapy treatments. Nurses play a key role in
care homes, from planning patient care to
administering medication. Expressions for offering
advice are introduced in this section, to help
students carry out their advisory role, providing
advice to care home residents on therapy and diet.
Assessing an elderly care home resident
Moving into a care home requires a big adjustment
and can often leave the new resident feeling
vulnerable. Indeed, many feel a significant loss of
independence. To facilitate this transition, the nurse
will carry out an assessment of the resident on
arrival. It is important to understand the resident as
a whole and not just their medical problems, if the
staff is to provide appropriate and individualised
care. Beginning with a question such as I’m just
going to ask you some questions first, so that we can get
to know you better. Is that OK? will serve to obtain
permission from the resident before posing a series
of personal questions. Nurses complete an
assessment form to ascertain the type of activities
the resident enjoys, whether they wear dentures,
have eyesight problems or have difficulties moving
around and require a commode or a walking frame.
This final section serves to review not only effective
question techniques but also many of the key terms
covered in earlier units in the course.
Recovery and assessing the elderly 8 56

Teacher’s notes
Warm-up
1 Ask students, in pairs, to brainstorm a list of
supplies for a hospital ward. On the board, write
the three categories: red, yellow and blue. Then
ask pairs to read out their lists, indicating the
correct category in each case. Depending on
your class, you may wish to divide students into
two teams and carry out this activity as a
competition: the first team to complete their
three lists are the winners.
2 Refer students to the stages for effective phone
communication and the telephone messages on
page 55. Ask them, in groups of three, to practise
taking messages on the phone: Student A is the
caller and Student B takes the message. Student
C should use the checklist in 7 to check that
Student B covers all the stages for effective
communication. Monitor and assist students
where necessary. When they have finished, ask
them to swap roles and repeat the activity.
Caring for a patient in the recovery room
Listening
1 Refer students to the illustration and ask: When
do patients go into the recovery room? (after an
operation). What happens in the recovery room?
(Medical staff monitor the patient’s progress
until they are ready to return to the ward.) How
do you think the patient feels? (anxious, tired, in
pain, sick or nauseous). Ask experienced nurses:
What questions do nurses ask patients when they
wake up in the recovery room after an operation?
Some students may be unsure about how to
form these questions in English. If this is the
case, ask them to think about the questions in
their L1 first. Ask pre-experience nurses, in small
groups, to brainstorm questions they think a
nurse would ask. Discuss answers as a class.
Refer students to questions 1–7 and ask them,
individually or in pairs, to complete the missing
words to form questions that a nurse might ask
a patient waking up in the recovery room.
Reassure them by explaining that they have
already come across many of these questions in
previous units. Check answers as a class.
Model the questions, using patient-friendly
intonation and a soft, reassuring tone. Ask
students, in pairs, to practise saying the
questions aloud, first chorally, then individually.
Monitor and assist them where necessary.
1 pain 2 breathe 3 name 4 hear 5 know
6 open 7 feel
2 ► 45 Tell students that they are going to listen
to a conversation between a nurse and a patient.
As they listen, they should tick the questions
from 1 that they hear. Reassure them that they
do not need to understand every word, just the
gist of the conversation. Depending on your
class, you may wish to play the recording twice.
2, 4, 7
3 Ask experienced nurses: What kind of tests do
nurses perform in the recovery room? (vital signs:
pulse, temperature, blood pressure, respiration
rate). Note that students may not know all these
terms in English. If this is the case, ask them to
describe and/or mime the tests and then refer
them to the box in the margin to confirm the
terms used in English.
Elicit/Pre-teach oxygen mask. Then refer students
to questions 1–5 and explain that they are going
to listen to the conversation in 2 again in order to
answer the questions. Play the recording,
pausing at intervals to allow students to write
their answers. Ask them to compare answers
with a partner, then check as a class.
1 every 15 minutes 2 yes 3 no 4 yes
5 a blanket
Vocabulary
4 On the board, draw a pain scale: draw a line and
along the line add the numbers 1–10 to represent
the scale of pain. Draw a smiley face above 1 and
a sad face above 10. Then ask: What is it? (a pain
scale). What is it used for? (measuring the level of
pain the patient is feeling). What does 10 mean?
(10 is the highest level of pain.) What does 1
mean? (no pain). Note that pre-experience nurses
may not yet have come across the pain scale but
encourage them to take a guess as to its use.
Refer students to 4 and ask them, individually or
in pairs, to put the words in the correct order to
form the question the nurse in 2 uses to ask the
patient about her pain. Then play the recording
again for students to check their answers.
Recovery and assessing the elderly 8 57
 On a scale from one to ten, one being no pain
at all, ten being the worst pain, what number is
your pain right now?
5 Model the question in 4, using patient-friendly
intonation. Ask students to repeat it two or three
times (chorally) until you are happy it sounds
natural. Then ask them to practise asking the
question in pairs. Monitor and assist students
with intonation where necessary.
Reading
6 Elicit/Pre-teach airway and anaesthesiologist.
Refer students to the notes. Explain that they
cover the actions a nurse must take when
dealing with a patient in the recovery room. Ask
students, individually or in pairs, to read the
notes and put the actions in the correct order.
Experienced nurses can work in small groups to
brainstorm a list of actions first and then
compare these with the list in 6. Check answers
as a class.
1 Check the identity of the patient.
2 Introduce yourself.
3 Listen to the anaesthesiologist give their
report.
4 Check the patient’s airway is open and
clear.
5 Take the patient’s vital signs every 15
minutes.
6 Compare the patient’s vital signs with the
anaesthesiologist’s report.
Extra activity
Ask students to put these verbs into the past
simple: check, compare, listen, introduce. Elicit/
Pre-teach the past simple of take (took). Then
ask them, in pairs, to imagine they are working
in the recovery room of a hospital. They should
check that their partner has carried out all the
actions on the checklist in 6. (e.g. A: Did you
check the patient’s airway was open and clear?
B: Yes, I did./No, I didn’t. I’ll do that now.). When
they have finished, ask them to swap roles and
repeat the activity. This activity will also serve
as a review of the past simple of regular verbs.
Language
Go through the Language box with the class and
ask students to read out the example sentences.
Point out that sometimes the past simple form of
an irregular verb is similar to the infinitive (e.g.
come – came) but sometimes it is entirely different
(e.g. go – went). Encourage students to keep a list
of the infinitive and past simple forms of
irregular verbs, along with an example sentence,
as and when they meet them.
On the board, write: The patient came out of
surgery 30 minutes ___ . Ask students to complete
the sentence. Explain that we use ago with the
past simple to say when something happened.
Ask a confident student: When did the class start?
Elicit an answer with ago (e.g. The class started an
hour/forty minutes ago.). Ask similar questions
around the class to practise the target language.
Explain that just as with regular verbs, we use
the auxiliary did + infinitive in questions. Point
out the use of didn’t + infinitive to form the
negative. On the board, write: the report / did /
write / you / ? Ask a confident student to put the
words in the correct order to form a question in
the past simple. Explain that the word order
changes when forming questions and use the
example sentence to indicate the correct order:
did + subject + infinitive.
7 Ask students, in small groups, to guess the past
simple forms of verbs 1–12. More confident
students may already know some of these.
1 came 2 woke up 3 brought 4 left 5 told
6 went 7 had 8 gave 9 spoke 10 said
11 drank 12 ate
8 Elicit/Pre-teach dinner and procedure. Explain to
students that sentences 1–4 are about the patient
from 2, Mr Wendall. Ask them, individually or
in pairs, to rewrite the sentences in the negative
form. Point out that they will need to use the
word any in some of the sentences.
1 He didn’t eat any of his dinner.
2 He didn’t drink any water.
3 He didn’t have (any) problems during the
procedure.
4 We didn’t bring him to the recovery room.
9 Ask students, individually or in pairs, to put
the words in 1–7 in the correct order to form past
simple questions. Depending on your class, you
may wish to check answers before asking
students to complete the next part of the activity.
Point out pain medication in question 5 and tell
them that another term used for this is pain relief.
Ask students to write full answers to questions
1–7. Depending on your class, you may wish to
do the first item as an example. Ask students to
compare answers with a partner, then check as
a class.
Recovery and assessing the elderly 8 58
 1 When did Mr Wendall come out of surgery?
He/Mr Wendall came out of surgery five
hours ago.
2 When did the doctor leave?
The doctor/He/She left a minute ago.
3 Did the nurse check his vital signs?
Yes, he/she did./Yes, he/she/the nurse
checked his vital signs.
4 Did the surgery go well?
Yes it did./Yes, it/the surgery went well.
5 Did the nurse give him pain medication?
Yes he/she did./Yes he/she/the nurse gave
him (some) pain medication.
6 Did the patient speak to the nurse?/Did the
nurse speak to the patient?
Yes he/she did./Yes, he/she/the patient
spoke to the nurse./Yes, he/she/the nurse
spoke to the patient.
7 What did the patient drink?
He/She/The patient drank a little water.
Speaking
10 Ask students, in pairs, to take the role of nurse
(Student A) and member of a patient’s family
(Student B). Explain that the nurse should talk to
the family member about the patient’s recovery
and that, when they finish, they should swap
roles and repeat the activity. Depending on your
class, you may wish to brainstorm a possible
scenario before asking students to carry out their
roleplay. For less confident students, suggest
they write out their conversation first. Monitor
and assist students where necessary.
Removing sutures
Language
On the board, write the first three stages of the
checklist on page 61: 1 Check the identity of the
patient. 2 Introduce yourself. 3 Listen to the
anaesthesiologist give their report. Tell students
that we can use the sequencers first, second and
third to explain the order of a procedure. Explain
that we can also use then to indicate the next
stage, and finally to show the last stage of a
procedure. Point out that it is better not to keep
repeating the same sequencer. Ask students to
read the Language box individually.
Note that there are many new lexical items
related to the unit in the Language box; reassure
students that these will be covered as they go
through this section. You may wish to allow
them time to read through the examples in the
Language box once again after completing 1 and
2. For further practice, ask students around the
class to read out the checklist on page 61 using
sequencers to separate each piece of information.
Reading
1 Depending on your class, you may wish to ask
students to do 2 before 1. Avoid pre-teaching
vocabulary from the text; instead, encourage
students to use the context to help them
understand any new words. Ask them to scan
the text and answer the question: What is a
suture? (fine thread used to close a wound; also a
verb: to join two parts of a wound together with
surgical thread). Then ask them to complete the
text with sequencers. Reassure them that it is not
necessary to understand every word, just to
complete the gaps. Check answers as a class.
1 First 2 Second 3 Third 4 Then 5 Finally
2 Refer students to illustrations A–H and ask
them, individually or in pairs, to match the
words in bold in the text in 1 to the correct
illustration. Check answers as a class.
A stitch cutter B sterile gloves C sterile
waste bag D sutures E cleansing solution
F apron G sterile tray H tied back
3 Elicit/Pre-teach inflammation and hurt. Refer
students to sentences 1–5 and ask them to read
the text in 1 again to decide if the sentences are
true or false. Depending on your class, you may
wish to correct at this stage, before asking
students to complete the second part of the
activity. Ask students, in small groups, to correct
the false sentences, then check answers as a
class. Finally, check understanding of securely,
remove, reassure, inside out, inside and around. You
may wish to allow students to check these in a
good bilingual dictionary.
1 F (Patients will probably prefer the word
‘stitches’.)
2 F (It doesn’t hurt.)
3 T
4 T
5 F (You should check before removing the
sutures.)
Vocabulary
4 Tell students that they are now going to read a
conversation between a nurse and a patient. The
nurse is removing the patient’s sutures. First, ask
students to simply read the conversation. Then
Recovery and assessing the elderly 8 59
 ask them, individually or in pairs, to read it
again, matching the words in bold (1–8) to the
words with similar meanings a–h. Ask students
to compare answers in small groups, then check
as a class.
1e 2g 3h 4c 5f 6a 7d 8b
Language
Ask: How might some patients feel when a nurse
removes their sutures? (stressed, worried or
anxious). Depending on your class, you may
wish to allow students to answer the question in
their L1. Explain that, in English, to help reduce
a patient’s stress, nurses often use the word just.
On the board, write: I’m going to snip your
stitches./I’m just going to snip your stitches. Point
out that we place just before the main verb.
5 Ask students to look at the conversation in 4
again and underline all the examples of just
(there are five). Check answers as a class.
You may just feel a pull.
First, I’m just going to clean your wound.
Now I’ll just cut the suture near the knot ...
With these scissors, I’ll just pull out the stitch.
Now I’ll just clean the wound again ...
6 Ask students, individually or in pairs, to rewrite
sentences 1–5 using just. Check answers as a
class. Then ask them, in pairs, to take turns
saying the sentences aloud. Encourage them to
use patient-friendly intonation.
1 I’ll just lift up the suture.
2 I’m just going to cut the stitches with these
scissors.
3 I’ll just check to see there are no signs of
infection.
4 I’ll just leave these stitches in for three more
days to let the wound heal.
5 I’m just going to put a new bandage on the
wound.
Speaking
7 Ask students, in pairs, to practise the
conversation in 4. Encourage them to use
patient-friendly intonation. Monitor and assist
students where necessary.
Extra activity
To reinforce the vocabulary in 4, ask students,
in pairs, to practise the conversation again, this
time using the new language items (a–h).
8 Ask students, in pairs, to practise describing the
procedure for removing sutures to their partner.
Tell them to use the text in 1 and sequencers,
encouraging them to begin their conversation as
per the example at the bottom of the page.
Depending on your class, you may wish to allow
students to write out their conversation first.
Monitor and assist students where necessary.
Talking about old age
Reading
1 Tell students that they are now going to talk
about old age and how people feel about being
old. Ask them, in pairs, to discuss questions 1–4.
Depending on your class, you may wish to give
students time, individually, to think about their
answers before discussing them with a partner.
Encourage them to write down their answers if
necessary. Ask students to compare answers
with another pair, then ask pairs to present their
ideas to the rest of the class.
2 Tell students that they are now going to read a
survey about growing old in the USA. Refer
them to questions 1–4. Ask them, individually or
in pairs, to read the survey and answer the
questions. Depending on your class, you may
wish to elicit/pre-teach the following words
first: depend on, gender, generally, respondent,
majority, nineties, financial security and younger
generation. Check answers as a class.
1 60 years old 2 35 percent 3 89 years old
4 good health, good friends, financial security
Speaking
3 Refer students to the final question in the survey
(Where should old people live?) and then to the two
questions in 3. Elicit/Pre-teach care home,
community assistance and elderly. Elicit examples
of community assistance (a cleaner, meals
delivered, someone who comes to take the
person shopping, to the library, etc.). Then ask
students, in pairs, to discuss the questions,
noting down their answers if necessary. Some
students may have difficulty expressing their
ideas in English; reassure them that accuracy is
not important for this activity and encourage
them to focus on fluency. Depending on your
class, you may wish to allow students to discuss
their ideas in their L1 first. Finally, discuss
answers as a class.
Recovery and assessing the elderly 8 60
 Suggested answers
3 Elderly people feel safer.
They receive 24-hour care.
Nurses can take care of their medical
problems or disabilities.
Their children feel happier that the staff are
taking care of their parents.
Vocabulary
4 Tell students that they are going to talk about
care homes for the elderly in more detail. Refer
them to illustrations A-J and explain that some
of these are facilities (e.g. garden) and some are
activities (e.g. exercise class). Then ask them,
individually or in pairs, to write F (facility) or A
(activity) for each illustration. Check answers as
a class. You may wish to allow students to check
these items in a good bilingual dictionary.
Ask: Which activities and facilities can you find in
care homes in your country? Do care homes in your
country offer different activities and facilities? If so,
which ones? What kind of day trips could a care home
in your town offer?
AF BF CA DA EF FF GA HF IA
JF
Listening
5 ► 46 Tell students that they are going to listen
to a conversation between Edwin, a new care
home resident, and a nurse. Ask them to listen
and write down the facilities and activities from
4 they hear. Reassure them that they do not need
to understand every word, simply get the gist.
Play the recording twice if necessary. Ask
students to compare answers with a partner,
then check as a class.
garden, TV room, nature walks, day trips,
library, computer room, dining room
6 Refer students to questions 1–4. Ask them to
listen again and answer the questions. Play the
recording, pausing at intervals to allow students
to write their answers. Ask them to compare
answers with a partner, then check as a class.
1 nature, reading 2 He has hearing problems.
3 two 4 to keep in touch with his family
Language
Ask: What are Edwin’s hobbies? (nature and
reading). Explain to students that they are going
to look at different ways of giving advice and
making suggestions. On the board, write: Why
don’t you _____? We could _____ . Ask students,
in small groups, to brainstorm suggestions for
Edwin (e.g. Why don’t you visit our library? We
could go for a walk in the country.). Point out that
both expressions are followed by an infinitive.
On the board, write: The pain in my back is worse
today. It’s a good idea to + infinitive. Ask a
confident student to complete the piece of advice
(e.g. It’s a good idea to talk to your doctor about your
pain medication.). With more confident students,
ask: What is the difference between this example and
the first two? (We use It’s a good idea to + infinitive
to give strong advice.). With weaker students,
explain that we use It’s a good idea to + infinitive
for strong advice. Ask students to read the
Language box individually.
Extra activity
Refer students to the audio script for track 46
on page 79 and ask them to underline all the
examples of giving advice and making
suggestions.
Answers
We could go and sit out there tomorrow if you
like .
Why don’t you go to the library this afternoon?
It’s a good idea to reserve a time to use the
computer.
Why don’t we go into the dining room?
7 Elicit/Pre-teach lonely, miss, arthritis, keep in touch
and progress. Ask students, individually or in
pairs, to complete conversations 1–5 using the
expressions in the Language box and the correct
form of the verbs in brackets. Point out that in
some cases (3 and 5) the advice may need to be
stronger. Depending on your class, you may
wish to do the first item as an example. Check
answers as a class.
1 Why don’t you put up 2 you could join 3 It’s
a good idea to speak 4 Why don’t you send
5 It’s a good idea to call
Recovery and assessing the elderly 8 61
 Extra activity
You can use this activity with more confident
students. Divide the class into two groups. Ask
each group to brainstorm 5-10 situations in
which someone would give advice or make a
suggestion and to write the first part of a
conversation for each situation as per the
conversations in 7. Ask the groups to swap
their sentences and to complete them with
advice or suggestions, using the expressions in
the Language box. Monitor and assist students
where necessary.
Assessing an elderly care home resident
Vocabulary
1 Refer students to the title of this section and ask:
What do you think ‘assess’ means? (test; ask
questions to understand a person/situation better).
Reassure them that they will be looking at this in
more detail as they go through this section. Point
out that we use the word resident for someone
who lives in a care home, not patient. Refer
students to photos A–F and ask: Who might use
these aids? (elderly people/patients, patients who
need aids to carry out simple daily functions like
walking, reading, hearing, etc.). Then ask them,
individually or in pairs, to match the photos to
the words in the box. Check answers as a class.
A dentures B grabber C walking frame
D glasses E commode F hearing aid
2 Tell students that they are now going to make
definitions for the aids in 1. Ask them to look at
1–6 and a–f and, individually or in pairs, match
the sentence halves to make the definitions.
Depending on your class, you may wish to do
the first item as an example. Note that some
students may find this activity a little difficult;
encourage them to use the language structure in
each sentence half to help them find the
answers. For experienced nurses and more
confident students, you may wish to ask them to
write their own definitions first and then
compare them with the definitions in 1–6. Check
answers as a class, then ask students to match
the definitions to the photos in 1.
1 c (photo E) 2 f (photo A) 3 e (photo D) 4 b
(photo B) 5 a (photo F) 6 d (photo C)
Listening
3 ► 47 Tell students that they are going to listen
to a conversation between a nurse and Dipak
Gyawali, a new care home resident. Explain that
the nurse is assessing the resident. Ask: Why do
you think the nurse is assessing the new resident?
(to find out more about him, his personality,
likes, dislikes, etc. Experienced nurses may also
answer that the nurse is assessing the resident in
order to be able to give him better care and
understand his needs – medical, physical,
psychological, etc.). Refer students to the
assessment form and check that they understand
the statements. Ask them to listen to the first
part of the conversation and choose the correct
words in italics. Play the recording (twice if
necessary), pausing at intervals to allow
students to select their answers. Ask students to
compare answers with a partner but avoid
correction at this stage.
1 Dipak 2 I see my family 3 Impolite or
unfriendly people 4 Italian and Indian 5 eggs
6 wear
4 ► 48 Refer students to the second half of the
assessment form and ask them to listen to the
second part of the conversation and complete
the missing information. Play the recording
(twice if necessary), pausing at intervals to allow
students to write their answers. Ask students to
compare answers with a partner but avoid
correction at this stage.
1 tennis 2 cricket 3 classical (music)
4 traditional 5 sports 6 the news 7 don’t
(really) read 8 walking stick 9 walking frame
10 don’t need 11 grabber 12 don’t have
13 have 14 glasses
5 Compare answers for 3 and 4 as a class. Before
confirming, you may wish to refer students to
the audio script for tracks 47 and 48 on page 79
so they can check their answers.
Writing
6 Ask students, in small groups, to read through
the question and make a list of possible answers.
Discuss answers as a class.
Recovery and assessing the elderly 8 62
 Suggested answers
Care home staff need to understand the
resident as a whole (personality, family
situation, friendships, support network) and not
just their medical problems. They need this
information so they can take better care of the
resident, suggest activities the resident might
like to do, other residents they might like to
meet and to make sure they don’t eat foods
they don’t like or foods they are allergic to.
Language
7 Tell students that they are going to review
question forms. Depending on your class, you
may wish to review question words (how, what,
where, when, etc.) before asking students to carry
out the activity. Ask students, individually or in
pairs, to complete the questions from the
conversation in 3 and 4 using the words in the
box. Check answers as a class. If necessary, go
through the question forms in more detail.
1 What 2 How 3 What 4 Who 5 What
6 Do 7 Are 8 Can 9 When
8 Ask students, in pairs, to take turns asking and
answering the questions in 7 using the
information in the conversation in 3 and 4 to
help them. Encourage them to use full answers.
Check answers as a class.
included in the case studies. On the board, write:
I’m just going to ask you some questions first so that
we can get to know you better. Is that OK? Explain
that it is important to ask the resident/patient
first if
it is OK to ask personal questions (i.e. to obtain
permission from the resident/patient). Model
the question and ask students to repeat it, first
chorally, then individually, until you are happy
it sounds natural.
Using case study 1, ask B Students (the nurse)
to interview A Students (Ms McDonald).
Encourage B Students to introduce themselves
first, request permission to ask questions and
then carry out the assessment. Remind them to
use patient-friendly intonation. Depending on
your class, you may wish to allow students to
write out their conversation first. Monitor and
assist students where necessary. When they have
finished, ask them to swap roles and, using case
study 2, carry out the second assessment.
Depending on your class, you may wish to ask
pairs to act out their conversations in front of the
class or in small groups. Encourage ‘observers’
to provide constructive feedback.
Now do Unit test 8, Progress test 4 and the Exit
test. For the Listening part of the Progress test,
use track 41. For the Listening part of the Exit
test, use track 46.

Suggested answers
1 Please call me Dipak./I would like to be
called Dipak.
2 I feel a little sad.
3 I enjoy spending time with my family, tennis,
cricket, music and watching sports on TV.
4 They are my grandchildren (Sunita and
Razu).
5 Impolite and unfriendly people make me
angry.
6 Yes, I like Italian and Indian food./Yes I like
curry, pasta and fruit like pineapple and
mango.
7 I don’t like bananas and eggs.
8 Yes, I can.
9 I saw them last month.

Speaking
9 Tell students that they are going to carry out an
assessment of a new care home resident. Put
them in pairs and refer them to case studies 1
and 2. Ask A Students to complete the
assessment form for Ms McDonald and B
Students for Mr Simpson. Encourage them to
invent any information that has not been

Recovery and assessing the elderly 8 63