If you have a look at my wix, you'll see that I have set up a simple page with an introduction to me (who am I? -apologies for the photos!) and a section on resources (I plan to add to it) and Links (to my facebook page, twitter and webpage)
I'm not sure how I heard about Wix but I thought I'd have a look and see what it was about. It appeared to be a very simple way to set up a web page. I thought I'd try it out and made a wix called 'Teaching English for Medical Purposes' . Very simple to use with only a few choices for editing which are located on the left side bar. Good, I thought. I can manage this.
If you have a look at my wix, you'll see that I have set up a simple page with an introduction to me (who am I? -apologies for the photos!) and a section on resources (I plan to add to it) and Links (to my facebook page, twitter and webpage)
I started thinking about how the wix could be used in the class-room or even on an online course. Teachers could set up a tab for their resources-perhaps some additional reading texts or 'word of the day' and students could have a tab for their contributions. Contributions could include an agony aunt (teacher) section where students ask advice about situations relating to English communication which they find difficult. Students may like to develop revision materials which they could upload for others to do. Finally, students could start a reflective journal, something which both doctors and nurses need to do as evidence of professional development.
You can add as many tabs as you like using the simple + button on the left hand side of the page. A small class could have one tab per student. Adding images is also easy. I tend to use Jing to make a screen capture of an image.
'SLC Specialist Language Courses brings together the best in business, industry-specific, exam, higher education, and specialist leisure language learning providers from around the world.We offer language schools and English courses, in-company training and languages for professionals, homestay tuition, cultural training, work placements, and online programmes. Courses are targeted, customisable, flexible, and offer excellent value.'
I am involved with SLC as a Consultant in English for Medical Purposes along with Byron Russell, Pete Sharma ,Seth Dickens and Nik Peachey. Without blowing my/our trumpets too much I think I can say that the reason we are involved is because we are specialists in our fields. This has become more and more important in ESP course development and course provision. In the early days of the Business English course, I had the experience which is shared by many teachers of being invited to develop a course in 'English for Nursing and Health' because 'you were a nurse,weren't you?'. Teaching materials were scarce, grossly outdated or non-existent. This was one of the reasons I co-wrote 'Cambridge English for Nursing' with Patricia McGarr in the first place.
I had been approached by my boss at an ELICOS school at an Australian TAFE (college of technical and further education) to get a 10 week course together for English students who were hoping to continue with studies in the healthcare or childcare area. I had to cover Nursing, Massage Therapy, Naturopathy, Childcare and anything else which was vaguely medical. Every year there was a Study group form Japan who would come over for a week. Invariably I would be told that they were all radiologists and would find that they were actually optometrists so would have to change lessons from lots of information about bones and X-rays to lots of information about eyes. Fortunately, they were too polite to complain.
By 2006 I had moved from the ELICOS department to Learning Support with lecturing in the Diploma of Nursing tipped into the job description. It quickly became obvious that international students needed a lot of support throughout the course and would have done well to have completed some pre-arrival learning as the health-related courses were very rigorous. International students had particular difficulty with workplace placements. It was already challenging for students to enter a hospital, nursing home or naturopath/massage clinic which was unfamiliar territory. Then, add the language challenge within a pressured environment and stress levels rose each week.
It became clear to me that training in the specialist language nurses would be using was imperative. The difficulty was to balance the technical language they need with the basic communication skills they would be using. The dialogues which I wrote for the 'Cambridge English for Nursing' books all came from personal experience. Some were jumbled together and some were experiences I had had but 'fixed up' to be better communications or rather the sort of communications we want nurses to achieve.
I have modified my views on the sort of input I would like to see in course books and in courses as I continue to work in hospitals in the South-West of England. Because I work as an Agency nurse, I tend to move around different wards and units and have the opportunity to experience how a newcomer feels. Each new place I work, I have to ask where things are kept and ask about the particular policies of the unit. There are a lot of communications to check that I am filling out paperwork as they want it filled out and to ask about things I am unsure of. It has given me a taste of the feelings of the newcomer without the stress of not speaking the language confidently. Terminology is not standard everywhere but it is usually only a few things which are slightly different. I hope that standardisation is coming as it is ridiculous to have three or four expressions for the same thing. I still find it odd that a blood glucose test can be referred to as a 'BM' (blood monitoring), cbs (capillary blood sugar), bsl (blood sugar level) or bgl (blood glucose level) !
Because I feel that overseas healthcare professionals need to understand medical and hospital terms to be able to work confidently in an English-speaking environment , I am writing books in a series 'English for Medical Purposes'. The books aim to supply practice in the vocabulary used while working in hospitals or nursing homes and practice in using the sorts of charts and documentation used in the workplace. They are more content-based than communication-focused course books. As such they complement the books which are currently on the market for doctors and nurses. Learning to communicate well in English is essential for the 'caring professions' but it is also important to have the vocabulary to communicate with. I hope my books are able to supply this!
Latest from a 'group of senior doctors and nurse' suggests that a standard,national system of recording Vital Signs could save a significant number of patients by alerting staff to the beginnings of health crises which could be treated sooner rather than later. The 'Early Warning Signs' or EWS form part of most Observation Charts but the procedure for reporting them is not standard and can lead to confusion. As an Agency Nurse I work in different wards across several hospitals, all NHS. They do not have the same system of reporting and charts can also be slightly different.
The colour-coded system was put in place by NSW Health a while ago as the SAGO system . The chart has a 'track and trigger' design which is coloured with Yellow Zones (early warning) and Red Zones (Rapid Response). On the back of the chart is a clear flowchart of the correct responses for each zone. There is no guessing involved. For example, if the blood pressure drops to a reading within the Yellow Zone nurses are guided in the response to take. The screen shots below have been taken from the 'Between the Flags Program' website of NSW Health as an example of the system.
For teachers and learners of English for Medical Purposes, these charts are great resources. Near authentic resources which can form the basis of role plays e.g nurses reporting the early warning signs of a patient 'Joseph Bloggs' . It's a good time to review expressions which describe increase in or decrease in ,e.g dropping, going up. Also, expressions used when talking about respiratory rate e.g. faster,slower, laboured.
Review the medical terms and abbreviations used in the chart as well, e.g arterial blood gases, PO2.
Charts such as these are important resources for students in EMP courses who aim to be able to work as healthcare professionals. The charts often form the basis of communications with colleagues during handover or patient review so it is essential that students feel comfortable using the specific language used in the charts. Developing a template for a discussion about patient observations is often helpful so that students feel confident when the time comes to initiate the conversation in the real environment.
Starting a conversation with a colleague about changes in a patient's vital signs may use expressions such as:
' I need to report some changes in Mrs Smith's Obs.'
'Mrs Smith is ambering now' (to amber = have a reading which is in the trigger zone)
'I'm concerned about Mrs Smith's Obs'
Expressions to explain a change in Obs may include:
Her BP is dropping, falling, decreasing
Her BP is rising, increasing, going up
Her pulse is fast, slow, bounding, thready
Her resps are slowing,depressed, rapid, laboured
Her temp is rising, falling. She's febrile/pyrexical. She's hypothermic
There's also scope to practise numbers. Temperatures are described ,for example, as 37.6 (thirty-seven point six) .Blood pressures are described as 'a number' over 'a number' ,e.g 160/110 = one hundred and sixty over one hundred and ten.
Numbers are often a challenge to remember quickly so practise beforehand is a good idea. A useful hint when practising blood pressure numbers is to practise the obvious ones,e.g 90/60, 110/70, 120/80,160/100 . Remember that digital machines give a more accurate number than manual sphygmomanometers e.g 93/62
'English for Medical Purposes:Medication Calculation for Nurses' provides practice in this area. A sample page :
An article in the BBC the day before yesterday, Kane Gorny inquest: Hospital neglect contributed to death was echoed in media reports on radio and newspapers and highlighted so many issues relating to nursing care and the current hospital culture not only in the UK but in many countries around the world. A summary of this tragic case is that Kane Gorny was not given the care he should have been given,not only by nursing staff but also by medical staff. The case was finally heard this week after two years of distress to Kane's family and,I would imagine,distress to the staff touched by the case.
I don't want to comment on the specifics of the case,nor should I as I don't know all the facts but I do want to go through some of the issues I think this case raises. And these issues are not new. They are raised again and again.
Firstly, I listened to a radio interview which asked the inevitable question 'Why don't nurses care about their patients any more? It wasn't a phone in programme or I would have expected to hear a lot of retired nurses phoning in to say that they managed wards filled with 60 patients and managed to feed and water them and fluff their pillows as well. The inevitable question is then asked about the value of university education versus hospital training.
I trained in a large public hospital in Sydney from 1979 to 1982. Hospitals were full of trainee student nurses as we had three intakes a year. The work was task oriented. One nurse did all the dressings,one nurse did all the washes, one nurse did the Obs. The dressings were simple and done several times a day, not allowing for any healing to occur. Either saline packs, dry dressings or Eusol 1:8. No documentation of what was done apart from 'dressing attended' written in the notes. These days, a Wound Care Assessment is made,often by a specialist Tissue Viability Nurse. A photograph of the wound may be taken after written permission has been gained ( a different form to fill in). Selection of a dressing is then made using specialist knowledge which needs to be updated frequently as policies change or new dressings come on the market. After the dressing is 'attended' , the care is documented. Compare this procedure to the 15 minute dressing done in 1980. Do we want to return to the 'good old days' when dressings only took 15 minutes and used less resources and staff time? Of course not. Nurses know what they do now follows best practice and their patients expect this.
Now, extract ' performance of dressings' and replace with any of the many nursing activities performed during a shift. Nurses don't just perform an activity. Each activity is assessed, planned,implemented and evaluated; this follows the so-called 'Nursing Process'. Paperwork must be filled in to ensure that care plans are followed and treatment is consistent. This is part of good communication but it takes time.
In a previous hospital where I worked I was asked to be the Project leader for the implementation of the Productive Ward Project. The Productive Ward aims to 'release time to care' by ensuring that the ward and its procedures are performed in as efficient a way as possible. This is a useful project ,however, whilst it doesn't pretend to deal with staff shortages, these are critical to address if time is to be available to spend with patients. No amount of tidying and reorganisation of stock will solve the problem of insufficient staff numbers. This is the second issue to come out of this sad case. Patients who are at a high risk of adverse incidents such as falls need one-to-one supervision or at the very least need a nurse to be present in the bay to keep an eye out for them. The set up of many hospital wards does not allow for constant visualisation of patients. This is especially true of the bay ward set up and also isolation 'side rooms'. Nurses need to enter the bays to see their patients and/or remain in the bay to monitor patients who are at a high risk of an adverse incident. Wards which are stretched for staff find that allocating one staff member to 'special' a confused or aggressive patient causes impossible strain on the remaining health care assistant who is left to manage the rest of the patients. And ,remember that some patients need two staff members to assist them to mobilise or use the toilet.
I have been in the situation at work where I don't know who to help first. To relatives who sit with their loved ones, it seems as though the patient has been forgotten. As nurses, we find ourselves saying 'We're just coming now to help' over and over. It was for this reason that NHS hospitals instituted the system of 'Intentional Rounding' for vulnerable patients. Every hour or two hours (whichever is assessed as appropriate) , nursing assistants do a round of vulnerable patients and offer fluids and toileting and check the bedside environment for safety. Pressure areas are also checked as it is known that pressure ulcers can start to develop within hours in immobile patients. Intentional Rounding ,whilst it may be seen as 'yet another form to fill in' ,is a good way of keeping basic nursing care in the forefront of the mind.
The final issue which I think this case raises is that of the changing make up of hospital patients. Surgical patients have a much quicker turn around than they used to when I started my training. In those days, patients were often still on the ward 7 to 10 days after surgery so we even removed their sutures before they were discharged. Orthopaedic patients were in traction for weeks and relatives almost became family members we saw them so often! These days, day surgery and minimally invasive surgery means that patients come into hospital in the morning and leave in the afternoon or early evening of the same day. Orthopaedic surgery such as hip replacements may take up as few as three hospital days. Patients need to be mobilised almost immediately on return to the ward and organised to leave as soon as possible. There are obvious benefits to day surgery and the quicker recovery times for patients,however, it has changed the style of nursing care and the pressures placed on nurses.
Medical patients have also changed. Where once we cared for the elderly we now care for the very elderly. Patients in their 90s visited by their 'children' who are in their 70s. The overlay of dementia in many elderly patients,both surgical and medical, places extra strain on nursing staff who try to manage patients' physical needs and ensure their safety. Simple care such as nutrition and fluids can be very difficult to achieve in patients who are confused or who have significant dementia. To give a recent personal example. I worked on a medical 'overflow' ward yesterday. We had four elderly patients out of 12 who had significant dementia and who needed constant encouragement to eat or drink anything. Each time fluid and food was offered, one member of staff had to cajole the patient into taking a mouthful. This happened every hour as I had instructed the healthcare assistants who worked with me to try to get the patients to at least have a mouthful of drink each hour and to document success or failure and report back to me. I worked with a good team who managed to get fluids and a minimal amount of food into the patients but it was time-consuming and would have been near impossible had any of the other patients needed more than the minimum amount of their attention.
These changes have not occurred overnight. We know that there are more 'very elderly' patients in our hospitals as people live longer. We know that the Baby Boomers are ageing. What people have perhaps not grasped is that the very Baby Boomers who are ageing form a large cohort of nurses. This is the large group who are on the verge of retirement. If we do not support younger nurses and encourage more people into nursing we are faced with a dire situation. This is not happening in one country only. This is a global problem and one we have seen coming for a long time.
I recently wrote a comment on the Nursing Times site regarding the Kane Gorny case. In essence I stated my viewpoint that nurses do not go into nursing not to care. They endure low pay and dismal working conditions which look to be made even more dismal. They certainly don't pick nursing for the salary or glamour factor. They pick nursing because they want to care. Nurses who are coming up the ranks need training to be able to care - they need support to learn the art of nursing. I firmly believe that nurses need the university level education they are now receiving to cope with the technical changes in healthcare and nursing. On the other hand, I believe they need more support to be able to put this knowledge into practice - to learn the art of basic nursing care which will help them make sense of the theory they have learned. If I took anything from my hospital training it was the ability to see concrete examples of the nursing care I needed to perform. This will always be the dilemma for educationalists in nursing., that is, striking a balance between theoretical learning and its practical application. I remember being in my last year as a student nurse and coming across a young boy who was suffering a prednisone induced psychosis. I have never forgotten his reaction and have never forgotten to monitor a patient's steroid intake carefully since.
I wonder what changes will come out of the very sad Kane Gorny case publicity. I hope many nurses will be able to find a voice to insist that hospital culture is changed and that nurses receive the support they need to learn the practical skills they need to cope with changing hospital conditions. I also hope that this case is not dealt with using the all-to-familiar blame culture which still exists in hospitals. This cul
I have been plodding along in self publishing for a few months now, making very small in-roads and making small sales,however, I would like to publicise myself more. I have decided to discount all English for Medical Purposes books on Lulu by 30% for the months of July and August to try to entice medical English students to buy and try.
In the mean time, the 'English for Medical Purposes:Doctors' continues to be used in a pilot programme in Belo Horizonte,
Brazil with good feedback from the doctors undertaking the course. There is more and more interest for medical English courses of this type as the world shrinks and people continue to travel. In effect, there are two strands to this type of EMP. The first is to provide practice in communication focussed activities so that doctors or nurses can talk with tourists who fall ill while travelling. The example of Brazil is becoming more common. Sporting or other events like The World Cup or Olympics draw many more tourists than usual to a country and,unfortunately, some of these tourists will be injured or fall ill during their stay. Doctors and nurses need to be able to communicate with them, sometimes under trying circumstances. Whilst an amount of medical terminology instruction is needed, mostly this will already be understood. The only difference may be pronunciation. What may not be understood are the everyday health terms which patients often use to describe symptoms. Expressions like 'bunged up' (constipated) or 'pissed' (very drunk) may not have been learned during General English courses!
The second strand which is increasing because of economic factors is 'medical tourism'. This describes the accessing of medical facilities overseas,typically cosmetic surgery, because costs are much lower than in the UK or USA. Any surgery requires careful post-operative instructions about medication and dressing changes to be given to patients. This is often done using English as the common language.
The materials required for these applications will need to focus on verbal communication skills with minimal writing practice in contrast with a course aimed at preparing doctors or nurses to work in a healthcare environment where they need to use appropriate hospital documentation and charts.So, understanding the NHS or Australian Health System would be a waste of valuable speaking practice time. Despite this,differences in the cultural expectations of patients and healthcare professionals should be examined to avoid serious difficulties. It is as well for doctors and nurses to be prepared for the kind of expectations their overseas visitor patients may have regarding time scales and the hierarchy of staff as they may differ from their own. For example, an overseas patient may interpret 'the doctor will see you soon' to mean 'within half an hour' whereas what was meant may have been 'probably not for a few hours'. Sometimes overseas patients may become anxious when procedures are performed differently from what they are used to and may fear increased risk of infection for example. It is important to be able to explain the procedure and reassure patients that the same precautions are followed albeit in a different way.
Another week and I've made good progress and learnt a bit more.
1. I decided to check out the lens which were similar to mine. I found some very good one to do with prefixes at 5th-6th-grade prefixes and suffixes. Also, some lenses directly related to nursing such as the NANDA nursing-diagnosis and How much does a CNA earn?
2. I'm still trying to understand back links with limited success.
3. I've also run Health Checks on my lens through the very useful Squidutils site . I discovered the importance of having the right Primary tag. And,having enough relevant tags for my lenses. I have tried to improve my tags which may have made a difference to my lens views which have increased.
4. I have not had any more Guest Comments and very few likes or tweets.
5. Another very useful connection was joining Authors Den , an authors' website where I have been able to showcase my lenses as well as post related articles. The response has been very positive. I am hoping that the flow on will be to my Lulu site which will result in more sales of my books and ebooks.
6. I have been pinging my lenses which should also result in more traffic but I am not sure how to judge it.
7. I have also used Stumble Upon to post my lenses as suggested by SquidUtils.
8. Digg was another site recommended by SquidUtils to draw attention to my lenses.
9. I have managed to get extra points for liking lenses and doing any quests which are open. My biggest point bonus was a very generous 500 points for logging in 30 days in a row.
I decided to have a look at the free nursing journals which are available online. International nurses who want to improve their English language skills often don't want or can't afford to subscribe to journals which will give them access to the vocabulary they need to work in an English-speaking country. I looked at the following journals and found a wealth of great resources which are completely free.
A quick review of free Nursing journals in English reveals:
The International Journal of Nursing and Midwifery has an archive of excellent articles going back to July 2009.
The journal of AORN, Association of periOperative Registered Nurse has peer-reviewed articles for nurses who work in the peri-operative field.
The BMC (Bio Med Central) is an open access, peer-reviewed journal that considers articles on all aspects of nursing research, training, education and practice. All articles are peer-reviewed.
The Internet Journal of Advanced Nursing Practice has some very good articles of current advanced practice nursing
The Iranian Journal of Nursing and Midwifery Research has archived articles going back to winter 2011.
The Journal of Nursing and Care is an Open Access Journal with a wide range of articles on general nursing care.
World of Irish Nursing has a range of articles, some about workplace issues, others about health issues relevant to the Irish health system
Apart from sites which are only in English, there are a few which are bilingual,for example
The Brazilian Text and Context Nursing which is available in Portuguese, Spanish and English
The Canadian Aporia The Nursing Journal which is in English and French
Make use of these free resources to practise the specialised language you need to use as Registered Nurses, Enrolled Nurses and Nursing Assistants. If you have a printer, print out an article you are interested in, read the article and revise unknown vocabulary. Does the article describe nursing procedures which are the same or similar in your country? How are they different? Are any of the nursing terms used recognisable to you?
On 17 May, 2012, The NHS employers website published an article called ‘Consultation on responsible officer regulations’ advising that surveys for public opinion on the amendments to regulations relating to Responsible Officers (RO) are to be submitted to the Department of Health by 13 July 2012. According to the website, consultation by the Department of Health will be in three areas, namely:
1. Deciding on the role of the NHS Commissioning Board in nominating and appointing Responsible Officers
2. Deciding on the role of Responsible Officers in assessing the language competence of overseas-trained doctors who are working in England.
3. Establishing whether a local authority will come within the definition of 'designated bodies' if the local authority has a connection to a public health doctor for example and whether a local authority could act as a responsible officer for doctors.
As an EMP (English for Medical Purposes) specialist, my main interest is in the area of language competency assessment of overseas trained doctors. The background to this issue is the fact that currently in the UK only non-EU healthcare professionals (doctors, nurses, physiotherapists, dentists etc) have their language skills assessed. I am a non-EU nurse who had to pass each of the four skills of an IELTS (International English Language Testing System) at a minimum of 7.0 before registering as a nurse in the UK. English is my first language. The UK is unusual in comparison with other English-speaking countries in that only non-EU workers are tested: EU health care professionals do not have their English language skills tested before working in the UK.
Recently, this anomaly was reviewed at European Parliament level which then started the process of thinking of the testing of all overseas-trained doctors but not all overseas-trained nurses for various, to my mind, bizarre reasons. Leaving this aside, I was interested to read Chapter Three of the ‘Consultation document: Responsible officers in the new health architecture’
Looking through the chapter, I came across a few points which raised questions in my mind about the effectiveness of the current system and likely effectiveness of the mooted system.
First, I read that the The National Health Service (Performers Lists) Regulations 2004 already require Primary Care Trusts (PCTs) to refuse to admit overseas-trained doctors, dentists or opticians to a Performers List if the PCT does not feel that the applicant ‘has the appropriate English language knowledge to enable them to carry out their function as a doctor in the PCT’s area.’ The idea being that the The Performers List ensures that the overseas doctor is ‘fit for practice’ i.e can work safely by being able to communicate effectively in English and therefore safe patient care is ensured.
Responsible officers in England (other countries in the UK have different regulations) have the same or similar functions to the PCTs . However, whilst ROs have a duty to check that medical practitioners have the required qualifications and experience for the job, there is no specific duty to check language competency.
On the other hand, The Coalition programme for government committed to ensure that foreign ‘healthcare professionals’ (did this include nurses?) have an adequate level of language competence so that NHS patients are not put at risk or harmed because of communication break downs.
Looking at the situation of doctors (as the nurses’ situation hangs in the balance) ,The Coalition agreement would tend to suggest that the RO legislation needs to be amended to make it clear that the function of a Responsible Officer explicitly extends to the testing of language competency before an overseas-trained doctor can set foot in a hospital and communicate with patients and colleagues. My first thought was, ‘ How is this to be done?’
The following section (section 3.7) talks about assessing language in a ‘proportionate way’ including a ‘proportionate use of language tests’. My next thought was ,’ Which language tests are they thinking of ? This is not explained or mentioned from what I can see.
The only reference to ‘how this competence would be assessed’ seems to be in stating that guidance would be sought from the GMC and the NHS Commissioning Board. ‘Guidance could also be amended quickly to take account of changing circumstances, such as any scheme intended to apply across healthcare professionals more generally’. I presumed this to refer to nursing.
Again, the proposal that ROs will notify concerns regarding language competency to the GMC does not include any clues about how the RO will assess language competency.
Cost was also alluded to but felt to be quite low, as ‘Under the existing system PCTs and NHS Trusts are required to undertake checks’ so it was felt there would be no change in test costs. But, I still felt I was missing something. What tests? My understanding was that there is no testing of EU doctors allowed so how can there be existing costs for ‘checks’ or are these ‘checks’ informal conversations with prospective doctors which are costed as admin time?
My final musings were about the ROs and their own competence to assess language competency. Surely this should be done by language specialists? If not, why did I have to undertake an IELTS test ( a language test administered by language specialists) before I was able to apply for nursing registration in the UK? It is already a silly situation whereby doctors and nurses (and other health care practitioners) from English-speaking countries who most probably count English as their first language have to front up for an IELTS test when their European colleagues who probably do not count English as their first language, do not. Having said that, in most English-speaking countries, everyone fronts up to prove their language competency before registering as a doctor or nurse or similar.
In Canada, nurses sit a CELBAN (Canadian English Language Benchmark Assessment for Nurses) http://www.celban.org/celban/display_page.asp?page_id=1 which specifically tests the ability to speak the English required for the healthcare environment . In other words, EMP. The question of whether IELTS is an appropriate language test for healthcare workers is another issue, however, at least it is a language test of some sort and of international recognition.
Many NHS hospitals have English classes for overseas doctors and nurses already working in the system. Obviously the need is recognized but it would seem a little like closing the stable door a bit too late.
co-author of 'Cambridge English for Nursing' Pre-Intermediate and Intermediate+