Wounds, Charts and Medication:

1. Wounds, Charts and Medication: Tips on teaching nurses Virginia Allum

2. Introducing ..Virginia Allum • Co-author with Patricia McGarr of ‘Cambridge English for Nursing’ (Int Plus and Pre-Int) • Currently Staff Nurse in a private hospital (mix of private and NHS patients) • Productive Ward Project Leader and Infection Control Link Nurse

3. Our session today • We’ll look at Wounds (an example of a nursing procedure ) / you’ll do some medical terminology activities • We’ll look at Charts (example of common writing skills needed by nurses) / you’ll complete a Wound Chart • We’ll look at Medication (use of maths terms and abbreviations) / you do a Find-a-Word

4. Before we start , Why teach Specialist English for Nurses? Nurses leave NHS for better life abroad Daily Mail 7 Nov,2010 ‘An increasing number of overseas nurses are already arriving in Britain to fill the rising number of hospital vacancies. Last year Britain imported 8,500 nurses and midwives - many coming from poor countries such as India, Pakistan and the Philippines.’

5. What do stakeholders demand of overseas nurses? • Ability to communicate effectively • Safe practice • High standards of technical knowledge • Cultural sensitivity and awareness • Good teamwork • Ability to work with other Health Care Professionals www.nursepostcard.com

6. Here to Stay? International Nurses in the UK 2003 (NMC) Four main areas of concern for hospital managers who employ overseas nurses 1. language 2. differences in clinical and technical skills 3. racism in the workplace 4. reaction of patients.

7. Language areas of need • Everyday communication • Nurse-to-nurse communication • Technical knowledge (medical terminology) http://www.nursingtimes.net/pictures/182xAny/7/2/1/1205721_1205409_nurse_talking_paperwork.jpg

8. Let’s look at wounds... • Or any nursing procedure • Specialised language (look at wound websites, prefixes + suffixes) (R, S, L, W) • Recycle general English (asking for info, giving advice, assessing pain, giving directions) • Maths terms e.g dimensions of wound, amount of discharge • Opportunity for role plays

9. A word about role plays • They are serious enough for ESP • Perfect opportunity to use specialised language in authentic situations (lots of handovers, telephone referrals in nursing) • Ss can write them and own them • Bring in guest speakers (e.g real nurses or student nurses ) to confirm authenticity

10. Wounds: opportunity to look at... • Verbal descriptions e.g. in handover • Written descriptions e.g. Wound Chart • Abbreviations • Equipment e.g Dressings • Documentation: Care pathways • Staff in specialty areas: Infection Control Nurse, Tissue Viability Nurse

11. What is there to say about wounds? • Types of wounds (surgical, ulcers, lacerations • Position on body (on the right ankle) • Description ( order of adjectives) • Colour (of the surrounding skin, wound discharge) • Size (width and depth) • Amount of exudate (small, moderate, copious)

12. What else? • Presence of drains • Equipment used (VAC) • Dressings ,surgical tape, bandages • Sutures, clips, staples and Steristrips • Nursing jargon v medical term (healing v granulating )

13. Types of wounds • Vocab : use Pharmaceutical company websites e.g. http://int.hansaplast.com/med-info/wound-care-beautiful-healing/types-of-wounds.html • Use pictures or diagrams ; match terms e.g. Match medical term to everyday term e.g contusion = bruise • Use nurse education on Pharmaceutical sites e.g. T.I.M.E on Smith & Nephew

14. Warning: Pictures of wounds on next slide • Use authentic photos of wounds if possible • Be advised that some are pretty awful! • Next slide : not too bad but..

15. 11 3 2 4

16. Now, in pairs, do handout exercise 1.

17. Describing a pressure wound What can you get out of it for a lesson? • Use body diagram (front and back) –see WSheet • Practice of body parts (everyday v medical term) • Practice of ‘ Where is the wound? (Position of the wound)- The wound is over the right lateral malleolus (ankle)’ • Exercise: Blank diagrams of the body with numbered wounds. In pairs, Where is wound (!)?

18. Body Diagrams • Terminology (body position – anterior, posterior etc) – on the back of.. • Parts of the body e.g where pressure ulcers may occur - on her sacrum • Everyday terms versus medical terminology - shoulder blade – scapula

19. Now, in pairs, do Exercise 2 • Look at the numbered diagrams of the body • Complete the table using terms in the box below • Further activities: make up double-side cards (everyday term one side, medical term reverse side) – pr work. • Speed work, 2 groups , complete table on WB . First team to get rid of cards, wins

21. Humerus Outside ankle bone back of the head calcaneus inside ankle bone Thigh bone pinna shoulder blade hip bone lower back Olecranon process spine flank Humerus Outside ankle bone back of the head calcaneus inside ankle bone Thigh bone pinna shoulder blade hip bone lower back Olecranon process spine flank Humerus Outside ankle bone back of the head calcaneus inside ankle bone Thigh bone pinna shoulder blade hip bone lower back Olecranon process spine flank

22. Matching cards - example

23. Using websites for inspiration • http://news.bbc.co.uk/1/hi/health/1751163.stm 'Living bandages' for wounds The technology for the 'bandage' was adapted from drinks cartons

24. Online: BBC Radio Transcripts http://www.bbc.co.uk/radio4/science/casenotes_tr_20050208.shtml RADIO SCIENCE UNITCASE NOTES 9. - Wound Healing

25. Use clips on websites: Wounds UK http://www.wounds-uk.com/ • Use demonstration videos as Listening Practice. • Prepare worksheets (missing terms) • Vocab matching • Ss design a teaching session e.g. How to set up a negative pressure wound treatment / in prs teach each other

26. Charts and Documents • Legal documents • Completed each shift • Used as communication between shifts • Nursing Care Plans • Integrated Care Pathways (Wound Charts) • Policies and Procedures

27. What are Nursing Care Plans?http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=32 • Use the online resource to create a printable Care Plan • Use as vocab resource • Use as ‘Handover Resource’ – S (nurse) gives information about wound care during handover e.g I’ve encouraged increase intake of protein-rich foods to help healing.

28. Integrated Care Pathways Wound Chart • ICPs require nurse to tick correct box • Reading > Writing • Specific terms used • Assessment often uses grading system (Grade 1: not too bad → Grade 5 : very serious

29. Wound Chart on p2 of worksheet • Vocab work – prefixes and suffixes - flashcards • Description of wounds – recycle descriptive language, order of adjs • Grade of pressure ulcer – match photos • Wound drainage (discharge) –jargon- purulent discharge = pus, discharge = ooze

30. Example of wound chart

31. Now, Exercise 3: Where is the wound? • Complete the Wound Chart using information in the scenario

33. The Wound Chart ex can be .. • A practice of handovers (write a dialogue using given info / complete missing terms in dialogue/ practise as a role play ) • Used for different scenarios (dog bite, fall , burn, operation) • Used to recycle language ( She’s got a .. , The ulcer’s on her sacrum...) • A practice of vocab of body parts / areas

34. Scenarios..here is another • Mr D Hatworth was repairing his fence when he accidentally dropped a piece of wood which grazed his right lower leg. He left the wound untreated for two weeks apart from dabbing on a bit of antiseptic cream. Now, the wound is painful to touch and is red and inflamed. There is a small amount of blood-stained discharge

35. Answers – students complete wound chart • Wound: abrasion • Wound Appearance: erythema, inflammation • Wound Drainage: Haemoserous • Pain: Site

36. Also, wound charts are a chance to.. • Do vocab exercises e.g prefix and suffixes e.gnecro-, -osis, haemat- , -oma, erythro- , ven-, • Make matching cards / flashcards • Practise communication skills e.g Advise patient on after care of wound dressing - It’s important to keep the dressing dry, You’ll have to come back next week for a new dressing→ make an appointment / make a phone call to confirm appointment with patient

37. Wound Chart language • Wound Type – ‘It’s a ..’ • Wound Appearance - ‘ It’s got.. , It’s got an area of..’ • Wound Drainage – ‘There’s a small amount of..’ • Pain - ‘ Is it painful? , Do you have any pain?’ When is the wound painful?

38. Medications – important area! • Safe and accurate practice is essential • Legal and patient health implications • Oral medications (tablets, liquids) • Nebulizers and inhalers • Injections: IMI ,IVI, • IV fluids • PR medications (suppositories, enemas) • Oxygen

39. Language skills needed • Abbreviations (R, W, L and S) e.g bd, tds • Maths terms e.g. Morphine 15mg – pronun. practice • Measurement terms e.g ml, mcg, 80, mg/ml, units • Medication use: e.g Read entries in BNF or MIMS e.g side effects • Check for interactions with other drugs e.g (R) literature on drug in blurb or on internet • Handover information e.g (S) intolerance to pain killer

40. Medications : opportunities for? • Research practice – journals, EBP online • Writing practice e.g develop a Public Health Poster on Hypertension drugs → present to class (speaking practice) • Reading and comprehension practice –e.g. Compare drugs used for diabetes- small group work, present to class → teamwork

41. Medication : language practice • Abbreviations e.g sc, prn • Terms e.gnocte, mane • Instructions e.g. Take this medication after food • Polite advice e.g It would be a good idea to.. • Warnings e.g you must keep the medication in the fridge

42. The Medication Chart • Understand terms used in the chart • Get a copy of a medication chart for practice • Latin terms • Maths terms • Use flashcards, cross-words, Find-a-Word to practise terms

43. Drug Chart - example Allergies Adverse Drug Reactions BD QDS TDS Anti-coagulants Slow Release

44. Ex 4: Medication Table • Read through the terms in the medication table • Ask your ‘teacher’ if you don’t understand any terms • Now, take turns to find a term explain the meaning to your partner • Hint: break into chunks or students will not survive this exercise!

46. Medication Find-a-word • In pairs, find a word relating to medication administration in the Find-a-Word • Tell your partner what it means • Use previous glossary to help you

47. In pairs, identify a term in the Find-a-Word below using the table above. Explain the meaning of the term to your partner.

48. Good medication calculation sites for nurses – lots of related terms • Medication Terms • http://home.sc.rr.com/nurdosagecal/Conversions.htm • http://www.jcu.edu.au/cgi-bin/nursing/test.cgi (if you have problems go to www.jcu.edu.au and Search: Nursing Calculations Practice

49. Other medication activities • Reading a Medication chart – use scenario • The IV Prescription Chart • The 5 Rights of Drug Administration – research and make an educational poster • Practice of role plays for medication administration / recycle questions / asking for information ‘Do you need something for pain?’ / giving advice ‘ It’s best to take this tablet with food’

50. Tips : Use websites • http://www.bhf.org.uk/living_with_a_heart_condition/treatment/medicines_for_the_heart.aspx • http://www.proprofs.com/flashcards/story.php?title=types-wounds