This is the second blog post in a row on
Medical English. No surprise really, as at Specialist Language Courses Towers,
we’re developing an exciting raft of online English courses for nurses and
doctors. As a result, we’ve taken a keen interest in any study that researches
and analyses how healthcare professionals use English at work. Such studies are
very useful for our course design process.
My latest reading is a chapter in ‘The
Handbook of English for Specific Purposes’, titled ‘English for Nursing’ and
written by Susan Bosher. The Handbook is a great resource for all things ESP.
In the article, Bosher cites three studies, one Canadian (Epp and Lewis 2008), one
American (Cameron 1998), and one Australian (Hussin 2002). Each of them looks
at nurses’ English language needs, and describes in some detail what areas of
language use are most common. This in turn helps inform us what language tasks
and skills should be integrated into the online English for Nursing courses we
design.
For this post, I’d like to discuss the
Canadian study. Epp and Lewis (2008) spent over 80 hours observing nurses in
various clinical settings, taking notes on their communicative interactions,
and them analysing them in terms of percentages spent on different tasks. They
found that nurses spent 56% of their time with patients, 34% with other
healthcare professionals, and 10% with patients’ families. In terms of actual
language tasks, the breakdown was as follows:
·
Asking for information 22%
·
Explaining 21%
·
Giving instructions 9%
·
Informing 7%
·
Responding to questions 6%
·
Suggesting 6%
·
Describing 6%
·
Small talk 5%
·
Discussing 5%
·
Comforting 4%
·
Making and receiving phone
calls 3%
·
Asking for help 2%
·
Offering to help 2%
·
Clarifying 1%
·
Apologising 1%
This breakdown
of language use into functions is interesting and enlightening. It shows a
number of key language tasks that should be integrated into any Medical English
course. ‘Asking for information’ includes the grammar of questions (“Could you
tell me..?”, “What happens if..?”, “How does it feel when..?”), as well as the
vocabulary relevant to the context. This might range from asking about specific
symptoms, to asking about pain, assessing pressure areas, carrying out a falls
risk assessment,or asking about breathing difficulties.
Explaining is
clearly crucial to effective communication, and again can be approached from a
grammatical angle – describing sequences, cause and effect, or conditionals
using ‘if-clauses’ (“If this happens, then this might happen”), as well as a
vocabulary perspective. There are many interactions that require a degree of
explaining, such as taking medications and their potential side-effects, common
hospital procedures, pre-operative preparation, post-operative care, or giving
an accurate handover.
In fact, each of the above functions listed
has its own common grammar and vocabulary. What really matters here is that
nurses learn the English necessary to communicate accurately with patients,
other healthcare professionals (nurses, doctors, consultants), and patients, in
order to ensure the provision of safe, effective care. This consists of 3 core
areas:
English grammar, including talking about
different times, different levels of likelihood, and sequencing events
correctly.
Situation-specific vocabulary of which
there is a lot. Healthcare is a wide field, and nurses need to know how to talk
to patients – as well as other staff and families – about common areas, some of
which are very complex.
Communicative skills, including
pronunciation, understanding what others say in a range of accents and
‘Englishes’, and communication strategies, such as clarifying, re-phrasing, suggesting,
expressing politeness or asking for repetition
Coming back to the Epp and Lewis’ list,
while it describes the various functions nurses use English for in practice, it
doesn’t go into the specific contexts in which they were using the language or
identify how high stakes the
interactions were. These may also be of considerable significance and impact on
how a Medical English course writer designs a syllabus. For example, ‘asking
for help’ only accounted for 2% of interactions. However, this specific function,
especially in emergencies, may be incredibly important to get right and it
therefore may assume equal importance to another language task where the stakes
– and the consequences – are not so high or serious.
To take this survey further, one move may
be to research a ‘Nursing English’ corpus of how English is used by nurses in
practice. Corpus linguistics is a relatively new approach to language analysis
but one which is having greater and greater impact on how English courses are
being designed and taught. Corpus linguistics is the study of ‘real life’
samples of English, so taking large bodies of language – both written and
spoken – and looking in detail at how language is used by people in practice in
many different situations, in ‘real life’. To do this for nurses would be a
difficult but very useful exercise. Getting a deep understanding of how English
is used by nurses would allow us to develop syllabi matching the specific
grammatical, lexical and communicative needs of nurses.
Until this happens, though, it is vital to
use the input provided by the research of Epp and Lewis as well as others in
the same field. I would also suggest we combine it with the insights provided
by practising nurses. Virginia Allum, who writes our online English for Nurses
courses, is a Registered Nurse, with career experience in the UK and Australia,
and has also lectured extensively on English for Medical Professionals. This enables her to write courses which
demonstrate a strong understanding of the issues facing non-native English-speaking
nurses, as well as a real command of the environment nurses work in.
Designing online English of Nursing courses
has proven to be a fascinating task so far. We are developing two courses, one
at an elementary/pre-intermediate level for nurses preparing or just starting
to work in an English-speaking environment, and one at a higher
intermediate/upper-intermediate level, for practising non-native nurses who
need to improve their accuracy, fluency and confidence in the workplace.
References:
‘English for Nursing’ by Susan Bosher, p263-281, ‘The Handbook of English for
Specific Purposes’, edited by Brian Partridge and Sue Starfield, published by
Wiley Blackwell, 2014