6 Personal care

prepositions with/without is covered in this section of

Briefing the unit: He hates using the commode., Do you need help
This unit focuses on developing language and skills with putting on your tights? Finally, in situations such
related to caring for the patient’s basic personal as these, nurses need to be able to distinguish
hygiene needs as well as wound care management. between offers, requests or refusals of help: What do
It also seeks to further improve effective you need help with? Could you give me a hand with …? I
communication skills, particularly the want to try and do it myself.
demonstration of empathy in situations that patients
might find embarrassing or frustrating. Empathy
Empathy is the ability to perceive and understand
Patient hygiene
another person’s emotions, a key aspect of nurse-
Personal hygiene involves far more than just the patient communication. However, it is not one that
physical act of cleaning the patient to reduce is easy to replicate, as emotions can be hidden or
potential infection; indeed it is more about caring for displayed through behaviour that contradicts how a
the overall well-being of the patient. It is therefore person actually feels. A patient complaint about the
essential that nurses help provide a conducive mistreatment of a geriatric patient suffering from
environment as well as the necessary assistance early dementia provides the context to this section.
required for their patients to carry out these basic Students are required to analyse the case and then
tasks as independently as possible. offer advice on how the nurse might improve his
communication with the patient.
Students begin this section by familiarising
themselves with vocabulary related to personal Patients can find loss of independence frustrating,
hygiene, including not only washing and dressing embarrassing, even humiliating and depressing. In
but also grooming (shaving, basic nail and hair care, the second half of this section, students look at ways
make-up) and oral hygiene. Keeping the patient to improve communication in such situations. They
informed of intentions is important when providing learn to recognise examples of empathy through
such assistance, as this is essential in terms of tone of voice, before developing expressions, not
maintaining patient dignity. Focus is therefore given only to show empathy (I understand how you must be
to the use of be going to + infinitive to talk about feeling.), but also to demonstrate both reassurance
intentions: I’m going to explain the procedure to you (Don’t be embarrassed, it can happen to anyone.) and
first.; and events that are planned: We’re going to respect for patient privacy (Do you want me to come
discharge Mr Singh later this afternoon. back later?) The unit then looks at how patients use
adjective endings -ing or -ed to inform the nurse
It should be noted that depending on the country of about how they themselves feel (depressed) or what
origin, nurses may or may not carry out the personal they think about the situation (humiliating).
hygiene duties mentioned above.
Wound management
ADLs – activities of daily living
Wound management refers to assessing, treating,
ADLs or activities of daily living consist of routine and dressing a wound. This final section seeks to
everyday activities people carry out without
develop key language items – saline solution,
assistance – bathing, dressing, oral hygiene and
absorbent dressing, tape and disposable gloves –
toileting (walking/eating are not covered in this
before working on skills for changing a dressing.
unit). Nurses refer to the ability or inability to
The Wound Assessment and Treatment Chart is
perform basic ADLs as a measurement of the
completed by the nurse when first assessing the
functional status of a patient. Students complete an patient’s wound. The chart includes a description of
ADL checklist to assess their patient’s ability to the wound type – traumatic, pressure ulcer (bed
carry these out either independently or with sore), the wound closure – open, sutured (stitches)
assistance, and acquire vocabulary for items used to or clipped, the kind of dressing required and how
help patients with their ADLs: bed pan, urinal
often it should be changed, as well as an assessment
bottle, walking frame, etc. Use of the -ing form after
of the level of pain the patient is feeling.
certain verbs love/hate/finish and following

Personal care 6 50
Teacher’s notes Extra activity
Show students pictures of patients (from
Warm-up magazines, online sources) or describe patients
– woman, heavily made up; a man with a five
1 On the board, write up your food journal for the
o’clock shadow, for example; and ask students
week and ask students to analyse and advise
to identify the items needed for washing and
you on your food intake.
grooming of these patients. Then ask them to
2 Divide the group into three and allocate one of come up with their own examples.
the following to each group: carbohydrates, fats,
proteins. Then ask each group to prepare a one-
minute presentation on their topic.
Extra activity
Patient hygiene Ask: Why is grooming important for patients?
(Patients should be encouraged to live as
normally as possible while in hospital and to
Vocabulary
regain their routine and daily tasks as quickly
1 Tell students they are going to listen to a charge as possible. The nurse is responsible for
nurse helping two patients with washing and encouraging this from the outset.)
grooming. Ask them to scan the pictures and
find an example each of an item used for Listening
washing and grooming. Then ask them, in pairs
or small groups, to label the items a–w. 3 ► 42 If you have less confident students, you
may wish to ask them to do 4 before 3 as it only
Depending on your group, you may wish to add
requires gist understanding.
a competitive element and divide the group in
two. The winning group is the one that is able to Tell students they are now going to hear a nurse
label all the items in a given time. Encourage helping the two patients, Mrs Turner and Mary,
students to use their knowledge of general with washing and grooming. Refer them to the
English to help them. statements 1–7 and ask them to listen and mark
the statements true (T) or false (F).
a washbowl b disposable wipes c comb
d brush e nail brush f hand cream g soap Play the recording again and ask students,
h toothbrush i kidney basin j shampoo individually or in pairs, to correct the false
k nightdress l dressing gown m towel statements.
n washcloth o blanket p deodorant q mirror
r swab s toothpaste t razor u shaving 1 F, She’s not totally independent – she needs
cream v make-up w pyjamas some assistance – e.g. she cannot go to the
bathroom to clean her teeth.
2 Elicit/Pre-teach: oral hygiene. Refer students to 2 F, Mrs Turner is breathless, Mary has no
the table and ask them, individually or in pairs, energy.
to put the items a–w into the correct column. 3 F, She says, ‘I can do that by myself.’
Ask them to look at the examples first. Point out 4T
5T
that some items might go into more than one
6 F, The nurse encourages the patients go
column.
slowly and take a rest when necessary.
7T
Washing: washbowl, blanket, disposable
wipes, soap, shampoo, towel, washcloth, swab
4 Play the recording again and ask students to tick
Grooming: nail brush, comb, brush, hand
the items that correspond to the correct patient,
cream, deodorant, mirror, razor, shaving
cream, make-up either Mrs Turner or Mary.
Oral hygiene: toothpaste, kidney basin, mirror,
Mrs Turner: kidney basin, swab
swab, toothbrush, towel
Patient clothing: nightdress, dressing gown, Mary: hairbrush, mirror, towel, washcloth
pyjamas

Personal care 6 51
 Extra activity Writing
Ask: Why is it important to encourage the patient 6 Refer students to the prompts 1–4 and the
to be independent? How can nurses encourage example. Ask them, in pairs, to think of a patient
patients to be more independent? (A nurse’s job is they know or refer them back to the patients in
to encourage independence as quickly as 3. Ask them to write three questions they could
possible. Patients find loss of independence ask their ‘patients’ about the future, using the
frustrating and embarrassing. Offer to help the prompts and be going to. Ask them to compare
patient in their daily routine, but don’t do their ideas with another pair.
things for them unless they ask the nurse to do
so.)
Note that some students may have difficulty
expressing these ideas effectively in English.
Reassure them that for this activity accuracy is
not important – just encourage them to discuss
their opinions.

Language

Be going to + infinitive for future

If necessary, review the form be going to first.
Refer students to audio script 42 on pages 75–
76 and ask them, individually or in pairs, to
underline examples of be going to + infinitive.
Ask: Why does the nurse use be going to +
infinitive in these situations? (The nurse uses
this form to keep the patient informed of what
is about to happen.)
Ask: Why is it important to keep patients
informed? (So that patients understand what is
happening/going to happen to them. It is also
an important aspect of maintaining patient
dignity.)
Give students time to assimilate the points
covered in the Language box.

5 Elicit/Pre-teach: bed bath, as we go along,

discharge, procedure.
Ask students to read through the situations 1–6
and think about the intention of the nurse or
doctor in each case. Then ask them, in pairs, to
complete the sentences and questions using the
correct form of be going to and the verbs in the
box. Ask them to compare their answers with
another pair before coming together as group to
check.

1 is going to help
2 am not going to give
3 Are (you) going to check
4 is not going to discharge
5 are going to explain
6 Are (you) going to take

Personal care 6 52
 ADLs – activities of daily living Language

-ing form
Vocabulary
On the board write: I like/love/hate … Ask
1 Ask students, individually or in pairs, to label students to come to the board and write
the aids using the words in the box. Encourage something about themselves using one of these
them to use their existing knowledge of English verbs. Check that they use the -ing form. Point
to deduce meaning. Come together as a group to out that the following verbs can also be
check. followed by -ing: begin, start, stop, finish.
Ask students, in pairs or small groups, to answer Brainstorm prepositions that also take -ing
the questions: What are the main ADLs? (with, without).
(Washing, toileting, dressing, oral hygiene, Tell students they will come across examples of
grooming. Also eating and walking.) Which these in the next activity.
ADLs would this equipment help patients with?
3 Refer students to the questions 1–5 and then ask
(Toileting: commode/urinal bottle/bed pan.
them to listen to the dialogues again. Check
Washing: shower chair. Walking/Moving
understanding of: shaving, shaky, tights, need a
around: walker/walking frame/walking stick.)
hand with.
Come together as a group to check.
Ask students to listen to the dialogues again and
1 commode 2 shower chair complete the responses to the questions. Ask
3 walker/walking frame 4 walking stick students, in pairs, to compare their answers,
5 urinal bottle 6 bed pan before coming together as group to check.
You may wish to suggest students check their
Listening answers by reading through audio script 43 on
2 ► 43 On the board write: independent, needs help page 76. This will serve to reinforce the target
and dependent. Check understanding of these structures and language covered in this section.
terms. Tell students they are going to hear a
nurse assessing four patients, Mr Karam, Elaine, 1 it’s difficult to hold the razor still without
cutting himself.
Samson and Mr Bates. Ask them to listen and
2 she can’t put her tights on without bending
write one of these assessments against the down.
appropriate ADL for each patient. 3 washing her hair.
If necessary, play the first part of the dialogue 4 He doesn’t want help with either cleaning his
with Mr Karam and check students understand teeth or getting dressed.
the example answer. 5 He doesn’t need help with going to the toilet
(although he may need to use a walker) and he
Play the recording again if necessary. Ask hates using the commode.
students to compare answers before coming
together as a group to check. 4 Ask students, individually or in pairs, to reorder
the words to form sentences. If necessary, do the
1 Mr Karam: washing = independent, first one as a group. You may wish to check the
grooming = dependent phrases are in the correct order before students
2 Elaine: washing = needs help, do the next part of the activity.
dressing = needs help, grooming = needs help
3 Samson: dressing = independent, oral Ask students to decide if the sentences represent
hygiene = independent offers of help, requests for help or refusals of
4 Mr Bates: toileting = needs help help. Refer students to the example first.

Personal care 6 53
 1 What do you need help with Elaine? Offer
2 Do you need help with anything else? Offer
3 Could you give me a hand washing my hair?
Request
4 Do you need help with cleaning your teeth?
Offer
5 I want to try to do everything by myself today.
Refusal
6 Can you help me? I need help getting to the
toilet. Request

Extra activity
This can be used as preparation for the
speaking activity in 5.
Refer students to audio script 43 on page 76
and ask them to underline possible responses
that the nurse might give to the patient
requests in 4. (Of course, Yes, no problem, I can
help you with that, Not to worry.)
Ask students to underline more examples of
patient refusals of help. (I’m OK with [the
shower/ showering], I’m OK thanks, It’s OK, I can
do it)

Speaking
5 Elicit/Pre-teach: fetch, get. Refer students to the
scenarios 1–3 and ask them, in pairs, to write
three short dialogues based on the scenarios.
Remind them to use the -ing form. Ask them to
practise reading their dialogues aloud, or pass
their dialogues to another pair for peer
correction and/or to read aloud.
Depending on your group, you may wish to ask
them to roleplay one of their dialogues to the
rest of the group.
6 Ask students to work with a different partner for
this activity. Student As use the ADL checklists
on page 47 and Student Bs to turn to page 69.
Explain that Student As will take the role of the
nurse who asks their patient (Student B)
questions to complete ADL checklist 1. Once
they have finished, Student As should use the
information in ADL checklist 2 to reply to
Student B’s questions.

Extra activity
Ask students, in pairs, to copy an empty ADL
checklist and complete it based on a patient
they know/someone they know well following
an operation/hospital stay. They then take
turns to roleplay the scenario with a partner,
using expressions and target language from the
unit.

Personal care 6 54
 Empathy 1 Toileting, washing, grooming, eating and
other simple tasks (not specified in text).
2 The poor care of her father by Nurse Jones
Reading during his stay in St Marc’s Ward.
1 Tell students they are going to read a complaint 3 Nurse Jones seems unhappy with his job in
form. Refer them to the form and the photo of general, and does not feel his salary is high
the patient. enough.
4 She wants the department to investigate her
Explain the photo would not usually be attached father’s case.
to a complaint form – this is to support students 5 Suggested answer: He needs be more caring
in this activity. towards his patients and show some empathy.
He should imagine he was caring for a close
Ask students, individually or in pairs, to read family member or friend. He should consider
sections 1 and 2 and answer questions 1 and 2. going on a communications course.
Then ask them to compare their answers with a
partner, before coming together as a group to Extra activity
check.
Ask experienced nurses: What is your experience
You may wish to ask students more structured of working with geriatric patients? Why might it be
comprehension questions to facilitate the difficult for nurses working in this kind of
reading process: What is the patient’s name? How department in general? Why might it be difficult to
old is he? What is his ethnic origin? Who is making assist patients with dementia with their ADLs?
the complaint? When did the incident take place?
Who is Ms Hynd and what did she do? When did the
complaint take place?
Pronunciation
3 ► 44 On the board write: empathy. Explain to
1 Patient is Winston Miller, 88 years old, of Afro students that Nurse Jones has been criticised by
Caribbean origin. His consultant is Dr Hew
the Complaints Board because he didn’t show
Jones from the Geriatrics department. The
empathy towards his patient. Ask students,
patient stayed in St Marc’s Ward between 15
and 20 May 2010. The patient’s daughter, Ms individually or in pairs, to read the definition on
Deidre Hynd, has made a formal complaint to the right of the page.
the hospital patient relations department. If your students are experienced nurses, put
2 Suggested answers: racism, poor treatment them into pairs or small groups to brainstorm
by the consultant, the medical procedure,
their own definition of ‘empathy’.
incorrect diagnosis, (if students are looking at
the photo, they might speculate that nobody If your students are pre-experience nurses, they
assisted the patient in getting around). may wish to check the translation in a good
bilingual dictionary.
2 Elicit/Pre-teach: dementia, geriatrics, impolite, treat
someone like a child, confused, unacceptable, Tell students they are going to hear three nurses
investigate, case. talking to their patients. Ask them to listen and
complete the table to show how much empathy
Refer students to questions 1–5 and ask them to each nurse demonstrates.
read Section 3 of the complaint form. Ask them,
in pairs, to compare their answers before coming Play the recording again if necessary. Reassure
together as a group to check. students that they may need to listen a few times
to hear the differences. Do not check the answers
at this stage.
4 Ask students, in pairs, to compare their ideas in
3 before coming together as a group to check.
Ask: How do the two nurses (nurses 1 and 3)
show empathy? What other ways can nurses
demonstrate/show empathy? (Touch:
arm/shoulder/hand, if appropriate; eye contact
and a ‘warm’ facial expression.)

Personal care 6 55
 Pre-experience nurses may find it difficult to
Extra activity
indentify expressions of empathy, but reassure
them they will be looking at this in more detail Ask students, in pairs, to read audio script 44
in 6. on page 76 aloud. Ask them to ‘feel’/notice the
difference between dialogues 1 and 3 and
1 a lot of empathy 2 no empathy dialogue 2. Swap roles.
3 a little empathy Ask students to take turns to roleplay
Tone of voice, expressions, e.g. I understand dialogues 1 and 3 again, this time encouraging
how you must be feeling., I can see it’s difficult them to use patient-friendly intonation
for you. patterns, touch, ‘warm’ facial expression, etc.
Ask them to feed back to the class about the
Extra activity experience.
Ask experienced nurses: On a scale of 1–5 (1 = Some students may have difficulty expressing
very easy), how easy is it to show empathy to these ideas effectively in English. Reassure
patients? Ask students to explain their rating. them that for this activity accuracy is not
important – just encourage students to discuss
5 Ask students to listen to the three dialogues their opinions.
again and complete the summaries about each
patient using the words in the box. Elicit/Pre- 7 On the board write: feelings and situations. Ask
teach: chemotherapy. Avoid pre-teaching the students to decide which adjectives from the box
words in the box to encourage students to go under each heading. (Feelings: depressed,
deduce the meaning from the context. embarrassed, frustrated, humiliated. Situations:
depressing, embarrassing, frustrating, humiliating.)
1 feeding himself, humiliating Check students understand: adjectives ending in
2 washing her hair, embarrassed
-ing describe the patient’s feelings while
3 sickness, depressing
adjectives ending in -ed describe the situation.

Vocabulary Ask students, individually or in pairs, to

complete the sentences, using an appropriate
6 Tell students they are now going to develop adjective from the box. Point out that more than
expressions they can use to improve one answer is sometimes possible. Come
communication with their patients. On the board together as a group to check.
write: show empathy, reassure the patient, respect
the patient’s privacy. 1 humiliating/embarrassing
2 humiliated/frustrated/embarrassed
Check understanding of: reassure, privacy. Ask 3 embarrassed/humiliated
students to reorder the words in 1–7 to form 4 depressed
expressions for each of the headings on the 5 frustrating/embarrassing
board. 6 embarrassing/humiliating
Remind students of the patient-friendly
intonation covered in Unit 2, (gentle rise and Extra activity
fall). Ask students, in pairs, to practise saying Ask students to think about a patient they
these expressions as if to a patient, using patient- know/someone they know who has been in
friendly intonation patterns. If necessary, ask a hospital and ask them to write three or more
stronger student to model an appropriate sentences about their ‘patients’ using the
intonation pattern for the first example. adjectives in 7.

1 I understand how you must be feeling.

2 I can see it’s difficult for you.
3 Please don’t worry Josh. Let me clean you up
and you’ll feel much better.
4 Don’t be embarrassed Sheila. It can happen
to anyone.
5 I’m used to it; it’s part of my job.
6 Do you want me to come back later?
7 I’ll bring a screen to put round the bed. You
can have a little privacy.

Personal care 6 56
 Wound management Additional activity
Refer students to audio script 45 on pages 76–
Listening 77. In pairs, ask them to take turns roleplaying
the dialogue between the nurse and Una
1 Ask: What does the term ‘wound management’ Hagans to help reinforce the target language
mean? (assessing, treating, dressing and changing a
items. Encourage students to use patient-
wound) What is your experience of wound
friendly intonation patterns.
management (of a patient/your own)?
Refer students to the pictures at the top of the
Writing
page and ask them, individually or in pairs, to
number the pictures 1–6 in the correct order for 3 Refer students to the chart and ask: What is it for?
cleaning a wound. Who completes it? When?

a2 b3 c4 d1 e5 f6 (The Wound Assessment and Treatment Chart is

completed by the nurse when he/she first
2 ► 45 Elicit/Pre-teach: heal, hardly, remove, assesses the patient. It includes a description of
odour, secure. Tell students they are going to hear the type of wound, the type of dressing required
a nurse treating her patient, Una Hagans. Refer and how often it should be changed, as well as
them to the dialogue and ask them, individually an assessment of the level of pain the patient is
or in pairs, to complete the nurse’s half of the feeling.)
dialogue using the words in the box. Pre-experience nurses may not yet be aware of
You may wish to ask students to label the this chart, but reassure them that they will have
pictures with the words in the box first. This will a better understanding at the end of this section
help them complete the nurse’s dialogue. Point of the unit.
out they only need to use eight of the twelve Ask students, in pairs, to read the Wound
words in the box to label the pictures – the other Assessment and Treatment Chart for Una
words in the box will be used to complete the Hagans. Encourage them to use a bilingual
dialogue. Note also that some words are used dictionary to check any of the terms they are
both to label the pictures and to complete the unsure of.
dialogue.
Point out that this is a slightly simplified version
Explain that nurses should always confirm the of the Wound Assessment and Treatment Chart.
patient’s name first before beginning wound Experienced nurses may notice some omissions.
care. Experienced nurses will already be aware
of this. Ask students, individually or in pairs, to fill as
much of the chart as they can from memory.
Brainstorm suitable questions a nurse might ask Then play the recording to allow them to add
for this. (Can you just confirm your name for me additional information. If necessary play the
(please)? Can you give me your full name please?) recording again. Refer the students back to the
Play the recording and ask students to listen and dialogue in 2 and come together as a group to
check. Play the recording again if necessary. check.
Ask students, individually or in pairs, to label Type of wound: surgical
the pictures using the words in the box. This will Infection: no
help reinforce the target language. Dressing frequency: daily
Antibiotics: no
Dialogue: 1 wound 2 antibiotics Odour: no
3 disposable gloves 4 sutures 5 dressing Pain assessment: 2
6 bin 7 pus 8 edges 9 saline solution Wound closure: sutures
10 absorbent dressing 11 tape Wound dressing: absorbent
12 wound assessment Comments: wound feels itchy
Pictures: 1 bin 2 sutures 3 wound
4 saline solution 5 disposable gloves
6 absorbent dressing 7 tape
8 wound assessment chart

Personal care 6 57
 Extra activity Extra activity
Ask students, in pairs, to explain the meanings Ask students, individually or in pairs, to write
of different sections of the chart (location/type a SOAP note for either/both patients in this
of wound, etc.) to the rest of the group. Ask section of the unit.
them to choose or allocate a section to each
pair. Preparing for the next unit
Alternatively, you could ask students to do this
for homework/self-study for informal In preparation for Unit 7, suggest the following to
presentation during the next class. your students:
• Think about how you feel talking about
4 Refer students to the photo on the right of the
problems of elimination/bodily functions
page and ask: What type of wound do you think it
with others/medical professionals.
is? If your students are experienced nurses, you
can also ask: How would you manage this type of • Do some (online) research into the treatment
wound? Avoid correcting at this stage. of problems related to patient elimination, e.g.
constipation.
Ask students to read through the case history for
the patient, Mia Fox. Check understanding of:
inflamed, moderate, antimicrobial dressing. Then ask
students, individually or in pairs, to complete
the Wound Assessment and Treatment Chart for
the patient. Ask students to compare their
charts, before coming together as a group to
check.

Name: Mia Fox

DOB: we know she is 19
Type of wound: burn
Location of wound: arm
Infection: yes
Dressing frequency: every third day
Antibiotics: oral
Odour: no
Pain assessment: 3
Wound closure: open wound
Wound dressing: antimicrobial dressing
Comments: patient burned arm in kitchen
accident

Speaking
5 Tell students they are going to roleplay a nurse
assessing the patient, Mia Fox. One student takes
the role of the patient, and the other the nurse.
Refer students (in pairs) to the prompts (1–4)
and ask them to use these to carry out the
roleplay. They then swap roles.
If necessary, start by brainstorming possible
expressions for each stage of the procedure as a
whole group activity. You can refer students
back to relevant units for each stage: 1 – unit 1, 2
– units 2 and 4, 3 – this unit, 4 – this unit.
Students may wish to write notes first before
carrying out the roleplay. They could use the
dialogue on page 50 as a model.

Personal care 6 58