wounds ,charts and medication: tips for teaching nurses

Wounds, Charts and Medication:

Tips on teaching nurses

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

Introducing ..Virginia Allum

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

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.’

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

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.

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

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

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

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

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)

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 )

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

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..

11

2

3

4

Now, in pairs, do handout exercise 1.

Photo number

Type of wound

1 a)Pressure Ulcer2 b)Surgical wound 3 c) Cut or laceration4 d) Bruise or contusion

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 (!)?

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

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

Number Everyday term Medical terminology

1 Heel (Heels)

2 Lateral Malleolus (Malleoli)

3 Medial Malleolus (Malleoli)

4 Greater Trochanter (s)

5 Sacrum

6 Ischial Tuberosity (Tuberosities)

7 vertebrae

8 Occiput

9 Ears

10 Shoulders

11 Scapula (Scapulae)

12 Elbow (Elbows)

13 Iliac Crest

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

Matching cards - example

Haemat- -oma erythr- Ven-

Necro- -itis Ser- Esch-

scab red blood Swelling

plasma dead Inflammation of Vein

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

Online: BBC Radio Transcripts

http://www.bbc.co.uk/radio4/science/casenotes_tr_20050208.shtml

RADIO SCIENCE UNITCASE NOTES 9. - Wound Healing

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

Charts and Documents

• Legal documents• Completed each shift• Used as communication between shifts• Nursing Care Plans• Integrated Care Pathways (Wound

Charts)• Policies and Procedures

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.

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

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

Example of wound chart

Now, Exercise 3: Where is the wound?

• Complete the Wound Chart using information in the scenario

WOUND CHARTNAME: Mrs A. Patient DOB: 30/ 11/ 1924WOUND TYPE TICK WOUND

APPEARANCETick Wound

DrainageTick Pain

Tick

Abrasion Blister Purulent(pus)

Site

Haematoma Erythema(Redness)

Haemoserous(Blood-stained fluid)

Dressing change

Laceration Inflammation Nil continuous

Ulcer Maceration(over-moist)

intermittent

Surgical incision Slough When limb elevated

Eschar(black, hard scab)

Nil

Epithelialisation(healing tissue)

Mrs Anna Patient has a 3 cm long laceration on her left forearm caused by a dog bite. The skin around the wound is red and inflamed . There is a moderate amount of greenish pus in the wound caused by an infection which is being treated with oral antibiotics. The wound dressing is being changed every two days at the Outpatient Clinic. The patient reports a small amount of pain when the dressing is changed. She takes a painkiller before the dressing change.

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

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

Answers – students complete wound chart

• Wound: abrasion• Wound Appearance: erythema,

inflammation• Wound Drainage: Haemoserous• Pain: Site

Also, wound charts are a chance to..

• Do vocab exercises e.g prefix and suffixes e.g necro-, -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

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?

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

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

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

Medication : language practice

• Abbreviations e.g sc, prn• Terms e.g nocte, 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

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

AllergiesAdverse Drug Reactions

BDQDSTDS

Anti-coagulants

Slow Release

Drug Chart - example

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!

Medical terms for medications Meaning

a.c Before mealsamps. Ampoules . This is the container for liquid medication for injection.b.d (or b.i.d) Twice a day (bi= two)Inh. Inhaler e.g Salbutamol inhalerIM or IMI Intramuscular ie an injection given into a muscleIV or IVI Intravenous ie an injection given into a veinIV Fluids Fluids given through an IV cannula. Also called a ‘drip’mane In the morningNeb. Nebulizer e.g Salbutamol nebulizerNeedle gauge Size of the needles eg 19g (drawing up needle) 21g (IM injections ) 23g (fine for sc injections)

NI Nurse Initiated medication e.g. Paracetamol, Coloxyl with Senna. nocte At nightOD or daily Once a dayoral By mouthp.c After mealsper NG through the nasogastric tube (through nose into the stomach)pr Per rectum e.g. a suppositoryprn whenever needed ( for pain, indigestion, constipation)q.i.d or qds Four times a day (quad= 4) .Doesn’t have to be in 6 hour intervals.R Refused by the pt. (written on the medication chart)s.c Subcutaneous ie an injection given into the subcutaneous layer of skin s.l Sublingual or under the tonguestat (statim) immediately e.g. a stat dose of insulint.d.s Three times a day (Ter in diem)top. Topical ie a cream or ointment e.g antibiotic creamunits Insulin is prescribed in units. E.g. 24 units of InsulotardVenflon Type of intravenous cannula. Abbrev to IVC .W Withheld (written on the medication chart) e.g. Digoxin because the pulse was 58.

1/24 or 10 Hourly or every hour2/24 or 20 Second hourly or every two hours4/24 or 40 Fourth hourly e.g. 4/24 T P R (Note: this is 6 times a day)6/24 or 60 Every six hours (Note: this is 4 times a day)

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

A N E B

M O O S

P E R R E C T U M

O A T B A

U L O E L N

F L U I D S I E

E N N C I N H

I J G

T E U

S C Q D S A

T R L A

A N T I B I O T I C

O P

V E N F L O N

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

Good medication calculation sites for nurses – lots of related terms

• Medication Terms• http://home.sc.rr.com/nurdosagecal/Conver

sions.htm• http://www.jcu.edu.au/cgi-bin/nursing/test.c

gi (if you have problems go to www.jcu.edu.au and Search: Nursing Calculations Practice

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’

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

Invite guest speakers

• Nursing lecturers• Nursing students• Nurses• Ask them to show authentic charts

and documentation (make sure any identifying information is obscured first) e.g hospital logo

Any questions?

Thank you for having me

PS: answers to the exercises are on my bloghttp://

englishfornursingandhealth.blogspot.com/