How do Nurses use English?

This is the second blog post in a row on Medical English. No surprise really, as at Specialist Language
Courses Towers, were developing an exciting raft of online English courses for nurses and doctors. As a
result, weve 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, Id 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

Explaining
Giving instructions
Informing
Responding to questions
Suggesting
Describing
Small talk
Discussing
Comforting
Making and receiving phone calls
Asking for help
Offering to help

22%
21%
9%
7%
6%
6%
6%
5%
5%
4%
3%
2%
2%

Clarifying
Apologising

1%
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:
1. English grammar, including talking about different times, different levels of likelihood, and
sequencing events correctly.
2. 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.
3. 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 doesnt 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 practicing
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
practicing non-native nurses who need to improve their accuracy, fluency and confidence in the
workplace.
If you are interested in finding out more and seeing what we have included in the English for Nursing
syllabi, please get in touch chris@specialistlanguagecourses.com.