THE GUIDELINES

NURSING ENGLISH
PART 3
EXCELLENT COMMUNICATION
What to say nurse?

LKP
MEDICA ENGLISH JAKARTA

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 Preface

This book has been designed to meet the requirements of student nurses and midwives
and entitled “Communication Skill, what to say nurse?” comes to the existence as a response to
the problems surrounding the student nurses and midwives who have no competent and ability in
communication.

First, the presence of these books is meant to guide the student nurses and midwives as
an applicant of English as a second language. This book also prepares the technique to perform
the dialogue according to a method in principles of communicative English teaching and
learning and also physical assessment, how to make resume and curriculum vitae.

Second, the MEJ Team has arranged the Integrated Nurse-Midwife Dialogue Book based
on daily basis in hospital. It is, therefore, for the preparation of ‘Registered Nurse’ to those who
are eager to go abroad.

Finally, some words of hope from the writer come in order that this book is useful to the
student nurses, midwife, and the readers.

MEJ
Printed in Bogor 2020

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Contents
Topic Page
Preface ………………………………………………………………………… 1
Contents ………………………..…………………………………………….. 2
Unit 1: Communication skill ............................................................................. 3
Unit 2: Nurse-Patient Relationship .................................................................... 6
Unit 3: Dialog Introduction …………………………………………………... 16
Unit 4: Nurse Dialog: Nurse to Doctor ……..……………………………….... 19
Unit 5: Nurse Dialog: Nurse to Nurse ……………………………………….... 23
Unit 6: Nurse Dialog: Nurse to Patient ………..…………………………….... 28
Unit 7: Nurse Dialog: Nurse to Patient’s family …………………………….... 41
Unit 8: Physical Assessment ............................... ……………………………. 45
Unit 9: Debate Motion ....................................................................................... 57
Unit 10: Interview, CV, & Resume …………………………………………...... 66
Appendix …………….…………………...................………………………… 72
References …………………………………………………………………….. 84

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 UNIT 1. COMMUNICATION SKILL
Communication skills are verbal and non-verbal words, phrases, voice tones, facial expressions, gestures, and body
language that you use in the interaction between you and another person.

A. Communication skills in a healthcare setting include the way you use to:
 Explaining diagnosis, investigation and treatment.
 Involving the patient in the decision-making.
 Communicating with relatives.
 Communicating with other health care professionals.
 Breaking bad news.
 Seeking informed consent/clarification for an invasive procedure or obtaining consent for a post-mortem.
 Dealing with anxious patients or relatives.
 Giving instructions on discharge.
 Giving advice on lifestyle, health promotion or risk factors.

B. Difficult Patients Situations in Medical Encounters

 The Silent or Reticent patient.
 The Rambling or Talkative patient.
 The Vague patient.
 The Angry patient.
 The Depressed or Sad patient.
 The Denial patient.
 The Anxious patient.
 Patient with Somatization.
 The Dependent and Demanding patient.
 The Dramatic or Manipulative patient.
 The Long Suffering, Masochistic patient.
 The Orderly and Controlled patient.
 The Manic, Restless patient.
 The Guarded Paranoid patient.
 The Superior patient.
 Breaking bad news.
 Caring for the dying patient.

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  Conflicted Roles
 Solving Conflicts.

C. What are the communication skills that will be assessed in OSCEs?

, doctors, physician, physicians, nurses, medical malpractice, medica
The OSCE exam is an assessment of clinical knowledge, skills, and attitude. The communication skills you
demonstrate and the process you go through in obtaining a history or performing a physical examination are more
important than determining a diagnosis.

The OSCEs examiners will be considering your:

Approach to the patient

You should:

 Introduce and orientate the patient and yourself

 Establish an attentive, respectful and non-judgmental relationship
 Acknowledge the patient's emotions and concerns

Listening, questioning and diagnosing

You should:

 Ensure you have understood the patient's symptoms/problem and concerns

 Summarize and clarify understanding

Explaining and advising

You should:

 Enable the patient to understand the problem/situation

 Reassure appropriately
 Summarize and clarify understanding

Involving patient in management

You should:

 Explore the patient's expectations/concerns

 Propose/explain management plan clearly
 Explore the patient's response
 Respect the patient's autonomy, and help him or her to make a decision based on available information and
advice
 Summarize and clarify understanding

Objective Structured Clinical Examination (OSCEs) is a form of performance-based testing used to measure
candidates’ clinical competence. During an OSCE, candidates are observed and evaluated as they go through a
series of stations in which they interview, examine and treat standardized patients (SP) who present with some type
of medical problem. When standardized patients (SPs) are utilized in OSCE exams, the linear sequence of the
multiple station and skill challenges bears remarkable similarity to that real environment.

“The OSCE is an approach to the assessment of clinical competence in which the components of competence are
assessed in a planned or structured way with attention being paid to the objectivity of the examination” Harden,
1988 .

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Objective Structured Clinical Examination (OSCEs) has proved to be so effective that it is now being adopted in
disciplines other than medicine, like dentistry, nursing, midwifery, pharmacy and event engineering and law.

D. How is the OSCEs done? The exam day.

Although OSCEs are performed in many settings in regard to the exam purpose, the organizing institution, and
available facilities, they all share similar procedures. On the examination day, you will go through the following
steps in sequence:

1. Registration: The first step is the registration. You will:

 Show your examination invitation card and an identification.
 Be reminded about the exam rules.
 Be checked for things which are allowed and other not allowed things.
 Receive your exam envelope which contains your ID badge, stickers, a pencil, a notebook o clipboard (both
with numbered blank papers), etc.

2. Orientation: The next step is orientation. An orientation video may be shown. Here:
 Exam format, procedures and polices will be reviewed.
 Introduced to your team and team leader.
 Instructed about your starting station and how to proceed.
 Your questions will be answered (and not allowed beyond this step).

3. Escorting to exam position: Now it is exam time.

You will be escorted to your station. You will stop by the assigned room door until a long bell / buzzer
announces the start of the exam.

4. Station Instruction Time:

This is one or two minutes to read the instruction about this station situation, patient, and required tasks.
Read carefully. At the next bell / buzzer enter the room.

5. The Encounter:
Start your encounter with the SP. This is a 5-20 minute encounter. Perform the required tasks. Stop at the
next bell / buzzer.

6. Post Encounter Period: Next is a question period.

There are some differences here. Some OSCEs will have no post encounter periods. Some will have one or
two minutes of the encounter period assigned to an oral questions asked by the examiner inside the exam
room. No more communication is allowed with the SP. Others have written questions to be answered on
paper or computer outside the exam room for 5-10 minutes. At the next long bell / buzzer, the first station
ended as well as the next station has started. You have to proceed to the next station quickly as it is the same
long bell / buzzer at step 4.

7. Repeat Steps 4 to 6:
Steps 4 to 6 will be repeated until you have been in all the stations. Some OSCEs will offer one or two short
rest periods.

8. Exam ended / Escorting to dismissal area: The exam is over.

You will be escorted back to the dismissal area for signing out. You will be asked to handle back all what
you had received on signing in, the ID badge, remaining stickers, all the papers, and the pencil. You may
also be asked to stay without outside contacts for some time (sometimes hours) for exam security reasons.

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 UNIT 2. NURSE-PATIENT RELATIONSHIP
A. COMPONENTS OF A THERAPEUTIC RELATIONSHIP

1. POSITIVE REGARD
Unconditional, non-judgmental attitude, implies respect irregardless of the patient’s behavior, background or
lifestyle. Eample:

Patient : “I was so mad, I yelled at my mother for an hour.”

Nurse : ”Well, that didn’t help, did it?” or “I can’t believe you did it.” or
: “you must have been really upset.”

2. ACCEPTANCE
Nurse does not become upset or respond negatively to a client’s outbursts, anger or acting out. Ex. A client puts his
arm around the waist of the nurse:

Nurse : “John, stop that! What’s gotten into you? I am leaving!” or

: “John, do not place your hand on me. We are working on your relationship with your
girlfriend and that does not require you to touch me. Now, let’s continue.”

3. GENUINE INTEREST
Nurse is clearly focused and is comfortable with icy and reliability himself/herself (client can detect artificial
behavior). Example. The nurse asking a question and then not waiting for an answer, talking over the client or
assuring the client that everything will be all right.

4. EMPATHY
Ability of the nurse to perceive the meanings and feelings of the patient and communicates that understanding to the
patient. Example:

Patient : “I’m so confused! My son just visited and wants to know where the safety deposit box
key is.”
Nurse : “You’re confused because your son asked for the safety deposit key?”

5. TRUST - patient is confident of the nurse and the nurse’s presence conveys integrity and reliability. Trusting
behaviors: caring, consistency, approachability, listening, keeping promises, honesty

6. SELF-AWARENESS & THERAPEUTIC USE OF SELF

Self-awareness- process of developing an understanding of one’s own values, beliefs, thoughts, feelings, attitudes,
motivations, prejudices, strengths and limitations and how these qualities affect others. Therapeutic Use of Self- the
nurse beginning to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping
skills and perceptions to establish relationship with clients.

7. JOHARI’S WINDOW UNKNOWN- UNDISCOVERED QUALITIES BY ONESELF AND OTHERS HIDDEN-

QUALITIES KNOWN ONLY TO SELF BLIND- QUALITIES KNOWN ONLY TO THERS OPEN - QUALITIES
ONE KNOWS ABOUT ONESELF AND OTHERS ALSO KNOW
If quadrant 1 is the longest list- indicates that the nurse is open to others. Smaller quadrant 1 means the nurse shares
little about himself/herself with others. If quadrants 1 and 3 are both small, the person demonstrates little insight.
GOAL- to work toward moving qualities from quadrants 2, 3 and 4 into quadrant 1.

8. THERAPEUTIC COMMUNICATION TECHNIQUES ACCEPTING

Indicating reception “yes.”, “I follow what you said”, nodding. Rationale: Indicates that the nurse has heard and
followed the train of thought. Does not indicate agreement but is nonjudgmental. Facial expression should also be
congruent with the verbal content.

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9. BROAD OPENING
Allowing the client to take the initiative in introducing the topic. “Is there something you’d like to talk about?”;
“Where would you like to begin?” Rationale: This makes explicit that the client has the lead in the interaction. It may
stimulate the client to take the initiative.

10. CONSENSUAL VALIDATION

Searching for mutual understanding, for accord on the meaning of the words. “Tell me whether my understanding
agrees with yours.”; “Are you using these words to convey that…?” Rationale: It is essential that the words being
used have the same meaning for both participants to avoid misunderstanding.

11. ENCOURAGING COMPARISON

Asking that similarities and differences be noted. “Was it something like…?”, “Have you had similar experiences?”
Rationale: Comparing ideas, experiences, or relationships brings out many recurring themes. It might also help the
client recall past coping strategies.

12. ENCOURAGING DESCRIPTION OF PERCEPTIONS

Asking the client to verbalize what she or he perceives. “What is happening?”, “What does the voice seem to be
saying?” Rationale: This may relieve the tension the client is feeling and he or she might be less likely to take action
on ideas that are harmful or frightening.

13. ENCOURAGING EXPRESSION

Asking the client to appraise the quality of his or her experience. “What are your feelings on regard to…?”, “does
this contribute to your distress?” Rationale: This may encourage the client to make his or her own appraisal rather
than accepting the opinion of others.

14. EXPLORING
Delving further into a subject or idea. (can also be thru asking for an example). “Tell me more about that.”, “Would
you describe it more fully?”, “give me an example of you and your wife not getting along. Rationale: Any problem
or concern can be better understood if explored in depth. If client is unwilling to explore, the nurse must respect.

15. FOCUSING
Concentrating on a single point. “This point seems worth looking more closely.”, “of all the concerns you’ve
mentioned, which is most troublesome?” Rationale: A useful technique when client jumps from one topic to another
(flight of ideas). To avoid overwhelming the client also.

16. FORMULATING A PLAN OF ACTION

Asking the client to consider kinds of behavior likely to be appropriate in future situations. “What could you do to let
your anger out harmlessly?”, “Next time this comes up, what might you do to handle it?” Rationale: Making definite
plans increases the likelihood that the client will cope more effectively in similar situations.

17. GENERAL LEADS

Giving encouragement to continue. “Go on.”, “And then?”, “tell me about it.” Rationale: Indicates that the nurse is
listening and following what the client had said without taking away the initiative for the interaction.

18. GIVING INFORMATION

Making available the facts that the client needs. “My name is....”, “Visiting hours are…”, My purpose in being here
is…” Rationale: Informing the client of facts increases his or her knowledge about a topic or lets the client know
what to expect. It builds trust.

19. GIVING RECOGNITION

Acknowledging, indicating awareness. “Good morning Mr. S”, “I’ve noticed that you’ve combed your hair today.
”Rationale: This shows that the nurse recognizes the client as a person, as an individual. It does not carry the notion
of value.

20. MAKING OBSERVATIONS.

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Verbalizing what the nurse perceives. “You appear tense” “I notice that your biting your lips”. Rationale: Sometimes
clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

21. OFFERING SELF

Making oneself available. “I’ll sit with you awhile”. “I’ll stay here with you”. “I’m interested in what you think”.
Rationale: It is important that this offer is unconditional, that is the client does not have to respond verbally to get the
nurse’s attention.

22. PLACING EVENT IN TIME OR SEQUENCE

Clarifying the relationship of events in time. “What seemed to lead up to…? “Was this before or after?” Rationale: It
helps both the nurse and client to see them in perspective. Client may gain insight in cause-and-effect behavior and
consequences.

23. PRESENTING REALITY

Offering for consideration that which is real. “I see no one else in the room”. “Your mother is not here; I am a
nurse.” Rationale: The nurse indicates what is real through not arguing with the client. The intent is to indicate an
alternative line of thought for the client to consider and not to “convince” the client that he/she is wrong.

24. REFLECTING
Directing client actions, thoughts, and feelings back to client.

Client : “Do you think I should tell the doctor…?

Nurse : “Do you think you should?”
Rationale : Encourages the client to recognize and accept his or her own feelings. The nurse
indicates that the client’s point of view has value and has the right to air opinions,
ideas.

25. RESTATING
Repeating the main idea expressed.

Client : I can’t sleep. I stay awake all night.”

Nurse : You have difficulty sleeping.
Client : ” I’m really mad, and upset”
Nurse : You’re really mad and upset.”
Rationale : Nurse repeats what the client has said in approximately or nearly the same words the
client had used to let the client know that he/she communicated the idea effectively.

26. SEEKING INFORMATION

Seeking to make clear that which is not meaningful or that which is vague. “I’m not sure that I follow.” “Have I
heard you correctly?” Rationale: This helps the nurse to avoid making assumptions that understanding has occurred
when it has not. Also for the client to articulate feelings.

27. SILENCE
Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, regain
composure, or continue talking. Nurse says nothing but continues to maintain eye contact and conveys interest.
Rationale: Gives time for the client to organize thoughts, direct the topic of interaction or focus on issues that are
most important.

28. SUGGESTING COLLABORATION

Offering to share, to strive, to work with the client for his or her benefit. “Perhaps you and I can discuss and discover
the triggers for your anxiety” Rationale: The nurse offers to do things with, rather than for the client.

29. SUMMARIZING

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Organizing and summing up that which has gone before. “Have I got this straight?”, “You’ve said that…”, ”During
the past hour, you and I have discussed..” Rationale: This seeks to bring out the important points of the discussion
and to increase the awareness and understanding of both participants.

30. TRANSLATING INTO FEELINGS

Seeking to verbalize client’s feelings that he or she expresses only indirectly.
Client : “I’m dead”
Nurse : “Are you suggesting that you feel lifeless?”
Rationale : To understand, the nurse must concentrate on what the client might be feeling to
express himself/herself this way.

31. VERBALIZING THE IMPLIED

Voicing what the client has hinted at or suggested.

Client : I cant’ talk to you or anyone. It’s a waste of time.”

Nurse : “Do you feel that no one understands.”
Rationale : The client may have difficulty communicating directly. The nurse should take care to
express only what is fairly obvious.

32. VOICING DOUBT

Expressing uncertainty about the reality of the client’s perceptions. “Isn’t that unusual?”, “Really?”, “That’s hard to
believe.” Rationale: Such permits the client to become aware that others do not necessarily perceive events in the
same way or draw the same conclusions.

33. REMINDER
Allow client to express feelings more often than possible without being judgmental in order to understand what is
going on with the client. This would facilitate better action in dealing with client’s concerns thus helping him arrive
at solutions at his own pace.

34. NONTHERAPEUTIC COMMUNICATION TECHNIQUES

D-iscourages expression of feelings
O-verwhelming the patient/client
R-eassuring the client
S-ympathizing with the client
A-rguing with the client
L-limiting the ideas, opinions, of the client
T-hreatening the client
J-udgmental
35. ADVISING - telling the client what to do. AGREEING - indicating accord with the client
“I think you should.”, “That’s right” Rationale: Implies that only the nurse knows what is best for the client.

36. AGREEING
Indicating accord with the client. “that’s right.” “I agree” Rationale: approval indicates the client is “right” rather
than “wrong’ which gives him/her the impression that he or she is right because of agreement with the nurse. There
is no opportunity for the client to change his or her mind.

37. BELITTLING FEELING EXPRESSED

Misjudging the degree of the client’s comfort.

Client : “I have nothing to live for.... I wish I was dead”

Nurse : “Everybody gets down in the dumps.”
Rationale : When the client tries to equate the intense and overwhelming feelings the client has
expressed to “everybody’, the nurse implies that the discomfort is temporary, mild,
self-limiting or not very important.
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38. CHALLENGING
Demanding proof from the client. “But how can you be President of the Philippines?” Rationale: This causes the
client to defend the delusions or misperceptions more strongly than before

39. DEFENDING
Attempting to protect someone or something from verbal attack. “This hospital has a fine reputation.” Rationale: this
implies that the client has no right to express impressions, opinions or feelings.

40. DISAGREEING
Opposing the client’s ideas. “That’s wrong”, “I definitely disagree with.....” Rationale: Implies that the client is
‘wrong” which may make the client defensive.

41. DISAPPROVING
Denouncing the client’s behavior or ideas. “That’s bad”, “I’d rather you wouldn’t” Rationale: This implies that the
nurse has the right to pass judgment on the client’s thoughts or actions.

42. GIVING APPROVAL

Sanctioning the client’s behavior or ideas. “That’s good.” “I’m glad that....” Rationale: this tends to limit the client’s
freedom to think, speak or act in a certain way.

43. GIVING LATERAL RESPONSES

Responding to a figurative comment as though it were a statement of fact.

Client : “They’re looking in my head with television camera.”

Nurse : “Try not to watch television”
Rationale : Often the client is at loss to describe his/her feelings, so such comments are the best he or she can
do. The nurse should focus on the feelings of the nurse.

44. INDICATING THE EXISTENCE OF AN EXTERNAL SOURCE

“What makes you say that?”, “What made you do that?”, “Who told you that you are a prophet?” Rationale: This
implies that the client was compelled to think in a certain way.

45. INTERPRETING
Asking to make conscious that which is unconscious. “What you really mean is....”, “Unconsciously you’re saying
that....” Rationale: The client’s thoughts and feelings are his or her own, not to be interpreted by the nurse or for
hidden meaning.

46. INTRODUCING AN UNRELATED TOPIC

Changing the subject.

Client : “I’d like to die.”

Nurse : “Did you have visitors last night?”
Rationale : This would make the nurse take away the initiative away from the client. This may
mean that the nurse does not know how to respond or is uncomfortable with the topic.

47. MAKING STEREOTYPED COMMENTS

Offering meaningless cliches or trite comments. “Keep your chin up.”, “Just have a positive outlook.” Rationale:
such comments has no value to the NPR.

48. PROBING
Persistent questioning of the client. “Now tell me about this problem. I need to know.” Rationale: This tends to make
the client feel used or invaded.

49. REASSURING
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Indicating there is no reason for anxiety. “Everything will be alright.” Rationale: attempts to dispel the client’s
anxiety by implying that there is not sufficient reason for concern completely devalue the client’s feelings .

50. REJECTING
Refusing to consider or showing contempt for the client’s behavior, ideas. “Let’s not discuss...” Rationale: This close
the topic off from exploration which may in turn make the client feel rejected.

51. REQUESTING AN EXPLANATION

Asking the client to provide reasons for thoughts, feelings, behaviors, events. “Why do you think that?”, “Why do
you feel that way?” Rationale: “Why” question is intimidating

52. TESTING
Appraising the client’s degree of insight. “Do you know what kind of hospital this is?” Rationale: This can force the
client to try to recognize his/her problems which may in turn meet the nurse’s needs but not helpful to the client.

53. USING DENIAL

Refusing to admit that a problem exists.

Client : “I am nothing.”
Nurse : “Of course, you’re something.”
Rationale : This dismisses the client’s comments without attempting to discover the feelings or meaning
behind them.

Therapeutic Communication Techniques Examples

1. Using silence The client says: "We drink and smoke a lot here." The
student thinks…how can that be…drinking alcohol in a
state hospital? But says nothing…using silence…the
client then says: "yes we drink a lot of cokes and smoke
a lot."

2. Accepting "Yes" or "I follow what you said"

3. Giving Recognition "I notice you combed your hair."

4. Offering self "I'll sit with you awhile."

5. Using Broad Openings "What would you like to talk about?"

"Tell me what's bothering you."

6. Using General Leads (using neutral expressions to "Go on. "Ummm..I am listening"
encourage continued talking by the client) "Tell me about it"

7. Placing he event in time or sequence "Was this before or after…?"

"What seemed to lead up to…?"

8. Making Observations "You appear tense"

"I notice you are biting your lips."

9. Encouraging Description of Perceptions "What do you think is happening to you right now…?"

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10. Restating Client: "I can't sleep. I stay awake all night."
Nurse: "You have difficulty sleeping"

11. Reflecting Patient: "Do you think I should tell the doctor?"
Nurse: "Do you think you should tell the doctor?"

12. Focusing "This point seems worth looking at more closely."

"You said something earlier that I want you to go back
to."

13. Exploring "Would you describe that more fully."

14. Giving Information "My name is…I am a student nurse.."

15. Seeking Clarification "What would you say is the main point of what you
said?"

16. Presenting Reality "Your mother is not here…I am a nurse."

Patient: "Did you bring my car today?"
Nurse: "No, you do not have a car. I drove my car here
today."

17. Voicing Doubt "That's hard to believe."

"Really?"

18. Seeking Consensual Validation

19. Verbalizing the Implied

20. Encouraging Evaluation (asking for the client's "How important is it for you to change this behavior?"
view of the meaning or importance of something)

21. Attempting to Translate Into Feelings " From what you say, I suspect you are feeling
relieved."

22. Suggested Collaboration "Let's see if we can figure this out.."

23. Summarizing " Let's see, so far you have said..."

24. Encouraging Formulation of a Plan of Action "What will it take to reach your goal of not hitting
anyone?"

25. Identifying themes ..asking client to identify "So what do you do each time you drink too much and
recurrent patterns in thoughts, feelings, and it's time to go home?" What is the major feeling you
behaviors have about all men?"

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B. COMMON CLIENT BEHAVIORS & NURSE RESPONSES

1. What to do if the client cries?

● Possible reactions by the nurse: Nurse may feel uncomfortable and experience increased anxiety or feel
somehow responsible for making the person cry.
● Useful responses by the Nurse: Nurse should stay with the client and reinforce that its all right to cry
often. It is at this time that feelings are closest to the surface and can be best identified.
● “You seem ready to cry.”, “You still are upset about your brother’s death?”, “What are you thinking right
now?”
● Nurse offers tissues when appropriate

2. What to do if the client asks the nurse to keep a secret?

● Possible reactions by the nurse: Nurse may feel conflict because the nurse wants the client to share
important information but is unsure about making such a promise.
● Useful responses by the nurse: Nurse cannot make such a promise. The information may be important to
the health or safety of the client and others.
● “I can not make that promise. It might be important for me to share it with other staff.”
● The client then decides whether to share the information or not.

3. What to do if the client leaves before the session is over?

● Possible reactions by the nurse: Nurse may feel rejected, thinking it was something that he or she did. The
nurse may experience increased anxiety or feel abandoned by the client.
● Useful responses: Some clients are not able to relate for long periods of time without experiencing an
increased in anxiety, On the other hand, the client maybe testing the nurse.
● “ I will wait for you here for 15 minutes until our time is up.”,
● During this time, the nurse does not engage in conversation with any other client or other staff.
● When the time is up, the nurse approaches the client, tells him/her that the time is up and restates the day
and time the nurse will see the client again.

4. What to do if another client interrupts during time with your selected client?
● Possible reactions by nurse: nurse may feel a conflict. The nurse does not want to appear rude. Sometimes
the nurse tries to engage both clients in conversation.
● Useful responses: The time the nurse had contracted with a selected client is that client’s time.
● By keeping their part of the contract, nurses demonstrate that they mean what they say and that they view
the sessions are important.
● “ I am with Mr. Rob for the next 20 minutes. At 10AM, after our time is up, I can talk to you for 5
minutes.”

5. What to do if the client says he wants to kill himself?

● Possible reactions by the nurse: Nurse may feel overwhelmed or responsible to “talk the client out of it”.
The nurse may pick up some of the client’s feelings of hopelessness
● Useful responses: Nurse tells the client that this is serious, that the nurse does not want harm to come to
the client and that this information needs to be reported to other staff.
● “ this is very serious Mrs. Lamb. I do not want any harm to come to you. I will have to report this to the
other staff.”
● The nurse can then discuss with the client the feelings and circumstances that led up to this.

6. What to do if the client says she does not want to talk?

● Possible reactions: the nurse new to this situation may feel rejected or ineffectual
● Useful responses: At first, the nurse might say something to this effect: “ Its all right. I would like to
spend time with you. We don’t have to talk.”
● The nurse might spend short, frequent periods of time (e.g. 5 minutes) with the client throughout the day.
● “ Our 5 minutes is up. I”ll be back at 10AM and stay with you for 5 more minutes.”
● This gives the client the opportunity to understand that the nurse means what he/she says and is back on

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 time consistently. This also gives the client time between visits to assess the nurse and perhaps feel less
threatened.

7. What to do if the client seeks to prolong the interview?

● Possible reactions: sometimes clients will open up dynamic or ‘juicy” topics right before the interview
time is up. This is often done to test or manipulate the nurse. The nurse might feel tempted to extend the
scheduled time or might not want to hurt the client’s feelings.
● Useful responses: The nurse sets limits and restates and reinforces the original contract.
● The nurse states that they will use the issues for the next session.
● “ Our time is up now, Mr. Jones. This would be a good place to start at our next sessions which is
Wednesday at 10 AM”

8. What to do if the client gives the nurse a present?

● Possible reactions: The nurse may feel uncomfortable when offered a gift-the meaning needs to be
examined.
● Is the gift: A way of getting better care, A way to maintain self-esteem, A way of making the nurse feel
guilty, A sincere expression of thanks.

15
 UNIT 3: DIALOG INTRODUCTION

Dialogue Model 1
Nurse : How do you do? I am Shanty
Student Nurse : How do you do, too. Mrs. Shanty. I am Miranda and my nickname is Randa
Nurse : I am a nurse in Darmais Hospital and you?
Student Nurse : I am a student nurse in Nusantara Nursing Academy.
Nurse : What year are you?
Student Nurse : I am a new student. So, I am the first year of Nursing Academy. Actually, I am the first
semester now.
Nurse : By the way, where do you live?
Student Nurse : I stay at dormitory but my permanent address is on Jalan Cendrawasih Number 19, South Jakarta
Nurse : Well, may I have your telephone number?
Student Nurse : All right. My phone number is 7755444
Nurse : Oh! That’s easy phone number
Student Nurse : I am sorry, Madam. I have a class now.
Nurse : Okay. Thank you
Student Nurse : You are welcome. See you later.

Dialogue Model 2
Harun : Hello, Joe, it has not seen you long time, how are you?
Joe : Hi…… Harun, it has not seen you long time, too. I am fine. Harun, Thank you, and how are you?
Harun : Oh….. I’m very well, thank you. By the way Joe, this is my Friend, Dr. Jossie, And
Dr. Jossie, this is Joe, a General Practitioner.
Joe : Hello, Dr. Jossie, how do you do?
Jossie : Hello, Dr. Joe. How do you do?
Joe : How do you do, too. It’s glad to see you.
Jossie : It’s glad to see you, too.
Harun : Well Joe. We have to go to hospital. See you later, Joe.
Joe : Okay……..see you later, bye.

Dialogue Model 3
Mala : Hello……How do you do, My name is Mala. May I know your name, please?
Ika : Of course. My name is Ika Lestari. You can call me Ika
Mala : Well. Ms. Ika, what do you do?
Ika : I’m a nurse
Mala : So am I. Where do you work?
Ika : I work in Honoris Hospital. So, how about you?
Mala : Oh, I’m in Hermina Hospital. And which ward do you work?
Ika : I am at Emergency Room.
Mala : I also work in Emergency Room.
Ika : Oh. We have the same job. Thank you and see you next time.
Mala : See you next time.

16
Dialogue Model 4
Nurse Rosa wants to introduce his friend to nurse Maria.

Rosa : Hi! Maria, how have you been?

Maria : I am very well, thank you and how is your life?
Rosa : Everything is running well, by the way, I want to introduce you to my friend.
Maria : Your friend? Who is she?
Rosa : She is Sendy
Maria : What does she do?
Rosa : She is nutritionist.
Maria : Where does she work?
Rosa : She works in Darmais Hospital.
Maria : Where is she now?
Rosa : She is on the way to this Hospital, look … she is coming!
Sendy : Hello! Rosa, how is keeping on?
Rosa : Fine, thanks and you?
Sendy : Pretty good.
Rosa : Well Sendy, this is Maria and Maria this is Sendy.
Sendy : Hi! How do you do, Maria?
Maria : How do you do too? Thank you.
Sendy : Rosa said that you’re a nurse? Where do you work, Maria?
Maria : Yes, I am. I work in this hospital at operating theater and you?
Sendy : I work in Harapan Kita Hospital but I want to move to this hospital.
Maria : Good and what’s department you will work here?
Sendy : I think, I will work in the nutrient dept.
Maria : Working in nutrient dept! Are you a nutritionist?
Sendy : Yes, I am.
Maria : Welcome to our hospital.
Sendy : Thanks.

Dialogue Model 5
Opal : It’s nice hospital, isn’t it?
Brian : Yeah Really.
Opal : By the way, my name is Opal Marenggo.
Brian : Glad to see you, I am Brian Nabir.
Opal : Pleasure to meet you. Excuse me, can you say again your first name?
Brian : Your mean, my first name?
Opal : Yes.
Brian : Oh, my first name is Brian and how should I call you?
Opal : Just call me opal.
Brian : And where are you from, Opal?
Opal : I am from Tokyo, Japan and you?
Brian : I am from Indonesia.
Opal : And what are you, Jane?
Brian : I am nurse and what about you?
Opal : I am a dentist.
Brian : Well, Opal. I have to go, see you later, Bye.
Opal : Okay, bye-bye.

17
RECEPTIONIST TO PATIENT: Making an Appointment
Clinic : Hello, Salemba Clinic.
Patient : Hello, I'm calling to make an appointment.
Clinic : Medical or dental?
Patient : Medical, please.
Clinic : Can you hold one moment? I will connect you.

Connect to the nurse

Clinic : Hello, can I help you?

Patient : I'd like to make an appointment for a check-up.
Clinic : Have you been here before?
Patient : No, I haven't.
Clinic : We have an opening on Friday, October 12th at 3 o'clock.
Patient : I'm sorry, I work on Friday's. Do you have any appointments available on Monday or Wednesdays?
Clinic : Our first Monday appointment would be October 22nd at 9 in the morning. Could you make that?
Patient : Yes, that would be fine.
Clinic : What is your name?
Patient : Suci Garcia.
Clinic : What is your phone number?
Patient : 764-2110.
Clinic : Is that the 0283 area code?
Patient : Yes, that's right.
Clinic : What is your date of birth?
Patient : 10/13/93.
Clinic : How will you be paying for this appointment? Do you have health insurance or medical coupons?
Patient : No, I don't. Can you tell me what the charge would be for this visit?
Clinic : We charge by sliding scale. You will need to bring your last 2 pay-stubs, an ID, and a Rp 100.000,-
deposit. Please come 1/2 hour before the time of your appointment to fill out a medical history.
Patient : OK. I will do that. Do your doctors and nurses speak Arabic?
Clinic : We do have some doctors and nurses on staff that speak Arabic. Would you prefer that?
Patient : Yes, please.
Clinic : OK. I've noted that on the schedule. We will see you on Monday, October 22 nd at 9 for a physical
check-up. Plan on spending about 1 hour at the clinic.
Patient : Thank you. Good-bye.
Clinic : Good-bye.

18
 UNIT 4: NURSE TO DOCTOR
Telephoning
Nurse Shelli : I’d like to speak to Dr. Kola of the Ambulance. Would you get him on the phone, please?
Nurse Maria : Certainly, I’ll do it at once, Nurse Shelli. (Kepada dirinya sendiri).
Now, what’s Dr. Kola’s number? Ah, here it is...five, three, zero, double six.

(Mengangkat gagang telepon)

Nurse Rose : Switchboard, can I help you?

Nurse Maria : Good morning, Nurse Rose. Nurse Maria here. Could I have an outside line, please
Nurse Rose : Oh, hello Nurse Maria. Hold the line a moment. (Penghubung berbicara tentang nada
sambungan). There you are, you‘ve an outside line now, you can hear the dialing tone.
Nurse Maria : Thank you. (Kepada dirinya sendiri). Five, three, zero, six, six.

(Nada berdering)

2nd Operator : Ambulance. Good morning, can I help you?

Nurse Maria : Good morning, would you put me through to Dr. Kola, please?
2nd Operator : Dr. Kola? Certainly. Who’s calling him?
Nurse Maria : Nurse Shelli of Salemba Hospital, would like to speak to him.
2nd Operator : Thank you. Hold the line, please.
Dr. Kola : Kola speaking.
2nd Operator : Good morning, Dr. Kola. I have a call for you from Nurse Shelli of Salemba Hospital.
Dr. Kola : Thank you, operator, put him through, please.
Nurse Maria : Dr. Kola?
Dr. Kola : Kola speaking.
Nurse Maria : Oh, good morning, Dr. Kola. Nurse Shelli is calling you. Would you hold the line a moment,
please. I’ll hand you over. Nurse Shelli?
Nurse Shelli : Yes?
Nurse Maria : Dr. Kola on the line now, Nurse Shelli. Will you take it in here, please?
Nurse Shelli : Thank you, Nurse Maria. Hello, is that Dr. Kola?
Dr. Kola : Good morning, Nurse Shelli.
Nurse Shelli : Ah, good morning, Dr. Kola, how are you?
Dr. Kola : Fine, thanks, and you?
Nurse Shelli : Very well, thank you.
Dr. Kola : I’m glad to hear it. Well, what can I do for you, Nurse Shelli? Hello, Nurse Shelli?
Nurse Shelli! Nurse Shelli!

Doctor Advise
Nurse Diana : Good morning doctor.
Doctor : Oh, good morning nurse Diana. Nurse Diana, would you like to take the child’s vital signs?
Nurse Diana : Of course, doctor. Wait a minute, please. I’ll take the data involving the temperature is 39
degrees Centigrade, the respiratory rate is 22 breaths/min, the pulse is 95 beats/min and
the blood pressure is 100/70 mmHg (millimeter of mercury).
Doctor : Thank you and how old is he?
Nurse Diana : According to health status card, he is 4 years old. So, what should nursing action do, Doctor?
Doctor : Firstly, please give compress to decrease his high body temperature. Don’t forget to monitor
intake and output in this afternoon. Please report me the child’s condition.
Nurse Diana : Thank you, doctor I’ll go to the patients’ room.
Doctor : You are welcome.

19
Visiting
Dr. Lie comes to surgical ward to visit Mr. Brown, accompanied by Nurse Ella.

Dr. L : Good morning, Nurse.

Nr. E : Good morning too, Dr. Lie.
Dr. L : I’d like to know condition of Mr. Brown.
Nr. E : Yes, Doc, this morning Mr. Brown complained pain on his lower abdomen and also his leg.
Dr. L : Did you give painkiller already?
Nr. E : Yes, I did and I examined his lower abdomen too.
Dr. L : What did you find?
Nr. E : I found his lower abdomen is distension and I think it is caused by urine who can’t be out.
Dr. L : I see, okay let’s examine him, now, Nurse!
Nr. E : Yes, Doc.
Dr. L : Don’t forget to bring stethoscope!
Nr. E : I do

Both of them go to Mr. Brown ‘s room to examine him. After examined Mr. Brown, then Dr. Lie and nurse back to
nurse station.

Dr. L : Well nurse, I think it’s better for you to apply an indwelling catheter for Mr. Brown then
observe if the urine contains blood and also give him pain killer if necessary.
Nr. E : Okay Doc, thanks.
Dr. L : Welcome.

Telephoning
Dr. Kola in emergency room is receiving a phone call from Nurse Shelli.

Nurse S : Hello, Good evening, is this emergency room?

Dr. K : Hello, yes this is emergency room, May I help you?
Nurse S : Yes, can I have some words with doctor in charge there?
Dr. K : Dr. Kola is speaking, and who is speaking, please?
Nurse S : This is nurse Shelli from surgical ward.
Dr. K : Yes, nurse Shelli, is there anything I can do for you?
Nurse S : Well, Doc, I am going to report about my patient.
Dr. K : Yes, what is your patient name?
Nurse S : My patient name is Mr. Baron.
Dr. K : What does his diagnose?
Nurse S : Compound fracture at tibia and fibula.
Dr. K : What is going on with Mr. Baron now?
Nurse S : Mr. Baron has pain on his leg at the moment.
Dr. K : What was he doing when the pain comes on?
Nurse S : He was trying to move his leg.
Dr. K : What have you done so far?
Nurse S : I have given Ponstan 500 mgs, oxygen 4 liters/min.
Dr. K : Good, what about his vital signs?
Nurse S : His vital signs are BP is 130/80 mmHg, P is 90 bpm, RR is 24 breaths per minute, and
T is 36.8 degrees Centigrade.
Dr. K : Okay, nurse Shelli, write my orders on your nursing note.
Nurse S : Okay, Doc.
Dr. K : Here my order: Give pethidine 50 mgs – P.R.N (I.M), Give Ponstan 500 mgs three times
a day (p.o), and Close monitoring for while.
Nurse S : Yes, Doc, I will give them immediately.
Dr. K : I’ll be there in a few minutes.

20
Reporting
Nurse Tanti : Good afternoon doctor, I want to report the patient’s condition who came this morning.
Doctor : Okay, tell me now.
Nurse Tanti : An hour ago, I took his vital signs including T is 38,5 degrees Centigrade, BP is 100/70 mmHg,
RR is 22 breaths/min, and P is 90 beats/min. He looked so pale and his skin was dry.
Not only he looks pale but also he looked blue in his skin. He passed water normally but he
often passed stool. For ten hours, he had bowel movement 6 times.
Doctor : What about the character of feces?
Nurse Tanti : The feces is liquid without blood
Doctor : What is total of fluid lost?
Nurse Tanti : About 1500 mls and total intake today is 1000 mls. What Should I do doctor?
Doctor : Apply infusion the ringer lactate with 15 drops a minute.
Nurse Tanti : All right, doctor. Thank you.
Doctor : You are welcome.

A Prescription
Patient : Good morning doctor, I could not sleep well last night
Doctor : Ooh good morning mr. Budi, I'm going to give you a prescription for some medicine to help you
get a better night's sleep.
Patient : Thank you doctor.
Doctor : Here, you can get this prescription at any pharmacy.
Patient : How often should I take the medicine?
Doctor : Just take one pill about 30 minutes before you go to bed.
Patient : How long should I take them?
Doctor : The prescription is for thirty days. If you're not sleeping well after thirty days, I'd like you to
come back in.
Patient : Is there anything else I can do to help me sleep at night?
Doctor : Don't worry so much about things at work. I know, I know... easier said than done.
Patient : Should I stay home from work?
Doctor : No, I don't think that's necessary. Just remember to stay calm.

Vital Signs
Nurse Mitha in medical ward calls Dr. Scott at his home to report about condition of Mr. Roby.

Nurse M : Hello, can I speak to Dr. Frank, please?

Dr. S : Dr. Scott’s speaking, who is speaking?
Nurse M : This is Nurse Mitha Zulvia from Bintaro Hospital.
Dr. S : Yes, Mitha, is there anything I can do for you?
Nurse M : Yes, doc, I am going to report about Mr. Roby’s condition.
Dr. S : What’s going on with him?
Nurse M : Well. Doc, This morning his temperature rises and he has headache too.
Dr. S : I see, how high is his temperature?
Nurse M : It’s about one hundred and four Fahrenheit.
Dr. S : Excuse me, can you convert it into Centigrade, please?
Nurse M : One hundred and four equals forty degrees Centigrade.
Dr. S : How often the temperature comes on and off?
Nurse M : The fever usually comes on in the afternoon or evening and off in the morning.
Dr. S : How is his pulse and respiration?
Nurse M : His pulse is 100 bpm and his respiratory rate is 24 breaths/min.
Dr. S : And what about his blood pressure, is it high too?
Nurse M : No really, his BP is 120/90 mmHg.
Dr. S : So, what have you done for him?
Nurse M : I have given tepid water compress, a lot of fresh water.
Dr. S : Okay, you can give him Paracetamol 500 mgs t.i.d and I’ll be there in a few minutes.
21
Check Patient’s file
Dr. Chyne (a general physician) comes to emergency room to examine Ms. Shelly.

Dr. C : Good morning, Nurse.

Nurse : Good morning, Dr. Chyne.
Dr. C : Can I see the file of Ms. Shelly.
Nurse : Yes, of course, here they are.
Dr. C : Thanks.
Nurse : You’re very welcome.
Dr. C : Well, can you tell me what happened with Ms. Shelly?
Nurse : According to information that I got, Ms. Shelly was hit by a car this morning and its look
like fracture on her leg.
Dr. C : Did you take X-Ray for her leg?
Nurse : Yes, I did and there is a compound fracture at tibia and fibula.
Dr. C : I see. Have you already called a surgeon?
Nurse : Which surgeon?
Dr. C : Dr. Ballito
Nurse : No, I have not called yet, why don’t you call him?
Dr. C : Okay, I will call him later.
Nurse : So, what do I have to do now?
Dr. C : I think, Dr. Ballito will surgery her bones.
Nurse : I think so, and we have to prepare her for surgery from now.
Dr. C : Yes, you are right, don’t forget to take her blood samples.
Nurse : I will.
Dr. C : Well, I am going to call Dr. Ballito, now.
Nurse : Okay.
Dr. C : I hope you can call Dr. Ballito too to inform him about this.
Nurse : I will.

22
 UNIT 5: NURSE TO NURSE

NURSING CARE
Heny : Hello. . .good morning
Ade : Hi. . .good morning
Heny : How are you today?
Ade : I am fine, how about you?
Heny : I am fine too thanks. By the way, where are you working now?
Ade : I work in a hospital MMC and you?
Heny : I work in a hospital Karawang. Can we share knowledge about nursing?
Ade : Sure, What you need to know about nursing?
Heny : How we provide good nursing care to the client?
Ade : We must keeping the patient’s body and clothes clean
Heny : What we do in providing comfort for the client?
Ade : We are treating him as a person and providing for his rest and relaxation.
Heny : What is the primary function of the medical team?
Ade : The primary function of this team is the care of the patient
Heny : Thanks for your information Ade, see you...
Ade : See you...

Book a Bed
Nurse Mitha from emergency room calls a nurse in surgical ward to book a bed for Ms. Smith.

Nurse D : Hello, this is surgical ward with nurse Dewi, may I help you?
Nurse M : Yes, this is nurse Mitha from emergency room.
Nurse D : Hi, Mitha, how are you doing?
Nurse M : I am pretty good thanks, who is speaking over there?
Nurse D : Dewi’s speaking, well Mitha, is there anything I can do for you?
Nurse M : Yes, do you still have one bed left?
Nurse D : Yes I have, for who?
Nurse M : For my patient. Ms. Smith Raymon.
Nurse D : Smith Raymon. What is her diagnose?
Nurse M : Compound fracture at tibia and fibula.
Nurse D : How old is she?
Nurse M : She is 22 years old.
Nurse D : Who is her doctor?
Nurse M : Her doctor is Dr. Ballito.
Nurse D : Did Dr. Ballito give some medicines for her?
Nurse M : Yes he did, I’ll tell you about her medication when I come to your ward.
Nurse D : That’s good and what time are you going to here, Mitha?
Nurse M : I am going to your ward at 11.00 a.m.
Nurse D : Mitha, is Dr. Ballito planning her to operate?
Nurse M : Yes he is. But I don’t know when is it, may be Dr. Ballito is going to make it late.
Nurse D : Okay, I’m going to prepare a bed for her first. See you later.
Nurse M : Thanks a lot, good bye.
Nurse D : Good bye.

23
Pre-operation List
Nurse Shelli asks nurse Monalisa about preoperation list of Ms. Juliet. Because Ms. Juliet will be operated by Dr.
Kola today.

Nurse S : Monalisa, have you checked the preoperation list of Ms. Juliet?
Nurse M : Yes, I have. I’ve checked all the list of Ms. Juliet this morning.
Nurse S : Very good. But let us check again together?
Nurse M : No problem nurse, what do you want to know about?
Nurse S : Have her parents already given signature on the consent form?
Nurse M : Yes, both of them have given signature on it.
Nurse S : Good and what about identification band on his hand, have you applied it?
Nurse M : It was done.
Nurse S : Does she have allergies or something?
Nurse M : Yes, she does, she has allergic to Penicillin and shrimp.
Nurse S : Good, don’t forget to tell it to nurse in OT and what about lab result, have you had it?
Nurse M : Yes, I have kept all the results of laboratories in the file.
Nurse S : Thanks and have you taken vital signs of her?
Nurse M : The last vital signs are BP is 120/80 mmHg, P is 80 bpm, T is 37 degrees Centigrade, and
RR is 20 breaths per minute.
Nurse S : And you have done preoperation, right?
Nurse M : Yes I have cleaned up and shaved the leg and I’ve told him to stop eat and drink at 12 midnight.
Nurse S : Well, I think most of preoperations we have done completely.
Nurse M : I don’t think so, there are still have preparation we have done yet.
Nurse S : What are they?
Nurse M : I have not removed yet all prosthetic aid that the patients have.
Nurse S : I think you can remove it now.
Nurse M : Okay. How about clean gown, cap, clean bath blanket can we put on now?
Nurse S : I think so and how about premedication injection?
Nurse M : I have injected it.
Nurse S : And infusion?
Nurse M : No, I have not applied yet.
Nurse S : Okay, after this you can apply infusion.
Nurse M : Yes.
Nurse S : Did she have any complaint before we send to OT?
Nurse M : No, she just told me that she passed water at 7.30 this morning and also she has put off
all the hair pins, make up and nail polish.
Nurse S : Good. Every thing is complete now, don’t forget bring your patient at one hour before surgery
begin.
Nurse M : Okay.

Handover
Nurse Maria and Nurse Ella do handover in the afternoon.

Nurse Maria : Good afternoon, Nurse Ella.

Nurse Ella : Good afternoon, Nurse Maria
Nurse Maria : How are patients today
Nurse Ella : Yeah, generally is calm and there is an incoming patient in room number 4, Mr. Jack
with head injury and he is still need observation every 15 minutes for vital signs. And
nurse Maria for Mr. Robi in room number 6 has been scheduled X-ray at 4 o’clock.
Nurse Maria : Nurse Ella, thanks for information
Nurse Ella : See you
Nurse Maria : See you

24
Telephoning
Nurse Betty in Scott’s clinic is receiving phone call from nurse Terry.

Betty : Good morning, Dr. Scott’s clinic, with nurse Betty, may I help you?
Terry : Hello, I would like to have a quick word with Dr. Scott, can I?
Betty : Of course you can, but if you don’t mind telling me with whom I speak to?
Terry : This is Betty. I am a nurse from Darmais Hospital.
Betty : Is that C E R R Y?
Terry : No, it’s T E R R Y.
Betty : Well nurse Terry, from what department are you?
Terry : I am from emergency dept.
Betty : Okay nurse Terry, I ringer you to his room but just in case if you get cut off, his extension is 223,
okay.
Terry : 223, okay, thanks.

Then the nurse Betty rings her to Dr. Scott’s room but nobody answers the telephone.

Betty : Hello nurse Terry, I just called Dr. Scott’s room but nobody gets the telephone, maybe
he is not in the office at the moment, would you like to leave a message?
Terry : Yes, please tell him that there is a patient with compound fracture at Tibia and Fibula in this
hospital.
Betty : Okay, “there is a patient with compound fracture at Tibia and Fibula in Darmais Hospital.”
Terry : Yes, you right.
Betty : Okay, I’ll try to call Dr. Scott and give the message to him immediately.
Terry : By the way, do you have the cellular phone number of Dr. Scott?
Betty : I think so. Just a moment, here it is 08158881592.
Terry : ‘08158881592’ okay, I will call him now but if you meet Dr. Scott, please tell him to contact me
at 93033095 in this afternoon.
Betty : ‘93033095’ yes nurse Terry, I’ll give Dr. Scott the message
Terry : Thank you. Goodbye
Betty : Goodbye.

Handover
Nurse Rita and Nurse Julia do handover in the morning.

Nurse Rita : Good morning nurse Julia.

Nurse Julia : Oh, good morning nurse Rita.
Nurse Rita : How are you?
Nurse Julia : I am fine thanks and you?
Nurse Rita : Very well thanks and how were patients last night?
Nurse Julia : All of the patient could sleep well and there is no problem
Nurse Rita : Good, and what is the schedule this morning for our patient?
Nurse Julia : There is a schedule for Mr. John that he is in the first day in rehabilitation phase to do range
of motion exercise today.
Nurse Rita : Okay, and thanks for information.
Nurse Julia : You are welcome.

25
Take Over
Nurse Yoland from emergency room is taking over Ms. Lybra to nurse Tia in surgical ward.

Nurse Y : Good morning nurse, I would like to meet nurse Tia, is she here?
Nurse T : Yes, I am Tia, you are nurse Yoland from emergency room, aren’t you?
Nurse Y : Yes, I am. I bring Ms. Lybra for you.
Nurse T : Good, is this Ms. Lybra?
Nurse Y : Yes, that’ right.
Nurse T : Let me bring Ms. Lybra to her room first.

Then nurse Tia brings Ms. Lybra to her room and moves her onto bed gently and carefully. After that nurse Tia asks
student to take vital signs of her, then she backs to nurse station for taking over Ms. Lybra with nurse Shinta.

Nurse T : Okay, nurse Yoland we can take over now.

Nurse Y : Okay.
Nurse T : So, what happened with her?
Nurse Y : Well, she was hit by a car yesterday evening, after we examined her, we found broken bone
on her leg.
Nurse T : Did you take X-rays for her?
Nurse Y : Yes, we did, on X-rays of her, we found compound at tibia and fibula.
Nurse T : I see, did you do something to treat her fracture?
Nurse Y : We did not manipulate her fracture much, we just gave temporary treatment.
Nurse T : And what did you do, so far?
Nurse Y : As I told you on telephone, we cleaned up the wound, applied IV solution with lactate ringer,
gave pain killer, closed monitoring and took blood sample.
Nurse T : Did you write all of them on nursing note?
Nurse Y : Yes, I did.
Nurse T : Did Dr. Scott make schedule to operate her?
Nurse Y : No, he didn’t make it yet, but Dr. Scott told me that you have to make close observation for a day.
Nurse T : Then Dr. Scott will make a schedule for her, won’t he?
Nurse Y : Absolutely, and these are medicines that Dr. Scott gave for her.
Nurse T : Thanks and I think that’s enough, if I need more information, I will call you later.
Nurse Y : Okay, thanks, good bye.
Nurse T : Good bye.

Patient’s Position
Nurse Doria and nurse pary are discussing about patient’s position.

Nurse D : What is the suitable position for the patient with catheterization enema?
Nurse P : The suitable position for the patient with Catheterization enema is the dorsal recumbent position
Nurse D : What about the patient with the short of breath (SOB)?
Nurse P : I think the semi fowler position.
Nurse D : What is the best position for examination of the patient’s rectal area?
Nurse P : It is the sim’s position.
Nurse D : What position is for the rectal procedure such as sigmoidoscopy?
Nurse P : The good position for the rectal procedure such as sigmoidscopy is knee – chest position.

26
The Cardiovascular System
Lecturer : Good morning student and how are you?
Student : Good morning sir. We are fine.
Lecturer : Well, we come to new topic today. And I’d like to talk about heart and its system. It often called
cardiovascular system. Is there any student here knows about heart?
Tony : Yes sir. I am Tony. Heart is one part of the inside human anatomy. It is vital organ in our body.
Lecturer : Okay, you have talked about anatomy. Do you know the anatomy of heart?
Tony : Heart consist of three layers; Pericardium, Myocardium, and endocardium.
The pericardium is the outer layer, while the myocardium is the middle layer, and endocardium is
the inner layer.
Dony : What about chamber sir?
Lecturer : All right. The heart is divided into two chambers, left and right. Each chamber consist of atrium
and ventricle. There are two atriums, right and left and two ventricles. OK. Now Jane what do
you know about valves?
Jane : So far as I know, valves are strong membranous openings that provide one way of blood flow.
Atrioventricular valves prevent back low of blood from ventricles to atrium during systole. The
valve that is located in the right side is called tricuspid and the left side named mitral. Other vales
are called semilunar valves. Their function is to prevent back flow from aorta and pulmonary
valves. Their function is to prevent back flow from aorta and pulmonary arteries into the ventricle
during diastole.
Lecturer : Very good explanation. Thank you. Anyway, I hope you discuss arteries, veins, pulse and their
functions. OK. Make a group consisting of four or five students. You can start now, please!

Admission System
Junior Student : Excuse me. May I ask you, please?
Senior Student : Sure, are you a junior student nurse?
Junior Student : Yes, I am. I am in the third semester
Senior Student : What can I do for you?
Junior Student : Hmm…. I am so strange with the hospital and next week I’ll have a
Nursing practice in Jakarta Budi Asih General Hospital
Senior Student : Have you prepared anything?
Junior Student : No, I haven’t, I have not prepared anything yet. I’d like to know the
hospital condition. Would you mind telling me?
Senior Student : Well, when I was practicing there I met my senior, too. She gave
me some information. And it’s so precious for me. There are many
units or wards in General Hospital where have had job training program.
But mainly, it is divided into three parts.
Junior Student : What are they?
Senior Student : The first is Admission Desk or Receptionist. The second one is the clinic
consultation and Special treatment or Services. The later is the option given to
the clients to have health care service available in hospital.
Junior Student : Then, What is the task at Admission Desk?
Senior Student : All right, all the staffs there should be friendly, active and cooperate.
They welcome and register incoming patients or clients.
Despite that, giving information about services, giving registration from and making
a code, ID card are their responsibility. Sorry …… I have a class now.
Junior Student : Thank you so much
Senior Student : You are welcome. Bye. Bye.

27
 UNIT 6: NURSE TO PATIENT
Phases in Dialogue Nurse to Patient:
Phase I : Greeting, introduction, and evaluation
Phase II : Info patient’s schedule and short term Contract
Phase III : Work phase
Phase IV : Evaluation procedure and long term contract

Blood Taking
Nurse Mia : Good morning Mrs. Ida. How are you today?
Patient Ida : I am not so well
Nurse Mia : And could you sleep well last night.
Patient Ida : I could not sleep well last night, because I have difficult in breathing, and what’s the best
position for me?
Nurse Mia : The position for you is the half of the sit down or elevate the head of the bed to an angle
of less than 45 degrees.
Patient Ida : Thanks Nurse
Nurse Mia : You’re welcome. And Mrs. Ida, you have been scheduled to be taken the blood for the laboratory
examination today.
Patient Ida : How much nurse Mia?
Nurse Mia : 2 cc
Patient Ida : Okay.
Nurse Mia : Mrs. Ida, I am going to prepare the equipment and 10 minutes I will be back.
Patient Ida : Okay, nurse.

Nurse Mia then prepares the equipment in CSSD for 10 minutes and she goes back to the patient’ room.

Nurse Mia : Excuse me, Mrs. Ida. Are you ready now?
Patient Ida : Yes, I am ready.
Nurse Mia : Now you remain in supine position and straighten your arm along side your body and fist.
I am going to sleeve up and tie your upper arm and you take a deep breath and retain
while I am inserting this needle into your vein, is that okay?
Patient Ida : Okay, Nurse.
Nurse Mia : Now, Get ready, I am going to give antiseptic with alcohol swab on your forearm and insert
this needle. Take a deep breath! Retain! Yes finish. Did you feel pain?
Patient Ida : Uh, Little as ant’s bite
Nurse Mia : Okay, thanks for co-operation and I will be back within 30 minutes to give result it.
Patient Ida : You are welcome.

Asking and Giving Directions

Mrs. Lily is looking for Delivery Ward in Bintaro Hospital then she asks to Information Center.

Mrs. L : Excuse me, Miss?

I.C : Yes, can I help you, Madam?
Mrs. L : I wonder whether you can help me?
I.C : I hope I can help you, what do you want to know, Madam?
Mrs. L : Yes, Could you tell me how can I get to delivery ward in this hospital?
I.C : Of course I can, delivery ward is in the third corridor.
Mrs. L : In the third corridor? But, where the third corridor is?
I.C : Okay, let me explain you, from here you just turn right then you will find a three junction on
corridor seven and you can turn right and go ahead, when you find another intersection,
you just pass it. And then you go over until next intersection. The delivery ward is in the
left side before pharmacy department.
Mrs. L : Thanks a lot, Miss.
I.C : Don’t mention it
28
Nursing Documentation
Nurse Betty is visiting Mr. Rizal’s room to make nursing documentation.

Nurse B : Good morning, Mr. Rizal?

Mr. R : Morning
Nurse B : How are you feeling, today?
Mr. R : I am feeling better, thanks
Nurse B : And how about your sleep, did you sleep well last night?
Mr. R : No, I didn’t.
Nurse B : Why?
Mr. R : You know nurse, I felt terrible, I felt painful on my leg.
Nurse B : Oh. I am sorry to hear that, may be the pain that you have now is caused by operation wound.
Mr. R : But I can’t stand it. It’s very painful.
Nurse B : I understand it, I will give extra pethidine 50 mgs to relieve your pain.
Mr. R : Thanks a lot, Nurse.
Nurse B : No problem. And by the way, how is your water works, can you pass urine well?
Mr. R : No, I can’t pass urine at all and I felt pain too on my lower stomach.
Nurse B : I see, let me check your abdomen first and can you lower down your pant, please?
Mr. R : No problem.
Nurse B : Good and now I will palpate your abdomen, if you feel pain, please tell me, okay?
Mr. R : Yes I will.

Nurse Betty then palpates the lower abdomen of Mr. Rizal, and she found that abdomen of him is distended.

Nurse B : Well, Mr. Rizal, I think the water in your bladder can not out spontaneously, may be there is
something wrong with your bladder.
Mr. R : Are you sure, Nurse?
Nurse B : Yes. And by the way how long did you have not pass urine?
Mr. R : Since 2 days ago.
Nurse B : Then did you drink a lot of water?
Mr. R : Yes I did, I took 8 glasses of water everyday.
Nurse B : Okay, Mr. Rizal, I try to call your doctor to inform this.
Mr. R : Thanks, Nurse
Nurse B : You’re very welcome.

Apply Infusion
Nurse : Good morning Mr. Bram? How are you feeling this morning?
Mr. B : Not bad sister, Thanks.
Nurse : Well Mr. Bram, today you will be operated, won’t you?
Mr. B : Yes, I will.
Nurse : Good, I am going to apply infusion in order to the doctor easier to give medication through your vein.
Mr. B : Oh yach … If you think that’s better for me you can go on.
Nurse : Will you lay down on the bed, please?
Mr. B : Okay. By the way is it hurt, Nurse?
Nurse : It will be little bit hurt but It’s okay, don’t worry.
Mr. B : Oh … see, don’t you use glove first before you carry on the procedure, Nurse?
Nurse : Absolutely yes. Now I am going to clear all IV tubing and IV catheter from air.
Mr. B : Good.
Nurse : Would you give me your hand, please?
Mr. B : What for?
Nurse : I’ll select your vein first, which one of them is the biggest vein.
Mr. B : Here my hand.
Nurse : Would you raise your arm because I want to put this water proof pad under your arm?
Mr. B : No problem.
29
Nurse : Thanks, then I’ll put this tourniquet above desired insertion site in order to occlude your blood flow,
maybe you will have tingling for while on your fingers but it’s okay.
Mr. B : Never mind.
Nurse : Good, and your skin will be cleaned by this alcohol swab.
Mr. B : Ehm …
Nurse : Well, this IV Catheter will be inserted into your vein through 45 degrees angle, I suppose you
don’t move your hand, okay!
Mr. B : Okay but be careful, please.

When the IV catheter is inserted into vein with bevel up and blood appears in the catheter, then the nurse advances
the catheter into vein.

Mr. B : Ups … Can you get it, Nurse?

Nurse : Of course, I got it, Sir and I’ll release the tourniquet then connect the catheter hub to adapter of infusion.
Mr. B : that’s relieve.
Nurse : Very good, I will put anti micro bacterial ointment cream first on insertion site then fix it using transparent
dressing.
Mr. B : Does it finish, nurse?
Nurse : It has done perfectly, Sir!
Mr. B : Thank you very much, Nurse.
Nurse : Anytime and I’ll bring you to operating theater in few minutes.
Mr. B : Okay … I am ready.

Injection
Today Mr. Baron will be operated and nurse Maria Comes to his room to make sure that everything is ready.

Nurse : Good morning Mr. Baron, How are you feeling today?
Mr. B : I am pretty well, thanks.
Nurse : Good and today you will be operated, won’t you?
Mr. B : Yes, you right.
Nurse : Do you still keep your mouth off from meals and drinks, don’t you?
Mr. B : Yes, I am still off from food and meals.
Nurse : Very good.
Mr. B : By the way, when will you bring me to operating theater?
Nurse : Don’t worry Sir, you will be brought to operating theater at 09. 45 p.m.
Mr. B : That’s relieve.
Nurse : And now, I will inject you this medicine at your buttock.
Mr. B : Injected again! What is that injection for?
Nurse : This medicine is called premedication, we usually give this injection one or two hours before operation
begins.
Mr. B : Does it hurt me?
Nurse : Little, it just like ant’s bite, now would you mind putting your body upside down?
Mr. B : On this bed? Okay.
Nurse : Yes, good, and would you lower down your trouser, Sir?
Mr. B : No problem.
Nurse : Well Sir, I hope, you don’t move when I inject this medicine, okay.
Mr. B : I will.
Mr. B : Does it finish, Nurse?
Nurse : Yes, and now could you change your gown with this operation gown, please?
Mr. B : No problem.
Nurse : Thanks.

30
Patient’s complaint
Nurse D : Good afternoon, Mr. Morino, is there something that I can do for you?
Mr. M : Yes, I feel pain, pain on my leg, Nurse.
Nurse D : I see, when did the pain come on and off?
Mr. M : The pain come on when I tried to move my leg.
Nurse D : How long the pain come on?
Mr. M : Its about five to ten minutes.
Nurse D : Okay, Mr. Morino, what does the nurse usually to combat your pain?
Mr. M : Yes, I was injected pain killer to relieve my pain by nurse Lewis yesterday afternoon.
Nurse D : Where did her inject that medicine?
Mr. : On my buttock.
Nurse D : Do you have any else complaint, Sir?
Mr. M : No, just pain on my leg.
Nurse D : Well, Mr. M, I will call Dr. Ballito and tell him about your complaint.
Mr. M : That’s excellent nurse.
Nurse D : And let’s see what he says.
Mr. M : Thanks, Nurse.
Nurse D : Meanwhile we wait the instruction from Dr. Ballito, please take Ponstan 500 mgs to relieve pain.
Mr. M : Yes, Nurse.
Nurse D : And also I am going to give you oxygen 4 liter/min then take your vital signs soon.

Blood Pressure Checking

A Nurse Comes to Mr. Lym’s room to take his vital signs

Nurse : Good morning Mr. Lym.

Mr. L : Good morning too, nurse.
Nurse : How are you doing now, Sir?
Mr. L : I am feeling terrible.
Nurse : Terrible! What is going on with you?
Mr. L : I have pain on my head.
Nurse : I see, do you have any else complaint, Sir?
Mr. L : And little stiff on my leg.
Nurse : Okay, Mr. Lym, let me check your blood pressure and your temperature first?
Mr. L : Yes, please.
Nurse : Would you mind lying down on your bed, please?
Mr. L : No problem.
Nurse : Can I have your arm, Mr. Lym?
Mr. L : Here it is.
Nurse : Good. Will you roll your sleeve up, please?
Mr. L : Yes.
Nurse : Good, now, I want to put this cuff around your upper arm then I’ll search your pulse
(brachialis artery) on your inner of lower arm.
Mr. L : Okay.
Nurse : Now, I am going to pump this bulb to inflate the cuff, maybe you will have tingling on
your fingers for while but it’s okay.
Mr. L : I see.

After the nurse pumps the bulb to inflate the cuff then she puts stethoscope over brachialis artery and listens the
sound of artery (corotcof) from beginning to ending, after she gets the result of B/P, she releases the cuff then puts it
back onto trolley.

Nurse : Well Mr. Lym, I am going to check your temperature now?

Mr. L : Okay.
Nurse : Could you raise your arm because I’ll put this thermometer on your armpit?
31
Mr. L : Like this nurse?
Nurse : Yes, thanks (then the nurse puts it at her armpit) and now place your left hand on your shoulder
for a moment?
Mr. L : With my pleasure.
Nurse : Very good.

After 5 minutes, she takes thermometer back from Ms. Lym’s armpit.

Nurse : Well Mr. Lym, your blood pressure is high enough, its about 160/90 mmHg and
temperature is 37.5 degrees Centigrade, pulse is 88 bpm, RR is 20 breaths/min, I will
report to Dr. Scott about your complaints. I’ll be back in a few minutes.
Mr. L : Thank you very much, Nurse.
Nurse : You’re welcome.

Pay for Consultation

Nurse Shelly is examining Mrs. Leny in her clinic.

Nurse S : Please have a seat Mrs. Leny?

Mrs. L : Thanks.
Nurse S : Well Mrs. Leny, what’s brought you here?
Mrs. L : I’ve temperature, Nurse
Nurse S : I see, how long has this been going on?
Mrs. L : Since 2 weeks ago.
Nurse S : Is your temperature come at particular time?
Mrs. L : Yes, I usually get feverish in the afternoon.
Nurse S : Do you have any else complaint, Madam?
Mrs. L : Yes, I’ve got headache too.
Nurse S : Ehm, what about your appetite, do you have it?
Mrs. L : Yes but sometime I don’t have it at all.
Nurse S : Okay Mrs. Leny, I’d like to examine you now. Can you lay down on the couch, please?
Mrs. L : No problem.
Nurse S : And would you like to put your clothes off, please?
Mrs. L : Okay.

Then Nurse Shelly examines Mrs. Leny for a few minutes.

Nurse S : Well, Mrs. Leny, I don’t think there’s anything to worry about. May be you just felt tired.
Mrs. L : That’s relieve.
Nurse S : Okay, try these tablets for a week and see me how you get on. Drop and see me again next week.
 Erythromicine 500 mg t.id
 Alpara 500 mg t.i.d
 Multiplex b.i.d
Mrs. L : And how much should I pay you for this consultation?
Nurse S : Just pay me 35,000 rupiahs
Mrs. L : Here the money, nurse.
Nurse S : Thank you

Doctor’s Schedule
Mrs. Nelly is asking to a nurse about Dr. Ballito’s schedule in Bintaro Hospital.

N
Nurse : Good morning too, is there anything I can do for you, Madam?
Mrs. N : Yes, I am looking for schedule of Dr. Ballito in this hospital.
32
Nurse : Let me see the schedule first, which one is Dr. Ballito, the tall one or the short one?
Mrs. N : The tall one.
Nurse : The tall one, is he a gynecologist, Madam?
Mrs. N : Yes, that’s right, he is a gynecologist.
Nurse : Well madam, Dr. Ballito’s schedule is on Monday, Wednesday and Saturday.
Mrs. N : In the morning or in the afternoon, Nurse?
Nurse : For Monday and Saturday, his clinical hours is at 9.00 to 11 in the morning.
Mrs. N : What about on Wednesday?
Nurse : For Wednesday, he has schedule in this hospital is at 5.00 until 8.00 p.m.
Mrs. N : I see, and by the way, where is Dr. Ballito’ room?
Nurse : Dr. Ballito’s room is on the third floor, room number one.
Mrs. N : Thanks
Nurse : No at all.

Blood Taking
A Nurse wants to take Mrs. Ray’s blood samples in Maternity ward.

Nurse : Good afternoon, Mrs. Ray.

Mrs. R : Good afternoon, Nurse.
Nurse : Well, Mrs. Ray, I just got a phone call from Dr. Scott.
Mrs. R : Dr. Scott, who is he?
Nurse : He is an gynecologist
Mrs. R : I see, so?
Nurse : Dr. Scott said that I have to take some blood samples from you before you will be operated.
Mrs. R : What is that for?
Nurse : We want to know about your blood Group, CBC, ESR, etc.
Mrs. R : I see, you can take it now.
Nurse : Good, thanks, now would you mind laying down on your bed, please?
Mrs. R : Okay.
Nurse : Thanks and now will raise your arm, please? Because I want to put this rubber sheet under
your arm.
Mrs. R : No. Problem.
Nurse : Can I have your arm, Madam?
Mrs. R : Which one, left or right?
Nurse : The right one, Madam.
Mrs. R : Here they are.
Nurse : Thanks, and now could you roll your sleeve up, Madam?
Mrs. R : Okay, Nurse.
Nurse : Good, and now will you fist your hand and I want to apply this tourniquet above your elbow?
Mrs. R : No problem.
Nurse : And now I am going to clean your skin by this alcohol.
Mrs. R : That’s good, Nurse.
Nurse : Please don’t move when this needle is inserted into your vein, maybe you will feel little bit pain
but it’s okay.
Mrs. R : Be careful, Nurse, I am afraid of needle.
Nurse : Don’t worry.

Then the nurse inserts the needle into vein, when the blood appears in the barrel, the nurse pulls back the plunger
slowly until the blood in the barrel is full of blood. Then she withdraws the needle gently then puts new alcohol swab
over the puncture site and fixed it by tape.

Nurse : I have your blood now.

Mrs. R : That’s relieve.
Nurse : Good, can you fold your arm, now!
33
Mrs. R : No problem.
Nurse : Thanks a lot.
Mrs. R : You are welcome.

TB-Disease
Nurse : Good morning Mrs. Nela, how can I help you?
Patient : Good morning nurse, I want to ask you a little about the disease tuberculosis, can you explain it?
Nurse : Of course, I can help a bit Mrs. Nela
Patient : What are the signs that a person has TB disease?
Nurse : Cough a lot for more than 3 weeks may be accompanied by blood
Patient : Does everyone who experience coughing up blood means suffering from tuberculosis?
Nurse : No, because coughing up blood can be caused by various reasons
Patient : Tuberculosis is spread through any media?
Nurses : Through the sparks that come out with sputum when coughing, it could be through the dust,
instrument eat / drink that contains TB germs
Patient : What is TB disease that is genetically inherited?
Nurse : TB disease is not genetically inherited, because tuberculosis disease is not hereditary
Patient : Are people who have been cured of TB disease can be contracted again?
Nurse : It can, because after recovering from tuberculosis there is no lifelong immunity
Patient : Can TB disease be cured completely?
Nurse : Able to follow the advice of health workers to take medication regularly
Patient : Could expose to TB disease if we live in a clean environment?
Nurse : The possibility of contracting we will still be there, because we live not only in our own
neighborhood.
Patient : What effects on the fetus when pregnant women were suffering from tuberculosis?
Nurse : Usually nutritional state of patients with tuberculosis is not good, so this may affect the
development of the fetus in the womb
Patient : How is our attitude in the house when there are family members who suffer from tuberculosis?
Nurse : Bring the patient to the doctor to get treatment on a regular basis
Patient : Pattern of life how should we have to avoid the disease tuberculosis?
Nurse : Healthy lifestyle is the key, because we do not know when we can be exposed to TB germs

RECEPTIONIST-NURSE-PATIENT: Getting Advice on the Phone

Clinic : Hello, Children's Clinic.
Mother : Hello. Could I speak to a consulting nurse please?
Clinic : Yes, Hold one moment please.
Mother : OK.

Nurse : Hello, how can I help you?

Mother : My son isn't feeling well and I'd like to get some advice.
Nurse : What seems to be the problem?
Mother : Well, he has been coughing for several days now. I'm wondering if he should come in and
see the doctor.
Nurse : How old is he?
Mother : He is 3 years old.
Nurse : Does he have any other symptoms like fever, runny nose, or loss of appetite?
Mother : No, actually other than the cough, he seems healthy. I am concerned though, because
some of his sister's friends have whooping cough and I know that it can be very
contagious. Isn't that a pretty serious illness?

34
Nurse : It can be serious with babies. Has your son been immunized against whooping cough?
Mother : I'm not sure. He did get all of the suggested vaccinations. I will look it up in our records.
Nurse : If he has been immunized recently, it is very unlikely that he would catch whooping
cough, even if he has been exposed.
Mother : Sounds like I don't have to worry about that, but what shall I do about his cough?
Nurse : The cough is probably a viral infection. It will help if you give him lots of fluids and a hot
bath before bedtime. A humidifier is also helpful. Keep an eye on the cough to watch to
see if it gets worse. Call us again if he has a fever or if you are still concerned.
Mother : Thanks for your advice.
Nurse : You are welcome. Good-bye.
Mother : Bye-bye.

Helping a Patient
Patient : Nurse, I think I might have a fever. It's so cold in here!
Nurse : Here, let me check your forehead.
Patient : What do you think?
Nurse : Your temperature seems raised. Let me get a thermometer to check.
Patient : How do I raise my bed? I can't find the controls.
Nurse : Here you are. Is that better?
Patient : Could I have another pillow?
Nurse : Certainly, Here you are. Is there anything else I can do for you?
Patient : No, thank you.
Nurse : OK, I'll be right back with the thermometer.
Patient : Oh, just a moment. Can you bring me another bottle of water, too?
Nurse : Certainly, I'll be back in a moment.

Some Troubling Symptoms

Patient : Good afternoon.
Nurser : Good afternoon. Have a seat. So, what have you come in for today?
Patient : Thank you. I'm feeling ill, I've got quite a bad cough, but I don't seem to have a fever.
Nurse : I see. How long have you had these symptoms?
Patient : Oh, I've had the cough for two weeks, but feeling ill just these past few days.
Nurse : Are you having any other problems?
Patient : Well, I've got a headache. I've also had a little bit of diarrhea.
Nurse : Do you produce any phlegm when coughing?
Patient : Sometimes, but it's usually pretty dry.
Nurse : Do you smoke?
Patient : Yes, a few cigarettes a day. Certainly no more than a half a pack a day.
Nurse : How about allergies? Do you have any allergies?
Patient : Not that I'm aware of.
Nurse : Does your head feel stuffy?
Patient : Yes, for the past few days.
Nurse : OK. Now let's have a look. Could you please open your mouth and say 'ah'?

Joint Pain
Patient : Good morning. Nurse Budi?
Nurse : Yes, please come in.
Patient : Thank you. My name is Budi Azhari.
Nurse : What have you come in for today Ms Andini?

35
Patient : I've been having some pain in my joints, especially the knees.
Nurse : How long have you been having the pain?
Patient : I'd say it started three or four months ago. It's been getting worse recently.
Nurse : Are you having any other problems like weakness, fatigue or headaches?
Patient : Well I've certainly felt under the weather.
Nurse : Right. How much physical activity do you get? Do you play any sports?
Patient : Some. I like to play tennis about once a week. I take my dog on a walk every morning.
Nurse : OK. Let's have a look. Can you point to the area where you are having pain?

Physical Examination
Nurse : When did you last come in for a physical exam?
Patient : I had my last physical two years ago.
Nurse : Have you had any other exams recently? Blood work, an EKG or an ultra-sound?
Patient : Well, I had a few X-rays at the dentist's.
Nurse : How have you been feeling in general?
Patient : Pretty well. No complaints, really.
Nurse : Could you roll up your left sleeve? I'd like to take your blood pressure.
Patient : Certainly.
Nurse : 120 over 80. That's fine. You don't seem to be overweight, that's good. Do you exercise
regularly?
Patient : No, not really. If I run up a flight of stairs, it takes me a while to get my breath back. I need
to get out more.
Nurse : That would be a good idea. How about your diet?
Patient : I think I eat a pretty balanced diet. You know, I'll have a hamburger from time to time,
but generally I have well-balanced meals.
Nurse : That's good. Now, I'm going to listen to your heart.
Patient : Ooh, that's cold!
Nurse : Don't worry it's just my stethoscope. Now, breathe in and hold your breath.
Please pull up your shirt, and breathe deeply. Everything sounds good. Let's take a look at
your throat. Please open wide and say 'ah'.
Patient : 'ah'
Nurse : OK. Everything looks ship shape. I'm going to order some blood work and that's about
it. Take this slip to the front desk and they'll arrange an appointment for the tests.
Patient: Thank you doctor. Have a nice day.

Pain that Comes and Goes

Nurse : How long have you been having this pain?
Patient : It started in June. So for more than five months now. My stomach hurts after some
meals, but not always.
Nurse : You should have come in earlier. Let's get to the bottom of this. Have you changed
your eating habits during this period?
Patient : No, not really. Well, that's not true. I'm eating the same foods, but less. You know, the
pain seems to come and go.
Nurse : How strong is the pain exactly? On a scale of one to ten, how would you describe the
intensity of the pain?
Patient : Well, I'd say the pain is about a two on a scale of one to ten. Like I say, it's not really
bad. It just keeps coming back...
Nurse : How long does the pain last when you get it?
Patient : It comes and goes. Sometimes, I hardly feel anything. Other times, it can last up to half
an hour or more.
Nurse : Is there a type of food that seems to cause stronger pain than other types?
Patient : Hmmm ... heavy foods like steak or lasagna usually brings it on. I've been trying to avoid those.
Nurse : Does the pain travel to any other parts of your body - chest, shoulder or back?

36
 or does it remain around the stomach area.
Patient : No, it just hurts here.
Nurse : What about if I touch here? Does it hurt there?
Patient : Ouch! Yesa, it hurts there. What do you think it is doctor?
Nurse : I'm not sure. I think we should take some x-rays to find out if you've broken anything.
Patient : Will that be expensive?
Nurse : I don't think so. You're insurance should cover routine x-rays.

Feeling Queasy
Nurse : Good morning, Mr Adams. How are you doing today?
Patient : Horrible! I can't eat anything! I just feel sick to my stomach. Take the tray away.
Nurse : That's too bad. I'll just put this over here for now. Have you felt queasy for very long?
Patient : I woke up during the middle of the night. I couldn't get back to sleep, and now I feel terrible.
Nurse : Have you been to the toilet? Any diarrhea or vomiting?
Patient : I've been to the toilet twice, but no diarrhea or vomiting. Perhaps, I should drink something.
Can I have a cup of tea?
Nurse : Certainly, I'll get you a cup immediately. Would you like black tea or peppermint tea?
Patient : Peppermint, please. Do you think I could have another blanket? I'm so cold. I think I'm getting
the chills.
Nurse : Here's an extra blanket. Let me tuck you in.
Patient : You're so sweet. What is your name?
Nurse : My name is Alice. I'll be on shift during the day for the next few days.
Patient : Hello Alice. My name is Jack. Nice to meet you.
Nurse : Let's get you feeling better Jack!
Is there anything else I can get for you?
Patient : That's alright. I think a cup of tea and a warm blanket should help.
Nurse : OK. I'll be back as soon as the tea is ready.
Patient : Thank you.

HIV
The patient, 32 years old with HIV. The blood test was taken merely as a check to a nagging doubt but the results
are positive. Patient quickly makes a nurse’s appointment, still in disbelief.

Nurse : Okay, the Lab staff tells me that you have used an at home blood test. What you have
To understand here is that these test for the mere presence of antibodies. They are
generally very -

Patient (interrupts) – I’m sorry. I just want to know that I understand this. Antibodies?

Nurse : Don’t apologize; if you don’t know what’s going on just ask.
Patient : Ok, thank you.
Nurse : They are made by your blood to attack anything in your body that does not belong to
you. So, the blood tests detect the presence of these. Let’s suppose for a second that someone
did have HIV. Their body would produce lots of antibodies. So the blood test will almost never
come out negative if someone does have HIV. But what happens occasionally is that antibodies
are around for some other reason and the blood test still comes out positive.
Patient : So-I probably don’t have HIV? How can I know for sure?
Nurse : I’m going to suggest that we just disregard the home test you have done. We’re not
incredibly familiar with these. Instead, we are going to do a blood test at the hospital called
an ELISA. Once again, it’s not unheard of to get “false positive” results. If you get positive
results, we will do another on the same blood sample. If those come out positive, we will do
a more advanced test called the Western Blot.
Patient : The Western What?
37
Nurse : It’s a relatively complicated test. You give us a sample and we look at the proteins in it
to see if the ones that make up the antibodies designed to protect against HIV are there
or not. Ok…let’s see. Hey, you have seen CSI? The Western Blot uses the process of Gel
Electrophoresis that they use for all the DNA fingerprinting.

Appointment
Mr. S : Good morning, Nurse.
Nurse : Good morning too. What kind I do for you, Sir?
Mr. S : Yes, I would like to meet Dr. Ballito.
Nurse : Of course, but if you don’t mind telling me, what for do you want to meet him?
Mr. S : I have an appointment with him at 9.15 a.m.
Nurse : I see, and what is your name, Sir?
Mr. S : My name is Chyne Scott.
Nurse : Sorry, how do you spell your last name?
Mr. S : It’s S-C-O-T-T and my first name is C_H-Y-N-E.
Nurse : And what are you, Sir?
Mr. S : I am an gynecologist from Salemba Hospital.
Nurse : Well, Mr. Scott, would you wait here for a moment, I am going to call him first.
Mr. S : Thanks a lot.
Nurse : Don’t mention it.

Dental Hygiene
Dental Hygiene Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
Sam
Gina the Dental Hygienist
: Hello.
: Hello Mr. Waters. I'm Gina. I'll be cleaning your teeth today.
: Dr. Peterson has just filled two cavities. Why do I need a cleaning?
: Well, we have to make get your teeth and gums clean and disease free.
: I guess that makes sense.
: Oral health leads to trouble-free teeth. I'll start off by removing plaque.
Please lean back and open wide.
: OK, I hope it's not too bad.
: Everybody gets plaque, even if they floss regularly. That's why it's important to
come in twice a year for check-ups.
: (getting his teeth cleaned, can't say much...)
: OK, please take a drink and rinse.
: Ah, that's better.
: OK, now I'll apply some fluoride. Which flavor would you like?
: I have a choice?
: Sure, we have mint, spearmint, orange or bubble-gum - that's for the kids.
: I'd like to have the bubble-gum!
: OK.
(applies fluoride) Now, let me give your teeth a final flossing.
: What type of floss tape do you recommend?
: Personally, I like the flat tape. It's easier to get between the teeth.
: OK, I'll remember that the next time I buy floss. How often should I floss?
: Everyday! Twice a day if possible! Some people like to floss after every meal,
but that's not absolutely necessary.
: (after finishing the cleaning) I feel much better. Thank you.
: My pleasure. Have a pleasant day, and remember to floss every day - at least
once a day!

38
Checking-In with the Dental Receptionist

Dental receptionists take care of administrative tasks such as scheduling appointments, and checking in patients.
They answer telephone calls and do paperwork such as sending out reminders to patients of appointment dates. In
this dialogue, you will practice the role of a patient who is returning for a yearly dental appointment.

Sam : Good morning. I have an appointment with Dr. Peterson at 10.30.

Receptionist : Good morning, can I have your name, please?
Sam : Yes, it's Sam Waters.
Receptionist : Yes, Mr. Waters. Is this the first time you've seen Dr. Peterson?
Sam : No, I had my teeth cleaned and checked last year.
Receptionist : OK, just a moment, I'll get your chart.
Receptionist : Have you had any other dental work done during the past year?
Sam : No, I haven't.
Receptionist : Have you flossed regularly?
Sam : Of course! I floss twice a day and use a water-pick.
Receptionist : I see you have a few fillings. Have you had any trouble with them?
Sam : No, I don't think so. Oh, I changed my insurance. Here's my new provider card.
Receptionist : Thank you. Is there anything in particular you'd like the dentist to check today?
Sam : Well, yes. I've been having some gum pain recently.
Receptionist : Alright, I'll make a note of that.
Sam : ... and I'd like to have my teeth cleaned as well.
Receptionist : Of course, Mr. Waters, that'll be part of today's dental hygiene.
Sam : Oh, yes, of course. Will I have x-rays taken?
Receptionist : Yes, the dentist likes to take x-rays every year.
However, if you'd prefer not to have x-rays, you can opt out.
Sam : No, that's alright. I'd like to make sure everything is OK.
Receptionist : Great. Please have a seat and the Dr. Peterson will be with you momentarily.
(After the appointment)
Receptionist : We'll need to schedule an appointment to come in for the fillings you need?
Sam : OK. Do you have any openings next week?
Receptionist : Let's see... How about next Thursday morning?
Sam : I'm afraid I have a meeting.
Receptionist : How about two weeks from today?
Sam : Yes, that sounds good. What time?
Receptionist : Can you come at 10 o'clock in the morning?
Sam : Yes. Let's do that.
Receptionist : Perfect, we'll see you on Tuesday, March 10th at 10 o'clock.
Sam : Thank you.

Dental Check-up
Sam : Hello, Doctor.
Dr. Peterson : Good morning, Sam. How are you doing today?
Sam : I'm OK. I've been having some gum pain recently.
Dr. Peterson : Well, we'll take a look. Please recline and open your mouth.... that's good.
Sam : (after being examined) How does it look?
Dr. Peterson : Well, there is some inflammation of the gums. I think we should also do a new set of S-rays.
Sam : Why do you say that?
Is something wrong?
Dr. Peterson : No, no, it's just standard procedure every year. It looks like you may have a few cavities as well.
Sam : That's not good news .... hmmm
Dr. Peterson : There are just two and they look superficial.
Sam : I hope so.
Dr. Peterson : We need to take X-rays to identify tooth decay, as well as check for decay between the teeth.

39
Sam : I see.
Dr. Peterson : Here, put on this protective apron.
Sam : OK.
Dr. Peterson : (after taking the X-rays) Things look good. I don't see any evidence of further decay.
Sam : That's good news!
Dr. Peterson : Yes, I'll just get these two fillings drilled and taken care of and then we'll get your teeth cleaned.

TOPICS FOR DIALOG NURSE TO PATIENT

Diarrhea Care Nursing Status Report Blood Specimen Care
Emotional Support Injection Administration Breathing Exercises
Spiritual Comfort Medication Care Chest Physiotherapy
Bowel Training Bill of Rights Clinical Measurements
Compliance with Fluid Volume Acute Pain Control Comfort Care
Fluid Therapy Medication Treatment Communication Care
Meals-on-Wheels Alcohol Abuse Control Contraception Care
Activities of Daily Living (ADLs) Chronic Pain Control Ear Care
Skin Care Enteral Tube Irrigation Edema Control
Ambulation Therapy Foot Care Enteral Feeding
Reality Orientation Physical Therapist Service Eye Care
Cast Care Drainage Tube Care Feeding Technique
Range of Motion Mental Health Care Health History
Rehabilitation Exercise Mental Health History Health Promotion
Pacemaker Care Nurse Specialist Service Hearing Aid Care
Intake Allergic Reaction Control Home Situation Analysis
Transfer Care Bladder Care Infection Control
Terminal Care Medication Action Inhalation Therapy
Counseling Service Speech Therapist Service Nausea Care
Fracture Care Wound Care Nutrition Care
Coping Support Respiratory Therapist Service Oxygen Therapy Care
Assistive Device Therapy Perineal Care Parental Feeding
Compliance with Diet Drug Abuse Control Perinatal Care
Bowel Care Mental Health Promotion Physical Examination
Musculoskeletal Care Weight Control Physical Health Care
Hydration Control Radiation Therapy Care Psychosocial Care
Stress Control Chemotherapy Care Pulmonary Care
Immobilizer Care Dressing Change Regular Diet
Mobility Therapy Incision Care Special Diet
Enema Nursing Care Coordination Specimen Care
Cardiac Care Professional/Ancillary Services Sputum Specimen Care
Pregnancy Care Medical Regimen Orders Stool Specimen Care
Intravenous Care Medication Side Effects Tracheostomy Care
Delivery Care Breastfeeding Support Universal Precautions
Postpartum Care Diabetic Care Urinary Catheter Care
Burn Care Enteral Tube Care Urinary Catheter Insertion
Sleep Pattern Control Enteral Tube Insertion Urinary Catheter Irrigation
Output Physician Status Report Urine Specimen Care
Mouth Care Medication Prefill Preparation Ventilator Care
Denture Care Social Worker Service Vital Signs
Behavior Care Occupational Therapist Service Wax Removal
Fertility Care Infertility Care Hemodynamic Care

40
 UNIT 7: NURSE TO PATIENT’S FAMILY

Inform Consent
Mr. B : Excuse me, is this emergency room?
Nurse : Yes, this is emergency room.
Mr. B : Well, I am Bram Bivida, I got information that my daughter just got an accident and she was
sent to this hospital.
Nurse : Let me check the list first, Sir and what is your daughter name?
Mr. B : Her name is Sherly Bivida.
Nurse : That’s right Mr. Bram, would you come in and have seat, please?
Mr. B : Thanks a lot, Nurse.
Nurse : Well, Mr. Bram, we have to fill in an admission form first and also sign a consent form too.
Mr. B : A consent form! What is that for?
Nurse : According to our examination that we have done, your daughter has fracture and broken bone
should be operated immediately.
Mr. B : I see.
Nurse : Good, now your daughter complete name is Sherly Bivida, can you spell her first name?
Mr. B : S-H-E-R-L-Y and her last name is B-I-V-I-D-A.
Nurse : And is she a Christianize?
Mr. B : Yes, she is.
Nurse : Is she married?
Mr. B : No. she is not.
Nurse : And what is she?
Mr. B : She is student.
Nurse : And where does she go to school?
Mr. B : She goes to Academy of nursing in Bintaro hospital.
Nurse : Then when and where was she born, Sir?
Mr. B : She was born in Jakarta on July 20th , 1985.
Nurse : Thanks. Can I have her ID Card, Sir?
Mr. B : No. problem, here it is.
Nurse : Thanks, and now where does she live?
Mr. B : She lives with us at Rafless street no. 95. West Cibubur Jakarta.
Nurse : Do you have phone number, Sir?
Mr. B : Yes Sure, my phone number is 021-8437891.
Nurse : It say here ‘Name and address of next kin’ who is her nearest relation in this town that
we can contact in emergency situation?
Mr. B : Me and my wife, you can contact me or her if there is something about my daughter.
Nurse : Do you live at the same address, Sir?
Mr. B : Yes, you right.
Nurse : Okay, is she allergic about some thing, such as food or drug, Sir?
Mr. B : Yes, she has allergic for Penicillin and White egg.
Nurse : Has she ever suffered from any disease before?
Mr. B : Yes she has, she ever has suffered a pharingitis for 5 days.
Nurse : Did you bring her medicines from previous doctor, Mr. Bram?
Mr. B : Yes.
Nurse : May I see those medicines, Sir?
Mr. B : Here they are (Amoxil 500 mgs t.i.d, FG Troches tab b.i.d, Paramex 500 mgs t.i.d).
Nurse : Thanks and when did she take these medicines?
Mr. B : This morning, Nurse.
Nurse : What about cardiac medicines, did she have it, Sir?
Mr. B : No, she hasn’t it.
Nurse : And now, last question, do you know her body weight and height, Sir?
Mr. B : If I am not mistaken, her weight is 55 kg and height is 170 cm.
41
Nurse : Well Mr. Bram, It is enough for the data, if you would like to wait here for a
moment, I am going to call the doctor to explain you about her condition, okay.
Mr. B : Thanks a lot, Nurse.
Nurse : Don’t mention it.

DOCTOR-NURSE-PARENT- PATIENT: Teethaches

Parent : Good morning. I have an appointment to see Doctor Kharis today
Nurse : Good morning. Oh Doctor Kharis is examining a patient right now. Please wait a moment.
Parent : Oh thank you.
Nurse : But at the first, you must sign up here. Who is sick?
Parent : Agus, my son. He has a toothache. Seems his tooth need to be taken out.
Patient : I do not want to have my tooth pulled out mom. Of course, it must be hurt.
Nurse : No kid, it does not hurt anyway.
Parent : That is true. Even though it hurts, the pain is just a second. Instead you feel the pain
from the toothache all day long.
Patient : But my friends said that it is so painful.

Suddenly Doctor Kharis comes out of the room.

Doctor : That is not true kid. It will not hurt you and it feels like being bitten by a small ant.
Have you ever bitten by an ant?
Patient : Yes I have Doc.
Parent : It means no pain, right?
Patient : Yes mom. But will you promise me Doc?
Doctor : Yes. I guarantee you will not get hurt.
Doctor : Yes. I guarantee you will not get hurt.
Nurse : Here is the file Doc!
Doctor : Okay let’s check Agus’s tooth!
Parent : Let’s do it Doc! He cannot hold it anymore. He has been in pain since last night.
Doctor : Have the tool already prepared?
Nurse : It has been ready Doc. Now we can do our job.
Parent : Come closer to Doctor Kharis, honey..
Patient : Yes mom!
Nurse : Please have a seat on this chair, Agus!
Doctor : Well now open your mouth widely!
Parent : Open your mouth widely son.. the doctor wants to check your teeth..
Doctor : Give me that injection!
Nurse : Here it is!
Patient : Ouch!! it is so painful Doc.
Doctor : Be calm you will feel the pain just for a while
Parent : How does it feel? Have you felt better now?
Patient : I feel better now. My toothache has gone. Thank you doc!
Doctor : You’re welcome. Now do not eat sweet foods too much and do not forget to brush your
teeth everyday.
Nurse : And do not forget to check your teeth regularly!
Patient : Of course, I will be more diligent brushing and checking my tooth regularly.
Parent : Thanks for your help!
Nurse and Doctor: You are welcome!

42
RECEPTIONIST-NURSE- PATIENT: Relationship
Mrs. Ratih : Excuse me. I want to check my son’s illness. Where should I go?
Receptionist : You can go ahead to check up your son with Children Specialist Doctor on the second floor.
Mrs. Ratih : Could you point me where the room is?
Receptionist : It’s on the second floor. You can go there by taking the elevator.
Mrs. Ratih : Very well. Thank you.
Receptionist : You’re welcome.
Andy : Where are we going, Mom?
Mrs. Ratih : We’re going to the Children Specialist Doctor’s room on the second floor for checking up
your illness.

[In the front of Children Specialist Doctor’s room]

[At the registrations counter]

Mrs. Ratih : Excuse me. I want to check up my son’s illness.

Nurse : Firstly, you need to fill in this form and take your queue number and then sit down to wait
until your queue number is called.
Mrs. Ratih : [Filling in the form and taking the queue number] Here you are. Thank you.
Nurse : Please have a seat while waiting.

[15 minutes later]

Nurse : Andy Hamzah, number 7!

Mrs. Ratih : Look, our number is mentioned. Let’s go enter the room, Dear.
Andy : Mom… um… I’m afraid. Will the doctor inject me?
Mrs. Ratih : Don’t worry, my dear. Mom will never leave your side.
Andy : Alright. Thank you, Mom.

[Inside the doctor’s room]

Mrs. Ratih : Good morning, Doc.

Doctor : Good morning, Ma’am. Please have a seat.
Mrs. Ratih : Thank you, Doc.
Doctor : Good morning, little guy. What is your name?
Andy : Um… my name is Andy.
Doctor : Wow, you look tough. How old are you?
Andy : I’m 9 years old.
Doctor : So, what brings you here, Dear?
Andy : Um… I had a fever and my throat is sore.
Mrs. Ratih : Yes, Doctor. Last night he had a fever. Then I gave him some medicine to bring down
his fever. And this morning, I thought that his fever had gone away, but after he woke
up he said that he got fever again. This time his temperature was higher than last night.
He complains that his throat is sore too.
Doctor : Okay…. Could you open your mouth widely, Andy? Say Aaaaa….
Andy : [opens his mouth widely]
Doctor : I think Andy gets Pharyngitis or sore throat. Did you eat some hot foods or salty snacks like
chips, Andy?
Andy : Um.. Yes, I think I ate too much potato and barbeque chips two days ago.
Doctor : I suggest you not to eat salty snacks and chips too much, Andy. They can get your
throat irritated and infected like now. But don’t worry with my medicines you’ll be fine soon.
Andy : Thank you, Doctor.
Doctor : Here is the prescription, Ma’am. You can go to the first floor to complete the administration
needs.
Mrs. Ratih : Thank you, Doc.

43
Doctor : Good bye, Andy. Get well soon.
Andy : Yes. Thank you, Doctor.

RECEPTIONIST TO PATIENT: Getting Patient Details

Receptionist : Hello, how can I help you?
Patient : I've got an appointment with Dr. Adams.
Receptionist : Are you Ms Moyers?
Patient : Yes, I am. I have an appointment at ten.
Receptionist : We just need to fill in some information for our files. Could you fill out these forms?
Patient : Certainly ... (comes back after filling out the forms) What's this form for?
Receptionist : It's just a privacy form informing you of our policies.
Patient : Is that really necessary?
Receptionist : I'm afraid it is. Could you also sign that form?
Patient : OK, there you go. Here's my insurance provider's card.
Receptionist : Thank you. OK, that'll be $20.
Patient : Why do I have to pay $20?
Receptionist : It's the deductible for office visits required by your health care provider.
Patient : ... but I'm insured aren't I?
Receptionist : Yes, of course. Your health care provider asks for deductibles on office visits.
Patient : Every time I turn around I've got some additional fee to pay.
I don't know why I pay for insurance!
Receptionist : I know it's frustrating. We also have a lot of paperwork. Every provider has different
forms and requirements!
Patient : This can't continue on like this!
Receptionist : I agree with that!

Getting Patient Details

Patient’s family : Good morning, nurse.
Nurse : Good morning, what can I do for you, Sir?
Patient’s family : I would like to ask you about my wife’s condition.
Nurse : All right, that your wife’s condition is still unconscious due to severe head injury,
but don’t worry because of estimated in this afternoon your wife begin to aware.
Patient’ s family : Oh, my God, help nurse, help my wife nurse.
Nurse : Of course Sir, I work in team and our team will give the best action for your
wife. You pray to God, please. We hope no matters that can life threatening her.
And in this afternoon later, if there is any something take place at your wife you
can press call light or call nurse in nursing station who in charge this afternoon.
Patient’s family : Thanks so much, nurse.
Nurse : You are welcome.

44
 UNIT 8: PHYSICAL ASSESSMENT
Learning Objectives
In this unit you will learn how to:
a. Recognize the patient’s expression
b. Revieww of system (ROS)
c. Practice physical assessment
d. Practice to make case report (Nursing care)
A structured physical examination allows
the nurse to obtain a complete assessment of the
patient. Observation/inspection, palpation, percussion
and auscultation are techniques used to gather
information.
Physical assessment is important in nursing. If
you are a nurse, you know that a comprehensive patient
health assessment is an important first step in
developing a plan to deliver the best patient care. During
the assessment, nurses may notice signs of potential or
underlying health issues that need to be addressed, as
well.
Neurological Assessment
Changes in level of consciousness; restlessness,
listlessness, confusion, disorientation, others. Any of
these changes may or may not accompany functional
disorders, or can be only temporary symptom of a
medical problem.
Respiratory System
Dyspnea, hyperventilation, others. Persons with certain
disorders of the nervous system will manifest signs of
respiratory distress; therefore, the mental status may also
be affected.
Cardiovascular System
Rapid or irregular pulse or even the opposite may occur,
a slowed pulse rate; many other changes may be
obvious, such as the depressed patient who may have a
slowing of all body systems.
Gastrointestinal System
These changes may include the minor complaints such
as chronic indigestion, nausea, cramps, vague stomach
pains, can also include symptoms such as vomiting or
diarrhea or constipation.
Genital-Urinary System
Urinary symptoms may include the
following: frequency or retention, scant urine which is
45
concentrated may be present in the person who is
depressed and not taking adequate fluids.
Assessment Techniques:
1. INSPECTION is the most frequently used
assessment technique. When you are using
inspection, you are looking for conditions you
can observe with your eyes, ears, or nose.
Examples of things you may inspect are skin
color, location of lesions, bruises or rash,
symmetry, size of body parts and abnormal
findings, sounds, and odors. Inspection is a
critical observation that should always occur
first during an assessment (Jarvis, 2012).
2. AUSCULTATION is usually performed
following inspection, especially with
abdominal assessment. The abdomen should be
auscultated before percussion or palpation to
prevent production of false bowel sounds.
Auscultation should never be performed over
patient clothing or a gown, as it can produce
false sounds or diminish true sounds. Be aware
that your patient’s hair may also interfere with
true identification of certain sounds. The
diaphragm is used to listen to high pitched
sounds and the bell is best used to identify low
pitched sounds (Jarvis, 2012; Edmunds, Ward
& Barnes, 2010).
3. PALPATION, another commonly used
physical exam technique, requires you to touch
your patient with different parts of your hand
using different strength pressures. During light
palpation, you press the skin about ½ inch to ¾
inch with the pads of your fingers. When using
deep palpation, use your finger pads and
compress the skin approximately 1½ inches to
2 inches. Light palpation allows you to assess
for texture, tenderness, temperature, moisture,
pulsations, and masses. Deep palpation is
performed to assess for masses and internal
organs (Jarvis, 2012)
4. PERCUSSION is used to elicit tenderness or
sounds that may provide clues to underlying
 problems. When percussing directly over
suspected areas of tenderness, monitor the
patient for signs of discomfort. Percussion
requires skill and practice. The method of
percussion is described as follows: Press the
distal part of the middle finger of your
nondominant hand firmly on the body part.
Keep the rest of your hand off the body surface.
Flex the wrist, but not the foreman, of your
dominant hand. Using the middle finger of your
dominant hand, tap quickly and directly over
the point where your other middle finger
contacts the patient’s skin, keeping the fingers
perpendicular. Listen to the sounds produced
(Jarvis, 2012).
These sounds may include:
Tympany sounds like a drum and is heard over
air pockets.
Resonance is a hollow sound heard over areas
where there is a solid structure and some air
(like the lungs).
Hyperressonance is a booming sound heard
over air such as in emphysema.
Dullness is heard over solid organs or masses.
Flatness is heard over dense tissues including
muscle and bone (Jarvis, 2012).
A. Following is the common questions as
Review of System (ROS) in Physical
Assessment
Examining the Child
Questioning the Parent
1. Does she sleep at the normal time?
2. Is he active, like other children?
3. Does she have a good appetite?
4. Does she eat at the usual times?
5. When did his first tooth appear?
6. Does she pass wind as normal?
7. Is her toilet normal?
8. Does she ever get diarrhea?
9. Does she have any rashes?
10. Does she ever bring up his food?
11. Has she ever had a fever?
12. Does she cough a lot?
13. Are you breastfeeding?
14. How often do you feed him?
15. Do you give him liquids?
16. When does you r child start to have a fever?
17. If your child is sick, does your child have a good
appetite?
46
ENT Examination
Questioning the Patient
1. Do you ever have nosebleeds?
2. Is there any bad smell from your nose?
3. How long is your voice been hoarse?
4. Do feel any pain inside your ears?
5. Is there any discharge from your ears?
6. Are you having any difficulty with your hearing?
7. Does your nose run a lot?
8. Do you have a sore throat?
9. Do you have bad breath?
10. Do you often have a fever?
11. Which one is worse?
12. Does it hurt when you swallow?
13. Does your throat feel itchy?
14. Is there something in your throat?
15. Do you cough often?
16. Do your ears feel full?
Respiratory Examination
Questioning the Patient
1. Do you cough a lot?
2. Do you ever get short of breath (SOB)?
3. Do you ever bring something up?
4. What color is the stuff you bring up?
5. Do you have any chest pains after exercise?
6. Any pains in your chest when you cough?
7. Do you smoke?
8. Do you cough when you smell certain foods or other
smells?
9. What is your job?
10. What brings on your cough?
11. Is it thick or light?
12. Do you wheeze?
13. How is your appetite?
14. Do you sweat at night?
15. Do you ever get short of breath?
16. Do you have an allergy?
17. Are you feeling better now ?
18. How are you feeling today ?
19. Have you take the medicine the doctors prescribe ?
20. Have you got any other symptoms ?
21. Have you eaten yet ?
22. Do you need me to call the Doctor ?
23. Have you got any other symptoms ?
24. Have you eaten yet ?
25. Do you need me to call the Doctor ?
26. Does your family have the same disease ?
27. Do you feel comfortable ?
28. Since when do you have this kind of disease?
Cardiovascular Examination 4. Is your period regular?
5. How many children have you had? How old is your
Questioning the Patient last child?
1. Do you get tired easily? 6. Have you had any miscarriages?
2. Do you get out of breath easily? 7. Do you have any discharge down below?
3. Do you have palpitations? 8. What’s the color of this discharge?
4. Is there any heart disease in the family? 9. Does it have a bad smell?
5. Do you get any pain in the chest? 10. Do you feel any pain while passing urine?
6. Are you nervous or anxious about anything? 11. Is sexual intercourse painful?
7. How about sore throats? 12. Do you feel any pain or discomfort down below?
8. Do you ever feel giddy? 13. Do you feel any pelvic pain?
9. What brings on your cough? 14. Is it a localized or a general pain?
10. Do you get headaches? Neurological Examination
11. Do you cough much?
12. Do you legs swell? Questioning the Patient
13. Do you ever have a hard time catching your breath ? 1. Do you get headaches?
14. Do you smoke, use alcohol or other drugs ? 2. Do you know when these headaches are coming on?
15. Do you ever feel like you don’t have energy, as 3. Do you feel sick when you get these headaches?
lethargic or fatigue ? 4. Do you ever have dizzy spells?
16. Do you have hypertension ? 5. Have you ever fainted?
17. Did you taking any medications or supplements for 6. Have you ever blacked out?
your disease ? 7. Do you see spots in front of your eyes?
18. Is there any heart disease in the family ? 8. Have you ever had a head injury?
9. Do you feel agitated – Never, or some of the time?
Gastrointestinal Examination 10. Are you a heavy drinker?
11. How is your life patteren ?
1. How long have you been felt this pain on your 12. Are you a heavy smoker ?
stomach? 13. Does you family have a similar disease ?
2. which part of the stomach hurts? 14. How long your headaches lasts ?
3. Do you get this after every meal? 15. How are the headaches characteristics you feel?
4. what did you eat last? 16. What do you do when you have a headaches ?
5. Are you eating late? 17. Where the location of headaches that often occur ?
18. What activity factors aggravate your headaches ?
6. When do you feel pain in the stomach?
19. How are you sleep patterns ?
7. what kind of pain in your stomach?
20. Can you focus on thinking?
8. Do you have heartburn? 21. Do you have any complaints besides headaches?
9. Are you having trouble swallowing?
10. Do you feel bloated? Genito–Urinary Examination
11. Are your stools hard?
12. what was your last weight? Questioning the Patient
13. do you like to eat spicy food? 1. Do you drink a lot?
14. How many times do you eat in a day? 2. Does in burn when you pass water?
15. Are you still feeling nauseous? 3. Do you strain when you pass water?
16. How much did you throw up? 4. Do you often get diarrhea, constipation?
17. Do you have diarrhea? 5. How many times do you have to go during the night?
18. Do you lose weight lately? 6. Have you noticed any blood in your water?
7. Does your motions smell bad?
8. Do you ever wet the bed?
Obstetrical and Gynecological Examination 9. Does your water dribble?
10. Do you wet yourself when you cough, laugh or
Questioning the Patient sneeze?
1. When was your last period? Was it heavy? 11. Do you wet yourself when you lift something heavy?
Was it painful? 12. Do you wet yourself when you play sport?
2. How long did it last? 13. Do you often have to rush to use the toilet?
3. When did your periods start? 14. Do you sometimes not make it to the toilet in time?
47
15. Do you wake up more than once during the night to
use the toilet?
16. Do you sometimes feel your bladder is not quite
empty?
17. Do you wet yourself when you stand up?
18. Do you wet yourself as you get off the bed?
19. Is your urine dark or light-colored?
20. Any blood in your urine?
21. Any difficulty controlling your urine?
22. Do you urinate more than usual (frequency,
nocturia)?
23. Any difficulty starting or maintaining the stream of
urine?
24. Any pain with or after urination?
25. What is your normal daily fluid intake?
Musculoskeletal Examination
Questioning the Patient
1. Does it hurt if you bend your knee?
2. Do you have any difficulty moving your arms or legs?
3. Have you had any falls?
4. Do you feel any weakness in your limbs?
5. Can you tell me exactly how you turned your foot?
6. Can you bend over and touch your toes?
7. Can I just have you walk to the door and back?
8. Does the knee feel tender here?
9. Do your muscle feel stiff in the morning?
10. Have you noticed any twitching of your muscle?
11. What is your complaint right now?
12. Do you have a history of the same disease in the
past?
13. Do you have a history of accident?
14. Is there a family that has the same disease as you?
15. How is your activity pattern?
16. How many hours you work a day?
17. Do you often exercise?
18. Are there any complaints when you are active?
19. Do you have structural abnormalities in your spine?
20. Do you have abnormalities in the shape of your
bones and joints?
21. Does it hurt if you bend your knee?
Integumentary Examination
Questioning the Patient
1. How long has the condition been present?
2. How often does it occur or recur?
3. Are there any seasonal variations?
4. Is there a family history of skin disease?
5. What are the patient's occupation and hobbies?
6. What medication is the patient taking?
7. Are there any known allergies?
8. Previous and present treatments and their
48
effectiveness?
9. Are there any treatments, actions or behavioural
changes which influence the condition?
10. When did you last experience any symptoms?
11. Are you awaiting any hospital referral or
investigations for this condition?
12. Does your condition limit your ability to work or
carry out your normal day to day activities?
13. How many days have you taken off work due to this
problem in the last two years?
14. Does your condition limit your ability to work or
carry out your normal day to day activities?
15. What type of skin do you have?
Dental Examination
Questioning the Patient
1. Can you tell me which tooth is causing the problem?
2. Where is it sore? – The top teeth or bottom teeth?
3. Is it sore all the time?
4. What sort of things make it sore?
5. Is it hot things? Cold things / Sweet things?
6. Is it a localized or a general pain?
7. Is it sore to touch?
8. Would it be sore if I were to tap the tooth?
9. How long have your had an anesthetic before?
10. Are you taking medicines at the moment?
11. When was the last time you visited your dentist?
Psychiatric Interview
Questioning the Patient
1. How do you get on with other people?
2. Do you find you can trust people?
3. Do you sometimes feel picked upon?
4. Do you think people like you generally?
5. Are you self – conscious?
6. Do you ever find that your thoughts stop dead and
leave your mind a complete blank?
7. Do you ever feel completely possessed by another
person?
8. Are you mood stable, or does it change greatly from
day to day?
9. Do you ever feel controlled from outside like a puppet
or robe?
10. Would you describe yourself as a happy and
contended person?
11. Do people think of you as a happy – go – lucky
person, the life – are soul of the party, or
perhaps rather gloomy and unhappy?
12. Do you have many friends?
13. Would you describe yourself as shy?
14. Do you ever get into a furious rage?
15. Have you ever hurt anyone?
16. Do you often lose your temper?
17. Do you always follow a set routine? - I come over (I feel) woozy (funny / queer / light –
18. Do you prefer things to be neat and tidy? headache / peculiar) when I get up suddenly
19. Do you ever tend to check things more than once or - I feel woozy (faint / dizzy)
twice? - I feel drowsy
20. Are you sometimes over emotional? - I feel giddy
21. Do you like to be the center of attention? - I feel the room spinning
22. Do you tend to rely on other people a great deal? - The room’s spinning
23. Have you usually got lots of energy? - The room spins when I stand too long
24. Do you find it difficult to cope with the demands of - Everything goes round
everyday life? - I see stars when I get up suddently
25. Have you ever been in trouble with the police? - I’ve split my head (scalp / skull) open
26. Do you dislike being told what to do? - I had a blackout
27. Do you sometimes feel like hurting people? - I blacked out / fainted
28. Why do not you spend your meal? - I feel week
29. Why do you look sad today? - I am not feeling very well
30. Why you don't sleep? - I feel fainted when I’m tired
- I could not sleep well
- I could not focus
B. Understanding Symptoms
Ears
These are some expressions which people use in - My ear aches (I’ve got earache)
conversation with one another or with a doctor. They - I’ve got ringing (buzzing / humming / banging) in
describe how a person feels, or they identify specific my ears
health problems. Notice the contracted forms “I’ve and - My ears feel (are) bunged up (clogged / blocked up)
I’m”. They are very common in spoken English. Note - I think I’m going deaf
also that “I’ve got … indicating possession, is more - I can’t hear
common in British English than in American English, - My ear’s discharging (running)
where “I have … “ is the usual form. Both forms are - I have waxy ears (wax in my ears)
used freely in the expressions below. Words followed by
the letter (v’) denoting “vulgar” are not used in polite Nose
conversation. - My nose is blocked (bunged up / congested /red / sore /
itchy / snotty / swollen)
Following is the common expression of the patient: - I’ve got a nosebleed
- I keep getting (having) nosebleeds
Scalp and Hair - My nose keeps running (I’ve got a runny nose)
- I’ve got dandruff. - I keep sneezing
- My scalp’s flaky (lumpy / bumpy) - My sinuses are blocked
- My scalp itches (my scalp’s itchy)
- My hair’s infested / infested with lice Mouth
- I’m suffering from (I have……) nits (lice / vermin / a. Teeth
insects) - My tooth aches / throbs
- My hair’s greasy (dry / brittle / receding) - My gums are swollen (I’ve got swollen gums)
- My hair’s falling out (dropping out / coming out) - My gums are receding (I’ve got receding gums)
- I’m going bald (losing my hair) - My wisdom tooth’s erupting (impacted / agony /
- I’m getting a bald patch giving me trouble)
- I’ve got split ends. - I have an abscess
- My gums are bleeding
Head - I’ve got mouth ulcers
- I’ve got a headache. - I have buckteeth
- I’ve got a splitting (dreadful / awful / terrible / bad)
headache b. Tongue
- My head aches / throbs - My tongue’s black (furry / white / coated / yellow)
- My head’s aching - My mouth (tongue) feel (is) dry (numb / furry)
- I’ve got a bad head - I have bad breath
- I’ve got a migraine
49
c. Lip - My back aches / throbs
- My lips are (feel) swollen (sore / cracked / dry / - I have backache
chapped / flaky / numb / bruised) - I’ve pulled (wrenched / twisted) a muscle in my back
- I’ve (got / keep getting) cold sores (a cut lip / a - I’ve wrenched (strained / bricked) my back
split lip) - I’ve got a bad back
- My back’s bad
Eyes - I think I’ve slipped a disc
- I can’t see out my left / right eye
- My eyes hurt (ache / sting / itch) Arms / Hands
- My eyes are sore / bloodshot - I’ve twisted (strained) my wrist
- I’ve got eyestrain - I’ve strained my elbow
- I’ve got a pain in my left (right) eye - I’ve got a pain in my elbow
- Everything’s fuzzy (blurred) round the edges - My hands feel cold
- I’m seeing spots (in front of my eyes) - I’ve got frostbite
- I’m short sighted - I feel a tingling sensation in my fingers
- I’m blind as a bat - I have chilblain
- My vision’s blurred - My fingers are (have gone) numb
- I’m long-sighted (far-sighted) - My hands are sweaty (hot / cold / warty)
- My eyes are itchy (I’ve got itchy eyes) - My palms are sweaty / I’ve got sweaty palms
- My eyes are red (pink / cloudy / milky) - My fingers tremble a lot
- I’m blue round the eyes - My hands have started shaking
- My eyes are itchy (I’ve got itchy eyes) - I’ve got B.O. (BO = body odor)
- My eyes are watering a lot - I smell under the armpits
- I’m seeing double (I see double) when I ... - I’ve got warts on my hands (fingers)
- I’ve got something in my eye - I have white patches (spots) on my nails
- I’ve got red eye - My nails break off easily (keep breaking / chip easily)
- I’ve got a style
Chest
Throat - I feel tightness in my chest
- I’ve got a sore throat (my throat’s sore) - I’ve got a pain under my ribs
- I have a bad throat - I get out of breath easily
- My throat aches - I find it difficult to breathe
- I’m hoarse / croaky - I’m fighting (gasping) for breath
- I’ve got (I keep getting) a frog in my throat - My tubes are all bunged up
- I’ve lost my voice - My lungs are clogged up
- My voice is hoarse - I’m bringing up (coughing up) phlegm (blood / mucus)
- I feel tightness in my throat - I’m bringing up (coughing up) green (greenly yellow /
- I can’t breathe yellow / brown / red / bloody / frothy) stuff
- I can’t swallow - My chest’s bad (I’ve got a bad chest)
- Food seems to stick in my throat - I’m coughing my guts up
- I’ve got a bad (terrible / hacking / racking) cough
Neck - My heart keeps missing (skipping / jumping) a beat
- I’ve got a stiff neck - I’ve got a wheezy chest
- My glands are swollen (I’ve got swollen glands) - My breasts hurt (ache / are tender / are swollen)
- I have a crick in my neck - I’ve got a discharge from my nipple (s)
- I’ve cricked (bricked) my neck - I have a lump in my breast (under my arm)
- My neck aches - Nurse, I am feeling tightness
- I strained my neck - I am not being comfort in this position
- I Have got a wheezy chest
Shoulders - I have an allergy , please don’t give me a shrimp
- I’ve got stiff shoulders - I have get a bad cough
- I’ve twisted (yanked / pulled / wrenched / - I can’t breathe
strained) a muscle in my shoulder - I can’t go to sleep
- I feel tired easily
Back - I don’t appetite
50
- My nose is blocked - I’ve got piles
- I feel tightness in my throat - There's blood in my urine
- My heart keeps missing a beat after taking medicine - My urine is smelly
- I snore when I sleep - I have pain in my abdomen after urinating
- I’m in constant state of anxiety when my asthma recurs - I usually wake up more than 3 times during the night to
- I get nauseated when my asthma recurs urinating
- I like to eat fast food - I get a burning sensation when urinating
- I often smoke and drink alcohol - I feel weak
- I feel giddy easily - I have pain in my lower abdomen
- My feet are swollen - I feel my bladder is not quite empty after urinating
- My heart beats fast
- My hand feel cold Genital Organs
- I often feel anxious - I have pain in my testicles (penis)
- My backaches - I can’t get it up
- I get nausated - I can’t get an erection
- I can’t keep it up
Stomach - I can’t climax (get an orgasm / come)
- I’ve got stomach ache (tummy-ache / - I strained my groin
stomach upset / cramps in my stomach) - I had a hernia
- I have an upset tummy - I’m impotent (frigid)
- I’ve got a guppy tummy (bad stomach) - I come too early
- My stomach is funny - I’ve got a problem with premature ejaculation
- I can’t keep anything down - I feel pain when having sex
- I’ve got indigestion (heartburn / wind) - I’ve been having a discharge from my vagina
- I get nauseated (I feel sick) - I’ve got a vaginal discharge
- I feel like I’m going to vomit (spew / puke / throw up / - I have trouble down below (down there / down stairs /
be sick / barf [us]) with the plumbing)
- I keep retching (barfing [us]) - I’ve missed a period
- I can’t bear to look at food - I’m late (overdue)
- I’ve got a gassy stomach - I’m pregnant (expecting / going to have a baby)
- I’ve got a poor appetite
- I don’t have any appetite Legs
- I’m (I’ve gone) off my food - I’ve pulled a muscle in my leg
- I’ve been having bad stomachache - I’ve pulled a hamstring muscle
- I get cramp in my leg (calves / thigh)
Bowels and Bladder - I’ve torn a ligament
- I’ve got diarrhea - I’ve snapped a tendon in my leg (thigh)
- I’m incontinent - I can’t bend my legs
- I keep wetting myself - My knee hurts like a prick
- I keep having (have) the occasional accident - My knees are stiff
- I sometimes leak - I’ve got a cartilage problem
- I’ve got a weak bladder - I have water on the knee
- I’ve got the runs (trots / shits) - I get pain in my shins
- I keep farting - I get a pain in the back of my legs
- I’ve got a lot of wind - I’ve bruised my leg
- I’ve got constipation (I’m constipated) - My foot keeps going to sleep
- I can’t go (to the toilet / loom / bog) - I get pins and needles in my legs (feet)
- I can’t take a shit - I’ve got chilblains in my toes
- I can’t pass water - I’ve got cramp in my thigh
- My stool (shit / crap / excreta / motions) is runny / - I have varicose veins
hard watery / like bullets / well-formed / loose) - I've pulled snapped a tendon in my leg
- My urine is yellowish (reddish / straw-colored) - I've pulled a hamstring muscle
- I get a burning sensation when urinating - My ankles are swollen
- I’ve noticed blood in my urine

51
 - I have trouble down below
Feet - I have missed a period
- I’ve sprained (twisted / turned) my ankle - I'm late
- I went over on my ankle - I'm pregnant
- My ankle gave - I'm use contraception
- I’ve got a pain in my heel - I feel pelvic pain
- I have a burning sensation in the soles of my feet - It is have bad smell
- I’ve got blisters - I feel pain while passing urine
- I’ve got an ingrown toenail - My periods are not always regular
- I get cramp in my toes - I feel stomachache when my period
- I have chilblains
- My ankles are swollen (have been swelling) Mental State
- I’ve got swelling of my ankles - I’m (I feel) depressed / fed up / listless / tire /
exhausted / bored / moody / miserable / down in
Skin the dumps / weepy / upset / afraid / frightened /
- I’ve got a rash (come out in a rash / broken out in a terrified / unhappy / confused / nervy / irritable /
rash) bad-tempered / edgy / under the weather /
- My skin’s blotchy (greasy / flaky / dry / clammy) aggravated / pissed off / like I’m knocking my head
- I feel itchy on a brick wall / bogged down / at the end of my
- I’ve got sensitive skin tether / out of sorts
- I keep scratching - I want to commit suicide (do away with myself / do
- My skin’s turned yellow myself in)
- My skin peeling (flaking / weeping) - I’m afraid of doing myself an injury
- I’ve got blackheads (whiteheads / open pores / spots / - I can’t cope
acne / pimples) - I’m afraid to go out
- I have an acne problem - I always have an uneasy feeling
- I’ve got badly sunburned - Everything seems to irritate me (I get easily irritated)
- I’ve got a mole that’s getting bigger in size - I feel hateful about everything
- I feel shy. - I’ve become very short-tempered
- I’m in on mood to do anything
Sleep - I don’t feel myself
- I can’t get to sleep - I’m always brooding
- I suffer from insomnia - I’ve no confidence in myself
- I can’t wake up in the morning - I feel hopeless
- All I want to do is sleep - I’m in constant state of anxiety
- I have nightmares / bad dreams - My nerves are bad
- I snore - My memory’s going
- I talk (walk) in my sleep - I’ve been hearing voices
- I have difficulty in remembering things
Obstetrical and Gynecological
- I feel pain when having sex
- I've been having a discharge from my vagina
- I've got vaginal discharge

52
Exercise 1
Identify the following data as subjective or objective. Remember: Subjective data are the
client’s perceptions or feelings; objective data are observable and measurable.

 Nausea …………………………….
 Cyanosis …………………………..
 Jaundice …………………………...
 Edema …………………………….
 Numbness …………………………
 Diaphoresis ……………………….
 Pallor ……………………………...
 Ptosis ……………………………...
 Dizziness ………………………….
 Stridor …………………………….
 Palpitations ………………………..
 Irregular pulse …………………….
 Shortness of Breath (SOB)……….
 Chest pain ………………………...

Exercise 2
Identify the appropriate assessment technique for the following assessment findings.

Assessment Findings Appropriate assessment technique

1. Organomegaly ……………………
2. Poor skin turgor ………………… a. Inspection
3. Resonance ………………………… b. Palpation
4. Skin color changes ……………… c. Auscultation
5. S1 and S2 ………………………… d. Percussion
6. Skin Texture ……………………… e. Fist Percussion
7. Fetal Position …………………… f. Ballottement
8. Floating knee cap ………………… g. Bimanual palpation
9. Kidney tenderness ………………
10. Deep tendon reflexes ……………
11. Bruit ………………………………
12. Thrill ………………………………

53
Exercise 3

CASE REPORT FOR MINI HOSPITAL

“NURSING CARE”

A. ASSESSMENT
The assessment was done on (month / date / y) at ……….
1. Identity
a. Client Identity.
Complete Name : …………………………..
First Name : …………………………..
Age : …………………………..
Address : …………………………..
Phone : …………………………..
Religion : …………………………..
Education : …………………………..
Occupation / Job title : …………………………..
Nationality : …………………………..
Race : …………………………..
Sex (M/F) : …………………………..
Blood Group : …………………………..
Marital Status (S/M/D) : …………………………..
Entrance Date : …………………………..
Reg. Number : …………………………..

b. Nearest Contact Person

Name : …………………………..
Age : …………………………..
Phone : …………………………..
Address : …………………………..
Job : …………………………..
Relationship with Client : …………………………..

2. The Main Complaint : …………………………………………….

3. Medical History
a. Medical Present History :
- The history of complaint : ……………………………………………
- Predisposing factor : ……………………………………………
- Duration : ……………………………………………
- Appear pattern : ……………………… gradually / suddenly
- Bear-down efforts to overcome : ……………………………………………
b. Medical Past History :
- Allergy history (drugs, food, animal, environment) :
……………………………………………………………………………………..

54
 - Accident history : …………………………………………..
Hospitalized history (when, reason, and how long) :
………………………………………………………………………………………
- History of drugs taking : ……………………………………………
c. Medical Family History (Genogram and explanation):
Diseases had ever been gotten by family member that to be risk factor
………………………………………………………………………………………
d. Psychosocial and Spiritual History
- Is there any nearest person with patient : ……………………………………
- Interaction in family (communication pattern, decision making, and society
activity)
…………………………………………………………………………………….
- Effect patient’s disease toward family : ……………………………………
- Problem that influence the patient : ……………………………………
- Coping – stress mechanism : ……………………………………
- Health perception : ……………………………………
- Value – belief system : ……………………………………
e. Home environment state : ……………………………………
f. Daily habitual pattern before be sick
- Nutritional - metabolic pattern : ……………………………………
- Elimination pattern : ……………………………………
- Personal hygiene pattern : ……………………………………
- Rest – sleep pattern : ……………………………………
- Activity – exercise pattern : ……………………………………
- Life style pattern : ……………………………….......
g. Habitual pattern during in hospital
- Nutritional – metabolic pattern : ……………………………….......
- Personal hygiene pattern : ………………………………......
- Sleep – rest pattern : ………………………………......
- Activity – exercise pattern : ………………………………...
4. Physical Assessment
a. Eyes system : ……………………………………
b. Ears system : ……………………………………
c. Respiratory system : ……………………………………
d. Cardiovascular system : ……………………………………
e. Hematology system : ……………………………………
f. Nervous system : ……………………………………
g. Digestive system : ……………………………………
h. Endocrine system : ……………………………………
i. Urogenitalia system : ……………………………………
j. Integument system : ……………………………………
k. Musculoskeletal system : ……………………………………
l. Immune system : ……………………………………
5. Supportive Data (diagnostic tests) : ………………………………..
6. Treatment (Therapy) : ………………………………..
7. Resume (Admit patient to the actions have been done): ………………………

55
B. PROBLEM LIST
Name : ………………….. Reg. No. : ………………
Age : …………………. Room : ………………
Acquired No. Focus Data Problem / NDX Resolved Date Sign
Date

C. NURSING CARE PLAN

Name : ………………. Reg. No. : ………………
Age : ………………. Room : ………………
Date Time No. NDx Planning Intervention Sign

D. NURSING NOTES
Name : ………………. Reg. No. : ……………..
Age : ………………. Room : ……………..
Date Time NDx. No. Implementation Pt. Response Sign

E. PROGRESS NOTES
Name : ……………………… Reg. No : ……………..
Age : ……………………… Room : ……………..
Date Time NDx. No. Evaluation Sign
S
O
A
P

56
 UNIT 9. DEBATE MOTION
Learning Objectives:
In this unit, students will be able to:
1. Identify the learning objectives. ...
2. Plan the specific learning activities. ...
3. Plan to assess student understanding. ...
4. Plan to sequence the lesson in an engaging and meaningful manner. ...
5. Create a realistic timeline. ...
6. Plan for a lesson closure.
==========================================================.
What is the Debate?
Debate is a process that involves formal discussion on a particular topic. In a debate,
opposing arguments are put forward to argue for opposing viewpoints. Debate occurs in public meetings, academic
institutions, and legislative assemblies. It is a formal type of discussion, often with a moderator and an audience, in
addition to the debate participants.
It is a common part of our lives and we all have argued at some point in our lives. Through a debate, a
participant tries to cancel the views and arguments of the opponent while safeguarding its own views with solid
proof and arguments.
In an academic and scholarly environment, it is considered as quite a fun and enlightening activity that not
only engages the audience but adds to their knowledge.

Debating Teaches Many Essential Skills

Using debates in the classroom can help students grasp many essential critical thinking and presentation skills.
Among the skills classroom debates can foster are:
- analytical thinking
- citizenship/ethics/etiquette
- abstract thinking
- clarity
- cross-examination/questioning
- point of view
- distinguishing fact from opinion
- identifying bias
- language usage
- Organization
- personal vs. political values
- Persuasion
- public speaking
- Research
- teamwork/cooperation
- many more!

57
Mini-Debate Strategy in Classroom
The teacher will share the rules of the mini-debate with the class. Some suggestions include:
1. Desks are lined up in two rows, face-to-face, allowing the partners to go head-to-head.
2. Participants may use research notes, as well as blank paper to make notes during the debate.
3. Each partnership will have three minutes to debate:
Partner 1--1 minute opening
Partner 2--30 second rebuttal
Partner 2--1 minute opening
Partner 1--30 second rebuttal
Partner 1--30 second closing
Partner 2--30 second closing
4. Before the debate starts, the teacher will model a debate by challenging a brave student. ( Neither one will
have notes--this will simply be a battle of wits for the practice:)

How to Write a Debate Speech

The basic formula for writing a debate is...
1. to be given an opening line,
2. to state and define your topic,
3. to signpost your arguments,
4. to rebut opposing viewpoints,
5. to give your own arguments,
6. and then round things off with a nice, simple conclusion.
If you'd like to find out how to optimise this formula and write the best debate speech that you're capable of
producing, then check out my other article.

Structure a classroom debate

To Conduct a Class Debate
1. Introduce the topic. All debates start with a topic, or resolution. ...
2. Assign the Affirmative and the Negative. There are two sides to any debate. ...
3. Give Time for Research. Your students will need time to research the issue. ...
4. Keep Track of Time. ...
5. Make a Judgment.

What are the Types of Debate?

The debate is divided into four types. Each type is used for a specific type of debate and all of them are
conducted differently and could take place for different purposes. Below is the types of debate:
1. Lincoln-Douglas Debate
2. Rebuttal Debate
3. Oregon-Oxford Debate
4. Parliamentary debate
5. Policy Debate

1. Lincoln/Douglas Debate Type

Lincoln/Douglas Debate Format
1. Short introduction of the LD debate format: ...

58
 2. Questions format: Cross-examination. ...
3. 1st Affirmative constructive – 7 minutes. ...
4. Cross-examination – negative asks affirmative – 3 minutes. ...
5. 1st Negative constructive – 8 minutes. ...
6. Cross-examination – affirmative asks negative – 3 minutes.
7. 1st Affirmative rebuttal – 4 minutes.

How do you win the Lincoln Douglas debate?

There are three main ways to win an L-D round:
1. Prove that your value is supported by your case, not supported by your opponent's case, and superior to your
opponent's value. 2. Prove that your case better supports your value than your opponent's case supports theirs.
1. The Introduction.
2. Definitions.
3. Value.

What format of debate is normally used?

The debate format is relatively simple; each team member of each side speaks for five minutes, alternating sides. A
ten-minute discussion period, similar to other formats' "open cross-examination" time follows, and then a five-
minute break (comparable to other formats' preparation time).

What are the criteria for judging a debate?

Criteria
1. Organization & Clarity: Main arguments and responses are outlined in a clear and orderly way.
2. Use of Argument: Reasons are given against the resolution. ...
3. Use of cross-examination and rebuttal: ...
4. Presentation Style:

What is value debate?

The value is usually a statement which one side is attempting to achieve throughout the debate. In general, the side
that best upholds his or her value premise, which was adequately defended, wins the debate. The value premise is
sometimes referred to as the "value" or simply "vp".

2. Rebuttal debate
What is rebuttal?
Rebuttal is a literary technique in which a speaker or writer uses argument, and presents reasoning or evidence
intended to undermine or weaken the claim of an opponent.

What is a rebuttal in a debate?

When two people debate, one of them makes an argument, and the other follows with a rebuttal, which, plainly
put, is the "no, you're wrong and this is why" argument.

What is an example of a rebuttal?

The definition of a rebuttal is an opposing argument or debate. An example of a rebuttal is a defense attorney
responding to allegations made by a district attorney against their client.

How do you start a rebuttal in a debate?

Write bullet points for your rebuttal according to the notes you took. Bring up each argument the speaker
presented. Provide details for the audience of why that argument either is not credible or does not relate to the
thesis. Counter any factually incorrect evidence that the speaker provided.

59
What should a rebuttal consist of?
By addressing and challenging each aspect of a claim, a rebuttal provides a counter-argument, which is itself a type
of argument. In the case of a rebuttal essay, the introduction should present a clear thesis statement and the body
paragraphs should provide evidence and analysis to disprove the opposing claim.

What is a rebuttal counter argument?

Counterargument: A counterargument is an argument (point/reason/view/evidence) that your opponent would
make. Rebuttal: A rebuttal is when you respond directly to your opponent's argument/point to explain/show
how/why they are wrong.

How does a rebuttal work?

rebuttal. When two people debate, one of them makes an argument, and the other follows with a rebuttal, which,
plainly put, is the "no, you're wrong and this is why" argument.

How do you end a rebuttal?

Writing a Conclusion
The conclusion of your rebuttal essay should synthesize rather than restate the main points of the essay. Use the
final paragraph to emphasize the strengths of your argument while also directing the reader's attention to a larger or
broader meaning.

What is the difference between counterargument and rebuttal?

A counterargument is an argument (point/reason/view/evidence) that your opponent would make. Rebuttal:
A rebuttal is when you respond directly to your opponent's argument/point to explain/show how/why they are
wrong.

How long is a rebuttal?

In high school, all four constructive speeches are generally eight minutes long and all four rebuttal speeches are
four or five minutes in length depending on the region; in college they are nine and six minutes long respectively.

Why is a rebuttal important?

The purpose of using rebuttal is to prove another argument as erroneous and false. It is very common in literature,
public affairs, law, and politics, where opponents put forward statements to negate or refute specific arguments
against them.

What is another word for counterargument?

Synonyms of counterargument may include rebuttal, reply, counterstatement, counter reason, comeback and
response. The attempt to rebut an argument may involve generating a counterargument or
finding a counterexample.

3. Oregon Oxford debate Type

What is Oregon Oxford debate?
Oxford -Oregon Debate or Forensic Debate , is the traditional debate format used in elementary, high schools, and
colleges all over the country. -There are two sides in this format : the Affirmative and the Negative. ...
A debate Moderator enforces the rules to ensure the debate's smooth conduct.

What is the format pattern of Oxford Oregon debate?

This is also known as the Cross-Examination Debate or the Forensic Debate. It is a traditional debate format used
in elementary, high schools, and colleges all over the country. The two sides of this format is Affirmative, which
proves the validity of proposition, and the Negative which disproves it.

60
What are the 2 sides of debate?
Both sides seek to win against the other while following the rules. One side is typically in favor of (also known as
"for", "Affirmative", or "Pro") or opposed to (also known as "against", "Negative", "Con") a statement, proposition,
moot or Resolution.

What are the two sides in Oxford Oregon debate?

There are 2 sides in this format : the Affirmative and the Negative. The Affirmative proves the validity of the issue
or topic called the Proposition while the Negative disproves it. Each team has two speakers and one scribe.
A Debate Moderator enforces the rules to ensure the debate's smooth conduct.

What is interpellation in debate?

(plural interpellations) (politics) The act of interpellating (questioning); the period in which government officials
are questioned about and explain an act, a policy or a point raised during a debate. (philosophy) The act of
interpellating: the act of identification.

Which side goes first in a debate?

1NC. The First Negative Constructive (1NC) is the first speech given by the negative team and the second speech
in the round. It is given by the first negative speaker. The 1NC will generally present all of the major arguments
which the negative plans to present in the round.

What is a debate judge called?

Case File. A collection of written material designed to prepare cases for debates. Chair Judge. The person who
controls a debate and manages the adjudication and feedback to teams afterwards. Chief Adjudicator.

How is a debate scored

Speaker points. The judge is charged not only with selecting a winner, but also must allot points to each debater.
"Speaker points" are numeric merit scores that the judge awards the debaters on their speaking skills. ... If the judge
does not, the decision is considered a "low-point win".

What's the difference between debating and arguing?

Debate is a process that involves formal discussion on a particular topic. In a debate, opposing arguments are put
forward to argue for opposing viewpoints.

What does an adjudicator do in a debate?

An adjudicator (often referred to as a "judge"), is a person who gives a critical evaluation of performances in
competitions, festivals or talent shows, resulting in the award of marks, medals or prizes. In BP debate,
an adjudicator weighs arguments and decides rankings in the house.

How can I be a good adjudicator?

Honesty and integrity. Being honest and impartial are a key characteristic of an effective Adjudicator and that
attribute applies for as long as an adjudicator holds him or herself out. Of course, we have seen that
some adjudicators come unstruck right at the start of the process when they accept appointments.

4. Parliamentary debate
Parliamentary debate (also referred to as "parliamentary") is an academic debate event. Many university-level
institutions in English-speaking nations sponsor parliamentary debate teams. In addition the format is currently
spreading to the high school level. Despite the name, the parli is not related to debate in governmental parliaments
beyond formal speaker titles such as "Opposition Leader" and "Prime Minister".

61
5. Policy debate

Policy debate is a two-on-two debate where an affirmative team proposes a plan and the negative team
argues why that plan should not be adopted. The topic for policy debate changes annually, so debaters throughout
the course of the year will debate the same topic.

Structure of policy debate

History
Traditionally, rebuttals were half the length of constructive speeches, 8–4 min in high school and 10–5 min
in college. The now-prevailing speech time of 8–5 min in high school and 9-5 in college was introduced in the
1990s.

The debate unfolds throughout a series of speeches as outlined below:

1. 1st Affirmative Constructive 1AC 8 minutes Negative Cross-Examination of Affirmative 3 minutes
2. 1st Negative Constructive 1NC 8 minutes Affirmative Cross-Examination of Negative 3 minutes
3. 2nd Affirmative Constructive 2AC 8 minutes Negative Cross-Examination of Affirmative 3 minutes 2nd
Negative Constructive 2NC 8 minutes Affirmative Cross-Examination of Negative 3 minutes
4. 1st Negative Rebuttal 1NR 5 minutes 1st Affirmative Rebuttal 1AR 5 minutes
5. 2nd Negative Rebuttal 2NR 5 minutes 2nd Affirmative Rebuttal 2AR 5 minutes
6. Prep Time (each team) 8 minutes One member of each team will perform the ‘first’ speeches, the other the
‘second’ speeches.
So the person who reads the 1AC wil also perform the 1AR, for example. Note that the debate begins with the
affirmative speaking first, and then switches midway through the debate where the negative speaks first, thus giving
the affirmative the ability to speak last.

Cross=Examination Periods
Following each constructive speech, there is a three-minute cross-examination period in which the
opposing team questions the team which just spoke. Usually, the cross-examination is conducted by the opponent
who will not speak next of the speaker who just spoke, but some cross-examinations are open, that is: either partner
may ask or answer questions. However, it is often frowned upon when a partner who is not the previous speaker
answers cross-examination questions

Common Questions
How do you plan a debate?
a. decide on the purpose of the debate. Start with one or more clearly stated intended learning outcomes that
will be achieved through debate. ...
b. research the background information. ...
c. help the learners prepare for the debate. ...
d. Prepare the debate plan. ...
e. Prepare the environment. ...
f. closing the debate.

What are the 7 E's of lesson plan?

So what is it? The 7 Es stand for the following. Elicit, Engage, Explore, Explain, Elaborate, Extend and Evaluate.

How can I be a good debater?

How To Be A Good Debater

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 1. Preparation of your topic.
2. Keep The Topic On Track
3. Speak slowly, clearly and charismatically.
4. Be confident with your topic.
5. Maintain Proper Body Language
6. Speak Loud And Clear
7. Listen and take notes.
8. Anticipate your opponent's questions before they're uttered.
9. Know The Form Of The Debate. ...
10. Use Of Debate Jargons

What are the rules of a debate?

Rules of Debate
a. There are two teams, each consisting of two or three speakers.
b. Each team has two or three constructive speeches, and two to three rebuttal speeches.
c. When worded as a proposition of policy, the topic requires the affirmative to support some specified action
by some particular individual or group.

How do you talk in a debate?

a. Understand the topic and choose a side.
b. Prepare statistics and analysis to support your argument.
c. Begin writing your introduction.
d. Include a brief layout of your argument.
e. Write the rest of your speech.
f. Rewrite the introduction.
g. Practice the beginning of your speech several times before the day of your debate.

How do you start a debate topic?

a. Be confident and prepare well for the debate topic. ...
b. Start your introduction in a clear and firm voice.
c. It is important to maintain gestures, posture, and eye contact with the audience.
d. Don't shout while doing a debate so be respectful and self-control.
e. Make sure that the facts and figures are true.

Do and don'ts of debate?

The Don'ts of debate:
a. Do not address the adjudicator.
b. Never carry the piece of paper or any other form of notes.
c. Do not forget about mannerism on the stage.
d. Do not interrupt other speakers while they are speaking.
e. Do not shout or talk loudly.
f. Do not use 'um' or 'em; within the speech.

What are the three parts of a debate?

A formal debate usually involves three groups:
1. one supporting a resolution (affirmative team),
2. one opposing the resolution (opposing team),
3. those who are judging the quality of the evidence and arguments and the performance in the debate.

What are the advantages of debate?

Learning to Debate and Public Speak reaps life long benefits.

63
 1. Develop excellent oral and written communication skills.
2. Develop excellent critical thinking skills.
3. Develop effective tools for research, organization and presentation.
4. Develop strategies to overcome fears of public speaking.

What are the two sides in a debate called?

Each debate involves two debating teams who take opposing sides of the topic, either affirmative (for) or negative
(against). The teams alternate speakers. The affirmative team speaks in support of the topic. ... The negative team
speaks against the topic.

What is the process of debate?

During the process of debate, the House follows a basic sequence of steps: providing notice of the motion, moving
and seconding the motion, proposing the question from the Chair, debating the motion, putting the question on the
motion, and arriving at a decision on the motion.

What are the qualities of good debater?

Qualities that every good debater needs to have
1. Focused and Steady. A good debater never deviates from the topic. ...
2. Good Listener. If you want others to listen to you, first you will have to listen to them.
3. Have an Outline Ready. ...
4. Respond Well.

What does the 1st speaker say in a debate?

As the first speaker of their side in the debate, the first speaker must discuss the status quo, (i.e., the present
system-its problems or success depending on what side of the topic they are on) put forward a definition and, in
normative debates, a model, and prove the most important arguments in a debate to be true.

What are the elements of debate?

Five Elements to Every Debate Round
1. The Judge. An academic debate is set up to persuade either a person or a group of people, not your
opponent.
2. The Resolution. This is a claim or proposition that both sides of the game agree to argue. ...
3. The Sides. ...
4. The Speeches. ...
5. The Decision.

What is the topic of a debate called?

The debate "topic" may also be called the "____________________________" or the
"________________________________." resolution/ proposition.

How is a debate scored?

Speaker points. The judge is charged not only with selecting a winner, but also must allot points to each debater.
"Speaker points" are numeric merit scores that the judge awards the debaters on their speaking skills. ... If the judge
does not, the decision is considered a "low-point win".

What is a debate judge called?

Case File. A collection of written material designed to prepare cases for debates. Chair Judge. The person who
controls a debate and manages the adjudication and feedback to teams afterwards. Chief Adjudicator.

What does a judge do in a debate?

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In competitive debates, the judge is the person who is responsible for deciding who wins and loses a debate.
The judge also assigns a range of points to individual debaters or teams of debaters. After the debate, the judge tells
the debaters how they voted and why they voted that way.

How do you address a judge in a debate?

Good morning(the time of day) ladies and gentlemen (OR respected judges and the members of the house) today I
XYZ(your name or slot no.)

How do you assess a debate?

Typical categories for assessment ask you consider if the competitor:
a. Directly addressed the topic.
b. Understood the basic issue.
c. Clearly explained their position.
d. Made a convincing case, complete with specific evidence.
e. Explained the other side's weaknesses.
f. Responded directly to the other side's critique.

How do I greet my judges in a debate competitions?

First of all, it’s not at all a compulsion that you have to specifically greet the judges; you can greet everyone in
general. And I’ve seen judges who see this as an act of buttering, so better avoid it!!

Here’s an example of how you can greet and start of-

Good morning(the time of day) ladies and gentlemen (OR respected judges and the members of the house) today I
XYZ(your name or slot no.) stands before you to speak on the topic “Censorship is necessary” and I’m strictly
against the motion. (OR to advocate that Censorship is NOT necessary.)

Example of Debate Topics

Educational Debate Topics
A college degree is essential for getting a good job.
Homeschooling is better than traditional schooling.
Schools should teach LGBT+ inclusive sex education?

Social Debate Topics

Gay marriage should be legalized.
Social media does more harm than good.
The government should provide free birth control.

Technology Debate Topics

Has social media benefitted or harmed people’s social lives?
Is the use of technology changing people for the better. . . or worse?.
What's better: traditional or online education?

More Controversial Debate and Argumentative Essay Topics

Children should be exposed to technology.
Gaming should be considered a sport.
Parents should be able to choose the sex of their child.

Health Debate Topics

Cosmetic procedures should be covered by health insurance.
Obesity should be labeled a disease.
All drugs should be legalized.

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 UNIT 10: INTERVIEW, CV, AND RESUME
Learning Objectives
In this unit you will learn how to:
1. Recognize the dialogue model in interview
2. Technique in interview
3. Make a curriculum vitae and application letter
A. Dialogue

Dialogue Model 1
Mr. David : Come in and have a seat, please.
Anita : Thank you very much.
Mr. David : Your name’s Anita, isn’t it?
Anita : That’s right.
Mr. David : Let me check your personal data.
You are twenty-three years old, single and live with your parents in Jakarta.
Anita : That’s correct.
Mr. David : Can you tell me something about your formal and informal education?
Anita : I graduated from a Nursing Academy just last month. I have also taken an
English Course at MEDICA ENGLISH for three years.
Mr. David : Did you take any other courses or attend seminars or workshops?
Anita : No, not yet. I plan to take a Computer Course in the evening.

Dialogue Model 2
Mr. Lie : Right, Miss. Alaida, you have told me about yourself, and your education.
Now would you tell me about your work experiences?
Alaida : Yes, As I told you I finished my college just last month. That’s why
I have no work experience, but I did some job training in some hospitals.
Mr. Lie : In which hospital did you do your job training?
Alaida : In 1996, I did my first job training in Bintaro Hospital for one month and
then in 1997, I did my second job training in Salemba International
Hospital.
Mr. Lie : Then why do you want to join our hospital?
Alaida : I know this hospital from my brother. He works here. He said that you had a
vacancy for an Emergency position. And I know that this hospital has a
very good reputation.
Mr. Lie : How much salary do you expect if you are successful in your application?
Alaida : I’d be happy if you could pay me Rp 5,000,000. including basic salary,
allowances, and meals but tax is excluded.
Mr. Lie : When are you ready to start work, Miss Alaida?
Alaida : At the time being, I’m unemployed. So I’m ready to start work anytime.
Mr. Lie : Okay, Miss. Alaida. Thank you for coming to this interview. I’ve taken all
your information as consideration and I hope that I can inform you next
week.
Alaida : Thank you.

66
Dialogue Model 3
Mr. Jordan : Right, Elma, you have told me about yourself, and your education.
Now, would you tell me your work experiences?
Elma : Certainly. As I told you I graduated from UPN. I joined a Pondok Indah
International Hospital for one year. Since the hospital went bankrupt, I
stopped working there. That’s why I am applying for a job in your hospital.
Mr. Jordan : I see. Then why do you want to join our hospital?
Elma : As far as I know. This is a big hospital with a good reputation.
Besides, your line of business seems suitable with my qualification.
Mr. Jordan : Talking about salary and other fringe benefit. How much salary do you
want to propose if you are accepted?
Elma : If you give me an opportunity to join your hospital, I hope that you can
offer me two million rupiahs. This amount includes basic salary, meals and
other allowances, but the tax will be paid by the hospital.
Mr. Jordan : I see, when are you ready to work, Elma?
Elma : As I told you. I just stopped working from the Pondok Indah International
hospital and I didn’t apply for a job in any other hospital. That is why, I
am ready to start work at anytime.
Mr. Jordan : Okay, Thank you for coming. I will keep all the information for
consideration and will inform you next week.

B. Substitution Drill
1. Let me check your personal data.
ID card.
certificate.
driving license.
2. You are twenty-three years old.
twenty.
twenty years of age.
3. You are single.
unmarried.
married with no children.
4. Can you tell me something about your education?
experience?
family?
side activities?
5. I graduated from a Secretary College.
Nursing Academy
University of Indonesia.
High School majoring in economics.

67
C. Substitution Drill
1. Would you tell me about your work experience?
job description?
salary proposal?
2. That’s why I have no work experience.
am interested in working here.
stop working here.
can speak English well.
3. He said that you had a vacancy for a secretary.
emergency position
HRD position.
security personnel
4. How much salary do you expect?
want?
propose?
5. I’d be happy to have Rp. 1,325,000 a month
Rp. 2,575,000 monthly
Rp. 3,250,000 per month
6. I hope that I can inform you next week.
send you a letter
give you a call

D. Commonly questions at interview

1. Your name’s ……….., isn’t it?

2. Let me check your personal data! You live in ………….with ……….
3. Could you tell me something about your formal and informal education?
Answer: ES, Junior and Senior High School, and academic and year, and course if any
4. Did you take any other courses or attend seminars or workshops associate with nursing? Answer: Yes/No,
I did/didn’t, I took ……..
5. Would you tell me about your work experiences?
Answer:
I have been working in …………..for/since ………
or
I had been working in ……………for/since ………
or
I have no work experience because ………..
6. What is your reason that you stopped working there?
Answer: My reason is …………..
7. Why do you want to join our hospital?
Answer: Because this hospital has good ………. and ……..
8. What is your motivation to work in our hospital?
Answer: I am looking for good ……………, …….…, ………., and ………..
9. How much salary do you expect if you are successful in your application?
Answer: I would be happy if you could pay me Rp …………….. / month
10. When are you ready to start work?
Answer: …………………..at any time

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E. CURICULUM VITAE

Personal Data

Name : Sherlly Kusumawardani

Address : Jl. Angrek 5/7 Jakarta 12001
Home Telephone : 021-70765817 (after 7:00 p.m.)
Office Telephone : 021-32509661
Place and Date of Birth : Jakarta, October 28th , 1983
Sex : Female
Proficiency in Languages : Fluent in English
Marital Status : Married with one child
Health : Excellent
Height : 1.70 m
Weight : 55 kg
Photograph : Enclosed
Job Objective : Nurse

Qualifications For The Job

Good education and fully conversant with all Nurse duties. Have poise, initiative, tact, good sense and
willingness to accept Nurse responsibilities.

Education
2005 to present The Study Program of Attending Nursing Course
Nursing in Jakarta (evening session)
UPN Veteran

2001 to 2004 Nursing Academy of Certificate

UPN Veteran in Jakarta

1998 to 2001 SMU 71 South Jakarta Pass and rank 3rd in class of
40

Special Award
The first winner in Speech Contest in Jakarta UPN Veteran in 2003.

Work Experience
2004 to present Name of Company on As Nurse, have had diver-
request sified Nurse, duties which

69
 include; do infusion, injec-
tion, vital signs, and make
a nursing documentation.

On of International Supervision of 5 practical

Hospital in Jakarta nurses
with staff of 920.
Achievements:
Could operate ECG and
Ventilator Machines.

Extracurricular Activities
- Member of PPNI (Persatuan Perawat Nasional Indonesia)
- Captain of basketball team, jogging, and swimming

Hobbies
Philately and chess

REFERENCES WILL BE PROVIDED ON REQUEST

70
F. APPLICATION LETTER

Jakarta, June 27th, 2006

The Personnel Manager

Bintaro International Hospital
Jakarta

Dear Sir,

APPLICATION FOR THE POST OF EMERGENCY

I read with interest your advertisement in today’s “Kompas” and would appreciate it if you could consider
my application.

I am 22 years of age and married with one child. I have a thorough knowledge of emergency and 3 years
experience as a nurse emergency in a famous hospital in Jakarta. Although I have had very pleasant
working conditions, I feel an organization such as your offers more scope for advancement than I can
expect from my present employer. Moreover, I have always aspired to work in an organization of
international standing.

I enclose two copies of testimonials by our hospital to vouch for my character and capabilities.

I hope I may be granted an interview at which I would be pleased to provide any further information you
may need.

Yours faithfully

Sherlly Kusumawardani
Phone: 93033095

Encs.

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Appendix 1

Names of Profession in Hospital Names of Ward and Department in Hospital

1. Acupuncturist 1. 24 Hours Ambulance Service
2. Anesthesiologist 2. 24 Hours Home Visit Service
3. Cardiologist 3. 24 Hours Hotline Service
4. Chief/Charge Nurse 4. Admission department
5. Angiographies dept
5. Cosmetic Surgeon 6. Body death room / Morgue
6. Dentist 7. CSSD = Central Sterile Supply Department
7. Dermatologist 8. Delivery room
8. Director of Nursing Service 9. Dentistry clinic
9. E.N.T specialist 10. Dispensary /pharmacy
10. ECG Technician 11. Doctor’s lounge
11. General Practitioner 12. E.N.T.
12. General Surgeon 13. Emergency room
13. Head nurse 14. Emergency Medical Service (EMS)
15. Endoscopies Dept
14. Hematologist 16. Geriatric ward
15. Internist 17. Hormonal clinic
16. Lab Technician 18. ICU
17. Leader Nurse 19. Information center
18. Medicines Man 20. Laboratory room
19. Midwife 21. Laundry department
20. Neurologist 22. Maternity ward
21. Nurse 23. Medical Check-up
22. Nutritionist / Dietician 24. Medical Evacuation Service (MES)
25. Medical ward
23. Obstetric/Gynecologist (OB/GYN) 26. Minor Surgery Room
24. Ophthalmologist 27. Nurse station
25. Orthopedic Surgeon 28. Nurse’s lounge
26. Pathologist 29. Nutrient Department
27. Pediatrician 30. Oncology dept (blood specialist)
28. Pharmacist/apothecary 31. Operating theater
29. Physician 32. Orthopedic ward
30. Psychiatrist 33. Out Patient Department (OPD)
31. Psychologist 34. Pediatric clinic
35. Pediatric ward
32. Pulmonalogist 36. Perinatology
33. Radiologist 37. Rehabilitation/physiotherapy
34. Surgeon 38. Sex Therapy Clinic
35. Urologist 39. Surgical ward
36. Venerologist 40. U.S.G dept
41. X-ray dept

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APPENDIX 2: COMMON
ABBREVIATION
 A – abortions – number of spontaneous or
elective abortions
 A/P or APU – antepartum unit (where long term
pregnant women stay in the hospital)
 AB- abortion
 accels – accelerations of the baby’s heart beat
(good thing!)
 AFI - amniotic fluid index
 AFP - Alpha Fetoprotein
 AGUS - atypical glandular cells of unknown
significance
 AMA - advanced maternal age
 AMA – against medical advice — OR —
advanced maternal age (over age 35) – I hate
this term
 amnihook – a plastic device, similar to a crochet
hook, used to break the membranes/water
 AP- antepartum
 AROM – artificial rupture of membranes
 ASCUS - atypical squamous cells of unknown
significance
 BBOW - bulging bag of water
 BHCG - beta human chorionic gonadotropin
(usually serum)
 BPP- biophysical profile
 BSO - bilateral salpingo-oophorectomy
 BTL - bilateral tubal ligation
 c/s – cesarean section – surgical birth
 CD – cesarean delivery – see c/s
 CEFM - continuous electronic fetal monitoring
 CHTN – chronic hypertension
 CIN - cervical intraepithelial neoplasia
 CNM – certified nurse-midwife
 cord! – usually yelled in an emergency – means
that an umbilical cord has prolapse through the
woman’s cervix, necessitating an emergency c-
section
 CPD – cephalopelvic disproportion – where the
baby’s head won’t fit through the pelvis (also,
see FTP and FTBP)
 CPD- cephalopelvic disproportion
 cryo – surgical freezing of the cervix to treat
abnormal pap smear results/precancerous lesions
on the cervix
 CST - contraction stress test
 CT - chlamydia trachomatous
 ctx – contraction
 CVS - chorionic villi sampling
 cx – cervix, cervical
73
 D & C – dilatation and curettage (see D&E), but
suction is used
 D & E – dilatation and evacuation (this could be
from a miscarriage, or from a retained placenta)
 decels – decelerations of the baby’s heart beat
(sometimes good, sometimes not good)
 DI/DI - dichorionic/diamniotic twins
 DIC - disseminating intravascular coagulopathy
 EAB – elective abortion
 EDC – estimated date of confinement – due date
 EDC/EDD - estimated date of
confinement/estimated date of delivery
 EDD – estimated date of delivery – due date
(see EDC)
 EFM – external fetal monitor (toco + u/s)
 EFW - estimated fetal weight
 EGA - estimated gestational age
 EMB - endometrial biopsy
 epid – epiduraL
 epis – episiotomy
 ERT - estrogen replacement therapy
 FAVD - forceps assisted vaginal delivery
 FHR/FHT- fetal heart rate/fetal heart tracing or
tone
 FLM - fetal lung maturity
 FSE – fetal scalp electrode (used to directly
measure the baby’s EKG/heartbeat)
 FTBP – failure to be patient (see FTP)
 FTP – failure to progress
 G – gravity – total number of pregnancies
 G_P_ gravida, para (TPAL - term, preterm,
abortions, living children)
 GA – gestational age
 GBS- group B beta streptococcus
 GDM - gestational diabetes mellitus
 GH - gestational hypertension (the most
currently correct name for PIH)
 GHTN – gestational hypertension
 GIFT - gamete intra-fallopian tube transfer
 GO - gonorrhea
 grand multip – a woman who has given birth to
at least 4 or 5 babies before
 GTD - gestational trophoblastic disease
 GTPAL – the number system to say how many
pregnancies a woman has had, and the outcomes
of the pregnancies
 gtt – drip
 HCG - human chorionic gonadotropin
 HELLP – a syndrome of hemolysis, elevated
liver enzymes and low platelets
 HELLP - hemolysis, elevated liver enzymes,
low platelets
 HGSIL - high-grade squamous intraepithelial
lesion
 HPL - human placental lactogen
 HPV - human papilloma virus
 HRT hormone replacement therapy
 HSG – hysterosalpingogram
 HSV - herpes simplex virus
 HTN – hypertension
 I&O – intake and output
 IP - intrapartum
 IUD - intrauterine device
 IUFD - intrauterine fetal death
 IUFD – intrauterine fetal demise
 IUGR – intrauterine growth restriction
 IUI - intrauterine insemination
 IUP - intrauterine pregnancy
 IUPC – intrauterine pressure catheter (used to
directly measure contractions in the uterine
cavity)
 IV – intravenous
 IVF – in vitro fertilization
 kiwi – a type of a vacuum used in births
 L – living – number of living children
 L&D – labor and delivery
 LDR - labor, delivery, recovery (all in one
room)
 LDRP - labor, delivery, recovery, postpartum
 LEEP - loop electrical excision procedure
 LGA – large for gestational age
 LGSIL - low grade squamous intraepithelial
lesion
 LMP – last menstrual period
 LNMP – last normal menstrual period
 LOA/LOT/LOP - left occiput anterior/left
occiput transverse/left occiput posterior
 LOF - leaking of fluid
 LTCS/LVCS - low transverse C- section/low
vertical C-section
 LTV – long term variability (how the baby’s
heart beat line looks on the monitor – it should
be fairly squiggly, which suggested
good/average/moderate LTV)
 MAB - missed abortion
 macro – macrosomic (also, see LGA)
 Mag – magnesium sulfate
 MBU - mother/baby unit
 MFM – maternal fetal medicine specialist,
perinatalogist, deals with high risk pregnancies
 MSAFP - maternal serum alpha-fetoprotein
 multip – a woman giving birth for the 2nd (or
more) time
 MVU - Montevideo units
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 NB - newborn
 NBN - newborn nursery
 NICU - neonatal intensive care unit
 NST - non-stress test
 NSVD - normal spontaneous vaginal delivery
 NT - nuchal translucency
 NTD - neural tube defect
 OB – obstetrician
 OCP - oral contraceptive pills
 OR – operating room
 OT - occiput transverse
 P – preterm – number of babies born from 20-37
weeks
 PACU – post anesthesia care unit
 PCOS - polycystic ovarian syndrome
 PES – preeclampsia syndrome
 PID - pelvic inflammatory disease
 PIH - pregnancy induced hypertension
 pit – pitocin (oxytocin) – used to stimulate
contractions
 POC - products of conception
 POD/PPD - post-operative day/postpartum day
 PP – postpartum; also post-prandial (after meals)
 PP Del – postpartum delivery
 PPD – postpartum depression (also is an
abbreviation for a test for tuberculosis)
 PPH – postpartum hemorrhage
 PPROM - preterm premature rupture of
membranes
 PPROM – prolonged premature rupture of
membranes
 primip – a woman giving birth for the first time
 PROM – premature rupture of membranes
(water breaks before labor begins)
 PTL – preterm labor
 PUBS - percutaneous umbilical blood sampling
 PUPPPS - pruritic urticarial papules and plaques
of pregnancy
 RN – registered nurse
 ROA/ROT/ROP - right occiput anterior/right
occiput transverse/right occiput posterior
 ROM - rupture of membranes
 SAB – spontaneous abortion (miscarriage)
 SD – shoulder dystocia – where the baby’s
shoulder is stuck during birth
 SGA - small for gestational age
 SGA – small for gestational age
 shoulder! – shouted out for assistance during a
shoulder dystocia
 SRMC single room maternity care
 SROM – spontaneous rupture of membranes
(“broken water”)
  STI sexually transmitted transmitted infection
 SVD – spontaneous vaginal delivery
 SVE – sterile vaginal exam
 T – term – number of pregnancies from 37-42
weeks gestation
 TAB – therapeutic abortion (see EAB, though a
TAB is usually for a medical reason)
 TAH - total abdominal hysterectomy
 terb – terbutaline
 TOA - tubo-ovarian abscess
 toco – tocodynomomanometer – big long word
that I can’t spell – the external device on the
fetal monitor to measure contractions
 TOL – trial of labor
 TOLAC – trial of labor after a cesarean birth
 TOP – termination of pregnancy
 t-pump – terbutaline pump
 TVH - total vaginal hysterectomy VAIN -
vaginal intraepithelial neoplasia
 U/A – urinalysis
 u/s – ultrasound, or ultrasound transducer (part
of the fetal monitor) to pick up the baby’s heart
beat
 UC – uterine contraction
 UDS – urine drug screen
 UHCG - urinary human chorionic gonadotropin
 US - ultrasound
 VAVD - vacuum-assisted vaginal delivery
 VBAC – vaginal birth after a cesarean birth
 VBAC - vaginal birth after C-section
 VE – vaginal exam (see SVE)
 VIN - vulvar intraepithelial neoplasia
 WNL – within normal limits

3. FORMULA
Table – 1 Common Systems of Units
System Unit of Mass Unit of Volume
Metric Gram (g) Liter (L)
Apothecary Grain (gr) Minim (m)
Household Pound (lb) Pint (pt)

Table – 2 Equivalents within Metric system

Units of Mass Units of Volume
1 kg = 1000 g 1L = 1000 ml
1g = 1000 mg 1 ml = 1000 µL
1 mg = 1000 µg 1 ml = 1 cc
130 g = 1 ounce 1,000 mL = 1 quart
15 g = 4 drams 500 mL = 1 pint
4g = 60 grains (1dram) 1 mL = 15 minims
1g = 15 grains 5 mL = 1 fluidram
60 mg = 1 grain 30 mL = 1 fluidounce
1 mg = 1/60 grain
0.6 mg (600 µg) = 1/100 grain

Table – 3 Temperature Conversion

Celsius to Fahrenheit Fahrenheit to Celsius
(ºC x 9/5) + 32 = ºF (ºF – 32) x 5/9 = ºC
Table – 4 Approximate Household Measures
1 teaspoonful 1 fluidram (fl dr) 4 – 5 mL
1 tablespoonful 4 fluidrams ( ½ fl oz) 15 or 16 mL
2 tablespoonfuls 1 fluid ounce 30 mL
1 pint 16 fl oz 500 mL
1 quart 32 fl oz 1000 mL
1 jigger 1 ½ fl oz 45 mL
1 cup 8 fl oz 240 mL
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 Table – 5 Conversion between Measurement Systems
Apothecary Metric
15 grains (gr) = 1g*
1 dram (dr) = 4g
15 minims (m) = 1 ml
1 fluid dram (f dr) = 4 ml

Household Metric
1 teaspoon (t) = 5 ml
1 tablespoon (T) = 15 ml
1 fluid ounce (f oz) = 32 ml (or 30 ml) ┼
1 pint (pt) = 480 ml (or 500 ml) ┼
1 quart (qt) = 960 ml (or 1000 ml) ┼
1 gallon (gal) = 3.85 L (or 4 L) ┼
1 pound avoirdupois (lb) = 0.46 kg (or 453.6 g)
1 kg = 2.2 lb
1 deciliter = 100 ml

Table 6 Prescription Abbreviations of Unit

Gram g (or gm)
Milligram mg (or mgm)
Microgram µg (or mcg)
Liter L (or l)
Milliliter ml (cc)
Grain gr
Minim min
Milliequivalent mEq
Cubic centimeter cc
Dram dr
Ounce oz
*Used for gases only

Table – 7 Pharmaceutical Abbreviations

Abbreviation/Phrase Translation
/d per day
aa (or aa) (ana) Of each
ac (ante cibum) Before meals
ad lib (ad libitum) Freely; as much or as often as wanted
aq water
bid (bis in die) Twice daily
c (cum) With
cap capsule
d day
dc or D/C discontinue
et and
ext extract
fl fluid
g, gm, or Gm gram (s)
gr grain (s)
gtt (guttae) Drops
h or hr hour (s)
hs (hora somni) At bedtime
L or l liter
LA long acting

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Lb or # pound (s)
mcg microgram (s)
meq or mEq milliequivalent (s)
MG magnesium
mg milligram (s)
min minute (s)
mL or ml milliliter (s)
MR X 1 may repeat once
NOC or noc at night
non rep (or non repetat) Do not repeat
NPO or npo nothing by mouth
NR or nr do not repeat
od (oculus dexter) Right eye
os mouth
os (oculus sinister) Left eye
OTC or otc over the counter
ou (oculus uterque) Both eye
p after
pc (post cibum) After meals
per by, through
PO (per os) By mouth
PR (per rectum) By rectal route
prn (pro re nata) According to circumstances/as needed
q every
q.i.d. four times daily
q.o.d. every other day
q2h, q3h, etc. every 2 hour, etc.
q4h Every 4 hours
qam or qAM every morning
qd (quaque die) Every day
qh (quaque hora) Every hour
qid (quarter in die) 4 times daily
qn or qnoc every night
qod Every other day
qs (quantum sufficit [satis]) As much as is necessary
rep repeat, refill
Rx treat, prescription
s Without
SOS if necessary
ss (or ss) (semis) One half
stat (statim) Immediately
tid (ter in die) 3 times daily
TO Telephone order
U unit (s)
ut dict as directed
vag vaginal
VO verbal order
w/ with
X times / multiply

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4. TECHNIQUES THAT FACILITATE COMMUNICATION
TECHNIQUES DESCRIPTION EXAMPLE
_____________________________________________________________________________________________
Silence Refraining from speech to give the client
(and the nurse) time to sort out thoughts and
feeling
Self-disclosure Sharing personal information at an
opportune moment to convey understanding
Suggestion Posing alternatives for client consideration
Confrontation Acknowledging discrepancies in the client’s
verbal and nonverbal behaviors; calling
attention to evasions, distortions, smoke screens,
and game playing
Concreteness Clarifying the meaning of the client’s
communication; being clear, direct, and to the
point
Genuineness Giving honest feedback when the client is ready:
acting in a congruent manner with the client
Immediacy Acknowledging what is accruing between the
nurse and the client as it happens
Empathy Experiencing another’s feelings temporarily
Respect Conveying openness, a nonjudgmental attitude,
and a desire to hear what the client has to say
Broad opening Using a general statement or question to
encourage the client to set the direction for the
session
Restating Repeating what the client has said to indicate
that the nurse is listening and interested; may
encourage the client to elaborate
Focusing Assisting the client to explore a specific topic
Client: “I hate you and everyone else.”
Nurse: “Remains silent, with the body in an open position, and
observes the client.
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Client: “My husband’s death was like losing a major part of my life.”
Nurse: “I had a similar feeling when my husband died.”
Client: “I won’t see a shrink!”
Nurse: “Have you ever thought about …?”
Client: “I don’t like that, either.”
Nurse: “What would happen if you …?”
Client: “I don’t have a problem with alcohol.”
Nurse: “You say that alcohol has not created any problems for you, yet
you have had two DWIs (driving while intoxicated) and your
wife nags you about your drinking.”
Client: “They said …”
Nurse: “Who said that?”
Client: “You look bored.”
Nurse: “I’m not bored, but I do feel very tired.”
Client: “Do you think I’m weird?”
Nurse: “Sometimes.”
Client: “I think I have the right to know as much about you as you
know about me.”
Nurse: “Sounds like you may not be too sure that I’ll be able to
understand what you are experiencing.”
Client: “This whole thing is a mistake. I shouldn’t even be here.”
Nurse: “Sounds like it’s difficult for you to be here.”
Client: “What difference does it make? You just think I’m wrong,
anyway.”
Nurse: “Try me. I’d like to hear about what’s been happening.”
Client: “Enters room, takes a seat, and looks expectantly at the nurse.
Nurse: “What’s up?” or “How has it gone since we last met?” or “How
are you today?”
Client: “I don’t belong here.”
Nurse: “You don’t belong here?”
Client: “Of course not. I’m not like the others here. I’m educated and
have a good job.”
Client: “I don’t know where to begin.”
Nurse: “What’s your biggest problem now?”
Client: “I can’t decide about ….”
Nurse: “Let’s talk about that. Perhaps more discussion will help you
decide.”
5. ANXIETY LEVELS AND NURSING IMPLICATIONS

The following chart presents manifestations of and nursing implications for the four primary levels of anxiety.
ANXIETY LEVEL MANIFESTATIONS NURSING IMPLICATIONS

Mild * Alertness * Client can be fully responsible for self.

* Maximal problem-solving ability
* Enhanced learning
Moderate * Selective inattention
* Impaired problem solving
* Complaints of feeling “uptight,”
“on edge,” or nervous
Severe * Narrowed attention
* Inability to grasp meanings
* Inability to problem solve
* Clingy or demanding behavior
* Many physiologic signs, includ-
ing increased blood pressure,
Dry mouth, restlessness, and
muscular tightness.
Panic * Inability to solve problems
* Client feels detached from
body or may feel “unreal”
* Breathing problems
* Loss of contact with reality
* Inability to recognize familiar
objects or person
* Erratic behavior
* Help client talk through situation and label feelings
* Use relaxation techniques
* Client needs structure and direction.
* Do not force client to make decisions.
* Provide one-on-one supervision.
* Give p.r.n. medication for escalating anxiety, as
ordered.
* Provide a nonstimulating environment.
* Use touch carefully. Do not physically touch the
Client without first obtaining permission or
explaining what you are doing; a severely anxious
client may misinterpret touch as an attack.
* Maintain a calm, soothing tone of voice.
* Act as a focal point, taking over the interaction and
actively directing the client’s attention to the nurse.
This usually has a calming effect on the client.
* Dress conservatively to maintain a soothing
environment; bright coloring can overstimulate
severely anxious and manic clients.
See nursing implications for severe anxiety.

6. THE COMMUNICATION CONTINUUM

Words can help the nurse create a healing atmosphere. But when chosen poorly, they can jeopardize nurse-client rapport and even
harm the client’s emotional well-being. Think of verbal communication as a continuum from destructive. Destructive communication
can damage a client’s self-esteem; constructive communication builds and preserves it.
--------------------------------------------------------------------------------------------------------------------------------------------
Destructive Communication Constructive Communication
--------------------------------------------------------------------------------------------------------------------------------------------
* Erodes self-esteem * Promotes self-esteem
* Conveys disrespect * Aids self-discovery
* Conveys respect

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7. COMPARING GRIEF AND CLINICAL DEPRESSION

A client who appears to be suffering from clinical depression may actually be experiencing a phase of grieving. This chart shows the
major distinctions between the two conditions.
----------------------------------------------------------------------------------------------------------------------------- -------------------------------
Characteristics of grief Characteristics of clinical depression
----------------------------------------------------------------------------------------------------------------------------- -------------------------------
* Healthy response * Unhealthy response
* Self-resolution * Self-resolution unlikely
* Little if any guilt * Overwhelming guilt
* Self-esteem intact * Loss of self-esteem
* Sadness * Hopelessness, despair, and helplessness
* Ability to meet life’s demands intact * Impaired ability to meet life’s demands
* No biochemical imbalance * Possible biochemical imbalance
* Temporary loss of interest in pleasurable activity * Pervasive anhedonia
(anhedonia)

8. NANDA taxonomy of nursing diagnoses

PATTERN I Exchanging (Mutual giving and receiving)

Altered nutrition: More than body requirements
Altered nutrition: Less than body requirements
Altered nutrition: Risk for more than body requirements
High risk for infection
High risk for altered body temperature
Hypothermia
Hyperthermia
Ineffective thermoregulation
Dysreflexia
Constipation
Perceived constipation
Colonic constipation
Diarrhea
Bowel incontinence
Altered urinary elimination
Stress incontinence
Reflex incontinence
Urge incontinence
Functional incontinence
Total incontinence
Urinary retention
Altered (specify type) tissue perfusion (renal, cerebral, cardiopulmonary, gastrointestinal, peripheral)
Fluid volume excess
Fluid volume deficit
High risk for fluid volume deficit
Decreased cardiac output
Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern
Inability to sustain spontaneous ventilation

80
 Dysfunctional ventilatory weaning response
High risk for injury
High risk for suffocation
High risk for poisoning
High risk for trauma
High risk for aspiration
High risk for disuse syndrome
Altered protection
Impaired tissue integrity
Altered oral mucous membrane
Impaired skin integrity
High risk for impaired skin integrity

PATTERN II Communicating (Sending messages)

Impaired verbal communication

PATTERN III Relating (Establishing bonds)

Impaired social interaction
Social isolation
Altered role performance
Altered parenting
High risk for altered parenting
Sexual dysfunction
Altered family processes
Caregiver role strain
High risk for caregiver role strain
Parental role conflict
Altered sexuality patterns

PATTERN IV Valuing (Assigning relative worth)

Spiritual distress (distress of the human spirit)

PATTERN V Choosing (Selecting alternatives)

Ineffective individual coping
Impaired adjustment
Defensive coping
Ineffective denial
Ineffective family coping: Disabling
Ineffective family coping: Compromised
Family coping: Risk for growth
Ineffective management of therapeutic regimen (individual)
Noncompliance (specify)
Decisional conflict (specify)
Health-seeking behaviors (specify)

PATTERN VI Moving (Involving activity)

Impaired physical mobility
High risk for peripheral neurovascular dysfunction
Activity intolerance
Fatigue

81
 High risk for activity intolerance
Sleep pattern disturbance
Diversional activity deficit
Impaired home maintenance management
Altered health maintenance
Feeding self-care deficit
Impaired swallowing
Ineffective breast-feeding
Interrupted breast-feeding
Effective breast-feeding
Ineffective infant feeding pattern
Bathing or hygiene self-care deficit
Dressing or grooming self-care deficit
Toileting self-care deficit
Altered growth and development
Relocation stress syndrome

PATTERN VII Perceiving (Receiving information)

Body image disturbance
Self-esteem disturbance
Chronic low self-esteem
Situational low self-esteem
Personal identity disturbance
Sensory or perceptual alterations (specify visual, auditory, kinesthetic, gustatory, tactile, olfactory)
Unilateral neglect
Hopelessness
Powerlessness

PATTERN VIII Knowing (Associating meaning with information)

Knowledge deficit (specify)
Altered thought processes

PATTERN IX Feeling (Being subjectively aware of information)

Pain
Chronic pain
Dysfunctional grieving
Anticipatory grieving
High risk for violence: Self-directed or directed at others
High risk for self-mutilation
Post-trauma response
Rape-trauma syndrome
Rape-trauma syndrome: Compound reaction
Rape-trauma syndrome: Silent reaction
Anxiety
Fear

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9. APGAR SCORING SYSTEM FOR NEONATES

The Apgar test rates a neonate’s condition at 1 minute after delivery and again at 5 minutes after delivery.
The following scores denote the neonate’s condition: 10, excellent; 7 to 9, adequate; 4 to 6, the neonate
needs close observation; below 4, the neonate needs immediate care and further evaluation. Note: If the
neonate’s natural skin color is not white, alternative tests for color are applied, such as color of oral and
conjunctival mucous membranes, lips, palms of hands, and soles of feet. Learn this useful mnemonic for
remembering the signs in the Apgar scoring system: A – Appearance; P – Pulse; G – Grimace; A – Attitude
(tone); R – Respirations.

SIGNS SCORE
0 1 2
Heart Rate Absent Below 100 beats/min Above 100 beats/min
Respiratory effort Absent Slow, irregular Good, crying
Muscle tone Flaccid Some flexion of extremities Active motion
Reflex irritability No response Grimace Vigorous cry
Color Blue, pale Body pink, extremities blue Completely pink

83
References
1. Jack C. Ricard, English for International Communication, 2005.
2. John Christopher Maher, International Medical Communication in English, 2010.
3. Janice Rider Ellis, RN, PhD., Elizabeth Ann Nowlis, RN, EdD., Patricia M. Bentz, RN, MSN. Modules for
Basic Nursing Skills, 6th Edition, Lippincott Philadelphia New York. 2006.
4. Julia B. Freeman Clark, Sherry F. Queener, Virginia Burke Karb. Pharmacology Basis of Nursing Practice,
6th edition, A Harcourt Health Sciences Company, Philadelpia, 2010, Mosby.
5. Carol J. Bininger, RN, PhD., Phyllis F. Healy, RN, C, PhD., Jane M. Lamp, RN, C, MS., Marianne W.
Rodgers, RN, EdD, PNP. American Nursing Review for NCLEX- RN, Third Edition, 2004.
6. Kenneth Beare, English as second Language Expert, Philadelphia New York. 2014.
7. Ardiansyah, Let’s speak English Nurse!, EGC, Jakarta, 2004.
8. Borland S., 90% of Hospitals Fail to Check on Nurses’ English Before Letting Them Work on Wards, Daily
Mail (2012)
9. McCabe C, Timmins F. Communication Skills for Nursing Practice, Palgrave MacMillan (2006)
10. Menon M., Migrant Nurses: Cross-cultural understanding or misunderstanding? Australian Nursing
(2008), Churchill Livingstone.
11. K C Bay, The Job Seeker’s Guide, PP Publishing Pte Ltd., Singapore, 2009.
12. Tim Harmoni, A Guide to Writing English Letters of Job Application, Harmoni, Jakarta, 2008.
13. www.nursedialog.com
14. www.communication skills for nursing.com.
15. Seeland, Lisa. (2000). Practical Refutation and an Effective First Affirmative Rebuttal. Rostrum. Retrieved
December 31, 2005.
16. "Nationals | National Parliamentary Debate Association". Parlidebate.org. Archived from the original on 27
September 2011. Retrieved 17 October 2011.

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