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ГАОУ СПО «Балашовское медицинское училище»
Рабочая тетрадь
для внеаудиторной работы
по дисциплине «Английский язык»
для студентов медицинских училищ и колледжей
Автор-составитель Фальковская Н. И.
Студент ______________________________ гр.
Отделение ____________________________
Специальность ________________________
ФИО_________________________________
Балашов2010
Оглавление
Пояснительная записка 3
Основная часть 4
1. Имя существительное 4
2. Глагол 9
3. Местоимение 12
4. Типы предложений в английском языке 14
5. Герундий 24
6. Имя прилагательное 29
7. Вопросы в английском языке 31
8. Имя числительное 33
Приложение 37
Литература 53
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Пояснительная записка
Рабочая тетрадь составлена в соответствии с программой дисциплины
«Английский язык» в соответствии с требованиями Государственного
образовательного стандарта для студентов медицинских колледжей и училищ,
обучающихся специальностям «Лечебное дело», «Сестринское дело»,
«Акушерское дело», «Фармация».
Рабочая тетрадь предназначена для организации внеаудиторной
самостоятельной работы студентов, которая способствует формированию их
познавательной активности, значительного интереса к изучаемому предмету и
лучшему усвоению профессиональных знаний. Тетрадь может быть
использована для контроля знаний на практических занятиях. Данное пособие
разработано с учетом того, что:
- усвоению учебного материала препятствует недостаточная школьная
подготовка у многих студентов и низкая эффективность усвоения
грамматических моделей иностранного языка;
- за отведенное количество аудиторных часов преподаватель может лишь
нацелить студентов, обозначить приоритетные направления и дать
консультацию. Многое зависит от самостоятельной работы студентов.
Данное пособие направлено на систематическую работу, учебный материал
распределен в нем по темам.
Пособие отражает современные тенденции и соответствует требованиям к
обучению практическому владению иностранными языками в повседневном
общении и в профессиональной сфере деятельности будущих специалистов.
Характер языкового материала и темы упражнений определяются
следующими концептуальными положениями:
1. Владение английским языком является обязательным компонентом
профессиональной подготовки современного специалиста.
2. Курс среднего профессионального образования продолжает школьный
курс.
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3. Данный курс иностранного языка носит коммуникативно
ориентированный характер. Его задачи определяются коммуникативными и
познавательными потребностями учащихся.
Цель пособия – способствовать повышению общей, коммуникативной и
профессиональной компетенции студентов.
В соответствии с социальным заказом государства основной целью курса
является обучение практическому владению разговорно-бытовой речью,
языком специальности, умению извлекать информацию из современных
информационных источников.
Данное пособие ставит также образовательные и воспитательные задачи.
Достижение образовательной цели означает расширение кругозора студентов,
повышение уровня их общей культуры и образования, а также культуры
мышления, общения и речи. Воспитательный потенциал предмета реализуется
путем формирования уважительного отношения к духовным ценностям культур
других стран и народов.
4
Составные части языка
Фонетика
звуки, интонация, ритм
Лексика
словарный состав языка
Грамматика
структурные связи
Знаменательные
- имя существительное- имя прилагательное- числительное- глагол- наречие- модальные слова- местоимение
Служебные
- артикль- предлог- союз- частица
The Noun. The Case of Nouns
Имя существительное. Падежи имен существительных
Active vocabulary
Parts of the body
Head and face:
eye – глаз
hair – волосы
nose – нос
ear – ухо
mouth - рот
lip – губа
neck – шея
tooth (teeth) – зуб (зубы)
tongue - язык
Морфология
части речи
Синтаксис
словосочетания, предложения
5
Arm and leg:
shoulder – плечо
nail – ноготь
arm – рука
finger – палец
hand – кисть, thumb – большой палец
leg – нога
knee – колено
foot (feet) – стопа (стопы)
toe – палец на ноге.
Rest of body:
chest (bust) – грудь
skin – кожа
side – бок
stomach – живот
back – спина
waist – талия
hip - бедро
Inside the body:
heart – сердце
brain – мозг
blood - кровь
Practice
1. Закончите предложения, используя слова из списка:
A hand has five _____.
A foot has five _____.
An adult has 32 _____.
You smile with your _____.
You smell with your _____.
The _____ is a symbol of love.
You hear with your _____.
You talk with your _____.
Your _____ type can be 0 (I), A (II), B (III) or AB (IV).
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2. Слова, обозначающие части тела, могут употребляться в переносном
значении. Закончите предложения, пользуясь словами из списка: mountain,
clock, bottle, arm-chair.
A _____ has arms, legs and a back.
A _____ has a face and hands.
A _____ has its foot.
Word building
Соедините корни из колонок, чтобы получились сложные существительные и
переведите их:
foot stick
hair chair
arm ball
hand brush
lip bag
Обратите внимание на способы образования новых слов и ответьте на
вопросы:
а) Каким способом образованы следующие слова? Из каких элементов они
состоят?
headache – головная боль,
football – футбол.
Определите состав сложных слов и переведите их:
newspaper, textbook, homework, volley-ball, note-book.
б) От каких слов образованы следующие слова:
writer – писатель
reader – читатель
to rewrite – переписать
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to re-read – перечитать
Переведите слова по словообразующим элементам:
doctor, teacher, worker, helper, professor, to reexamine, to replace, to rename, to
reconstruct, to redo.
в) Как называется такое явление? Переведите слова и определите часть речи
этих слов:
to work – the work
to help – the help
to act – the act
Образуйте существительные согласно модели и переведите пары
существительных:
N – noun – существительное,
V – verb – глагол,
A – adverb – прилагательное.
N+ship – friend + ship = friendship relation, partner, member
N+hood – child + hood = childhood mother, neighbour, brother
V+er – read + er = reader to drive, to work, to play
A+ness – mad + ness = madness dark, happy, ready
A+ity – public + ity = publicity active, creative, noble
The Case of Nouns
Падеж
common case
(общий падеж)
genitive case
(притяжательный падеж)
shop, dog, man, family the room of the sister – my sister’s room
idea, house, sister the son of my friend – my friend’s son
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Употребляется с одушевленными существительными; указывает, что
слово нужно переводить в родительном падеже.
Запомните:
Обратите
внимание:
Переведите на русский язык:
Ann’s table, this man’s book, the boy’s bag, the women’s pens, the boys’ books.
To be in the Present Simple Tense form
Изучите таблицу спряжения глагола to be в Present Simple. Ответьте на
вопросы:
1) Как изменяется глагол to be?
2) Как образуются отрицательная и вопросительная формы?
Practice
1. Вставьте глагол to be в соответствующем времени, лице и числе:
1) I _____ a medical student now.
2) Soon we _____ nurses.
3) My sister _____ ill. She _____ in the hospital now.
4) We _____ pupils last year.
5) They _____ teachers.
2. Поставьте следующие предложения в отрицательную и
вопросительную формы:
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The girls’ room is good.Но:The children’s room is good.
При переводе меняется порядок слов
1) They were in Moscow.
2) He will be in France.
3) She is an engineer.
4) I am on holiday now.
По таблице спряжений группы Indefinite изучите спряжение глаголов.
Обратите внимание на:
а) окончания смысловых глаголов в Present и Past Indefinite и на
вспомогательные глаголы в Future Indefinite в утвердительной форме;
б) появление в отрицательной форме вспомогательного глагола do и изменение
его в Present и Past на место частицы not;
в) форму смыслового глагола;
г) место вспомогательных глаголов в вопросительной форме и на
неизменяемость смыслового глагола;
д) краткие ответы.
Прослушайте, переведите и прочитайте.
Bad Habits
He sleeps a lot. Does he sleep much? Yes, a lot.
He drinks a lot. Does he drank much? Yes, a lot.
He smokes a lot. Does he smoke much? Yes, a lot.
He talks a lot. Does he talk much? Yes, a lot.
Does he eat much? Yes, a lot.
Does he read much? No, not much. Oh!
Дополните недостающие глаголы и инсценируйте диалог.
1. A: _____ you still need this dictionary?
B: No, I _____.
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is, isn’t, are, aren’t, am, do, don’t, does, doesn’t, can, can’t
A: _____ I have a moment, then?
B: Sure.
2. A: _____ your new flat very big?
B: No, not very, but it _____ comfortable.
3. A: Ruth speaks Russian. _____ she?
B: Yes, she _____ and her Russian _____ good.
4. A: _____ I help you?
B: Yes, please. _____ I speak to Mr. Reston?
A: I _____ sorry. Mr. Reston _____ in at the moment.
5. A: Excuse me _____ you very busy at the moment?
B: No, not very _____ come in!
6. A: _____ you remember me?
B: Yes, I _____. You _____ Peter Todd. _____ you?
A: Yes, I _____.
Прочитайте и заучите наизусть, обращая внимание на употребление
вспомогательных глаголов.
In class.
Are the students here?
Yes, they are.
Is the teacher here?
Yes, she is.
Does she speak English?
Yes, she does.
Do they speak English?
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Yes, they do, a little.
Has she got the textbook?
Yes, she has.
Have they got the textbooks?
Yes, they have.
Can they understand the teacher?
Yes, they can.
Can she understand them?
Yes, she can, sometimes.
The Pronoun
Местоимение
В следующих колонках обратите внимание на выделенные местоимения и
ответьте на вопросы.
I am here All know me All know my work
He is here All know him All know his work
She is here All know her All know her work
It is here All know it All know its work
We are here All know us All know our work
You are here All know you All know your work
They are here All know them All know their work
1. Как называются местоимения в каждой из колонок?
2. На какие вопросы они отвечают, и какими членами предложения являются?
Imperative
Повелительное наклонение
В английском языке просьба, приказ выражаются следующим образом:
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Предложения начинаются с глагола-сказуемого в форме инфинитива без to:
Go to the doctor. Give a tablet.
Отрицательная форма образуется с помощью don’t:
Don’t open the window.
Если действие планируется совместно с говорящим:
Let’s do it together.
Practice
Прослушайте, переведите и прочитайте:
Let’s Meet Ted
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Let’s meet Ted.
Yes, let’s.
Let’s meet Ed.
Yes, let’s.
Let’s meet Eve.
Yes, let’s.
Let’s meet Steve.
Yes, let’s.
Let’s see Nell.
Yes, let’s.
Let’s see Bell.
Yes, let’s.
Let’s see Eve.
Yes, let’s.
Let’s see Steve.
Yes, let’s.
Прослушайте, переведите и прочитайте:
Let’s leave soon so as not to miss the plane.
Let’s leave soon so as not to miss the train.
Let’s go now so as not to miss the bus.
Let’s go now so as not to miss the class.
Скажите по-английски:
1. Возьмите ампулы с витамином В.
2. Примите 2 столовые ложки теплого отвара.
3. Взболтайте микстуру перед употреблением.
4. Примите эти капли с молоком.
5. Дайте рецепт, пожалуйста.
6. Выпишите лекарство от головной боли.
7. Храните свечи и растворы в темном и прохладном месте.
8. Не принимайте эти порошки на голодный желудок.
9. Продолжайте внутривенное введение.
10. Промойте желудок больному немедленно.
11. Не курите!
Запомните пословицы:
Don’t cross the bridge before you come to it. – Наперед не загадывай.
Leave and learn. – Век живи, век учись.
Never put off till tomorrow what you can do today. – Не откладывай на завтра то,
что можешь сделать сегодня.
There is / There are Impersonal Statements
Безличные, неопределенно-личные предложения
There is / There are – обстоятельный оборот, указывающий на
местонахождение лица или предмета в определенном месте. Эта конструкция
употребляется, когда мы сообщаем слушающему о предметах, неизвестных
ему. На русский язык эту конструкцию переводят «есть», «находиться».
Practice
Переведите следующие предложения:
1. There are two terms in the academic year.
2. There will be a meeting at the Institute.
3. There is a hostel near our Institute.
4. There was no medical article the yesterday’s newspaper.
Прослушайте, переведите и прочитайте:
Is There a Post Office Near Here?
- Is there a Post office near here?
- Yes, there is. Cross the road and turn right.
- Thanks a lot.
- Is there a snack bar near here?
- Yes, there is. Cross the road and turn left.
- Thanks a lot!
- Not at all.
- Is there a bus stop near here?
- Yes, there is. First left, second right.
- You can’t miss it. Thanks a lot!
- That’s all right.
Выучите пословицу:
While there is life there is hope. – Пока дышу, надеюсь.
Impersonal Statements
Безличные предложения
На русский язык безличные предложения переводятся как неопределенно-
личные: Тепло. Поздно. Интересно и т. д.
Practice
Ответьте на вопросы, используя слова из списка: sunny, warm, cold, cool,
snowing, hot, raining, cloudy.
How’s the weather in the winter? It is _____ .
How’s the weather in the fall? It is _____ .
How’s the weather in the summer? It is _____ .
How’s the weather in the spring? It is _____ .
Переведите предложения:
1. It is known that the increase of the number of leucocytes takes place when a
person is ill.
2. It is determined that in the man the corpuscles form from 39 to 50 percent of the
blood volume.
3. It is considered that heart sounds are very important in making the diagnosis of a
heart disease.
The Simple Sentence. Parts of the Simple Sentence.
Простое предложение. Части простого предложения.
Как и в русском языке, в английском выделяют пять членов предложения:
подлежащее, сказуемое (главные), дополнение, определение, обстоятельство
(второстепенные). В отличие от русского, в английском языке порядок слов в
предложении фиксированный.
ПодлежащееSubject
сказуемоеpredicate
дополнениеobject
обстоятельствоadverbial????
I work as a nurse at a hospital.
Practice
1. В следующих предложениях определите члены предложения и
разместите их по графам таблицы.
1) My friend gets a stipend at the end of a month.
2) He’s brother was ill yesterday.
3) I shall see the doctor tomorrow.
2. Сделайте разбор по членам предложения и ответьте на вопросы:
The teacher asks the student at the lesson.
The student asks the teacher at the lesson.
1. Чем отличаются эти предложения друг от друга? Влияет ли порядок слов на
смысл английского предложения?
2. На каком месте стоит подлежащее? Сказуемое? Дополнение?
Обстоятельство?
Запомните пословицу:
An apple a day keeps the doctor away. – Ешь по яблоку в день, и врач не
понадобится.
Present and Past
Настоящее и прошедшее время
I have got – I had
He says – he said
They go – they went
We spend – we spent
I write – I wrote
I drive – I drove
She leaves – she left
She keeps – she kept
They sell – they sold
They tell – they told
I teach – I taught
I think – I thought
Прослушайте, переведите и прочитайте:
When Did She Come?
When did she come?
She came at seven.
When did she leave?
She left at eleven.
When did they start?
They started at five.
When did they finish?
They finished at nine.
What did you buy?
I bought a new hat.
What did they bring?
They brought a stray cat.
It was very small. Now it’s big.
Where Did They Go?
Where did they go?
They went to the theatre.
What did they see?
They saw a new play.
How did they like it?
Oh, they enjoyed it.
We must all go and see it, they say.
Определите время сказуемого в следующих предложениях:
1. Present Indefinite
2. Past Indefinite
3. Future Indefinite
1) His sister studies at school.
2) You will see him tomorrow.
3) I went to the college at 7 o’clock.
4) Who took my book?
5) They work every day.
6) I shall read this book next week.
Прочитайте и переведите вопросы к подлежащему в Present и Past
Simple:
A.
1. “Who likes coffee with milk?” “I do”
2. “Who knows that girl?” “He does”
3. “Who needs that cassette?” “We do”
4. “Who left that message?” “Mr. Clark”
5. “Who come first, Bob or Ted?” “Ted”
B.
1. “Which of you speaks English?” “Ann does”
2. “Which of you speaks French?” “I do”
3. “Which of you like animals?” “We all do”
4. “Which of them plays the piano?” “Lucy”
5. “Which of them helped you?” “Miss Ellis”
Переделайте 1-е и 3-е предложения в Past Indefinite, а 2-е и 4-е – во
Future Indefinite:
1. Many students want to join the Foreign Language Society.
2. My friend always helps me in Anatomy.
3. He does not study French as he studies English.
4. Medical students study many subjects.
Выучите пословицу:
Never say die. – Не вешай нос.
The Present Simple Tense or the Present Continuous Tense
Настоящее неопределенное или настоящее продолженное
1. Заполните пропуски в формулировке следующего правила:
Утвердительная форма the Present Simple Tense образуется с помощью
_____ . Вопросительная форма the Present Simple Tense образуется с помощью
форм вспомогательного глагола _____ и _____ смыслового глагола.
Отрицательная форма the Present Simple Tense образуется с помощью форм
вспомогательного глагола _____ и _____ смыслового глагола. Форма
вспомогательного глагола _____ употребляется, если подлежащее находится в
3-ем лице единственного числа.
He Loves the Internet
Alex Dale can’t keep a pet because he’s too busy.
He gets up at half past six (that isn’t very easy).
He gets home at ten o’clock, then eats and goes to bed.
He hates noisy parties.
He loves the Internet.
2. Заполните пропуски в формулировке следующего правила:
Утвердительная форма the Present Continuous Tense образуется с
помощью форм вспомогательного глагола _____ и _____ смыслового глагола.
Вопросительная форма the Present Continuous Tense образуется с помощью
форм вспомогательного глагола _____ и _____ смыслового глагола, при этом
_____ ставится перед подлежащим. Отрицательная форма the Present
Continuous Tense образуется с помощью форм вспомогательного глагола _____
и _____ смыслового глагола.
Practice
Прочитайте диалоги и заполните пропуски, используя слова в скобках:
1. A: How good is your English?
B: Not bad. It _____ (get) better slowly.
2. A: Where _____ (you and your family / usually spend) the holidays?
B: Oh, we _____ (always / go) to France.
3. A: Which _____ (you / prefer), doing sport or playing computer games?
B: Neither. I _____ (usually / listen to) music in my spare time. But my brother
_____ (love) playing football.
Прочитайте и переведите:
What’s Going On?
What are you doing?
I’m watching the telly.
What’s Ben doing?
He’s talking to Kelly.
What’s Ann doing?
She’s taking a shower.
What’s Ted doing?
He’s watering the flowers.
What are you doing?
We’re having a talk.
What are they doing?
They are taking a walk.
The Present Perfect Tense or the Past Simple Tense
Настоящее завершенное и прошедшее неопределенное
Выбор между Present Perfect и Past Simple зависит от того, связано ли
действие, свершившееся в прошлом, с настоящим моментом или нет.
Present Perfect не употребляется с обозначениями истекшего периода
времени: yesterday, a minute ago, last month.
Сравните:
Present Perfect
A: I have finished the test.
B: Have you? Good.
A: I have not read he’s new book yet.
B: Neither have I.
Past Simple
A: I finished it fifteen minutes ago.
B: Oh, did you?
A: I really his other books.
B: So did I.
Прослушайте, переведите и прочитайте.
Ann Has Been to London Three Times.
Ann’s been to London three times.
She’s been to Paris twice.
She’s met a lot of people there.
She finds them very nice.
She writes a lot of letters.
She gets a lot of calls.
She’s got a lot of friends abroad.
She says she likes them all.
Выучите стихотворение наизусть. Объясните употребление Past Simple,
Present Perfect:
Pussy Cat, Pussy Cat,
Where have you been?
“I’ve been to London
To look at the Queen”.
Pussy Cat, Pussy Cat,
What did you see there?
“I saw a little mouse
Under her chair”.
Practice
Работайте с партнером. Прочитайте следующие диалоги.
- What’s the matter with you?
- I have a toothache.
- I’m sorry to hear that. What happened?
- I ate candies all day yesterday.
* * *- What’s the matter with you?
- I have a backache.
- I’m sorry to hear that. What happened?
- I practiced shaping all day yesterday.
Переведите предложения, обращая внимание на использование Past
Indefinite и Past Perfect:
1. Исследователь закончил свои наблюдения на прошлой недели.
2. Мы узнали, что исследователь уже закончил свои наблюдения.
* * *
1. Врач изолировал больного до того, как он поставил диагноз инфекционного
заболевания.
2. Врач изолировал больного на прошлой неделе.
Modal Verbs
Модальные глаголы
Обратите внимание на значение и употребление модальных глаголов
“can”, “may”, “must”. Ответьте на вопросы:
I can speak English.
We can go to Moscow.
You may take this book.
He must come today.
Я могу (умею) говорить по-английски.
Мы можем (в состоянии) поехать в Москву.
Вы можете (вам разрешается) взять эту книгу.
Он должен (обязан) прийти сегодня.
1. Как переводятся модальные глаголы “can”, “may”, “must”?
2. Могут ли они употребляться самостоятельно или только в сочетании с
другими глаголами?
3. В какой форме стоят смысловые глаголы после модальных?
4. Изменяются ли модальные глаголы по лицам и числам?
5. Как образуется отрицательная и вопросительная формы?
Поставьте предложения в утвердительной форме:
1. Must the students work much during the whole term?
2. He could not enter the Institute last year.
3. Can he become a good therapeutist?
4. May this remedy do you any harm?
Practice
1. Работайте с партнером. Расспросите партнера о том, что он может и
чего не может делать, используя идиомы, слова и выражения из следующей
таблицы:
Model: Can you swim? – Yes, I can. / No I can’t.
I can drive, but I can’t fly a plane.
I Play any musical instruments the guitar, piano, saxophone
II Speak any foreign language French, English, Italian
III Play the games, do activities baseball, football, tennis
IV Use a computer, vacuum, cleaner, mobile phone
V Others explain the theory of relativity, recite poetry
Представьте, что вы медицинский работник со стажем. Объясните
вновь принятому работнику, что он должен (обязан) делать и что не должен.
You must:
__________
__________
__________
You mustn’t:
__________
__________
__________
Выучите пословицу:
A man can die but once. – Двум смертям не бывать, а одной не миновать.
Переведите предложения, обращая внимание на модальные глаголы.
1) В колледже вы должны получить глубокие знания по медицине.
2) Можно мне посетить вашу лекцию?
3) Вы можете (в состоянии) легко выполнить это задание?
4) Мы должны закончить работу в 6 часов.
5) Медсестра должна быть особенно внимательна к лежачим больным.
The Gerund
Герундий
1. Герундий – это название действия, в котором сочетаются свойства, как
глагола, так и существительного.
2. Герундий образуется из основы глагола + окончания ing
write + ing = writing, read + ing = reading.
3. Герундий, наряду с инфинитивом употребляется после глаголов like и love.
I like reading.
Jane loves dancing.
Я люблю читать.
Джейн любит танцевать.
4. Герундий – единственный (и очень удобный) способ назвать действие после
предлога:
Thank you for coming.
She is good at explaining difficult
things.
Спасибо, что пришли.
Она хорошо объясняет сложные
понятия.
Practice
Повторите, употребляя подсказанные слова:
1. Thank you for coming.
calling; writing to us; visiting us; helping us.
2. Sorry for being late.
calling so late; keeping your book; missing so many lessons.
3. I like skating.
sking; fishing; reading; listen to good music.
4. She is good at cooking.
making cakes; making films; taking photos; speaking to visitors.
Переведите:
1. Спасибо, что позвонили врачу.
2. Извините за опоздание на лекцию.
3. Мне нравится помогать сидячим больным.
4. Аня любит делать внутривенные инъекции.
5. Спасибо, что пришли к больному так быстро.
Закончите предложения, употребляя герундий.
1. When did you finish
discuss your plans?
do your homework?
clean the flat?
read that book?
2. We enjoyed
3. He kept
go to a rock concert.
go to a disco.
take long walks.
make the same mistakes.
repeat the same thing.
ask questions.
Закончите предложения, выражая свою точку зрения:
1. I’m really interested in _____ .
2. I’ m looking forward to _____ .
3. _____ is something that makes me nervous.
4. _____ is one of my favorite things to do at the weekend.
Замените инфинитивы, данные в скобках, герундием.
1. After the recovery the patient stopped (to lose) his weight.
2. My brother had to give up (to smoke) due to chronic bronchitis.
3. The young physician tried (to introduce) various new ways of treatment.
4. You must avoid (to catch) a cold as you have just been ill with pneumonia.
5. What has perverted you from (to attend) this lecture?
Запомните: функции герундия в предложении.
1. Подлежащее
Smoking is not allowed. Курить не разрешается.
2. Именная часть составного сказуемого
Abortion is removing of the fetus. Аборт – это удаление плода.
3. Дополнение
He knew of my studying in the medical
college.
Он знал о моей учебе в медицинском
колледже.
4. Определение
There are different methods of treating
this disease.
Существуют различные способы
лечения этого заболевания.
5. Обстоятельство
After receiving necessary information
we can perform the operation.
Получив необходимые данные, мы
можем сделать операцию.
Таким образом, герундий может переводиться как существительное,
инфинитив, деепричастие, придаточное предложение.
The passive Voice
Пассивный залог
Образование: to be + V3 (Past Participle)
The Active Voice
I asked
He asked
She asked
The Passive Voice
I was asked
He was asked
We were asked
Прочтите предложения и ответьте на вопросы:
1. В каком времени и в какой форме стоит сказуемое в левой колонке и как
переводятся эти предложения?
2. Из чего состоит сказуемое в колонке справа? Переведите предложения. Дайте
форму страдательного залога.
3. Что изменяется в этой формуле при изменении по временам, лицам и
числам?
4. Что остается неизменным в этой формуле?
5. Поставьте глагол to be в нужной форме для образования Present и Future
Indefinite Passive.
6. Как образуются отрицательные и вопросительные формы в страдательном
залоге?
Practice
I Переведите предложения:
1. These operations are performed by me.
2. Medical students are taught Anatomy in practical class.
3. The lecture in Biology is delivered on Monday.
II Найдите предложения, которые стоят в страдательном залоге:
1. This text-book is experimental.
2. Many experiments are carried out by students.
3. He is happy because he studies at the Medical Institute.
4. I am given lesson in many subjects.
5. Anatomy is taught at the Medical Institute.
Переведите предложения:
1. Нам дают книги.
2. Меня часто спрашивают.
3. Операции проводятся хирургом.
4. Учебники пишутся для студентов.
5. Нас часто видят в библиотеке.
Прослушайте, переведите и прочитайте:
It’s Not My Fault!
I’m terrible sorry, but it wasn’t my fault.
I wasn’t asked, I wasn’t told.
I wasn’t asked to do that job.
I wasn’t asked to wait for Bob.
I wasn’t told to call you back.
I wasn’t told to stay and help.
I wasn’t asked to come today.
I wasn’t asked! I’m not to blame.
fault – вина
blame – винить
It’s not my fault
I am not to blameЯ не виноват.
The Adjective. Degrees of Comparison
Прилагательное. Степени сравнения имен прилагательных
Степень ПоложительнаяPositive
СравнительнаяComparative
ПревосходнаяSuperlativeФорма
синтетическая- er, - est
cleanhot
happy
cleanerhotter
happier
the cleanestthe hottest
the happiestаналитическая comfortable
difficultmore comfortable
more difficultmost comfortable
most difficult
Нерегулярные степени сравнения
good – better – best
bad – worse – worst
little – less – least
much / many – more – most
Practice
I. Образуйте степени сравнения от следующих прилагательных и
наречий:
well, responsible, deep, happy, high, early, great, new, easy, much, clear, interesting.
При помощи каких слов сравниваются одинаковые по качеству прилагательные
в английском языке?
1. Her article is as interesting as his.
2. Her article is not so interesting as
his.
Ее статья такая же интересная, как
его.
Ее статья не такая интересная, как
его.
II. Определите каким способом происходит сравнение в предложениях и
переведите их.
1. I am as tired as he is.
2. You must be more responsible for your work.
3. He knows Latin worse than his friend does.
4. Solomin’s knowledge of Anatomy is not so deep as Petrovs.
5. They came to the Institute earlier than usual.
III. Переведите предложения
1. Бакерия – один из самых известных хирургов в мире.
2. Студент Попов сделал работу быстрее, чем студент Иванов.
3. Чем больше вы работаете, тем легче сдавать экзамены.
4. Его работа лучше вашей, но работа Анны – самая лучшая.
5. Я живу не так далеко от института, как мой друг.
6. «Скажите, этот доктор более опытный, чем тот?» - «Все наши врачи имеют
высшую категорию».
Прочитайте и переведите:
Which is Bigger?
Which is bigger, France or England?
Which is smaller, Holland or Finland?
Which is larger, London or Glasgow?
Which is smaller, Leeds or Moscow?
France is bigger than England.
Holland is smaller than Finland.
London is larger than Glasgow.
Leeds is smaller than Moscow.
Why Study?
The more we study, the more we know. The more we know, the more we forget.
The more we forget, the less we know. The less we know, the less we forget. The less
we forget, the more we know. So why we study?
Вопросы в английском языке
Вопросы бывают четырех типов: общие, специальные, альтернативные и
разделительные.
Общие вопросы.
Общими вопросами называются такие вопросы, на которые можно
ответить да (yes) или нет (no). Такие вопросы начинаются с вспомогательного
глагола.
Do you study anatomy in college? Yes, I do.
Специальные вопросы.
С помощью специальных вопросов выясняется какой-либо факт или
обстоятельство. Они относятся к одному из членов предложения и начинаются
с вопросительного слова.
Where do you study? I study at the Balashov medical college.
Альтернативные вопросы.
Альтернативные вопросы предполагают выбор одного из двух возможных
вариантов и требуют полного ответа.
Do you study Latin or Surgery in the first year? We study Latin in the first year.
Разделительные вопросы.
Цель разделительного вопроса состоит в уточнении того или иного факта
или обстоятельства. Эти вопросы требуют полного ответа.
You study English, don’t you? Yes, I study English.
You don’t study English, do you? No, I don’t study English.
Practice
I. Прочитайте предложения:
Does she speak English? Can you treat rheumatism? Did he prepare his laboratory
work yesterday? Must they attend this lecture?
Как называются такие вопросы, и какой в них порядок слов?
II. Проанализируйте следующие предложения, ответьте на вопросы:
Who studies anatomy? Who carried out laboratory analyses yesterday? Who will
prepare the article tomorrow?
1. Какие вопросы называются «специальными»?
2. К какому члену предложения заданы эти вопросы, и какой порядок слов
требуется построения таких вопросов?
Напишите вопросы к заданному предложению:
My friend carried out a valuable experiment at the laboratory last week.
III. Ответьте на альтернативные вопросы:
1. Does the term “aetiology” mean the causes of the disease or the mechanism of its
development?
2. Is reanalysis an instrumental or a laboratory study?
3. Are haemorrhage and vomiting subjective or objective symptoms?
4. Is a productive cough associated with the discharge of sputum or is it dry?
IV. Образуйте присоединенные вопросы:
1. Her name is Judy, _____ ?
2. We are students of the medical school _____ ?
3. We spoke about it at the last meeting, _____ ?
4. Petrov has got a new book, _____ ?
5. I have done a lot of work today, _____ ?
Прочитайте и переведите:
Too Many Questions.
Have you been there?
Have you seen it?
Have you bought it?
Have you brought it?
Have you read it?
Have you said it?
Has he heard it?
Has he learned it?
Have they used it?
Have they closed it?
Have you called him?
Have you told him?
Could you take a break, please?
I can’t answer so many questions at once!
Computer Crazy
I haven’t done my homework.
I haven’t read the text.
I haven’t learned the dialogues –
I need them for the test.
I haven’t read the paper.
I haven’t heard the news.
I haven’t left the house yet.
I have lost my new black shoes.
You may think I am crazy.
Don’t think so, wait a bit.
I have bought a new computer game.
I can’t stop playing it.
The Numerals
Имя числительное
Именем числительным называется часть речи, обозначающая количество
или порядок предметов. Имена числительные делятся на количественные,
отвечающие на вопрос сколько? и порядковые, отвечающие на вопрос
который?
Practice
Работайте с партнером. Задайте ему эти вопросы, затем поменяйтесь
ролями.
1. When were you born?
2. What is your height and weight?
3. What is your address?
4. What is the population of your town?
5. What is the population of Russia?
Заполните заявление на работу
Job Application
____________________________________________________________________
Name _______________________________________________________________ Last First Middle
Country of current citizenship ____________________________________________
Gender Male / Female
Date of birth __________________
Address ______________________
Telephone ____________________ Fax _____________ E-male ________________
Marital status (single, married, widowed, divorced)
Age of children, if any __________
Date of school graduate _________
Academic degrees _____________________________________________________ Degree Date received
Current position _______________ since ____________
Previous position ______________ since ____________ till ____________________
Прослушайте, переведите и прочитайте:
See Me at Seven.
See me at seven. See me at seven.
See me at five.
See me at nine.
Fine.
See Nell at seven.
See Bell at eleven.
See Ted at five.
See Ed at nine.
Fine.
Let’s Meet at Five.
Let’s meet at five.
Fine!
Let’s meet at nine.
Fine!
Let’s meet at seven.
Yes, let’s.
Let’s meet at eleven.
Yes, let’s.
Let’s meet at ten.
Yes, let’s.
Please tell Ben,
OK!
Прочитайте и переведите:
1. at five, at six, at seven, at nine, at ten.
2. Please see me at ten.
3. Let’s meet at five.
4. Let’s eat at six.
5. Let him see me at eleven.
6. Let Ted meet me at nine.
Попросите встретить вас:
A: Please meet me at five.
B: Fine.
Попросите повидаться с вами:
A. Please see me at five.
B. Fine.
at 7; at 9; at 6; at 8; at 11.
Прослушайте, переведите и прочитайте:
“Fifty?” “No, Fifteen”.
1. Fifty? No, fifteen.
Sixty? No, sixteen.
Eighty? No, eighteen.
Ninety? No, nineteen.
Seventy? No, seventeen.
Oh, I see.
2. 15 teams? No, 50 teams.
16 films? No, 60 films.
18 lists? No, 80 lists.
19 tests? No, 90 tests.
Oh?
Разыграйте диалог, меняя время встречи.
A. Let’s meet at five.
B. At five? Let me see… Let’s meet at five fifteen.
A. Fine, only don’t be late.
6.00-6.15; 7.00-7-15; 8.00-8.15; 9.00-9.15; 10.00-10.15; 11.00-11.15; 12.00-12.15.
Повторите, меняя время
It isn’t ten yet. It is only nine.
Yet – до сих пор, пока еще.
9.00-8.00; 8.00-7.00; 11.00-10.00; 7.15-7.00; 9.15-9.00; 6.15-6.00.
Повторите, меняя возраст
1. Bobby isn’t seven yet. He’s only six.
6-5; 8-7; 9-8; 11-10.
2. Bess isn’t sixteen yet. He’s only fifteen.
17-16; 18-17; 19-18.
3. He isn’t fifty-five yet. He’s only fifty.
56-55; 57-56; 59-58; 60-59.
Приложение
ТЕКСТЫ ДЛЯ САМОСТОЯТЕЛЬНОЙ РАБОТЫ (Basic Nursing:
Theory and Practice. Third Edition. P. Potter, A.G. Perry. Mosby-Year Book,
Inc., 1995. ТЕКСТ АДАПТИРОВАН И СОКРАЩЕН)
NURSING THEORIES. ROLES AND FUNCTIONS OF THE NURSE
The following sections describe, in chronological order, the general focus of
several important theories of the philosophy of nursing. A nursing curriculum will
often include one or more of these nursing theories as a part of its conceptual
framework (see Table SUMMARY OF NURSING THEORIES).
Peplau's Theory
Hildegard Peplau's theory (1952) focuses on interpersonal relationships people
form as they pass through developmental stages. Nursing's purpose is to educate the
client and family and help the client to reach mature personality development (Chinn,
Jacobs, 1991). Therefore the nurse develops a nurse-client relationship in which the
nurse is a resource person, counsellor, and surrogate. When the client seeks help, the
nurse discusses the nature of the problem and explains the services available. As the
nurse-client relationship develops, the nurse helps the client to identify the problem
and potential solutions. The client gains from this relationship by using available
services to meet needs. When the original needs have been resolved, new needs may
appear.
Abdellah's Theory
The nursing theory developed by Faye Abdellah et al. (1960) emphasises
delivering nursing care for the whole person to meet physical, emotional, intellectual,
social and spiritual needs. The nurse needs knowledge and skills in interpersonal
relations, psychology, growth and development, communication, sociology, and the
basic sciences, as well as specific nursing skills. The nurse, a problem solver and
decision maker, forms an individualised view of the client's needs, which may occur
in the following areas:
1. Comfort, hygiene, and safety
2. Physiological balance
3. Psychological and social factors
4. Sociological and community factors
In these areas, Abdellah et al. (1960) identify 21 specific client problems (often
referred to as "Abdellah's 21 nursing problems"), which emphasise the physical (e.g.,
maintenance of elimination or sensory function) and psychological needs (e.g., main-
tenance of effective verbal and non-verbal communication) of each client. The nurse
helps the client meet these needs by facilitating and maintaining a healthy physical
condition in the best therapeutic environment possible. The nurse uses interpersonal
skills, sound medical knowledge, and community resources to provide individualised
holistic care.
Henderson's Theory
Virginia Henderson's nursing theory involves basic needs of the whole person.
Henderson (1964a) defines nursing as:
assisting the individual sick or well in the performance of those activities con-
tributing to health or its recovery (or to a peaceful death) that he would perform un-
aided if he had the necessary strength, will, or knowledge. And to do this in such a
way as to help him gain independence as rapidly as possible.
Henderson (1964) identifies specific needs, often called "Henderson's 14 basic
needs," such as breathe normally, sleep, and rest. These emphasise maintaining a
safe, healthy way of living, associated with good hygiene, an active social life, and
personal development.
Orlando's Theory
To Ida Orlando (1961), the client is an individual with a need that, when met,
diminishes distress, increases adequacy, or enhances well-being (Chinn, Jacobs,
1991). Her theory focuses on nurses' reactions to client behaviour in terms of the
client's immediate need (Torres, 1986). Orlando's theory describes three elements—
client behaviour, nurse reaction, and nurse actions—that compose the nursing
situation (Marriner-Tomey, 1994). After nurses assess the client's needs, they
recognise the impact of that need on the client's level of health and then act
automatically or deliberately to meet the need. Nursing acts to reduce the client's
distress.
Johnson's Theory
Dorothy Johnson's theory of nursing (1968) focuses on how the client adapts to
illness and how actual or potential stress can affect the ability to adapt. For Johnson
the goal of nursing is to reduce stress so the client can move more easily through the
recovery process. Johnson's theory focuses on basic needs in terms of the following
categories or subsystems of behaviour:
1. Security-seeking behaviour
2. Nurturance-seeking behaviour
3. Mastery of oneself and one's environment according to internalized
standards of excellence
4. Taking nourishment in socially and culturally acceptable ways
5. Ridding the body of waste in socially and culturally acceptable ways
6. Sexual and role identity behaviour
7. Self-protective behaviour
The nurse assesses the client's needs in these categories. The client is able to
function fairly effectively in the environment under normal conditions. When stress
disrupts normal adaptation, however, behaviour becomes erratic and less purposeful.
The nurse identifies the inability to adapt and provides nursing care to resolve
problems in meeting the client's needs.
King's Theory
Imogene King's theory (1971,1981) also focuses on the interpersonal
relationship between the client and nurse. The nurse-client relationship is the vehicle
for the nursing process, a dynamic interpersonal process in which the nurse and the
client are affected by each other's behaviour and the health care system. The nurse
communicates to assist the client in re-establishing or maintaining a positive
adaptation to the environment.
Orem's Theory
Dorothea Orem's (1971) definition of nursing emphasises the self-care needs of
the client. Orem describes her philosophy of nursing as follows:
Nursing has as a special concern man's needs for self-care action and the
provision and management of it on a continuous basis in order to sustain life and
health, recover from disease or injury, and cope with their effects. Self-care is a
requirement of every person—man, woman, and child. When self-care is not
maintained, illness, disease, or death will occur. Nurses sometimes manage and
maintain required self-care continually for persons who are totally incapacitated. In
other instances, nurses help persons to maintain required self-care by performing
some but not all care measures, by supervising others who assist patients, and by
instructing and guiding individuals as they gradually move toward self-care.
The goal of Orem's self-care deficit theory is helping the client achieve self-
care. Nursing care is necessary when the client is unable to fulfil biological,
psychological, developmental, or social needs. The nurse determines reasons a client
is unable to meet self-care needs, actions that will enable the client to meet these
needs, and client self-care abilities.
Neuman's Theory
Betty Neuman forms a total-person model by incorporating the holistic concept
and the open-system approach (Marriner-Tomey, 1994). Neuman views the person as
a dynamic composite of physiological, sociocultural, and developmental variables
functioning as an open system (Neuman and Young, 1972). Her goal of nursing is to
assist individuals, families, and groups to attain and maintain a maximal level of total
wellness.
The nurse assesses, manages, and evaluates client systems and focuses on
factors affecting the client's response to stressors. Nursing actions are in one of the
following levels of prevention: primary, secondary, and tertiary. Primary prevention
strengthens a line of defence through identification of actual or potential risk factors
associated with stressors. Secondary prevention strengthens internal defences and
resources by establishing priorities and treatment plans for identified needs. Tertiary
prevention focuses on readaptation (Neuman, 1982).
Levine's Theory
Myra Levine's nursing theory (1973) views the client as an integrated being who
interacts with and adapts to the environment. Conservation of energy is a primary
concern. In this theory, health is viewed in terms of conservation of energy in the
following areas, which Levine calls the "four conservation principles of nursing":
1. Conservation of client energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity. With this approach, nursing care
involves conservation
With this approach, nursing care involves conservation activities aimed at
optimal use of client's resources.
Roles and Functions of the Nurse
A contemporary nurse possesses knowledge and skills in a variety of areas. In
the past, nurses provided care and comfort while they carried out specific nursing
functions, but changes in nursing have expanded the roles of nurses to include health
promotion, illness prevention, health restoration, and concern for the whole client
(see box above).
ROLES AND FUNCTIONS OF THE NURSE______________________
CARE GIVER
The nurse directly helps the client to regain health through the healing process.
The nurse addresses the holistic health care of the client, including helping the client
and family restore emotional and social well-being.
DECISION MAKER
The nurse, before taking any action, interprets available information and decides
the best approach for the individual client. These decisions can be made alone, with
the client and family, or with other health care professionals.
PROTECTOR AND CLIENT ADVOCATE
The nurse maintains a safe environment, helps prevent injury, and protects the
client from possible adverse effects related to treatment. The nurse also protects the
client's human and legal rights and assists him or her in asserting those rights if the
need arises.
MANAGER
The nurse delegates responsibility, supervises other health care workers,
manages the resources of the practice setting, and coordinates activities.
REHABILITATOR
The nurse assists the client's return to maximal functioning through teaching and
helping the client to cope with changes associated with illness or disability.
COMFORTER
The nurse cares for the client as a person through emotional support. The client
needs help in reaching therapeutic goals.
COMMUNICATOR
The nurse is continually involved in promoting communication among all
people affected by the client's' needs. Communication is critical in meeting the needs
of clients, families, and communities.
TEACHER
The nurse explains concepts and facts about health care to the client, reinforces
learning, and evaluates progress. Teaching is individualized and may be formal or
informal
Career Roles. Career roles are specific employment positions. Most skills re-
quired for the expanded roles of the 1980s and 1990s are taught in baccalaureate
nursing programs. These skills are now directed toward the generalist practitioner.
The newer requirements for nursing specialization are redefining the term "expanded
role" (Mechanic, 1988). Nursing specialties have input into the educational require-
ments for these roles and career opportunities (see box at left).
One method of redesigning nursing roles has been the focus of differentiated
nursing practice. This practice had early design in the educational setting where
graduate-expected competencies were based on different types of educational
experiences. Differentiated practice is now expanding into clinical practice as new
nursing roles incorporate primary nursing and case management principles (Harkness
et al., 1992). Broadly defined, differentiated practice structures roles and functions of
nurses according to education, experience, and competence, while recognizing the
importance of all roles to create a community of professional nursing practice
(Koerner, 1992). For example, in such a system there is a clear difference between
the responsibilities of a baccalaureate-prepared nurse versus one with an associate's
degree.
CAREER ROLES____________________________
NURSE EDUCATOR
Nurse educators work in schools of nursing, staff development departments, and
client education departments. They provide educational programs for student nurses
and nurses and teach clients about self-care and home care. They usually are required
to have graduate nursing education.
CLINICAL NURSE SPECIALIST
Clinical nurse specialists work in critical, acute, long-term, and community
health care agencies (Figure 1-5). They often specialize in managing specific
diseases, and they function as clinicians, educators, managers, consultants, and
researchers. They have master's degrees in nursing.
NURSE PRACTITIONER
Nurse practitioners are certified to provide health care to clients, usually in
outpatient or community settings. Adult nurse practitioners provide primary care to
adults; family nurse practitioners provide primary care for families; pediatric nurse
practitioners provide care for infants and children; gerontology nurse practitioners
provide care to older adults; and obstetrics-gynecology nurse practitioners provide
primary care for women. Most have master's degrees in nursing.
CERTIFIED NURSE-MIDWIFE
Certified nurse-midwives are certified by the American College of Nurse-
Midwives to provide independent care for women during normal pregnancy, labor,
and delivery. They practice in conjunction with a health care agency, which provides
assistance.
NURSE ANESTHETIST
Nurse anesthetists are registered nurses who have advanced training in
anesthesiology. They provide surgical anesthesia under the supervision of an
anesthesiologist and administer anesthetics to clients during minor surgery.
NURSE ADMINISTRATOR
Nurse administrators manage client care within a health care agency. They may
hold middle-level (e.g., head nurse) or upper-level (e.g., director) management
positions. They usually have baccalaureate degrees in nursing and may have master's
degrees.
NURSE RESEARCHER
Nurse researchers investigate nursing problems to improve care and to define
and expand the scope of nursing practice. They may be in academic, independent, or
community settings. They must have a graduate degree in nursing. In some settings, a
doctoral degree is required
Health Care Team
In most practice settings, the nurse works with other health care professionals to
provide total care for clients (see box below). The involvement of many persons in
the client's health care can pose risks for fragmenting care. Because nurses have the
greatest opportunity to interact with all professionals in the health care team, they of-
ten coordinate and integrate services within the care plan.
OTHER HEALTH CARE TEAM MEMBERS______________________
PHYSICIAN
A physician is a professional who has earned a degree of doctor of medicine or
doctor of osteopathy and has passed a licensing examination. Most physicians
specialize their practice of medicine. Nurses work closely with physicians under
supervision or as collaborators.
PHYSICIAN ASSISTANT
Physician assistants have medical training and work under the direction of
physicians in hospitals, clinics, and private offices (they do not practice in Canada).
Nurses work with them as they do with physicians.
THERAPIST
Therapists are licensed to assist in the examination and treatment of clients in
special ways (i.e., as physical, occupational, or respiratory therapists). Their
education varies but usually involves 4-year programs. Nurses collaborate with them
and evaluate their work.
PHARMACIST
Pharmacists are licensed to formulate and dispense drugs. They may have
bachelor of science degrees or doctorates in pharmacology. Pharmacists provide
valuable information to nurses about drugs and their use and effects.
SOCIAL WORKER
Social workers are trained to counsel and refer clients to appropriate agencies.
They have baccalaureate or master's degrees. Nurses work together with them to
identify the best resources for the client, particularly when the client returns home.
CHAPLAIN
Chaplains offer spiritual support and guidance to clients and their families. They
may be employed by an agency or provided by a church in the community. A client
may request a chaplain, or a nurse may refer the client to one.
NURSING AS A PROFESSION
Professionalism
"Professionalism of nursing will be achieved only through the professionalhood
of its members" (Margarita Styles, 1982). Nursing is not simply a collection of spe-
cific skills, and the nurse is not simply a person trained to perform specific tasks.
Nursing continues to evolve into a profession. No one factor absolutely differentiates
a job from a profession, but several characteristics are basic to any true profession.
Sociologists ranging from Flexner in 1900 to Caplow in 1950, Etzioni in 1960, and
Levenstein in 1985 have studied the characteristics of professions. They agree that
some core characteristics are true for any profession. These include education, theo-
retical body of knowledge, the provision of a specific service, the autonomy of mem-
bers, and a code of ethics. Nursing clearly shares, to some extent, each of these char-
acteristics and faces controversial issues as nurses strive for greater professionalism.
Education. An earlier section describes the three basic types of educational
preparation for registered nurses. As a profession, nursing requires that its members
possess a significant education, but the issue of educational standardization is a major
controversy in nursing today. Most nurses agree that nursing education is of great
importance to practice and that nursing education along with continuing education
must respond to the changes in health care created by scientific and technological ad-
vances.
Theory. Nursing knowledge has been developed through nursing theories.
Theoretical models are frameworks for nursing curricula and clinical practice and
also lead to research that increases the scientific basis of nursing practice. A theory is
a way of understanding a reality, and, in this general sense, all practicing nurses use
theories they have learned as a part of their clinical practice. Theoretical frameworks
help nurses to understand the scope of their practice and to select interventions most
likely to assist clients to an improved state of health.
Service. Nursing, like other professions, provides a specific service. Today,
nursing is a vital part of the health care delivery system, providing holistic and com-
prehensive services to clients with varying needs. Nurses are now the largest group of
professionals in this system. Approximately 2 million people are now registered
nurses, and one study indicates that approximately 80% of them are employed (Aiken
andMillinix, 1987).
Autonomy. Autonomy means that one is reasonably independent and self-
governing in decision making and practice. It has been difficult for nurses to attain
the degree of autonomy enjoyed by some other professionals. Some data suggest that
the history of nursing has been a struggle by nurses for autonomy in the face of dif-
ferent societal expectations (Cohen, 1992). In the past, physicians, hospital adminis-
trators, and others in the health care delivery system have found nursing autonomy
difficult to understand and support. Through clinical competence and greater educa-
tional preparation, however, nurses are increasingly taking on independent roles in
nurse-run clinics, collaborative practice, and advanced nursing careers. A 1992 nurs-
ing research study indicated a positive relationship between the highest level of nurs-
ing education and the autonomy of nursing roles (Schutzenhofer, 1992).
Greater responsibility and accountability come with increased autonomy. Ac-
countability means the nurse is answerable, professionally and legally, for the type
and quality of nursing care provided to clients. The nursing profession regulates ac-
countability through standards of practice, nurse practice acts, nursing audits, and
certification.
Code of Ethics. Nursing has had a code of ethics since 1903. The code of ethics
describes the goals and values of the nursing profession and establishes a code of
conduct by which nurses function. Ethical principles within the code provide a foun-
dation for nursing practice. In addition, nurses incorporate their own values and eth-
ics into their practice.
NURSING PROCESS
Historical perspective
Nursing has always been directed at serving the health care needs of society.
Nursing originated with the desire to keep people healthy and provide comfort, care,
and assurance to the ill. Nursing was distinguished in its early history as a form of
community service and was originally related to a strong instinct to preserve and pro-
tect the family. Although the goals of nursing have remained relatively the same over
the centuries, its practice has been influenced by the changing characteristics of soci-
ety. Thus nursing has gradually evolved into a modern profession.
Nursing is as old as medicine. Throughout history, nursing and medicine have
had an interdependent relationship. During the era of Hippocrates, medicine practiced
without nursing, and during the Middle Ages, nursing practiced without rational
medicine.
Many ancient societies did not value human life so the caretakers of life were
less respected. The nurse tended to the hygiene of clients in the home under the direct
supervision of a physician. Nurses did not participate in activities to promote health
nor did they teach families how to care for the ill.
Under the influence of Christianity, nurses gained respect, and the practice of
nursing expended. Although nursing became increasingly humanistic, there was still
no formal education or training for nurses.
The Sisters of Charity (1633) was founded by St. Vincent de Paul. The sisters
cared for people in hospitals, asylums, and poorhouses. The sisters also became
widely known as visiting nurses because they cared for sick people in their homes.
The first supervisor of the Sisters of Charity was Louise de Gras who established
perhaps the first educational program to be associated with a nursing order. The pro-
gram included experience in the hospital, home visits, and the care of the ill.
In the eighteenth century, the growth of cities
brought an increase in the number of hospitals and a
greater role for nurses.
In 1860 Florence Nightingale wrote Notes on
Nursing: What It Is and What It Is Not for the
layperson. Her philosophy of nursing practice
reflected the changing needs of society. She saw the
role of nursing as having "charge of somebody's
health" based on the knowledge of "how to put the
body in such a state to be free of disease or to
recovery from disease".
During the same year she developed the first organized program of training for
nurses, the Nightingale Training School for Nurses at St. Thomas Hospital in Lon-
don.
Modern definitions and philosophies of nursing
As nursing has evolved, expanding its roles and concepts, theorists have defined
nursing in many ways. Florence Nightingale addressed nursing as a discipline in 1859
and believed that the nature of nursing knowledge was distinct from medicine. Con-
ceptual and theoretical nursing models provide knowledge to improve practice, guide
research and nursing curricula, and identify the goals of nursing practice. Theory
provides the nurse with goals for assessment, diagnosis, and intervention. It also pro-
vides common ground for communication and for professional autonomy and ac-
countability. The following table describe the general focus of important theories of
the philosophy of nursing. A nursing curriculum will often include one or more of
these nursing theories as a part of its conceptual framework.
The term nursing process was first introduced by Lydia Hall in 1955. In 1966
Virginia Henderson identified basic nursing actions as independent functions and
stated that the nursing process uses the same steps as the scientific method. Since
1973, nursing educators and clinicians began to use the five-step process model on a
regular basis.
Nursing process is a systematic problem-solving method for providing individu-
alized care for clients in all states of health. The client is viewed as an individual and
a member of a social unit that includes the family and significant others. The nurse
includes the client and family and significant others in each step of nursing care.
The nursing process has five interrelated steps: assessment, nursing diagnosis,
planning, implementation and evaluation. During the assessment phase, information
about the client is gathered to identify client problems. The collected information is
analyzed, and specific client health care problems are stated during the nursing diag-
nosis step. During the planning step, goals expected outcomes and nursing care are
planned with the client. Actual nursing care is delivered during the implementation
phase. The evaluation step allows the nurse and client to evaluate the success of
nursing care through achievement of client goals and expected outcomes. These
sequential steps provide a systematic format that ensures continuity of client care and
maintenance of professional standards while assisting clients to regain, maintain, or
promote health.
The nursing process is the unifying concept of nursing; it is the method by
which nursing is practiced systematically and provides the means by which nurses
demonstrate accountability and responsibility to clients and families.
Overview of nursing process
The purposes of the five-step nursing process are to establish a client data base;
identify the clients health care needs; determine priorities of care, goals and expected
outcomes; establish a nursing care plan and provide nursing interventions to meet cli-
ent needs; and determine the effectiveness of nursing care in achieving client goals.
Relationship of steps of nursing process
Each step of the nursing process is essential to the problem solving technique
and is closely interrelated with the other four steps. During assessment, the nurse
collects data about the client from a variety of sources. This information is used for
problem identification so that planning and implementation are appropriate to the
client's needs; it is also the basis for accurate evaluation.
Nursing diagnosis involves formulating diagnostic statements that identify the
client's health-related problems. The accuracy of these statements depends on the
thoroughness of the assessment, including data collection, sorting and clustering, and
validation. The identified nursing diagnoses form the framework for the nursing care
plan. Nursing diagnoses thus provide the nurse with an individualized client-centered
focus.
During the planning step of the process, a care plan is formulated. It is
individualized based on the assessment and nursing diagnoses. The care plan contains
client goals with expected client outcomes and appropriate nursing interventions.
Expected outcomes are the criteria used to evaluate the effectiveness of care.
Implementation is the action step of the nursing process. During this step,
individualized client care is delivered according to the care plan. Interventions are
continually modified as deemed necessary by an ongoing nursing assessment of the
client's responses.
The last step of the process is evaluation. The nurse determines the client's
progress toward meeting expected outcomes and achieving goals and the success of
the nursing interventions. This step provides for revision of the nursing care plan as
necessary to resolve the client's health problems.
The entire process is sequential and interrelated; each step depends on the
previous one. The sequence is logical in that client information is gathered before
determining the client's health care needs. Nursing care is provided according to the
plan, and nursing care is evaluated in terms of achievement of expected outcomes. It
is dynamic in that any step may be reviewed and revised during evaluation. It is
dynamic flexibility that allows the nurse to respond to changing client needs.
Theoretical Comparison
The focus of nursing process is problem identification and resolution. Problem
solving and the scientific method are theoretical approaches used to identify and
resolve problems in nursing and other professions. The nursing process shares several
characteristics with the problem-solving and scientific methods. The components of
both can be correlated with each step of nursing process.
Benefits
When the nursing process is used to organize and deliver nursing care, the client
becomes an active participant in an individualized health care process. Through the
planning phase, the care plan communicates to the health care team the client's spe-
cific problems, the prescribed interventions, and the expected outcomes of care. The
client receives comprehensive and consistent care. The evaluation of successful
achievement of expected outcomes and quality improvement studies document the
quality of care promoted by the use of the nursing process. The nursing process also
assists in cost containment because nursing care is based on client needs.
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