In response to the growing shortage of skilled workers in the nursing sector, nursing education in Germany has recently undergone major changes. As part of a large-scale education reform that came into force at the beginning of 2020, the former tripartite system of nursing apprenticeships (adult nursing, children nursing, and geriatric nursing) were merged into one apprenticeship profile. Restructuring the nursing curriculum involved the implementation of general subjects such as English, thus leading to the need for new adequate English language teaching materials. This chapter explores how corpus linguistics can serve as a helpful tool for the development of teaching materials in the specialized field of nursing education.

The promotion of students’ communicative skills is the main focus of EFL teaching in the nursing education context. Hence, a spoken corpus for the medical context (Social English for Medical Context ‑ SEMC) was created based on transcripts from the three medical television shows Emergency Room, Dr. House, and Grey’s Anatomy. The selected shows proved to be suitable with regard to medical accuracy and their potential to promote communicative skills. Five corpus-informed sets of English as a Foreign Language (EFL) teaching materials for nursing schools were developed as a first step towards establishing English as a general subject of nursing education in Germany.

1. Background

In the course of the recent major reform of nursing education in Germany and the subsequent implementation of English as a general subject in the nursing curriculum, the need for new, adequate English language teaching materials for this particular vocational school context arose. Since vocational education aims to meet the requirements of the learners’ future professional practice (Belcher 2006: 134), teaching materials are preferably based on naturally occurring language produced in authentic situations of the respective work environment. The present chapter explores how corpus linguistics can serve as a helpful tool for the development of authentic teaching materials in the specialized field of nursing education (for a detailed account of the benefits of corpus linguistics in language teaching in general and in the vocational school context in particular, see chapters “About the project”, “Developing ESP learning activities for vocational education with a custom virtual corpus” and “Exploring hospital interactions with Grey’s Anatomy”).

In order to identify the specific requirements for English teaching materials in the nursing education context, the education reform and its implications for the educational practice, as well as formal prerequisites, learners’ language needs, characteristics of potential learning groups and learning targets will be analyzed in the following.

1.1 Nursing care reform and educational practice

The nursing profession in Germany is a relatively young profession in comparison to other countries such as the United States (Menche 2007: 24). Education in nursing is constantly changing and evolving. The most recent development is the nursing care reform of 2017, which came into effect on the first of January 2020 (Jürgensen 2019: 7) as a response to the demographic change on the one hand and the lack of nursing staff on the other (Hamar/Kuckeland/Schneider 2019: 152). The legislative reform merges the former tripartite system consisting of three separate nursing training programs (one for each patient age group: geriatric, pediatric, and adult nursing) into a single job profile referred to as the generalized nursing apprenticeship (Jürgensen 2019: 7). Duration of the apprenticeship amounts to three years in total and, in contrast to other countries, is subject to a particular dual training system that combines theoretical components (taught at vocational schools) with practical training on the job in different clinics and outpatient clinics (Pflegeberufereformgesetz – PflBRefG 2017: 2584). More specifically, the three-year program is divided into specialized classes, general subjects, and practical training. One concrete objective of the education reform is to provide trained nurses with a qualification that enables them to work in other European countries (Bundesministerium für Gesundheit – BMG 2018: n.p.).

The reform implies reformulating the nursing curriculum with regard to the technical subject contents on the basis of the framework curriculum of the state school authority. Each nursing school is required to transfer these guidelines into its own curriculum. In addition to the restructuring of the technical subject contents, the implementation of four general subjects, English, German, Politics, and Religious education was also an essential aspect of the reform.

The guidelines of the local Ministry of Education (Niedersächsisches Kultusministerium – NKM 2009a) serve as a common ground for English teaching in nursing education. The guidelines for English refer to the subject as ‘English / Communication’, which already indicates a particular focus on promoting the students’ communicative competence.

1.2 Formal prerequisites for teaching materials and learners’ language needs

As briefly mentioned above, the Ministry of Education’s guidelines for English in the context of nursing education refer to the subject as ‘English / Communication’, which stresses the focus of the communicative competence in vocational schooling. This specific feature of English in nursing education, as well as the characteristics of potential learning groups and specific learning targets have to be taken into careful consideration when approaching the creation of suitable EFL teaching materials.

English is of great importance for nursing trainees for several reasons. Miyake/Tremarco (2005: 32) draw attention to the fact that, due to its status as an international lingua franca, English in particular can serve as a linguistic bridge in communication with patients and their family members. This is essential because the number of patients hospitalized in countries with official languages other than their native languages is rising worldwide. It is important for nurses to be able to successfully communicate in order to ensure comprehensive care. Listening and speaking skills have to be carefully addressed to enable nurses to engage in professional communication (Akbari 2016: 24). Klitzing et al. (2007: 42) add that the majority of medical studies are published in English. Receptive skills in general should therefore also be focused on in English language teaching for nurses. However, this aspect of language learning is not addressed in this chapter.

The English curriculum for nursing schools is based on two important sources: the framework directive of the Ministry of Education in Lower Saxony (NKM 2009a) as well as existing research evidence regarding learners’ language needs (Guhde 2003; Miyake/Tremarco 2005). It is important to note that the ministry’s guidelines are formulated in a fairly general manner and that it is up to every school to create a school-specific curriculum for the subject.

The guidelines formulated in the framework directive of the Ministry of Education in Lower Saxony consist of four central competence areas, namely ‘Reception’, ‘Production’, ‘Interaction’, and ‘Mediation’. The guidelines describe each competence in detail and list examples of possible teaching materials and methods that may be applied in class. The competence ‘Reception’ is defined as the students’ ability to understand common texts specific to the vocational context (NKM 2009a: n.p.). The Ministry of Education states that this skill describes the idea that students are able to follow and understand basic lines of discussions and speeches. The list of example texts includes technical texts and newspaper articles. Texts to address listening skills include communicative situations, podcasts, and video sequences. ‘Production’ describes the students’ ability to write texts and statements in the target language depending on the situation and purpose. These can include answers to questions of text comprehension or filling out forms. Spoken communication is central to this competence and refers to giving a presentation or to reporting something. The third competence is ‘Interaction’. The individual learner should be able to ask for relevant information in connection with typical professional tasks. The students should be able to apply simple communication techniques. Taking a patient’s medical history is a good example of this competence. The final competence described in the framework is ‘Mediation’. It does not only refer to the translation of language material into the target language but also to the ability to orally summarize texts and utterances in English (ibid.).

The emphasis on particular skills varies according to the year of schooling. Following the recommendations of Miyake/Tremarco (2005: 33), in the beginning the focus lies on ‘Reception’ and ‘Production’, skills closely related to the teaching of technical terms and vocabulary acquisition. In the course of the apprenticeship, the focus shifts towards the competence of ‘Interaction’, emphasizing the students’ communication skills more strongly.

In addition to the language needs of the nursing students it is also important to pay attention to the rising need for media skills. Trübswetter/Figueiredo (2019: 345) looked at the potential of computer-based learning methods in nursing schools. They underline the need for schools to foster students’ technical competence in the new nursing curriculum in order to remove barriers and to build up confidence in using electronics. This demand results from changes in the work environment and increasing technology use that has to be mastered by nurses in the clinical setting, e.g., the electronic patient file (Trübswetter/Figueiredo 2019: 348).

In summary, it can be said that the competences required for nursing students are centered on social interaction and communication in the clinical setting. According to Miyake/Tremarco (2005: 23), the language type needed to facilitate communication is the so-called ‘Social English’ as opposed to ‘Technical English’, which is considered less important in nursing education. The term ‘Social English’ refers to language likely to be used in interactions with different individuals, whereas ‘Technical English’ is is characterized by vocabulary likely to be encountered in the clinical setting (Miyake/Tremarco 2005: 24). The authors (Miyake/Tremarco 2005: 33) suggest limiting ‘Technical English’ in the classroom of nursing education to basic technical vocabulary, such as anatomical terms and clinical symptoms. ‘Technical English’ can build on learning in previous years of schooling (Miyake/Tremarco 2005: 26). They conclude by stating that ‘Social English’ becomes increasingly important in the course of the apprenticeship as it enables communication with patients and other individuals in the clinical setting. Miyake/Tremarco (2005) strongly suggest focusing on ‘Social English’ in the last year of the nursing education program. A closer look at the nursing curriculum for the subject ‘English / Communication’ of a nursing school in Lower Saxony (see table 1) shows that these recommendations have been followed. Towards the last year of the program, the emphasis shifts from the receptive competence and ‘Technical English’ to the competence of ‘Interaction’ centered on ‘Social English’.

Although the guidelines of the Ministry of Education (NKM 2009a: n.p.) describe important competences of the nursing students, they are very vague and lack detail. Therefore, additional sources had to be consulted in order to determine precise language needs for nurses.

Cameron (1998) looked at language needs for nursing students in class and clinic. His study is recurrently used to serve as a basis for nursing curricula (Bosher 2013: 264; Cameron 1998: 215). Cameron (1998: 205) based his needs assessment on a needs-definition that is understood in four ways: analytic, democratic, diagnostic, and discrepancy. A reference group, for example nursing educators and students, forms the basis of the analytic and democratic needs perspectives. By consulting a reference group, one is more likely to identify useful needs for the learners’ group and to minimize the risk of overlooking essential needs. For example, educators and students articulated the need for extra practice in class (Cameron 1998: 206). The discrepancy approach of Cameron’s needs definition refers to observed differences between the actual performance of a student and the required action (ibid.). The diagnostic needs definition aims to rank the identified needs with regard to frequency and relevance of the respective need (Cameron 1998: 207). Clearly, Cameron’s underlying needs definition is comprehensive and takes several aspects of language learning into consideration.

Cameron (1998: 215) identifies five major needs of nursing students, which are displayed in Fig. 1. As mentioned above, the determined needs ‘serve as suggestions for course content’ (Cameron 1998: 203) and are recurrently cited by other authors (Bosher 2013: 264; Nation 2013). The first need that Cameron (1998: 208) defines is ‘Speech Production Accuracy’. It is subdivided into the four categories pronunciation, vocabulary, grammar, and discourse. ‘Academic Performance’, as the second need, consists of five individual skills, such as writing and listening. The third need, ‘Clinical Performance’, is split into several smaller parts, of which three are of special interest to this chapter: getting information, transmitting information to a patient or a family member, and social interaction with different individuals at work. ‘Dialect (Cultural) Variation’, is the fourth need that Cameron (1998: 214) describes. It relates to cross-cultural awareness of nurses with regard to a multicultural patient group and colleagues. And finally, the need ‘Inferencing Skills’ is based on Cameron’s definition of inference, which refers to observations that may be drawn with respect to a speaker’s communicative intention (ibid.).

Not all of the needs identified by Cameron will be addressed in this chapter. The designed teaching materials in this chapter are exclusively developed to satisfy the needs one and three. Fig. 2 gives an overview of the two selected need statements and intends to provide a better understanding of each need.

A further source consulted to identify specific language tasks with which nursing students will be confronted at work are the results of a study conducted by Epp/Lewis (2009). The authors observed nurses in the clinical setting for a certain period of time and identified a range of essential and recurring language tasks (Epp/Lewis 2009: 308). The majority of communication takes place with patients, also referred to as clients (see Fig. 3). Individual language tasks performed by nurses range from ‘giving instructions’ over ‘asking for information’ to ‘making small talk’. All identified language tasks with the associated percentages of the time spent on the tasks are shown in Fig. 4.

1.3 Characteristics of potential learning groups

The requirement for a nursing apprenticeship in Germany is the middle school qualification known as the ‘Realschulabschluss’ (NKM 2009b: n.p.). The guidelines of the Ministry of Education (NKM 2009a: n.p.) define the B1 level as the language proficiency level of students who have completed secondary education. According to the ministry’s guidelines (ibid.), the students have acquired a general language vocabulary and grammar rules in their previous ten years of general schooling. Experience shows that each nursing class regularly contains a small number of high school graduates who acquired a higher level of language proficiency during their thirteen years of schooling (B2/C1) (Niedersächsischer Bildungsserver – NibiS 2020: n.p.). For an educator, it is crucial to keep this heterogeneity in mind in terms of internal differentiation. Generally, this term refers to the idea that teaching content and materials are carefully tailored to the different student groups with regard to their level of proficiency. There are different teaching methods that can be used in combination with each other in order to support the different learning needs of a group. Donath/Klemm (2013: 145), for example, name the method peer correction and suggest letting students work in small groups to create a safe learning environment.

With the new care reform, it is possible for students who have finished a two-year apprenticeship as nursing assistants to skip the first year of the generalized nursing apprenticeship and to enter the second year of schooling (Ministerkonferenz – MK 2020: 3). This reduction of the number of training years is based on the idea that these students have attained a solid foundation of nursing and work experience in advance (Jürgensen 2019: 14). The school curriculum for nursing assistants also includes a moderate level of English language teaching (Jürgensen 2019: 62). Therefore, it is reasonable to assume that these students also have a satisfactory general language vocabulary and already acquired a moderate knowledge of technical vocabulary.

Generally, nursing students show strong motivation for the apprenticeship because it is a first step in their professional career. However, in recent years German nursing students’ motivation and independent learning skills seem to have decreased (Baumgarten/Ayerle 2016: 56). The authors (Baumgarten/Ayerle 2016: 53) point out that nursing students face increasing demands that arise from demographic change and growing complexity of work processes. The students seem distracted by new media more than ever (Baumgarten/Ayerle 2016: 56). Trübswetter/Figueiredo (2019: 345) agree and go on to predict that new media will become a component of nursing education for years to come. Incorporating media competence into the curriculum is a crucial measure to promote a reasonable use of technology in the future. They go on to underline that these actions represent a necessary reaction to rapidly changing work processes in healthcare (ibid.).

To sum up, the creation of corpus-based teaching materials for nursing schools in Lower Saxony is shaped by the binding guidelines of the Ministry of Education (NKM 2009a: n.p.) for the subject ‘English / Communication’, nurses’ language needs as identified by Cameron (1998: 215), frequent language tasks as identified by Epp/Lewis (2009: 308), as well as by the individual characteristics of learners in the nursing context.

2. Methodology and procedure

The previous section has shown that social interaction and communicative skills are the focus of English teaching in the context of nursing education. The corpus-based teaching materials designed for teaching English to future nurses in the course of the present study are therefore centered on ‘Social English’. Existing medical corpora have failed to sufficiently cover this particular language type. Consequently, a corpus specifically representing ‘Social English’ had to be compiled.

In general, corpora that have been derived from medical contexts are of particular interest for the material development for future nurses. Sketch Engine, a web-based tool to create and investigate preloaded and individually compiled language corpora, offers a large corpus in this field, the Medical Web Corpus (MWC). The MWC contains over 33 million words predominantly from medical websites. A wordlist analysis of nouns has shown that this corpus contains a large number of broader technical terms in health care and medicine, such as infection, therapy, and diagnosis. It also contains more specific words from the medical field with lower frequencies, such as hemorrhage, anemia, and dilatation. The MWC is well suited to generate vocabulary lists for the nursing students. Nation (2013: 305) stresses that wordlists are a possible tool for teachers to help the students with vocabulary acquisition. However, a closer look at the MWC makes clear that this particular corpus, with its large variety of technical vocabulary, is not suitable for promoting the nursing students’ communicative skills during their apprenticeship. Therefore, a smaller specialized corpus was compiled as suggested by Aston (2001: 37), who points out that from a pedagogical perspective, it can be beneficial to turn to a small specialized corpus instead of a large general one.

To allow for the promotion of the learners’ communicative skills, a corpus for social English entitled ‘Social English for Medical Context (SEMC)’ was compiled using the online corpus tool Sketch Engine. The SEMC contains more than 920.000 words taken from 225 television transcripts and can be considered an addition to the MWC.

The methodological approach to generate a spoken corpus from television shows is based on the findings of Levshina (2015: 23), who points out the similarities between online subtitles and daily spontaneous conversations in American and British settings. Apart from the authenticity of the linguistic interaction, the technical correctness of the selected medical television shows is of importance here. A review conducted by Hoffman et al. (2018: 202) emphasizes the fact that physicians participate in the writing process of the scripts and that this ensures the correctness of the medical conditions and techniques in the shows. The authors go on to suggest that teachers may use television scripts for educational purposes in class (Hoffman et al. 2018: 215).

The next step was to determine suitable medical television shows for the creation of the subcorpus. The final selection of fictional medical shows is based on available studies on this particular topic. Hoffman et al. (2018: 202) examined Emergency Room (ER), Grey’s Anatomy and Dr. House. The realistic medical representation in ER is particularly highlighted in various studies (Oswald 2009: 112). Krüger-Brand (2006: 2350) goes on to report that ER contains many scenes with typical everyday hospital life issues, such as tensions between patients and their family members or communication with patients in general. Wong et al. (2009: 2) draw attention to the effective communication skills presented in scripts from Dr. House and Grey’s Anatomy. Leucht (2013: 81) confirms the medical accuracy in Dr. House and ER. Nevertheless, it is important to point out that the selected medical television shows predominantly focus on the medical staff rather than on the nursing staff. Therefore, the television scripts used for the SEMC may cause a shift of emphasis in the communication presented.

The television scripts can be obtained from specific websites. The transcripts of Grey’s Anatomy were taken from Forever Dreaming Transcripts (2020), the transcripts of Dr. House from LIVEJOURNAL (2020) and those of ER from the website Simply Scripts (2006). The transcripts were selected randomly by choosing every other transcript of the corresponding website with exception of ER. For this show, a total of six transcripts was available and therefore all six were included. In total, 175 transcripts of Grey’s Anatomy and 44 of Dr. House were selected.

3. Corpus-based teaching materials for the subject ‘English / Communication’

The following section describes five sets of teaching materials for nursing schools in Lower Saxony for the general subject ‘English / Communication’. The time required for each set is a 90-minute classroom session. The description of each set is prefaced by a brief identification of the learners’ needs and the linguistic relevance of the corpus-based worksheet. Furthermore, each set is embedded in the nursing curriculum with close connection to the underlying framework in the curriculum of the Ministry of Education (NKM 2009a: n.p.). Each subsection closes with ideas for the further use of the teaching materials in following classroom sessions. The materials cannot be seen in isolation but rather in a succession of consecutive classroom sessions. One session can serve to introduce a topic and a subsequent session either to explore the topic in more detail or to provide additional time for practice (Hutchinson/Waters 2010: 108-109).

3.1 Giving instructions vs. informing someone

The first worksheet targets vocabulary acquisition in the nursing students’ first year of schooling. With reference to the guidelines of the Ministry of Education (NKM 2009a: n.p.), this worksheet can be used to facilitate the competence areas ‘Reception’ and ‘Production’. As pointed out above, two of the core language tasks of nurses are ‘giving instructions’ and ‘informing a patient’ (Epp/Lewis 2009: 308). In order to form correct sentences in this regard, nursing students have to adequately use typical phrases for these tasks (Cameron 1998: 209). The worksheet therefore aims to teach relevant patterns that are associated with ‘informing someone’ and ‘giving instructions’ in the clinical setting. These patterns, e.g. ‘I need you to’ or ‘I have to’, first have to be learned as idiomatic chunks (Aston 2001: 15) before they can be fluently applied in varying communicative situations. This exercise may not only help the nursing students to acquire relevant phrases, but also helps to raise learners’ awareness of the particular context these phrases are used in (Aston 2001: 16).

The worksheet (Fig. I + II) is divided into two parts. Firstly, common phrases for ‘giving instructions’ and ‘informing someone’ are introduced with the help of concordance lines from the SEMC. Sketch Engine was used to generate a 2- to 6-gram list on the basis of which phrases commonly used to perform recurrent language tasks were identified. The n-grams which ranked highest (count 281), e.g. ‘I have to’, were mixed with n-grams of mid-frequency (count 92), e.g. ‘I want you to’. An additional collocation search provided the concordance lines for the first exercise of the worksheet. The relevant phrases appear in bold to emphasize the targeted patterns in the concordance lines. Nation (2013: 147) suggests the classification of items into groups as a possible activity for students to engage with concordance lines. Following Nation’s suggestion, the students are asked to read the concordances and to categorize the phrases in bold into two groups, the phrases that can be used to give information and the ones to give instructions.

Secondly, the students are asked to practice the use of the phrases by completing sentences on the exercise sheet. This exercise allows the students to recall the items when the context is presented (ibid.). The sentences chosen for exercise 3 of the worksheet were compiled from various concordance lines of the same collocation search in the SEMC corpus. The concordance lines present the target phrases in authentic and diverse contexts. As the corpus is compiled from TV transcripts and predominantly represents communicative interaction, some concordance lines contain informal expressions such as ‘gonna have to’. These underline the language authenticity but need to be addressed in class to increase students’ awareness of the formal vs. informal tone of certain words and phrases (see exercise 2 on the worksheet).

The teaching set can be continued in following class sessions by using the acquired phrases in the form of a practical application in the nursing school’s skills. The students get together in pairs and improvise a patient-nurse-interaction by using the acquired phrases for ‘giving instructions’ and ‘informing a patient’. This sequence allows the students to practice and strengthen the acquired verbal phrases in connection with operational nursing tasks. The previous class session functions as a language learning task and the following session as an activity-oriented communicative task (Legutke 2013: 94). The combination of subject teaching and language teaching facilitates the development of the learners’ vocational competence (Legutke 2013: 116; NKM 2009a: n.p.).

3.2 Offering and asking for help

This teaching set is based on the language tasks of ‘offering help’ and ‘asking for help’ as identified by Epp/Lewis (2009: 308). The targeted competence areas from the guidelines (NKM 2009a: n.p.) are ‘Production’ and ‘Interaction’. Typically, nurses perform these tasks in contact with patients but also with family members and other professionals in the work setting (Epp/Lewis 2009: 307). The aim of the exercises of this set is to improve the ‘Speech production accuracy/appropriateness’ of the nursing students with regard to their grammar structure of asking questions (Cameron 1998: 209). The focus is not on a specific type of question. Instead, it aims at making the students familiar with different ways of asking for and offering help because actual interaction with patients and colleagues does not exactly correspond to the arranged dialogues presented in many conventional schoolbooks (O’Keefe/McCarthy/Carter 2007: 22; Gabrielatos 2005: n.p.). The lack of authenticity in textbook conversations has been linked to poor communication skills at all proficiency levels (Savova 2018: 85). To address this problem, concordance lines have been selected from the SEMC corpus and used as a foundation for the exercise. The broad context with rich exposure to the use of help (n/v) targets the communicative competence of the students (Belcher 2006: 148).

In order to extract suitable examples, a concordance search with the lemma help (n/v) was performed in Sketch Engine and revealed a total of 887 concordances. By skimming the concordances for suitable contexts, e.g., significantly asking for and offering help, the number of concordances was minimized to a manageable number of 40 for the students to analyze in class (Fig. IV + V). The aim of the worksheet is based on Gabrielatos (2005: n.p.). Students are asked to identify different ways of using help. In order to expose the students to authentic interactions, the chosen concordance lines display different contexts for the use of help. The concordance lines include instances of ‘asking for help’, ‘offering help’, and also occurrences of ‘calling for help’. The learners should be able to notice the differences. In addition, the students are asked to think of reasons why someone would ask for help in different ways. Students are expected to understand that a call for help is usually linked to an emergency situation and requires a rapid response on their part (Menche 2007: 15). The chosen ‘Think!-Pair!-Share!’ teaching method is a form of cooperative learning, which initiates the exchange of ideas and facilitates the students’ communicative competence by maximizing the speaking time of each student (Grieser-Kindel/Henseler/Möller 2017: 186). This approach meets the recommendations by Donath/Klemm (2013: 145) to react to the possible heterogeneity of the learners.

For consolidation, the students can practice asking questions in a role-play. For this exercise, the learners can team up with their neighbor. The first step is to think of a typical situation they experienced on the ward which involved helping a patient, a family member or a colleague. Secondly, they are asked to write a short dialogue with the help of the concordance lines from the sheet. The next step is to assign the different parts and practise the role play. Once they feel confident enough and can speak freely, they act out their role play. This teaching method consolidates the competence of the learning group and constitutes a holistic approach by combining the introduction of a new term with practising and subsequently testing it (Legutke 2013: 92). The complete exercise sheet can downloaded by clicking on Fig. III-V.

3.3 Belly vs. stomach – appropriateness of word choice

This exercise is intended for the second year of schooling and targets the appropriateness of word choice. Cameron (1998: 209) places this particular language need in the field of ‘Speech production accuracy’. With regard to the guidelines of the Ministry of Education (NKM 2009a: n.p.) this worksheet can be used in class to address the competence areas ‘Reception’ and ‘Production’.

As mentioned above, communication with patients is a core task of nurses. The communication of nursing professionals is characterized by a nursing care jargon and an interdisciplinary nature of the language in use (Marchwacka 2018: 173). Since the patient has little or no medical knowledge, the communication of nurses has to function as a bridge between the two opposites. Therefore, it contains a mixture of technical terminology, technical jargon, and everyday language (Marchwacka 2018: 179). Nonetheless, the nurses still have to maintain a professional distance to patients in their language. It is mandatory to differentiate between a factual and a relationship level, which makes the avoidance of colloquial expressions – especially with regard to excretions and particular body parts – absolutely essential (Menche 2007: 178). For this reason, the teaching material targets the appropriateness of word choice. A keyword analysis of the SEMC corpus was performed in order to identify frequently used colloquial expressions in conversations with patients and health professionals. This was followed by a keyword analysis in the MWC to determine the equivalent of the informal words.

A total of four colloquial expressions were chosen for the exercise, which are: belly, poop (v/n), pee (v/n), and puke (v/n). As a next step, a simple concordance analysis was performed to extract suitable sentences which display the relevant word in context. For each word, five sentences were chosen for the exercise sheet. With the exception of sentences containing the word stomach, all sentences were extracted from the SEMC corpus. The concordance search for the word stomach was not satisfactory due to decontextualization of the search results. Therefore, the sentences for stomach were selected from the MWC instead.

The assignments make the students use the corpus material and take a similar form to the exercises suggested by Gabrielatos (2005: n.p.). First, they have to find a German translation and decide whether the word is a noun or a verb. Then they have to determine whether the word is used formally or informally. Finally, they have to match the words, so that each informal expression has a matching formal equivalent. The exercise sheet can viewed as Fig. VI-VII.

The teaching set can be further developed by watching short extracts of the episodes of the fictional medical TV series on the basis of which the SEMC corpus was complied. As an observational task, the students could be asked to identify colloquial expressions in conversations they have watched and to rephrase the transcripts in appropriate medical language. This would ensure the repetition of the linguistic items, as required by Hutchinson/Waters (2010: 108). The teaching set would also improve the students’ listening competence, as required by the Ministry of Education (NKM 2009a: n.p.).

3.4 Getting information – conducting a patient interview

According to Epp/Lewis (2009: 308), about 30 percent of the speech acts of nurses involve asking for information and giving instructions to patients or family members. In this teaching set, the focus is on the ‘Clinical performance’ of the nursing students. Cameron (1998: 211) distinguishes two different needs for the particular competence of ‘Getting information’, namely a medical interview (assessment) and a physical examination. The former is a task that is performed at the early stage of a patients’ admission to the hospital on the ward. The assessment of patients’ independence and their need of care are of special interest. In order to determine the individual needs, the nurses have to get the patients’ medical history (Menche 2007: 302). The latter refers to the fact that an assessment usually involves a brief physical examination with nursing procedures such as measuring temperature, dressing a wound or giving medication (Oelke 2007: 639). This teaching set will exclusively focus on the patient interview and not on the physical examination. To my knowledge, there are no teaching materials that address the specific language task of getting information from a patient. In her textbook of basic vocabulary for nurses, Jibidar (2017: 151) presents a dialogue for a patient assessment but merely limits it to asking for a patient’s phone number and address. Compared with the sample patient records which are used in Germany (cf. Oelke 2007: 638; Menche 2007: 308), it becomes clear that Jibidar’s short extract is insufficient to meet the particular needs of German nursing students. The worksheet covers the competence areas of ‘Interaction’ and ‘Production’ (NKM 2009a: n.p.) and is intended for the third year of schooling (see table 2).

For the worksheet, keywords from a sample patient record based on Oelke (2007: 638) were extracted. The words were entered into Sketch Engine in order to perform a concordance search in the SEMC corpus. The extracted keywords are listed in the table below (table 3). With the help of the concordance lines, a language support sheet was developed for the nursing students. The support sheet is based on teaching materials designed by Grieser-Kindel/Henseler/Möller (2012: 106-107). It supports the students with a variety of ways to ask for a certain kind of information in the patient record. The language support sheet is designed to equip the students with enough necessary language knowledge, so that they can practise the act of conducting a patient interview in the subsequent class sessions (Hutchinson/Waters 2010: 109).

The phrases and sentences used in the language support sheet are exclusively derived from concordance lines from the SEMC corpus to ensure the use of authentic language. The support sheet is in Fig. VIII + IX. Additionally, an English patient history form was created (see Fig. XI) considering the listed information based on Oelke (2007: 638). The history sheet asks for basic patient information usually contained in every German assessment sheet. It is important to highlight that there is a clear separation between the medical assessment and the nursing assessment in Germany. The former is conducted by the medical staff and contains information regarding the clinical picture of the patient in conjunction with their medical history, such as their history of heart diseases (ibid.). Therefore, these types of questions are not included in the language support sheet for the worksheet, but are included in the medical history form for the sake of authenticity. It is important to note that the patient form is not given to the patients but instead exclusively filled out by the nurses (ibid.). Therefore, the students need to be trained how to ask the right questions in order to fill out the form correctly.

The assignments are marked by a three-way approach. Firstly, the students are asked to familiarize themselves with the patient history form and to look up unknown words in a dictionary. Since the main competence focus of the third year of schooling is on interaction and the communication skills of the learners (see table 1), the worksheet is designed to equip the students with sufficient language support so that they can fully engage in the communication task and benefit as much as possible from the time in class (Legutke 2013: 95).

Next, the students are asked to highlight matching parts of the language support sheet with the patient history form to provide an orientation for the students. The last step is to team up and actually practise a fictional patient assessment. The exercise sheet can be downloaded by clicking on Fig. X. Legutke (2013: 97) points out the importance of students practising acquired competences. It enables the learners to prove their language skills and to experience the language in a real-case scenario (Legutke 2013: 98). Therefore, the worksheet, which is designed for a 90-minute classroom session, should also be used in the following lessons. According to the learners’ proficiency levels, the following class sessions should offer additional practising time and eventually the actual presentation of the role play (Legutke 2013: 94). Getting the students to videotape their medical interview scenes could modify the act of presenting. Ideally, this would be done in the nursing school’s skills lab. Rattani/Kaakour (2019: n.p.) encourage the use of self-produced screenplays in the classroom. Additionally, this innovative teaching method can be used to facilitate the students’ production skills by focusing on the act of screenwriting instead of a more improvised acting approach, as evident in my worksheet. It also facilitates the students’ media competence, as required by Trübswetter/Figueiredo (2019: 345).

3.5 Additional contexts of help (v/n)

The last unit of the teaching sets developed in the course of the present chapter is designed for the third year of nursing schooling (see table 2). Unlike the other teaching materials, this exercise is characterized by the learners’ direct use of the concordancing tool Sketch Engine and makes the students actively engage with the SEMC corpus. According to Cameron (1998: 214), the targeted language need is ‘Speech production accuracy’ in the context of ‘Vocabulary learning’ and the ‘Clinical performance’. More precisely, it facilitates the ability of ‘recognizing and deflecting cranky behavior and insults’ in order to respond in a de-escalating way (ibid.). The relevant competence areas of the Ministry’s guidelines are ‘Interaction’ and ‘Production’ (NKM 2009a: n.p.).

As mentioned above, Epp/Lewis (2009: 308) have pointed out that the speech acts of offering and asking for help are two of the main language skills of nurses. The teaching set presented in section 3.2 addresses this particular need. However, since the lemma help is highly frequent in the SEMC corpus (count 723), it is necessary to look at additional meanings of the word besides the ones identified by Epp/Lewis (ibid.). This should enable the students to accurately respond to statements by patients and family members involving the word help in a context other than asking for it.

Knowing a word involves various aspects, such as the written and spoken word form, knowledge of grammar, and knowledge of its meaning and associations (Nation 2013: 145). Nation (2013: 132) lists a range of activities that are suitable for vocabulary learning in order to address the meaning, concept, and reference of a word. My worksheet is based on Nation’s suggestions to strengthen the concept and reference of a word. This particular aspect of vocabulary knowledge ‘involves having a clear idea of the underlying meaning of a word that runs through its related uses, and also involves being aware of the range of particular uses it has, that is, what it can refer to’ (Nation 2013: 134-135). This activity enables the learner to understand the word help when it is used in a new context. Moreover, it helps the students to use the word in new ways (ibid.). Useful techniques to facilitate the named skills are ‘finding common meanings’ and ‘playing at word detectives’ (Nation 2013: 132). The former is a technique which helps the learners to understand the core meaning of a particular word (Nation 2013: 135). The latter refers to an activity where the learners look for information about a word they are already familiar with (Nation 2013: 136). The worksheet combines both activity types for the word help (v/n).

As mentioned above, in their previous year the students have been introduced to the word help. Naturally, the students are left with a positive connotation of the word, since they have intensely experienced it within that particular context. In this exercise, the students will be introduced to new uses of the word help.

Notice the differences of usage in example 3) and 5) in comparison to the usage in 4). Both have a negative connotation, but in 4), the person uttering the sentence rejects the help that is being offered, whereas in 3) and 5), the focus is on the fact that the help which has been offered and accepted is not helpful. Patients’ statements like these require a different type of response from the nurses. This particular corpus-based teaching set is supposed to raise awareness of the versatile use of help in the medical work field in order to induce an appropriate reaction in response to the explicit meaning of the sentence.

It is important to note that in order for the students to work with a corpus compiled by their teacher, such as the SEMC, it is necessary for them to create an account beforehand. This way, the teacher can share the specialized corpus with the class. It is recommended to do this prior to the actual class session. Ideally, this can be combined with an introductory class session on Sketch Engine and corpus linguistics in general. An introductory session might contain basic information on the tool itself. Sketch Engine’s website (Sketch Engine 2020: n.p.) provides a short YouTube video well-suited for this purpose and presents an additional listening comprehension for the students.

In this hard version of using corpora, the students have direct access to the teacher’s SEMC corpus. Stevens (1991: 42) underlines the importance of the worksheet design for this type of teaching material. It has to walk the students through every single step of the process as closely as possible and gradually release them to their independent investigation of the concordance lines. The assignment sheet has been designed to meet that particular need by integrating screenshots from the homepage itself to underpin the directions (see Fig. XII-XIV). Both students and teacher will be provided with laptops from the school and a free version of Sketch Engine. Since each classroom is equipped with a projector, the teacher can demonstrate each step to ensure additional guidance.

The assignments are based on Gabrielatos’ (2005: n.p.) and Kennedy/Miceli’s (2001: 82) approaches to the hard version of corpus use in language teaching and learning. The first step is to introduce the students to the underlying question: ‘In what other ways can you use the word help other than to ask for it or offer it?’ This is followed by the outlined search strategy of asking the students to perform an advanced concordance search in the SEMC corpus with the lemma of interest. The added lemma context is not with five tokens for both sides left and right. The advanced concordance search of help in connection with not makes the overall number of concordance lines more manageable (count 160) for the students. In comparison, a simple concordance search gives an overall count of 887 lines. Asking the students to search all 887 instances might be overwhelming and it will be particularly difficult to identify additional patterns of the word of interest.

After the concordance search is completed, the students are asked to analyze the concordance lines for uses of help in connection with not. This marks the third step identified by Kennedy/Miceli (2001: 82) and is referred to as ‘observing the examples found and selecting relevant ones’. During their search, students will come across familiar concordance lines used in the worksheet from the second year of schooling (see section 3.2). As mentioned above, it is very important that the teacher ensures close guidance of the students, for example by demonstrating how to see the word in fuller context by clicking on the key word (Gabrielatos 2005: n.p.). Also, Sketch Engine has a selection function, so that after the students have examined all concordance lines and ticked suitable ones for the particular context, they can look at their selected lines.

Once the students turn to their downsized choices, they are asked to examine the use of help in this new context. For further investigation, they can either print out their selection or work with a copy. They can also open a word document and paste the concordance lines into the document. After the students have classified the new forms, the next step, according to Thomas (2017: 20), is to form generalizations. According to Kennedy/Miceli (2001: 82), this marks the last step in the learners’ investigation and is referred to as ‘drawing conclusions’. One possibility to continue the teaching set in the following classroom sessions is to practise how to appropriately react to the diverse uses of help in the clinical setting.

4. Conclusion

The English language teaching materials developed in the course of the present study are a first step towards successfully implementing the subject ‘English / Communication’ in the new curriculum of nursing education in Germany. So far, the worksheets are merely theoretical and still need to be practically tested in the classroom setting.

Corpus-based teaching materials should be seen as an addition to existing teaching methods and materials (Gabrielatos 2005: n.p.). They are not at any time intended to replace conventional language-teaching methods, such as the work with textbooks.

Although a variety of aspects relevant for the design of corpus-based teaching materials was considered in the present study, a closer examination of other characteristics of nursing remains necessary to ensure the teaching materials’ maximum usability. These include cultural differences and varying ways of understanding, communicating and coping with health-related issues (Bosher 2013: 265).

Another factor still in need of examination are the language needs of German nursing students. Since the care reform is fairly recent, we still lack a particular needs assessment in Germany with regard to English language skills in class and clinic. Therefore, the language needs for the teaching materials developed in the course of the present study were derived from Anglo-American and Canadian studies conducted by Cameron (1998) and Epp/Lewis (2009). Yet, these countries have different training systems. For this particular reason, it is quite likely that a German assessment will yield differing needs to varying degrees. Compared to other countries, the nursing profession in Germany is organized in two different ways: as an apprenticeship and as a course of studies. Regardless of the chosen course of education, the nurses perform similar tasks at work that do not differentiate with regard to the level of responsibility or level of payment (Baumgarten/Ayerle 2016: 53). However, some fundamental differences could be identified. For example, unlike in Germany, academic skills such as writing texts and reading studies are part of the American nursing tasks (Cameron 1998). Furthermore, German nurses are predominantly responsible for therapeutic and nursing procedures, which do not include medical prescriptions or examinations, as is the case for their American colleagues. These differences can be attributed to the diverging education systems: in most countries, nursing training is almost exclusively located in the academic field and is not offered as dual training as it is in Germany (Menche 2007: 56-57). This stresses the necessity for a German needs assessment on the one hand, but also underlines restrictions that apply to transferring the foreign needs analysis to the development of teaching materials for German vocational schools on the other. Nevertheless, the foreign needs analysis offers a suitable starting point for determining the needs of German nurses with regard to English language learning in class and clinic.

Bosher (2013: 265) underlines the importance of cultural differences in nursing education because they can affect the communication with patients and their family members in various ways. It is essential to take these aspects into account when selecting specific topics in English lessons in order for nursing students to develop a competent and sensitive handling of it in class and clinic.

With regard to the corpus used for the development of teaching materials for the nursing school context, it may be worth considering compiling a spoken corpus based on authentic English interaction in the German clinical setting rather than on communication of fictional American medical television shows.

Römer (2009: 92) advises to create a database which contains useful corpus-based exercises for nursing education. Additionally, the database should list suitable corpora that teachers and students can turn to for this particular setting.

Generally, teaching education should also be targeted in the course of the reform. One option could be to refine university training programs by offering elective courses. These could train future teachers in various fields of vocational education and target relevant aspects, such as topic selection, task development, and the use of corpus linguistics in connection to vocational language teaching. Ideally, the elective courses could help to raise teachers’ awareness of students’ needs and train them to determine learners’ needs in general. Corpus linguistics could be incorporated into the courses as a potential teaching method in vocational language teaching.

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