The Language Teacher
November 2003
Analysis of Vocabulary in English Textbooks for Student Nurses
Fumie Takakubo
Matsuyama School of Nursing
At present, the English needs of nurses in Japan are mainly associated with using, and understanding, technical terms in medicine and nursing. This strongly indicates that a crucial part of teaching English to student nurses, in order to meet these needs, will be to develop their lexical knowledge of these technical terms (Watanabe, 1998). However, the tight curriculum employed in nursing schools and the student nurses' general lack of motivation to learn English make the teaching of vocabulary difficult (Takakubo, 2002). A questionnaire study by Takakubo (2002) suggests that newly-enrolled student nurses are aware of the need for vocabulary in their future work and are motivated to learn medical terms. These circumstances suggest useful vocabulary should be selected for teaching and it should be taught effectively.
No analysis of a corpus containing a wide range of texts has yet been published regarding English vocabulary for Japanese nurses. Teachers often rely on textbooks for vocabulary teaching, but they need to be aware of the risks of teaching particular lexical items that reflect the biases of textbook writers. Considering that student nurses are required to study general nursing English at nursing schools, it is necessary to evaluate existing English textbooks for student nurses in order to decrease this bias as much as possible.
What Words to Teach
Although a word's frequency and range of textual occurrence are not the only criteria for its selection in EFL instruction, many researchers agree that frequency information is important because high-frequency words provide learners with a greater probability of meeting the word again (Nation and Waring, 1997, p.17). Nation and Waring go on to report that high frequency words can result in considerable benefits for both teachers and learners but teachers also should be aware of the risk that other factors such as usefulness, importance, or psychological affect may not coincide with the actual frequency of use of some words.
Sinclair and Renouf (1988) state that the basic principles for word selection are frequency, patterns of usage, and the typical combinations that words form. As many researchers have suggested (Bowles, 2001; Schmitt and Carter, 2000; Willis, 1990), the typical combinations that words form, the lexical phrases and meanings associated with the commonest words economically provide learners with good coverage and they are a key element of fluent language production. This notion also supports the importance of patterns of usage, word-forms and multi-word units in lexical knowledge for nursing English.
Factors Affecting Word Learnability
The factors affecting word learnability include pronounceability, length, morphology, abstractness, idiomaticity and multiplicity of meaning (Carter, 1998, p.185-243; Laufer, 1997). Pronounceability and length can be drawbacks in learning technical terms in nursing. On the other hand, many of the technical terms in medicine and nursing can be broken down into their morphemes, which can facilitate the recognition of a new word and its subsequent production. Technical terms in nursing often sound complicated but they are basically concrete words. The abstractness of some medical/nursing terms may be negated when their meanings are explained thoroughly. No complicated idioms and very few multiple meanings exist in technical terms in medicine and nursing. Nursing terms that appeared in the wordlists of textbooks for student nurses are analyzed morphologically in this study in order to suggest a way to systematically teach nursing terms.
Purposes of the Study
The aims of this study are: 1) To analyze lexical items in wordlists of English textbooks for student nurses and examine discrepancies in word selection. A composite wordlist was constructed using subsidiary lists from ten English textbooks. This study focuses on 'frequency', and the frequency of occurrence in general English of words in the composite wordlist were examined. In addition, words were analyzed for how many textbooks have each word in their subsidiary lists in order to examine any discrepancies in word selection. 2) To build up a list of words appearing frequently in the wordlists and analyze them from a pedagogical point of view, that is, high-frequency words are analyzed for 'patterns of usage' and 'the typical combinations that words form'. 3) To identify prefixes and suffixes which are used to construct technical terms appearing in the wordlists, in order to find a way to teach technical terms as systematically as possible and to increase learnability.
Materials
The publication lists of the major publishing companies in the nursing field in Japan were checked for titles, and 20 books in total, as of September 2001, were identified as having (a) the word, 'nurse(s)' or 'nursing' or 'hospital' in their titles and (b) the word, 'English' or 'conversation' in their titles. Six books were excluded because they were termed dictionaries in their titles. The remaining 14 books were published as books for nurses or student nurses according to their prefaces. Among these 14 books, exercises and activities were included in ten textbooks. The books with no exercises or activities were practical handbooks which were designed to be carried around at work, and were not teaching materials and were, thus, not included. Therefore from the original twenty books, only the ten with exercises and activities were used in the analysis. The textbooks used for the analysis, as well as the location of their wordlists, are listed in the Appendix.
Wordlists
The wordlists and the footnotes were used for analysis for the following reasons. Almost half of the units of the textbooks are organized in terms of the vocabulary associated with a particular specialization, and even model dialogues or discourses were categorized in the same way. Words employed in the textbooks differ greatly. This is presumably because available space for the model dialogues or the texts is limited in the textbooks, and contents vary greatly depending on the textbook writers' experiences as medical doctors or nurses. The percentages of the exercises and activities which targeted the acquisition of language varied between 11% and 100% for each textbook and most of them focused on vocabulary rather than grammar (data not shown). Therefore, it was determined that they should not be ignored in analyzing vocabulary from quantitative and qualitative aspects. If only the texts were analyzed and the lexical items targeted in the exercises and the activities were not included in the source, it would increase the risk that words used often in a particular dialogue or text would be regarded as ones appearing frequently in the textbooks. In total, 22 short wordlists and 8 long wordlists collected from nine textbooks were analyzed. Book 4 (Fujieda and Mann, 2000), a compilation of reading material, had no wordlists but its footnotes were used as a source for the composite wordlist. The lexical items analyzed were considered as essential, important and useful in nursing English by the authors as stated in the preface of each textbook examined.
The wordlists and footnotes used include only whole words and collocations appearing in model dialogues, texts, exercises or activities, and contain no separate prefixes or suffixes. The words in the subsidiary lists were collected to form a composite wordlist and were further analyzed. A total of 6,007 word tokens and 2,650 word types appeared in the composite wordlist. Tokens will be used in this paper to express the total number of words in each subsidiary wordlist including multiple occurrences of the same word with its collocations. Generally, each word occurs only once in each textbook's wordlist, unless it forms collocations, for example; if the wordlist of one textbook analyzed had two collocations with 'psychiatry' and the wordlists of three other textbooks had the word 'psychiatry' alone, the occurrence for 'psychiatry' in the composite list was calculated to be five tokens. Types will be used to express the number of different words in the composite wordlist.
Results and Discussion
In total, 2,650 word types were observed in the composite wordlist (Table 1). In order to know if the selection of these word types was biased by the textbook writers, the word types were analyzed for how many of the textbooks examined had each word type in their subsidiary wordlists. Hereafter, range is used to express the number of subsidiary wordlists in which a word occurs, for example; when a word type appears in ten different textbooks, it has a range of ten.
Table 1. Analysis of Word Types
|
Range
|
Total word types / Number
|
Basic English types(1) / Number (%)
|
High-frequency types(2) / Number (%)
|
Medium-frequency types(3) / Number (%)
|
Junior/Senior High-school texts types(4) / Number (%)
|
Monbusho- prescribed list types(5) / Number (%)
|
|
10
|
1
|
1 / (100)
|
1 / (100)
|
0 / (0)
|
1 / (100)
|
0 / (0)
|
|
9
|
2
|
1 / (50)
|
1 / (50)
|
0 / (0)
|
2 / (100)
|
0 / (0)
|
|
8
|
5
|
2 / (40)
|
2 / (40)
|
1 / (20)
|
3 / (60)
|
0 / (0)
|
|
7
|
12
|
6 / (50)
|
5 / (42)
|
4 / (33)
|
7 / (58)
|
2 / (17)
|
|
6
|
29
|
11 / (38)
|
11 / (38)
|
10 / (34)
|
22 / (76)
|
5 / (17)
|
|
5
|
40
|
12 / (30)
|
11 / (28)
|
6 / (15)
|
17 / (43)
|
6 / (15)
|
|
4
|
96
|
15 / (16)
|
16 / (17)
|
11 / (11)
|
32 / (33)
|
2 / (2)
|
|
3
|
293
|
19 / (6)
|
28 / (10)
|
15 / (5)
|
51 / (17)
|
5 / (2)
|
|
2
|
501
|
17 / (3)
|
20 / (4)
|
7 / (1)
|
25 / (5)
|
10 / (2)
|
|
1
|
1,671
|
3 / (0.2)
|
2 / (0.1)
|
4 / (0.2)
|
6 / (0.4)
|
1 / (0.1)
|
Notes:
Total number of word types observed = 2,650.
(%) = Ratios of numbers of each word types to total number of word types for each range.
(1) = words appearing in a Basic English wordlist proposed by Richards (in Carter, 1998, p.26-27).
(2) = high-frequency headwords (top 1,900 words in English shown by 5 or 4 black diamonds in the Collins COBUILD English Dictionary (CCED).
(3) = headwords shown by 3 black diamonds in CCED (1,500 words, following the top 1,900 words in order of frequency).
(4) = words appearing in One World-1, 2, 3 and/or Unicorn-1, 2, Reading.
(5) = word appearing in the Monbusho's prescribed wordlist for EFL textbooks for junior-high school students.
Only 89 word types (approximately 3%) appeared in the subsidiary lists of five or more textbooks out of ten (Table 1). This suggests that only a small percentage of the word types are in relatively frequent use among the textbooks examined. Only one word type, 'medical', occurred in the wordlists of all the textbooks analyzed. 'Blood' and 'fever' were the only word types observed in nine textbooks out of ten. 'Care', 'nurse', 'obstetric', 'pediatric' and 'test' were observed in eight textbooks. The word types were further analyzed for their features.
Analysis of words types: Use of basic English
The word types were compared with Richards' minimum basic vocabulary for the learning of general English selected by (cited in Carter, 1998, p.26-27), and with the 1,900 most frequent headwords or the following 1,500 words of English in order of frequency according to the Collins COBUILD English Dictionary (CCED)(COBUILD, 1998) (Table 1). Among the word types with ranges from five to ten, thirty-three words (37%) were found in the wordlist proposed by Richards (cited in Carter, 1998, p.26-27). The number of words which were among the 1,900 most frequent headwords in CCED was 31 (35%), and 53 words (60%) appeared in the top 3,400 words in the CCED. Words which were not on the general English lists included 'bladder', 'liver' and other names of body parts, and such terms as 'obstetric', 'pediatric' and 'X-ray', which are often used for names of departments or units of hospitals. Basic terms used in descriptions of symptoms or conditions of patients, such as 'fever', 'acute' or 'sore' were also among those not included in these lists.
Inclusion of words in Monbusho's prescribed wordlist and Monbusho-approved textbooks for junior or senior high school students
The data suggest that the textbook writers assume that student nurses need to become familiar with general lexis as well as specialized vocabulary for the acquisition of nursing English. Most (96%) newly-enrolled student nurses participating in Takakubo's study (2002) were high-school graduates. Therefore, the words appearing in the wordlists of more than 50% of the textbooks were examined to see if they were introduced to learners at junior or senior high schools. The Japanese Education Ministry (Monbusho) has prescribed a list of 507 words which must be included in Monbusho-approved EFL textbooks (Monbusho, 1989a) for junior-high school students. The identification was carried out referring to the Monbusho's prescribed wordlist, One World-1, 2, 3 (a series of Monbusho-approved level-one textbooks for public junior high school students for the 1998-1999 school year) and Unicorn-1, 2, Reading (a series of textbooks for public senior high-school students for the 1998-1999 school year) (Monbusho, 1989b). The results are presented in Table 1. Among 89 word types with ranges from five to ten, 13 words (15%) were found in the Monbusho's prescribed wordlist, 52 words (58%) appeared in One World-1, 2, 3, and/or Unicorn-1, 2, Reading.
Bowles (2001) demonstrates that the vocabulary taught varies even across the same level of Monbusho-approved textbooks for public junior high school students. Miura (2000) points out the variability existing in Japanese government-authorized conversation textbooks for senior high school students. In addition, differences in English proficiency levels and the number of contact hours in class make it almost impossible to know for sure exactly which English words Japanese students encountered at junior and senior high schools. Nevertheless, the data suggest a possibility that student nurses would have been exposed before enrolling in nursing schools to some of the general lexis which textbook writers assume to be frequently used in nursing care. It will be important for teachers to remind student nurses of these general lexical items.
Collocation
Among the tokens appearing in the wordlists of five or more textbooks, those that appeared more than ten times in the composite wordlist accounted for approximately half (data not shown). They were analyzed further for how many times each word appeared as a component of collocation(s) in the composite list. Table 2 shows that they are presented as collocations most of the time. For instance, the word 'pain' occurred in the composite list 64 times in total, but 'pain' alone was observed only five times in the composite list. The rest were: 33 collocations that consisted of an adjective for degree or kind of pain and the word 'pain', such as 'severe pain', 'acute pain', 'constant pain', 'dull pain' or 'stabbing pain', 20 collocations that consisted of 'an adjective derived from the name of a part of the body' and 'pain', such as 'chest pain', 'abdominal pain' or 'back pain', and two for 'pain killer'. Adjectives for degrees or kinds of pain, and adjectives derived from names of parts of the body are medical terms. Therefore, the collocations consisted of a medical term and a general word 'pain' to form useful lexical items in nursing English. Collocations for 'nurse', 'diet', 'blood' and 'room' were also analyzed from this point of view and the pattern of medical term and general vocabulary was observed in most of the collocations examined.
Table 2. Numbers of Different Collocations for Each Word Type Occurring in the Composite Wordlist
| Range / Word/ Number of different collocations | Range / Word / Number of different collocations |
| 10 / medical / 14 9 / blood / 41 fever / 12 8 / care / 25 nurse / 46 pediatric / 14 test / 27 7 / body / 9 breast / 4 emergency / 7 heart / 16 liver / 8 nose / 16 pain / 59 room / 41 throat / 11 X-ray / 13 6 / abdominal / 15 bed / 17 cough / 7 delivery / 9 disease / 21 |
6 / doctor / 8 ear / 10 examination / 13 eye / 25 foot / 7 general / 10 head / 18 hospital / 10 mouth / 5 stomach / 11 surgery / 14 unit / 13 5 / area / 11 chest / 10 diet / 42 meal / 8 muscle / 6 pressure / 15 sputum / 13 stool / 4 tongue / 6 tube / 13 |
Technical terms
As shown in Table 1, approximately 63% of word types appeared in just one textbook. The analysis of these words revealed that most of them were technical terms and they were present in the wordlist alone, that is, not in any form of collocation (data not shown). This suggests that the technical terms which are considered to be useful and important in nursing English and placed in the wordlists in the textbooks vary depending on the textbook writers. Therefore, when teachers choose a textbook for nursing English, they need to be wary of words employed in textbooks due to textbook writers' individual choices. One way to teach technical terms systematically and to increase learnability is by teaching useful affixes. Word tokens were analyzed morphologically to identify useful prefixes and suffixes and the results are shown in Table 3.
Table 3. Prefixes and Suffixes Identified and Numbers of Word Types Containing Each Prefix or Suffix (Number of words = 342)
| Prefix / Number of word type | Prefix / Number of word type | Suffix / Number of word type | Suffix / Number of word type |
| anti- / 18 pre- / 12 peri- / 11 cardio- / 10 endo- / 9 gastro- / 9 neuro- / 8 post- / 8 hyper- / 6 sub- / 5 pro- / 5 |
hypo- / 4 lympho- / 4 neo- / 4 ob- / 4 ortho- / 4 radio- / 4 semi- / 4 hemo- / 3 ophthalmo- / 3 path- / 3 per- / 3 pharma- / 3 super- / 3 ultra- / 3 cross- / 2 non- / 2 sym- / 2 angio- / 1 hepa- / 1 osteo- / 1 psycho- / 1 |
itis / 29 -(o)logy / 28 -osis / 22 -graphy / 17 -ectomy / 11 -ache / 9 -oma / 9 -scope / 8 -scopy / 8 -cyte / 6 -gram / 6 -ism / 5 |
-lysis / 4 -rrhea / 4 -stomy / 3 -therapy / 3 -burn / 2 -genic / 2 -meter / 2 -pathy / 2 -plegia / 2 |
Note: Total number of word types examined = 2,650.
The results indicate that although technical terms employed in the textbooks vary greatly, approximately 13% (342/2,650) of the word types contained prefixes or suffixes. In particular, the prefixes 'anti-', 'pre-', 'peri-' and 'cardio-' and the suffixes '-itis', '-(o)logy' and '-osis', and '-graphy' have great importance. In addition, general suffixes such as '-tion' or '-ist' were also found to be essential as components of technical terms. The number of technical words with '-tion' was 98 and '-ist' accounted for 29 words. The suffix, '-tion', often constructed nouns from verbs used in nursing or medicine, for instance 'pulsation', 'palpitation' and 'perspiration', and '-ist' formed nouns designating specialists in nursing or medicine, such as 'neurologist', 'ophthalmologist' and 'bacteriologist'.
Conclusion
This study focused on the vocabulary in textbook wordlists, and evaluated textbooks as materials for teaching lexical items. The results suggest that reminding students of general vocabulary is important as well as introducing technical terms to them. The general vocabulary appears to form collocations in the wordlists with nursing or medical terms. It will be necessary for teachers to help students to become familiar with these useful collocations. Regarding technical words, prefixes such as 'anti-', 'pre-', 'peri-' and 'cardio-' and suffixes such as '-itis', '-(o)logy', '-osis', '-graphy', '-tion' and '-ist' were found to be of great importance in introducing technical terms systematically to student nurses.
The validity of using the vocabulary lists in these textbooks themselves as an indication of what might be useful to nurses was not intended in this paper, and no attempt to ascertain actual frequency of lexical use by nurses was made. In future research, a large corpus of English actually used by Japanese nurses would need to be created and analyzed for this purpose. Words, word forms and fixed lexical phrases frequently observed in nurses' actual conversations would be of great interest and oral English should also be included in the corpus and analyzed to find actual frequency data of lexical use.
As a final note, one problem related to the introduction of vocabulary to students using the textbooks is that the exercises and activities often rely on a translation-based method and many of them are non-creative and non-interactive. One of the pedagogically effective ways that student nurses can incorporate words into their vocabulary and use them in English communication could be to design speaking exercises for role-playing, pair-work, and/or group activities such as performing short plays or playing games focused on the appropriate uses of targeted lexical items. Topics and/or situations in nursing need to be incorporated into tasks, exercises and activities teachers design in order to motivate students. The use of audio-visual materials for instance films, videos, television, audio tapes, computer software could aid in pursuing communicative goals in the classroom. Teaching methods for lexical items in nursing/medical English need to be explored in further study.
Acknowledgment
The author would like to express sincere gratitude to Susan Hunston, Carol Rinnert and Adrian Paterson for their comments and suggestions.
References
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- Carter, R. (1998). Vocabulary: Applied linguistic perspectives (2nd. ed.). London: Routledge.
- Collins COBUILD English Dictionary (2nd. ed.). (1998). London: HarperCollins.
- Fujieda, K., & Mann, R.W. (2000). An abridged version of "Intensive care: The story of a nurse by Echo Heron". Tokyo: Japanese Nursing Association Publishing Company Ltd.
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Fumie Takakubo teaches nursing/medical English at Matsuyama School of Nursing. Her research interests include classroom second language acquisition and materials development.
Appendix
Textbooks Used and Locations of Wordlists
| Textbooks (in chronological order) | Locations of wordlists |
| 1. Austin, D. & Crosfield, T. (1998). English for nurses. Tokyo: Hirokawa Publishing Co. | A long list at the end of the book |
| 2. Takashina, T., Kinoshita, K., & Barraclough, G. (1999). English conversation license for nurses. Tokyo: Igakushoin. | A short list at the beginning of each unit and a long list at the end of the book |
| 3. Setzler, H.H., Hale, C. A., & Suzuki, D. (1999). Graded reading and conversation series for nurses. Tokyo: Igakushoin. | A short list in each 'vocabulary and expression' section, and a long list at the end of the book |
| 4. Fujieda, K., & Mann, R.W. (2000). An abridged version of "Intensive care: The story of a nurse by Echo Heron". Tokyo: Japanese Nursing Association Publishing Company Ltd. | Footnotes at the bottom of each page |
| 5. Koga, H. (2000). Basic English for medical care. Tokyo: Yumi Press. | A list in the middle of the book, and a long list at the end of the book |
| 6. Chinen, C., & Kohtaki, M. (2000). Christine no yasashii kanngo-eikaiwa [Christine's easy English conversation for nursing care]. Tokyo: Igakushoin. | A long list at the end of the book |
| 7. Ozaki, T. (2000). Hajimete no kangoeigo [Nursing English for the first-time learners] Tokyo: Igakushoin. | A long list at the end of the book |
| 8. Sukegawa, H., Engel, N., & Fukaya, K. (2000). Nursing today in America. Tokyo: Igakushoin. | A long list at the end of the book |
| 9. Niki, H., Sunagawa, H., & Sharts-Hopko, N. (2000). Rinshoh kango eigo [English for clinical nursing care] --- Let's listen, speak and learn. Tokyo: Igakushoin. | A short list at the end of each unit |
| 10. Kawai, N. (2001). Medical English for nurses. Osaka: Medica Press. | A long list at the end of the book |
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