論文摘要：
護理紀錄乃護理程序中非常重要的一部分，為重要之文件。護理紀錄有其特殊之省略語法。而在台灣的護理專業人員不論在學或就業期間皆以中英文夾雜方式書寫護理紀錄。隨著越來越多的外籍病人與看護加入醫療體系，中英夾雜不僅阻礙了來自不同語言背景護理人員彼此間的了解及國際化，且隱藏醫療風險。因此，本研究除了針對護理人員的專業英語需要而研發一套因應該需求的教材之外(Nursing English for Pre-professionals)，並以臺灣北部某技術學院152位五專部護理系四年級學生作為教學實驗對象給予護理紀錄省略語法教學、並以一次前測、兩次後測以評量教學效果。本教學研究以相依樣本T檢定的統計分析方法來探討受試學生在前後測分數的差異。並分別針對九個依變項做前後測的檢定。相依樣本T檢定的結果顯示經教學介入後，受試學生在Total (八項加總) 的前測和後測分數上有差異存在，並且後測分數（M=0.67）顯著的高於前測分數（M=0.18）。McNemar-Bowker檢定的統計分析結果顯示受試學生前測時偏好的語言和後測時偏好的語言有不一樣的分配。 護理記錄中英文夾雜的語言現象形成的原因包含語言文法能力問題、  醫院語言環境之影響(如醫生以英文書寫)、 及工作時間壓力等。 除了醫學術語外，如何應用專業語彙與語法並以之有效解決病人的問題是護理專業英語的重要研究議題。

Abstract: 
Nursing note writing, a very important part of nursing procedures, can be about what a nurse did, what s/he is doing and what s/he is planning to do for the patient.  Although written in an abbreviated form, it is not written arbitrarily.  However, it is very common that the nursing pre-professionals switch codes in their writing of nursing notes.  As nursing note is part of the legal document, and with more and more patients as well as foreign care givers joining the medical context, nursing schools are facing the challenge of improving the quality of English education.  Therefore, this project employed the established grammar lists developed from the textbook: Nursing English for Pre-professionals as a tool to teach 152 nursing students from the 5 year program of a nursing department at an institute of technology in Taiwan.  Taken as a whole, the teaching treatment has significant effect (*p<.05) on the subjects in all the eight grammar categories in both the posttest (M=.66) and the retention (M=.53).  In dealing with language preference, among the 82 valid subjects, 50 of them preferred to write in Chinese at the beginning.  However, only half (N=25) of the subjects preferred Chinese in the end of the study while thirty nine preferred Code Switching.  At the beginning, the subjects mostly believed that they used Chinese at work.  However, at the end of treatment, most of them believed that they switched codes at work.  And when they worked at hospitals, “time constraint” was the most frequently perceived difficulty at work, with “grammar” being the second most often perceived difficulty.  Finally, other than a form-focused grammar course, also highly recommended is during the junior years, the teaching of problem solving skills be added as part of the content of the ESP course.

TABLE OF CONTENTS
ACKNOWLEDGEMENTS………………………………………………….…….……….i
CHINESE ABSTRACT…………………………………………………….……..………ii
ENGLISH ABSTRACT…………………………………………………….….……..….iii
TABLE OF CONTENTS…………………………………………………...……………..v
LIST OF TABLES……………………………………………………………....……....ix	
LIST OF FIGURES………………………………………….………………….……….x
CHAPTER ONE: INTRODUCTION
1.1 Background and Motivation………………….………….……….……....…1
1.2 Statement of the Problem……………………………….…………….…….2
1.3 Purpose of the Study.…………………………………………………........10
1.4 Research Questions…………………………………………….…..………10
1.5 Significance of the Study…………………………….….…………...…….11
1.6 Definition of Terminology……………………………..………….….........13
1.7 Organization of the Dissertation..…………………...………………..........15
CHAPTER TWO: REVIEW OF THE LITERATURE
     2.1 English for Specific Purposes (ESP)..…..………….…….…………...........17
          2.1.1 Origins of ESP………………………………………………………17
		2.1.2 Content-Based Teaching………………………………….…………18
2.1.3 The Branches of ESP……………………….……………….………20
2.2 The Nursing Communication Strategies…………………………….……...22
2.2.1 Nursing Professionals and English Proficiency…………………..…26
2.2.2 Status of Nursing Note..….…………………………………...…......28
2.2.3 Charting—a Process of Problem Solving……………………….......31
2.3 The Sociolinguistic Problem and the Consequential Needs...………………32
2.3.1 Code Switching in Communication.………………………..……….33
2.3.2 The Code Switching Phenomenon and the Motivations…………….37
2.3.3 Code Switching and the Consequential Learners’ Needs...……...…..41
2.3.4 Delayed Needs and Narrow Focus.……………………………….…42
2.4 Course Design and Language Learning Theories.…………………………..44
2.4.1 Product vs. Process Oriented Approach…………………….……….44
2.4.2 Kaplan’s Straw-man Theory.……………………………………...…49
2.4.3 Functions and Forms…………………………………………….….50
2.4.4 The Role of Consciousness…………………………………..….….54
2.4.5The Princi¬ple of Debt Incurred……………………………….…..…58
2.5 Summary…………………………………………………………………...61
CHAPTER THREE: METHODS
3.1 Design of the Study.…………………………………………………….......64
3.1.1 Subjects………………………………………………………….......64
3.1.2 Instruments....…...…………………………………………………..65
3.1.2.1 Development of Teaching Materials……………...………….65
3.1.2.2 Instruments for Teaching Treatment…………………………72
3.1.2.3 Nursing Note Grammar Test…………………………..….….73
3.1.2.4 The Survey Questionnaire………………………………...…74
	3.1.3 Procedure of Teaching Treatment…………………………………...75
	3.1.4 Procedure of Nursing Note Grammar Test………………………….75
	3.1.5 Scoring of the Grammar Tests………………………………………76
3.2 Data collection, Analysis and Statistics…………….………………………76
3.3 Summary………..…………………………………………………………..77
CHAPTER FOUR: RESULTS
	4.1 Treatment Effect……………………………...…………………………….79
4.1.1 Eight Grammar Categories………………………………………….80
4.1.1.1 Omitting the Subject…………………………………………80
				4.1.1.2 Omitting the Object……………………………………….…81
4.1.1.3 Omitting Subject and Auxiliary Be…………………….….…82
4.1.1.4 Omitting Article “the” ……………………………………….83
4.1.1.5 Omitting Verb Be…………………………………………….83
4.1.1.6 Omitting Passive Auxiliary Be…………………………….…84
4.1.1.7 Using Abbreviation………………………………………..…85
4.1.1.8 Writing with a Tense…………………………………………86
4.2 Code Switching….……………………………………………….…….…...87
4.3 Difference in Language Preference………...…………………….…............88
4.4 Other Results…………………………………………………….………….91
4.4.1 Language Use…………………………………………….………….91
4.4.2 Perceived Difficulties at Work…………………..……….………….92
4.5 Summary.……...…………………………………………………….............93

CHAPTER FIVE: DISCUSSION
5.1 The Easy vs. the Difficult Nursing Note Grammar Categories……………..95
5.1.1 The Difficulty in Using Appropriate Tenses.…………………...…...95
5.1.2 Significant Treatment Effect of Subject and Object Omission……...98
5.1.3 Better Retention Score of Omitting Be Verb………………………100
	5.2 Code Switching in a Qualitative View…...………….……………..……...100
5.2.1 More Code Switching and Mixing at Pretest…….………………...101
5.2.2 Slight Increase of Code Switching at Posttest.……...………..........103
5.2.3 Very Little Code Switching at Retention.………….………………106
5.2.4 Chinese Is the Matrix Language in the Code-switched Writing..….110 
5.3 Difference in Language Preferences………………………………………116
    5.3.1 The Code Switching Phenomenon and the Motivations…………...117
    5.3.2 Difference in Belief of Language Use at Three Treatment Times…119
5.4 Impact of Doctors’ Diagnoses and Orders………………………………...121
5.5 Summary…………………………………………………………..………126
CHAPTER SIX: CONCLUSIONS
6.1 Summary of the Study…………………………………………….………128
6.2 Pedagogical Implications……………………………………….…………129
6.2.1 Goal-oriented Nursing English Course Design………………….…130
6.2.2 A Form-focused, Product-oriented Course…………………..….…131
6.2.3 What Kind of Focus and on What Forms?.………………..............132
6.2.4 Nursing ESP Course Design—Goes Hand in Hand with GEPT......135
6.2.5A Systematic Approach to ESP Course Design…………………….136
6.3 Limitations and Suggestions for Further Research………………………..137  
6.3.1 Limitation of the Study.……………………………………………137
6.3.2 Suggestions for Futures Nurses……………………………………140
6.3.3 Suggestions for ESP Teachers and Researchers…………………...140
6.3.4 Concrete Ways to Cooperate………………………………………142
6.3.5 Inter-discipline Cooperation……………………………………….142
REFERENCES.………………………………………………………………………..144
LIST OF APPENDICES
Appendix I: Samples of Admission Note.…………………………………..…155
Appendix II: List of PQRST Questions for Pain Assessment…………………159
Appendix III: ‘Hints and Kinks‘ for Nurses…………………………………..165
Appendix IV: Samples of Situational Dialogues and Nursing Notes……..…..167
Appendix V: List of Tips for Treatment………………………………….…...180
Appendix VI: Test and Questionnaires (with answer key)……………….…...183
Appendix VII: Pretest/Posttest/Retention…………………………….....…….187
Appendix VIII: Consent Form………………………………………………...192
Appendix IX: Nursing Notes Coding Results………………………..………..193
Appendix X: Mandarin Phonetic Symbols……………………………............198

LIST OF TABLES
Table 2-1: A Sample Patient Assessment Form…………………………………...….30
Table 4-1: One-way ANOVA—Overall Improvement Due to Treatment……….…...80
Table 4-2: Omitting Subject--One-way ANOVA with Repeated Measure…….……..81
Table 4-3: One-way ANOVA with Repeated Measure--Omitting Object…………....82
Table 4-4: One-way ANOVA with Repeated Measure--Omitting Subject and Be…..82
Table 4-5: One-way ANOVA with Repeated Measure--Omitting Article “the”……..83
Table 4-6: One-way ANOVA with Repeated Measure--Omitting Verb Be……….…84
Table 4-7: One-way ANOVA with Repeated Measure--Omitting Passive Be….……85
Table 4-8: Abbreviation--One-way ANOVA with Repeated Measure…………….…85
Table 4-9: One-way ANOVA with Repeated Measure—Tense……………………...86
Table 4-10: Language Preference via McNemar-Bowker Test……………………....88
Table 4-11: McNemar-Bowker Test--Language Preference in Two Posttests……….90
Table 4-12: Beliefs of Languages Used at Work via McNemar Test…………….…..91
Table 4-13: Perceived Difficulties at Work……………………………………….….93
Table 5-1: Distributions of Types of Motivations across Languages at Work……...119
Table 5-2: Doctors’ orders and the Consequential Nursing Notes……………….…124
Table 6-1: Descriptions and Examples of Professional Nursing Notes…………….134

LIST OF FIGURES
Figure 1.1: An Admission Note Excerpt…………………………………………...….6
Figure 1.2: Concept of the Study…………………………………………………….12
Figure 2.1: Hints and Kinks of PQRST……………………………………………...26
Figure 2.2: A Dynamic Product vs. Process Approach to Teaching
EFL Nursing English………………………………………………...…..48
Figure 2.3: Causative Relationships in ESP Pedagogy……………………….....…..50
Figure 3.1: The 16 Specialties of Medicine……………………………………….....66
Figure 3.2: Teaching Treatment--Tip 5………………………………………………72
Figure 4.1: Comparison of Language Preference between Pretest and Retention..…89
Figure 4.2: Comparison of Language Preference between Posttest and Retention…90
Figure 4.3: Beliefs of Languages Used at Work at Different Treatment Times…..…92
Figure 5.1: Language Preference at Retention……………………………………..116
Figure 5.2: Beliefs of Languages Used at Work at Different Treatment Times……120
Figure 6.1: Product-oriented Course Design for the Five Year Nursing Program…130

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