Living the Language: A nurse's guide to English usage in Australian life and work

Living the Language A nurse’s guide to English usage in Australian life and work

Contents 03

1. Workplace communication

18

Establishing rapport

04

Workplace responsibilities

19

Active listening

05

Professional standards and code of conduct

20

Using plain English and paraphrasing

06

Working with other nurses

21

Communicating bad news

07

Working with doctors

22

Using available resources

09

Working with other members of the healthcare team

23

Working with interpreters

10

Understanding medical terms and abbreviations

24

3. Social Communication

11

Fear of the phone

25

Australian slang and expressions

12

The ISoBAR communication tool

26

Accents and diversity

13

Documentation

27

Best practice

14

Clinical handovers

28

Manners and etiquette

16

2. Patient Communication

29

Topics for conversation

17

Person-centred care

30

Indirect speech and understatement

31

Humour

1.

Workplace Communication In this section we highlight the different ways of working that you may encounter in the Australian healthcare system. We will discuss the concept of a ‘collegial’ style of working and the challenge this may pose to overseastrained nurses unfamiliar with this approach in healthcare settings.

We provide advice on some practical aspects of communication which overseas-trained nurses often find challenging.

These include communicating by phone, verbal handovers, written documentation and record-keeping. We also offer guidance on understanding the specific language of your setting – the abbreviations and medical terms you’ll need to know.

1. WORKPLACE COMMUNICATION

Workplace responsibilities

How to manage those differences?

Ask team members about expectations

Chuntao says...

“You need to like thinking by yourself and give the medication, does she need stronger pain killer? Does she need another medication?… in China we usually just follow the doctors.”

Attend multi-disciplinary meetings to understand who’s involved and their different roles and responsibilities Research the roles within your setting so you understand where you fit in Observe colleagues as they interact and identify and copy appropriate behaviours Develop the confidence to advocate for your patient with doctors and the wider team

Angelica says...

“They ask us about how the patient is feeling and do you think we need to change the medication and ah, these are both questions they can ask from us, but in our country it was entirely different - the doctors were more powerful than the nurse.”

Is your experience like that of Chuntao and Angelica?

If so, you’ll notice that in Australia nurses, doctors, and other healthcare professionals function as one team, adopting what is known as a multi-disciplinary or interprofessional approach centred around the patient.

What differences might you notice about your new working environment?

Being part of a multi-disciplinary healthcare team – doctors, physiotherapists, dietitians, pharmacists, and occupational therapists among others Being expected to express professional opinions – show medical knowledge and critical-thinking skills A higher level of teamwork between doctors and nurses Being expected to make decisions independently of doctors’ instructions

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1. WORKPLACE COMMUNICATION

Professional standards and code of conduct It’s important to know that effective communication is an expectation from you as a nurse registered with the Nursing and Midwifery Board of Australia (NMBA).

This includes: Communicating clear and accurate information about a patient in your care in a timely manner to your colleagues in a healthcare setting Communicating effectively, recognising, and respecting a person’s dignity, culture, values, beliefs, and rights For more information, you can access the NMBA’s professional standards and code of conduct on their website.

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1. WORKPLACE COMMUNICATION

Working with other nurses In the Australian healthcare system, you may work with nurses with different designations – nurse practitioners, registered nurses, enrolled nurses and even student nurses.

Each designation has its own scope of practice as defined by the NMBA. It’s important that you’re familiar with your own scope of practice and are guided by what you can and can’t do depending on your designation or type of registration. You can refer to the different standards

In most hospital settings, you will be allocated responsibilities and patients in a working shift by the nurse-in-charge. In some clinical areas, you may also be part of a team of two or more nurses. It’s important that you know your responsibilities before you start your shift.

If you’re unsure, talk to the nurse-in-charge and clarify what your responsibilities are for the shift.

Good communication fosters teamwork and camaraderie, especially when working in a nursing team. Below are some tips on working effectively with other nurses:

Get to know your team members at the start of the shift. It’s not uncommon to have an additional or replacement nursing staff for a shift due to staff illness or increased demand. Make sure that you know who you will be working with. This will help you have a better idea of how each individual functions within the team.

Don’t be afraid to ask for help. There will be times when you’re overwhelmed with tasks. When that happens, don’t hesitate to reach out to other nurses or your nurse-in-charge.

There will also be times when you’re not that busy. When you can, ask around if anyone needs a hand with anything, such as checking on patients’ vital signs or doing a visual check on a patient. When you do help out with another nurse’s patient, make sure that you clearly document what you’ve done by writing it down and verbally communicating it to the nurse responsible for that patient.

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1. WORKPLACE COMMUNICATION

Working with doctors Building the confidence to advocate for your patients with doctors.

Nurses and doctors communicate regularly and for varied reasons such as developing patient care plans, discussing concerns, and confirming details of medical procedures.

Nurses who report good relations between themselves and doctors report higher levels of job satisfaction, lower emotional exhaustion, better perceived quality of care and lower patient mortality (Bruyneel, Lesaffre, Meuleman, & Sermeus, 2019).

Within the person-centred care model, your priority is to advocate for your patient. You will need the confidence to discuss with doctors the care your patients need and any other patient-related concerns you may have.

For this reason, learning to manage relationships and communicate effectively with doctors is very important.

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1. WORKPLACE COMMUNICATION

What challenges could you face working with doctors?

Doctors are always occupied

Abdo says...

Their time is in high demand

“I learnt over time that before you go and speak to a doctor you need to gather important evidence that you may perceive that the doctor may ask you... instead of running back and forth from the participant to the patient… so I would say like gathering more information from the participant before going to the doctor is a good skill.”

Opportunities to discuss patient care are brief Doctors’ attitude/professional posture towards nurses

Prisha says...

“It actually can be difficult even now because some surgeons they can be quite rude… and everyone knows they are rude and you know, “Oh God, if I say something he is going to be so rude to me.” ... “Oh God, if I say it I will be in trouble but I need to say it.”

How to overcome problems Be mindful of your responsibilities towards your patients – your sense of duty.

Be prepared with any relevant patient information ahead of a conversation.

Seize opportunities to clarify patient care plans when you can.

Communicate clearly and concisely – use the ISoBAR communication tool (see page 12), which is expected in many healthcare settings in Australia.

Angelica says...

“So whenever I see like a group of doctors coming in… I have to like get plans after like the morning rounds and it is difficult to just keep on chasing… so I make sure that I go with them [on rounds] and chat with them like what the plan is.”

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Reference Bruyneel, L., Lesaffre, E., Meuleman, B., & Sermeus, W. (2019). Power Distance and Physician–Nurse Collegial Relations Across 14 European Countries: National Culture is Not Merely a Nuisance Factor in International Comparative Research. Journal of Nursing Scholarship, 708-716.

1. WORKPLACE COMMUNICATION

Working with other members of the healthcare team Aside from other nurses and doctors, you will regularly work with a few different health professionals and non-health workers.

The size of the team depends on your workplace – it can be a small team in a GP clinic or a large team in a major city hospital. It’s important to remember that everyone has their own part in ensuring patient safety and quality of care.

Tips to work effectively as part of a healthcare team: Familiarise yourself with the members of the healthcare team. This may include both clinical (e.g., allied health) and non-clinical workers (e.g., administrative staff).

Introduce yourself if you’re meeting someone for the first time. Ask them about their role and area of responsibility. This way you’ll understand how they contribute to patient care and management.

If you can, try to build rapport by talking to them when you see them. It could be a short exchange of greetings or chat about things outside of work.

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1. WORKPLACE COMMUNICATION

Understanding medical terms and abbreviations With greater responsibility comes the need to understand a wider range of medical terms and abbreviations.

Most nurses are faced with this communication issue as soon as they find themselves working in a new healthcare facility.

Additional resources Medical Dictionary by Farlex Department of Health’s Acronyms and Glossary Australian Nurses’ Dictionary (6th ed.)

Better Health Channel

Other ways you can help yourself

There are several sources to help you find meanings for words, acronyms, and phrases you don’t understand. Ask your employer for the list of acceptable abbreviations for your specific workplace.

Take note that some abbreviations that you used overseas may not be used in Australia.

Asking colleagues to define terms Using Google to clarify terms Taking a course

Medication errors Medication errors contribute to many hospital admissions and clinical incidents.

Engaging in self-study

Because of this, it’s important to only use clear and accepted terms. As a nurse, you can ensure that the risk of medication errors is minimised as much as possible. Below are some tips to keep in mind:

Review abbreviations that are NOT to be used

Use plain English and avoid jargon Print all text, especially drug names Use the generic drug names Print drug names in full Use metric units in drug doses Put a zero before a decimal point for a dose less than 1. For example, use ‘0.5’ instead of ‘.5’ Do not use symbols

The Australian Commission on Safety and Quality in Health Care sets out principles for safe, clear and consistent terminology for medicines, as well as safe terms, abbreviations and dose designations for medicines. View their recommendations.

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Reference Government of South Australia. (2011). Spell it out: standardised terminology, abbreviations, and symbols to be used when communicating about medicines. Accessed from: https://www.sahealth.sa.gov.au/wps/wcm/connect/ dd45b8804390a6f58bc3dfbc736a4e18/Spell+it+out+Guidelines+2011. pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACEdd45b8804390a6f58bc3dfbc736a4e18-nwKuOLS

1. WORKPLACE COMMUNICATION

Fear of the phone Any communication difficulties you already have are often made worse when it comes to using the phone.

Telephone communication is generally harder as there are no non-verbal cues to aid understanding and factors such as accents can really get in the way.

Speaking to doctors on the phone is a task that many new overseas-trained nurses find especially difficult.

Why is it difficult?

Having to think and speak quickly Guilt - fear of interrupting a busy doctor No body language to read Accents are tricky Fear of sounding stupid

Top tips to take the fear away Use the ISoBAR tool (see page 12) to structure your conversation Be prepared with what you need to say and be clear about the outcome you want Stick to the facts Speak clearly and concisely– get to the point quickly Practise first with a colleague Role-play common situations e.g., on the phone with ambulance paramedics Have pre-prepared lines like “Let me check on that and get right back to you.”

Listen attentively Summarise the conversation to check for comprehension Don’t be afraid to ask questions for clarification

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1. WORKPLACE COMMUNICATION

The ISoBAR communication tool

I

Introduce or identify patient, self and team

IDENTIFICATION

S

SITUATION

O

Provide current working diagnosis, specific clinical problems, concerns and critical laboratory results

Check, update and discuss recent vital signs

OBSERVATION

B

Update and discuss relevant medical and support information

A

Outline plan for assessment, treatment and discharge

BACKGROUND HISTORY

AGREE TO A PLAN (ACTIONS)

R

RESPONSIBILITY AND RISK MANAGEMENT

Confirm shared understanding; clarify tasks (read back critical information to check understanding), timing and responsibility is transferred

Reference Australian Commission on Safety and Quality in Healthcare. (2020). Clinical handover. Accessed from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/communication-clinical-handover/action-607 12 | Living the Language

1. WORKPLACE COMMUNICATION

Documentation

What are the challenges?

Good record keeping is vital for effective communication and integral to promoting continuity of care and safety for patients.

Writing quickly

In a worst-case scenario, written documentation also provides evidence should there ever be a complaint from a patient/client about their treatment.

Knowing what to include and what not to include

Being clear – can be read by other healthcare providers

Getting the tone right

Examples of written documentation might include: Handover notes Care plans Admissions paperwork Medication and observations charts Referral letters Discharge summaries Overseas-trained nurses sometimes struggle with written forms of communication. This may be due to differences between the new workplace format and the nurse’s previous setting.

Ichika says...

“At the beginning… I didn’t really know how to write it down because of course I know like in Japanese what we should write down but of course in Australia they have a different way to write it to start the sentence.”

Know your responsibilities in record keeping by checking: • The NMBA’s Professional Standards and Code of Conduct • Your employer’s policies

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How to overcome them Familiarise yourself with templates used in your workplace Read good examples from other nurses to understand what is expected Adopt writing style of colleagues Memorise and employ standardised sentences and phrases Practise using best-practice templates e.g., OET Referral Letter Refer to a manager for guidance

1. WORKPLACE COMMUNICATION

Clinical handovers Clinical handovers involve “a transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person / family / legal guardian or professional group on a temporary or permanent basis” (RCH, 2019).

As a nurse, you may provide a clinical handover of one or more patients to another nurse or other members of the healthcare team, including doctors, physiotherapists, radiologists, dietitians, etc.

You may need to handover a patient at the end of your shift, when you transfer a patient to another ward, or when you must leave them for a procedure or test.

Why accurate and complete handovers are essential Providing accurate and complete handovers minimises and prevents communication errors, and promotes patient safety. An effective handover also ensures continuity of care, where the management of a patient is seamlessly transferred from one healthcare provider to another.

Key principles of clinical handover Preparing and scheduling clinical handover Having the relevant information at clinical handover Organising relevant clinicians and others to participate Being aware of the patient’s goals and preferences Supporting patients, carers, and families to be involved in clinical handover, in accordance with the wishes of the patient Ensuring that clinical handover results in the transfer of responsibility and accountability for care.

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1. WORKPLACE COMMUNICATION

Challenges in giving handovers Giving verbal handovers can be nerve-wracking.

You’re often expected to provide a lot of information in a short amount of time. Similarly, preparing written handovers can be time-consuming, especially if you’re looking after multiple patients.

Limited time Too much information Too many distractions

Strategies to overcome them Use a structured clinical handover tool (e.g., ISoBAR tool). Your employer or your specific ward or work area may have an approved structure for clinical handovers. This may also be in a form of a handover checklist. Use this tool to prepare your handover in advance, so that you will not miss any important information.

Emphasise important details and changes in care or management. This is so that the person you’re handing over to can prioritise any crucial information.

Take note that non-verbal communication when handing over is also relevant.

This includes the tone of your voice, your body language, and attitudes. You can also use non-verbal cues from your colleagues to check if they understand you.

After handing over a patient, ask if your colleagues have any questions. This provides a way for them to clarify or check anything about your patient’s care.

Choose a suitable environment that’s free from distractions. You want your listener’s full attention when handing over to minimise any errors. A quiet and secluded space also allows you to focus as you go through your handover notes.

In some work areas, bedside handover is commonly practised. This is also an effective strategy to involve your patient as you discuss their management.

Reference Australian Commission on Safety and Quality in Health Care. Communication at clinical handover. Accessed at: https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/communication-clinical-handover Department of Health, Victoria. Clinical handover. Accessed at: https://www2.health.vic.gov.au/Api/downloadmedia/%7B9350B651-3885-4DD2-B618-D4E624EEC210%7D Giske, T., Melas, S. and Einarsen, K. (2018). The art of oral handovers: A participant observational study by undergraduate students in a hospital setting. Journal of Clinical Nursing, 27: e767-e775.

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2.

Patient Communication Nurses tell us that tasks related to communicating with patients and their families often present the greatest challenge when starting work in a new English-speaking setting. Difficulties can arise from the ‘person-centred care’ model, an approach to nursing practice which may be new to incoming nurses and different from the accepted model of care in their home country.

In this section we: Explain the person-centred approach Discuss the communication challenges it presents Offer tips and strategies to overcome these challenges

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2. PATIENT COMMUNICATION

a. Person-centred care

Was your experience like these nurses?

What is person-centred care?

How is it different from the model of care in other countries where you trained/worked?

What communication challenges may this pose for you as an overseas trained nurse?

Person-centred care is recognised as “the foundation to safe and high-quality care”. Some if its features may be familiar to you, others will be strange and even clash with your previous ways of working. Person-centred care is an expectation within the Australian healthcare system.

Person-centred care means that: Care focuses on the individual’s particular healthcare needs The person is an equal partner and active participant in the planning of care Their opinions are important and respected

Bolin says…

“In China… well we should say family kind of centred care not really patient… because in China if patient got cancer, the patient will be last one to know.”

Prisha says... ““Here we have to engage the patient in their care, like they need to be explained everything. In India it was different like that, if we want we can give some information to them but not everything.”

Chuntao says...

“In China they like one nurse doing medication, one nurse doing IV and one nurse look after observations… So it is all task individualised like nursing responsibility but here it is more like one nurse is looking after everything.

So observation, medication, personal hygiene, everything.”

They are involved in every step of their treatment Workplace procedures are patient rather than task focused

It requires that: We think about the effect of what we’re doing on the person as a whole We act on what people want when we plan and deliver their care We always have the person’s safety, comfort, and well-being uppermost in our minds We communicate well across multidisciplinary teams to meet the person’s needs We advocate for the patient – uphold their rights to the highest degree

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Communication challenges presented by person-centred care Working across teams Need to build rapport Confidence to advocate for the person Providing information in a format that is acceptable to them and helps them make decisions Explaining complex information in plain English Paraphrasing for patients and families what a doctor has said

2. PATIENT COMMUNICATION

Establishing rapport

Tips on building rapport for overseas nursesdoctors

What is rapport?

Memorise and rehearse a clear introductory routine involving a concise opening statement

O’Toole defines rapport as the development of a therapeutic relationship based on mutual understanding (respect, empathy and trust) (O’Toole, 2016). Establishing rapport is a central concept in the model of person-centred care.

Why is it important to establish rapport?

To gain a patient’s trust To make them more receptive to the care you will be giving As preparation for gaining consent for care or medical intervention To reassure a patient and make them feel acknowledged and valued

Prepare generic topics for opening a conversation e.g., the weather, how did you sleep Notice what’s going on e.g., a patient had a new visitor during your last shift Use body language to show empathy e.g., maintaining eye contact, open posture Be outwardly confident to reassure patients of the care they are receiving Convey detail about even the most basic of procedures being performed such as blood pressure monitoring or hand-care Remember details during handover that you can bring into conversation e.g., went for CT scan yesterday evening

Some obstacles to gaining rapport Not knowing what to say Being focused on the task rather than the patient Time constraints through pressure of work Not using what you already know about the patient.

Prisha says…

“When we are going to have any procedures… for say wound dressing… we go to patient’s room and ask them that ah, this is what I am going to do and I need this one to be done and it will not take much time and I explain them what the procedure is going to be like and how much time it will take.

Is it painful or not painful? And communicating with them while doing the procedure so that it can make them comfortable.”

Angelica says...

“Hello my name is Angelica and I came to (let us say) check your wound,” or something so just introduce yourself and then, um ask, “Hi, how are you?” “Did you sleep well yesterday,” or something just to start with a casual conversation.

Prisha says...

Reference Professionals. In G. O’Toole, Communication: Core Interpersonal Skills for Healthcare Professionals. Elsevier.

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“You greet the patient and you have to first introduce yourself… then you have to really tell what will be going to happen and it depends on what is the condition of the patient what is happening during that um, day.”

2. PATIENT COMMUNICATION

Active listening What is active listening?

Why is it important?

Tips on active listening for overseas nurses Active listening is an important part of person-centred care. It is closely related to empathy.

Nurses often feel they want to offer a solution or reassurance to patients especially when a patient is visibly in distress. In many cases, especially with end-oflife patients, this isn’t possible or appropriate.

Active listening offers strategies that allow you to help someone without the need for you to try to solve their problems. It also offers the language you need to manage those kinds of conversations.

Skills of active listening (Bramhall, 2014) Asking open questions e.g., “how are you?”

Asking open directive questions: for example: “How are you since I last saw you?”

Looking and listening for cues Reflecting back to show you have heard what was said and to expand the conversation Body language – open posture, good eye contact, gestures

Phrases to help you become a good active listener Exploring cues: “You said you are not with it, can you tell me more about that?”

Screening: “Is there something else?”

Clarifying: “You said you are not with it, from what you say, it sounds like it is hard to concentrate?”

Reflecting back: Patient “I thought I would bounce back after the surgery, but that hasn’t happened.” Nurse: “Bounce back?” (pick up the cue and pause for the patient to say more) Reference Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard, 53-59.

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2. PATIENT COMMUNICATION

Using plain English and paraphrasing

Tips for overseas nursesdoctors

An important part of person-centred communication is learning how to talk about medical issues using words that a patient without a medical background can understand.

Build up a bank of plain English words to complement your existing medical vocabulary e.g., bruise for hematoma, needle for cannula, ‘to lie on one’s back’ for ‘to lie supine’.

Why is it necessary?

For mediating between doctor, patient, and family.

In this role nurses are often called on to summarise, paraphrase or translate into plain English complex medical scenarios For gaining consent. Patients and their families must be able to understand the care or treatment they are consenting to For checking your own understanding of what a doctor or patient has just told you.

Prisha says…

“So I can only do that when the doctor had been there and has explained any condition to the patient beforehand… and then the patient and family comes back and “What did he talk about please say again?” ...kind of like paraphrase for them like this means for example your heart isn’t really doing too well, not pumping.”

Abdo says...

“We have to give lots of morphine so in this case we have to use very specific medical terms and then we try to explain to family members because we have to really get consent from them that they agree with what we are going to do... some people are really against using morphine… They believe that it might make the person’s life go quicker but actually it is not true so you have to really explain.”

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Organise and reflect on information before paraphrasing

Follow your paraphrasing with a short phrase like ‘Is this correct?’ to make sure you have understood correctly Practise using phrases such as: ’Did you understand what the doctor said?

‘Let me explain a different way’ ‘What this means is …’

2. PATIENT COMMUNICATION

Communicating bad news Nurses often report that communicating bad news to patients and patient families is the most difficult communication task they face in their work.

While the breaking of bad news usually falls to doctors, there are many daily scenarios faced by nurses that require confidence and competence in the delivering of bad news.

Day to day examples of handling bad news Preparing patients/relatives to receive bad news Supporting patients/families following bad news Creating opportunities for patients/families to talk about bad news Helping patients/relatives come to terms with the implications of bad news over time Being present when a doctor breaks bad news Sudden death situations

Useful phrases and words for communicating bad news Having some well-tested, standard phrases that you can practise saying will help you feel more confident in these situations. The following is adapted from the book ‘How to Break Bad News’ (Buckman, 1992).

Giving information honestly but sensitively in plain English Use language that is appropriate to your patient’s ability to understand, with minimal medical and technical jargon.

For example, say “He has died,” rather than “he has gone/passed away.”

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Acknowledging emotions “Hearing the result of the bone scan is clearly a major shock to you.”

“Obviously this piece of news is very upsetting for you.”

“I can see this is very distressing.”

“That’s not the news you wanted to hear, I know.”

Responding empathetically Empathic responses help to validate the recipient’s feelings and show that you have given some consideration to their feelings “I wish the news were better.”

Handing difficult questions This may include, “Am I going to get better?” “Am I going to die?” “How long do I have?” A sample answer may be: “That’s a difficult question, there are no simple answers.”Do not be afraid to say, “I don’t know.”

2. PATIENT COMMUNICATION

Using available resources

Angelica says...

“I have to do that first in my head and have a script ready for them in my head before I picked up the phone and called but it was quite confronting with the first, the first ever death that I have had.”

Tips to develop your skills Seek opportunities to see good skills modelled by another nurse Find a mentor to guide you in best practice Remember the role of body language when delivering bad news Memorise or rehearse key phrases – particularly useful in an emergency

Your skills in building rapport will provide a good foundation for managing difficult conversations.

Reference Buckman R. (1992). How to Break Bad News, a guide for health care professionals. University of Toronto Press, Toronto. Buckman R. (2007) SPIKES Makes Bad News Easier, Conversations in Care. http://www.conversationsincare.com/web_book/chapter05.html [accessed 12 March 2007].

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2. PATIENT COMMUNICATION

Working with interpreters There will be times when you’re looking after a patient who also has English as a second language. In Australia, you can use interpreters to make sure that the patient and their family understand medical terms or phrases that are too technical.

Remember that as a nurse, it is part of your duty of care to make sure that your patients fully understand the management that they are receiving. This is an essential component of informed consent.

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Before accessing an interpreter, check if your workplace has a policy in using one. In some simple day-to-day situations (e.g., asking what they’d like to eat), getting a patient’s family member to translate may be appropriate.

However, some more serious forms of communication such as consenting to a surgical procedure likely requires the use of an accredited interpreter.

Resource on interpreters Better Health Channel (Victoria): https://www.betterhealth.vic.gov.au/health/ ServicesAndSupport/cultural-and-linguistic-diversity-andhospital#family-or-friends-as-interpreter to Break Bad News’ (Buckman, 1992).

3.

Social Communication As a newly hired nurse you will be mixing in with people from many different backgrounds in both your professional and personal life.

Some overseas-trained nurses say that they find it harder to communicate on a social rather than a professional level.

This is because they may be less familiar with general or cultural topics than workplace ones.

In addition, the way people speak English and the words they use vary greatly across groups. Humour plays a key role and accents can also be a major issue in a multicultural environment like a hospital.

In this section we examine: Australian slang and expressions Manners and etiquette Topics for conversation in social situations The role of humour and understatement

3. SOCIAL COMMUNICATION

Australian slang and expressions “What time is the ambo booked for Mr. Smith in Bed 13? Make sure his discharge meds and paperwork are ready so there won’t be any dramas when the ambo gets here.”

Are there any words or expressions above that didn’t make any sense?

Australian slang, idioms and expressions are a key feature of everyday communication in Australia. You will encounter these at work and out in the community.

Because they don’t always make sense literally, it’s a good idea to familiarise yourself with the meaning of the most common ones and how they are used. Including idioms and expressions will make your English sound more natural.

Resource on interpreters Australian slang

Meaning

Example

ambo

ambulance

What time did you book the ambo?

arvo

afternoon

Any plans this arvo?

avo

avocado

This avo’s pretty good.

barbie

barbecue

We’re having a barbie at the park tomorrow.

barrack

to show support

What team do you barrack for?

bathers

swimsuit

We’re going for a swim. Don’t forget your bathers.

bloke

man

The bloke in bed 5 is waiting for a scan.

brekky

breakfast

What did you have for brekky?

chockie

chocolate

She’s gone out to grab some chockies.

cuppa

cup of tea

Would you like a cuppa?

flat out

really busy

Would you mind giving me a hand? I’m flat out.

footy

football

Are you going to the footy?

hard yakka

hard work

Picking fruits is hard yakka, mate.

lollies

sweets/candies

Pick up some lollies on your way back.

no worries

no problem

No worries, mate. It’s all good.

servo

service station

Stop by a servo and get some snacks.

sunnies

sunglasses

Have you seen my sunnies?

thongs

flip flops

He’s only wearing thongs again.

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3. SOCIAL COMMUNICATION

Accents and diversity Someone’s accent when speaking English is influenced by where and how that person learned English.

Someone who grew up in Australia may speak in an Australian accent, while others who have English as a second language and learned it elsewhere may pronounce words differently.

As a nurse in a culturally diverse country like Australia, you can expect to hear many different accents in your workplace and out in the community. Some migrant communities in Australia have even adopted their own blend of English and native language.

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3. SOCIAL COMMUNICATION

Best practice Don’t feel bad if you find it difficult to understand some words, slang, or expressions when talking to someone.

There are strategies that you can use to minimise any misunderstanding or confusion in social situations. Below are some of them: If you can’t understand a word, ask the speaker to repeat themselves or to speak more slowly.

It’s okay to ask for clarification. For example, “What did you mean when you said ‘dog’s breakfast’?”

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Listen closely and try to remember and repeat commonly used words and phrases.

Use Google to clarify meanings of slang terms if you don’t feel comfortable asking.

Try to use these words or phrases when you can. If unsure, you can always ask, “Did I use that word/phrase correctly?”

Watch Australian movies/TV shows and listen to local radio stations to familiarise yourself with Australian expressions, slang, and idioms.

3. SOCIAL COMMUNICATION

Manners and etiquette Meeting for the first time

Out and about While Australians are generally laidback, there are some social rules to keep in mind.

When meeting someone for the first time, it’s common courtesy to introduce yourself. Australians are not very formal, especially in social situations. Common greetings including a simple hi, hello or g’day (good day) are acceptable. You might also get asked ‘How’s it going?”, which is a common expression to ask how you are.

A handshake and a smile also go a long way when you introduce yourself to someone new!

Dining Someone might invite you to their home for a gathering or a party. In the summer, you might even get an invite to a backyard ‘barbie’ (or barbecue). As a form of courtesy, always ask the host if there’s anything that they would like you to bring to the gathering. When in doubt, it’s polite to bring a bottle of wine for the hosts.

Don’t cut in line or as Aussies call it, ‘push in’.

It’s considered rude to do so and you will likely get confronted if you try. Stay in the queue and wait for your turn.

Don’t leave your rubbish (trash) behind. Not only will you get a fine if you’re caught doing it, it’s also generally frowned upon. Throw away your rubbish in rubbish bins or take it with you until you find one.

Give people space. This means not standing very close to another person and leaving spare seats if you can in public transport or keeping your distance in a shop or restaurant.

Appropriate body language. Australians usually look a person in the eye when talking to them.

You might also get invited to a ‘B.Y.O.’ gathering. B.Y.O. stands for ‘bring your own’, and is essentially a potluck gathering where each guest brings some food or drinks to share. Sometimes you may hear someone say, ‘bring a plate’. This also just means B.Y.O. When dining out, it’s common to split the bill or pay for the food and drinks that you ordered. You can clarify this before agreeing to dine out to avoid any awkward conversations after meals, particularly if it’s in an expensive place. Tipping is not commonly practised in Australia.

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Everyone deserves a fair go. Australian society is founded on egalitarian values. This basically means treating everyone equally.

Be respectful of indigenous culture and communities. The Aboriginal and Torres Strait Islander people are the traditional owners of Australian land. It’s important that you show respect to their culture and traditions.

In some cultures, if you’re given a gift, it’s considered rude to open it straight away. Not so in Australia – you can open it immediately and express your appreciation.

3. SOCIAL COMMUNICATION

Topics for conversation When meeting people casually, whether it’s at the supermarket or passing a neighbour on the street, it’s worth having a few topics ready with opening lines that will help you to confidently start a conversation and ‘break the ice’.

What to talk about Choose these topics to avoid awkward silences, seem friendlier, easily get to know someone new and build foundations for deeper friendship.

The weather

“This weather is crazy! It was nice and sunny this morning, and now it’s raining. I hope it clears up soon, don’t you?”

Sports/Australian Football or Footy

“Who do you barrack for (support)?”

Holidays

“What plans have you got over the holidays?

We’re probably going camping.”

Work

“I’m really busy at work nowadays. Is it the same for you?”

Food/cooking

“Have you been to that restaurant? I heard the food’s really good.

Arts and Entertainment

“Have you seen anything good on the telly lately?”

Plans for the day/weekend

“The day’s almost over! Any plans after work?”

Observations

“Nice shoes. Where did you get them?”

Topics to avoid Avoid these topics as you don’t want to cause an argument or make people uncomfortable or want to leave the conversation: Politics

Personal Gossip

Religion

Offensive jokes

Personal Finances

Topics that are inappropriate or too sensitive in nature

Age and Appearance

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3. SOCIAL COMMUNICATION

Indirect speech and understatement “Perhaps we could grab lunch sometime if you want.”

Would this statement leave you wondering if you’d been invited for lunch or not? Possibly! A phrase like this is typical of indirect speech and understatement – a style of communication which is commonly used. By speaking in this way, all parties are protected from possible confrontation and standards of politeness are upheld.

This can be frustrating if you come from a country where people are transparent about what they think and feel.

You’ll find yourself having to ‘read between the lines’ to understand what they really mean which may be a challenge.

The use of understatement is common in Australia.

This may be done to be funny or in some cases to show modesty. You will find that most Australians are relaxed, down to earth, and don’t like giving off an impression that they’re better than anyone else.

Some more examples of understatement are found here.

Yeah, nah and nah, yeah: what do these mean?

The first time you hear ‘yeah, nah’ as a response to a question, you’ll most likely be confused as to what it means. Is it a yes or a no? It’s not that simple!

According to a study on this Australian expression, using ‘yeah, nah’ allows the speaker to show that they’ve considered the question (‘yeah’), before actually responding (‘nah’). This expression has slowly become popular in the late ‘90s, and you will come across it in different situations in Australia.

It can be confusing at first, but you’ll get used to it!

Reference Burridge, K. and Florey, M. (2002). ‘Yeah-no He’s a Good Kid’: A Discourse Analysis of Yeah-no in Australian English, Australian Journal of Linguistics, 22:2, 149-171 30 | Living the Language

3. SOCIAL COMMUNICATION

Humour A vital element in all aspects of life is a sense of humour. Australian humour has been said to sit somewhere between American and British sensibilities.

In Australia, making fun of someone in a friendly way can be a sign of closeness. In your culture this may be inappropriate, but in Australia this usually isn’t meant to cause offense.

You may also be surprised when Australians make fun of themselves. This is known as self-deprecating humour.

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Uses of humour To build rapport To relax a room To downplay achievement and appear modest

However it’s important to know that there are situations when humour can be inappropriate, especially in the workplace. When in doubt, be on the safe side and avoid using humour in a professional environment.

Living the Language A nurse’s guide to English usage in Australian life and work Postal address The OET Centre PO Box 16136 Collins St West VIC 8007 Australia Telephone AUS +61 3 8658 3963 UK +44 1202 037333 USA +1 855 585 0125 Website www.occupationalenglishtest.org