Blog — Clinical Spanish

Spanish for rehabilitation nurses: the motivation conversation with the patient who says “ya no puedo” on day three of PT, the swallowing restriction the patient is violating because “nectar-thick” has no Spanish equivalent, and the wound care discharge lesson that has to make a non-nurse caregiver independent in fifteen minutes

Pedro Hernández is 68, a retired construction worker from Guerrero, nine days post left-hemisphere ischemic stroke. He spent three weeks in the acute-care hospital before his transfer to the inpatient rehabilitation facility, and he has lost fourteen pounds. He still has some expressive difficulty — he knows what he wants to say, but the words come out slower than they used to, and sometimes the wrong word comes out first. His daughter Carmen is 39, works the morning shift at a dental office, and visits every evening from five to seven. She brings food. The discharge summary Pedro arrived with says: “modified texture diet — nectar-thick liquids per SLP, pureed solids. Right forearm PIV site healing, wound care daily until closed. Neurology follow-up in three weeks.” On day three of PT, Pedro sat back down after his second stand attempt and said, “ya no puedo más.” The physical therapist documented “patient declined third rep” and left the gym. Pedro has not stood again today. In the evening, Carmen brought soup. Pedro drank the broth. The broth is a thin liquid. The nurse who comes to do wound care at 7 PM is also the nurse who is scheduled to do Pedro’s discharge wound care teaching with Carmen before Carmen leaves at seven. She has fifteen minutes. Three failure modes that repeat, in some variation, on every inpatient rehabilitation unit where Spanish is the patient’s first language.

Day three on the rehabilitation unit

The first two days in a rehabilitation facility are often the easiest from a participation standpoint. The patient is arriving from acute care, still partly in the acute-care mindset, still tracking the immediate medical events, still somewhat carried by the momentum of having just survived something. The physical therapist is new. The occupational therapist is new. The nursing staff is new. The PT asks Pedro to stand, and Pedro stands, because that is what you do when someone with a badge asks you to stand.

By day three, the acute-care momentum is gone. Pedro is not in a hospital. He is in a place where he will be for another three weeks, and where the job, every day, is to do something that is hard and that makes his deficit visible to himself. He spent forty years in construction. He carried things. He worked on ladders. He was the person in his family who fixed things. Now he is holding on to a gait belt while a woman thirty years younger than him walks beside him in case he falls. “Ya no puedo más” is not a refusal. It is a report. The nurse’s job is to find out what it is a report of.

Three failure modes in rehabilitation nursing Spanish

1. The motivation conversation when the patient says “ya no puedo”

The phrase “ya no puedo” in the inpatient rehabilitation context has at least four distinct referents, each of which requires a different clinical response. A nurse who hears “ya no puedo” and documents “patient declined” has not assessed the patient. She has recorded the output of an assessment that was never conducted.

The four things “ya no puedo” can mean

Physical incapacity: The leg genuinely will not hold. The balance is not there. The affected side has not had enough reps today to be reliable. This is a PT call, not a nursing call, but the nurse who can identify it can communicate it accurately: “El paciente reporta que la pierna no lo aguanta — no descarta el ejercicio, reporta la limitación física.”

Pain: Standing hurts. Not the leg — the shoulder, the hip, the surgical site, the IV site that has been irritated for three days. Post-stroke shoulder pain in the hemiplegic side is common and is often not captured in the chart unless the nurse asks about it separately. A patient who stops exercise because of pain that is not the pain the PT is tracking is a patient who needs an analgesic review, not a motivational conversation.

Fatigue: Sleep disruption in inpatient rehabilitation facilities is nearly universal. Pedro’s roommate has a television. The blood pressure check was at 5 AM. The overnight nurse came in at 2 AM for a medication. A patient who slept three hours is not a patient who can be expected to do three stand repetitions in a morning session. Fatigue-as-refusal looks the same as capacity-limitation-as-refusal unless someone asks about the night.

Psychological exhaustion or grief: Around day three to five of an inpatient rehabilitation admission, many post-stroke and post-surgical patients experience what is sometimes called the “wall.” The acute-care numbness has worn off. They understand where they are, how long they will be there, and what recovery will actually require. In a 68-year-old man who spent his life in physical work and who is now being helped to stand by someone a third his age, “ya no puedo más” may mean none of the above. It may mean: “I understand now what happened to me, and I do not know if I can be what I was.” This is not a PT problem. It is not a medication problem. It is a nursing problem, and it requires a different vocabulary from the other three.

The branch question

Before any intervention — before calling the PT, before reviewing the analgesic schedule, before flagging for a social work referral — the branch question:

“¿Siente que la pierna no lo aguanta, o es otra cosa?”

(Does it feel like your leg won’t hold you, or is it something else?)

This question separates the physical report from the non-physical in one exchange. A patient who says “sí, la pierna no me aguanta” (yes, my leg won’t hold me) has given a physical report. The next question is about the specific mechanism: “¿Siente que le falta fuerza, o que pierde el equilibrio?” (Does it feel like you lack strength, or like you lose your balance?) These are different PT findings and communicate differently to the physical therapist.

A patient who says “no, es que…” and pauses has opened a non-physical door. The follow-up is not another physical question. It is the permission to stay there:

“¿Me puede contar más?”

Pain versus fatigue: the distinction that changes the session

If the pause reveals pain, the localization question:

“¿Dónde le duele cuando intenta pararse? ¿Es en la pierna, o en otra parte?”

The “o en otra parte” (or somewhere else) is the phrase that catches the non-primary pain report. Post-stroke shoulder pain, in particular, is often not the pain the patient leads with, because it is not the pain that seems most relevant to the exercise the therapist is asking about. A patient who stops standing because his hemiplegic shoulder hurts when he puts weight through his arm may not connect that pain to the standing task unless the nurse asks about it separately.

The pain quality question that distinguishes intensity from tolerance:

“¿El dolor es fuerte — el tipo que le hace parar — o es un malestar que siente que puede aguantar si lo apoya algo?”

(Is the pain strong — the kind that makes you stop — or is it a discomfort you feel you could bear if something supported you?) This question does two things: it gives the patient a framework for reporting that distinguishes “stop now” pain from “manageable with help” pain, and it introduces the concept of a support modification without telling the patient to push through pain he has already named as a stop.

If the branch reveals fatigue, the sleep check:

“¿Durmió bien anoche? ¿Pudo descansar?”

A patient who slept two hours is a patient whose refusal is a physiological report, not a motivational problem. The PT communication becomes: “El paciente reporta no haber dormido bien anoche — mejor intentar la sesión de la tarde.” This is a different communication than “patient declined.”

The emotional opening: day three on the unit

If the branch reveals something that is not physical, not pain, and not sleep, the question that opens the door without requiring the patient to name an emotional state:

“¿Hay algo que lo preocupa, además del ejercicio? ¿En qué está pensando?”

(Is there something worrying you, besides the exercise? What are you thinking about?) This question does not ask Pedro how he feels. In many traditional Mexican and Central American cultural contexts, particularly for men of Pedro’s generation, naming emotional distress to a relative stranger — and to a younger woman he has known for two days — is not the normative response to distress. Pedro will say “estoy bien” to “¿cómo se siente?” even if he is not fine. He may not say “estoy bien” to a question about what he is thinking about.

The future-oriented question that works for the patient who has not yet named the grief:

“¿Cómo ve usted lo que viene — cuando salga de aquí, cómo se imagina que va a estar?”

(How do you see what’s coming — when you leave here, how do you imagine you’ll be?) This is not a clinical assessment question. It is an invitation to name what the patient is carrying that the nursing assessment form does not have a field for. A patient who says “bien, espero” (fine, I hope) is not the same patient as the one who says “pues… ya veremos” (well… we’ll see) or “no sé si voy a poder trabajar” (I don’t know if I’ll be able to work) or, most directly, “mi familia va a tener que cuidarme” (my family will have to take care of me).

Any of those last three answers is a social work referral, and possibly a psychology or chaplain referral, depending on the facility. But the nursing role in that moment is not to hand off immediately. It is to acknowledge, briefly and without making a promise:

“Eso es algo importante. Voy a hablar con el equipo para que podamos apoyarle con eso también.”

The purpose frame that reconnects the exercise to what Pedro values

After the branch and the acknowledgment, if Pedro has the capacity to continue and the clinical team agrees, the frame that reconnects the PT goal to what Pedro values:

“El objetivo de lo que estamos haciendo aquí — el ejercicio, caminar, todo — es que cuando salga, pueda manejarse solo en su casa. No tiene que quedar exactamente igual que antes — eso lo van a ver los médicos con el tiempo. Pero lo que hacemos aquí es para que no dependa de otra persona para hacer las cosas de todos los días.”

This sentence does not promise full recovery. It does not tell Pedro that if he works hard enough he will be back on a ladder. It connects the PT stand repetition to independence — the specific thing that a 68-year-old man who spent his life in construction is most likely to name as the loss he is managing. It frames the exercise not as an institutional requirement but as a tool for something Pedro already wants.

The short version, for when there are only two minutes before the next patient:

“Cada vez que se para, aunque sea una vez, es un paso para poder manejarse solo después. No tiene que ser perfecto hoy.”

(Every time you stand, even once, is a step toward being able to manage on your own later. It doesn’t have to be perfect today.) The phrase “no tiene que ser perfecto hoy” is not a motivational cliché in this context. For a patient who spent forty years in a job where a measurement that is off by a centimeter is a mistake, the removal of the perfection standard is a genuine permission.

2. The modified-texture diet restriction the patient is violating because “nectar-thick” has no Spanish equivalent

Carmen brought soup on day one. Pedro drank the broth. The broth is a thin liquid. The nursing order says “modified texture diet per SLP — nectar-thick liquids, pureed solids.” No one has told Carmen, in terms Carmen understands, that the broth is not permitted. No one has told Pedro, in terms Pedro understands, why the restriction exists. Pedro has not aspirated. This is not evidence that the restriction is unnecessary. This is evidence that he has been lucky four times. Silent aspiration — the kind that produces pneumonia without producing coughing during the meal — does not announce itself.

The aspiration mechanism in patient Spanish

The explanation of the restriction that produces compliance is not “el médico lo ordenó” (the doctor ordered it) or “la restricción dice que no puede tomar líquidos finos” (the restriction says you can’t have thin liquids). The explanation that produces compliance is the mechanism explanation in terms the patient can picture:

“Cuando usted tuvo el derrame, los músculos de la garganta que controlan cómo baja el líquido no trabajan exactamente igual que antes. Si usted toma un líquido muy flojo — como agua, café, o el caldo de la sopa — hay una posibilidad de que una parte pequeña entre al pulmón en vez de al estómago.”

Then the sentence that is the most important sentence in the explanation:

“No duele cuando pasa. Muchas veces la persona ni lo nota. Por eso existe la restricción aunque usted no lo sienta.”

(It doesn’t hurt when it happens. Many times the person doesn’t even notice it. That’s why the restriction exists even though you don’t feel it.) This sentence is critical because the most common reason patients discount aspiration restrictions is the absence of symptoms. Pedro has been drinking the broth, has not coughed, has not felt anything go the wrong way, and has therefore concluded, reasonably, that the restriction does not apply to him or is not necessary. The sentence “no duele cuando pasa” removes the symptom-based reasoning before the patient makes it.

The consequence, in patient-Spanish terms:

“Si una cantidad pequeña de líquido entra al pulmón todos los días, puede causar una infección en el pulmón — una pulmonía. Eso atrasaría su recuperación varias semanas. La restricción es para que eso no pase.”

The phrase “atrasaría su recuperación varias semanas” (would delay your recovery by several weeks) is more motivating than “puede causar una infección seria” for a patient who is already tracking his recovery timeline. It connects the aspiration consequence to the thing the patient most wants, in concrete terms.

The texture vocabulary that has no clinical-to-patient-Spanish translation

“Nectar-thick” is an IDDSI framework term. It has no patient-Spanish equivalent. The nurse who says “no puede tomar líquidos finos” (you can’t have thin liquids) has communicated the prohibition without communicating what it excludes. “Fino” in patient Spanish may mean refined, or light, or diluted — not necessarily the viscosity level the SLP framework describes.

The food comparison that works:

Nectar-thick (IDDSI level 2): “Un líquido espeso — como un jugo de durazno sin colar, o atole ligero. No tan espeso como miel, pero más espeso que el agua.” (A thick liquid — like unstrained peach nectar, or thin atole. Not as thick as honey, but thicker than water.) “Atole ligero” will be recognized immediately in Mexican and Central American households. “Jugo de durazno sin colar” (unstrained peach juice) works for patients who are less familiar with atole.

Honey-thick (IDDSI level 3): “Muy espeso, como la miel — baja despacio de la cuchara.” (Very thick, like honey — it falls slowly off the spoon.) Most patients in any Spanish-speaking cultural context will recognize honey.

Pureed (IDDSI level 4): “Consistencia de puré — sin pedacitos, sin fibras. Como puré de papa o puré de camote, pero sin grumos.” (Purée consistency — no chunks, no fibers. Like mashed potato or mashed sweet potato, but without lumps.) The “sin pedacitos” (without small pieces) clarification matters because “puré” in home cooking often refers to a dish that is mostly smooth but not entirely uniform.

The soup conversation: the specific case

When the nurse finds Pedro has been drinking the broth, the conversation that addresses the specific violation without turning Carmen’s care into a source of shame:

“La sopa que trajo Carmen — el caldo — es un líquido flojo, como el agua. Ese es exactamente el tipo de líquido que la terapeuta del habla le pidió que evitara por ahora. El caldo puede pasar al pulmón de la manera que le expliqué.”

“Lo que sí puede tomar: la parte espesa de la sopa, como el puré de verduras o los frijoles bien molidos, si están sin pedazos. Y si tiene atole o jugo de durazno del que viene un poco espeso — eso también está bien.”

The structure of the conversation matters as much as the vocabulary. “La sopa que trajo Carmen” names the specific item without making Carmen the source of harm. “La terapeuta del habla le pidió que evitara” locates the restriction with the clinical authority rather than with the nurse, which is accurate and which prevents Carmen from feeling that the nurse is overriding her care. And the “lo que sí puede” (what you can have) section comes immediately after the prohibition, because a patient who receives only the prohibition will solve for it on his own.

The compliance check in the form of an open question:

“¿Puede decirme qué ha tomado de lo que Carmen le ha traido estos días?”

Not “¿Ha tomado el caldo?” (Have you been drinking the broth?) which is a yes/no question that will produce “no” from a patient who knows the correct answer is no. The open question “qué ha tomado” requires the patient to inventory rather than to confirm, which is a different cognitive task and which produces more honest reports.

The family instruction: what Carmen can bring

Carmen needs to understand the restriction in terms that let her apply it to future meal decisions without calling the unit before every visit. The instruction that gives her a working taxonomy rather than a list of prohibitions:

“Lo que puede traer: postres espesos como el flan, el arroz con leche bien espeso, el puré de camote. Tamales bien molidos sin coraño de maíz. Licuados espesos, como batido de platano sin agua extra.

Lo que no puede traer: café, agua, jugos, caldos, sopas de caldo. El problema no es el sabor ni los ingredientes — es la consistencia del líquido. Si no sabe si algo está bien, muéstremelo antes de dárselo. Me da gusto revisar.”

The last two sentences do the most important structural work: “el problema no es el sabor ni los ingredientes” removes the implication that Carmen’s cooking is the problem, and “muéstremelo antes de dárselo” (show me before you give it to him) makes the nurse a resource for the uncertain case rather than a rule enforcer for every case. Carmen is more likely to ask if the frame is “I’m happy to check” than if the frame is “call before bringing anything.”

3. The wound care discharge lesson that has to make a non-nurse caregiver independent in fifteen minutes

The discharge wound care lesson for Pedro will happen tonight, with Carmen, at the end of a visit that started at five and is supposed to end at seven. Carmen has two children at home. She works a morning shift. She has been visiting every evening for eleven days. The nurse has fifteen minutes before Carmen needs to leave to pick up her kids. When Carmen leaves tonight, she will be the person doing Pedro’s wound care at home, alone, at night, every night, until the wound is closed or until the follow-up appointment determines it no longer needs daily care. She has no clinical training.

The compression problem

A discharge wound care lesson that produces a competent caregiver in a language that caregiver fully understands takes approximately thirty minutes, including the demonstration, the teach-back, the supply check, and the decision algorithm for abnormal findings. A discharge wound care lesson that produces the chart note “family verbalized understanding” in a language the caregiver partly understands takes fifteen minutes and produces the chart note from the nurse’s perspective and a vague sense that everything will be fine from the caregiver’s.

When fifteen minutes is what exists, the nurse’s job is to use the fifteen minutes in the order that produces the most clinically useful outcome if Carmen’s attention drops after the first ten. That order is: decision algorithm first, procedure second, teach-back third. Most wound care discharge lessons teach in the opposite order: procedure first, then signs of infection, then “call us if you’re worried.” The nurse who teaches procedure first and signs of infection last is betting that Carmen will still be fully present at minute thirteen. The nurse who teaches the decision algorithm first ensures that even if Carmen absorbs nothing else, she knows when to call.

Starting with the why

Before any procedure vocabulary, one sentence that explains why this matters:

“La herida necesita que alguien la revise y la limpie todos los días hasta que el médico diga que ya está cerrada. Si no se cuida bien, puede infectarse, y eso puede atrasar la recuperación de su papá.”

The phrase “puede atrasar la recuperación de su papá” (it could delay your father’s recovery) is the highest-stakes consequence in terms that Carmen already cares about. She has been here every evening for eleven days. She is not going to hear “atrasar la recuperación” and decide not to do the wound care.

The three-tier decision framework

Before the procedure:

“Primero le quiero explicar cuándo llamar a la clínica y cuándo ir a urgencias — eso es lo más importante de todo lo que le voy a decir.”

(First I want to explain when to call the clinic and when to go to the ER — that is the most important thing of everything I’m going to tell you.) This sentence signals to Carmen that what follows is critical, and it tells her why she needs to pay attention to this part specifically.

Then the three tiers:

Normal — no llamar todavía:

“Los primeros días, es normal ver un poquito de líquido claro o rosado claro, y los bordes del tejido se ven rojizos. Eso es parte de la cicatrización. No tiene que llamar por eso.”

Llame a la clínica durante el día:

“Llame si ve cualquiera de estas cosas: el líquido se pone amarillo o verde; el olor se pone fuerte o feo; los bordes de la herida se ponen más rojos, o el rojo se extiende a la piel de alrededor; hay más hinchazón que ayer. Esas cosas no son emergencia, pero sí hay que reportarlas durante el horario de la clínica.”

Vaya a urgencias ahora, no espere:

“Estas tres cosas son urgencia: fiebre — temperatura arriba de 38 grados, que son 100.4 en Fahrenheit; la piel alrededor de la herida está caliente al tacto y ve una línea roja que se extiende desde la herida hacia el brazo; o el líquido se pone café oscuro, o de repente hay mucho sangrado. Esas tres cosas son: no espere a la mañana, vaya ahora.”

The “línea roja que se extiende” (red streak that extends) is the lymphangitis sign named as a visual landmark rather than as a clinical finding. It is something Carmen can identify at midnight by looking at Pedro’s arm without any clinical training. Naming it as a visual landmark — color plus directionality plus extension from the wound site — is more useful than naming it as “lymphangitis” or “spreading infection.”

The reason to teach the three-tier framework before the procedure is that the most costly error is not a poorly executed dressing change. The most costly error is Carmen looking at yellow wound drainage at 11 PM on a Thursday and deciding to wait until the clinic opens Friday morning because she does not know which category it belongs to. The decision algorithm is the single piece of the discharge lesson that prevents that error.

The procedure sequence

After the decision framework, the procedure in numbered steps:

“Hay cinco pasos. Primero: lávese las manos con jabón por veinte segundos antes de tocar la herida — eso es lo más importante para evitar una infección. Segundo: quite el vendaje viejo con cuidado — si está pegado a la piel, mójelo un poquito con agua tibia y espérese un minuto antes de jalarlo, para no jalar la piel. Tercero: mire la herida — aquí es donde usa lo que le acabé de explicar sobre qué es normal y qué hay que reportar. Cuarto: límpiela con la solución y los materiales que le vamos a dar. Quinto: póngale el vendaje nuevo de la manera que vamos a practicar ahora.”

Numbered steps in Spanish create a procedural scaffold that Carmen can follow at home without needing to remember connected prose. The “cinco pasos” (five steps) framing also gives Carmen a way to know where she is in the process at any moment, which reduces the anxiety of doing a clinical procedure for the first time alone.

The handwashing step is first, and the nurse names it as “lo más importante para evitar una infección” (the most important thing to prevent infection), because in a compressed lesson, the first step is the step most likely to be remembered. A caregiver who forgets step four but remembers step one will wash her hands. A caregiver who is taught handwashing at the end of the lesson as a general hygiene reminder is less likely to treat it as a clinical priority.

The wet-before-removing tip for stuck dressings — “mójelo un poquito con agua tibia y espérese un minuto antes de jalarlo” — prevents the wound bed disruption that is the most common complication of at-home dressing removal by untrained caregivers who were never told that a stuck dressing can be released without tearing.

The teach-back that closes the gap

After the demonstration, the teach-back directed at a specific clinical scenario rather than at general understanding:

“Para asegurarme de que expliqué bien: si mañana en la noche usted ve que el líquido de la herida se pone amarillo y tiene un olor fuerte, ¿qué haría?”

(To make sure I explained it clearly: if tomorrow night you see that the wound drainage has turned yellow and has a strong smell, what would you do?) The specific scenario — yellow drainage and strong smell — is the “call the clinic” tier from the decision framework. A caregiver who says “llamaría a la clínica” (I would call the clinic) has retained the right answer. A caregiver who says “lo limpiaría bien” (I would clean it well) has retained the procedure but not the decision algorithm. A caregiver who says “esperaría a ver” (I would wait and see) has told the nurse exactly what she needs to re-teach before Carmen leaves.

The framing “para asegurarme de que expliqué bien” (to make sure I explained it well) places the burden of the teach-back on the nurse’s explanation, not on Carmen’s comprehension. This matters because a caregiver who is made to feel tested will produce a correct-sounding answer. A caregiver who is told that the nurse is checking her own teaching will produce an honest one.

The supply check and the after-hours number

Before Carmen leaves:

“Antes de que se vaya: ¿tiene en casa todo lo que necesita? ¿El jabón, los vendajes del tamaño correcto, y la solución para limpiar?”

A caregiver who nods through discharge teaching and arrives home to discover she has no gauze will use a paper towel, or wait until the morning, or do nothing. The supply check is not a formality. It is the difference between a wound care plan that works and a wound care plan that works on paper.

Then the two numbers:

“Este es el número de la clínica durante el día — lunes a viernes, de 8 a 5. Y este es el número de la enfermería de guardia para las noches y los fines de semana. No tiene que esperar a la mañana si algo le preocupa a las 11 de la noche. Si ve la línea roja o la fiebre, eso no espera — vaya a urgencias.”

The repetition of the “línea roja” at the end of the session is deliberate. It is the visual sign that is most time-sensitive and most likely to be missed at night. Naming it twice — once in the three-tier framework and once at the end of the session — increases the probability that Carmen will recognize it if she sees it.

The Spanish for physical therapists reference page covers the full PT-session vocabulary: the exercise instruction set, the pain localization sequence, and the progress description phrases for the daily PT note. This post covers the nursing role in the motivation conversation that happens when the PT session does not go as planned and the chart note says “patient declined.”

For the orthopedic post-surgical rehabilitation patient — total knee, total hip, ORIF — where the wound care runs concurrently with PT and the discharge timeline is compressed by insurance authorization, Spanish for orthopedic nurses covers the pre-op Spanish consent conversation, the post-op pain vocabulary, and the discharge teaching for patients going home with a wound drain. The modified-texture diet framework in this post applies to any stroke or neurological rehab patient; for the post-stroke patient specifically, stroke assessment in Spanish covers the acute-phase vocabulary for the NIH Stroke Scale in Spanish, the thrombolytic decision conversation, and the family notification in the first thirty minutes.

The wound care vocabulary in section three of this post is a compressed version of the full framework in wound care in Spanish, which covers chronic wound management, pressure injury staging in patient Spanish, and the weekly wound measurement conversation. For the nurse who does wound care as a primary specialty, the Spanish for wound care nurses reference page has the quick-lookup phrase set for wound assessment, debridement explanation, and the irrigation procedure. The wound care Spanish phrases page has the pocket-card format for bedside reference.

For the broader discharge planning conversation — medication reconciliation at discharge, follow-up appointment instructions, and the teach-back framework for complex multi-step instructions — discharge instructions in Spanish covers the vocabulary and the teach-back structure for caregivers who will be managing multiple instructions simultaneously after discharge. The practice scenarios include a rehabilitation context discharge scenario with a family caregiver and a wound care teach-back sequence, voiced in patient Spanish with tap-to-translate transcripts and debrief takeaways. The 50-phrase PDF has the PT motivation phrase set, the wound inspection vocabulary in the three-tier format, and the aspiration symptom screen in a pocket-card format for rehabilitation nurses.