KISS Grammar Game
The Nursing Edition
Notes to the Answer Keys
A Special Note on Level 2:
Because this project required so much more
time than I expected, I did not create the graphic answer keys for Level
2. I have, however, left the notes for them in this section. The percentage
count in Level 2 includes only "additional" adjectives, adverbs, and coordinating
conjunctions, i.e., those that are not already chunked in prepositional
The first word in a subordinate clause,
in this case, "there," is left in blue as a word to be connected, but it
stands for the entire clause.
The KISS approach eliminates expletive "there"
and "it," treating them as a normal subject with a predicate noun as a
complement. Although some teachers (and many linguists) do not like this
approach, my students find it much easier and have never had any problems
with it. As for subject/verb agreement, a PN must equal the subject, so
if the PN is plural, so is the subject.
It is possible to separate "seems to
be" into a finite verb with an infinitive as a PN, with "relationship"
then becoming the PN of the infinitive. Teachers are welcome to explore
that explanation with students, but the answer keys follow the principle
A good argument can be made that "in their
own care" functions adverbially to "have," i.e., it defines where they
have input more than it defines the input itself. I would accept either
4 -- Clauses: Subordinate and Main
The last two subordinate clauses provide
a good opportunity for a discussion of meaning and syntax. I have treated
them as two predicate nouns to "being," but the subject of "being" is "one."
Are the two clauses one "factor," or two? Personally, I see it as a combination
of additive and causative relationships, perhaps -- "Because the patient
is in her own home, she feels more comfortable and has much more input...."
In this view, the "in her own home" is the factor, or cause of the relationship.
But what it causes are two further causes -- comfort, and more input. Thus,
there is a causal relationship among home, comfort, and input that make
the three of them into "one" factor.
Having struggled with this sentence
for a while, I might have written it as "one being that the patient is
in her own home, thereby feeling more comfortable and having much more
input in her own care." We are, however, at a point of very sophisticated
syntactic and stylistic choices. Note that the two subordinate clauses
(or in my version single clause and two gerundives) are predicate nouns
within a noun absolute that is used as an appositive. Not only is this
very sophisticated, but in writing it, Ms. Johnson was also struggling
with the "she/he" problem. (See the Notes on Style.)
As so often is the case, the little words
cause the analytical problems. In the KISS approach, "than" can be either
a preposition or a subordinate conjunction. Some students may therefore
want to view it as a preposition here. If they were to do so by making
all of "what is seen in other care facilities" as its object, I would not
object (pun unintended). They cannot, however, acceptably make "than what"
a prepositional phrase. Should they do so, they will have no subject for
"is." If you are lucky, the students will simply ignore "than" at this
level, and they can then deal with it in Level 4. [For more discussion
of "than" as a preposition and subordinate conjunction, visit
or simply start the visit at Cobweb Corner -- http://www.pct.edu/courses/evavra/ED498/R.
4 -- Clauses: Subordinate and Main
As noted for Level 1, I would accept "than
what is seen in other care facilities" as a prepositional phrase. But then,
I'm weird. Technically, if we want to view "than" as a subordinate conjunction,
then part of the clause is ellipsed. Filled out, it would be "than what
is seen in other care facilities *is/are close*." The entire "what"
clause functions as the subject of the ellipsed "is" (or "are"). Technically,
therefore, there should be two sets of brackets instead of just one: "[than
[what is seen in other care facilities] *is/are close*.]" At some
point, students should learn to understand this use of "than" as a subordinate
conjunction. Otherwise, they may write something comparable to the sentence
I received from a young female many years ago: "Nobody can train a horse
better than me." This sentence, however, is probably a bad place
to try to deal with it for the simple reason that it is further complicated
by the "what" clause as subject. Some teachers may think their students
are ready for it, but with most students, with this sentence, I would
probably opt for the explanation using the prepositional phrase.
Some teachers may consider "safety
and well-being is important" as an error in subject/verb agreement, but
I see it as the equivalent of "bread and butter is a good snack."
Because the writer used "is," instead of "are," I assume that the writer
agrees with me. This may, of course, be a point for class discussion.
4 -- Clauses: Subordinate and Main
"So" is unusual in that it can be either
a coordinating or a subordinating conjunction. Here, a period after
"own," and a capital "S" on "so," would be perfectly acceptable. And that
would make "So" a coordinating conjunction -- used to begin a sentence
(and thus join two separate sentences) in the same way that "And"
and "But" can be used. But ", so" indicates a subordinate conjunction.
This particular case is interesting -- note what happens if there were
a period and capital letter. The content of the "so" clause would
have the writer, not the nurse, as its source, and thus the sentence would
not state, as clearly as it does, that the nurse knows that "the safety
and well-being of the patient is very important." Not only that, the subordinate
"so" indicates that they are important because the family and patient are
on their own.
Level 2 -- Adjectives,
Adverbs, and Coordinating Conjunctions
Some students may recognize "sure" as an
adjective. If they do, count it. I have left it as uncounted because I
believe most students will have a problem with it at this level.
"[C]ontinue to progress" is also acceptable
as a finite verb. Because they have not yet dealt with infinitives, I would
not expect students to get "to progress" as the DO of "continue. They may,
however, surprise you.
4 -- Clauses: Subordinate and Main
For the function of the "their" clause,
see Level 5.
5 -- Verbals: Gerunds, Gerundives, and Infinitives
Teachers' attitudes toward this level of
Round 8 will determine whether or not they can use the KISS Grammar Game
successfully. There is no question that the infinitive phrase to
make sure [their patients continue to progress [when they are not with
their patients]] is difficult. The difficulty arises primarily from the
common, but not all that frequent, ellipsed infinitive construction.
The construction appears after a limited number of verbs, and takes the
form ("make," "want," "elect," "chose," "help" X *inf* Y).
If students have been working
at Level 5 for a while, they would have seen not only several simpler examples,
but also examples in which the infinitive is not ellipsed: "He wanted her
to go." "They helped him to paint his house." "They chose Karen to be their
representative." Having seen examples in which the infinitive is
not ellipsed, students find it easier to understand cases in which it is:
"We elected Clinton president." "Susan made the house a home." Once they
have seen a few of these examples, then they would be prepared to tackle
the "to make sure ..." phrase in this round.
Once they have been given adequate
preparation, I would expect students to simply figure it out. How would
they do so? By using the regular questions and common sense. The first
question would be "to make what?" Well, "sure" seems to answer, but meaningfully,
one can't make "sure." One has to make something sure. What, in this case,
is that something? That subordinate clause is just sitting there, right
after "sure." And the meaning of the sentence is that the nurse will do
her best to make the situation expressed in the clause a reality, or, in
another word, "sure." Thus we have a "to make X Y" situation, and the way
we have been explaining them is by using an ellipsed infinitive.
Complicated? Yes, and No.
For anyone who has not mastered the simpler examples, it is probably beyond
what Vygotsky calls the "zone of proximal development," i.e., it is beyond
comprehension. But mastery of the simpler examples, according to Vygotsky,
expands the zone of proximal development, thereby bringing a more complicated
situation, such as this one, into the zone.
In practical terms, this is a
game. If none of the students explain the phrase, nobody gets any points.
It's no big loss. If my students were just beginning at Level 5 and met
this sentence, I would probably say something such as "That's a complicated
example. We'll see things like that again later." And I would move on to
the next round. [Unless someone asked, of course, in which case I would
explain, the length of the explanation depending on the apparent interest
of the class.] If my students had seen several of the simpler examples,
and had been working at Level 5 for a while, the probability of my explaining
Teachers who feel that EVERYTHING
must ALWAYS be explained, will have trouble with this round -- and
with the KISS approach in general.
An argument can be made that "In other environments"
modifies "can rely," and depending on the situation, I might accept the
argument. (Or I might let the members of the teams propose their arguments
for and against, and base my decision on that.) My own sense, however,
is that the phrase defines the nurses, not the verb. In other words,
the writer is distinguishing nurses "in other environments" from the home
6 -- Eight Additional Constructions
Interestingly, Webster's New Collegiate
Dictionary (1961 edition) does not give a part of speech for "etc." I could
argue (but I don't know how well) that "etc." should be considered an interjection
because it reflects the writer's throwing in the idea that more examples
could be given. I'm sure that some people will consider that argument lame,
so I'll make the more practical argument: within the rules of KISS grammar,
which are supposed to be simple, the only thing that appears to apply is
the interjection. Most students will probably accept this, and any student
who can give a better explanation should be awarded five bonus points.
("Proof" of a better explanation would be a majority vote of the students
in the class.)
"In" will create some discussion -- which
should include the concept of ellipsis. The question to pose to students
is "What is meant here? ... carried in _______?" The obvious meaning
(although the specific words may differ) will always be expressed in a
prepositional phrase: "into the patient's home (apartment, abode, etc.)."
Because the meaning is obvious, the last part of the phrase is ellipsed.
[If you are lucky, a wiseacre will respond with "in bags." The rest of
the class will laugh, and their laughter will only prove that that answer
is obviously inappropriate.]
Should it be offered, I would accept taking
"for proper treatment" to "needed."
At level 5, some students will prefer to
view "needed" as a gerundive, which is fine, but not necessary.
5 -- Verbals: Gerunds, Gerundives, and Infinitives
In this case, I have split "Having to run"
into the gerund plus infinitive as DO, but I would also simply accept "Having
to run" as the gerund. It's the instructor's (or even the students')
It is possible to extend this sentence
to Level 5 and consider "to rely" as an infinitive, DO of "have."
An optional, "unofficial" explanation
is to consider "there" as an expletive, "teamwork" as the subject, and
"is seen" as the finite verb.
4 -- Clauses: Subordinate and Main
This is a good sentence for discussing the
colon and semicolon to separate main clauses. The basic difference
is between "same" (colon) and "different" (semicolon). Note that the very
marks -- two dots, versus a dot and a comma -- reflect "same" and "different."
For Additional Discussions
of Style and/or Logic
This selection was "randomly" selected
from a fourteen-page paper, "Community Health Experience," written by Jennifer
Johnson for an advanced Nursing course. I have qualified "randomly,"
because I needed a passage that could fairly well stand alone and be comprehensible
and interesting to a middle school audience. I promised Ms. Johnson that
I would edit out any major mistakes, but I did almost no editing. And,
I decided to let the "she/he" problem stand, primarily because it can provide
excellent material for class discussions. There is no easy answer.
Some people might say that the
answer is simply to make everything plural -- not "nurse," but "nurses."
Out of context, answers are easy. But in this essay, changing every "nurse"
into "nurses" would undercut a major theme -- the one-on-one, i.e., singular,
relationship between a home health nurse and a patient. This is pointed
out in Round 10: "In the other environments nurses can rely on other to
make phone calls, hand them ...." This sentence sets up the next three,
all of which focus on the independence ("no teamwork") of the home health
nurse. Changing every "nurse" into "nurses," every "patient" into "patients,"
would obscure this relationship.
And so, in the course of writing
the paper, Ms. Johnson tried to deal with this "she/he" problem. [I note
that she always puts "she" first.] Sometimes, as in Rounds 7 and 11, she
simply used "she." But, in the back of her mind, Ms. Johnson realized that
males might object. Thus, in Rounds 8 and 12 we get "her/his." In
Round 3, she used "their": "the home health nurse and their patients."
The possibility of using the plural to solve the problem is probably what
led to the "they" in Round 5: "...not only does she/he talk, but they also
listen ...." And the blurring of the singular/plural distinction gets carried
over into the patients, as in Round 4: "... the patient is in their own
home thereby feeling more comfortable, and they have ...."
Edit to fix the problem? There
are a few changes that I would make quickly, but in most specific cases,
I wouldn't know what to do. This is not a problem in syntax -- it is a
question of usage, i.e., social customs and acceptance. Women found a ubiquitous
"his" insulting, probably with good reason. But as a result, EVERY
writer, even the most polished, has to struggle with how to handle the
"she/he" problem in specific cases. This edition, therefore, provides students
will some good examples to discuss.
[Do the following after students have at least
read the entire selection.] Ask students to rewrite the sentence to eliminate
the pronoun "I." One of the revisions that you will probably get is "Focusing
on the home health nurse, there is a distinguishable and notable difference
...." If you are working below Level 5 (verbals), simply point out to students
that all words, except interjections, must chunk to another, and that in
the original "Focusing" chunks to "I." Therefore, this revision does not
work very well. You will probably also receive: "There is a distinguishable
and notable difference between her/his daily regimen and that of a nurse
in a hospital or long-term care facility." If you are lucky,
you will receive: "The daily regimen of a home health nurse differs
from that of a nurse in a hospital or long-term care facility." [If
no one offers this, ask students to revise the sentence to make "regimen"
the subject of the main clause.] Ask students who have interesting, acceptable
revisions to write them on the board. Then have the class discuss the differences.
In the course of this discussion, the teacher
should probably not state that one version is better than another, but
some points should be made (hopefully, by the students themselves). For
one, this sentence is a topic sentence for both paragraphs in the
selection, and the selection is about the home health nurse's regimen.
Putting "regimen" in the subject slot thus puts the most important idea
in the most prominent grammatical slot. [I would also point out that the
second sentence (Round Two) establishes the topic sentence of this paragraph,
and the first sentence of the next paragraph (Round Nine) establishes the
topic of its paragraph. Most of my college Freshmen are unaware of this
There will probably also be some discussion
of "distinguishable and notable." What information do these words give
to the reader? Because the writer is going to describe the differences,
the differences must be distinguishable. "Notable," on the other hand,
implies worthy of being noted. You might want to have students discuss
what happens if we attempt to change these words into adverbs in the revision
with "regimen" as subject: "The daily regimen of a home health nurse
differs [distinguishably? notably?] from that of a nurse in a hospital
or long-term care facility." One way of dealing with the problem of
acceptability is to ask for a show of hands from the students: how many
consider "distinguishably" acceptable in this sentence? "Notably?"
Rounds Two and Three [at Level
4 or higher]
Ask students to combine sentences two and three
into one. For example:
One of the most distinguishable differences is the nurse-patient relationship
that is formed: [or --] there seems to be a better or closer relationship
between the home health nurse and their patients.
Ask students to discuss the differences. Warning: The KISS approach
is based on a theory of natural syntactic development. According
to that theory, most students master subordinate clauses somewhere between
seventh and tenth grades. Rushing natural development will probably do
more harm than good. (Don't fool with Mother Nature!) I would suggest that
you not use this exercise with students below eighth grade, and that the
second and third versions (above) are probably best used only with students
in tenth grade or higher.
The colon (formal) and dash (informal) indicate that the second main
clause is a more detailed version of the first, i.e., the logical relationship
is one of identity. A ", and" does not work here because it implies that
the two main clauses present two different ideas. Likewise, a semicolon
isn't good here because it implies not only that the ideas are different,
but also that they are somehow contrasting.
One of the most distinguishable differences is that there seems to be a
better or closer relationship between the home health nurse and their patients.
One of the most distinguishable differences is that a better or closer
relationship is formed between the home health nurse and their patients.
"Or" normally implies one or the other,
not both. But is this the case here, or are the relationships both "better"
and "closer"? Interestingly (to me, at least), "better and closer" would
not here express the intended meaning. What appears intended is that the
relationship between "better" and "closer" is causal, i.e., better because
closer. To express this idea specifically, the sentence would read:
"There seems to be a better (because closer) relationship ...." The preceding
sentence, however, requires some very advanced syntactic manipulation -
a subordinate clause ("because it is closer") which is semi-deleted and
then used as an interjection. Now, however, we run into the problem
of audience. All that fancy syntax will strike many readers as strange
and awkward. For most audiences, therefore, I would go with Ms. Johnson
-- "better or closer."
Round Four [at Level 4 or higher]
Ask students to revise this sentence, eliminating
the initial "There": "Several factors strengthen or add to this relationship."
What does "add" add to the meaning of the
Ask students to revise the sentence by de-combining
it into two main clauses and eliminating "one being":
Several factors strengthen this relationship. Because the patient is
in their own home, they feel more comfortable and they have much more input
in their own care.
The original sentence is sophisticated, but a bit awkward. It attempts
to deal with two primary logical relationships: (whole / part -- "factors"
/ "one") and (cause / effects -- "in ... own home" / "more comfortable"
and "more input"). Syntactically, however, the effects end up out of parallel,
one in a gerundive, one in a clause. The two examples of revision put the
two effects together, either in main or in subordinate clauses. You may
also want to use these revisions to discuss the question of what Wanda
Van Goor refers to as "MIMC" (Main Idea in Main Clause). Although some
members of ATEG disagree, many of us believe that the most important idea
should normally be in the main S/V/C pattern. In the first of the examples
of revision, "the patient is in their own home" is in a subordinate clause
of cause, and the effects are in two main clauses. [Note that the effects
are, in fact, the "factors" that strengthen the relationship.] In the second
example, the effects are in subordinate clauses of result, and "The patient
is in their own home" occupies the main S/V/C slots. There is no "right
or wrong" answer to this MIMC, but it would again be an interesting question
to have students discuss and then simply vote on by a show of hands. [Having
students vote, in this way, helps the class members see how other people
-- their potential readers -- would interpret the sentence. If there is
a heavy majority for one side of a vote, then the odds are that that version
would be a more effective sentence.]
Several factors strengthen this relationship. The patient is in their
own home, so they feel more comfortable and they have much more input in
their own care.
Discuss the difference in meaning if "more"
is considered an adverb to "therapeutic" as opposed to an adjective to
"communication." What are the different implications of each version?
[In one case, the nurse needs to know how to make conversation "therapeutic";
in the other, she/he simply needs to talk more???] Or does it function
Is there a cause/effect relationship hidden in
this sentence? Therapeutic communication is never defined, but is the relationship
"Another factor is communication -- the home health nurse utilizes much
more therapeutic communication because she not only talks, but also
listens attentively." As a reader, I'm not sure, but if that is the case,
the subordinate clause could have made it clear.
Within the context of the
paragraph, what would be the effect of moving the "because" clause
to the beginning of the sentence?
The "so" clause, apparently
of result, does not clearly connect to any of the verbs in the sentence.
(The safety and well-being of the patient is always important. It is not
the result of the nurse's knowing, or leaving, or of the family being on
its own.) Ask students to revise the sentence to see if they can find a
better connection. For example:
Because the patient and family are on their own
after the nurse leaves, the safety and well-being of the patient is especially
The preceding may be an improvement, but the problem
with the "so" clause is actually one of content, and the problem may have
been caused by grammar. Three subordinate clauses are a lot to juggle in
short-term memory, especially when one of them ("after") is embedded in
another. It is theoretically quite possible that, by the time the writer
got to the "so" clause, she had lost her train of thought. If we look at
the purpose of this sentence in context, it follows the sentence which
introduces the relationship between nurse and family. Perhaps what the
writer meant to say was something such as "so the family must be well-informed
of the patient's condition and care."
The ninth sentence is
the topic sentence for the paragraph. In one sense, it is nice and simple
(KISS). You might, however, want to discuss with students ways in which
this sentence could be better tied to the topic sentence of the preceding
paragraph. (See the notes for Round One.) For example, "Another difference
is that the home health nurse must be organized."
Ask the students to revise
this sentence to make "the home health nurse" the subject of the main clause.
But, as she goes into her patient's home,
the home health nurse must carry all the papers needed for accurate documentation
and all the equipment needed for proper treatment.
Then have the students discuss the differences.
"[C]ostly, lengthy, and
hazardous" are vague. "Lengthy" implies "time-consuming," but costly and
hazardous? Ask students to brainstorm for what might be meant here. Then
ask them to revise the sentence (or write additional sentences) to clarify
Within the essay from which
this selection is taken, this sentence ends the discussion of the nurse's
regimen. The final clause of the sentence introduces an idea that has not
been covered in any detail. Ask students to revise the sentence in an attempt
to provide a better conclusion. For example:
Because home health nurses have to rely solely
on self (There is no teamwork seen here.), they must not only be proficient
in a broad range of care, but also have excellent interpersonal and organizational
Suggestions for Writing
After the students have
analyzed the sentences and discussed the structure and functions of the
various sentences, ask them to write a paper in which they describe the
skills needed for a job of their choice, a job that they are familiar with.
You might want to point out to students that this essay was written by
a nursing student for a nursing instructor. As a result, this part of the
paper includes no specific examples. We can assume, in other words, that
the instructor would already know numerous examples, and that what the
instructor wanted to see was the student's conclusions. You could therefore
have students write two different papers: one like this one, and one in
which the student includes numerous examples so as to explain the job to
people who have no experience with it. [You can then use some of your students'
essays to create additional editions of the game.]