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 phrases.


Round 1

      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.

Round 3

      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 of KISS.

Round 4

      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 answer.       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.)

Round 6

      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 --       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.

Round Seven

      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.       "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.

Round Eight

      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.       For the function of the "their" clause, see Level 5.       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 would increase.
       Teachers who feel that EVERYTHING must ALWAYS  be explained, will have trouble with this round -- and with the KISS approach in general.

Round 10

      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 health nurses.       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.)

Round 11

      "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.

Round 12

      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') choice.

Round 13

       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.       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

General Discussion:

       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.

Round One

     [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 organizational technique.]
      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:

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.

Round Three

      "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 sentence?
     Ask students to revise the sentence by de-combining  it into two main clauses and eliminating "one being":

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.]

Round Five

      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 as both?      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.
Round Six      Within the context of the paragraph, what would  be the effect of moving the "because" clause to the beginning of the sentence?
Round Seven      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: 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."

Round Nine

     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."

Round Eleven

     Ask the students to revise this sentence to make "the home health nurse" the subject of the main clause. For example: Then have the students discuss the differences.

Round Twelve

     "[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 the meaning.

Round Thirteen

     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:
Suggestions for Writing Assignments

     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.]