OET

Writing

Practice
Tests
CONTENTS

Introduction to the Occupational English Test (OET) .................. 1

Speaking Sub-Test Overview ......................................................... 3
Structure of the Test ...................................................................... 5
General Tips .................................................................................. 9
Recommended Reading for OET Speaking ....................... :.--........ 13

SAMPLE ROLE PLAYS

Role Play 1 .................................................................................. 27

Role Play 2 .................................................................................. 37
Role Play 3 .................................................................................. 47
Role Play 4 .................................................................................. 51
Role Play 5 .................................................................................. 57
Role Play 6 .................................................................................. 63
Role Play 7 .................................................................................. 69
Role Play 8 .................................................................................. 75
Role Play 9 ................................................................................... 81
Role Play 1.0 ................................................................................ 87
Role Play 11 ................................................................................ 93
Role Play 12 ................................................................................ 97
Writing Sub-Test Overview ....................................................... 103
Vl Contents

PRACTICE TESTS WITH SAMPLE LETTERS

Practice Test 1 ........................................................................... 113

Writing Task 1 .................................................................... 118
Writing Task 2 .................................................................... 120
Writing Task 3 .................................................................... 122
Practice test 2 ... , ........................................................................ 125
Writing Task ....................................................................... 128
Practice test 3 ............................................................................ 131
Writing Task ....................................................................... 135
Practice test 4 ............................................................................ 13 7
/
Writing Task 1 .................................................................... 141
Writing Task 2 .................................................................... 143
Writing Task 3 .................................................................... 145
Practice test 5 ............................................................................ 147
Writing Task ....................................................................... 150
Practice test 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 3
Writing Task ....................................................................... 155

References.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
INTRODUCTION TO THE
OCCUPATIONAL ENGLISH TEST {OET)

OET or Occupational English Test is an international exam that

assesses the language comrnunication skills. of healthcare professionals
who seek to register and practice in Australia, New Zealand,
Singapore, Dubai, or any English-speaking environment. It covers
/
all four language skills (Reading, Listening, Writing, and Speaking)
with an emphasis on communication in a healthcare environment.
0 ET has been developed specifically for twelve healthcare
professions: Dentistry, Dietetics, Medicine, Nursing, Occupational
Therapy, Optometry, Pharmacy, Physiotherapy, Podiatry, Radiography,
Speech Pathology and Veterinary Science. The Reading and Listening
modules are the same for all health professionals taking the exam. The
Writing and Speaking modules are profession specific.

This book has been designed for nurses looking to improve

their English Language skills in speaking and writing to successfully
pass the Occupational English Test. This book will help you gain
the speaking and writing skills essential for scoring A/B grade in the
OET examination.

It is a one-stop solution for successfully passing the speaking and

writing sections of the OET. It covers intensive speaking practice
using 12 cue cards with model answers that a candidate is expected
to produce to score an A/B grade. It also includes intensive writing
exercises with ten writing tasks and model answers. Also, the book
includes separate sections containing useful tips and efficient exam
strategies for speaking and writing which will improve the performance
remarkably and guarantee a passing score. -The materials have been
2 OET Speaking and -Writing Made Easy for Nurses

specifically designed to reflect the types of tasks found in 0 ET

examination. This book will also provide a clear understanding of the
assessment criterion on which the candidates are scored for speaking
and writing modules.

For more information on test dates, test fees, testing venues and
official materials, please visit www.occupaitonalenglishtest.org

/
SPEAKING SUB-TEST OVERVIEW

The speaking sub-test takes about 20 minutes. It is a profession-

specific test in which the candidates are required to complete two
role plays based on typical workplace situation. The candidates use
materials specially designed for their profession to perform the role
plays. In other words, you would be enacting the role of a nurse and
will be expected to demonstrate the ability to deal with (ituations
that occur realistically in the workplace. For instance,
• Asking questions to the patient.
• Answering the patient's questions
• Engaging with a variety of patients of different ages, health
problems and concerns.
• Explain medical conditions and treatments 1n a dear and
accessible way.
• Rephrase ideas 1n a variety of ways to help or persuade a
patient.
• Reassure a worried or an angry patient. The interlocutor
will take on the role of a patient or in some cases, a patient's
caregiver or family member.
STRUCTURE OF THE TEST

Initially, there is a short warm up talk about your professional

background after which you are given two roles, one after the other
and you have 2-3 minutes to prepare yourself for each role play.
The interview is recorded, and the recording is then assessed by two
different assessors in Australia. The interlocutor is not assessing you.
The interlocutor follows a script so that the interview strti'cture is
similar for every candidate.

Assessment criterion and tips to improve each criterion

Candidate's performance in the two role plays is assessed against five

criteria:

Overall communicative effectiveness - including how well you can

maintain meaningful interaction.

TIPS
• In each role play, take the initiative to gather and give
information as a professional does.
• You should talk to the interviewer like you would do to a
patient.
• Deal with the points given on the role-card clearly by asking
questions and explaining as necessary.
• Make sure you use a simple language that 1s easily
understandable by the patient.
• Remember that you are interacting with the patient and not
just explaining to him/her.
6 OET Speaking and Writing Made Easy for Nurses

Intelligibility - including pronunciation, intonation, stress, rhythm

and accent.

TIPS
• Consider every aspect that makes up this criterion; not just
pronunciation, but also the use of stress to emphasise the
most important information and use of intonation to signal
whether you are asking a question or making a statement.
• Practice common words that use these sounds *e.g. 'this',
'that', 'father', 'mother'+.
• Notice how pronunciation in your language is different from
English - e.g. the ends of words often show different meanings
in English: 'cut', 'cup', 'worry', 'worries', 'worried'. /

• Find and practice the pronunciation of common words and

phrases in English used in your job.

Fluency - including the rate (speed) and natural flow ofspeech.

TIPS
• Speak at a natural speed for the situation.
• Consider the listener's problems if your speech is too slow
- e.g. losing the flow of argument, feeling frustrated while
waiting for you to finish, etc.
• Consider the listener's problems if your speech is too fast -
e.g. being unable to break up the stream of language into
meaningful pieces, feeling overwhelmed.
• Aim for even speech that is not broken up into fragments by
reducing hesitation or speaking in 'bursts' of language.
• Us~ paus~s to make what you are saying dear like for ernphasis
or to separate the points you are making.
• Try to avoid overuse of sounds *err, um+ and filler words
*'0 K', 'yes'+ to fill gaps while you prepare what to say next.
 Gurleen Khaira 7

Appropriateness - including the use of suitable professional language,

and the ability to explain in as simple terms as necessary and appropriate~y
given the scenario of each role-play.

TIPS
• Practice explaining medical and technical terms and procedures
in simple language, for instance, giving general advice for good
health about diet, losing weight, care of wounds, smoking
cessation, etc.
• Ask questions to check the patient's understanding if ir seerns
appropriate to the situation.

Resources of grammar and expression - including the accuracy

and range of the language used; how efficiently and naturalty you can
communicate in a healthcare setting.

TIPS
• Show flexibility by using different phrases to communicate
the same idea.
• Make sure you can form questions correctly; particularly those
questions that you often use with patients while investigating
their complaint or taking their medical history *'How long ... ?',
'When'+.
• Work on areas that will help you convey information
accurately. For example:
• Articles [the, a/an]: 'there chance of infection' for 'there's a
chance of infection.'
• Prepositions: 'I can explain you about asthma' for 'I can
explain to you about asthma.'
• Countable/uncountable: 'not much side effects' for 'not
many side effects.'
• 'I recommend you that you take this medication twice a day.'
(Wrong).
• 'I recommend that you take this medication twice a day.'
8 OET Speaking and Writing !v1ade Easy for Nurses

• 'When it happened?' for 'When did it happen?'

• 'Not much painful' for 'not very painful' *adj+ or 'not much
pain' [n].

Remember that the OET is a test of English-language skills - NOT

a test of professional knowledge. The medical information needed
to carry out the role-play is provided on the cue card. The role-play
is designed so that knowledge of a medical condition or treatment
will not affect the exam in any way. You will be assessed on how
effectively you deal with the communicative situation on the card,
NOT on your knowledge of the particular medical topic.

/
GENERAL TIPS

l. The introductory section of the Speaking sub-test is not assessed.

Use this time to 'warm up' and get used to speaking to the
interlocutor.
2. When preparing for the OET test, practice using the
communicative functions that you are likely to need in any
/
consultation context: explaining, summarising, clarifying,
eliciting information, reassuring etc.
3. Remember that you are being tested on your communicative
ability and not on your medical knowledge, and any medical
information required for the roleplay will be given on the card.
When preparing for the test, focus on developing your ability to
communicate appropriately with the patient in the role-play.
4. Speak loudly and clearly so the assessors can grade your
performance fairly using the set criteria.
5. Talk naturally with the interviewer during the identity check and
background information stage of the interview. Use this time to
settle down and feel comfortable in the test environment.
6. Read the role card carefully and make any notes you want on the
card. You can keep the card during the role-play for reference.
7. Take time to read through the role play card carefully.
8. Don't follow a formula for the role-play that may not be
appropriate, e.g. sometimes you do not need to introduce
yourself because it is clear you know the patient already.
9. Practice with another candidate, friend or colleague beforehand
so you know what it feels like to do a role-play.
10 OET Speaking and Writing Made Easy for Nurses

10. If you have any questions about what a word/phrase means, how
it is pronounced, or how a role-play works, ask the interlocutor
during the preparation time. You are not penalised for doing
this.
• Use the notes on the role card to guide the role-play:
~ What is your role?
~ What role is your interlocutor playing - patient, parent/
son/ daughter, carer?
~ Where is the conversation taking place?
~ What is the current situation?
~ How urgent is the situation?
~ What background information are you given about the
patient and the situation?
~ What are you required to do?
~ What is the primary purpose of the conversation
[e.g. explain, find out, reassure, persuade]?
~ What other elements of the situation do you know about?
[e.g. The patient appears nervous or angry; you don't have
much time+.]
~ What information do you need to give the patient?
• Consider how you would act if this were a real situation you
encountered while doing your job.
• Be ready to start off the role-play yourself. The interlocutor
will indicate that preparation time is over, but you need to
begin the conversation.
• Introduce yourself if it is appropriate *but not if you know the
patient already+.
• Focus on the issue described in the role-play information.
• Don't take a full history of the patient unless the notes require it.
• If you don't understand something the patient says, ask him/
her to repeat or explain it.
 Gurleen Khaira 11

• If you notice a misunderstanding between you and the patient,

try to resolve it.
• If the patient seems upset or confused, try to find out why.
• Don't worry if the interlocutor stops the role-play after five
minutes, as there is no penalty for not completing all the
elements on the role card.

/
 RECOMMENDED READING FOR
OET SPEAKING

Using Open-Ended and Closed-Ended Questions in OET

Speaking

In OET Speaking, you would be making use of both open-ended

and closed-ended questions. /

Open-ended questions are the ones that start with who, what,
where, when, why, which and how. Open-ended questions let
the patient answer with something other than a yes or no that
encourages patient elaboration or further conversation with the
patient, maximizing opportunities for listening and understanding
symptom-defining answers.

For example,
-t • Who brought you to t~e hospital?
• What did you eat today?
• Where do you feel pain?
• When did you first notice the infection?
• Why didn't you seek any treatment earlier?
• Why did you cease taking your medication?
• Which medicine did you take at home?
• How did you hurt your arm?
• How long have you had the pain for?

Closed-ended questions are usually answered with either a simple

yes or no and can be used to obtain specific information or verifying
pati en t understanding.
14 OET Speaking and Writing Made Easy for Nurses

For Example,
• Do you exercise?
• Did you take any pain-killers before coming here?
• Are you allergic to anything?
• Do you work?
• Do you have any ongoing medical conditions?
• Have you ever been hospitalized?
• Have you ever had any surgery?
• Does anyone in your family suffer from this condition?
• Is anyone in your family suffering from this condition?
• Has your appetite/weight changed recently?
/

Difference between Direct and Indirect Language

Choosing an appropriate language for the patient you are speaking

to is an important part of the OET speaking test. When your patient
is sensitive or embarrassed about the condition, it is better to use
indirect language. Indirect language is unnecessary for conditions
which are routine or for when the patient feels comfortable.
For instance, men and women react differently to illnesses
and may be embarrassed or uncomfortable talking about certain
conditions. To encourage such patients, it's irnportant that questions
are asked politely.

Sample indirect statements

Investigating the reason for presentation

• Would you mind if I asked you some questions to get a better
understanding of your condition?
• If you don't mind me saying, I notice you've put on some
weight since I last saw you.
• In your own time, could you describe your symptoms to me?
• I am afraid I need to ask some personal questions/a personal
question. May I proceed?
 Gurleen Khaira 15

• Firstly, I would like to talk about your feelings. Are you

comfortable discussing them right now?
• Would you mind telling me about the difficulties you and
your children are facing?
• Could you tell me how you have been coping at home?

Persuading a patient/Giving Advice to a patient

• Have you thought about trying to .................. ?
• This n1ight not be what you were hoping to hear, but the
best way to recuperate/for an optimal recovery is to ... (quit
smoking/alcohol/lose weight etc.)
• I understand that you dislike the idea of. .............. (taking
medication/losing weight etc.) However,/That being said/
Having said that/With that said, I am afraid there is no other
option. It is important/Imperative/paramount/indispensable
that you follow my advice to ensure your good general health.
Otherwise, it may have adverse effects on you( health.

Empathetic phrases

Empathy is a vital component of any health practitioner-patient

relationship and has been associated with improved patient
outcomes. Empathetic phrases enhance the therapeutic effectiveness
of your communication as well as increases the efficiency of gathering
information from the patient.
Empathetic phrases to encourage patients to talk about their feelings!
symptoms
• I can see that must have been hard for you.
• Can you bear to tell me just how you have been feeling?
• Thank you for telling me how you have been feeling.
• I appreciate you telling me this. It helps me understand the
situation much better.
• Have you told me enough about h_ow you are feeling to help
me understand things?
16 OET Speaking and Writing Made Easy for Nurses

• I think I understand a little of what you have been feeling

now. Let's look at the practical things that we can do together.
• I can see that this has been very difficult for you to cope with.
• I can appreciate how difficult it is for you to talk about this.
• I can sense ho\v angry you have been feeling about your illness.
• I can see that you are quite upset.
• I can understand it must be frightening for you to know the
pain might keep coming back.
• That must have been (past)/must be (present) very difficult/
tiring/frightening/painful/ emotionally draining for you.
• I know how you must be feeling.
• I am sorry to hear that! /

• Aww, it's a pity to hear that!

Reflecting listening skills and paraphrasing

The process of treating a patient requires a holistic approach which

necessitates considerations beyond treating a disease. It demands
several skills in a doctor along with technical expertise. Patients often
use vague language during a consultation using word choices that
may not accurately reflect what they mean. An effective way to make
sure you understand what the patient wishes to say and to ensure that
you don't miss relevant information is to paraphrase what the patient
has said. Paraphrasing is repeating your interpretation of what the
patient says. This will enable you to better identify the patient's
meaning rather than just focussing on the words they use.
To reiterate, the purposes of paraphrasing are
• To check your understanding of what a patient is saying.
• Helping the patient by simplifying and focusing what they are
saying.
• Encouraging the patient to elaborate.
• Providing a check on the accuracy of your perceptions For
instance,
 Gurleen Khaira 17

• "If I have heard you right, you conveyed that ... ?" Is that
correct?
• "If I heard you right. .. ?" or "If I understand you correctly ... ?"
• "If I understand you right, you're saying that ... ?" or " ... you
.
b e11eve t h at....I" or " ... you ree
I: 1 t h at. ...I"

• So, what you are saying is ... Is that right?

• \X'hen the patient talks for too long, say "Could I just interrupt
you there for a second?"
• So it sounds like ...
• In other words ...
• You tnean ........ . /

• So, to put it another way, you believe/feel that. ..

• To rephrase what you said, ...

Examples:
Picking-up verbal cues
• You said that you feel miserable; could you tell me more about
these feelings/why have you been feeling this way?
• When you say that " ...... ", would you add some information/
give more details regarding this?

Picking-up non-verbal cues - facial expressions, tone, body

language
Hint: [Identify whether patient is unconcerned/angry/agitated/
sad/nervous/embarrassed] from cue card.
• It loo.ks like ...
• It seems that ...
• I sense that you are very sad/embarrassed/angry; would it help
if we talked about it?
~ You sound sad/concerned/anxious/unsure when you say this;
would it help talking about it?
 18 OET Speaking and Writing Made Easy for Nurses

• I sense that you are not quite happy/satisfied/sure with the

explanation/about the advice you have been given - Is that right?
·11 ,.
...•,.··· • A1n I right in thinking that you are reluctant/resistant to the
advice you have been given.

Giving advice

Explaining why something is important:

• It is important for you to start doing some kind of exercise for
at least 20 n1inutes every day.
• It is necessary for you to cut down on some of the foods in
your diet that are not particularly healthy. For instance, fried
foods or foods rich in cholesterol. /
• It is recommended that you try changing your lifestyle.
• It is imperative that you take your medicine regularly.
• It is paramount that you reduce your alcohol intake.
• It is indispensable that you quit smoking or at least try to cut
down on the number of cigarettes you smoke per day.
• It is crucial that you reduce your weight to avoid adverse
effects op your health.
• What I would like you to do is ......... (ensure compliance
with medication/healthy diet/eat more fruits and vegetables).
• Why not ... (try healthier alternatives?)
• In cases like these, the first thing to try ts changing your
lifestyle.
• I suggest that .. .
• I advise that .. .
• I strongly recommend that ...
• You need to ...
• It would be beneficial if you ...
• I am afraid it is extremely important/essential/imperative/
critical/for you to ...
 Gurleen Khaira 19

• It's essential that you ...

-~

• I strongly suggest/urge/advise you to ...

e
• It is essential. ..
• This might not be what you were hoping to hear, but the best
way to improve your health is ...
• Let's consider some ways by which you can incorporate
healthier changes in your life.
r
The patient may become fearful/difficult/noncompliant/reluctant
at this stage and may not want to follow your suggested plan of
1
action/treatment. It is important that you first acknowledge or
validate the patient's concerns and then provide a justification to
make them reconsider their decision. It is important (o ascertain
why the patient is finding it difficult to con1e to terms with your
treatment recommendation. It is possible that the patient has
incorrect beliefs that can be addressed with a simple conversation. A
patient must be explained the implications of refusing your advice
t
in simple terms that are understandable to him/her, but at the same
time, it is equally important to remember that it is within a patient's
right to refuse medication or treatment and that decision must be
respected.
• I appreciate what you are saying, and it's your right to get
discharged/refuse treatment with an informed understanding
of the risks involved with this decision. Can I explain the risks
associated with getting discharged against medical advice/
refusing medication or treatment? Would that be okay?
• I understand that the final decision is up to you. However, you
must understand the risks involved with this. Is it okay if I can
discuss that with you?

Sample expressions that can be used to validate/acknowledge

patient concerns that must be done empathetically.

• I completely understand that it must be complicated for you,

considering the stage you are in. It must be overwhelming!
20 OET Speaking and Writing Made Easy for Nurses

• I understand it is challenging for you to cope with this

situation and it is a reasonable reaction.
• Your concerns are understandable. It's not unusual for people
to react in this way.
• I understand you dislike this idea. It's common for people to
feel this way.
• I can understand your worries/ concern.
• I know how you are feeling. With that said, ..... .
• I can understand how you feel. That being said, ..... .
• I can see why you have this concern. Having said that, ..... .
• I understand/see why you are worried. However, ..... .
/

The next step would be to re-assure the patient to manage their

anxiety, fear or worries. For instance,

• You do not need to fear.

• This Clinic/This hospital has an excellent reputation, and
your health and safety are our utmost priority.
• I am a qualified nurse with a good nursing experience. Please
do not worry at all.
• Statistically speaking, the likely outcome for you is excellent.
• There is nothing to be alarmed about.
• I am afraid that there is no other way.
• Believe me, if there were another way, I would have told you.
• This is the best option, I assure you.
• There are no two ways about it.
• It's your health at stake here.
• You will hardly feel anything. It will just be a pinch.
• We will be here to help you.
0
We will be here to look after you.
• Try not to worry about.
 Gurleen Khaira 21

• I assure you there is nothing to worry about.

• I arn certain that staying in the hospital is in your best interests.
• Please relax; we are here to help you.

Explaining the risks associated with not taking the recommended

treatment.

• If you do not follow my advice, it may have adverse effects on

your heal th.
• The results of not getting the treatment can be detrimental.
• This is the reason why you need to get admitted/undergo this
treatment.
/

• For this reason, you need to ...

• If you do not take your medication on time, it might delay the
recovery time.
• I hope you understand why it is important for you to stick
to the diet/undergo the tests/take the pills/not smoke/to get
plenty of rest, otherwise ...

-
• If you do not modify your lifestyle, your disease may
::::
progress.
• Your condition might exacerbate if you discharge against
medical advice

Only proceed further when your patient has agreed to your plan
of action

Use statements like:

• I hope I have cleared up/assuaged your worries? Does that
make you feel a bit better?
• Is that okay?
• How does that sound?
• Are you happy with that?
22 OET Speaking and Writing Made Easy for Nurses

Useful vocabulary practice for speaking and writing

• As well as - also/ and - He is a drinker as well as a smoker.

• As well as this - also - As well as this, she also consumes a fat-
rich diet.
• Overwhelming - emotionally difficult - I can understand this
must be overwhelming for you. Please let me explain why this
is in1portant. If you do not stop smoking/drinking ........ .
• Adverse - harmful - If you do not follow my advice; it will
have adverse effects on your health.
• Reiterate - repeat - to reiterate what we discussed today, you
will have to make changes .. ./To repeat what you just said, you
have a stressful job, and you barely get time to exercise, is that
correct?
• Cornerstone - foundation - Good diet/Regular exercise is a
cornerstone for leading a healthy life.
• Perhaps - used to express uncertainty - Perhaps, you could
consider cutting down on smoking/drinking one day at a time.
• Probably - used to express uncertainty - Probably, you can
join a support group like Alcoholics anonymous to meet
people who are in the same condition.
• Incorporate preventative/precautionary measures - You must
incorporate these changes into your lifestyle to get your health
on track. You must incorporate preventative measures into
your lifestyle to ...
• Mitigate - make something less severe or painful - Painkillers
will help to mitigate/reduce/ease/relieve the pain.
• Alleviate :--- Painkillers will help to alleviate the pain. Is there
anything that alleviates your pain?
• Susceptible - likely/prone/sensitive/vulnerable - Patients with
liver disease may be susceptible to infection. If you do not lose
weight, you are susceptible to ...
• Compliance - please ensure compliance with the suggested
medication regimen.
 Gurleen Khaira 23

• To begin with - used for enumeration - To begin with, I will

explain ... after that ... then ... following that ... Finally ...
• Significant - Important - Adopting a low-fat diet will improve
your health significantly

s • Remarkable - note-worthy - Adopting a healthy lifestyle will

s improve your health remarkably.
• Vital - crucial/essential/critical - Please do not underestimate
how vitally important this is.
• Detrimental - tending to be harmful, negative, adverse- If you
J
continue to smoke/ drink, it will have detrimental effects on
J
your health
t • Adherence - compliance - Please ensure adher511ce to the
recommended exercise program/medication regime and so on.

- i

s
 /

SAMPLE ROLE PLAYS

ROLE PLAY 1

Candidate cue card

Setting: Community Health Centre
Nurse: You are talking to John Williams, a 35-year-old computer
engineer who has been referred by his GP for advice on weight loss.
He has been experiencing breathlessness on exertion an_si has been
advised by his General Practitioner to lose weight for improving his
health. He is overweight and has a BMI of 25.

Task

Discuss the importance of losing weight.

Ask questions about his lifestyle including drinking and eating habits.
Provide advice on getting a suitable diet and physical activity (increase
physical activity, reduce alcohol intake, eat fruits and vegetables).
Advise the patient to come back for a review in four weeks' time.

Interlocutor cue card

Setting: Community Health Clinic
Patient: Your name is John Williams. You are 35-year-old and work
as a comp:uter engineer. You drive half a mile to work and spend your
evenings in front of the TV or the local pub with friends. You usually
miss breakfast because of your busy schedule and tend to eat snacks
or fast food during the day. Recently, you have noticed a marked
decrease in your energy levels, particularly in the afternoons.
On weekends, you take care of your six-year-old nephew. You
lead a busy life and do not get any exercise or physical activity..
28 OET Speaking and -\Xlriting Made Easy for Nurses

You do not have any significant health problems, but lately, you
have been getting breathless while playing with your nephew on the
weekends. You do not believe that you need to lose weight, as being
overweight is quite common these days.

Task

Respond to the nurse's questions.

Express concern that it will be hard to make changes to your lifestyle.
Reluctantly agree to comply with the advice and return in a month's
time for a review.

Sample Transcript
/
Nurse: Good Morning, I am the Community Health Nurse, and
my name is Gurleen. How are you doing today?
Patient: Hello Gurleen, I am doing well.
Nurse: That's good to hear. Is it okay if I address you as
Mr Williams?
Patient: Yes, that's fine.
Nurse: Ok. So, Mr Williams, You have been referred by your
doctor so that we can have a little chat. The doctor is
concerned about your weight.
Patient: But I don't think my weight is that serious an issue. You see
tonnes of overweight people these days. That's what I tried
to tell the doctor as well; half of the country has a weight
problem if you read the papers.
Nurse: That may well be the case Mr Williams, but I think we
must. consider the long term effects of being overweight.
Moreover, I have been informed that you have been
experiencing breathlessness with exertion. Is that right?
Patient: Oh yes, I get out of breath while playing with my nephew. I
look after him on the weekends; and over last two months,
I have been getting breathless while having a bit of a kick
around him.
 Gurleen Khaira 29

Nurse: Hmm, This is probably not something that you were

hoping to hear, but being overweight is one of the causes
of your shortness of breath. Moreover, carrying extra
weight predisposes you to health problems. Therefore, it
is iinperative that we discuss some ways about stabilising
your weight to avoid future complications. Is that ok?
Patient: Ok. Well, Yes.

Nurse: Good. Now, I just have a few questions for you before I can
advise you, if I may?
Patient: Ask away.

Nurse: Thank you. Could you tell me if you get any physical
activity daily? For instance, exercising or walking 9f playing
some sport?
Patient: I have a hectic schedule; honestly, I do not get the time. I
go to work in the morning, and I get so exhausted during
the day that I either crash in front of the TV or spend time
with my mates in the local pub.
Nurse: Ok. Would you mind telling me about your eating habits?
Patient: Oh, I normally skip breakfast because I have to rush to
work. During the day, I eat snacks from the cafeteria or get
fast food in the lunch hour.
Nurse: Alright. And could you tell if you drink?
Patient: Yes, I have a few beers with my mates in the evenings; but,
it's only a form of a recreation.
Nurse: Ok. And do you have any ongoing medical conditions, for
example, hypertension or diabetes?
Patient: Thankfully, no! But my problem's the afternoon. My
energy level declines by three o clock.
Nurse: Ok. Thank you for answering my questions. It helped me
to understand the situation much better. Let's look at some
practical things that we can do together to help you now.
Does that sound good?
30 OET Speaking and Writing Made Easy for Nurses

Patient: Yes.

Nurse: Great. Well, Mr Williams, firstly I want you to consider

including some physical activity in your routine. There are
different ways to do this. Do you like exercising?
Patient: Um, I don't mind it but like I said earlier, I have a busy life,
so it's difficult to take time out to exercise.
Nurse: That's fine. How far is your workplace from your house?
Patient: Oh, not far. It's about half a mile from where I live.
Nurse: Ok, So how do you get to work?
Patient: I take my car. If I didn't, I would be late.
Nurse: Ok. I understand Mr Williams, but if I may suggest, you
should try and incorporate some activity into yaCir daily
routine. You could consider walking to work or taking
a bicycle to work. It is an efficient and effective way to
improve your health and fitness. The good thing is that
your workplace isn't far off and the distance between your
work and home allows for it. How does this sound?
Patient: I am not sure. I already struggle to get to work in time.
Nurse: Hmm, I understand your concern, but it would not take as
long as you think it will. You might need to wake up 30-45
minutes earlier than usual, but this way you will be able to
incorporate a much needed cardio activity in your lifestyle. If
you feel you are getting very late, take the bus and walk back
home. How do you feel about what I am proposing so far?
Patient: Well, I suppose it's not that bad.
Nurse: I am glad to hear that. Apart from this, you might want
to rethink your diet. A nutritious and well-balanced diet
with physical activity is the cornerstone of maintaining
good health. At the moment, you are barely getting one
nutritious meal. You must start with a healthy breakfast so
that you do not need to snack up till lunchtime. How does
this sound?
Patient: Well, if I am getting up early, I might as well try.
 Gurleen Khaira 31

Nurse: That's good. Eating a healthy breakfast will keep your

r energy levels up during the day. Moreover, you need to
include fruits and vegetables in your diet. Would you be
able to do this?
Patient: Well, my sister 1s a veggie and Mun1 prepares salad and
stuff in the evening, so I have no excuse really. I am not that
keen on it. ..
Nurse~ Hmm, I can understand. But eating a healthy diet is
paramount to your general well-being. I can sense you are
worried about changing habits all at once so you can make
gradual changes by including one or two portions of fruits
and vegetables in your diet each day. They are healthier
substitutes for snacking too.
Patient: 0 k, I can try ...

Nurse: That would be nice. And as for your alcohol consumption,

can I suggest you limit your intake to one or two pints at a
time?
Patient: One or two pints? That's hard. This 1s the only form of
relaxation I have.
Nurse: I know, I appreciate that, but it is of vital importance that you
reduce your intake. I am not advising to give it up altogether,
but only suggesting that you can limit your intake.
Patient: I will think about it.

Nurse: I understand it's going to be difficult at first, but it is

indispensable that you lose weight to avoid any adverse
effects on your health. Eventually, this will have a bearing
~n all aspects of your life.

Patient: Hmm, I suppose I can give it a try.

Nurse: I am glad to hear that. You can start with the little changes
at first, and I recommend that you visit me in 4 weeks'
time to assess your progress. If you have any questions in
the meantime, you can contact me-here at the centre. Does
that sound Ok?
32 OET Speaking and Writing Made Easy for Nurses

Patient: Yes, it sounds alright. I will see you after a month.

Speaking description - What a good student is expected to produce in

this role play

Introduction

In this task, the student (nurse) is speaking to a patient who has been
referred to the community health centre for advice on weight loss.
The role card suggests that this is the first time the patient is visiting
this centre so introductions would be appropriate.
• Good Morning, I am the Community Health Nurse, and my
name is Gurleen. How are you doing today?
/
The nurse should ask the patient what he/she would prefer to be called
(first name or last name). This is simply a matter of courtesy and
respect as some people prefer to be called by their first names while
others prefer to be addressed as Mr or Mrs followed by their last name.
• How may I address you?
• What do you prefer to be called?

For this task, the patient's name is John Williams, and let's he prefers
to be addressed as John.
The next step would be to confirm the reason for his/her visit.
• So, John, you have been referred by your doctor so that
we can have a little chat. The doctor is concerned about
your weight. Moreover, I have also been informed that you
have been experiencing breathlessness with exertion. Is that
right?
• I unders~and that you have been referred by your General
Practitioner today for a discussion about your weight. Is that
correct?

1. Discuss the importance of losing weight.

For this part, the discussion should be opened in a respectful and
non-judgmental way. The student should emphasize the importance
 Gurleen Khaira 33

of losing weight by pointing out that being overweight may be one of

the causes for patient's breathlessness. However, care must be taken
that the conversation is positive and encouraging.
• I think we must consider the long-term effects of being
overweight.
• This is probably not something that you were hoping to
hear but being overweight is one of the causes of shortness of
breath.
• Carrying extra weight predisposes you to health problems.
• Therefore, it is imperative that we discuss some ways about
stabilizing your weight to avoid future complications. Is
that ok?

2. Ask questions about the patient's general lifestyle including

drinking and eating habits.
For this part, the student will need to ask questions regarding
patient's general lifestyle including his/her eating and drinking
habits. Students must demonstrate an understanding of the correct
word order and grammar of common history-taking questions.
Given the time limit, students should ask only relevant questions
pertaining to his/her dietary pattern and physical activity in his/her
routine. As a sign of respect, patient's permission must be sought
before taking the history-taking.
• Would it be okay if I asked you some questions about your
lifestyle?
• Do you mind if I ask you some questions about your lifestyle?
• I just have a few questions for you before I can advise you, if I
may?
• Before proceeding further, I would like to ask you a few
questions about your lifestyle. Is that ok?

The next step would be to ask relevant questions using open-ended

questions as well as closed-ended questions to get insightful responses
from the patient.
34 OET Speaking and Writing Made Easy for Nurses

Open questions
• Could you tell me something about your eating habits?
• What kinds of foods and beverages do you eat on a typical day?
• Would you mind telling me about your eating habits?

Closed questions
• Cou 1d you tell if you drink alcohol? If yes, how often do you
drink and how many units of alcohol do you consume?
• Do you get any physical activity daily? For instance, exercising
or walking or playing some sport?
• Once the patient has answered the questions, the student
should take the lead and use a speech transition phrase to
indicate that the history - taking has been completed, and the
pa ti en t would now be advised on things he/ she can do to lose
weight. .
• Thank you for answering my questions. It helped me to
understand the situation much better. Let's now look at some
practical things that we can do together to help. Does that
sound good?

3. Provide advice on increasing physical activity and eating a suitable

diet (reducing alcohol intake, eating fruits and vegetables).
For this part, the student can explain the lifestyle changes to improve
the patient's health while allowing opportunities for the patient to
ask for clarification or express opinions. Use of 'signposting phrases'
will help separate distinct points (reducing alcohol intake, eating
fruits and vegetables). The student should try to determine whether
the patient is willing to acknowledge that he/she would make
lifestyle changes as advised. This would demonstrate awareness that
the patient may be reluctant to make lifestyle changes. In this case,
the student should use empathetic language to persuade the patient
by acknowledging that change is difficult but also state that the
advice is in the patient's best interests. The student should re-enforce
the benefits of making these changes. If the patient is concerned
 Gurleen Khaira 35

about making changes all at once, the student should attem.pt to

arrive at a favorable outcome by proposing an acceptable alternative.
• There are three things I am going to recommend to you.
• Firstly, I want you to consider including some physical activity
in your routine. There are different ways to do this. Do you
like exercising?
• (If the patient expresses concern about not having enough
time to exercise due to a busy lifestyle, the nurse can politely
suggest him to consider other alternatives) - You should try
and incorporate some activity into your daily routine. You
could consider walking to work or taking a bicycle to work.
It is an efficient and effective way to improve your health and
fitness. It would not take as long as you think it ~ill. You
might need to wake up 30-45 minutes earlier than usual, but
this way you will be able to incorporate a much needed cardio
activity in your lifestyle. If you feel you are getting very late,
take the bus and walk back home. How do feel about what I
am proposing so far?
• Secondly, you might want to rethink your diet. A nutritious,
well-balanced diet with physical activity is the cornerstone of
maintaining good health. How does this sound?
• Eating a healthy breakfast will keep your energy levels up
during the day. Moreover, you need to include fruits and
vegetables in your diet. '
• (If the patient is reluctant to change his/her diet) - Eating a
healthy diet is paramount to your general well-being. I can
sense you are worried about changing habits all at once, so you
can i:nake gradual changes by including one or two portions of
fruits and vegetables in your diet. They are healthier substitutes
for snacking too.
• Finally, as for your alcohol consumption, can I suggest you
limit your intake to one or two pints at a time?
• (If the patient expresses concern about cutting down on
alcohol) - It is vitally important you reduce your intake.
36 OET Speaking and Writing Iv1ade Easy for Nurses

And I am not even advising to give it up all together but

simply suggesting that you can limit your intake.

4. Advise the patient to come back for a review in four weeks' time.
This is the final task of the role play, and the role play should be
concluded by advising the patient to return in four week's time
and motivating the patient to adhere to the suggested changes for
promoting weight loss.
• You can start with little changes at first, but it is indispensable
that you lose weight to avoid any adverse effects on your
health. Eventually, this will have a bearing on all aspects of
your life.
• I recommend that you visit me in 4 weeks' time to asstss your
progress. If you have any questions in the meantime, you can
contact me here at the centre. Does that sound good?
t

ROLE p·LAY 2

Candidate cue card

Setting: Hospital Ward
Nurse: You have been called to the patient's bedside. The patient's name
is Maria Rodriguez, a 37-year-old woman who was admitted to the
hospital yesterday with a fractured leg. You notice that she 190ks quite
agitated. It's early morning, and the doctor is on a round in the hospital.

Task

Find out why the patient is angry. Explain that your visit was delayed
as you were attending to a critical patient.
Empathize with the patient regarding her complaint(s) and calm the
patient down.
Ask her about the pain (pain score, whether on-going pain-relief
medication is effective). Explain that you need to call the doctor to
change her pain-relief medicine.
When asked, explain that eating a snickers bar is against hospital
safety rules. Encourage her to discuss her dietary preferences with
the hospital dietician.

In terlocu to.r cue card

Setting: Hospital Ward
Patient: You are Maria Rodriguez. You are 37-year-old and were
admitted to the hospital yesterday with a fractured leg. You are in a
lot of pain, which has not subsided despite the pain-killer medicine
which was given to you earlier by the hospital staff You rang the
buzzer 30 minutes ago, but no one has come to see you. Your husband
38 OET Speaking and Writing Made Easy for Nurses

has just left; as a result, you feel alone in the hospital, and the pain is
making you very uncomfortable. This is the first time you have been
hospitalized. Moreover, you hate the hospital food and are craving
chocolate. You are distraught and very angry with the hospital staff
for neglecting you while you were in pain.

Task
Agitatedly tell the nurse that you are extremely upset and want to file
a complaint. Explain that you have been waiting for the nurse for 30
minutes while being in pain. Tell the nurse that your pain score is 11
and you want a stronger pain-killer.
Demand the nurse to get stronger medication herself (because calling
the doctor seems like another delaying tactic to you). /
Ask the nurse to see the doctor and inquire about his whereabouts.
Express dissatisfaction with the hospital food and ask the nurse if you
can eat a snickers bar.

Sample Transcript
Nurse: Hello Mrs Rodriguez, my name is Gurleen, and I am going
to be taking care of you today. I see that you rang the buzzer?
Patient: Finally! I rang the buzzer 30 minutes ago. Where were you?
Nurse: I apologise for the delay Mrs Rodriguez, I had to urgently
attend to a critical patient. How are you feeling?
Patient: I think no one seems to care. I am in a lot of pain, but this
is a ridiculous hospital!
Nurse: I can sense that you are quite upset. Could you please
elaborate on what happened?
Patient: Well, not just upset. I am distraught and angry and in a
lot of pain. This is horrible. No one has ever treated me
like this.
Nurse: I am so sorry to hear that. I apologize for the rough
experience that you have had. Please let. me know how I
can assist you?
 Gurleen Khaira 39

Patient: If you cared, you would have been here earlier ... Your sorry
isn't good enough. I am going to file a com.plaint against
you and everyone here!
Nurse: I can see you are incredibly upset Mrs Rodriguez. It's
important that we understand each other completely.
Would you mind telling me what's bothering you?
Patient~ I rang the buzzer 30 minutes ago. I have been sitting here
and waiting for someone to give me my medicine to help
ine with my pain. But, no one cares in this hospital! You are
all useless!
Nurse: Thank you so much for sharing this with me. I can now
understand how frustrating it must have been to wait while
/
you were in pain. I am sorry for this; I will ensure that it
does not get repeated. ,

Patient: Yes! I need to get some tablets now. This pain is killing me.

Nurse: Certainly, but before that, would you mind telling me how
severe the pain is on a scale of 0 to 10 where 0 is no pain
and ten being the worst you have ever experienced?
Patient: It's like an 11.

Nurse: I am sorry that your pain level 1s so high. Did the pain
medication we gave you earlier help at all in alleviating the
pain?
Patient: No, it's really not helping. I need something stronger.

Nurse: Right. So, here's what I am going to do. I am going to call

the doctor and let him know that the pain medication you
are on isn't helping to control your pain and you are in a
lot of pain right now. I need to ask him if we can give you
something stronger. Does that sound good?
Patient: Wow! That's another delaying tactic you have there! Just
get me a strong pain-killer; it's all I am asking.
Nurse: I know it's very difficult to cope ""'.'ith the pain; however,
I am only allowed to give medication as prescribed by the
40 OET Speaking and Writing Made Easy for Nurses

physician. It's beyond my scope to change the medication

without the doctor's order. Your safety is my priority, and
it's crucial that the doctor agrees to switch your medication.
That being said, I will ensure that you do not have to wait
long.
Patient: Hmm. In that case, where is the doctor? Shouldn't he be
here for this? I would like to see him.
Nurse: I understand your concern. It's early morning, so he's
probably on a round and should be coming to see you soon.
Patient: But, I am in pain ... What could be more important to him
than this?
Nurse: I know that it's distressing to be in this situation. -1--lere's
what I recommend, let's call him first and form a plan of
action to manage your pain. I will also ask him to visit you
at the earliest. Would that be okay?

Patient: Yes, I would like something to help with this pain. My

husband just left, and I am alone. On top of that, this pain
is making me so uncomfortable. I need to feel better.
Nurse: Is this your first time in the hospital?
Patient: Yes. And I don't know for how long I will have to stay here.
I don't like anything here. The food's horrible too.
Nurse: Ok. That does make sense. I can see why you have been
upset. It's hard enough to be in the hospital, let alone, with
other stuff going on. Regarding the food, I can request the
hospital dietician to visit you shortly to discuss your food
preferences after which she can customise your diet plan
to meet your needs. How do you feel about what I am
proposing?
Patient: Yes, that's a good idea. Can you ask her if she can include a
snickers bar in my food for dessert?
Nurse: Well, regrettably, food from outside including a snickers
bar is against the safety rules of the hospital. This is because
 Gurleen Khaira 41

eating healthy food is indispensable for your health and

recovery. Having said that, you can ask your dietician
about adding some healthier alternatives like a banana cake
or fruit plate to your meal plan. Would that be okay?
Patient: 0 K, that's fine.

Nurse: Ok. Here's what I am going to do next. I am going to

call the doctor regarding your medication, and following
that, since you do not have any family here, I will check
on you at least once in every hour to ensure that you have
everything you need. I will also notify the dietician to visit
you soon. Is that alright?
Patient: Yes, that sounds like a good plan.
/
Nurse: OK. I will be back soon with your medication.
Patient: Alright, thank you, nurse.

Nurse: You're welcome.

Speaking description - What a good student is expected to produce

In this role play, the student (nurse) has been called to the patient's
bedside. The student should start the role play with a polite
introduction and investigate the reason for being called to the
patient's bedside.
• Hello, my name.is Gurleen, and I am going to be taking care
of you today. I see that you rang the buzzer?
• Hello, my name is Gurleen, and I am the attending nurse on
duty today. I see that you rang the nurse call button. Please let
me know how I may assist you?

The student should ask the patient what he/she would prefer to be
called (first name or last name). This is simply a matter of courtesy and
respect as some people prefer to be called by their first names while
others prefer to be addressed as Mr or Mrs followed by their last name.
• How may I address you?
• What do you prefer to be called?
 42 OET Speaking and Writing Made Easy for Nurses

1. Find out why the patient is angry

The patient seems agitated, so the student will need to ask open-ended
indirect questions to find out the cause that has triggered this reaction.
• You seem angry. Would you mind telling me what's bothering
you?
• I can see that you seem angry. Would you please tell what's
troubling you?
• I hope you don't mind my saying this, but it seems that something
is disturbing you. Could you please tell me what's going on?
• I can sense that you are quite upset. Could you please elaborate
on what happened?
• I can see you are incredibly upset. It's important th~,,f we
understand each other completely. Would you mind telling
me what's bothering you?

The student should exercise reflective listening skills to acknowledge

or validate the patient's concerns to demonstrate an understanding
of the situation. This can be done by repeating/ paraphrasing or
reflecting back what the patient's response. This "reflective listening"
will not only affirm that the patient is being heard but also provide
more opportunity to the patient to express himself/herself.
• If I understand you correctly, you are angry about the delayed
! bedside visit. Is that right?

2. Explain that you were attending to a critical patient

Once it has been established that the patient is upset regarding the
delayed bedside visit, the student should explain the reason for the
delay. However, care must be taken to do this empathetically. Use
polite expressions to justify the reason for being late.
• I apologise for the delay. I had to attend to a critical patient
urgently.
• I am sorry this has happened. I was attending to a critical patient.
• I am sorry that you had to wait for so long. The reason my
visit was delayed is that I was attending to a patient in critical
condition.
 Gurleen Khaira 43

3. Empathize with the patient regarding his/her complaint(s) and

calm the patient down.
For this part, the student must empathetically respond to
the patient's complaints to validate his/her feelings and show
understanding. The students can also use back channelling when the
patient is expressing her complaints to make him/her feel heard. For
.
instance, i e "Okay" , "Uh - h u h" , "R·ig h t " , "M mm" , b ut
utterances l"k
the student needs to demonstrate an awareness of intonation and
timing while using these. It is also important to include expressions
of apology to defuse the patient's anger or at least prevent him/
her from becoming angrier. The student should adjust the style of
communication when talking to an agitated patient (calm tone,
speaking slowly and clearly). /
Also, the student should continue to ask what he/she can do
for the patient. This shows again that the health professional cares
enough about the situation and wants to help to rectify it.
• I am so sorry to hear that. I apologise for the rough experience
that you have had. Please let me know how I can assist you?
• Thank you so much for sharing this with me. I can now
understand how frustrating it must have been to wait while
you were in pain. I am sorry for this; I will ensure that it does
not get repeated.
• I am so sorry that this is happening to you. I understand this
must have been very difficult for you.
• Given everything that you have told me, it's understandable
that you feel this way. What can I do to help you?

4. Ask him/her about the pain (pain score, whether ongoing pain-
relief medication is effective).
When the patient has calmed down and demands pain relief
medication for pain management, the student would need to use
suitable expressions for pain assessment. Since pain is a subjective
experience and may not be clearly articulated by many, a pain scale
1nay be used to encourage the patient to self-report the intensity or·
severity of the pain.
44 OET Speaking and Writing Made Easy for Nurses

• Would you mind telling me how severe the pain is on a scale

of 0 to 10 where 0 is no pain and ten being the worst you have
ever experienced?

The student should use polite expressions to inquire about the

efficacy of the pain-relief medication given earlier.
• I am sorry that your pain level is so high. Did the pain
medication we gave you earlier help at all in alleviating the
pain?

5. Explain that you need to call the doctor to change his/her pain-
relief medicine.
For this part, the student would need to explain that a stro~er
medication can only be administered with a physician's orders. It
needs to be done skillfully as the patient is in pain and has already
had to wait for 30 minutes. Therefore, the nurse should justify this
step by explaining that this decision is the patient's best interests. It
can also be explained that prescribing a new medication is beyond the
nurse's limits of competence. The student can also provide emotional
reassurance to the patient by ensuring that the patient would not
have to wait long. At the same time, empathetic phrases should be
used to acknowledge the patient's pain.
• So, here's what I am going to do. I am going to call the doctor
and let him know that the pain medication you are on isn't
helping to control your pain and you are in a lot of pain right
now. I need to ask him if we can give you something stronger
if he's comfortable with that. Does that sound good?
• I know it's difficult to cope with the pain; however, I am only
allowed to give medication as prescribed by the physicia.n. It's
beyond my scope to change the medication without doctor's
order. Your safety is my priority, and it's crucial that the doctor
agrees to switch your medication. That being said, I will
ensure that you do not have to wait long.

In case the patient demands to see a doctor, the. student should

calmly explain that he/ she is on rounds and offer to call the doctor
 Gurleen Khaira 45

for managing the patient's pain. At the same time, it should be

recognised that the situation is difficult for the patient to cope with.
Also, the student should reassure the patient by conveying that the
doctor is concerned about the patient's welfare and should be seeing
the patient as early as possible.
• I understand your concern and where you are coming from.
It is early morning, so he's probably on rounds and should be
corning to see you soon.
• I know that it's distressing to be in this situation. Here's what
I recommend, let's call him first and form a plan of action to
manage your pain. I will also ask him to visit you as early as
possible. Would that be okay?
/
The next step would be to check if the patient 1s okay with this
decision. If the patient expresses dissatisfaction while being in the
hospital, some probing questions n1ay be asked to find out if there is
anything else bothering the patient.
• Is this your first time in the hospital?

The next step would be to pick up verbal cues and acknowledge their
concerns by using empathetic phrases that signal sensitivity to their
predicament. The student can also offer
• That does make sense. I can see why you have been upset. It's
hard enough to be in the hospital, let alone, with other stuff
going on.

6. Encourage the patient to discuss his/her dietary preferences with

the hospital dietician.

For this part, the student should attempt to arrive at a favourable .

outcome for the patient by suggesting that he/she discusses food
preferences with the hospital dietician.
• Regarding the food, I can request the hospital dietician to visit
you shortly to discuss your food preferences after which she
can customise your diet plan to meet your needs. How do you
feel about what I am proposing?
46 OET Speaking and Writing Made Easy for Nurses

The role play should conclude with a structured end by collaborating

with the patient to arrive at an acceptable plan.
• Here's what I am going to do next. I am going to call the
doctor regarding your medication, and following that, since
you do not have any family here, I will check on you at least
once in every hour to ensure that you have everything you
need. I will also notify the dietician to visit you soon. Is that
alright?

/
ROLE PLAY 3

Candidate cue card

Setting: General Practitioner Clinic
Nurse: You are speaking to Tim Robinson, a 40-year-old man who
has come to the clinic for a routine check-up. He is travelling to
Cambodia and Vietnam next month for work, and th~ General
Practitioner has asked you to advise him on the recommended travel
immunisations before international travel.

Task

Find out about his vaccination history (tetanus, hepatitis A, and

influenza/flu) and the duration of his travel.
Explain that he needs to get vaccinated against typhoid, hepatitis A,
and tetanus (recommended by WHO for travelers to Cambodia and
Vietnam that are medium risk countries).
Explain and emphasize the importance of getting his vaccinations
updated at least two weeks before travelling abroad (tetanus can be
fatal, and vaccination needs to be administered once in every ten
years; a combined vaccination can be given for hepatitis A and
typhoid now and a booster after six months).
Reassure him that the vaccinations are not painful and are generally
well-tolerated.

Interlocutor cue card

Setting: General Practitioner Clinic
48 OET Speaking and Writing Made Easy for Nurses

Patient: You are Tim Robinson, a 40-year-old international business

manager. Your company is sending you to Cambodia and Vietnam
next month for four weeks. Your doctor has suggested you speak to
a nurse in the clinic regarding advice on recommended vaccinations
before travelling overseas.

Task
Explain, when asked, that you vaccinated yourself against flu this
year and were vaccinated for tetanus and hepatitis A and B as a child
(approx. 30 years ago).
Ask the nurse why you need to get vaccinated again stressing that
you have been managing well without these medications all these
/
years and that you will be staying at a five-star resort, so the risk of
infection is minimal.
Explain that you hate injections because they are painful and
uncomfortable. Reluctantly agree to get the vaccinations today.

Sample Transcript
Nurse: Good morning, Mr Robinson. Thanks for coming to see
me. My name is, Gurleen, and I am the clinic nurse.
Patient: Hello, Gurleen. Thanks for talking to me.
Nurse: That's ok. The doctor has informed me that you will be
travelling overseas next month. Is that right?
Patient: Yes, that's correct. I work as the International Business
Manager, and my company is sending me to Cambodia
and Vietnam next month.

Nurse: I see. H?w long are you going for?

Patient: I suppose I will be gone for around four weeks.
Nurse: Ok. The doctor has asked me to ensure that your
vaccinations are up-to-date before your trip. So, can I ask
you some questions about your immunisation history?

Patient: Yes, absolutely.

l-
~
 Gurleen Khaira 49

Nurse: Could you tell me when you received immunisations for

tetanus, flu, and hepatitis A?

Patient: Well, I have been fairly regular with my flu shots every
year. In fact, I got one earlier this year. About the rest, let
me see. I do not accurately remember since I do not have
my immunisation record, but I do remember that I was
vaccinated against tetanus and hepatitis A and B in my
childhood - you can say about 30 years ago.

Nurse: Ok. So, what you are saying is that you have had a flu vaccine
earlier this year and have not repeated vaccines for hepatitis
A and B or tetanus since your childhood. Is that right?

Patient: Yes, that sounds about right.

/
Nurse: Alright. Since you are travelling to Cambodia and Vietnam,
which are both medium risk countries as per the World
Health Organisation, I would advise you to update your
vaccinations for tetanus, hepatitis A, and typhoid.

Patient: Oh no! Do I really need to get all these? I mean I have been
managing pretty well all these years. I do not understand
why I need to go through the hassle of getting these again.
Also, my company has arranged my stay at a five-star resort,
so I do not see a reason to worry.

Nurse: Yes, I understand what you are saying; nevertheless, it's

crucial for your protection. There is a moderate to high
risk of these diseases if you are travelling to Cambodia
and Vietnam, and a straightforward and effective way to
prevent these diseases is vaccination. While I understand
that you were vaccinated during your childhood and have
been managing well, some vaccines need to be repeated
after a few years as their efficacy is limited.

Patient: Is that so? I was not aware of this! I always thought that they
are sufficient for a lifetime and I have lifelong immunity.

Nurse: No, you need to update your v~ccinations for tetanus,

typhoid, and hepatitis A. A tetanus vaccination needs to be
 50 OET Speaking and Writing Made Easy for Nurses

updated once every ten years, and it's pararnount that you
are vaccinated against tetanus because it can be lethal and
dangerous. We can give you a combined vaccination for
hepatitis A and typhoid, which should give you immunity
against these during your trip. Once you are back, you can
come back for a booster dose after six months.
Patient: Right. So, you suggest that I get these before travelling?

Nurse: Yes, it is also important to ensure that there is a gap of at

least two weeks between your vaccination and travel dates.
Patient: That does not leave me with much time. I suppose I need
to get the vaccinations either this week or the next.
Nurse: That's right. Just like eating well and exercising, pr<?J'er
vaccination is the cornerstone of main raining good health.
Patient: Oh well! You do have a point, but you see I hate injections
and needles. It's painful and uncomfortable.
Nurse: It's understandable. It's totally normal to feel a little
anxious, uneasy, and hesitant about getting injections. But
as with most things, having a positive attitude will make the
experience easier. In fact, it's not as painful as anticipated
and the pain is generally tolerable. You might feel a little
pinch and some pressure. If it hurts, it will hurt only for a
short time.

Patient: Hmm, ok. I don't think I have a choice. So, I might just get
it over with.

Nurse: Would you be willing to get these vaccinations today?

Patient: Well, ok. I think I will get the vaccinations today. After all,
how hard can it be, right?

Nurse: Exactly. I am glad that you agree. Please wait here, and I
will be back shortly with the vaccines.
ROLE PLAY 4

Candidate cue card

Setting: Hospital Ward
Nurse: You are speaking to a 45-year-old woman, Natalie Johnson,
who has been admitted to the hospital with a suspected stroke. You
have been asked by the doctor to administer a Warfarin injection
(anticoagulant) to the patient.

Task

Take the medical history of the patient before giving the injection.
Explain that after the injection, Warfarin needs -to be taken in tablet
form every day for the next four weeks.
Explain that you need to check if she can continue her herbal
supplement as it may interfere with Warfarin or cause side effects.
Emphasize the importance of cautionary measures regarding Warfarin
(minimise Vitamin K in diet, avoid OTC medicines due to their
interaction with Warfarin, take a dose at the same time each day).
Offer to provide a detailed patient information leaflet on Warfarin.
Educate the patient about possible side-effects of Warfarin (nose
bleed/bruising/blood in urine occasionally etc.)
Advise the patient to contact the doctor immediately 1n case of
unusual or prolonged bleeding

Interlocutor cue card

Setting: Hospital Ward
52 OET Speaking and Writing Made Easy for Nurses

Patient: Your name is Natalie Johnson. You are a 45-year-old

woman who has been admitted to the hospital with a suspected
stroke. You do not have any significant medical history except for
polycystic ovary syndrome for which you take herbal supplements.
You do not drink alcohol and have never smoked. You are speaking
to a nurse who has come to give you a warfarin injection. Your
father also takes Warfarin tablets, which causes his nose to bleed
occasionally.

Task
Respond to the nurse's questions.
Be reluctant to the idea of giving up your herbal supplements.
/
Ask the nurse for necessary information on things to avoid while
taking this medication.
Request more information about "foods to avoid" as you are
uncertain about which foods have Vitamin K.
Explain that you are concerned about possible side effects and ask if
you can stop the medication in case of nose bleeds.

Sample Transcript
Nurse: Hello, Ms Johnson. My name is Gurleen, and I am one of
the registered nurses on ward duty today.
Patient: Hello, Gurleen.
Nurse: I am here to give you your medication. Is that ok?
Patient: Yes, that's alright.
Nurse: Thank you. Your doctor has prescribed Warfarin. It's an
anticoagulant medication used for thinning the blood.
Patient: Yes, err, I think they are the tablets that my father takes for
his heart condition.
Nurse: Yes, Warfarin is usually taken in pill form, but in your case,
the doctor has advised an injection to get i~ working more
quickly.
 Gurleen Khaira 53

Patient: Oh, alright.

Nurse: Before I can give you the injection, I need to ask you a few
questions. Is that alright?
Patient: Ok, go ahead.

Nurse: Do you have any ongoing medical conditions like

hypertension or diabetes?
Patient: Yes, I have polycystic ovary syndrome.

Nurse: Ok. Do you take any medication for it?

Patient: Ah, yes, I take a herbal supplement which helps to calm
down its symptoms.
Nurse: Ok. Are you on any other medication at the m9ment?
Patient: No, I am not taking anything else.

Nurse: Are you allergic to any medication?

Patient: Not as far as I know.

Nurse: Ok. Can I ask if you drink alcohol?

Patient: No

Nurse: Alright. And would you mind telling me if you smoke?

Patient: No, I have never smoked in my life.

Nurse: So, to go over what you said: you are not on any medication
at the moment, you are not allergic to anything, you
do not smoke or drink alcohol, and you are taking a
herbal supplement for polycystic ovary syndrome. Is that
correct?
Patient: Yes, that's right.

Nurse: Alright, I am going to give you the injection now following

which you will need to start taking it in tablet form on an
everyday basis for the next four weeks.
Patient: Ok. For a whole month did you say?

Nurse: Yes, that's correct. Also, I need to check with the doctor
whether you can continue taking your herbal supplement.
54 OET Speaking and Writing Made Easy for Nurses

Patient: What? Why? It really helps me in calming down the

symptoms. I do not think it's dangerous in any way.
Nurse: Well, Warfarin can cause problems if it's taken with some
herbal supplements. Therefore, I need to check with the
doctor once, and you can take it if he approves.
Patient: What kind of problems?

Nurse: Some supplements interfere with the medication's efficacy

or may cause side effects; so it's imperative that we take the
doctor's consent in this matter.

Patient: Oh, alright. Well, I think I will avoid it at the moment,

just to be on the safe side. Is there anything else that might
interfere with this medicine and needs to be avoided? /
Nurse: Yes, there are some things you need to be mindful of.
Firstly, you need to take your medication at the same time
each day. Do you think you will be able to do that?
Patient: Yes, it's not a problem. I will manage.

Nurse: Good. Secondly, do not take any over the counter

medication without checking with the doctor first. Like I
mentioned earlier, there may be potential implications of
adding new drugs to this medication.
Patient: Sure, I understand.

Nurse: Finally, you will need to minimize your intake of foods rich
in Vitamin K, as they can make the Warfarin less efficient.
Have you understood so far?

Patient: Yes ... except ... I am not sure I know which foods are rich
in Vitamin K ... I mean ... how do I know what to avoid?

Nurse: Yes, I understand what you are saying. I can give you a
patient information leaflet with detailed information about
managing your diet while you are on Warfarin.
Patient: Alright. That sounds good.

Nurse: Do you have any questions about what we just discussed?

 Gurleen Khaira SS

Patient: Umm ... yes, I am worried about its side effects. Sometimes
these tablets give my dad nosebleeds.
Nurse: Right, nosebleeds can be a side effect of Warfarin. At times,
people pass blood in the urine or get bruises. That being
said, these happen only occasionally. Warfarin is generally
well-tolerated by patients. It is not something to be
concerned about. However, in case the bleeding is excessive
or prolonged, you must contact the doctor immediately.
Patient: Oh, you mean it can cause a hae1norrhage?

Nurse: I can understand it's frightening, but it's not common.

Still, you need to seek immediate medical advice in case
the bleeding is unusual. Warfarin is not dangerous if
/
you adhere to the instructions outlined in ·the patient
information leaflet. And in case you notice a symptom that
you feel is a cause for concern, get attention immediately.
Patient: Ok, in case I notice heavy bleeding, I should stop the
medication, right?
Nurse: Yes, in the case of severe bleeding, the doctor might regulate
the dose, so it will be best to check with the doctor before
resuming the medication in that case.

Patient: Ok.

Nurse: Is there anything else that you would like to ask?

Patient: No, I guess ... I will read the leaflet and let you know if I
have any questions.
Nurse: Yes, that's a good idea. I hope I could address your concerns.

Patient: Yes, the conversation helped.

Nurse: Thank you. I will just get the patient information leaflet
for you, and you can press the buzzer in case you need
anything else.
Patient: Ok, thanks.
ROLE PLAY 5

Candidate cue card

Setting: Accident and Emergency
Nurse: You are speaking to Ms Tanya Groom, a 31-year-old woman,
who is complaining of a severe throbbing headache on the right side
of the forehead. She is distressed as the severe pain is prev5nring her
from participating in work and wants medication for /immediate
relief, for getting back to work for a major business meeting.

Task

Take a relevant history of the patient's condition (onset, triggers,

severity, etc.) Enquire about the patient's nature of work.
Explain your preliminary diagnosis of a migraine (probably triggered
by stress). Persuade her to wait for 30 minutes to see one of the
doctors.
Reassure her and explain why it is best to wait and see a doctor.

Interlocutor cue card

Setting: Accident and Emergency
Patient: You are Tanya Groom, a 31-year-old woman. You have an
excruciating headache on the right side of your forehead and above
the ear. You work as the marketing director of a large business and
want to get back to work quickly for a meeting. You have to come
to the A & E to get medication by a doctor or a nurse - you don't
really care.
The headaches started three weeks ago_ (2 attacks in a week) and
are accompanied by nausea and dizziness, and the pain is so sharp
 58 OET Speaking and Writing Made Easy for Nurses

and painful ( 10/ 10) that you cannot get any work done. The sunlight
from your office window and staring at your computer screen makes
the headaches much worse and sometimes even causes ringing in her
ears. At times, you start to see bright spots on the computer before
onset. It is relieved by Tylenol or sleeping for one or two hours. You
have to work long and stressful hours at your desk every day. You
have been increasingly stressed at work recently because you are
behind schedule with multiple upcoming project deadlines.

Task

Explain your concern about wanting to leave soon for a meeting.

Respond to the Nurse's questions about your symptoms and work.
/
Be difficult to convince when the nurse is explaining about, the
possibility of a migraine and need to see a doctor.
Eventually, you agree to wait for another 39 minutes to see a doctor.
Sample Transcript
Nurse: Hello, my name is Gurleen, and I will be your attending
nurse today. What is your name?
Patient: Yeah, Hi, I am Tanya Groom.
-
~1
Nurse: Ok. What brings you here Ms Groom?

Patient: I have an excruciating headache on the right side of my

head. It feels like someone has gripped the right side of my
neck. I am running a bit late for work and just want a tablet
or injection for pain-relie£
Nurse: That's terrible. I hope you don't mind that I need to ask
you a f~w questions regarding your headaches before
prescribing a medication. May I do that?

Patient: Sure, Go ahead.

Nurse: So, is the pain on just one side of the head?

Patient: That's right; on the right side of the forehead and above the
right ear.
 Gurleen Khaira 59

Nurse: And how severe is the pain. On a scale of 1 to 10, how

would you rate your pain with one being the lowest and 10
is the worst pain you have ever experienced?
Patient: Oh, well. .. I would rate it at a 10. It's crippling.
Nurse: That's a pity. That must be really difficult to cope with. Could
you tell me if it is a throbbing pain or a dull or sharp ache?
Patient: wrell, I would describe it as throbbing.
Nurse: Ok. Is this the first time or you have had them before?
Patient: No, this is the third week. They come at varied times -
almost twice a week.
Nurse: So, what you are saying is that you started getting these
headaches about three weeks ago and you have Kad at least
two episodic attacks every week. Is that right?
Patient: Yes, that's about right.
Nurse: And during these episodes, how long did the pain last?
Patient: Well, it lasts between 15 minutes to 2 hours, is quite
persistent, and the pain gets more intense with time.
Nurse: alright. Is the pain accompanied by any nausea, vomiting,
or dizziness?
. Patient: Ah, well. . . It usually makes me nauseous and dizzy but
only until the time the headache lasts.
Nurse: Ok. Is there anything that alleviates your pain?
Patient: Yes, the pain subsides with Tylenol or sleeping for 1-2 hours.
Nurse: OK. Could you tell me if anything exacerbates your pain?
Patient: Yes, I have noticed that sunlight from my office window
and staring at the computer screen makes the pain much
worse. In fact, sometimes it causes ringing in my ears as
well. Oh, there's another thing, just before the headaches, I
sometimes see bright spots on the computer screen.
Nurse: Ok. Could you tell me about what kind of work you do?
Patient: I am the marketing director of my company.
60 OET Speaking and Writing Made Easy for Nurses

Nurse: Alright. And how many hours do you work?

Patient: Well, that depends. Normally I have a 40-50 hour work
week, but I have been running behind on some project
deadlines lately, and that is why I have had to increase my
working hours.
Nurse: Oh, that sounds stressful.
Patient: Oh yes, very! In fact, I have not been able to concentrate
at work. The headaches are making me lag behind at
work.
Nurse: Alright. Based on our consultation today, your symptoms
are consistent with a migraine. You can see a doctor here in
about 30 minutes who will be able to confirm the diagn95is
and prescribe some medications.
Patient: (agitatedly) What? What do you mean? I just want some
medication so that I can get back to work I have some
important commitments today, and all I want from you
is some medication to make these headaches go away. I
certainly do not have any time to wait!
Nurse: I understand your concern, Ms Groom. However, your
health is our utmost priority. If you do not seek the right
treatment at this stage, you may continue to experience
severe pain in the future, which will interfere with your
work. Therefore, it is imperative that you consult a doctor
today itself so that he can prescribe the right medication
and suggest if any lifestyle modification is required.
Patient: Oh Lord! I do not know what to say! And what do you
mean lifestyle modification?
Nurse: I know this is a lot to take in. Since you have a stressful
job, it is a possibility that stress is triggering the headaches.
That being said, let me re-assure you that a migraine is
easily manageable with the right medication and lifestyle
adjustments which will be determined by the doctor.
Patient: But what about my meeting? It is crucial. ..
 Gurleen Khaira 61

Nurse: I completely understand that it must be challenging for you,

considering the stage you are in) it must be overwhelming!
It's quite normal to feel this way, but I strongly urge you
to see the doctor to prevent future episodes which may be
worse than what you have been experiencing.

Patient: Well, I suppose I can wait another half hour and get my
meeting postponed.
Nurse: I am glad to hear that. The doctor will see you in about
30 minutes. I will also give you a patient information
leaflet about a migraine which will explain some of the
things I have been talking about. If you have any questions
after you read it just let me know. OK?
/
Patient: Sure, thank you!
ROLE PLAY6

Candidate cue card

Setting: Accident and Emergency
Nurse: You are an A & E nurse. A young woman has presented at
A&E with a thermal burn to her forehead. She is hysterical and is
demanding immediate medical attention. /

Task

Find out about the injury. ·

Explain the likely treatment (give an analgesic injection, ointment to
prevent infection, cover with gauze, painkillers for home).
Empathize with her about her concerns and explain the importance
of healing wound flrst.
Explain how she can care for the wound at home (keep it
moisturized, covered, use a sunscreen, use aloe Vera gel, healthy diet
and remain hydrated to enha~ce recovery and minimize scarring).
Reassure the patient about scarring (scars may fade over time,
preventative care of wound at home to reduce scarring, if a scab develops
don't pull it, plenty of cosmetic treatments available after the burn has
healed in about 3-6 weeks, dermatologist to offer more information).
Ask the patient to come back in two weeks' time for review.

Interlocutor cue card

Setting: Accident and Emergency
Patient: You are a 23-year-old aspiring model. You burned your
forehead with a hair curling iron while getting ready for an outing
64 OET Speaking and Writing Made Easy for Nurses

with friends. It happened while you were watching TV at the same

time. You applied a compress using a cold towel on the burned area,
which you had read online some time ago. You called your friend
about this, who advised you to come here. You are now distressed
due to burning pain and are worried about whether the injury would
leave a permanent scar on your face.

Task

Respond to the Nurse's questions.

Express concern about permanent scarring as it could hurt your
career.
Be unconvinced about nurse's explanation about scarring and request
more information. Ask about how long it would take for the burn
to heal.
Eventually, agree to wait for the wound to heal and see a dermatologist.
Agree to come back for a review in 2 weeks' time.

Sample Transcript
Nurse: Hello, my name is Gurleen, and I am going to be your
Emergency room nurse today. What do you prefer to be
called?

Patient: Susie

Nurse: Alright. I understand you have a burn on your forehead. Is

that right?

Patient: Yes, I am in a lot of pain ...

Nurse: I am sor~y to hear that. I can understand it's hurting quite a

bit. I will give you something for the pain in a moment and
attend to the wound. Before that, would you mind telling
me how it happened?

Patient: Ah. Yes ... I was getting ready to go out with some friends,
and I was using this hair curling iron to curl my hair ... and
I wasn't paying attention because I was watching something
 Gurleen Khaira 65

on the TV at the same time. I know I should have been

more careful ...

Nurse: Aww, that's a pity! And can you tell me what you did next?
Did you apply anything •On the burn area?

Patient: Ah, yes. I had read online some tin1e ago that it's best to
apply a compress to a burn using a cold towel, so I did
that ... I was still in pain, so I rushed straight to the hospital.

Nurse: That's good, you did the right thing. Leaving the burn area
unattended for too long could have led to an infection.
Have you taken any pain-killer at home?

Patient: No, I called my friend who asked ine to come here ... It's a
. pain
seanng . .... ' /

Nurse: Don't worry. The first thing I am going to do is to give

you an injection for pain-relief now. Then, I will clean the
burned area and apply an antibiotic ointment to prevent
any infection. After that, I will put a skin protectant to cover
the burn area. I will also give you some painkillers that you
can take at home in case the pain comes back again.

Patient: Oh, ok. Do you think it will leave a scar? It would be awful
if it left a scar. ..

Nurse: I can sense that you are worried about scarring but try not
to be too concerned. I suggest you focus on your treatment
and healing at the moment because proper wound and
burn care is crucial to the overall healing process and
essential in preventing an infection. Is that alright?

Patient: Yes ... But I am terrified of getting a scar on my face ... You
see, I am an aspiring model. .. And it can really hurt my
career ...

Nurse: I understand your concern. Let me will explain some

things you can do at home to improve the healing process
and minimise the scarring. Would you be willing to listen
about those?
66 OET Speaking and Writing Made Easy for Nurses

Patient: Right. Ok

Nurse: So, as I mentioned earlier, I will explain some things that

you can do at home. Firstly, it is always important to
keep the wound clean and dry. It would help if you can
moisturise your skin daily and keep the area covered with
a skin protectant. Do not forget to use a sunscreen for
protection against UV rays. Also, you could use Aloe Vera
gel fot its soothing properties but make sure it does not
have any additives in it. Would you be able to this?

Patient: Yes, I will 1nanage ...

Nurse: That's good. Moreover, it's vital that you look after yourself.
Our body heals properly and quickly if you rem:Yn
well-hydrated and eat a healthy diet high in protein.
Nutrition's very important.

Patient: Yes, I am ok with that ... but please tell me about scarring. I
am anxious about it.

Nurse: Right, speaking of scarring, if the wound develops a

scab, do not pull it off as that may lead to scarring. Also,
keeping the burned area moisturised and covered would be
beneficial as it will allow new skin cells to fill in quickly and
maintain the skin flexible, preventing cracking or scabbing
and minimising scarring. So, once the burn has healed, the
appearance of scars will improve over time as it evolves and
matures.

Patient: No ... I don't understand ... Please tell exactly when it will
heal ... and in how much time the scar will fade away?

Nurse: Yes, I can sense that you are anxious regarding this ... let
me assure you that regular application of moisturizer and
sunscreen and a healthy lifestyle will go a long way in
aiding the skin's natural regeneration process. Having said
that, if you want to get rid of a scar completely, there are
different cosmetic treattnents and product~ available these
days to minimise the discolouration or scars.
 Gurleen Khaira 67

Patient: Please tell me about those ... I am keen on anything that

will not leave a mark on my face ...
Nurse: Sure, Sarah. For an optimal advice on such options, I would
advise you to see a dermatologist who will be able to offer
different solutions for reducing the scarring. However, we
would need to wait until you have recuperated completely.
I hope that's ok with you?
Patient: Umm, yeah ... So, how much time would it take for the
burn to heal completely?
Nurse: Well, it may take anywhere between 3-6 weeks for it to
heal. In the meantime, you need to keep a keep a diligent
eye on the healing area to watch for any poten)ial infection
and contact us immediately if you notice any swelling.
After all, healing is the most important thing right now.
Patient: Hmm ... ok.

Nurse: So, I am going to clean the burned area now, put an

ointment and cover it with a gauze. You need to be back
in two weeks' time so that I can check on the wound. Will
you do that for me?
Patient: Yes, absolutely.

Nurse: That's good to hear. As discussed earlier, once your burn

has healed, I will schedule an appointment with the
hospital dermatologist who can then provide treatment for
the scarring if necessary.
Patient: Ok. That sounds good. I will wait for it to heal and then
see a dermatologist about it ... thank you!
Nurse: · You're welcome. See you in two weeks.
ROLE PLAY 7

Candidate cue card

Setting: Waiting Room - Emergency Department
Nurse: You are speaking to Rosaline Anderson whose 6-year-old son,
Jimmy Anderson, was brought to the hospital this morning with a
2-week history of headaches and vomiting. The docto_vordered an
MRI scan which revealed a tumour at the back of Jimmy's brain on
the right side. He has been admitted to the hospital for a surgery
and will be discharged after a week following his operation. Jimmy
had to be sedated before the MRI scan to remain still during the
procedure due to which MRI took longer time. At present, he's
under observation. The doctor has informed Rosaline about the
MRI results and surgery. She is distressed and completely shocked
with this information as she believed that her son was suffering from
the flu.

Task

Empathize with the mother and reassure her about Jimmy's recovery.
Explain why the MRI was delayed and say she will be able to see
Jimmy shortly.
When asked, explain that surgery is safe and Jimmy's pain will be
managed with pain-relief.
Respond in a positive way to Rosaline's questions about the
reoccurrence of a tumour (doctor believes a tumour is noncancerous,
not likely to return, MRI tests after operation for some months for
monitoring) and potential problems after _the surgery (possibility of
problems with physical abilities or behaviour, or speech difficulties).
70 OET Speaking and Writing Made Easy for Nurses
·----

Reassure her about follow-up care after discharge (Occupational

Therapists, Physical therapists, speech therapists, and Visiting
Nurses, a support group for connecting with caregivers).

, Encourage her to look after herself and not feel guilty about Jimmy's
condition.

Interlocutor cue card

Setting: Waiting Room - Emergency Department
Patient: Your name is Rosaline Anderson. Your son, Jimmy Anderson,
aged six years, has been suffering from vomiting and headaches for
past two weeks. You are divorced and have no contact with Jimmy's
father.
,/
You believed it was the flu and brought him to the hospital this
morning to rule out why he wasn't recovering. The doctor ordered
an MRI test for further investigation. You have had to wait for
almost 5 hours in the hospital and have not seen Jimmy since. A
few minutes ago, the doctor came to see you and said that Jimmy
had a tumour in the back of his head on the right side requiring a
surgical removal. You are shocked, saddened, and confused with this
diagnosis.

Task
Express concern regarding the diagnosis and his recovery.
Ask about Jimmy's whereabouts and explain that you have not seen
him for 5 hours.

Ask questions about the dangers of the surgery, the pain Jimmy is
likely to experienc~, chances of reoccurrence, and the possibility of
long-term effects on Jimmy's health.

Request more information about the availability of post-discharge

care.

Say that you feel responsible for Jimmy's condition and should have
been more careful as a mother.
 Gurleen Khaira 71

Sample Transcript
Nurse: Hello, Mrs Anderson, my name is Gurleen, and I am one
of the registered nurses in this hospital. It's nice to meet
you.
Mother: Hello
Nurse: I know that the doctor was here before me to discuss
Jimmy's _MRI scan results with you. Would you mind
telling me what you understood from what the doctor said
to you?
Mother: Yes, he was here and stated that Jimrny has a tumour at the
back of his head on the right side, and needs surgery. It's
unbelievable! He's so young, and I just don't k9Dw what to
do.
I
Nurse: I know this comes as a shock to you. I also understand how
worrying it must be. I am here to reassure you that he's
going to be okay and will make a complete recovery soon.
Mother: I am so confused ... I thought it was just the flu. He wasn't
recovering, so I brought him here to see if it was something
serious. And now the doctor says it's a brain tumour. It's
shocking!
Nurse: Yes, regrettably it's true. The presenting symptoms were
similar to the flu, but the investigations have confirmed the
diagnosis of a tumour in his head. In Jimmy's case, it was
the pressure at the back of his head causing the headaches.
You did the right thing by bringing him to the hospital
today.
Mother: Tell me, is he going to be okay?
Nurse: Yes, the doctor is highly skilled, and Jimmy will receive
the best possible care in this hospital. He will be able to
recuperate soon.
Mother: Where is Jimmy at the moment? I haven't seen him at all
since morning. It's been 5 hours. The doctor said I cannot
see him for another hour.
72 OET Speaking and Writing Made Easy for Nurses

Nurse: I understand your concern, Mrs Anderson. I apologise

for the fact that you had to wait so long. Jimmy had
to be sedated so he could remain still for the MRI scan
procedure. Right now, he's in the ward and is being closely
monitored by our staff You will be able to see him shortly.

Mother: Oh ... I am in shock! I cannot think straight at the moment.

Nurse: I know you are overwhelmed. Take your time to process this
information. And let me know if you have any questions
about what you have been told.

Mother: So, the doctor says Jimmy needs surgery. It's just so scary to
think that my little boy is going to be operated upon. Is the
surgery dangerous? /

Nurse: I know it's a lot to take in. The doctor has advised a surgery
because a tumour needs to be removed from Jimn1y's
head. There is nothing to be alarmed about the surgery
as your son is safe hands. Following the surgery, he will be
monitored for a week in the hospital to check progress in
his condition.

Mother: Oh, my baby, he's going to be in a lot of pain, is it?

Nurse: Your anxiety is understandable. However, try not to be

too concerned about this as the pain-killers will be very
effective in alleviating his pain.

Mother: But, can it reoccur? What are the chances of it happening

again?

Nurse: The doctor believes that Jimmy's tumour is noncancerous

and these kinds of tumours don't come back once they
have been removed, causing no further problems. Having
said that, the doctor will repeat MRI tests in some of your
follow-up appointments to monitor Jimmy's condition.

Mother: Ok. But, my greatest fear at the moment is about this

tumour's effect on Jimmy's cognitive abilit~es. Will it have
a long-term impact on his brain?
 Gurleen Khaira 73

Nurse: As with any surgery, it will take some time to recover,

and Jimmy may experience problems with physical
abilities, behaviour, or speech difficulties. But, we will
provide support with overcoming any problems that he
may have.

Mother: Still, tell me more about the options that would be available
for me. I am a single parent, and I don't know whether I
will be able to provide the required care.

Nurse: Right, I do understand what you mean. At the time of

discharge, you will be provided with detailed written and
verbal instructions about the transition to care at home.
Also, Occupational Therapists, Physical therapists, speech
therapists, and Visiting Nurses will be able to assist Jimmy
in transitioning to healing after discharge if required.

Mother: Hmm. I have been a terrible mother. I am so busy with

work. Had I taken more care, Jimmy would have been fine
today.

Nurse: Don't blame yourself, Mrs Anderson. The exact cause of

a tumour is unknown; therefore, you do not have to feel
responsible for it. I understand that the news has stunned
you, and you are under a lot of pressure, but looking
after yourself is also necessary. Let me explain, if you are
healthier, you will be able to help and support in a better
way. Does that make sense to you?

Mother: You are right, but I still can't come to terms with it. It's all
happened so suddenly.

Nurse: . Yes, I do understand that it's going to take some time to

absorb this information. We are going to be with you and
Jimmy every step of the way. Moreover, I can refer you
to some local support groups where you will be able to
connect with caregivers of people who have survived brain
tumours. This will be an excellent opportunity for you to
understand their experiences. -
74 OET Speaking and Writing Made Easy for Nurses

Mother: Yes, speaking to other parents might help. I would

appreciate that.

Nurse: It's not a problem Mrs Anderson. I will check on Jimmy's

condition and will be back shon:ly to take you to his room.

/
ROLE PLAY 8

Candidate cue card

Setting: Home Visit
Nurse: You are visiting James Morrison, a 64-year-old man, who has
been discharged from the hospital three weeks ago following a left
total knee replacement. At the time of discharge, he wa,s advised to
use a walker for his activities of daily living and ensure compliance
with physical therapy at home until his follow-up appointment
scheduled next month.
His wife called the hospital today and explained that her husband
1s not using his walker since last evening. She is concerned about
him hurting his knee and has asked you to speak to him. During
your visit today, you also notice that he's not using a walker to walk
around the house.

Task

Find out why the patient is refusing to use a walker.

Educate the patient on the importance of using a walker for his
recovery (to help with balance, putting less weight on the operated
knee due to weakened muscles).
Persuade the patient to use a walker until his follow-up appointment.
Explain the risks involved if he refuses to comply with your advice.

Interlocutor cue card

Setting: Home Visit
Patient: Your name is James Morrison. You underwent left total knee
replacement three weeks ago. At the time of discharge, you were
76 OET Speaking and Writing Made Easy for Nurses

advised to use a walker for six weeks and continue with physical
therapy at home until your follow-up appointment scheduled next
month. But, you discontinued use of a walker last evening as you are
able to walk independently without its support now.
Your knee is healing well, and you have been diligently
complying with the recommended medication and exercise regime;
however, using a walker makes you feel disabled and old. You have
been independent all your life, and you do not want to be dependent
on anything for routine activities.
You are now speaking to a nurse from the hospital who has come
to check on your progress.

Task /

Respond to the nurse's questions.

Explain that you are complying with the exercise program and
medication for recovery.
Ask why using a walker is necessary when you are easily able to walk
without its support. Express concern about becoming dependent on
a walker.
Reluctantly agree to use a walker until your follow-up appointment.

Sample Transcript
Nurse: Good morning, Mr Morrison. My name is Gurleen, and
I am a Registered Nurse from the hospital where you
underwent your knee replacement surgery. I have come to
check on your recovery. How are you doing?
Patient: Hello dear, I am doing well.
Nurse: That's good. Are you facing any problems that I need to be
aware of? For instance, any pain or swelling in the knee?
Patient: Not at all. I am recovering well now.
Nurse: Alright. That's good to hear Mr Morrison, I hope you don't
mind me asking this, but I noticed that you are not using
your walker while walking. At the time of discharge, you
 Gurleen Khaira 77

were advised to use a walker at home till your follow-up

appointment. May I ask why you aren't using it?
Patient: Oh, I stopped using it last evening. I can walk perfectly
now. So, I thought I'd give a try to walk without help. In
fact, it's a sign that I am recovering, isn't it?
Nurse: Yes, it's a good sign. But, with that said, it's a part of your
treatment to use a walker for assistance with activities
of daily living, and you shouldn't discontinue its usage
without doctor's consent.
Patient: Well, I did use it for three weeks, but I do not see any use
of it now. I am easily able to walk without pain.
Nurse: Mr Morrison, it's crucial to comply with the post-discharge
/
instructions for your recuperation. Otherwise, it may delay
the recovery process or even have adverse effects on the
operated knee.
Patient: Oh, yes, but I have been diligently complying with the post-
discharge instructions. I am regular with exercise and take
my medicines on time. So, if I am gaining independence
with walking without a walker, it's a sign that my knee is
getting better.
Nurse: Yes, but it's important to understand that your knee muscles
are weakened at present, and you should give yourself time
to regain strength and endurance and a walker allows
you to put less weight on the operated leg. Moreover, a
walker will help with your balance and prevent falls. It's is a
preventative measure, just like wearing a seatbelt. Does that
make sense to you?
Patient: Hmmm. But, the problem is that I don't like being
dependent. I don't like being overly reliant on something;
it seems like it's taking away my independence.
Nurse: I absolutely understand where you are coming from,
Mr Morrison. But, allow me to explain why it's indispensable
to use a walk until you have recovered completely. May I
proceed?
78 OET Speaking and Writing Made Easy for I'\Jurses

Patient: Yes, sure.

Nurse: Firstly, this is not something that you would be using long-
term. You will be weaned off the walker as soon as the
doctor feels that your knee has recovered completely and
can easily bear your weight. Secondly, it's not something
that you will become dependent on; it's simply a smart
thing to do to prevent any complications. How does this
sound?
Patient: But, it makes me feel weak. I have been very active all my
life, and I am otherwise quite healthy. For me, it's a sign of
disability to use a walker while walking to the bathroom or
kitchen.
/
Nurse: Yes, your concerns are understandable. Having said that, it's
important to realise that you are in no way dependent on a
walker for your mobilisation. This is simply something that
will facilitate your movement, something that will maintain
your mobility with less fatigue. From a different standpoint,
it's increasing your freedom rather than curbing it.
Patient: But, I really thought I had overcome this need. It's been
three weeks now. It's just embarrassing.
Nurse: I appreciate you telling me this Mr Morrison, and I
understand your perspective. But, you must consider the
risks associated with walking unassisted. Firstly, without
a walker, you are putting your full weight on the surgical
knee while standing or walking. This may slow your healing
time even more. Would you want that to happen?
Patient: Of course not!

Nurse: Secondly~ in the first couple of weeks following knee

replacement surgery, many people are tired and prone to
falls. That's why the use of a walker is recommended to
prevent serious injuries. Do you understand why a walker
would be helping you in recovering faster?
Patient: Yes, it sounds logical.
 Gurleen Khaira
79

Nurse: Yes, it would be beneficial for you to use a walker until you
see the doctor next. As your knee strengthens, you will be
able to walk on your own soon.

Patient: Hmm, well, I suppose I can use it for a few more weeks.

Nurse: That's great. Do you have any questions that you would
like to ask?

Patient: Oh, no dear. Thanks for coming today.

Nurse: You're welcome. I will take your l~ave now. Take care!

/
ROLE PLAY9

Candidate cue card

Setting: Mental Health Clinic
Nurse: You are speaking to a Julie Thomas, a 45-year-old project
manager in the high-stress world of corporate finance, prior to her
consultation scheduled in 15 minutes. She has been referred to
/
your clinic by the company's employment assistance program after
she missed a few business meetings and has been inconsistent with
showing to work.

Task

Ask the patient about how she has been feeling in the last few weeks-
mood, energy levels, sleep, impact on family, work, and lifestyle, the
risk of self-harm.
Empathize with her regarding her feelings.
When asked about depression, Explain that only the doctor can give
a definitive diagnosis. Explain that the doctor might write to her
employer for a leave of absence if deemed necessary.
Reassure her about different treatment options for depression -
support group, short term medication.

Interlocutor cue card

Setting: Mental Health Clinic
Patient: You are Julie Thomas, a 45-year-old project manager in the
high-stress corporate finance job. Your employer has referred you to
a mental health clinic as per the company's Employment Assistance
Program. Over the last three months, you have been feeling "fed up"
82 OET Speaking and Writing Made Easy for Nurses

with your life. When you wake up, the world seems black, and you
feel you are slogging through life. You have difficulty falling asleep
and often wake up during the night after which you are unable to
sleep again. Last night, you woke up at 4 am and watched the clock
ticking away. Moreover, you have been tearing up often, for instance,
one day you burst into tears when you dropped some sugar.
You have two children, a son aged 15 years and a daughter aged
13 years. Your husband passed away last year in an accident. After his
demise, you didn't get time to grieve. You had to support your family
as a single parent due to which you lost yourself in work. However,
your energy levels have been so low lately that you are exhausted
most of the time causing you to be inconsistent "With showing up at
work and spending the entire day on your sofa. Initially, you enjo~d
playing and swimming with your kids, but you have lost interest in
everything now. Despite these negative feelings, you cannot think of
hurting yourself because of your children.

Task
Respond to the nurse's questions.
Explain that you feel like a failure at everything.
Ask if you are depressed - your colleagues seem to think so.
Express concern about losing your job due to depression and
becoming dependent on depression medication.

Sample Transcript
Nurse: Hello Ms Thomas, my name is Gurleen, and I am one the
registered nurses in this facility. What would you like to be
called?
Patient: You can call me Julie.
Nurse: Alright ] ulie, you have been referred to our clinic by your
employer. Is that right?
Patient: Yes, I didn't have a choice. My boss order~d me to come
here ... I don't want to lose this job ...
 Gurleen Khaira 83

Nurse: Yes, your employer feels that you are having difficulty with
balancing work and life, so he thought it would be a good
idea for us to have a discussion, to see if we could help.
Would that be alright with you?

Patient: Yes.

Nurse: Right. In your own time, could you tell me how you have
been feeling lately?

Patient: Uhm. I am just fed up really ...

Nurse: Could you give me more details about what's been going on?

Patient: Ahem ... well, things just seem to be piling up ... I just don't
appear to cope with things ... -kids and work.
/
Nurse: I am sorry to hear that! Would it be okay if l asked you
more detailed questions about how you have been feeling?

Patient: Ok.

Nurse: Let's start by talking about your mood first. How have you
been feeling for the last few weeks?

Patient: I'd say a bit fed up. I get up in the morning, and everything
seems very black. It's like I am slogging through life ...

Nurse: Right. So, just to check for my understanding, when you

say that everything seems black, do you mean you feel
miserable?

Patient: Yes, miserable and fed up really ...

Nurse: Can you remember when you started feeling this way?

Patient: Uhm ... not exactly. But a few months ago ... I guess ...
.3 months ...

Nurse: Right. Have you been feeling tearful? Has that been
happening recently?

Patient: I dropped some sugar the other day and burst into tears.

Nurse: Right. So, it's the slightest things that make you tearful.
Things that wouldn't ordinarily bother you. Is that correct?
84 OET Speaking and Writing Made Easy for Nurses

Patient: Yes.

Nurse: Ok. So, you have been feeling very low with episodes
of tearfulness. What about your energy levels? Are you
managing to keep up with things?
Patient: I used to do a lot with my kids; go swimming, playing ...
But now I just spend the day on the sofa unless I have to go
to work.
Nurse: Alright. How many children do you have?
Patient: I have two kids ... a son and a daughter.

Nurse: Ok. And how old are they?

Patient: My son's 15 and my daughter is 13.
/

Nurse: So, how have you been managing at work?

Patient: I haven't been going in much. I am just exhausted.

Nurse: Hmm, It's indeed quite difficult to feel this way. Do you
have any support at home? What about your husband?
Patient: He passed away in an accident last year.

Nurse: I am very sorry to hear that! Is it alright if I ask how you

have been dealing with his loss? I mean, have you shared
your feelings with someone you trust?
Patient: No, I didn't have the time. As a single parent, I had to work
long hours to pay the bills; kids, house mortgage, bills. It
was just too much.
Nurse: Hmm. . . It must be challenging if things are difficult all
around. With all this going on, how are you sleeping Julie?
Patient: Oh, it ta~es me ages to sleep ...

Nurse: Right ... and do you wake up during the night?

Patient: Yes, last night I woke up at 4 ... And I just watched the
clock go round and round ...
Nurse: Ok and what about things that you nor~ally enjoyed? Is
there anything that makes you happy or energetic these days?
 Gurleen Khaira 85

Patient: I used to enjoy spending time with my kids ... but not
anymore ... I am useless with them. I cannot cook for them ...
but, I don't bother anymore ... what's the point really?
Nurse: I can understand how distressing it must be! What do you
think might be causing it?
Patient: I don't know really. I am terrible at work. I am failing as a
mom ... but the worst is ... Lying alone at night. .. when the
kids are in bed ... it's exhausting ...

Nurse: Ok. Julie, I know how painful this is for you to talk about. I
need to ask a rather difficult question and one that I would
ask anyone in your situation. Have things ever been so bad
or low that you thought about harming yourself?
/
Patient: No ... I wouldn't ... For the;_ sake of my kids ...

Nurse: That's good. Thank you for telling me how you have
been feeling. The doctor will see you shortly in about 10
minutes. In the meantime, you could ask me any questions
that you have on your mind.

Patient: My colleagues think I am depressed. Do you think I am

suffering from depression? I might lose my job if my
employer finds out ...
Nurse: Hmm, I understand your concerns about the job. If deemed
necessary, the doctor can write a note to your employer for
a leave of absence. Regarding depression, only the doctor
will be able to give a definitive diagnosis. However, just to
reassure you, if that's the case, it is curable, and you will be
given adequate treatment until you get back on your feet
and coping easily with routine events and feeling as normal
· as possible.

Patient: What kind of treatments ... I don't want to be addicted to

medication ... I have seen people becoming dependent on
medication for years ...
Nurse: I understand your concern. However, it would be best to
leave it to the doctor to create a coordinate a treatment
86 OET Speaking and Writing Made Easy for Nurses

plan. He will be able to discern whether you will benefit

from medication or not. He might link you with a support
group, where you can explore your feelings with others in
a safe, facilitated setting, or start a mild medication for a
brief period.

Patient: Hmmm ... Ok. I will see what he says.

Nurse: Is there anything else that you would like to know?

Patient: No.

Nurse: Ok. So, the doctor would be ready to see you shortly.

/
ROLE PLAY 10

Candidate cue card

Setting: General Practitioner Practice
Nurse: You are speaking to Jenny, an 18-year-old girl who had
presented to the clinic yesterday complaining of generalised weakness,
lethargy, and inability to do the routine work frony· previous few
weeks. She also complained of breathlessness while climbing stairs
for her house.
Upon examination, the doctor advised a blood test which
revealed that her Haemoglobin was 8 g/dl. The normal range of
Haemoglobin in women is between 11-16 g/dl. The doctor suspects
that she is anaemic and has asked you to speak to her.

Task

Explain that her I-IB is low due to which she is suffering from anaemia.
Reassure her that anaemia is a common condition and is easily
treatable.
Briefly, explain about anaemia (not enough Haemoglobin/ red blood
cells in the blood).
Suggest some treatment options that increase iron intake in the diet
with foods like red meat/steak, leafy green vegetables like spinach/
kale, iron fortified cereals, or see a dietitian for dietary advice, a
course of iron tablets that need to be taken after a meal to avoid side
effects.
Offer a patient infonnation leaflet about anaemia.
Ask her to come back in 4 weeks' time for another blood test.
88 OET Speaking and Writing Made Easy for Nurses

Interlocutor cue-card
Setting: General Practitioner Clinic
Patient: Your name is Jenny. You are an 18-year-old undergraduate
student. You have a busy lifestyle and do not get time to cook at
home. You mainly rely on muffin or bagel and coffee for breakfast
and eat ready meals for lunch and breakfast. Over the last few
weeks, you have been feeling exhausted and weak due to which you
are unable to complete routine work. Also, you have been getting
breathless while climbing the stairs to your house. You visited your
GP yesterday, who asked you to get a blood test for investigation.
You have been called to the clinic today to get the blood test
reports and speak to a clinic nurse about your condition.
/

Task

Ask the nurse whether your blood test reports have been received.
Sound alarmed when the nurse says you are suffering from anaemia.
Ask more information about anaemia stating that you have heard of
it but do not know exactly.
Request information on treatment of anaemia.
When asked, explain your dietary routine and state that you do not
like eating leafy vegetables like spinach.
Ask for how long would you need to take iron tablets.

Sample Transcript
Nurse: Hello, my name is Gurleen, and I am one of the Registered
Nurses in this facility. Is it okay if I call you Jenny?
Patient: Hello, yes, that's fine.
Nurse: So, how are you doing Jenny?
Patient: Oh nurse, I have not been feeling very well. I have been
feeling exhausted and weak. I have been experiencing
breathlessness while climbing the stairs of my house.
Sometimes, I am unable to do routine .work. I am so
worried about what's happening to me.
 Gurleen Khaira 89

Nurse: I can understand it has been difficult for you Jenny. You
came to see the doctor yesterday regarding this, right?

Patient: Yes.

Nurse: and he asked you to get a blood test?

Patient: Right, yes ... do you have the results?

Nurse: Yes, we got your results this morning. The first thing I want
to do is to share the results with you. And then we can discuss
the cause and potential treatment. Is that okay with you?
Patient: Yes, yes ... that's fine

Nurse: Ok. So, you were tested for your haemoglobin for which
the standard range in women is between J.-1 - 16 g/ dl.
However, your level was found to be 8 g/ dl. Based on these
reports, the doctor believes that you are suffering from
anaemia, which means having a low haemoglobin level.

Patient: Oh my gosh ... How can this be happening to me?

Nurse: Yes, I know it must be overwhelming! But let me reassure

you that iron deficiency or anaemia is fairly common and
is easily treatable as well; so, there is nothing to be alarmed
about.

Patient: Right. ..

Nurse: Shall I tell you more about this condition or you have some
prior knowledge about .it?
Patient: Well, I have heard of it ... But I do not exactly know what it is?

Nurse: Anaemia is defined as a condition when the blood does not

contain enough healthy red blood cells or haemoglobin.
These cells are essential for carrying oxygen around the
body.
Patient: Oh ... alright. .. but how do I cure it because I am finding it
difficult to cope with this condition.

Nurse: There are a couple of things that I would suggest you try.
Firstly, you must increase the amount of iron intake in your
90 OET Speaking and Writing Made Easy for Nurses

diet. Can you tell me something about your diet at the

moment?
Patient: Well, I am really busy with my university course load so I
cannot cook, and I usually eat ready-made meals ... but I
always considered it be reasonable and well-balanced .. .
Nurse: Alright. Can you give me more details?
Patient: Yes ... so for breakfast, I usually get a muffin or bagel and
coffee, and for lunch and dinner, I usually eat fried chicken
with mashed potatoes or a pizza or hamburger ... or ready-
to-eat noodles ...
Nurse: Ok. I can understand you relying on those for convenience
due to a busy lifestyle, but the problem with ready me)lls
and fast food is that you don't get a proper balance of
nutrients with them.
Patient: Ahan ...

Nurse: So, what I'd ask you to do is to adapt your diet perhaps
to include more iron-rich foods in your diet. Before I
suggest what some of those foods are, can I ask if you are a
vegetarian or non-vegetarian?
Patient: I am a non-vegetarian.

Nurse: Ok, the reason I asked that is that one of the best sources of
iron is lean red meat or steak ... would you consider eating
that for lunch or dinner?
Patient: Yes. I can give it a go.

Nurse: Good. There are also leafy green vegetable options that
you can try ... Things like kale, spinach, etc. and for your
breakfast~ you might consider iron fortified cereals, etc.

Patient: Hmmm. I can incorporate cereals, but I don't like spinach

or kale ...
Nurse: Would it be okay if I can refer you to a dietician who can
provide relevant guidelines and healthy food options, based
on your condition and food preferences?
 Gurleen Khaira 91

Patient: Yes, that would be wonderful.

Nurse: Alright. The other I'd like you to consider is taking a course
of iron tablets. This can be really useful for the treatment of
iron deficiency. What it does is it supplements the amount
of iron you are getting in your diet.

Patient: 0 K ... would that be short term?

Nurse: Yes. Often, people respond very well to those. However,

you may experience sorne side-effects if you take them on
an empty stomach. So, it's imperative that you take those
after a meal.

Patient: Oh. Ok, I will 1nake sure I remember that.

/
Nurse: Great. So, just to go over what we discussed today. You
will need to make some changes in your diet for which I
will schedule an appointment for you with the dietician.
Moreover, you have agreed to take a course of iron tablets
to supplement the iron level. You must remember to take
them after a meal; otherwise, you may experience some
side-effects.

Patient: No. I will do these things for sure.

Nurse: Good. I also have a patient information leaflet about

anaemia for you which I thought you might take home
and read in your time.

Patient: Oh, thank you ... this would be quite helpful for me.

Nurse: Alright. Let me know if you have any questions.

Patient: Yes ... So, how long would I have to take these tablets for?

Nurse! At this stage, you will need to take the tablets for four weeks
before you come back for another blood test after which
the doctor will advise whether these need to be continued
or not.

Patient: Alright. Thank you.

Nurse: You're welcome. Have a good day!

ROLE PLAY 11

Candidate cue card

Setting: Hospital Ward
Nurse: You are speaking to Ms Zarina Malik, a 23-year-old PhD
student who hasd been admitted two days ago with severe left loin
pain and tenderness, vomiting, fever, dysuria, and uriyiary frequency.
A diagnosis of acute pyelonephritis (kidney inflammation due to
bacterial infection) has been made. She still has a fever and has not
been able to eat or drink anything yet because of persistent nausea. She
has been given intravenous fluids and is taking regular analgesia for her
loin pain. She is upset and is insisting on discharging herself from the
hospital. However, the doctor feels she is not flt to go home at present.

Task

Find out why the patient wants to be discharged. Empathize with the
patient regarding her concerns.
Explain the nature of her illness and emphasize the importance
of staying by advising on the risks of getting discharged from the
hospital without doctor's consent.
Offer to resolve the issue by shifting her to a different ward.

Interlocutor cue card

Setting: Hospital Ward
Patient: You are Zarina Malik, a 23-year-old PhD student. Three days
ago, you began to feel feverish and sweaty and started to vomit. You
then developed a severe left loin pain and felt awful. Two days ago,
your partner brought you to the emergency department. You did not
94 OET Speaking and Writing Made Easy for Nurses

want to go but felt too weak to argue. You feel a little better now
although you were hot last night and still cannot face food. You feel
you could take antibiotics and painkillers by mouth.
This is your first time in the hospital, and you hate it. You are in
a large ward full of noisy and confused patients. You are upset, tired
and angry about the situation, although this is not directed at the
doctor or nurse you are speaking to. You are desperate to go home
because you feel will be better at home.

Task
Explain why you want to be discharged.
Ask for the reason for keeping you in the hospital. /

Explain that you can continue treatment at home and come back if
the condition gets worse. Reluctantly agree to stay if you can be away
from the confused patients.

Sample Transcript
Nurse: Hello, my name is Gurleen, and I am one of the registered
nurses on duty today. What would you prefer to be called?
Patient: Hello Gurleen, you can call me Zarina.
Nurse: Ok. Zarina, I have come to know that you are insisting on
getting discharged from the hospital. Is that right?
Patient: Yes, I am desperate to go home. Can you ask the doctor,
and then call my partner to take me home?
Nurse: Zarina, I can sense that you are upset. Do you mind telling
why you want to get discharged and go home?
Patient: I cannot .rest here. The patients are all confused here, and
the ward is so noisy. Nurses are coming in and out; I cannot
sleep at all. I haven't slept properly for two nights. How can
I get rest here?
Nurse: Aww, it's a pity to hear that! I can understa~d how difficult
it must be for you. However, you need to adhere to the
 Gurleen Khaira 95

doctor's advice who feels that you cannot be discharged

right now given the severity of your infection. You have
not recovered completely and going home at this stage will
expose you to an inadequately treated medical condition
which might get exacerbated at home.
Patient: I know that! I feel unwell, but I am a lot better now. And,
I can continue the antibiotic therapy at home. If my
condition gets worse, I can always come back.
Nurse: I know what you are saying. However, oral antibiotic
therapy can be given to pa ti en ts who are able to eat and
drink orally. In your case, you need to be given pain-killers
and antibiotics intravenously as your body is not tolerating
any form of food at the moment. /

Patient: I know, that's because I do not feel like facing any food or
drink. But, I am sure I will be able to take the medicines
with water orally. I am ready to force water down with
medicines even if that makes me feel sick.
Nurse: I can understand how keen you are to go home, but right
now you have a severe infection in your body which requires
clinical care. Due to this, you might not keep the medicines
down, and that can have adverse effects on your health.
Patient: I am so tired and confused. I don't understand why it's
happening to me! Do you know what could have caused
this?
Nurse: Well, the doctor believes that recurrent episodes of Urinary
tract infection in the past may have caused this infection.
That's the reason the doctor wants you to stay longer in the
hospital so that you can be treated thoroughly.
Patient: But, I was never hospitalised for urinary tract infection. I
was always given a course of antibiotics for home which
was effective in curing me.

Nurse: Right, but kidney infections can be caused by germs

travelling up from a bladder infection. While a Urinary

l
96 OET Speaking and Writing Made Easy for Nurses

Tract Infection can be treated at home, kidney infection is a

more severe condition requiring prompt medical attention.
Patient: It's just medicine! Why can't I complete a course of antibiotics
at home where I will get a restful environment? If my health
worsens, I can be back. I am determined to go home.
Nurse: I appreciate what you are saying, and it's your right to get
discharged with an informed understanding of the risks
involved with this decision. Can I explain something the
risks associated with getting discharged against medical
advice? Would that be okay?
Patient: Yes, that's fine. Go ahead
Nurse: Thank you Zarina. If you do not get adequate treatment;it
home, you may have detrimental effects on your health. For
instance, it may lead to permanent damage to your kidney
or cause kidney failure. In some cases, it may even result in
blood poisoning which is a life-threatening condition.
Patient: Look, I want to get well. It's just that I feel I would be better
off at home. I just can't bear this environment anymore.
Nurse: I understand Zarina. It's indeed distressing to be in your
situation, especially when you cannot get a peaceful
environment. That being said, you need to be rational and
consider the implications associated with going home at
this point. How about we can shift you in a different ward
which is not as busy as this one? How does that sound?
Patient: If I can get some sleep there, I don't mind getting my
treatment in the hospital
Nurse: That's good Zarina. It's in your best interests to stay longer
at the hospital. It is important that you are assessed by
the doctor before discharge to check that you have fully
recovered. I will discuss this with my supervisor and shift
you to a quieter ward or a semi-private room soon.
Patient: Ok. That sounds good.
Nurse: I am glad to hear that. I will be back shortly.
ROLE PLAY 12

Candidate Role Play Card

Setting: General Practitioner Clinic
Nurse: You are speaking to a 71-year-old woman who has come to
the clinic for a check-up. You notice that she looks uncomfortable
and embarrassed. /

Task

Ask for details about her complaints (urinary frequency, unnary

urgency, urine incontinence). Find out how she has been coping at
home (impact on lifestyle, treatment sought).
Explain your preliminary diagnosis of urge incontinence.
Reassure the patient and respond to her questions about treatment
(prevalent in elderly, treatable with bladder training, pelvic floor
muscle exercises, medication).
· Explain what you want the patient to do next (schedule an
appointment with a urologist for treatment, offer continence pads/
disposable undergarments).

Interlocutor Role Play Card

Setting: General Practitioner Clinic
Patient: You are a 71-year-old woman who has come to her General
Practitioner's clinic. Over the last few (approx. 4) weeks, you have had
an increased urination frequency along with an urgency to urinate
occasionally. However, the symptoms have gradually worsened - you
urinate every 2-3 hours and have the need 2-3 times a day. On bad
days, the urge to urinate is so strong that urine leaks on the way to
98 OET Speaking and Writing Made Easy for Nurses

the bathroom. You feel very embarrassed about this fact as this is not
a ladylike characteristic.

Task
Answer the nurse's questions about your complaints honestly, but
don't be forthcoming and sound self-conscious in your replies.
When asked, tell the nurse that you did not feel the need to seek
any treatment until now because you thought this was a natural
result of ageing. You could also mention social withdrawal, restrict
fluid intake (sips of water), and exercise cessation due to fear of
leakage.
Sound alarmed about the diagnosis of urge incontinence and aslyif
it is treatable.
Be open to the idea of seeing a doctor and using continence pads,
disposable undergarments.

Sample Transcript
Nurse: Hello, My name is Gurleen, and I will be your attending
nurse today. How may I address you?

Patient: Hi, you can call me Sarah.

Nurse: Nice to meet you, Sarah! What brings you here today?

Patient: Oh, I am having some problems with ... um ... having to go

to the bathroom often.

Nurse: Would you mind if I asked you some questions to get a

better understanding of your condition?

Patient: Ok.

Nurse: When you say you are going to the toilet often, is it due to
your bowels or urination?

Patient: Ah, it's for peeing mainly.

Nurse: Right. How long have you had this problem?

Patient: I can't recall exactly ...

 Gurleen Khaira 99

Nurse: That's alright. Can you ren1ember if you have had this
problem during the past three months?
Patient: Not three months ... it started ... maybe ... 4 weeks ago.

Nurse: Ok. Can you tell me how many times you have to use the
bathroom in a day?
Patient: Uh. It's a lot. I feel like I am constantly going ... Once every
2-3 hours.
Nurse: Alright. And whenever you had the urge that you need to
empty the bladder, were you able to postpone it comfortably?
Patient: Oh no, I get a desperate urge ...

Nurse: Oh no! That must be quite hard for you!

/
Patient: Yes, I feel like a failure ...

Nurse: I am sorry to hear that!

Patient: Hmm

Nurse: So, coming back to the urgency, how often do you get a
sudden urge to urinate that makes you want to rush to the
bathroom?
Patient: Ah well, since last few weeks ... about 2-3 times a day!

Nurses: OK. I am afraid I need to ask you a personal question.

Whenever you get a strong urge to empty the bladder,
has there ever been a time when you could not get to the
bathroom fast enough?
Patient: (seemingly embarrassed) Ah ... I try ... I usually rush as
soon as I can ... but ...
Nurse: Go on ...
Patient: On bad days, it leaks ...

Nurse: Oh, that must be difficult!

Patient: Yes. It's frustrating.

Nurse: I understand that it must have been distressing for you.

Coming back to this, Did you seek any treatment for these?·
100 OET Speaking and Writing Made Easy for Nurses

Patient: No, I just thought it's due to getting older. .. and; it's so
embarrassing to talk about it.
Nurse: I can appreciate how difficult it is for you to talk about this.
So, what kind of impact has it had on your lifestyle?
Patient: Ah, well, it's turned my life around completely. I am
constantly going to the bathroom. So I cannot go out or
attend social events or travel to any place ... I even stopped
exercising for fear of leakage.
Nurse: Thank you for telling me how you have been feeling. It
helps me to understand the situation much better. Is there
anything else that you would like to add?
Patient: No ... That's pretty much ... Oh, ... there's one thing. I h~)le
been restricting my fluid intake. I am scared that it will
deteriorate my condition.
Nurse: So, when you say restricting, do you mean you haven't had
any fluid at all?
Patient: oh no, I mean I just have sips of water.

Nurse: Alright. So based on our consultation, I believe that you are

suffering from urge incontinence. Do you have any prior
information about this?
Patient: (sounding alarmed) No ... I am not sure ... Is it serious? Are
their treatment options available?
Nurse: lJrinary incontinence is a common problem, especially in
women. It happens when there is involuntary leakage of
urine from the bladder. Its prevalence increases as people
get older. That being said, let me assure you that it is easily
treatable with medication and several treatment options.
And it is not something to be alarmed about.
Patient: (sighs) ah ... ok. So, what kinds of treatment options are
available for me?
Nurse: In addition to the medication, treatments like Bladder
training and Pelvic Floor muscle exercises will assist in
 Gurleen Khaira 101

managing your condition. For this, I would advise seeing

a urologist who specialises in treating incontinence of the
bladder. Would it be okay if I can schedule an appointment
for you to1norrow at the same time?
Patient: Ah, thank you! Would be appreciated.

Nurse: That's alright. In the meantime, I will suggest you to use to

use disposable undergarments and continence pads so that
your leak can be managed and it does not hold you back
from activities you enjoy. How does that sound?
Patient: Yes, that would be hugely helpful. Thank you, nurse .

. ,

~
WRITING SUB-TEST OVERVIEW

The writing sub-test consists of one task and takes 45 minutes. The
Writing module is profession-specific. In other words, the materials
will be specially produced for your profession.

Structure of the test /

You will receive stimulus material (case notes) that includes

information based on which you will be writing a letter. The case
notes will be followed by a writing task that will have relevant
instructions about the recipient and purpose of writing the letter.
You have to write a letter as advised in the writing task. The letter
may be a referral letter, a letter of transfer or discharge, or a letter to
advise or inform a patient or carer.
The first five minutes of the test is reading time. During this
time, you can study the task and notes [but not write, underline or
make any notes of your own]. For the remaining 40 minutes, you
write your response to the task in a printed answer booklet provided,
which also has space for rough work.
Use the five minutes 'reading time' efficiently to understand the
task's requirements. The test is designed to give you enough time to
write .your answer after you have carefully considered the following
questions:
What is your role? Who is the recipient?
What is the current situation?
How urgent is the current situation?
 104 OET Speaking and Writing Made Easy for Nurses

What is the main point you must communicate to the reader? What
supporting information is necessary to give to the reader? What background
information is required for the reader to know? What information is
unnecessary for the reader?
Next, consider the best way to present the information relevant
to the task:
Should the current situation be explained at the start of the letter
[e.g. in an emergency situation}? In what sequence can the ideas be
presented depending on the urgency of the situation?

What are the writing skills tested?

The task in the writing sub-test expects you to demonstrate that y6u
can write a letter for a typical workplace situation and the demands
of your profession.
Your performance is scored against five criteria which are:

Overall task fulfilment - including whether all aspects of the task are
fulfilled, and whether the response is of the required length.

Tips to improve this criterion

., • Get sufficient practice in writing within the word limit. The

~
task is designed so that the word limit is enough to fulfil the
task and gives the assessors an appropriate sample of writing
to assess.

• Always read the instructions carefully and then identify what

information to include for a particular task. Do not include
information that the intended reader already knows [e.g. if
you are replying to a colleague who previously referred the
patient to you].

Appropriateness of language - including the use of appropriate

vocabulary and tone in the response, and whether it is organised
appropriately.
 Gurleen Khaira 105

Tips to improve this criterion

• Organise the information clearly. Remember that the
sequence of information in the case notes may not be the most
appropriate sequence for the letter.
• Highlight the primary purpose of the letter at the start. This
provides context for the information that is included. (For
example, ongoing care and support, home visits to provide
assistance, urgent assessment and further management).
s Be clear about the level of urgency for the communication.
• Always keep in mind the reason for writing and what the
reader must need to know. Don't just summarise the case notes
provided.
/
• Focus on important information and minimise incidental
detail.
• Be explicit about the organisation of the letter wherever
appropriate, .e.g. 'First I will outline the problems the patient
has, then I will make some suggestions for his treatment.'
• Consider using dates and other time references [E.g. Three
months later, last week, a year ago] to give a precise sequence
of events where needed. What ways of presenting the
information makes it clear and helpful for the target reader?
• Stick to the relatively formal tone that all professional letters
are written in.
• Maintain a neutral and professional tone appropriate for
formal written communication. Informal language and SMS
texting style are not suitable.
• Give the correct salutation. If the recipient's name and title are
provided, use them.
• Show awareness of the audience by choosing appropriate
words and phrases. If you are writing to another professional,
technical terms and, possibly, abbreviations may be
appropriate. If writing to a parent or a group of lay people, use
non-technical terms and explain ·carefully.
 106 OET Speaking and Writing Made Easy for Nurses

Comprehension of stimulus - including whether the response shows

that you have understood the situation and provided relevant rather than
unnecessary information to the reader.
Tips to improve this criterion
• Demonstrate that you have understood the case notes
thoroughly by taking relevant information from the case notes
and transforming it to the letter.
• Be clear about the most pertinent issues for the reader.
• Don't let the main issue hide by including too m.any supporting
details.
• Show the connections between information in the case notes
if they can be made. However, do not add information that is
/
not given in the notes [e.g. a suggested diagnosis], particularly
if the reason for the letter is to get' an expert opinion.
• Be explicit if the stimulus material includes questions that
require an answer. You shouldn't hide the relevant information
in a general summary of the notes provided. Make sure the
target reader will understand precisely what he/ she is being
asked to do.

Control of linguistic features [grammar and cohesion] - including

how effectively you communicate using grammatical structures and
cohesive devices ofEnglish.
Tips to improve this criterion
• Make sure you demonstrate a range of language structures to
show that you can use language accurately and flexibility in
your writing.
• Use complex sentences as well as simple ones appropriately.
• Split a long sentence into two or three sentences if you feel
they wordy.
• Review areas of grammar to ensure they convey intended
meaning accurately. Particular areas to focus on might include:
• Articles - a/ an, the *e.g. 'She had an operation'. 'on the internet'+
 Gurleen Khaira 107

• Countable and uncountable nouns [e.g. some evidence, an

opinion, an attack].
• Verb forms used to indicate past time and the relationship
between events in the past and now [past simple, present
perfect, past perfect] adverbs that give time references *e.g.
'two months previously' is different from 'two months ago'+.
• Prepositions following other words *e.g. 'Thank you very
much for seeing ... ', 'sensitivity to pressure', 'my examination
of the patient', 'diagnosed with cancer'+.
• Passive forms *e.g. 'he was involved in an accident' NOT 'he
involved in an accident'+.
• Use connecting words and phrases ['connectives'+ to link ideas
/
together clearly [e.g. however, therefore, subsequently, etc.].

Control of presentation features [spelling, punctuation and

layout] - including how these areas affect the message you want to
communicate.
Tips to improve this criterion
• Take care with the placement of commas and full stops.
• Make sure there are enough to separate ideas into sentences.
• Make sure there are not too many - keeping elements of the
text connected meaningfully.
• Leave a blank line between paragraphs to show the overall
structure of the letter.
• Do not write on every other line - this does not help the
reader.
• Check for spelling mistakes and spelling consistency
throughout the writing [e.g. with a patient's name+ J.
• Remember that some of the words you write are also in the
case notes - check that the spelling used is the same.
• Be consistent with spelling: alternative spelling conventions
[e.g. American or British English] are acceptable as long as the
use is consistent.
108 OET Speaking and Writing Made Easy for Nurses

• Do not use symbols as abbreviations in formal letters.

• Use a clear layout to avoid any miscommunications.
• Make sure that poor handwriting does not confuse the reader
over spelling and meaning.
• Write legibly so the assessor can grade the response fairly using
the set criteria.
• Watch out for words that are commonly confused or misspelt
such as:
• Advise (verb), advice (noun).
• Severe (meaning serious or acute) not sever.
9
Loose (adjective), lose (verb): e.g. to lose weight.
• Loss (noun), lost (verb, past and past participle forhi;
adjective): e.g. his loss of weight.
• Were, where.
• Which, not wich.
• Planned, not planed.

Helpful hints to score A/B grade

• Use the 5-minute reading time effectively. You should read

the information carefully and plan an answer which addresses
the task. The time allowed for the Writing sub-test is designed
to be sufficient for you to use 5 minutes for reading and
preparation before writing your answer.
• Counting words would waste time. When preparing ·for
the test, practice writing the tasks within the word limit so
that you kn?w when you have written enough in your own
handwriting.
• A critical aspect of OET writing is the selection of case-notes.
Think carefully about the particular task. What does the target
reader need to know, and in what order of importance? What
is the outcome that you want to achieve, i.~. what do you
want the reader to do with the information? It is essential· to
 Gurleen I<haira 109

get sufficient practice in selecting and organising the stimulus

information appropriately.
• There are certain functions that you will need for the task, such
as summarising steps already taken, advising ofpotential adverse
effects, outlining recommendations, and making suggestions far
fallow-up. Make sure you are familiar with structures and
vocabulary relevant to these functions.
e Do not forget to get adequate time-limited practice that
will help you to learn how to manage your time within the
40-minute timeframe.
• Do take the time to understand the requirements of the
particular task. Don't assume it's the same as any practice test.
• Do make sure you understand the situation described in the
case notes.
• Have a spare pen or pencil ready just in case.
• Organise what you want to say before you start writing to get
a clear idea of how much detail you can include.
• Indicate each new paragraph clearly as you write, perhaps by
leaving a blank line or by using an indent.
• Write clearly. Don't make it difficult for the assessor or
read your response o.r understand the organisation of the
information.
• If you have changed what you wrote, use clear marks [e.g.
arrows, numbers] to show the sequence in which the parts of
your text should be read.
• Cross out anything you do not want the assessor to read, such
as drafts or mistakes.
-
 /

PRACTICE TESTS WITH

SAMPLE LETTERS
PRACTICE TEST 1

WRITING SUB-TEST: NURSING

TIME ALLOWED: READING TIME: 5 MINUTES WRITING
TIME: 40 MINUTES
Read the case notes below and complete the writing task which
follows. /

CASE NOTES:
Mrs Anita Ramamurthy, a 59-year-old woman, is a patient in the
(IPD) In-patient-department of a hospital in which you are charge
nurse.

Hospital: Sydney Women's Hospital

Patient details

Marital status: Married

Height: 5' 4"

Weight: 87 kg

BMI: 33 - Obese

Address for correspondence: #648, Bourke Street, Sydney

Admitted: 18/06/2017

Date of discharge: 23/06/2017

Diagnosis: Acute appendicitis with Appendicular lump

114 OET Speaking and Writing Made Easy for Nurses

Treatment: Conservative management with IV antibiotics (Planned

for interval appendectomy in 6 wks).

Social background: Businesswoman (Education Consultant) -

Hectic life, travels a lot due to work.
Lives with her husband, Mr Krishnan Ramamurthy
Two daughters both married.
Elder daughter stays in India - about three hours away, works
as an Entrepreneur; younger daughter in Canada, works as a
dentist.
Husband - primary caregiver, elder daughter visits with husband
once in a year, Scared of hospitalization, prone to anxiety relat>d
to this fond of eating out, rarely cooks at home, sedentary lifescyle,
complains of no time to exercise due to work, does not drink or
smoke.

Diet: Whole Milk, Ice-cream shakes, Fruit drinks, Doughnuts,

Pancakes, Waffles, Pizzas, Cheeseburgers, Biscuits, muffins, Cajun
Fries, Hash brown

Medical background: Known case of Essential Hypertension (20I4)

and Diabetes Mellitus type-2 (20 I 0) (not compli~nt with diabetic
medication).

Admission diagnosis: Complaints of pain in abdomen in right iliac

fossa since I 7106120 I 7 Pain was sudden in onset, acute in nature and
was non-radiating fever (documented up to IOI-degree F), aversion
to food, evaluated outside where USG Abdomen revealed Acute
Appendicitis, admi~ted for further evaluation and management.

Physical examination: Conscious, oriented, No pallor, no icterus,

No Clubbing, No Lymphadenopathy, no pedal Oedema BP: 126/84,
Temp-afebrile, Pulse - 72/min, RR - 22/min.
SP 02 98°/o, CNS-NAD, Chest - Bilateral entry equal, No
added sounds.
 Gurleen Khaira 115

Nursing management and progress:

18/06/2017: Abdomen CT (plain) 18/06/2017 - acute appendicitis

with hypodense area in the region of base of appendix at its
attachment with caecum? Phlegmonous collection.
Possibility of sealed perforation cannot be ruled out; total
leucocyte count - 21,000/cumm.
I/V Fluids, broad spectrum antibiotics (Imipenem), PPI,
Analgesics, antipyretics, other supportive treatment (6/6), Regular
Blood Sugar 1v1onitoring (6/6).

19/06/2017: TLC - 18,000/cumm; complaints of considerable

pain in abdomen, headache, sips of water, . extremely distressed,
/
constipation, unable to pass gas.

20/06/2017: TLC - 14,000/cumm; complaints of insomnia,

headache, tenderness in abdomen, weakness, tolerating sips of
coconut water and tea.

21/06/2017: TLC - 11,000/cumm; tolerating soft diet, can ambulate

with assistance, complained of weakness, Rev. Dietician re diabetic diet.

22/06/2017: TLC - 8,000/cumm, able to ambulate slowly,

independent with ADLs.

23/06/2017: Pt. stable, accepting orally well, adequate urine output,

TLC showing improving trend, Pt. stable, Rev. Endocrinologist
- regular chart BSL, INJ Human Mixtard Subcutaneously bd
(12 hourly) 8 units (1 wk.) AC Breakfast and 6 units AC dinner.

Assessment: Pt. stable with plan for interval appendectomy (6 wks).

Medications: TAB Dalo (Paracetamol) 650 mg, t.i.d. (8 hrly) for 3

days then PRN.
TAB Pantocid (Pantoprazole) 40 mg mane for 10 days Tab
Tenorid 25 mg (Atenolol) mane.
Tab Supradyn (multivitamin) mane, Tab Farobact 200 b.d.
116 OET Speaking and \Xlriting Made Easy for Nurses

Discharge Plan: Avoid strenuous activities/Travel

Advised to lose weight (exercise program to start after
appendectomy).
Normal Diabetic diet and low-fat diet - Pt. requests more
information, esp. simple recipes that can be easily prepared at home.
Monitoring of fasting and postprandial blood sugars (present
chart during Follow-up consultation).
Follow up in OPD on 30/06/2017 at 3 PM.
Husband advised to contact us immediately in case of persistent
high grade Fever/pain (at 03492250);
Pt. concerned re monitoring of blood glucose levels and insulin
injections Husband requests home visit for demonstration. /

WRITING TASK 1

Using the information given 1n the case notes, write a referral

letter to Ms Prabha, Shrishti Nursing Home Care Agency, Sydney,
requesting a home visit to provide instructions on self-monitoring of
blood glucose levels and administering insulin injections following
Mrs Ramamurthy's discharge.

In your answer
• Expand the relevant case notes into complete sentences
• Do not use a note form
• Use letter format

WRITING TASK 2

The patient has requested advice on simple recipes for low-fat

diabetic diet. Write a letter to Ms April, Dietician, 258, George
Street, Sydney on the patient's behalf. Use the relevant case notes
to explain Ms Ramamurthy's condition and information he needs.
Include medical history, BMI, and lifestyle. Information should be
sent to her home address.
 Gurleen Khaira 117

In your answer
0 Expand the relevant case notes into con1plete sentences
= Do not use note form
• Use letter format

WRITING TASK 3
Using the i~formation provided in the case notes, write a letter
detailing the post-discharge care required for the patient to the
patient's husband, Mr Krishnan Ramamurthy, #648, Bourke Street,
Sydney.

In your answer /
• Expand the relevant case notes into complete sentences
• Do not use note form
• Use letter format
PRACTICE TEST 2

WRITING SUB-TEST: NURSING

TIME ALLOWED~ READING TIME: 5 MINUTES WRITING
TIME: 40 MINUTES
Read the case notes below and complete the writing task which
follows.

CASE NOTES:
Mr Tej Singh is a 41-year-old man who has been a patient at a clinic
you are working in as a head nurse.

Today's date: 31/01/2017

Name: Mr Tej Singh Randhawa

DOB: 09/09/1976

Address: 28, Raymond Street, Romaville

Medical history: Hypothyroidism - thyroid replacement

No history of trauma or weight loss
Hospitalized (201 O) due to appendicitis
No POHx (No previous ocular history)
No. allergies Immunizations are current
Smoker (Cigarettes & Cigars) Teetotaler

Social history: Works as a Systems Analyst

Arrived in Australia from India with wife in 2012 as a permanent
resident
126 OET Speaking and Writing Made Easy for Nurses

Lives in own home

Married - wife Mona Randhawa aged 37
1 daughter

10/01/2017
Subjective: Headache, right-sided, no cough, no dizziness, denied
vomiting and nausea.
HA accompanied with significant nasal discharge.

Objective: P 96, BP 130/70, T 101.0 f, neuro exam normal, neck

supple.

General Assessment: Alert, well-nourished, well-developed min,

Infectious sinusitis.

Plan: Given Augmentin (Amoxicillin/clavulanic acid).

24/01/2017
Subjective: Complaints of severe headaches (HA), right-sided,
throbbing, radiating to light eye, teeth, and jaw lasting 15 mins to <
2 hrs, persistent HA intermittent episodes, pt. described pain as "like
someone has put red hot poker in my head." Pain so severe (10/1 O)
that pt. unable to stand still, Sit down or go to bed, no effect when
light/ noise avoided rhinorrhoea, no nausea, no vomiting.

Objective: P 105, BP 150/90, Physical & Neuro exam normal, neck

tender-right side.

Assessment: Cluster Headache.

Plan: Given acetaminophen and nonsteroidal anti - inflammatory.

29/01/2017
Subjective: Pt. accompanied by wife, Mona.
Previous complaints of severe headaches - occurring in episodic
attacks associated with rhinorrhoea and epiphora.
 Gurleen Khaira 127

Right eye "Droopy" and sometimes as "sunken" eyelids, first

Noted by Mona 1 day ago, facial flushing before and during HA.

Objective: Right eye upper eyelid drooping, Constriction of pupil

right eye in dark lighting, decreased sweating on right side of face.
P 95 BP 130/85.

Assessment: possibility of? Horner's syndrome.

Referral plan: Referral to ophthalmologist for further evaluation

and management.

/
PRACTICE TEST 3

Read the case notes below and complete the writing task which follows.
Your name is Diana Jones. You are the charge nurse on the
medical ward where Mrs Davies was admitted as a patient.

Hospital: Prince Wales Hospital

/
Patient details

Name: Nina Davies

Sex: Female

DOB: 25/12/1943

Address: 95, Eagle Vale Sydney

Occupation: Retired Librarian

Race: Caucasian

Marital status: Married

Next of kin: Thomas Davies, John Davies

Family Hx: Mother died at 40 - Cancer, Father died at 57 - coronary

Hear't disease.
2 siblings, brother aged 79 with CAD, twin sister with
osteoporosis and depression.

Social history: Lives with husband 1n own house. Home has 2

stories, 2 steps to entrance, Supports full bath on second floor only,
2 grown children living nearby.
132 OET Speaking and Writing Made Easy for Nurses

Pt. is very active; walks 1-2 miles/ day, stopped smoking 30 years
ago, has an Occasional drink, drinks a cup of coffee a day, reports
diarrhoea and gas with dairy products.

Allergies: NKDA (No known drug allergies)

Past Medical History: Diagnosed with osteoporosis - first signs

noted in 2015.
Mild hyperlipidaemia
Mild Hypertension
Coro nary artery disease
Tendonitis of R. Shoulder
PTCA (percutaneous transluminal coronary angioplasty) - 2009
- without recurrence

Medications: Simvastatin (Zocor) 20 mg. daily Aspiring daily -

pain in ribs and back Furosemide, (Lasix) 10 mg. daily Alendronate
(Fosamax) 10 mg. daily Calcium + Vit. D 600 mg. daily Vit. E,
Vit. C, Mg.

Date of admission: 28/ 6/2017

Date of discharge: 02/0712017

Chief complaint: Injury on the left hip - had a fall after slipping
on ice

Dx: Fractured L NOF

Nursing management & progress

28/06/2017: Admitted through ER medical evaluation found her a

good candidate for Left Hemiarthroplasty.

Post-opt: IV Fluids at 100 cc/hr, morphine 10 mg IM q. 4 hours as

needed for pain, IV famotidine (Pepcid) 20 mg.
Every 12 hours due to GI distress post-op, cefazolin (Ancef) 1 g.
IV q. 8 h. X 3 doses.
 Gurleen Khaira 133

29/06/2017: Complaints of hip and back pain, Pt. restless and

confused with hallucinations-possibly due to morphine
Doctor discontinued IM morphine, replaced with hydrocodone/
acetaminophen 5 ing./325 mg
(Lortab) 1 or 2 q. 4 to 6 hours as needed for pain
IV famotidine (Pepcid) switched to oral route Aspirin and
furosemide restarted

30/06/2017: PT (physiotherapy) started, complaints of dizziness

and light-headedness almost resulting in a fall
Found to be hypotensive - diuretic (furosemide discontinued)

01/07/2017: PT continued. /

Complaints of constipation - not had a bowel movement since

surgery Docusate 100 mg. daily
Can ambulate short distances with a walker Assistance with
AD L's

02/07/2017: Original dressing changed

Ready for discharge

Discharge plan: LLE (Left lower extremity) wt. bearing limited to

30 °/o for next 6 weeks
Elderly husband not able to care for her; home not set up for a
walker
Neither of children can take her in their homes - lack of space,
too many Stairs, and working spouses.
Decision is made to transfer her to Helping Hand rehabilitation
centre near her house
Continue Physio program and medication Assistance with ADL
Staples to be removed on day 14 Dressings, to remain dry & intact.

Discharge medications: Hydrocodone/acetaminophen 5 mg/325 mg.

(Lortab) 1 to 2 q. 4 to 6 hours prn pain.
134 OET Speaking and Writing Made Easy for Nurses

Acetaminophen 325 mg. I to 2 q. 4 to 6 hours prn headache or

minor pain
Famotidine (Pepcid) 20 mg. b.i.d.
Docusate I 00 mg. daily
Alendronate I 0 mg. daily

/
PRACTICE TEST 4

You are the registered nurse on the Cardiology Unit at St Luke's

Hospital, Adelaide. Ms Kylie Weiss is a patient in your care.

Today's date: 09/07/2017

Patient details /

Name: Ms Kylie Weiss

DOB: 21/05/1952

Address: 8758, Pulteney Street, Adelaide, SA, 5000

Telephone: (04) 7649-5748

Date of admission: 071071201 7

Presenting complaint: BIBA - brought in by ambulance

2-hour history of intermittent discomfort in jaw and heaviness
in both forearms constant discomfort - Pale, clammy, nauseated
IV access in ambulance, 10 mg IV Morphine on route, Aspirin
300 mg chewed, Glytrin spray x 3
ECG showing ST elevation

Diagnosis: Myocardial Infarction Medical History

Weight: 85kg

Height: 170 cm
138 OET Speaking and Writing Made Easy for Nurses

Diet: Rarely cooks at home - eats muffins or pancakes for breakfast

Likes eating fast foods - fries, hamburgers, sausages, lobster,
onion rings, ice cream,steak
Ex-smoker - 1994
Non-drinker

Medical history: Mild osteoarthritis

Mild asthma - no exacerbations within last 5 years
Dyslipidaemia - (Raised cholesterol) - not treated

Medications: NIL

Family history: Brother - CABG - 70 years /

Sister MI - 60 years
Mother angina

Social history:

Marital status: Married with one daughter

Husband-Peter Weiss, 67 years, retired, aged pensioner
Daughter, Ryena Weiss, lives in London

Occupation: Works as a taxi driver, mixed shifts

Medical treatment: Blood tests - Troponin I (indicative of damage

toheart muscle in most instances) performed by nursing staff along
with CBC. - Hs TNI >50000 (N > 16 female)
ECG - ECG on arrival to ED by Nurse, shows ST elevation -
Leads Vl,V2,V3,V4 Elevation -
Anterior MI Emergency Medication - IV Morphine, Oxygen,
Clexane, loading dose of Ticegralor
Emergency Angioplasty - Due to presentation of pain,
ST elevation on ECG - Direct stenting to proximal LAD
Echocardiogram - to indicate damage to heart muscle and
treatment.
 Gurleen Khaira 139

Ejection fraction 35°/o

Pain/Discomfort - managed
Fluids encouraged - to flush dye decrease risk of AKI (Acute
Kidney Injury)
Fasting Bloods (Lipids, Diabetes, TNI, CBC, Biochem)- High
cholesterol levels identified
Commenced on Atorvastatin 40 mg OD, Metoprolol 23.75 mg
OD, Cilazipril 0.5 mg OD, Aspirin 100 mg OD, Ticegralor 90 mg
BD, Glytrin spray for chest pain
Nil further pain/discomfort Cardiac status stable
Radial site, nil ooze, swelling, pain or discomfort
Pt. seemed confused regarding diagnosis, realify of near death
expenence
Educated re event, MI diagnosis and modifications to risk factors
(Cholesterol, wt. loss)
Riv by Physiotherapist - cardiac exercise program provided
Riv by dietician - diet to promote weight loss and lower
cholesterol levels
Concerned about being unable to manage home on her husband's
pens - S/W (social worker) input required for this

09/09/2017: Preparing for discharge

Discharge medications: Commenced on Atorvastatin 40 mg OD

Metoprolol 23.75 mg OD
Cilazipril 0.5 mg OD, Aspirin 100 mg OD
. Ticegralor 90 mg BD
Glytrin spray prn for chest pain

Discharge plan: No driving motor vehicle for 6 weeks.

Refer to Cardiac Rehabilitation Nurse Specialist - compliano
with risk factor management (wt.. loss, low cholesterol diet)
medications, education re about MI and its management
140 OET Speaking and Writing Made Easy for Nurses

Refer to Occupational Therapist - to provide guidelines for

returning to work, driving and normal daily activities
Refer to Social Worker - due to inability to work for 6 weeks,
6-week recovery from MI, assess eligibility for sickness allowance/
benefits from the Australian Government Department of Human
Services

Writing Task 1

Using the information given in the case notes, write a referral letter
to Ms Nina Gill, Cardiac Rehabilitation Nurse Specialist, Cardiac
Rehabilitation Clinic, 41, Jones St, Adelaide outlining important
information.
/

Writing Task 2

Using the information 1n the case notes, write a referral letter to

Mr Barney Dyer, Occupational Therapist, Home Occupational
Therapy Services, 8 5 Flinders Street, Adelaide requesting him to
visit Ms Weiss at home and provide guidelines for returning to work,
driving and normal daily activities.

Writing Task 3

Using the information given 1n the case notes, write a letter to

Ms Linda Gold, Social Worker, Gold Social Services, 478, Collins
Street, Adelaide requesting her to visit Ms Weiss at her home and
assess her eligibility for receiving a sickness allowance or other
benefits from the Australian Government Department of Human
Services.
PRACTICE TEST 5

You are a registered nurse at the Royal Brisbane Hospital where

Anthony Nutt is a patient in your care.
Read the case notes below and complete the case notes that follow.

Today's date: 29/05/2017

Patient name: Anthony Nutt

Address: Unit 8, 37 Albert Street Brisbane 4000

Age: 86 years

DOB: 19/07/1931

Next of kin: Son, Joseph Nutt

Medical history: Breast Cancer 20 years ago - right total mastectomy

- did not receive adjuvant radiation, chemotherapy, or hormone
therapy or medical follow-up postoperatively.
Dementia
Non smoker
No known allergies
Non-drinker

Family history: Mother died of colon cancer

Social history: Retired 20 years ago

Married - wife suffering from newly onset dementia
One son - Joseph Nutt, 52-year-old, unmarried - lives 30
minutes away.
148 OET Speaking and Writing Made Easy for Nurses

Diagnosis: recurrent infiltrating ductal carcinoma of the breast.

23/05/2017
Presented to ER with ulcerated, haemorrhaging right anterior
chest mass
Per the patient - developed a mass on his anterior chest wall - 2
years ago
Mass increased in size, began to ulcerate - bled this morning -
did not seek medical treatment until this morning

Objective: Temperature - 97.4°F

Pulse - 80
RR (Respiration Rate) - 14
/
pulse oximetry of 100°/o on room air
BP - 162/88.
A right-sided pedunculated 8 c1n x 7 cm mass with a cauliflower-
like appearance on chest-ulcerated, erythematous, malodorous, and
with scant bleeding
White blood cell count 6,500
Haemoglobin 12.4
Haematocrit 36.2
Platelet count 178,000.
Creatinine of 1. 72
Glucose 106
A CT chest - a soft tissue mass in right chest wall measuring 5.2 x
2. 75 x 5 cm with postoperative changes of the right axilla.
• Incisional biopsy of right breast mass performed 28/052017
Pathology returned consistent with Recurrent moderately
differentiated duct carcinoma of the breast with ulceration of
overlying epithelium - Stage 3.
• Pt. not found to be suitable for chemotherapy or curative
treatment - Oncology evaluation and geriatric .assessments by
doctor.
 Gurleen Khaira 149

• Pt. commenced on hormone therapy with tamoxifen 20 mg

daily with one course of palliative radiation.
• Family meeting called - son verbalized concerns over mother's
state of health; son unable to take time off work to care for
father-says he won't be able to cope; hospice care recommended
for pt. - consensus decision.
• Pt. to be transferred to Queensland Aged Care Centre for
hospice care - Bed available from 2910512017 for patient.
• Pt.'s wife to be admitted to the same facility due to general
deconditioning when bed is available; mother to live with son
interim.

Discharge plan: Transfer to Aged Care home

./
Son will visit weekly
Contact community social worker to notify son when bed
available for wife at Queensland Aged Care Centre.
 PRACTICE TEST 6

Read the case notes below and complete the writing task that follows.
You are Ramona Decosta, a senior nurse working with Helpline
Hospital.

Patient name: Tom Clarke

/
DOB: 21/09/1954

Address: 92 Lygon Street Carlton Melbourne

Phone: 0422-894-896
1(1

Social background: Married - Wife, Miranda Clarke, aged 58 years.

i
I
ii
Lives together Retired - Police officer
-
I',1
-·
~: Two daughters
~
'
p j Elder daughter - works in Sydney, Younger daughter - lives in
-
~
I Adelaide
l
~ ·~
Quite active
·~

I
t
Medical history: Hypertension - 1985
J

1 i
\
i
Did not seek treatment till 2000; now managed with Ramipril
GERD. (Gastro esophageal Reflux Disease) - 1999

I
I Surgical history: R Ankle dislocation surgery following a car
~'
accident - 1982 - hospitalized for 3 weeks
J

I~
Septoplasty - 1985
Surgery for Anal Fistula - 1992
~·
I. Eye replacement lens surgery - 2007
Il
A
154 OET Speaking and \X!riting Made Easy for Nurses

Hobbies: Cycling, watching movies, sports, reading, travelling,

playing golf and Tennis

26/08/2016: Accident with a motorbike while cycling, claimed he

was going at a moderate speed, a motorbike hit him while overtaking,
he landed on the left side of his body
FOOSH (Fall on outstretched hand) injury to L elbow presented to
ER - limited range of motion and extreme pain
X-RAY - Nondisplaced fracture of the coronoid process of the ulna,
marrow oedema head and neck of radius involving articular surface,
n1oderate joint effusion

Treatment: Sling to keep the elbow immobilized - 6 weeks,

Capsule CM Plus, Panadol, Ibuprofen, hot compress for pain ahd
inflammation
Next Appointment in 6 weeks' time

06/10/2016: X-ray- injury healing well

Tab D gain qw
Tab CM Plus - qd
Sling taken off
Exercise program - at home

01/11/2016: Pt. complains of stiffness and limited range of motion

in the elbow
Arrange home visits by physiotherapist for rehab program
Tab D gain - qw
Tab CM plus - qd
Follow-up appointment - 15/12/2016
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