GURLEEN KHAIRA 

SPEAKING AND WRITING MODULES 

Nurses' Guide to the Updated 
OET 2.0 
 
Nurses' Guide to the Updated 
OET 2.0 
SPEAKING AND WRITING MODULES 

GURLEEN KHAIRA 
notionpress 
INDIA 
SINGAPORE • HALATSIA 
 
Notion Press 
Old No. 38, New No. 6 McNichols Road, Chetpet Chennai - 600 031 
First Published by Notion Press 2018 Copyright © Gurleen Khaira 2018 All Rights Reserved. 
eISBN 978-1-64324-460-0 
This  book  has been published with all efforts taken to make the material error-free after the consent of the 
author.  However,  the  author  and  the  publisher  do  not  assume  and  hereby  disclaim  any  liability  to  any 
party  for  any  loss,  damage,  or  disruption  caused by errors or omissions, whether such errors or omissions 
result from negligence, accident, or any other cause. 
No part of this book may be used, reproduced in any manner whatsoever without written permission from 
the author, except in the case of brief quotations embodied in critical articles and reviews. 
 
Contents 
Preface 
Chapter 1 
What’s new in the UPDATED OET SPEAKING TEST? Chapter 
2 
Useful Skills for OET Speaking Test Chapter 3 
Questioning Techniques Chapter 4 
OET Speaking Course – Pocketbook 
Sample Role-plays 
Role Play 1 Role Play 2 Role Play 3 Role Play 4 Role Play 5 Role Play 6 
Role Play 7 Role Play 8 Role Play 9 Role Play 10 Role Play 11 Role Play 12 
Role Play 13 Role Play 14 
 
Role Play 15 Writing SUB-TEST Assessment Criterion – Writing Writing 
Sub-Test: NURSING 
Writing Task 
Writing Task 1 Writing Task 2 Writing Task 3 Writing Task 4 Writing Task 
5 Writing Task 6 Writing Task 7 Writing Task 8 Writing Task 9 Writing 
Task 10 Writing Task 11 Writing Task 12 Writing Task 13 Writing Task 14 
Writing Task 15 Writing Task 16 Writing Task 17 Writing Task 18 Writing 
Task 19 
References 
 
Preface 
OET  is  an  international  English  language  test  that  assesses  the  language 
communication  skills  of  healthcare  professionals  who  seek  to  register  and 
practice in: 
Australia, 
New Zealand, 
United Kingdom (Doctors and Nurses only), 
Ireland, 
Singapore, 
Dubai 
It covers all four language skills (Reading, Listening, Writing, and Speaking) 
with an emphasis on communication in a healthcare environment. 
OET  has  been  developed  specifically  for  12  healthcare  professions: 
Dentistry,  Dietetics,  Medicine,  Nursing,  Occupational  Therapy,  Optometry, 
Pharmacy,  Physiotherapy,  Podiatry,  Radiography,  Speech  Pathology  and 
Veterinary  Science.  The  Reading  and  Listening  modules  are  same  for  all 
health  professionals  taking  the  exam  and  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  so  that  they  can  successfully  pass 
the Occupational English Test. 
For more information on test dates, test fees, testing venues and official 
 
materials, please visit www.occupationalenglishtest.org. 
Disclaimer:  This  book  is  meant  for  OET Preparation only and is not intended 
as  a  substitute  for  the  medical  advice  of  physicians.  The  reader  should 
regularly  consult  a  physician  on  matters  relating  to  his/her  health  and 
particularly  with  respect  to  any  medication  or  symptoms  that  may  require 
diagnosis  or  medical  attention.  The  case  studies  used  for  speaking  and 
writing  are  a  work  of fiction. Names, characters, places, events, and incidents 
are  either  products  of  the  author’s  imagination  or  used  in a fictitious manner. 
Any  resemblance  to  actual  persons,  living  or  dead,  or  actual  events  is  purely 
coincidental. 
 
Chapter 1 
What’s new in the UPDATED OET 
SPEAKING TEST? 
There  are  no  changes  to  the  format  of  the  Speaking  sub-test.  However,  new 
assessment  criteria  are  being  introduced  from  September  2018  which  has 
been discussed in detail below. 

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  take  this  part  of  OET  using 
materials  specially  produced  for  their  profession.  In  other  words,  you  would 
be  enacting  the  role  of a nurse and will be expected to demonstrate the ability 
to deal with situations that occur realistically in the workplace. For instance, 
• 
Asking questions to the patient. 
• 
Answering the patient’s questions 
• 
Engaging with a variety of patient types, e.g., different ages, various health 
problems, different concerns. 
• 
Explain medical conditions and treatments in a clear and accessible way. 
• 
Rephrase ideas in a variety of ways to help or persuade a patient. 
 
• Reassure a worried or 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 
following  which  you  are  given  two  role-plays,  one  by  one,  and  you  have  3 
minutes  to  prepare  yourself  for  each role play. The interview is recorded, and 
two  different  assessors  in  Australia  then  assess  the  recording.  The 
interlocutor is not assessing you. Each role play is 5 minutes long. 

Updated Assessment Criteria-Speaking sub-test 

Linguistic criteria (6 marks each) 
Communication criteria (3 marks each) 
Intelligibility Relationship building 
Fluency Understanding and incorporating the 
patient’s perspective 
Appropriateness of language Providing structure 
Resources of grammar and expression 
Information gathering 
Information giving 

Linguistic Criteria 
Intelligibility – how well your speech can be heard and understood. It 
includes pronunciation, intonation, stress, rhythm, pitch, and accent*. 
TIPS 
 
Consider • 
each  aspect  that  makes  up  this  criterion:  not  just  pronunciation, 
but also use of stress to emphasize the most important information, and use of 
intonation to signal whether you are asking a question or making a statement. 
• 
Practice the pronunciation in English of common words and phrases used in 
your profession. Fluency – how your speech is delivered in terms of the rate 
(speed) and natural flow of speech. 
TIPS 
• 
Speak  at  a  natural  speed.  If  your  speech  is  too  slow,  the  listener  might  feel 
frustrated  while  waiting  for  you  to  finish  or  may  lose  the  flow  of  the 
argument.  Similarly,  if  the  speed  is  too  fast,  it  might  difficult  for  the  listener 
to comprehend. 
• 
Pauses  contribute  to  an  improved  understanding-  therefore,  use  pauses 
effectively  in  your  speaking.  Please  refer  to  the  example  in  this  book  to 
understand how pauses can be used effectively during your OET Speaking. 
• 
Aim for even speech [not broken up into fragments] – reduce excessive* 
hesitation or speaking in ‘bursts’ of language or excessive self-correction or 
fillers. *The word excessive here is used because some repetition or 
hesitation or self-correction or during speech is natural and is acceptable. 
However, if these have an impact on your ability to be understood, then your 
score will be affected. 
Appropriateness  of  language  –  including  the  use  of  suitable  professional 
language  and  the  ability  to  explain  in  simple  terms  as  necessary  and 
appropriately, given the scenario of each role-play. 
TIPS 
• 
Practice  explaining  medical  and  technical  terms  and  procedures  in  an 
appropriate  language  (non-medical  words)  to  patients.  For  instance,  giving 
general advice for good health about diet, losing weight, care of 
 
wounds, smoking cessation, etc. 
• 
Consider how your language will need to be adjusted to suit the patient type 
and context. For example, consider how your tone, pitch, and language will 
vary when you are delivering bad news to a patient or when speaking to an 
angry or withdrawn or depressed patient. Resources of grammar and 
expression – including the accuracy and range* of the language used; how 
effectively and naturally you can communicate in a healthcare setting. 
TIPS 
• 
Demonstrate your ability by paraphrasing or different phrases to 
communicate the same idea to the patient. 
• 
Make  sure  you  can  form  questions correctly (word order) – particularly those 
questions  that  you  often  use  with  patients  while  investigating  the  presenting 
complaint or taking medical history [‘How long...?’, ‘When’]. 
TIP: 
*Choose  to  demonstrate  a  range  of  grammar  in  your  OET  Speaking.  A 
student  who  chooses  to  use  simple  grammar  and  does  not  make  any  mistake 
is  not  likely  to  get  a  high  score  in  the  Speaking  sub-test.  In  other  words,  to 
score  a  high  grade  in  the  OET  exam,  it’s  not  enough  to  make  any  mistakes 
(accuracy), you will also need to use a variety of grammatical structures. 

Communication criteria Relationship building 

consists of 4 sub-criteria 
1. 
Initiating the interaction appropriately Greeting your patient in a friendly, 
confident, and welcoming manner to establish rapport 2. 
Demonstrating an attentive and respectful attitude Seeking patient’s 
permission or consent before asking questions or 
 
moving on during the consultation. Being sensitive to patients when talking 
about embarrassing matters 3. 
Adopting a non-judgmental approach Being accepting and respectful towards 
patient views and avoid making any judgmental comments or statements 4. 
Showing empathy for feelings/predicament/emotional state 

Understanding and incorporating the patient’s 

perspective consists of 3 sub-criteria 
1. 
Eliciting and exploring patient’s ideas/concerns/expectations – this means 
finding out more about patient’s perspective or feelings of their illness and, if 
required, encouraging elaboration by asking follow-up questions. Once the 
patient’s worries or anxieties are known, it’s easier to reassure them and 
construct an effective management plan. 2. 
Picking up patient cues like hesitation, change in volume or tone, pauses and 
using verbal facilitation techniques like using reflecting statements to 
encourage patient participation. 3. 
Relating  explanation  to  elicited  concerns  or  expectations-  this  means  using 
patient  perspective  when  providing  information  later.  For  example:  let’s 
assume  your  patient  says  that  it’s  hard  for  her to take time off from work and 
she’s  concerned  that  she  might  be  diagnosed  with  something  that  will have a 
significant  impact  on  her  life.  When  you  are  explaining  the treatment advice, 
you  could  say  “I  know  that  you  have  a busy schedule, and you are concerned 
about  making  any  big  changes  to  your  routine.  So,  I  suggest  that  we  take 
small steps to manage this condition.” 

Proving structure consists of 3 sub-criteria 

1. 
Sequencing  the  interview  purposefully  and  logically  –  Controlling  the 
direction  of  the  conversation  and  sequencing  the  conversation  logically  and 
purposefully. That being said, it needs to be balanced with a 
 
patient-centred approach. 2. 
Signposting changes in the topic – use discourse markers to move from one 
task to another. 3. 
Using organizing techniques in explanations (outlined below) 
Categorisation, i.e., forewarning about categories about to be provided. For 
example, Let’s first talk about your medical history and later I’d like to ask 
some questions about your routine including eating and sleeping habits. 
Labelling – attaching a label to the “advice” to persuade your patient. It’s 
imperative that you take some steps to control your weight. OR 
It’s vital that you cut down your drinking. 
It’s imperative that you take your medications on time to recuperate. 
Chunking  –  Breaking  down  the  information  into  chunks  and  giving  it  to  the 
patients  in  small  increments  and  allowing  them  time  to  absorb  each  block  of 
information. 
Repetition – repeating the information and summarising at the end. 
For example: 
To summarize what we have discussed today,.... 
Just to go over what we have discussed today,... 
summarising gives the patient an opportunity to clarify details, make 
corrections and add further contributions 

Information gathering consists of five sub-criteria 

1. 
Facilitating the patient’s narrative using active listening, Back- channelling, 
using echoing statements to encourage patient participation, paraphrasing and 
reflecting statements. 2. 
Using  initially  open  questions  appropriately moving to closed questions. This 
is  commonly  referred  to  as  the  cone  technique.  In  this  book,  you  will  also 
learn about using focused questions and probes to 
 
gather information from the patient. 3. 
Not using compound/multiple or leading questions – explained later in the 
book in the section titled “What not to do during history taking in this book.” 
4. 
Clarifying statements which are vague or need amplification. For 
example: 
• 
Could you please explain what you mean by......? 
• 
I am sorry, but I missed the last sentence. Could you please repeat it? 
• 
Here’s what I have understood,............................ Is that correct? 5. 
Summarizing information to encourage connection and invite further 
information For example: So, what you are saying is........Is that an accurate 
summary or would you add something to that? 
Summarising provides the patient with an opportunity to clarify details, make 
corrections and add further details. 
• 
To go over what you have told me,........Is that an accurate summary? 
Summarizing would give your patient an opportunity to clarify details, make 
corrections, and add additional information if necessary. 

Information giving consists of 5 sub-criteria 

1. 
Establishing initially what the patient already knows – This means assessing 
what the patient already knows and giving information accordingly. Find out 
what the patient knows and has experience of to understand what and how 
much more they want to know. It will also assist you in providing the correct 
amount and type of information to the patient. 2. 
Periodically  pausing  when  giving  information, using the patient’s response to 
guide  next  steps  –  Use  ‘chunking  and  checking’  to  provide  information  in 
small  blocks  of  information  and  then  checking  the  patient’s  understanding 
before proceeding further. This helps the 
 
patients in retaining and recalling the information better. Don’t forget to clear 
and simple language, avoiding any medical jargon, when giving information 
to the patients, and use the patient’s responses as a guide to decide what 
information to supply next. 3. 
Encouraging patient to contribute reactions/feelings – This means 
encouraging active participation from the patient and allowing them to ask 
questions, express doubt, or seek clarification regarding the information. 4. 
Checking whether the patient has understood information –Use statements 
like “To ensure that you have understood everything correctly, would you 
mind repeating back to me what we have discussed?” to check the patient’s 
understanding. 5. 
Discovering what further information, the patient needs – This means asking 
directly if the patient would like to know additional details. For example: Are 
there any other questions that I can answer? 
• 
To  enhance  active  patient  participation,  employ  patient  engagement 
techniques  and use more open-ended questions to elicit information regarding 
patients’ needs and preferences, and encourage patients to ask questions. 
• 
Use  tools  such  as  the  teach-back  method  to  determine  whether  patients 
understand  the  risks,  benefits,  and  alternatives  to  treatment.  Teach-back  can 
help to focus patients and clinicians on what’s important. 
• 
Make use of everyday language instead of medical jargon in communicating 
with patients or substitute decision-makers. Remember that 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 advantage or disadvantage you 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 specific medical topic. 
General Tips 
 
• 
• 
• 
• 
• 
• 
• 
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. During this 
time, ask the interlocutor if you have any questions about what a word/phrase 
means, how it is pronounced, or how a role-play works. 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. Speak loudly and clearly at a natural 
speed. You are allowed to make notes on the cue-card and keep it with you 
while performing the role-play. Take time to read through the role play card 
carefully. 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. 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 dont 
have much time]. 
 
• 
• 
What information do you need to give the patient? Take the initiative to start 
the roleplay yourself. Don’t worry if the interlocutor stops the role-play after 
five minutes – there is no penalty for not completing all the elements on the 
role card. 
 
Chapter 2 
Useful Skills for OET Speaking Test 
Step 1 
The first step is introducing yourself and your role in a confident and friendly 
manner. It helps in establishing rapport with the patient. 
(Note:  At  times,  your  cue  card  may  suggest  that  you  already  know  the 
patient,  so  an  introduction  would  not  be  necessary;  however,  you  may  still 
ask how your patient will prefer to be addressed). 
This depends on how you greet your patient and introduce yourself, 
ensuring that you have clarified your role. 
For introducing yourself, you may use the following: 
• 
Hello, my name is (your name here), and I will be your attending nurse today. 
• 
Hello, my name is (Your name here), and I am one of the Registered Nurses 
in this facility. 
• 
Hello, my name is (Your name here), and I will be looking after you today. 
Your introduction will match the setting of the roleplay. If the setting is in the 
Emergency Department, you could say: 
• 
Hello, my name is Gurleen, and I am one of the Registered Nurses on 
 
duty today. Some of the settings commonly used in OET role plays are: 
• 
Medical Centre 
• 
Community Health Centre 
• 
General Practice 
• 
Emergency Department of a hospital 
• 
Home visit to a patient’s house 
• 
Hospital outpatient department 
• 
School Use a polite and welcoming opening like: 
“Good morning/good afternoon” My name is ______________________, 
and I will be your attending nurse today. 
“Good morning/good afternoon” My name is _______________________, 
and I am one of the Registered Nurses in this facility. 
Next step would be to ask the patient’s name. 
• 
Can you give me your name, please? Then, ask how he/she would like to be 
addressed. 
Some people prefer to address the patient as “sir” or “ma’am,” using this 
language can feel systematic, as though you are following a script. 
The student should ask the patient what he/she would prefer to be called (first 
name or last name). 
This  is  merely  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? NOTE: In some cases, you may 
already know the patient (for instance when 
 
the  patient  is  returning  for  a  follow-up  visit  or  has  been  admitted  to  the 
hospital  ward).  In  those  cases,  an  introduction  may  not  be  necessary.  During 
the  preparation  time,  you  could  ask  the interlocutor what he/she would prefer 
to be called, and begin the role play. 
For example: 
• 
Good Morning David, how are you feeling today? 
• 
Good Afternoon Samantha, how are you doing today? Alternatively, 
you could say: 
• 
May I confirm your ID details with you. Please confirm your first and last 
name for me. 

Step 2 
Use  the  background  information  to  understand  what  you  already  know about 
the  patient’s  current  situation  and  use  this  to  formulate  the  initial  question or 
statement.  In  other  words,  the  opening  statement  or  question  should  match 
the background information on the cue card. 
For instance, if you are meeting the patient for the first time, use the 
following open-ended questions to open up the discussion. 
Use open-ended questions like: 
• 
What brings you here today? 
• 
What would you like to discuss? 
• 
How can I help you today? 
• 
How may I assist you today? 
• 
I see that you rang the buzzer. What can I do for you? (When the patient is 
admitted to the hospital). Use a closed-ended question when you already 
know the reason for patient’s visit, or it’s a follow-up visit? 
For instance: 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Am I right in thinking that you have been referred by your doctor to discuss 
regarding your weight/smoking/hypertension? (Depending on the cue card) 
Am I right in thinking that you have come here about your arthritis? Am I 
right in thinking that you are here to talk about your hypertension? Use the 
background information in the cue card to identify clues or elements which 
can form the basis for your opening question. For instance- if the cue card 
states that the patient has an emotional reaction (seems anxious, upset, and 
angry, frustrated), address this in your opening question. 
I can see you that seem upset/anxious/angry/frustrated. Could you tell me 
what is bothering you? I can see you that seem 
upset/worried/anxious/angry/frustrated. Would you mind telling me what the 
problem is? 

Step 3: Complete the tasks on the cue card 

Plan  the  execution  of  the  role  play  depending  on  the  tasks  mentioned  in  the 
cue-  card.  Signposting  could  be  useful  to explain the schedule or sequence of 
the  tasks.  Since  you  are  responsible  for  initiating  the  role  play,  these 
expressions will be helpful in structuring the role play. 
Do not forget to obtain the patient’s agreement while doing this. 
Shall we start with... and then we will discuss the treatment options later. Is 
that okay with you? Before proceeding further, I would like to ask you some 
questions to get a detailed picture of your situation. Would that be okay? 
Would it be okay if I can ask you some questions about your........and then 
discuss some things you can do to manage your condition? So, here’s what I 
am going to do. First, I will ask you some questions about your lifestyle. 
Then, I would suggest some things you can to do to manage your condition. 
And later/after that, I would be happy to answer any questions that you might 
have. May I proceed? 
 
Before • 
I take you through the treatment options, I’d like to ask you some 
questions about your condition. Is that alright? 

Step 4: Concluding the role play. 

Your  conclusion  will  match  the  cue  card;  however,  some  ways your roleplay 
can  be  concluded:  reiterate  the  advice,  schedule  an  appointment  for  review, 
or  offer  a  patient  information  leaflet  to  reinforce  the  patient’s  understanding 
of a medical condition, etc. This will match the situation on the cue card. This 
is by no means an exhaustive compilation but lists commonly used scenarios. 
Examples: 
Example 1 – Briefly summarize what has been discussed during the role-play 
• 
To reiterate, you will gradually cut down on the number of cigarettes daily 
and join a smoking cessation program. 
• 
To summarize what we have discussed today, 
• 
Just to go over what we have discussed today,........................... 
• 
Now, if you wouldn’t mind going over the advice, I have just given? 
• 
Now, if you won’t mind, can we go over the advice I have just given? 
Example 2 – Let the patient know what happens next 
• 
I will review your progress after two weeks. (include a timescale, if 
mentioned on the cue card) 
• 
What I will do for you right away is...... (as suggested on the cue card) 
Example 3 – Ask the patient if there is anything else that they can be helped 
with. 
• 
I’m glad that I was able to help today. Is there anything else I can help you 
with? 
• 
Is there anything else that you would like to ask? 
• 
Before we finish, is there anything more you want to ask? Example 4 – Offer 
a patient-information leaflet, if mentioned on the cue card 
 
•  Thank  you.  Here  is  a  patient-information  leaflet  which you will find useful. 
If  you  have  any  additional  questions,  please  do  not  hesitate  to contact me. (if 
mentioned on the cue card) 

Showing courtesy in OET SPEAKING 

Using language that reflects common courtesy will keep your interactions 
with the patient respectful and consequently improve rapport. 
Below are some other examples of responses that should be avoided and 
some courteous phrases that can be used to replace them. 
Phrases to avoid Phrases to use 
You will need to wait to see the doctor 
If it’s ok with you, can you wait for some time to see the doctor? 
If you don’t mind, can you wait for some time to see the doctor? 
The doctor is attending to a critical patient who needed to be seen quickly. I 
apologize for the inconvenience this has caused. 
Would you mind waiting just a few more minutes? 
I don’t know Let me find out..... 
Allow me to find that out for you 
I am afraid it’s not within my scope to answer this question at the moment. 
Please allow me a little time to get that answer for you. 
The Basics 
 
Let’s look at the most common courtesy words, which can be used in a 
conversation as a signal of mutual respect. 
“Please” 
Do not forget to say please when asking for information from the patient! 
Doing otherwise seems rude. 
“Thank you.” 
When the patient answers your questions and provides information, say 
Thank you for answering my questions. 
“Sorry” 
If your patient is angry or agitated about something, it is courteous to 
apologize. 
I am sorry for the inconvenience that this has caused. 
I am sorry that your pain is so high. 
I apologize that you had to wait for so long. 
Doing so demonstrates that someone has taken it personally upon themselves 
to resolve their concern/query and helps in reassuring the patient. 

Providing Reassurance and Immediacy 

To  assure  the  patient  that  his/her  concern  is  crucial  to  you,  it’s  vital  to 
provide  them  with  a  sense  of  immediacy.  This  demonstrates  that  you 
understand  the  value  of  the  patient’s  time/their  concern  and  you  are  doing 
your bit to speed up the process. 
“Right away.” 
Using this phrase signals that the process addressing the patient’s concern has 
been enacted. For example: 
“I’ll contact the doctor right away and let him know that you are in pain so he 
can prescribe some medication to relieve your pain.” 
 
Using positive words in OET SPEAKING 
• 
Definitely 
I will definitely make sure that it gets sorted.../the concern is shared with the 
doctor/Ward Manager (conflict resolution) 
• 
Absolutely 
I absolutely agree... (To empathize with patients).... 
• 
Certainly 
Small changes in your lifestyle will certainly help in making a big difference 
to your health in the long run. 
• 
Fantastic 
That is fantastic (to motivate your patient) 

Clarifying a Situation 
There  will  be  occasions  when  the  patient  feels  as  though  they  have  fully 
detailed  their  symptoms/condition,  yet  you  cannot  quite  understand  the 
situation. 
In these scenarios, use the following phrases: 
“Pardon me.” 
Rather than using ‘what?’ Use more formal expression such as ‘Pardon me’ 
when you miss a small part of the conversation. 
“Forgive me...” 
For example, “Forgive me, I didn’t quite catch the last sentence. Could you 
please repeat it for me?” 
Backtracking – going back to something in the conversation. 
In OET Speaking, it can be used to 
 
1. 
• 
• 
• 
2. 
• 
• 
3. 
• 
• 
• 
• 
• 
Clarify the meaning of something you don’t understand. When you 
say______________, do you mean...? Could you please explain what you 
mean by......? I am not sure I understood that completely. Do you mind 
repeating it for me? To recap the patient’s responses For example: 
From what I have understood so far, you have been experiencing indigestion 
for the past few weeks, and at times, it is accompanied by headaches which 
last for a few hours and are only relieved with medication. You feel the 
indigestion is caused when you eat rice for dinner. Is that right? OR 
In summary, it seems that.......... (patient’s symptoms here) ..................... 
Have I covered everything? At the end of the role-play as a final summary of 
what has been agreed so far For example: 
So, to backtrack, So, to reiterate what we have discussed so far,... To recap 
what we discussed today, Just let me check what you have told me so far... Is 
that an accurate summary? 
Acknowledging a patient’s feelings 
To build rapport with your patient, it is vital that the patients feel that their 
thoughts have been acknowledged. 
I understand your perspective. 
 
• 
• 
• 
• 
• 
• 
• 
• 
I understand where you are coming from. “I realize this is difficult” This is 
effective in terms of acknowledging the patient’s problem without voicing 
any personal thoughts on the matter. “Now that I’m aware, I will ensure that 
your concerns are taken care of, and you don’t face any inconvenience.” I can 
appreciate this is difficult for you. 

Signposting language to structure the role play 

Signposting  is  used  to  provide  a  structure  to  a  consultation;  it  can  be  used 
when  moving  from  one  section  to  another.  It  also  helps  the  patient  to 
understand  the  direction  the  conversation  is  going  in  and  why  and  can  be 
used  to  obtain  the  patient’s  consent  when  asking  questions  on  sensitive  or 
embarrassing topics. 
In OET Speaking, signposting can be used at different stages of the role play. 

Transitioning from the introduction to history 

taking 
OK, before proceeding further, I’d like to ask you some questions about your 
pain. Is that alright? I’d like to start by asking some general questions to 
understand your condition. To give me a better understanding of your 
situation, is it okay if I can ask you some questions. If you don’t mind, I am 
just going to ask you a few questions about your lifestyle. Would that be 
okay? It is a good idea to provide a rationale or reason or asking the question. 
For example: 
If you don’t mind, I want to ask some questions about your medical history. 
It 
 
will help me to assess your condition in a better way. 

To ask permission before moving to the 

information- gathering stage. 
• 
Can I start with questions about your lifestyle before discussing treatment 
options? 
• 
May I ask you some questions about your family history? 
• 
I am going to ask you some questions about your lifestyle. Is that ok? 
• 
Is it OK if I ask you some questions about your lifestyle? 

To ask personal questions or questions on sensitive 

topics 
• 
I have to ask you some personal questions if that’s OK. 
• 
If it’s alright with you, I need to ask you some personal questions. 
• 
If you don’t mind, I’d like to ask some questions about your sexual history. 
• 
Do you mind if I ask some questions about your lifestyle? 

To justify a specific line of questioning 

• 
Since this condition can be hereditary, I’d like to ask some questions about 
your family history. 
• 
If  you  don’t  mind,  I  want  to  ask  you  some  questions  about  your  sexual 
partners  and  sexual  practices.  I  can  appreciate  that  these  questions  are  very 
personal, but they are crucial for the examination. 

To outline the sequence of the consultation 

• 
First, I’d like to ask you some questions to get a detailed understanding of 
your condition and then we can talk about ways to treat the problem. 
 
I • 
am  going  to  divide  this  talk  into  two  parts:  I’d  like  to  start  by  asking  you 
some  questions  about  your  lifestyle  and  routine and then I will go on to some 
suggestions about making changes to your current lifestyle. Is that okay? 
• 
First, I’ll ask you some questioning about your complaints 
• 
Then, I will explain the likely cause of your symptoms 
• 
After that, I will take you through some treatment options and things you can 
do to manage your condition 
• 
Following that/Finally, you can ask me any questions that you may have. 

To move from one topic to another 

• 
Now that we’ve discussed some treatment options, I’d like to know about any 
questions or concerns that you have on your mind. 
• 
What I’d like to do now is to discuss some ways you can manage your 
present condition. 
• 
Before I can discuss the treatment options, I’d like to summarize your 
symptoms to ensure I have accurate information 
• 
Thank  you  for  answering  my questions. I have all the information I need, and 
now I’d like to suggest some lifestyle modifications to improve your health. 
Closing 
• 
Before we wrap-up, is there anything that you would like to ask? 
 
Chapter 3 
Questioning Techniques 
Investigating the presenting complaint or taking a 
history of the patient 
In  OET  Speaking,  asking  about  the  presenting  complaint  requires  a  series  of 
questions  in  a  particular  order.  During  the  role-play,  you  would  be  making 
use of both open-ended and closed-ended questions. 
Open-ended  questions  let  the  patient  answer  with  something  other  than 
yes  or  no,  encouraging  patient  elaboration  or  further  conversation  with  the 
patient,  maximizing  opportunities  for  listening  for  understanding  and 
symptom-defining  answers.  Open  questions  open  up  the  discussion  and 
encourage  the  patient  to give a detailed response, allowing patients to express 
themselves in their own words. 
For example, 
• 
How are you doing today? 
• 
How are you feeling? 
• 
How is everything going? 
• 
How have you been? 
• 
What brings you in today? 
• 
What seems to be the problem? 
• 
Who brought you to the hospital? 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
What did you eat today? Where do you feel pain? 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? Tell me about the pain. What are you doing for the 
pain? 
Closed  questions:  (require  a  one-word  answer)  (Yes,  No,  or  a  specific  piece 
of  information),  without  encouraging the patient to express themselves in any 
detail. 
Do you exercise? Are you feeling any pain? 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? Is anyone in your family suffering from this 
condition? Has your appetite/weight changed recently? Are you available at 
11.30 am tomorrow for your next appointment? How often do you exercise? 
Are you taking any medication? 
Closed-ended questions Open-ended questions 
Where is the pain? Tell me about the pain. 
Do you have any pain at the moment? How are you feeling? 
Ae you married? Tell me about your family. 
 
Can you come next week on Tuesday for your follow up? 
When are you available for your follow-up appointment? 
Do you exercise regularly? Tell me about how much physical 
activity do you get daily. 
Focused  questions:  Questions  that  are  used  to  limit  the  range  of  query  to  a 
specific  topic  are  called  focused questions. These can be used to ask for more 
information  about  a  particular  problem.  These  questions  narrow  the  range  of 
patient  responses  but  still  invite  more  than  a  one-word  response  from  the 
patient. 
Examples: 
• 
You mentioned that you feel anxious/scared. Could you please tell me more 
about it? 
• 
You said that you sometimes get a mild pain in your right shoulder. Do you 
mind telling more about it? Probes: Probing means to inquire into someone or 
something specifically. Probes are used to ask for further detail about a 
specific topic. Probes aren’t necessarily questions; these can be words or a set 
of phrases that are used to gain more information about the same topic. In 
other words, probes are used to facilitate the patient’s response. 
Examples: 
• 
How does that make you feel? 
• 
How do you feel about that? 
• 
Is there anything that I left out? 
• 
Would you like to add anything to that? 
• 
How long have you had these problems? 
• 
Is there anything that alleviates your pain? 
• 
Is there anything that exacerbates your condition? 

What not to say or do in OET SPEAKING? 

 
Do not use “Multiple” or “Leading” questions in OET Speaking. 
Multiple questions- several questions asked at the same time can be 
confusing for the patient; therefore, you should ask one question at a time. 
• 
Does the pain always occur in the same place, and how painful is it on a scale 
of 0-10 where 0 is no pain and ten is the worst? 
• 
Do you drink and smoke? This question may be confusing for a 
patient to answer in case he/she does one of the above. The patient could be a 
smoker but not a drinker or vice-versa. 

Transforming multiple questions 

Multiple questions Transformation 
How do you feel this morning – did you get enough sleep last night and 
enough to eat for breakfast? 
How do you feel this morning? (pause for reply) 
How did you sleep last night (pause for reply)? 
How was breakfast this morning? (Pause for reply) 
Where do you live, and how many people live with you. 
Tell me about your living situation. 
Did stress, travelling or something else cause the problem? 
What do you think caused the problem? 
What  have  you  been  eating  this  past  month?  How  much  do  you  eat  at  one 
time? How often do you eat? 
Tell me about your eating habits this past month. 
Leading questions- those that “lead” the patient towards a particular answer. 
 
Transforming leading questions 
You are not eating too well, are you? 
Have you noticed any changes to your appetite? 
Back-channelling can be used to encourage the patient to talk more. It can be 
used to show interest, attention and a willingness to keep listening. Back 
channelling is the feedback you give to the patient to show that you 
understand what he/she is saying. 
It usually takes the form of utterances such as uh-huh, yeah, mmm, okay, 
right, I see, ahan, go on....OK, wow! Really? 
When used appropriately, this can facilitate communication and create 
rapport between listener and speaker. 
Take note of the intonation 
Using a falling tone usually indicates that you think the patient has finished 
or that you want to take a turn in the conversation 
Examples: 
• 
uh-uh, go on, I see, right, yes (rising intonation) 
• 
I’m listening; please continue 
• 
Tell me more.... 
• 
And.... 
• 
Uh-hmm...(followed by silence/pause) 
Communicating with patients on sensitive or embarrassing topics 
When talking with your patients about sensitive or uncomfortable topics, use 
the following steps to make your patients comfortable and to facilitate the 
conversation. 
1. 
Use probes to investigate a concern further 
Examples: I hope you don’t mind me asking, but ... 
 
Would you like to talk about...... 
Is there anything else you’d like to tell me about this? 
2. 
Reassure the patient that the consultation is confidential and that they can 
openly share their information without anyone else finding out 
Example: Everything that you tell me in here is completely confidential. 
3. 
Justify – provide a rationale for asking questions: explain why certain 
questions are relevant to the discussion 
Examples: This question will help in getting a detailed picture of your 
condition. 
It’s  important  that  I  ask  you  some  questions  about  your  sexual  history.  I 
know  it’s  personal,  but  it  will  help  me  in  assessing  your  situation  much 
better. 
4. 
Acknowledge - validate that you have understood what the patient has said 
and thank them for providing information. 
Examples: I can understand that this was hard for you to tell me, so I really 
appreciate your honesty. 
Thank you for telling me about that. 
Thank you for answering my questions. I know this wasn’t easy. 
What you’ve told me is really helpful. 
Choosing  an  appropriate  language  for  the  patient  you  are  speaking  to  is  an 
integral  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 important that questions are asked politely. 
 
Direct vs. Indirect Language when asking questions 
Use  the  following  starting  phrases  to  make  your  questions  politer.  Adding 
these  phrases  would  soften  the  questions  and  demonstrate  a  sensitive  and 
respectful  attitude  towards  your  patients  while  asking  questions  about 
uncomfortable or sensitive topics. 
• 
Can you tell me ... 
• 
Would you mind telling me 
• 
Tell me ... 
• 
I wondered ... 
• 
I wonder... 
• 
Can I ask ... 
• 
Would you be able to tell me ...? 
• 
May I ask ... 
• 
Please tell me ... 
• 
I wonder if you could tell me ... 
• 
Let me ask you ... 
• 
Can I ask ... 
• 
Can you tell me ... 
• 
Do you mind telling me about.... 
• 
I am wondering if you can tell me something about your.... 
• 
Would you mind telling me about......? Examples of indirect 
questions: 
• 
Would you mind if I asked you some question to get a better understanding 
of your condition? 
• 
If you don’t mind, I would like to ask you some questions about your 
health/general lifestyle before proceeding further. 
• 
In your own time, could you describe your symptoms/complaints to 
 
me? 
• 
I am afraid I need to ask some personal questions/a personal question – May I 
proceed? 
• 
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? 

Reflective listening skills and paraphrasing for 

clarification 
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 in your words what you interpreted someone else to 
be  saying.  This  will  enable  you  to  identify  the  patient’s  meaning  rather  than 
just focusing 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, focusing what they are saying. 
• 
Encouraging the patient to elaborate. 
• 
Providing a check on the accuracy of your perceptions Examples: 
• 
“If I hear 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 believe that...?” 
or “... you feel that...?” 
• 
You mean............ 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
So, to put it another way, you believe/feel that... To rephrase what you said,... 
So, what you are saying is....Is that correct? Let me see if I have everything 
we talked about? So it sounds like..... In other words..... It looks like..... So 
what you are saying is....You mean............ It seems that...... Always clarify 
whether what you have paraphrased is accurate by asking: 
Is that right? Is that correct? Would you like to add anything to that? Is that 
an accurate summary? Have I understood that correctly? Is there anything 
else? 
Examples of how you can paraphrase patient responses 
Patient’s response Paraphrase 
I haven’t been eating well due to having back-to-back meetings at my office. 
I often skip breakfast because I am running late, and I don’t get time for 
lunch due to work, and dinner is usually a quick bite because I am busy 
working on my presentations for the next day. 
In other words, due to competing demands on your time, you have been 
missing meals and not eating properly. 
 
The doctor told me to take these antibiotics until the pills ran out, but I felt 
better the next day, so I stopped. 
As I understand it, you stopped taking the medication when you felt better 
even though your doctor told you to finish the prescription. 
I don’t believe that drinking regularly is bad. I have been drinking whiskey 
regularly and nothing bad has happened to me. 
So, what you are saying is, you are not convinced that drinking alcohol 
regularly is dangerous because it hasn’t affected you. 
I’d like to lose some weight, but with my friend’s weddings around the 
corner, I feel it won’t be possible. 
To put it another way, you feel that this is a difficult time of the year to lose 
weight. 
Example 
Nurse:  Alright.  Thank  you  for  answering  my  questions. Let me ensure I have 
noted  everything  correctly:  You  have  been  having  chest pain for the past few 
days  which  sometimes  radiates  to  your  shoulder.  The  pain  is  about  a  6  on  a 
scale  of  0 to 10 and is a burning feeling that causes tightness in the chest. The 
pain  usually  lasts  10  minutes  but  can  last  as  long  as  40  minutes.  Getting 
overexerted  at  work  seems  to  trigger  the  pain,  and  it  gets  better  with  an 
aspirin. Is there anything else that you would like to add? 
Useful tips 
When the patient talks for too long 
• 
Could I just interrupt you there for a second? 
• 
So what I have understood so far is that.............. Is that right? 
What if the patient says something that is confusing or unclear? 
Ask the patient for clarification: 
• 
I am sorry to interject, but I am not sure I understood that completely. Could 
you repeat it? 
• 
I am sorry to interrupt; I missed the last few words you said. 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
I didn’t quite follow that. Can you say it again, please? Sorry, could you 
repeat that for me, please? Can you please clarify what you mean when you 
say......? Do you mean.............? Sorry, I don’t understand what you mean. I 
am sorry, I am not sure I understand what you mean by.... Sorry, I am not 
sure I know what you mean. Active Listening 
Picking up on patient cues 
(Listening to verbal cues or the change of pace and intonation in the patient’s 
tone) 
You sound a little worried about your situation. That must have been 
difficult. You said that you feel miserable; could you tell me more about 
these feelings/why you have been feeling this way? When you say that 
“.......”, would you add some information/give more details regarding this? 
Identify whether the patient is 
unconcerned/angry/agitated/sad/nervous/embarrassed] from cue- card. 
It looks like..... It seems that. I sense that you are very 
sad/embarrassed/angry; would it help to talk about it? You sound 
sad/concerned/anxious/unsure when you say this; would it help to talk about 
it? I sense that you are not quite happy/satisfied/sure with the 
explanation/about the advice you have been given – Is that right? 
 
• Am I right in thinking that you are reluctant/resistant to the advice you have 
been given? 

Pauses 
Pauses  play  a  significant  role  in  your  OET  Speaking  and  encourage  patient 
understanding  and  participation.  They  are  used  to  separate  different  thoughts 
or  ideas.  You  should  pause  periodically  to  allow  the  listener  to  digest  the 
message you have delivered to that point. 
Consider the change in impact when you practice the dialogue given 
below with and without pauses. 
Version 1 (without pauses) 
Now,  Ralph,  I’d  like  to  briefly  summarize  your  history  to  be  sure  I  have  the 
details  correct.  You  have  been  suffering  from  stomach  pain  since  yesterday, 
and  you  have  experienced  some  heartburn.  You  have  taken  medication  from 
the pharmacy, but it has not relieved your symptoms. Is that right so far? 
Version 2 (with pauses) 
Now,  Ralph,  (Pause)  I’d  like  to  briefly  summarize  your  history  (Pause) to be 
sure  I have the details correct. (Pause) You have been suffering from stomach 
pain  since  yesterday  (pause),  and  you  have experienced some heartburn. You 
have  taken  medication  from  the  pharmacy  (pause),  but  it  has  not  relieved 
your symptoms(pause). Is that right so far? 
Pausing at each stage enables the listener to absorb the information and, if 
necessary, gives them the opportunity to stop and correct you. 
Let’s quickly revise what we have learnt up to this point. 
Steps involved when taking a patient’s history in OET 
Speaking 
Establishing rapport 
 
(Begin with a nice greeting; introduce yourself and your role in a welcoming 
manner) 
Questioning technique for gathering information: Use the cone technique for 
taking the history of the patient- moving from open to closed questions. 
Using verbal facilitation skills as Back channelling “I see, Go on” to 
encourage the patient’s responses 
Using clarifying questions, where necessary. 
• 
Could you elaborate more about the problems you have been having? 
• 
Could you describe your symptoms to me in a little more detail? 
• 
I am sorry, but could you please repeat that? 
Summarizing the patient’s response to check the accuracy of the information 
• 
So, I’d just like to briefly summarize your history to be sure I have the details 
correct......... Is that right so far? 

Normalizing statements 
Some  patients  may  have  difficulty  in disclosing some information about their 
problem  or  condition,  especially  if  they  are  anxious  or  embarrassed  or 
uncomfortable talking about it. 
One  way  of  reassuring  the  patient  is  to  use  normalizing  statements,  i.e., 
statements that normalize their problem. These statements are used to let your 
patient  know  that  they  are  not  alone  in  having  certain  problems,  symptoms, 
or experiences. 
Starting  your  sentence  with  phrases  like  this  is a common problem, many 
people  feel  ..., many people tell me ..., often I have been told that ... can make 
the  patients  comfortable  and  encourage  them  to  volunteer  information  about 
sensitive topics. 
Examples: 
 
A • 
lot of people have difficulty in taking the initial steps to lose weight. 
• 
Many people find the instructions/guidelines for taking their medication 
complicated. 
• 
This is a common problem, and it is sometimes connected to not getting 
enough physical activity. 
• 
It is perfectly natural for people to feel this way. 
• 
It is a common occurrence, and it’s not unusual for this to happen for 
people in your age group. 
Eliciting information: Communicating with challenging or 
withdrawn patients 
• 
You seem very low in yourself. Can you tell me what’s going on? 
• 
You appear very distant – why is that? 
• 
You seem very sad – can I ask what you are thinking? 
• 
You look quite disturbed- what’s on your mind? 
• 
I can see that you look very anxious- would you mind telling me what is 
bothering you? 
• 
You seem upset- do you mind telling what’s the problem? 
• 
I understand this is very difficult for you talk about it. 
• 
That must be very challenging for you. 
• 
I can understand it’s hard as it’s a big change in your life, and it’s natural to 
feel overwhelmed. Having said that, I am here to assist you. 
• 
I  know  this  must  be  distressing  you.  That  being  said,  I  am  here  to  help  you. 
(validating a patient’s concern who is anxious, concerned or upset) 
• 
You seem very far away! (used in case the patient is withdrawn or 
unresponsive) Please tell me what is on your mind. 
• 
How are you feeling at the moment? 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
How do you feel right now? I appreciate (appreciate here means to 
understand) the problems this has caused you. I can understand your 
frustration, but this is the only option we have at the moment to ensure that 
you remain in good general health. (used to persuade a patient) I am sorry 
that you feel........................ I can assure you it wasn’t intentional. (if the 
patient is angry) 

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 increase 
the efficiency of gathering information from the patient. 
Some useful expressions that can demonstrate sensitivity and empathy 
during your consultation are: 
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 in understanding the situation 
much better. Have you told me enough about how you are feeling to help me 
understand things? I think I understand now a little of what you have been 
feeling. 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 (here, appreciate means to understand) 
I can sense how 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! I can perfectly understand how difficult that 
must for you to cope with. It can be quite distressing, but there are ways to 
help manage it. I can appreciate that it’s difficult to follow these instructions 
or I can appreciate that it’s difficult to make these changes in your lifestyle. 
However, it is imperative that you do this to ensure good general health or to 
ensure a complete recovery. I have noticed that you seem a little 
uncomfortable with this suggestion. Having said that, this would be very 
beneficial for you or this would improve your health. I can understand why 
you feel that way, and it can be overwhelming. I am sorry to hear that. 

Explaining treatment and advising patients 

Like  indirect  language  can  be  used  while  asking  questions  to  make  your 
patient  feel  comfortable,  it can also be used when giving instructions or when 
advising your patients. 
When  giving  instructions,  use  tentative  language  such  as  (I  was 
wondering)  or  modal  verbs  such  as  (this  might  be,  could  you.....,  would 
you......)  as  it  softens  the  instruction.  Doing  this  makes  your patients feel like 
they are responding to suggestions instead of being told what to do. 
Direct Indirect 
 
You need to stop smoking (this might be considered a too direct and comes 
across as a command rather than an instruction). 
If you could try to cease smoking, it would be very beneficial for your health. 
You need to lose weight If you could try to lose some weight, 
it would be very helpful for maintaining good health. 
You need to cut down on salty and fat-rich foods. 
Would you be able to cut down on salty and fat-rich foods? 
You will need to incorporate some physical activity into your routine. 
I would recommend that you incorporate some physical activity into your 
routine. 
I was wondering if it’s possible for you to incorporate some physical activity 
into your routine. 
If you want to lose weight, you should substitute items like pizza with a salad 
to control the number of calories you consume. 
Could you try substituting the pizza that you have for lunch with a salad? It 
would be very helpful in controlling the daily calorie intake. 

Use polite expressions to give advice: 

• 
Are you willing to...? 
• 
Would you be willing to...? 
• 
Would you at least give me time/a chance to suggest some ways to manage 
your condition? 
• 
I will outline some things you can do... 
• 
You could consider... 
• 
Another option is.... 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
To begin with, I would suggest..... I would like to start by suggesting.... Have 
you thought about...... What I would like you to do is........ (ensure 
compliance with medication/healthy diet/eat more fruits and vegetables) Why 
not.... (try healthier alternatives ?) Let’s consider some ways by which you 
can incorporate healthier changes in your life. Would you like to try and quit 
smoking? There are medications and support groups available for people who 
want to quit smoking. If you like, I can get you some information about it. I’d 
like you to focus on what we can do now to improve your health. Have 
considered giving up smoking? I’d like to talk with you about your diet. 
Exercise will benefit in maintaining good health. I know it might be little 
difficult at first but it will have a profound impact on your health in the long 
run. I think you could start by walking 15 minutes every alternate day and 
gradually increase the duration 
Version 1 (Judgemental approach towards the patient’s 
smoking) 
Version 2 (Non-judgemental approach towards the patient’s 
 smoking) 
Nurse: Hello Sigma. Nurse: Hello Sigma. 
Sigma: Hello, Nurse. Sigma: Hello, Nurse. 
Nurse: How are you feeling? Nurse: You seem disturbed. How 
are you feeling? 
Sigma: I can’t seem to catch my breath these days. It’s really scary 
Sigma: I can’t seem to catch my breath these days. It’s really scary 
 
sometimes....to gasp for air. sometimes....to gasp for air. 
Nurse: Well, no wonder. All those years of smoking have affected your 
health now. (judgmental about patient’s smoking) 
Nurse: I can see that you are concerned. Could you tell me more about it? 
Sigma: You are making me feel guilty. 
Sigma: Yes, I am frequently out of breath. The other day, I was at the 
supermarket, and I found myself gasping for breath. 
Nurse: I didn’t mean to make you feel that way. It’s just the reality. (no 
reassurance) 
Nurse: I understand how difficult that must be. Let’s focus on what we can do 
now to improve your health. If you do not mind me saying, this may have to 
do with your smoking. Have you thought about quitting? 
Sigma: I want to kick this bad habit. It’s just......... I don’t know where and 
how to start? 
Nurse: I am glad that you are thinking about it. That’s a good sign. We will 
do our best to help you and support you every step of the way. 
Sigma: What if I fail. I am not sure if I will be able to cope up. 
Nurse: It’s a reasonable concern. Think about your choices here. What are the 
advantages and disadvantages of quitting smoking? And even if you do 
relapse, we will support you to re-start again. 
 
Sigma: Hmm okay. 

Signposting language when explaining treatment 

and giving advice to patients 
• 
Let me explain what you can do to recover from this condition. Firstly, 
.....Secondly,............., Next,......... 
• 
That brings me to the next point........ 
• 
Moving on to the next option..../next advice....... Another thing you can do 
is.......... 
• 
There are three things you need to consider. First of all, you should lose 
weight. Then, you must cut down...... Finally,....................... 
• 
Let me briefly outline what you can do to ensure good general health. 
In addition/Besides this, you could include portions of fruits and vegetables 
in your diet. 
There are a few things I need to tell you about managing your current 
situation. Firstly, 
• 
There are a couple of things I want to advise you. 
• 
I want to suggest a few things which you can do to ensure a full recovery. 
• 
Basically/Briefly, I have three things to say. 
• 
I’d like to begin/start by ... 
• 
Let’s begin/start by ... 
• 
First of all, I’ll... 
• 
... and then I’ll go on to... 
• 
Then/Next ... 
Use the following linking words when adding items 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Also, Likewise, Moreover, Furthermore, In addition, As well as this, In 
addition to this, Apart from this, Besides that Moving on Going back to To 
sum up Finally 

Vocabulary for “emphasizing” your advice 

Really- You really need to reduce your weight 
Certainly- If you follow my advice, it will certainly improve your health 
Definitely- If you comply with my advice, it will definitely improve your 
health 
Especially  –  To  ensure  good  health,  you  will  need  to  make  changes  to  your 
lifestyle,  especially  your  smoking.  I  am  concerned  about  your  health,  and  I 
want  you  to  know  that  quitting  smoking  is  the  most  important  thing  you  can 
do to protect your current and future health. 
Marvellous- Many patients in similar situations/with similar conditions have 
had marvellous/tremendous results by making small changes in their lifestyle. 
Reassure - I reassure you that you will be able to make a complete recovery if 
you adhere to these instructions. 

Persuading reluctant or difficult patients 

 
Use the following phrases to explain and highlight why adherence to your 
advice is important 
• 
Your weight is not in the ideal range, and I am concerned about the long-term 
effects on your health. 
• 
Your weight is higher than it should be, and I am concerned about your 
health. 
• 
I understand what you are saying, but you must consider the long-term effects 
it  can  have  on  your  health.  I  know  it’s  hard,  but  I  am  afraid  there’s  no  other 
way. If you do not make these changes, you run the risk of.... 
• 
It is imperative that you lose weight, else it can make you susceptible to 
serious complications for the future 
• 
It is necessary that you comply with the treatment advice 
• 
It is essential that you heed my advice. 
• 
It is vital that you consider making these changes to your lifestyle. 
• 
It is paramount....... 
• 
It is indispensable...... 
• 
It is crucial......... 
• 
The most important thing is to... 
• 
It would be beneficial if you can..... 
• 
It is a good idea to include portions of fruits and vegetables in your eating 
habits. 
• 
It would be helpful... 
• 
It is strongly recommended that... 
• 
It is important for you to start doing some kinds of exercise for at least 20 
minutes every day. 
• 
I am concerned about your health and want the best possible outcome for 
you. 
• 
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 on your 
health. 
• 
In cases like these, the first thing to try is changing your lifestyle. 
• 
I suggest that.... 
• 
I advise that..... 
• 
I strongly recommend that..... 
• 
It would be beneficial if you 
• 
I am afraid it is extremely important/essential/imperative/critical/for you to... 
• 
It’s really important that you... 
• 
I strongly suggest/urge/advise you to... 
• 
It is essential... 
• 
This might not be what you were hoping to hear but the best way to improve 
your health is.... 

Checking patient’s acceptance: 

• 
Is that okay? 
• 
How does that sound? 
• 
Are you happy with that? 
• 
How do you feel about what I am proposing? 
• 
How do you feel about that? 
 
I • 
hope I have cleared up/assuaged your worries? Does that make you feel a 
bit better? 

Verbal Reassurance is provided to show that 

• 
The patient’s concerns or fears are real and important 
• 
You understand the patient’s concerns or fears as a health professional 
• 
There is hope for recovery However, it must be genuine and truthful; 
otherwise, it can become false reassurance. 
Consider the following examples. 
Patient:  I  have  had  this  infection  for  three  weeks  now,  and  the  pain  keeps 
getting  worse.  I  am  so  sick  of  this.  I  hate  living  like  this.  Is  there  a  qualified 
doctor in this hospital who can make me feel better? 
Nurse:  I  understand  that  it  has  been  quite  challenging  for  you  with  all  that 
you  have  been  going  through.  Indeed, health concerns can be very draining. I 
just  want  to let you know that you are in the right place, and we are doing our 
very best to care for you. 
Patient: It’s my second week in the hospital. My accident was seven days 
ago. Will I ever get better? 
Nurse:  I  can  see  that  you  are  concerned  about  your  health,  but  it  can  take 
several  weeks  to  recover  for  the injuries to heal completely. Having said that, 
you are making steady progress. 
Patient: No one cares in this hospital. I rang the buzzer so many times, but it 
seems that no one is bothered to check on me. 
Nurse:  I  understand  that  you  are  angry.  I  was  attending  to  a  critical  patient 
and  therefore  couldn’t  be  here  earlier.  That  being  said,  your  health  is  my 
priority, and I will ensure that you are looked after properly. 
Patient: I have been independent all my life, and I do not want to become 
dependent on medication. I can tolerate this pain. 
 
Nurse:  I  understand  your  perspective.  However,  at  this  time,  it  is  imperative 
to  relive  your  body  of  the  pain  so  it  can  focus  on  healing  itself.  Therefore, 
you  must  take  the  medication.  Also,  regarding  your  concern  about  becoming 
addicted, I assure you that nothing of this would happen as this is a temporary 
arrangement. 
Avoid offering ‘False Reassurance’ to your patient 
You have nothing to worry about. (saying something that is not true) 
Don’t worry. Everything will be alright (assuring the patient about something 
that may not happen) 
There’s no need to cry. It will all work out. (promising something that may 
not happen) 

Reassuring statements 
• 
I hear what you are saying. You are concerned about your health. 
• 
It’s ok to cry when you feel like it. I can wait for you. 
• 
I appreciate that you are worried. Is there anything I can do for you? 
• 
I know you are concerned that your progress is slow, but you are making 
steady progress and would recuperate soon. 
• 
You did the right thing coming to the hospital. We have experienced doctors 
and the latest equipment to treat your condition. 
• 
It’s okay to feel sad. 
• 
It’s ok to cry. 
• 
I will do everything I can to make you feel comfortable during your stay. 
• 
Would  you  like  me  to  contact  the  social  worker  to  talk  with  you  about  any 
services that might be available for you while you recover your strength? 
 
With rest, the right medication, and a stress-free mind, you will feel 
• 
better. 

Showing Empathy 
Empathy is the ability to experience a situation through the eyes and feelings 
of another person. Empathy allows your patient to feel greater acceptance. 
• 
That must have been (present perfect for actions that began in the past)/must 
be (present) very 
• 
................(difficult/tiring/frightening/painful/emotionally draining) for you. 
• 
I know how you must be feeling 
• 
I understand your concern 
• 
I understand how you are feeling 
• 
I can relate to that. 
• 
I understand how you feel. That being said........(give advice) 
• 
I understand why you have this concern. Having said that......(give advice) 
• 
I understand/see why you are worried. However.......(give advice) 
• 
I am sorry to hear that! 
• 
Aww, it’s a pity to hear that! 
• 
I can see that you are not happy with this suggestion. 
• 
I do see your point 
• 
I do understanding your perspective 
• 
I do understand where you are coming from 
• 
I can see how worried you are about making changes to your lifestyle, but 
you must consider the long-term effects.... 
• 
I can see you are anxious about making changes to your routine. 
Nevertheless,. 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
If I were you, I would react in the same way It’s a reasonable reaction. Your 
reaction is justified It is indeed quite hard to accept something we are not 
ready to do. I completely understand that it must be very difficult for you, 
considering the stage you are in, it must be overwhelming! I understand it is 
challenging for you to cope up 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 completely 
understand that it must be very difficult for you, considering the stage you are 
in, it must be overwhelming! I understand it is challenging for you to cope up 
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 reassure the patient to manage their anxiety, fear or 
worries. 
For instance, 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
This Clinic/This hospital has an excellent reputation, and your health and 
safety is our utmost priority There is no need to be alarmed. The staff here is 
very competent and will look after you diligently. I am a qualified nurse with 
good nursing experience. Please do not worry at all Of course, the final 
decision is up to you. However, the sooner it will be done, the better! There is 
nothing to be alarmed about I am afraid 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. We 
will be here to help you. We will be here to look after you. or We are here to 
look after you. Try not to worry about. I assure you there is nothing to worry 
about. I am certain that staying in the hospital is in your best interests. Please 
relax; we are here to help you and to suggest how to manage. I understand 
your concern; however, following my advice is imperative to your well-being 
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. We will be here to help you. We will be here to look after you. 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Try not to worry about. I assure you there is nothing to worry about. I am 
certain that staying in the hospital is in your best interests. Please relax; we 
are here to help you and to suggest how to manage. 

Explaining risks to their health in case they refuse 

the treatment or advice 
If you do not comply with my advice, it can have adverse effects on your 
health The results of not getting the treatment can be detrimental. If you do 
not take your medication on time, it might delay the recovery time. If you do 
not modify your lifestyle, your disease may progress. Your condition might 
exacerbate if you discharge against medical advice. 
Acknowledge the patient’s perspective before 
outlining the risks 
I understand that it’s not easy, but if you continue like this, it will make your 
condition worse! I know it’s not easy, but it’s imperative that you adhere to 
this advice to recover from your illness. I can see you have concerns 
regarding this. That being said, it’s vital that you follow my advice to ensure 
good general health. I can understand it’s difficult for you. I can appreciate 
that it’s going to be difficult making these changes. I understand it’s not easy, 
and it’s tough to make changes to a busy schedule, but as I see it- there’s no 
alternative. If not make some changes now, you run the risk of...... 
 
Reinforcement should follow the above explanation 
• 
So,  I  hope  you  understand  why  it’s  vital  for  you  to  stick  to  the  diet/undergo 
the tests/take the pills/not to smoke/to get plenty of rest and so on. 
• 
This is the reason why you need to get admitted/undergo this treatment 
• 
For this reason, you need to............ 

Use statements like to check’s patient agreement 

• 
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? 
The  patient  may  become  fearful/difficult/noncompliant/reluctant  at  this  stage 
and  may  not  want  to  follow  your  suggested  plan  of  action/treatment.  It  is 
crucial  that  you  first  acknowledge or validate the patient’s concerns and then, 
provide  a  justification  to  make  them  reconsider  their  decision.  It is important 
to  ascertain  why  the  patient  is  having  difficulty  coming  to  terms  with  your 
treatment  recommendation.  It  is  possible  that  the  patient has incorrect beliefs 
which  can  be  addressed  with  a  simple  conversation.  A  patient  must  be 
explained  the  implications  of  refusing  your  advice  in  simple  terms  that  are 
understandable  by  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  in  this 
decision.  Can  I  explain  something  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 alright okay if I can discuss that 
with you? 

Negotiating 
• 
I’d like to propose that... 
• 
I recommend/suggest... 
• 
How do you feel about... 

Responding to patient concerns or reluctance 

• 
Maybe it would be better to... 
• 
Perhaps a better idea would be... 
• 
May I offer an alternative? I propose that... 
• 
Given your health, a better solution might be... 
• 
Would you be willing to accept a compromise? How about....? 
• 
Would you agree to....? 

Giving a Reason in Negotiations (explaining the 

risks associated with non-compliance) 
• 
The reason for that is... 
• 
This is because... 

Prioritizing Interests 
• 
The most important issue for us is... 
• 
We intend to ensure that you recover completely. For this,... 
• 
Our main priority is your health. For this, 
• 
If you do not follow this advice, your health might exacerbate... 
• 
If you do not comply with my treatment advice, your condition might 
 
deteriorate. 

Checking patient’s agreement 

• 
Is that acceptable to you? 
• 
Does that sound reasonable to you? 
• 
Does that seem realistic to you? 
• 
Will you agree to this? 
• 
Can you agree to that? 
• 
Do we have an agreement? 
If anything: use this phrase to correct an assumption 
For example: 
Patient: Will the medication improve my energy levels? 
Nurse: Well, if anything it will make you feel drowsy in the short term. 
Patient: Will I start gaining weight as soon as I take this medication? 
Nurse: Well, if anything you will lose a little bit of weight first before the 
weight gain starts. 

Summary 
You  may  have  to  advise  several  lifestyle  modifications  to  your  patients  that 
they  may  find  uncomfortable  for  example,  weight  loss/management,  giving 
up smoking/drinking, making dietary adjustments, etc. 
Use the following steps to approach conversations on sensitive topics. 

Step 1: Seek permission 

Ask for the patient’s permission before opening up the discussion. 
• 
Would it be okay if we discuss how your weight can be managed to 
 
ensure it’s in a healthy range? 
• 
If you don’t mind, I’d like to discuss some ways you can incorporate some 
physical activity into your life to adopt a heart-healthy lifestyle. 

Step 2: Using the ‘right’ words 

Avoid unpleasant or judgmental language. Be firm but kind. 
For  example:  Instead  of  saying,  “You  are  obese  and  need to reduce weight.”, 
say  “Your  weight  is  above  the  normal  range;  to  ensure  good  health,  it’s 
advisable to lose the excess weight.” 

Step 3: Explain risks with not complying with your 

advice 
(To persuade patients) Make it a compelling case, and to do so, highlight the 
risks associated with not adhering to your advice. 
I  do  understand  your  reluctance. It’s a daunting prospect to make changes 
to  your  everyday  routine;  however,  you  must  consider  the  risks  associated 
with carrying excess weight/smoking/sedentary lifestyle/etc. 
Reducing your alcohol intake is an essential step towards avoiding 
medical problems like cardiovascular disease or fatty liver disease. 
Excess weight can put you at risk of having a heart attack. 

Step 4: Engage the patient to show that you are on 

his/her side and are concerned about their health 
I am concerned about your health. 

Step 5: Offer realistic advice to get agreement from 

the patient 
The advice you will offer should be based on the patient’s lifestyle. For some 
 
patients, a daily walk will be a tremendous step forward while for others, a 
rigorous exercise regime may be possible. 
Example:  If  a  patient  eats  large  servings  or  portions  of  food  in  a  day, 
provide  tips  about  slowing  down  when  eating,  filling  up  on  lower-calorie 
foods and downsizing instead of upsizing. 
For others who skip meals, emphasize the importance of eating balanced 
meals throughout the day. 
Ask questions about your patient’s lifestyle and everyday activities so 
that you can suggest practical, manageable, and measurable goals. 
For  example,  I  understand  your  perspective.  How  about  this?  You  can 
begin  with  15  minutes  of  walk  daily  and  gradually  increase  the  duration  of 
the walks. 
You  could  also  refer  your  patient  to  a  support  group  or  offer  a  patient 
information  leaflet  for  better  management  of  the  specific  condition  you  are 
advising  them  on.  Be  sure  to  provide  advice  that  causes  minimum disruption 
in their lives. 

Step 6: Reinforce the importance of making 

changes 
Stress the hopeful aspect of your advice and reiterate that small steps can lead 
to a big difference in the long run. 
Dealing with a reluctant patient 
Step 1 – Empathize 
• 
If I were you, I would react in the same way. 
• 
I understand how you feel. 
• 
Of course, it’s difficult to be in your position right now. 
Step  2  –  Justify  your  advice  by  explaining  the  consequences  of  non- 
compliance  and  make  the  patient  realize  that  they  are  responsible  for 
their health. 
 
• 
• 
• 
• 
• 
• 
• 
If you continue to do this, it can have adverse effects on your health. If you 
do not take your medication on time, it can lead to unfavorable outcomes. 
You must consider the repercussions that this can have on your health You 
must think of the long-term effects that it can have on your health Of course, 
at the end of the day, it’s your decision to comply with the advice, but I 
would advise.... 
Here, you could use phrases like “I am afraid” or “unfortunately” for 
emphasis. 
I am afraid if you do not cut down on your smoking, it can exacerbate your 
condition Unfortunately, it is imperative that you cut down on processed 
foods to control your hypertension. 
 
Chapter 4 
OET Speaking Course – 
Pocketbook 
Beginning the conversation 
Thanks for coming in. (not to be used when the patient is admitted in the 
hospital or during a home visit). 
Next, state your name and clarify your role. 
Get permission to have the discussion 
Set goals for the discussion – seek the patient’s permission before asking 
questions or introducing a discussion. 
“I’d like to go over your test reports, would that be ok?” 
“Today I plan to discuss...is that okay?” 
“Before,  proceeding  further,  I’d  like  to  ask you some questions. It will help 
me in getting a clearer picture of your condition. Is that okay?” 
“The doctor is worried about your weight. Is it okay if I ask you some 
questions about your eating habits and lifestyle?” 
“I’m concerned about your uncontrolled sugar levels. Would it be alright if 
I asked you some questions first?” 
“I’m wondering if you mind answering some questions about your 
 
medical history. It will help me to understand the situation much better.” 
Questioning techniques for information gathering and Active Listening skills. 
Open-Ended Questions 
“What brings you here today?” 
“Can you tell me about your concerns?” 
“How have you been feeling?” 
“What seems to be bothering you?” 
“Could you tell me something about your eating habits?” (Focused 
question – open question but limits the scope) 
Closed-Ended Questions 
“Do you have any ongoing medical illnesses?” 
“Do you drink alcohol?” 
“Have you had any similar problems in the past?” 
“Does anyone in your family suffer from this condition too?” 
“Did you take any medication before coming here?” 
Use an empathizing statement to show that you recognize the patient’s 
emotion and understand it. 
“I’m sorry this has happened, and I understand how it would make you feel 
that way.” 
“I hear what you’re saying. That must have been very difficult.” 
“I get your point. It is obviously very upsetting.” 
“I can see it’s really difficult for you to talk about this.” 
“I can appreciate that it isn’t easy to talk about this” 
 
“I do understand that it’s stressful to talk about this.” 
“It must be hard to talk about this” 
“I can see how difficult it is for you.” 
“It sounds frustrating.” 
Facilitating 
• Do not interrupt the patient, but use back-channeling (Okay, uh-huh, 
hmmm, I see, Alright, go on...etc.) to facilitate the conversation. 
• A nod to let the patient know you are following them. 
Use “Tell me more” statements 
“Tell me more about that.” 
“I can see that you sound/seem anxious. Could you tell me more about 
what’s bothering you?” 
Clarifying 
“So, if I understand you correctly, you are saying...” 
“Tell me more about that.” 
“From what I have understood.........,” 
“So, let me see if I understand.......” 
“What I hear you saying is...” 
Explaining medical advice 
Do not use medical jargon and explain the facts in a manner that the patient 
will understand. 
Present the information in small “chunks” to facilitate the patient’s 
understanding. Use signposting or discourse markers to make the 
conversation easier to follow. After each chunk, verify the patient’s 
understanding. 
 
“Are you with me so far?” 
“Do you have any questions that I can answer at this stage?” 
“Are you clear with what I have just explained?” 
“Would you like to ask any questions about what I have just explained?” 
Elicit patient’s ideas, feelings, or concerns 
“Can you tell me about how you feel?” 
“Could you tell me how this makes you feel?” 
“Can you tell me what you are thinking at the moment?” 
“I can see that you seem anxious.” 
“I can see that this has made you anxious. Would you like to share what’s 
on your mind?” 
Checking the patient’s understanding 
Before explanation, assess the patient’s understanding of their condition. 
Ask what the patient already knows and take note of the discrepancies in the 
patient’s understanding and what is actually true. 
“Tell me what you know about your condition so far.” 
“Please tell me what you understand about your condition until now.” 
“Could you tell me what you know about your condition so far?” 
“To ensure we are on the same page with understanding your condition, so 
can you tell me...” 
Acknowledgement, Validation, and Empathizing 
 
You may not agree with the patient’s feeling or way of thinking but respond 
empathetically to show that you respect the patient’s perspective. 
“That must have felt terrible when...” 
“Most people would be upset about this.” 
“I do understand your concern.” 
“I know it’s upsetting for you” 
“I can appreciate that it is difficult for you.” 
“I do understand how challenging it must be for you.” 
Negotiating 
3-step approach 
1. Empathize to validate the patient’s feelings 
(Use a normalizing statement like: “Most people would feel that way.”) 
“I can understand your perspective.” 
“I get your point.” 
2. Outline the benefits associated with your advice 
3. Explain the risks associated with non-compliance 
(Use “unfortunately” or “I am afraid” ) 
Use persuading statements like 
“It’s really important that we resolve this.” 
“Given the risks associated with non-adherence, I strongly advise you to 
consider my advice.” 
“I can understand your reluctance, but it’s important that you 
 
prioritize your health.” 
“I strongly urge you to comply with this advice; otherwise, the 
repercussions could be harmful to your health.” 
More examples: 
“I understand your resistance and many people would think the same, but 
I’m afraid, there’s no other option at the moment. You need to prioritise 
your health.” 
“It’s never easy making lifestyle changes, but it’s imperative for your 
health currently; not doing so would put you at risk of serious harm.” 
“I can understand your perspective, but if you do not comply with my 
advice, it could lead to adverse effects on your health.” 
Then, check the patient’s agreement by asking clarifying questions. E.g. 
Is that okay with you? 
How does that sound? 
Does that seem plausible to you? 
Does that sound realistic to you? 
Wrapping up the conversation 
Ask if the patient has any questions or concerns 
“Do you have any other questions or concerns?” 
Reiterate/Summarize the discussion or the advice provided or clarify with the 
patient their expectations of treatment and outcome. 
“So, this is what we’ve decided.” 
Ask the patient to repeat back to you their understanding of the plan. 
 
“To check your understanding, could you please repeat back to me what we 
have discussed today?” 
“Do you mind repeating back to me what we have discussed? I want to 
ensure that we are both clear about what we have discussed.” 

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 important. 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 reiterate 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....... 
• 
Aww, it’s a pity to hear that! 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
I am sorry to hear that! Mitigate- make something less severe or painful- 
Painkillers will help to mitigate the pain. Synonyms: reduce/ease/relieve 
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 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 Remarkable - note-worthy- Adopting a 
healthy lifestyle will improve your health remarkably. 
Vital Please do not underestimate how vitally important this is. 
Synonyms- crucial/essential/critical 
The importance of this treatment cannot be emphasized strongly enough. 
Detrimental- tending to be harmful, negative, adverse- If you continue to 
smoke/drink, it will have detrimental effects on your health You seem 
distressed, is there anything on your mind that you would like to discuss with 
me? Adherence-compliance - Please ensure adherence to the recommended 
exercise program/medication regime and so on. 
 
Sample Role-plays 
 
Role Play 1 
Candidate Cue-card 
Setting: Hospital Ward 
Nurse:  You  have  been  called  to  the  patient’s  bedside.  The  patient  is  a 
37-year-  old  man/woman  who  was  admitted  to  the  hospital  yesterday  with  a 
fractured  leg.  You  notice  that  he/she  looks  quite  agitated.  It’s  early  morning, 
and  the  doctor  is  on  rounds  in  the  hospital.  He/She  was  given  a  painkiller 
earlier today. 
Task: 
• 
Find out why the patient is angry 
• 
Explain that you were attending to a critical patient 
• 
Empathize with the patient regarding his/her complaint(s) and calm the 
patient down. 
• 
Ask him/her about the pain (pain score, whether ongoing pain-relief 
medication is effective). 
• 
Explain that you need to call the doctor to change his/her pain-relief 
medicine. 
• 
Find out if the patient has any other concerns 
• 
Encourage the patient to discuss his/her dietary preferences with the hospital 
dietician 

Interlocutor cue-card 
 
Setting: Hospital Ward 
Patient:  You  are  37  years  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.  You rang the buzzer 
30  minutes  ago,  but  no  one  has  come  to  see  you.  You  feel  alone  in  the 
hospital,  and the pain is making you very uncomfortable. This is the first time 
you  have  been  hospitalized.  You  are  annoyed  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. 
• 
Answer the nurse’s questions about why you are angry. 
• 
When asked, tell the nurse that your pain score is 11 and you want a stronger 
pain-killer. 
• 
Demand the nurse gets a stronger medication herself/himself (because calling 
the doctor seems like another delaying tactic to you). 
• 
Ask the nurse if you can see the doctor and inquire about the doctor’s 
whereabouts. 
• 
When asked about other concerns, express dissatisfaction with the hospital 
food. 
Speaking description of what a good student is expected to produce 
Introduction 
In  this  roleplay,  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? 

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  that  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. 

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,  utterances  like  “Okay,”  “Uh-huh,” 
“Right,”  “Mmm,”  but  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  may  be  used  to  encourage  the  patient  to 
self- report the intensity or severity of the pain. 
• 
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 stronger 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  physician.  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 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 coming 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 will be to check if the patient is okay with this decision. 
It’s  important  that  the  patient’s  views  are  elicited  by  asking  questions  like 
“How  does  that  sound?”  or  “Is  that  okay  with  you?”.  It’s  very  important  to 
adopt  a  non-judgemental  approach  towards  the  patient’s  perspective  and 
acknowledge the legitimacy of the patient to have his/her own views. 

6. Find out if the patient has any other concerns 

 
If  the  patient  expresses  dissatisfaction  while  being  in  the  hospital,  some 
probing  questions  may  be  asked  to find out if there is anything else bothering 
the patient. 
• 
Besides this, is there anything else bothering you? 
• 
Apart from this, is there anything else that I can assist you with? 
The next step would be to pick up verbal cues and acknowledge their 
concerns by using empathetic phrases that signal sensitivity to their 
predicament. 
• 
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. 

7. 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? 
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? 
For this role-play, let’s assume the patient is a female and wants to be 
addressed as Mrs. Rodriguez. 
 
Sample Transcript 
Nurse: Hello, my name is Gurleen, and I am the attending nurse on duty 
today. I see that you rang the nurse call button. How may I address you? 
Patient: Call me Mrs. Rodriguez. 
Nurse: Mrs. Rodriguez, you seem angry. Would you mind telling me what’s 
bothering you? 
Patient: Finally, someone is asking! I rang the buzzer 30 minutes ago. Where 
were you? 
Nurse: I apologise for the delay. I had to attend to a critical patient urgently. 
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 apologise for the rough experience that 
you have had. Please let me know how I can assist you? 
Patient: If you cared, you would have been here earlier... Your sorry isn’t 
good enough. I am going to file a complaint 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  medicine  to  help me with my pain. But, no one cares 
in this hospital! You are all useless! 
Nurse: Thank you so much for sharing this with me. It helped me to 
understand the situation much better. 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 is 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  if  he’s  comfortable  with  that.  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  with  the  pain;  however,  I  am  only 
allowed  to  give  medication  as  prescribed  by  the  physician.  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.  Is  that 
alright? 
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 and where you are coming from. 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. 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? 
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: I can understand. 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. 
Patient: Yes. And I don’t know for how long I would have to stay here. 
Nurse: Besides managing your pain, is there anything else too that I can assist 
with? I want to ensure that you are properly looked after. 
Patient: Yes, I don’t like the hospital food at all. 
Nurse:  Thanks  for  sharing  this with me. 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 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. 
Does that sound okay? 
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. 
 
Role Play 2 
Candidate Cue-card 
Setting: Community Health Centre 
Nurse:  You  are  talking  to  a  35-year-old  computer  engineer  who  has  been 
referred  by  his/her  doctor  for  advice  on  weight  loss.  The  patient  has  been 
experiencing  breathlessness  on  exertion  and  has  been  advised  by  his/her  GP 
to  lose  weight  to  improve  his/her  health  status. The patient is overweight and 
has a BMI of 25. 
Task: 
• 
Discuss the importance of losing weight (breathlessness may be caused by 
overweight). 
• 
Ask questions about the patient’s general lifestyle including drinking and 
eating habits 
• 
Provide advice on increasing physical activity and eating a suitable diet 
(reducing alcohol intake, eating fruits and vegetables). 
• 
Advise the patient to come back for a review in four weeks’ time. 

Interlocutor cue-card 
Setting: Community Health Clinic 
Patient: You are 35 years old and work as a computer engineer. Your office is 
10  minutes  away  from  home,  and  your  evenings  are  spent  either  in  front  of 
the  TV  or  in  the  local  pub  with  friends.  You  usually  miss  breakfast  because 
of being too busy 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. 
You  lead  a  busy  life  and  do  not  get  any  exercise  or  physical activity. You do 
not  have  any  significant  health  problems,  but  lately,  you  have  been  getting 
breathless while playing with your nephew on weekends. 
Task: 
• 
Ask why it is important to lose weight (being overweight is common) 
• 
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 description for what a good student is expected to produce 

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, let’s assume that the patient’s name is John Williams, and 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 understand 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- 
judgemental  way.  The  student  should  emphasize  the  importance  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 of stabilising 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. 
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 
Could 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  patient  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  about 
making  changes  all  at  once,  the  student  should  attempt  to  arrive  at  a 
favourable 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  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  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  make  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.  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  weeks’  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  assess  your  progress.  If 
you  have  any  questions  in  the  meantime,  you  can  contact  me  here  at  the 
centre. Does that sound good? 

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. How may I address you? 
Patient: Call me John. 
Nurse: Ok. So, John, 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  John,  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. 
Nurse:  Hmm,  this is probably not something that you were hoping to hear but 
being  overweight  is  one  of  the  causes  of  shortness  of  breath.  Moreover, 
carrying  extra  weight  predisposes  you  to  health  problems.  Therefore,  it  is 
imperative  that  we  discuss  some  ways  of  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 or 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: I see. 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 relaxation. 
 
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.  Here’s  what  I  have 
understood,  you  have  a  hectic  lifestyle  which  makes  it  difficult  for  you  to 
find  time  to  exercise.  Mornings  are  particularly  busy  due  to  which  you  skip 
breakfast,  and  during  the  day  you  rely  on  fast  food  from  the  cafeteria.  In  the 
evenings,  you  sometimes  go  to  the  local  pub  where  you  have  a  few  beers.  Is 
that an accurate summary? 
Patient: Yes, sounds about right. 
Nurse: Okay. Let’s now look at some practical things that we can do together 
to help. Does that sound good? 
Patient: Yes. 
Nurse:  Great.  Well,  John,  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: Oh, I take my car. If I didn’t, I would be late. 
Nurse:  I  see.  (pause)  John,  but  if  I  may  suggest,  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.  The  good  thing  is  that  your  workplace  isn’t 
far  off  and  the  distance  between  your  work  and  home  allows for it. Does this 
sound realistic? 
 
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 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,  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. 
Nurse:  That’s  good.  Eating  a  healthy  breakfast  will  keep  your  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 is a veggie and Mum 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.  They  are  healthier  substitutes  for  snacking 
too. 
Patient: Ok, 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 is the only form of relaxation I 
have by having a drink with my mates. 
Nurse: I know, I appreciate that, but it is vitally important you reduce your 
 
intake.  And  I  am  not  even  advising  to  give  it  up  all  together  but  simply 
suggesting that you can limit your intake. Does that sound like something that 
you will be able to do? 
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 on 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  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? 
Patient: Yes, it sounds alright. I will see you after a month. 
 
Role Play 3 
Candidate Cue Card 
Setting: General Practitioner Clinic 
Nurse:  You  are  speaking  to  a  40-year-old  man/woman  who  has  come  to  the 
clinic  for  a  routine  check-up.  He/She  is  travelling  overseas  next  month  with 
work,  and  the  General  Practitioner  has  asked  you  to  advise  him/her  on 
recommended travel immunisations prior to international travel. 
Task: 
• 
Find out about his/her vaccination history (tetanus, hepatitis A, and 
influenza/flu) and the duration of his travel. 
• 
Explain  that  he/she  needs  to  get  vaccinated  against  typhoid,  hepatitis  A,  and 
tetanus  (recommended  by  WHO  for  travellers  to  Cambodia  and  Vietnam  – 
medium risk countries). 
• 
Explain and emphasise the importance of getting his/her vaccinations updated 
at  least  two  weeks  prior  to  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/her that the vaccinations are not painful and are generally 
well-tolerated. 

Interlocutor Cue Card 

Setting: General Practitioner Clinic 
 
Patient:  You  are  a  40-year-old  man/woman  and  work  as  an  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  prior  to  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. 
• 
Resist the idea of getting injections because you feel they are painful and 
uncomfortable. 
• 
Reluctantly agree to get the vaccinations today. 
For this role-play, let’s assume the patient is a male, and his name is Tim. 

Transcript 
Nurse: Good morning. Thanks for coming to see me. My name is Gurleen, 
and I am the clinic nurse. What do you prefer to be called? 
Patient: Hello, Gurleen. You can call me Tim. 
Nurse: Ok Tim. 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. How 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. 
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.  In  addition,  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,  and  your  point  is  well  taken; 
nevertheless,  it’s  crucial  for  your  protection  to  get  these  immunisations. This 
is  because  there  is  a  moderate  to  high  risk  of  these  diseases  if  you  are 
travelling  to  Cambodia  and  Vietnam,  and  a  simple  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 
 
effective for a lifetime and I have lifelong immunity. 
Nurse:  No,  you  need  to  update  your  vaccinations  for  tetanus,  typhoid,  and 
hepatitis  A.  A  tetanus  vaccination  needs  to  be  updated  once  every  ten  years, 
and  it’s  paramount  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, right vaccination is 
the cornerstone of maintaining 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  who  has  been  admitted  to 
the  hospital  with  a  suspected  stroke.  You  have  been  asked  by  the  doctor  to 
administer a Warfarin injection (anti-coagulant) 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 with the doctor if she can continue her herbal 
supplement (it may interfere with Warfarin or cause side effects) 
• 
Emphasise  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 
• 
Advise the patient to stop the medication and contact the doctor immediately 
in case of unusual or prolonged bleeding 

Interlocutor Cue Card 

Setting: Hospital Ward 
Patient: 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 your concern about taking Warfarin as it gives your dad nosebleeds 
For this role-play, let’s assume the patient’s name is Natalie. 

Transcript 
Nurse: Hello, My name is Gurleen, and I am one of the registered nurses on 
ward duty today. How may I address you? 
Patient: Hello, Gurleen. Call me Natalie. 
Nurse: Natalie, 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.  Have  you  heard  of  this  medication 
before? 
Patient: Yes, err, I think they are the tablets that my father takes for his heart 
condition. 
Nurse: Yes, Warfarin is usually taken in tablet form, but in your case, the 
 
doctor has advised an injection to get it working more quickly. 
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 moment? 
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. 
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:  I  can  sense  that  you  are  concerned  regarding  giving  up  the 
supplement.  Allow me to explain why I said that. 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  medicine  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  effective.  Do  you  have  any 
questions 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 concerns about what we just discussed? 
Patient: Umm...yes, I am worried about taking Warfarin. Sometimes these 
tablets give my dad nosebleeds. 
Nurse:  Right,  I  can understand why you have this concern. I will explain why 
your  dad  gets  nosebleeds  with  Warfarin.  Nosebleeds  can  be  a  side  effect  of 
Warfarin.  That  being  said,  let  me  reassure  you  that  these  happen  only 
occasionally,  and  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 haemorrhage? 
Nurse:  I  can  understand  it’s  frightening,  but  it’s  not  a  common  occurrence. 
Still,  as  a  precautionary  measure,  I  want  to  advise  that  you  should  seek 
immediate  medical  advice  in  case  the  bleeding  is  unusual.  Also,  in  such  a 
situation,  stop  taking the medication until the doctor advises you to resume it. 
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 some 
more questions. 
Nurse: Yes, that’s a good idea. I hope I was able to 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 a 31-year-old man/woman who is complaining of 
a  severe  headache  and  is  demanding  medication  for  pain  relief.  He/she  is 
clearly distressed and seems to be in a hurry. 
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 him/her to wait for 30 minutes to see one of the doctors. 
• 
Reassure him/her and explain why it is best to wait and see a doctor. 

Interlocutor Cue Card 

Setting: Accident and Emergency 
Patient:  You  are  a  31-year-old  man/woman.  You  have  an  excruciating 
headache  on  the  right side of your forehead and above the ear. The headaches 
started  three  weeks  ago  (2  attacks  in  a  week) and are accompanied by nausea 
and  dizziness,  and  the  pain  is  so  strong  and  painful  (10/10)  that  you  cannot 
get  any  work  done.  You  work  as  the  marketing  director  of  a  large  business 
and  work  long  stressful  hours.  The  sunlight  from  your  office  window  and 
staring at 
 
your  computer  screen  makes  the  headaches  much  worse  and sometimes even 
causes  ringing  in  your  ears.  It  is  relieved  by  Tylenol  or  sleeping  for  one  or 
two  hours.  You  have  been  increasingly stressed at work recently because you 
are  behind  schedule  with  multiple  upcoming  project  deadlines.  You  want  to 
get back to work quickly for a meeting. You have to come to the A & E to get 
medication from a doctor or a nurse- you don’t really care. 
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 
• 
Become irritated and obstinate about the suggestion of waiting for the doctor 
(it would waste your time) 
• 
Reluctantly agree to wait for another 30 minutes to see a doctor. 
For this role-play, let’s assume the patient is a woman, and her name is Tanya 
Groom. 

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. 
Nurse: Ok. You seem distressed Ms. Groom. Please let me know how I can 
assist you? 
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-relief. 
Nurse:  That’s  terrible.  I  hope  you  don’t  mind  that  I  need  to  ask  you  a  few 
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. 
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: Well, 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  had  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 other problems? 
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. 
Nurse: Ok. Could you tell me about what kind of work you do? 
Patient: I am the marketing director of my company. 
Nurse: Alright. And how many hours do you work? 
Patient:  Well,  that  depends.  I  usually  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 due 
to 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 diagnosis 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 crucial work-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! It will simply waste my time. 
Nurse:  I  understand  what  you  are  saying,  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! I cannot wait for the doctor. 
Don’t you get it? I have an important meeting. 
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. It’s imperative that you get 
an 
 
expert  opinion  about  management  of  this  condition  to  avoid  any  adverse 
effects  on  your  health  and  work.  The  diagnosis  and  the  recommended 
recovery plan will be determined by the doctor only. 
Patient:  But  what  about  my  meeting?  It  is  crucial...Nurse:  I  completely 
understand that it must be very difficult for you, considering the stage you are 
in,  it  must  be  overwhelming!  It’s  reasonable  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.  Could  you  try  to  get  your  meeting 
postponed to sometime later during the day? 
Patient: Well, I suppose I can wait another half hour and get it done. 
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. Is that okay? 
Patient: Sure, thank you! 
 
Role Play 6 
Candidate Cue Card 
Setting: Accident and Emergency 
Nurse:  You  are  an  A  &  E  nurse.  A  young man/woman has presented at A&E 
with  a  thermal  burn  to  his/her  forehead.  He/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). 
• 
Empathise with him/her about her concerns and explain the importance of 
healing wound first. 
• 
Outline  the  things  he/she  can  do  tat  home  to  enhance  recovery  and  minimise 
scarring  (keep  it  moisturised,  covered,  use  a  sunscreen,  use  aloe  Vera  gel, 
healthy diet and remain hydrated) 
• 
Reassure  him/her  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  burn  has  healed  in  about  3-6  weeks, 
dermatologist to offer more information after wound has healed). 
• 
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  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  about  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 burn would leave a permanent scar on your face. 
Task: 
• 
Respond to the Nurse’s questions. 
• 
Explain your 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 will it take for the burn to heal. 
• 
Eventually, agree to wait for your wound to heal. 
• 
When asked, agree to come back for a review. 
For this role-play, let’s assume the patient is a female, and her name is Susie. 

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 injury on your forehead. Is that 
right? 
Patient: Yes, I am in a lot of pain..... 
Nurse: I am sorry 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  on  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  time  ago  that  it’s  best  to  apply  a 
compress  to  a  burn  using  a  cold  towel,  so  I  did  that...  I  was  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 me to come here.... It’s a searing 
pain....! 
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  pain-killers  that 
you can take at home in case the pain comes back again. 
Patient: Oh, k. 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 perspective and it’s a reasonable 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? 
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  for  its  soothing  properties  but 
make sure it does not have any additives in it. Would you be able to this? 
Patient: Yes, I will manage... 
Nurse:  That’s  good.  Moreover,  it’s  vital  that  you  look  after  yourself.  Our 
body  heals  properly  and  quickly  if  you  remain  well-hydrated  and  eat  a 
healthy  diet  high in protein- Nutrition’s very important. Would you be able to 
eat a nutritious well-balanced diet? 
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  keep  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. Do you have any questions 
about what I just explained? 
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  moisturiser  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  treatments  and  products  available  these  days  to  minimise  the 
discoloration or scars. 
 
Patient: Please tell me about those... I am keen on anything that will not leave 
a mark on my face.... 
Nurse:  Sure,  Sarah.  For  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  potential  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  so  that  you  can  continue  your  career  as  a 
model without any stress. 
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  the  mother  of  a  6-year-old  boy, Jimmy, who was 
brought  to  the  hospital  this  morning  with  a  2-week  history  of  headaches  and 
vomiting.  The  doctor  ordered  an  MRI  scan  which  revealed  a  tumour  at  the 
back  of  his  brain  on  the  right  side.  The  patient  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. He has been admitted to the hospital 
for  a  surgery.  The  doctor  has  informed  the  mother  about  the MRI results and 
surgery. She is distressed and completely shocked with this information. 
Task: 
• 
Empathize with the mother and reassure her about her son’s recovery. 
• 
Explain why the MRI was delayed and tell her that she will be able to see her 
son shortly. 
• 
When asked, explain that surgery is safe and her son’s pain will be managed 
with medication. 
• 
Respond  in  a  positive  way  to  mother’s  questions  about  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). 
• 
Reassure her about follow-up care after discharge (Occupational Therapists, 
Physical therapists, speech therapists, and Visiting Nurses, 
 
support group for connecting with caregivers). 
• 
Encourage her to look after herself and not feel guilty about her son’s 
condition. 

Interlocutor Cue Card 

Setting: Waiting room - Emergency Department 
Patient:  This  morning,  you  brought  your  6-year-old  son  to  the  ED  this 
morning.  You  are  a  single  parent.  He  has  been  suffering  from  vomiting  and 
headaches  for  past two weeks. 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  your  son  since.  A  few 
minutes  ago,  the  doctor  came  to  see  you  and  said  that  your  son  has  a tumour 
in the back of his head on the right side requiring a surgical removal. 
Task: 
• 
Express your dismay at how unexpected the diagnosis is (as you believed it 
was a flu). 
• 
Inquire about your son’s whereabouts (you have not seen him for 5 hours). 
• 
Ask  questions  about  dangers  of  the  surgery  (the  pain  your  son  is  likely  to 
experience,  chances  of  reoccurrence,  and  possibility  of  long-term  effects  on 
his health). 
• 
Seek advice on availability of post-discharge care. 
• 
Express concern that you were not a good parent to Jimmy and should have 
been more careful. 
For this role-play, let’s assume the mother’s name is Mrs. Anderson. 

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.  I  am  here  to  ensure  that  you  have  understood 
everything and to answer any questions that you have on your mind. 
Mother:  Yes,  he  was here and said that Jimmy 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 know what to do. 
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. 
Nurse:  I  understand  your  concern  regarding  Jimmy,  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  Jimmy’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 abilities. Will it have a long-term impact on his brain? 
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  about  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 as you are 
a  single  parent  but  looking  after  yourself  is  also necessary. Let me explain, if 
you are healthier, you will be able to help and support Jimmy in a better way. 
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.  You  weren’t  expecting  this  when  you 
brought  Jimmy  to  the  hospital;  therefore,  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  a  good  opportunity  for  you  to  understand  their 
experiences. 
Mother: Yes, speaking to other parents might help. I would appreciate that. 
Nurse: Sure. You will receive ongoing support from us throughout. Do you 
have any other questions that I can answer? 
Mother: Well, no. You’ve been quite helpful. Thanks. 
Nurse: It’s not a problem Mrs. Anderson. I will check on Jimmy’s condition 
and will be back shortly to take you to his room. 
 
Role Play 8 
Candidate Cue Card 
Setting: Home visit 
Nurse:  You  are  visiting  a  64-year  old  man/woman who underwent a left total 
knee  replacement  three  weeks  ago.  At  the  time  of  discharge,  the  patient  was 
advised  to  use  a  walker  for  his/her  activities  of  daily  living  and  ensure 
compliance  with  physical  therapy  at  home  until  his/her  follow-up 
appointment scheduled next month. 
His/her spouse called the hospital today and explained that he/she is not using 
his  walker  since  last  evening.  The  spouse  is  concerned about him/her hurting 
his/her  knee  and  has  asked  you to visit the patient at their house. During your 
visit  today,  you  also  notice  that  the  patient  is  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  importance  of  using  a  walker  for  his/her  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/her follow-up appointment 
• 
Explain the risks involved if he/she does not use the walker during the 
recovery phase 
 
Interlocutor Cue Card 
Setting: Home visit 
Patient:  You  are  a  64-year-old  man/woman.  You  underwent  left  total  knee 
replacement  three  weeks  ago.  At  the  time  of  discharge,  you  were  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  now  able  to  walk  independently  without 
its  support.  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. 
• 
When  told  that  not  using  a  walker  can  delay  recovery, become defensive and 
say that you are complying with the recommended management plan. 
• 
Discuss your concerns about using a walker (makes you feel disabled and 
old). 
• 
Reluctantly agree to use a walker until your follow-up appointment. 
For this role-play, let’s assume the patient is a male, and his name is Mr. 
James Morrison. 
Transcript 
Nurse:  Good  morning,  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 may I address you? 
Patient: Hello dear, you may call me Mr. Anderson. 
 
Nurse: Alright Mr. Anderson, how you doing? 
Patient: 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 my 
asking  this,  but  I  noticed  that  you  are  not  using  your  walker  while  walking. 
At  the  time  of  discharge,  you  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:  I  want  to  get  better,  and  I  am  doing  everything  I  can.  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,  I  appreciate  that  Mr.  Morrison,  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. 
 
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? 
Patient: Yes, sure. 
Nurse:  Firstly,  this  is  not  something  that  you  would  be using for a 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  your  telling  me  this  Mr.  Morrison,  and  I  understand your 
perspective  about  not  wanting  to  feel  dependent.  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! I 
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. 
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 leave now. Take care! 
 
Role Play 9 
Candidate Cue Card 
Setting: Mental Health Clinic 
Nurse:  You  are  speaking  to  a  45-year-old  project  manager  in  the  high-stress 
world  of  corporate  finance,  prior  to  his/her  consultation  with  the  doctor 
scheduled  in  15  minutes.  He/She  has  been  referred  to  your  clinic  by  the 
company’s  employment  assistance  program  after  he/she  missed  a  few 
business meetings and has been inconsistent with showing to work. 
Task: 
• 
Ask  the  patient  about  how  he/she  has  been  feeling  in  the  last  few  weeks- 
mood,  energy  levels,  sleep,  impact  on  family,  work,  and  lifestyle,  risk  of 
self-harm 
• 
Empathise with him/her regarding her feelings 
• 
When asked about depression, respond that only the doctor can give 
definitive diagnosis 
• 
When client expresses concern about his/her job, say that the doctor will be 
able to write a note for a leave of absence if deemed necessary 
• 
Reassure him/her about different treatment options for depression – support 
group, short term medication 

Interlocutor Cue Card 

Setting: Mental Health Clinic 
Patient: You are 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  Employer  Assistance  Program.  Over  the  last  three  months, 
you  have  been  feeling  “fed  up”  with  your  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  spouse  passed  away  last  year  in  an  accident.  After  his/her  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  enjoyed  playing  and  swimming  with  your  kids  but  have 
lost  interest  in  everything  now.  Despite  these  negative  feelings,  you  cannot 
think of hurting yourself because of your kids. 
Task: 
• 
Respond to the nurse’s questions 
• 
Ask if you are depressed- your read online that your behaviour may be 
associated with depression 
• 
Express concern about losing your job due to depression and not becoming 
dependent on depression medication 

Transcript 
Nurse: Hello, 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 Julie, you have been referred to our clinic by your employer. 
Is that right? 
Patient: Yes, I didn’t have a choice. My boss ordered me to come here....I 
 
don’t want to lose this job... 
Nurse:  Yes,  your  employer feels that you are having difficulty with balancing 
work  commitments,  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 seem to 
cope with things..-kids and work things. 
Nurse: I am sorry to hear that! Would it be okay if I 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 in yourself 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 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? 
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 takes 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 normally enjoyed? Is there 
anything that makes you happy or energetic these days? 
Patient:  I  used  to  enjoy  spending time with my kids....but not anymore... I am 
useless  with  them.  I  cannot  cook  for  then.  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 mum...but 
the  worst  is...  Laying  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 it. 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  the  meantime,  you  could  ask  me  any 
questions that you have on your mind. 
Patient: I read something online about depression, and I think I may be 
depressed. Do you think I am suffering from depression? 
Nurse:  I  am  afraid  I  cannot  answer  that.  It’s  not  within  my scope of practice. 
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,  coping  easily  with  routine  events 
and feeling as normal as possible. 
Patient: Hmm....I might lose my job if my employer finds out... 
Nurse: I understand your concerns about the job. If deemed necessary, the 
doctor can write a note to your employer for a leave of absence. 
Patient: What kind of treatments are available for depression? I don’t want to 
 
be addicted to medication... I have seen people becoming dependent on 
medication for years... 
Nurse:  I  can  appreciate  your  fears  regarding  becoming  dependent  on 
medication.  However,  it  would  be  best  to  leave  it  to  the  doctor  to  create  a 
coordinate  a  treatment  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  an  18-year-old  boy/girl  who  had presented to the 
clinic  yesterday  complaining  of  generalised  weakness,  lethargy,  and inability 
to  do  the  routine  work  from  previous  few  weeks.  He/She  also  complained  of 
breathlessness  while  climbing  stairs  for his/her house. Upon examination, the 
doctor  advised  a  blood  test  which  revealed  that  his/her  Haemoglobin  was  8 
g/dl.  The  normal  range  of  Haemoglobin  is  between  11-16  g/dl.  Given  the 
findings  of  his/her  physical  examination,  the  doctor  suspects  that  the  patient 
is  anaemic  and  has  asked  you  to speak to him/her. The patient does not know 
her test results yet. 
Task: 
• 
Explain that his/her HB is low due to which he/she is suffering from anaemia 
• 
Reassure him/her that anaemia is a common condition and is easily treatable 
• 
Briefly, explain about anaemia (not enough Haemoglobin/red blood cells in 
the blood) 
• 
Outline  some  treatment  options  (increase  iron  intake  in  diet  with  foods  like 
red meat/steak, leafy green vegetables like spinach/kale, iron fortified cereals, 
meet  a  dietician  for  dietary  advice,  a  course  of  iron  tablets-  need  to  be  taken 
after a meal to avoid side effects) 
• 
Offer a ‘patient information leaflet’ about anaemia 
 
• 
• 
• 
• 
• 
• 
Ask him/her to come back in 4 weeks’ time for another blood test 

Interlocutor Cue Card 

Setting: General Practitioner Practice 
Patient:  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  dinner  and 
believe  that  you  eat  a  balanced  diet.  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 If asked, say 
that you have heard of anaemia but do not know exactly what it is 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 
For this role-play, let’s assume that the patient is a female, and her name is 
Jenny. 
Transcript 
Nurse: Hello, my name is Gurleen, and I am one of the Registered Nurses in 
this facility. What’s your name? 
Patient: Hi, my name is Jenny. 
 
Nurse: Ok. 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  having  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. 
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  normal 
range  in  women  is  between  11-  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. That’s why you have 
been having breathlessness. 
Patient: Oh my gosh... How can this be happening to me? 
Nurse:  Yes,  I  know  it must be overwhelming to hear this! 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  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  meals  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:  That’s  alright.  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? 
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  effective  for  treatment  of  iron  deficiency.  What  it 
does is it supplements the amount of iron you are getting in your diet. 
Patient: K...would that be short term? 
Nurse:  Yes.  Often,  people  respond  very  well  to  those.  However,  you  may 
experience  some  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 make sure I remember that. 
Nurse: Do you have any questions about what I just said? 
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. 
Nurse: Let me know if you have doubts or questions. 
Patient: No, I don’t have any other questions at the moment. 
Nurse: Great. So, to ensure that you have understood everything correctly, 
would you mind repeating back to me what we have discussed? 
Patient: Sure. I will need to make some changes in my diet for which you will 
schedule  an  appointment  with  the  dietician.  Moreover,  I  will take a course of 
iron  tablets  to  supplement  the  iron  level  for  four  weeks,  and  these  must  be 
taken after a meal to avoid any side effects. And also, I will come back for a 
 
blood test after one month. 
Nurse: That’s right. I also have a patient information leaflet about anaemia 
for you which I thought you might take home and read in your own time. 
Patient: Oh, thank you...this would be quite helpful for me. 
Nurse: You’re welcome. Have a good day! 
 
Role Play 11 
Candidate Cue Card 
Setting: Hospital Ward 
Nurse:  You  are  speaking  to  a  23-year-old  Ph.D.  student  who  was  admitted 
two  days  ago  and  was  diagnosed  with  acute  pyelonephritis  (kidney 
inflammation  due  to  bacterial  infection).  He/She  still  has  a  fever  and  has  not 
been  able  to  eat  or  drink  anything  yet  because  of  persistent  nausea.  He/She 
has been given intravenous therapy until now. 
He/She is upset and is insisting on discharging herself from the hospital. 
However, the doctor feels he/she is not fit to go home at present. 
Task: 
• 
Find out why the patient wants to be discharged. 
• 
Respond  to  the  patient’s  statement about continuing the treatment at home by 
explaining  the  nature  of  his/her  illness  and  possible  risks  (patient’s  body 
rejecting oral medication) 
• 
Emphasise  the  importance  of  staying  by  outlining  the  risks  of  getting 
discharged  without the doctor’s consent (kidney damage or failure, the risk of 
blood poisoning) 
• 
Offer to resolve the issue by shifting him/her to a different ward 

Interlocutor Cue Card 

Setting: Hospital Ward 
 
Patient:  You  are a 23-year-old Ph.D. student. You were hospitalized two days 
ago  owing  to  a  kidney  infection.  You  feel  a  little  better  now  although  you 
were hot last night and still cannot face food or drink. 
This  is  your  first  time  in the hospital, and you hate it. You are in a large ward 
full  of  noisy,  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 believe that you will be able to 
get  adequate  rest  there.  You  feel  you  will  be  able  to  take  antibiotics  and 
painkillers by mouth at home. 
Task: 
• 
When asked, discuss why you want to be discharged from the hospital. 
• 
Tell the nurse that you want to continue the treatment at home and can come 
back if your condition gets worse 
• 
Be difficult to convince, but reluctantly agree to stay if you can be away from 
the confused patients 
For this role-play, let’s assume the patient is a female, and her name is 
Zarina. 

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 tell him 
that I want to get discharged from the hospital? 
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 rested here? 
Nurse:  I  am  so  to  hear  that  Zarina.  I  can  understand  how  difficult  it  must  be 
for  you.  I  apologize  for the experience that you have had. However, you need 
to  adhere  to  the 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 aggravated 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  patients  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 food and drink 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 by mouth. 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:  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. 
Nurse:  Presently,  your  infection  is  quite  severe.  You  have  a  fever,  and  your 
body  is  not  tolerating  any  food  or  drink.  That  is  why  we  are  giving  you your 
medication  intravenously.  If  you  go  home,  and  your  condition  exacerbates, 
you  would  require  prompt  medical  attention  which  is  possible  if  you  stay  in 
the  hospital.  So,  I  hope  you  understand  that  going  home  at  this  stage  can 
endanger your health. 
Patient: Well, I still want to go home. I just cannot stay here anymore. I 
won’t 
 
be able to get any rest here. I get disturbed now and then, and I know I won’t 
get better like this. 
Nurse:  I  appreciate  what  you  are  saying,  and  it’s  your  right to get discharged 
with  an  informed  understanding  of  the  risks  involved  in  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  at  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  if  you stay longer at the 
hospital.  It  is  vital  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 so that your sleep 
is not disrupted and you get proper rest. 
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/man  who  has  come  to  the 
clinic  for  a  check-up.  You  notice  that  he/she  looks  uncomfortable  and 
embarrassed. 
Task: 
• 
Take a relevant history of the patient’s condition (urinary frequency, urinary 
urgency, urine incontinence) 
• 
Ask how the patient has been coping at home (impact on lifestyle, treatment 
sought) 
• 
Explain your preliminary diagnosis of urge incontinence 
• 
Reassure  the  patient  and  respond  to  his/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 man/woman who has come to his/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  urgency  2-3  times  a  day.  On  bad  days,  the  urge  to  urinate  is 
so  strong  that  urine  leaks  on  the  way  to  the  bathroom.  You  feel  very 
embarrassed about this fact. 
Task: 
• 
Answer the nurse’s questions about your complaints honestly, but don’t be 
forthcoming and sound self-conscious in your replies. 
• 
If  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. 
• 
When  asked  about  coping  at  home,  mention  social  withdrawal,  restricting 
fluid intake (sips of water), and exercise cessation due to fear of leakage 
• 
Sound alarmed about the diagnosis of urge incontinence and ask if it is 
treatable 
• 
Be open to the idea of seeing a doctor and using continence pads, disposable 
undergarments 
For this task, let’s assume that the patient is a female, and her name is Sarah. 

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... 
Nurse: That’s alright. Can you remember 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 fast 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? 
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.  Just  to  recap  what  you  just  told me, for 
the  last  one  month, you have had an increased urination frequency along with 
an  urgency  to  urinate  occasionally.  The  symptoms  have  gradually  worsened, 
and  you  urinate  every  2-3  hours  and  have  urgency  2-3  times  a day. At times, 
the  urge  to  urinate  is  so  strong  that  urine  leaks  on  the  way  to  the  bathroom. 
It’s  impacting  your  life  negatively  by  preventing  you  from  exercising  and 
socializing. Is there anything else that you would like to add? 
Patient: No.. That’s pretty much... Oh,...there’s one thing. I have 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:  That  must  be  very  difficult.  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:  Urinary  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  managing  your  condition.  For 
this,  I  would  advise  seeing  a  urologist  who  specializes  in  treating 
incontinence  of  the  bladder.  Would  it  be  okay  if  I  can  schedule  an 
appointment for you tomorrow 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.  In  this  way,  you  won’t  have  to  restrict  your  fluid  intake,  and  you 
will able to go out of the house and participate in the activities that you enjoy. 
Patient: Yes, that would be hugely helpful. Thank you, nurse. 
Nurse: You’re welcome. Do you have any questions about what we discussed 
today? 
Patient: No. I am relieved that it’s treatable. I will see you tomorrow. 
 
Role Play 13 
Candidate cue-card 
Setting: Hospital Ward 
Nurse  You  are  speaking  to  a  50-year-old  man/woman  who  is  scheduled  to 
undergo  colostomy  in  your  hospital  day  after  tomorrow.  He/she  has  never 
had  surgery  in  her  life  and  seems  anxious  about  the  operation  and  its  effects 
on life at home. 
Task: 
• 
Find out about his/her concerns and empathize with the patient 
• 
When asked, explain that the surgery will be performed under anesthesia and 
will not be painful 
• 
Outline  the  management  plan  to  support  the  patient  at  home  after  surgery 
(discharge  instructions  by  stoma  nurse  about  care,  equipment,  diet  after 
surgery) 
• 
Reassure  the  patient  that  the  surgery  will  not  prevent  his/her  participation  in 
any  social  activities  (support  by  GP  and  district  nurses  to  enhance  patient’s 
recovery during adjustment phase) 
• 
Offer to schedule a meeting with the Stoma Care Nurse tomorrow 

Interlocutor cue card 

Setting: Hospital Ward 
You are a 50-year-old man/woman who is scheduled to undergo colostomy 
day after tomorrow. You have never had any surgery in your life, and you are 
very 
 
anxious about the procedure. You are also worried about the effects of the 
surgery on your self-care and believe it will negatively impact your social 
life. 
Task: 
• 
When the nurse asks, explain your fears regarding the surgery (how painful 
the surgery would be) 
• 
Express  concern  about  whether  you  will  be  able  to  return  to  your  life  before 
the  surgery  without  any  embarrassment  (coping  at  home,  participation  in 
social activities) 
• 
Sound alarmed about managing care at home after discharge 

Sample phrases: 
Introduction: 
• 
Hello,  my  name  is  Gurleen,  and  I  will  be  your  attending  nurse  today.  As  I 
understand  from  your  case  notes,  you  are  scheduled  to  undergo  a  colostomy 
day after tomorrow. Is that correct? 
• 
Thank you for the confirmation. You seem quite anxious. May I ask what’s 
been bothering you? 
• 
I  do  understand  your  anxiety.  It’s  a daunting prospect, especially because it’s 
your  first  surgery.  That  being  said,  let  me  assure  that  we  will  care  for  you  at 
every  step:  before  and  during  the surgery. Could you tell me a bit more about 
your fears or worries in regards to the surgery? 
• 
Yes,  that’s  a  reasonable  reaction.  However,  there’s  nothing  to  be  alarmed 
about  because  your  surgery  will  be  performed  under  general  anesthesia,  and 
you  will  not  experience any pain during the procedure. Even after the surgery 
will  be  done,  any  post-operative  pain  will  be  managed  effectively  with 
medication. Does that make you feel a bit better? 
• 
I can sense your anxiety about coping at home after the surgery. If I 
 
• 
• 
• 
were  you,  I  would  be  worried  about  my  transition  to  routine  life  too.  Let  me 
assure  you  that  you  will  be  provided  comprehensive  support  to  adjust 
physically  and  psychologically  after  the  surgery  to  ensure  that  it  does  not 
adversely impact your life in any way. 
The  Stoma  Care  Nurse  will  meet  you and give you instructions on colostomy 
care,  and  equipment  required  so  that  you  don’t  feel  completely dependent on 
someone  for  care.  Before  your  surgery,  the  nurse  will  guide  you  through  the 
basic  principles  of  managing  at  home  while  you  are  recovering  from  your 
surgery  to  ensure  that  the  surgery  does  not  prevent  your  participation  in 
everyday activities. Do you have any questions at this stage? 
Yes,  I  do  see  where  you  are  coming  from.  Please  be  assured  in  this  regard 
because  constant  follow-up  review  is  also  maintained  to  ensure  that  you  are 
well-adjusted  to  a  new  lifestyle  and  capable  of  self-care.  Your  GP  and 
community  nurses  will  support  you  during  the  recovery  period  so  that  the 
surgery  does  not  prevent  your  participation  in  social  activities.  Home  visits 
will  be  arranged  to  monitor  your  health  and  support  you  in  case  you 
experience any difficulties. 
Would  it  be  okay  if  I  schedule  a  meeting  with  the  Stoma  Care  Nurse 
tomorrow?  It  will  you  the  opportunity  to  discuss  your  fears  towards  having 
surgery and post-surgery with her. 
 
Role Play 14 
Candidate cue card 
Setting: General Practice Clinic 
Nurse:  You  are  speaking  to  a  49-year-old  man/woman  who  has  undergone  a 
barium  enema  earlier  today.  He/She  presented  two  days  ago  with  complaints 
of  abdominal  discomfort  and  change  in bowel habit. You have his test results 
which are unremarkable but notice that he/she looks angry. 
Task: 
• 
Find out why the patient is angry 
• 
Ask if the patient is still experiencing any pain 
• 
Explain  that  enema  is  generally  not  painful  for  people  and  probably  that  is 
why  he  was  not  informed  earlier.  (patient  might  have  sensitive  bowel  due  to 
which it was painful) 
• 
Empathize with the patient 
• 
Explain that the purpose of performing the procedure was to examine his/her 
colon and rectum for cancer 
• 
Reassure the patient that his/her results are normal and the doctor will see 
him/her shortly to prescribe medication for his complaints. 

Interlocutor cue card 

Setting: General Practice Clinic 
Patient: You are a 49-year-old man/woman who has been experiencing 
 
abdominal  discomfort  and  change  in  bowel  pattern  since  last  week.  You 
visited your GP two days ago for examination who advised you to undergo an 
enema  today.  Although  you  were  informed  about  the  procedure  earlier  and 
were  told  that  it  would  be  uncomfortable,  you  found  it  very  painful. You felt 
vulnerable  and  humiliated  and  would  have  never  agreed  to  it  had you known 
how awkward it would make you. 
Task: 
• 
When asked, explain why you are angry 
• 
When asked, say that while you are not experiencing any pain presently, you 
feel the procedure was unwarranted 
• 
Ask why you were not previously informed that enema is a painful procedure 
• 
Demand a satisfactory explanation for why this procedure was prescribed for 
you 
• 
Sound alarmed when the nurse mentions cancer 
• 
Ask about the treatment for your complaints of abdominal discomfort change 
in bowel habits 

Answer expectation: 
Introduction: To establish a positive relationship and creditability, introduce 
yourself in a polite and friendly tone. 
“Hello, my name is Gurleen, and I am one of the Registered Nurses in the 
clinic.” 
Since  the  cue  card  suggests  that  the  patient  has  attended  your  clinic  before, 
proceed to check the identity of the patient. Also, do not forget to ask how the 
patient prefers to be addressed. 
“Could you please confirm your first and last name for me?” 
“Thank you. How may I address you, sir/madam?” 
Let’s assume the patient’s name is Frank Mathew, and he prefers to be called 
 
Frank. 
Task 1: (acknowledge the patient’s emotion and ask an open-ended question 
to probe) 
“Frank, it seems to me that you are agitated. Could you please tell me what’s 
bothering you?” 
“Frank, I see that you seem upset. Could you please tell me what’s going 
on?” 
Task 2, 3, 4: 
Once the patient has explained the reason for his anger, use reflective 
listening to confirm the reason. 
“To confirm if I have this right, you are angry because you underwent an 
enema and it was very painful and uncomfortable for you. Is that, right?” 
The  next step is to find out if the pain is experiencing any pain with a focused 
question.  Although  it  is  important  to  address  your  patient’s  emotional  needs, 
attend  to  your  patient’s  physiological  needs  first  if  the  patient  is  in  pain  or  is 
otherwise experiencing discomfort. 
“Could you please tell me, did the pain last just while the procedure was 
happening or are you still having any pain?” 
If  your  patient  does  not  have  any  pain presently, assuage his complaint about 
not  being  warned  earlier.  However,  do  acknowledge  his  complaint  so  that 
your explanation does not seem dismissive. 
“I  do  understand  what  you  are  saying,  Frank.  An  enema  is  generally  not 
painful  for  people,  but  occasionally some people might experience some pain 
if their bowel is too sensitive. 
I  take  your  point,  Frank.  I  guess  the  reason  you  were  not  given  a  warning 
about  the  pain  earlier  was  that  enema  is  usually  not  painful  for  people. 
However,  occasionally  some  people  may have some pain if their bowel is too 
sensitive.” 
This  should  be  followed  by  an  empathetic response. Empathy is the ability to 
experience  a situation through eyes and feelings of another person. When you 
respond empathetically, it allows the patient to feel greater acceptance. 
 
Transitioning from Task 3 to Task 4: 
Use  empathetic  responses  that  convey  that  your  patient’s  concerns  are  real 
and  important  to  you  and  you  understand  his  concerns.  By  recognizing  and 
acknowledging  your  patient’s  feelings,  you  validate  those  feelings  thereby 
demonstrating empathy. 
“That being said, it does sound like you had an awful experience. It’s a 
reasonable reaction to be angry, and I am sorry that you had to go through 
that.” 
“Having  said  that,  it  sounds  like  you  had  a  horrible  experience.  I  can 
understand  why  you  are so angry. If I were you, I would probably react in the 
same way.” 
Task 5 and 6: Explain as to why this procedure was necessary to assess his 
condition for something serious. 
“I  understand  your  perspective.  The  reason  doctor  advised  you  to  have  an 
enema  was  because  the  doctor  was  worried  that  your  symptoms  were  related 
to  something  serious  like  cancer.  However,  I  am  glad  to  tell  you  that  your 
results are fine and it’s not a serious condition.” 
“Let  me  reassure  you  that  you  have  nothing  to be concerned about. Although 
the  experience  was  distressing  for  you,  it  performed  as  a  precautionary 
measure, and your results are absolutely fine.” 
“Regarding  your  complaints  about  abdominal  discomfort  and  change  in 
bowel  habit,  the  doctor  will  be  here  shortly  and  will  discuss  the  treatment  to 
resolve your complaints.” 
 
Role Play 15 
Candidate cue card 
Setting: Emergency Room 
Nurse: You are speaking to a 25-year old man/woman who has presented 
himself/herself to the Emergency Room. He/she looks very uncomfortable. 
Task: 
• 
Find out the reason for the patient’s visit 
• 
When the patient demands medication for migraine treatment, ask whether 
the patient has been clinically diagnosed with a migraine 
• 
Take a relevant history of the patient’s condition (the type of pain, pain score, 
other symptoms) 
• 
Explain that he/she needs to see the doctor who would meet the patient after 
30 minutes 
• 
Explain the risks involved in self-diagnosis/self-treatment 
• 
Emphasize the importance of getting a confirmed diagnosis from the doctor 

Interlocutor cue card 

Setting: Emergency Room 
Patient:  You  are  a  25-year-old  man/woman  suffering  from  a  headache.  You 
have  been  suffering  from  a  left-sided  headache  since  yesterday.  The  pain  is 
“pounding” and is accompanied by nausea and vomiting. You have increased 
 
sensitivity  to  light  and  sound,  and  over-the-counter  painkiller  has  not  been 
effective  in  alleviating  the  pain.  You  looked  up  your  symptoms  on  some 
online websites and found that your condition is indicative of a migraine. 
Task: 
• 
When asked, tell the nurse that you have a migraine and want medication for 
its treatment. 
• 
Respond to the nurse’s questions about your symptoms 
• 
Resist the idea of waiting for a doctor because you are convinced that you 
have a migraine and do not see the point in waiting for 30 minutes. 
• 
Be difficult to convince, but reluctantly agree to wait for a doctor 

Language expectation 
Introduction 
In this task, the student (nurse) is speaking to a patient who has come to the 
clinic and is asking for medication. 
The role card suggests that this is the first time the patient is visiting you so 
introductions would be appropriate. 
• 
“Good Morning, I will be your attending nurse today, 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?” 
Task 1 and 2 
The next step would be to confirm the reason for his/her visit. The role-play 
also mentions that the patient seems very uncomfortable, so this information 
 
can form the basis of the opening question as well. 
• 
“I can see that you are very uncomfortable. Please let me know what I can do 
for you?” 
• 
“You seem very uncomfortable. Please let me know what’s bothering you?” 
When the patient says that he/she needs medication for a migraine, ask 
questions to investigate if he has ever been clinically diagnosed by a doctor 
regarding the diagnosis. At the same time, sound empathetic because the 
patient is in pain. 
• 
“I am sorry that you are in pain. Can I ask, have you ever been diagnosed 
with a migraine by a doctor?” 
Task 3 
When  the  patient  refuses,  explain  that  you  need  to  take  the  history  of  his 
symptoms  to  get  a  detailed  understanding  of  his  condition.  Do  not  forget  to 
seek his permission before asking questions. 
• 
“Before proceeding further, I’d like to ask you some questions to get a 
detailed understanding of your condition. Is that ok?” 
Task 3 
Use cone technique (open question leading to closed questions) and indirect 
language to investigate the patient’s presenting problem. 
• 
“Could you please tell me more about your symptoms/problems? – Open 
question 
• 
Could you tell how long have you had this problem?/Could you tell me when 
the symptoms began? 
• 
On a pain scale of 0 to 10, 0 being no pain and 10 being the worst pain you 
have ever experienced, would you be able to rate your pain? 
• 
Is there anything that alleviates your pain? 
• 
Is there anything that exacerbates your pain? 
• 
Have you taken any medication prior to your visit? 
 
• 
• 
• 
Is the pain accompanied by other symptoms or Is the pain radiating to other 
parts of the body?” 
Transitioning from Task 3 to Task 4 
“Thank  you  for  answering  my  questions.  Based  on  our  initial  conversation,  I 
believe  you  need  to  consult  with  the  doctor  to  get  an  assessment.  The  doctor 
would be here in 30 minutes.” 
Elicit the patient’s expectations by asking questions like: 
“Is that okay with you?” “Is that alright?” 
Transitioning from Task 4 to Task 5 
When  the  patient  resists  the  idea  of  waiting  for  a  doctor,  provide  a  rationale 
for  getting  an  expert  opinion  and  not  relying  on  the  internet  for  diagnosis. 
Also,  demonstrate  active  listening  by  responding  to  patient  clues  (reluctance 
to see the doctor). 
“I  can  understand  that  you do not want to wait for the doctor and that looking 
up  your  symptoms  online  can  be  expedient/convenient,  but  it  can  be 
remarkably dangerous. Let me explain.” 
5- Explain the risks involved in self-diagnosis/self-treatment 
The  first  step  here  would  be  to  acknowledge  the  patient’s  efforts  to  make 
them  feel  that  their  ideas  are  important  and  are  validated.  It’s  important  to 
adopt a non-judgmental approach towards the patient’s ideas. 
“I  appreciate  that  you  are  using  the  internet  to  stay  informed;  however,  you 
must  discuss  your impressions with a doctor for a confirmed diagnosis. There 
is  a  lot of misleading information on the internet, and when you self-diagnose 
yourself  without  an  expert  opinion,  some  nuances  of  a  diagnosis  may  be 
missed.  Also,  a  closer  examination  may  uncover  an  underlying  disease  or 
illness,  or  it  may  not  be  as  serious  as  you  think  it  is.  If  I  treat  you  for  a 
migraine,  but  in reality, you might have a different problem, it can exacerbate 
your condition and lead to adverse consequences. Self-diagnosis can have 
 
tremendous negative repercussions/consequences.” 
Transitioning from Task 5 to Task 6 
Therefore, the only way to avoid this type of risk is to go for a professional 
diagnosis by a doctor. 
Encourage the patient to verbalize his/her concerns by asking questions like: 
• 
“Is that acceptable to you?” 
• 
“Does that make sense?” 
Task 6 
If the patient is hesitant, reinforce the importance of your advice. 
“I  do  understand  your  perspective;  that  being  said,  as  I  discussed  earlier,  the 
accuracy  of  the  information  on  the  internet  is  unreliable,  and  it’s  not  within 
my  scope  to  prescribe  you  any  medication  without  checking  with  the  doctor. 
How  about  this?  Let  me  check  with  the  doctor  if  he/she  can  see  you  as  early 
as  possible,  so  you  do  not  have  to  wait  longer.  I  will  ensure  that  it  does  not 
take long.” 
Closing the role play 
“I am glad that you agreed to wait for the doctor. Please take a seat and wait 
here while I check how soon the doctor can see you.” 
 
Writing SUB-TEST 
There will be no changes to the writing test in the 
Updated OET Structure of the test 
You  will  receive  stimulus  material  (case  notes)  which  includes  information 
based  on  which  you  will  be  writing  a  letter.  The  case  notes  will  be  followed 
by  a writing task which 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 
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? What is the main point you must communicate 
to the reader? 
 
What supporting information is it necessary to give to the reader? What 
background information is necessary 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? 
 
Assessment Criterion – Writing 
The  task  in  the writing sub-test expects you to demonstrate that you can write 
a  letter  based  on  a  typical  workplace  situation  and  the  demands  of  your 
profession. 
Your performance is scored against five criteria which are: 

Overall task fulfilment – including whether the 

response is between180-200 words and whether 
enough information has been included for the 
task/recipient. 
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 

suitable words, phrases and style of language; and 
how the information has been organised. 
 
Tips to improve this criterion 
• 
Organize  the  information  clearly  –  remember,  the sequence of information in 
the  case  notes  may  not  be  the  most  appropriate  sequence  of  information  for 
the letter. 
• 
Highlight  the  main  purpose  of  the  letter  at  the  beginning  of  the  letter  in  the 
introductory  paragraph.  (For  example,  ongoing  care  and  support,  home visits 
to provide assistance, urgent assessment and further management etc.) 
• 
Consider  using  dates  and  other  time  references  [E.g.  Three  months  later,  last 
week,  a  year  ago]  to  give  a  clear  sequence  of  events  where  needed.  Which 
way  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,  professional  tone  appropriate  to  this  kind  of  written 
communication.  Informal  language,  slangs,  contractions,  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  writing  to  another  professional,  medical  terms  and  abbreviations  may  be 
appropriate;  if  writing  to  a  parent  or  someone  who  is  not  a  health 
professional, use non-medical terms and explain carefully. 
Informal Formal 
Thanks for your help. Thank you for agreeing to assist in 
this matter. 
Hello there! Dear Mr/Ms/Dr or Dear Sir/Madam 
 
I’m  writing  to  let  you  know  how  you  can  care  for  Nancy  at  home  after  her 
discharge 
I am writing regarding Ms. Nancy’s future care requirements following her 
discharge 
I’d like to ask for some help for Ms. Kumar who had a coronary bypass 
surgery in our hospital. She is getting better and is going to be discharged 
today. 
I am writing to request follow-up care for Ms. Kumar who is recovering from 
a coronary bypass surgery and is scheduled to be discharged from our facility 
today. 
Make sure that the patient is compliant with his physiotherapy and oversee 
his medications? 
Could you please ensure adherence to the recommended physiotherapy 
regime as well as monitor his response to the prescribed medications? 
Please look after this patient from now on. 
I would greatly appreciate if you could take over the management of this 
patient from this point on. 
Feel free to contact me for any information. 
Should you require more information, please do not hesitate to contact me. 

Comprehension of stimulus – including whether you 

understand the case-notes and select relevant case- 
notes to include in your response 
Tips to improve this criterion 
• 
Demonstrate that you have understood the case notes thoroughly selecting the 
details  that  are  relevant  for the recipient of the letter. Your purpose of writing 
the  letter  should  be  clear-  do  not  just  provide  a  general  summary  of  the  case 
notes in the letter. 
• 
Show the connections between information in the case notes if these 
 
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. 

Control of linguistic features [grammar and 

cohesion] – including how effectively you 
communicate using the grammatical structures and 
cohesive devices of English. 
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, where appropriate. 
• 
Split a long sentence into two or three sentences if you feel you are losing 
control of it. 
• 
Review areas of grammar to ensure they convey intended meaning accurately 
• 
Use  connecting  words  and  phrases  [‘connectives’]  to  link  ideas  together 
clearly  [e.g.  however,  therefore,  subsequently,  consequently,  nevertheless 
etc.]. 
To understand this criterion better, practice the following exercise: 
1. 
Ms.  Jones  is  being  discharged  today  and  requires  home  visits  from  you 
___________________  she  does  not  own  a  car  and  cannot  travel  to  the 
hospital. 
• 
Because 
• 
But 2. 
Ms.  Sharma  is  anxious  about  coping  with  her  illness  on  her  return  home; 
_______________,  please  liaise  with  a  social  worker  to  resolve  her concerns 
following her discharge. 
 
Nevertheless 
• 
• 
Therefore 3. 
The  patient  sustained  left-sided  hemiplegia  during  hospitalisation; 
___________________,  he  is  depressed  owing  to  loss  of  mobility  and 
independence. 
• 
Consequently 
• 
Subsequently 4. 
Upon admission, a metal plate ________________ surgically inserted for 
stabilising her right shoulder. 
• 
Was 
• 
Is being 5. 
The  patient  has  responded  well  to  the  treatment  postoperatively  and  has 
attained  a  significant  recovery;  _____________,  ongoing  management  is 
required from you to support her as she recuperates. 
• 
Nevertheless 
• 
Hence 6. 
Mr. Kumar ________________________hypertension since 1998. 
• 
Has had 
• 
Had 7. 
Ms. Davies often _____________ comfort in unhealthy and fatty foods, 
which is probably the reason for her being overweight. 
• 
Seeks 
• 
Is seeking 8. 
Ms. Sharma was prescribed ___________________ analgesic for pain in the 
knee. 
• 
An 
• 
The 9. 
Mr. Smith presented to us with __________________ of right-sided 
throbbing headache. 
 
Complained 
• 
• 
Complaints 10. 
Ms. Singh has been ____________ to modify her lifestyle to ensure good 
health. 
• 
Advised 
• 
Advice 
Answers: 
1. 
because 
2. 
therefore 
3. 
consequently 
4. 
was 
5. 
nevertheless 
6. 
has had 
7. 
seeks 
8. 
an 
9. 
complaints 
10. 
advised 

Control of presentation features [spelling, 

punctuation and layout] 
Tips to improve this criterion 
• 
Take care with the placement of commas and full stops. 
• 
Leave a blank line between paragraphs to show the overall structure of the 
letter. 
• 
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. Do not use 
symbols as abbreviations in formal letters. Use a clear layout to avoid any 
miscommunications. Write legibly in a way that the handwriting does not 
confuse the reader over spelling and meaning, and the assessor can grade the 
response fairly using the set criteria. 

Helpful hints 
Use the 5-minute reading time effectively. You should read the information 
carefully and plan an answer which meets the needs of the reader. When 
preparing for the test, practice writing the tasks within the word limit so that 
you know when you have written enough in your own handwriting. A very 
important aspect of OET writing is the selection of relevant case-notes. Think 
carefully about the particular task. What does the reader need to know, and in 
what order of importance? What is the outcome that you want to achieve, i.e. 
what do you want the reader to do with the information? 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. Cross out anything you do not want the 
assessor to read, such as drafts or mistakes. Always proof-read your letter to 
check for any mistakes in grammar, style, and spelling. While practicing the 
letters, one way to proof-read the letter is to read out loud. This is especially 
helpful for spotting run- on sentences, but you might also hear other problems 
that you may not see when reading silently. Alternatively, you could read 
through once (backwards, sentence by sentence) to check for fragments; and 
read again forward to ensure that subject-verb agreement. 
 
Writing Sub-Test: NURSING 
TIME ALLOWED: 
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: 
READING TIME: 5 MINUTES 
#648, Bourke Street, Sydney 
Admitted: 18/06/2017 
Date of discharge: 23/06/2017 
Diagnosis: Acute appendicitis with Appendicular lump 
 
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 Sydney – 
about three hours away, works as an Entrepreneur; younger daughter in 
Canada, works as a dentist Husband is the primary caregiver, elder daughter 
visits with husband once an year, Scared of hospitalization, prone to anxiety 
related to this Fond of eating out, rarely cooks at home, sedentary lifestyle, 
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 (2014) and 
Diabetes Mellitus type-2 (2010) (not compliant with diabetic medication) 
Admission Diagnosis: Complaints of pain in abdomen in right iliac fossa 
since 17/06/2017 Pain was sudden in onset, acute in nature and was 
non-radiating fever (documented up to 101-degree F), aversion to food, 
evaluated outside where USG Abdomen revealed Acute Appendicitis, 
admitted 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 O2 98%, 
CNS-NAD, Chest- Bilateral entry equal, No added sounds 
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 
Monitoring (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 
ADL’s 
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  hrly)  8  units  (1  wk.)  AC 
Breakfast and 6 units AC dinner 
Assessment: Pt. stable with plan for interval appendectomy (6 
wks) 
Medications: TAB Dolo(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. 
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 3PM. 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  in  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 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. 
In your answer 
• 
Expand the relevant case notes into complete sentences 
• 
Do not use note form 
• 
Use letter format 
WRITING TASK 3 
Using  the  information  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 
 
Writing Task 
 
Writing Task 1 
Using  the  information  given  in  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. 
Sample answer 
Sample 1 
23/06/2017 
Ms. Prabha Shrishti Nursing Home Care Agency Sydney 
Re: Mrs. Anita Ramamurthy; aged 59 
Dear Ms. Prabha 
The  purpose  of  this  letter  is  to  request  a  home  visit  for  Mrs.  Ramamurthy,  a 
diabetic  patient,  who  needs  education  on  self-monitoring  her  blood  glucose 
levels  and  administering  insulin  injections.  She  has  had type-2 diabetes since 
2010 and has poor adherence to its management. 
She  presented  to  us  on  18/06/2017  and  was  diagnosed  with  acute 
appendicitis.  During  hospitalization,  the  adopted  treatment  plan  included 
conservative  management  and  plan  for  interval  appendectomy  six  weeks 
later.  Her  recovery  has  been  encouraging/promising  so  far,  and  she  is  being 
discharged back home today. 
She has been educated regarding the role of nutrition in effectively 
 
controlling  her  diabetes  by  the  dietician.  Moreover,  the  hospital 
endocrinologist  has  advised  her  to  chart  blood  glucose  daily  and  control  her 
sugar  levels  with  insulin  injections  until  her  follow-up  visit  scheduled  on 
30/06/2017.  She  is  accepting  of  this  but  feels  that  she  is  not  skilled  at  doing 
these herself. 
Consequently, at her husband’s request, I am requesting you to visit her at 
her  home  and  provide  necessary  guidance  so  that  she  can  competently 
perform these procedures. 
Enclosed herewith are all pertinent details. Should you have any further 
inquiries, please do not hesitate to contact me. 
Yours sincerely (Your name here) Sample 2 
23/06/2017 
Ms. Prabha Shrishti Nursing Home Care Agency Sydney 
Re: Mrs. Anita Ramamurthy; aged 59 
Dear Ms. Prabha 
I  am  writing  to  request  a  home  visit for Mrs. Ramamurthy, a diabetic patient, 
who  needs  education  on  self-monitoring  her  blood  glucose  levels  and 
administering  insulin  injections.  She  presented  to  us  on  18/06/2017  and  was 
diagnosed  with  acute  appendicitis.  She  has  recovered  significantly,  and  her 
appendectomy is scheduled after six weeks. She is being discharged today. 
She  has  been  suffering  from  type-2  diabetes  since  2010  and  has  poor 
adherence  to  its  management.  During  hospitalization,  she  has  been  educated 
regarding  the  role  of  nutrition  in  effectively  controlling  her  diabetes  by  the 
dietician.  Moreover,  the  hospital  endocrinologist  has  advised  her  to  chart 
blood  glucose  daily  and  control  her  sugar  levels  with  insulin  injections.  She 
has been asked to present her blood glucose chart during her follow-up visit 
 
scheduled on 30/06/2017. She is willing to perform these procedures but 
lacks the confidence to do these independently. 
Therefore,  her  husband  has  requested  a  home  visit  for  the  demonstration 
of  blood  glucose  monitoring  and  taking  insulin  injections  at  home.  It  would 
be  greatly  appreciated  if  you  could  visit  her  and  provide  the  requisite 
instructions so that she can perform these procedures on her own. 
Enclosed herewith are all pertinent details. Should you have any further 
inquiries, please do not hesitate to contact me. 
Yours sincerely (Your name here) Charge Nurse 
 
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. 
23/06/2017 
Ms. April Dietician 258 George Street Sydney 
RE: Ms. Anita Ramamurthy; 59-year-old businesswoman 
Dear Ms. April 
The  purpose of this letter is to request information about low-fat, diabetic diet 
for  Ms.  Ramamurthy  who  presented  to  us  on  18/06/2017  and  is  being 
discharged  back  home  today.  She  has  been  treated  for  acute  appendicitis 
while  hospitalization  and  is  scheduled  to undergo interval appendectomy in 6 
weeks’ time. 
Socially,  she  leads  a  sedentary  lifestyle  and  consumes  a  fat-rich  diet 
consisting  of  fast  foods  and  sugary  drinks.  Additionally,  her  BMI  is 
remarkably  high (33). Her medical history is remarkable for hypertension and 
poorly- controlled diabetes type 2. 
Upon admission, she was managed conservatively with intravenous 
antibiotics and other supportive treatment. Additionally, she was assessed by 
a 
 
dietician,  who  educated  her  on  the  role  of  proper  nutrition,  and  an 
endocrinologist  for  ongoing  management  of  her  diabetes.  Following  her 
discharge,  she  has  been  advised  to  ensure  adherence  to  a  low  fat,  diabetic 
diet. 
She  has  requested  detailed  advice  on  dietary  guidelines,  including simple 
recipes  that  can  be  prepared  at  home,  for  losing  weight as well as controlling 
her  diabetes.  It  would  be  greatly  appreciated  if  you  could  send  the  requested 
information to her home address. 
Thanks for considering this request and sending her this information at 
the earliest. 
Yours sincerely (Your name here) Charge Nurse 
 
Writing Task 3 
Using  the  information  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. 
23/06/2017 
Mr. Krishnan Ramamurthy 648, Bourke Street Sydney 
Dear Mr. Ramamurthy 
I  am  writing  regarding  Ms.  Anita  Ramamurthy’s  future  care  requirements 
after  she  has  been  discharged.  Her  recovery  has  been  encouraging  so  far  but 
continued monitoring and attention will be necessary. 
Ms.  Ramamurthy  made  significant  progress  in  her  condition  during  her 
stay,  and  her  infection  is  controlled  now.  Her  surgery  has  been  scheduled 
after  six  weeks.  Following  her  discharge,  she  has  been  advised  to  ensure 
compliance  with  a  low-fat,  diabetic  diet.  Ms.  Ramamurthy  has  requested 
more  information  about  dietary  guidelines  and  simple  recipes  which  will  be 
directly  sent  to  your  house  by  a  dietician.  It  is  also  necessary  that  she  avoids 
travelling or rigorous activities. 
Besides  that,  she  needs  to  chart  blood  glucose daily and control her sugar 
levels  with  insulin  injections.  We  are  aware of your wife’s concern regarding 
this;  therefore,  a  home  visit  by  a  nurse  has  been  arranged  for  instructions  on 
correct  technique  of  these  procedures.  In  case  she  experiences  any  persistent 
pain or fever, please contact us immediately at 03492250. 
 
Of note, the blood glucose chart needs to be presented during the follow-up 
consultation scheduled next week on 30/06/2017 at 3 PM. 
We hope Ms. Ramamurthy continues to make a speedy recovery. 
Yours sincerely (Your name here) Charge Nurse 

Writing Sub-Test: NURSING 

TIME ALLOWED: 
WRITING TIME: 40 MINUTES 
Read the case notes below and complete the writing task which follows. 
CASE NOTES: 
Mr. Tej Singh is a 41 years 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 (2010) due to appendicitis No POHx No allergies 
Immunizations are current Smoker (Cigarettes & Cigars) Teetotaller 
READING TIME: 5 MINUTES 
 
Social History Works as a Systems Analyst 
Arrived in Australia from India with wife in 2012 as a permanent resident 
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 Alert, well-nourished, well developed man 
General Assessment Infectious sinusitis 
Plan Given Augmentin (Amoxicillin/clavulanic acid) 
24/01/2017 
Subjective Complaints of severe headaches (HA), right- 
sided, throbbing, radiating to right 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 (10/10) 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 non-steroidal 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 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 
 
Writing Task 4 
Using  the  information  given  in  the  case  notes,  write  a  referral  letter  to  Dr 
John  Dyer,  an  ophthalmologist  at  West  Suburban  Eye  Care  Centre,  396 
Remington  Boulevard,  Suite  340,  Romaville  requesting  him  to  look  into  this 
case. 
Sample Answer 
31/01/2017 
Dr John Dyer West Suburban Eye Care Centre 396 Remington Boulevard 
Suite 340 Romaville 
Re: Mr. Tej Singh Randhawa; DOB: 09/09/1976 
Dear Dr Dyer 
I  am  writing  to  request  an  assessment  and  further  management  of  Mr. 
Randhawa  who  is  presenting  with  signs  and  symptoms  consistent  with 
Horner’s syndrome. 
Initially,  he  presented  to  us  on  10/01/2017 complaining of rhinorrhea and 
headaches.  At  that  time,  it  was  suspected  that  sinus  pressure  was  causing the 
headaches; consequently, he was treated for infectious sinusitis. 
He  returned  two  weeks  later  with  deteriorating  symptoms.  At  this 
subsequent  visit,  he  complained  of  excruciating,  right-sided,  throbbing 
headaches  that  occurred intermittently and did not subside despite attempts to 
rest. Additionally, he reported of concurrent aching teeth and previously 
 
described  rhinorrhoea.  A  diagnosis  of  a  cluster  headache  was  made,  and  the 
patient  was  prescribed  acetaminophen  and  non-steroidal  anti-inflammatory 
medications. 
On his last visit two days ago, he presented along with his wife who noted 
that  his  right  eye  (ipsilateral  to  the  headaches)  seemed  “droopy  and  sunken” 
and  that  his  face  flushed  preceding  and  during  the  headaches.  Moreover,  the 
pupil  of  his  right  eye  constricted  in  darkness,  and  he  had  decreased  sweating 
on the right side of his face. 
Given the above, it would be greatly appreciated if you could assess, 
examine, and treat the patient as deemed appropriate. 
Please contact me in case you have any questions. 
Yours sincerely (Your name here) Head Nurse 
Sample letter 2 
31/01/2017 
Dr. John Dyer West Suburban Eye Care Centre 396 Remington Boulevard 
Suite 340 Romaville 
Re: Mr. Tej Singh Randhawa; DOB: 09/09/1976 
Dear Dr. Dyer 
I  am  referring  the  above-captioned  patient  who  is 
demonstrating/presenting/manifesting/exhibiting  signs  and  symptoms 
suggestive of/indicative of/consistent with Horner’s syndrome. 
Mr. Randhawa has attended our clinic thrice over the past three weeks, 
during which time he has had several episodes of severe right-sided 
headache. 
 
He  first  presented  on  10/01/2017  with  complaints  of  a  headache  and 
rhinorrhoea.  On  that  day,  he  was  prescribed  Augmentin  based  on a diagnosis 
of infectious sinusitis. 
He  returned  two  weeks  later  with  complaints  of  dressing  right-sided 
throbbing  headaches,  which  occurred  periodically  and  were  not  relieved  by 
rest.  Additionally,  rhinorrhoea  had  persisted,  and  headaches  were 
accompanied  by  aching  teeth.  The  symptoms  were  suggestive  of  a  cluster 
headache;  consequently,  he  was  commenced  on  acetaminophen  and  non- 
steroidal anti-inflammatory medications. 
Two  days  ago,  accompanied  by  his  wife,  he  presented  again  as  his  right 
eye  seemed  ‘droopy  and  sunken.’  Moreover,  his  wife  reported  that  his  face 
flushed  before  and  during  headaches.  An  examination  that  day  revealed 
decreased  sweating  on  the  right  side  of  his  face  and  that  his  right  pupil 
constricted in darkness. 
Given the above, it would be greatly appreciated if you could assess, 
examine, and treat the patient as deemed appropriate. 
Please contact me with any questions. 
Yours sincerely (Your name here) Head Nurse 
Read the case notes below and complete the writing task which follows 
CASE NOTES: 
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 
Date of Birth 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 Heart disease, has 2 siblings, brother aged 79 with CAD, twin sister 
with osteoporosis and depression 
Social History/ Lives with husband in own house. Home has 2 
stories, 2 steps to entrance, Supports full bath on second floor only, 2 grown 
children living nearby Pt. is very active; walks 1-2 miles/day, stopped 
smoking 30 years ago 
Diet Occasional drink, drinks a cup of coffee a day, 
reports diarrhoea and gas with dairy products 
Allergies NKDA 
Past Medical Diagnosed with osteoporosis -first signs noted in 
2015 
History Mild hyperlipidaemia, Mild hypertension, 
Coronary artery disease, Tendonitis of R. Shoulder, PTCA, 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 02/07/2017 
Chief Complaint Injury on the left hip - had a fall after slipping 
Dx Fractured L NOF 
Nursing Management And 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 postop, cefazolin (Ancef) 1 g. IV q. 8 h. X 3 doses 
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 mg./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 
Complaining of constipation- not had a bowel movement since surgery 
Docusate 100 mg. daily Can ambulate short distances with a walker 
Assistance with ADL’s 
02/07/2017 Original dressing changed; 
Ready for discharge 
Discharge plan LLE (Left lower extremity) wt. bearing limited to 30 % 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 Acetaminophen 325 mg. 1 to 2 q. 4 to 
6 hours prn headache or minor pain Famotidine (Pepcid) 20 mg. b.i.d. 
Docusate 100 mg. daily Alendronate 10 mg. daily 
 
Writing Task 5 
Using  the  information  in  the  case  notes,  write  a  referral  letter  to  the  Ms. 
Susan  Parry,  Charge  Nurse  at  Helping  Hand  Rehabilitation  centre,  Eagle 
Vale,  Sydney,  NSW  where  Mrs.  Davies  will  be  discharged  to  from  your 
ward. 
In your answer 
• 
Expand the relevant case notes into answers 
• 
Do not use note form 
• 
Use letter format 
Sample Answer 
02/07/2017 
Ms. Susan Parry Charge Nurse Helping Hand Rehabilitation Centre Eagle 
Vale Sydney NSW 
Re: Mrs. Nina Davies; DOB: 25/12/1943 
Dear Ms. Parry 
I  am  writing  to  request  rehabilitative  care  for  the  above-captioned  patient,  a 
patient  of  osteoporosis  since  2015,  who  was  admitted  to  our  hospital  on 
28/06/2017  with  a  fractured  left  NOF,  underwent  left  hip  hemiarthroplasty 
under our care, and is scheduled to be transferred to your facility today. 
Postoperatively, a physiotherapist reviewed her on the 3rd day of 
 
hospitalization  and  initiated  an  exercise  program  to  promote  strength  and 
recovery.  At  present,  she  can  ambulate  short  distances  with  a  walker.  Her 
LLE weight bearing is limited to 30% for next six weeks. 
Her  husband  is  unable  to  provide  care  for  her  in  their  home,  which is not 
set  up  for  a  walker;  therefore,  it  would  be  greatly  appreciated  if  you  could 
take  over  the  management  of  this  patient  from  this  point  on.  Please  ensure 
compliance  with  the  prescribed  medication  regime,  attached  to  this  letter,  as 
well  as  the  recommended  exercise  program.  Additionally,  she  requires 
assistance  with  ADL. Of note, her staples need to be removed on Day 14, and 
the dressing should remain dry and intact until then. 
Her medical history reveals the presence of mild hypertension, mild 
hyperlipidemia, and coronary heart disease. 
Please do not hesitate to contact me in case of any queries. 
Yours truly Diana Jones Charge Nurse Prince Wales Hospital 
WRITING SUB-TEST: 
TIME ALLOWED: 
WRITING TIME: 40 MINUTES 
Read the case notes below and complete the writing task which follows. 
CASE NOTES: 
You are the registered nurse in the Cardiology Unit at St Luke’s hospital, 
Adelaide. Ms. Kylie Weiss is a patient in your care. 
Today’s date: 09/07/2017 
Name: Ms. Kylie Weiss 
D.O.B.: 21/05/1952 
NURSING 
READING TIME: 5 MINUTES 
 
Address: 8758, Pulteney Street, Adelaide, SA, 5000 
Date of admission: 07/07/2017 
Presenting complaint: BIBA (Brought in by ambulance) – 2 hour history 
intermittent discomfort jaw/heaviness in both forearms, constant discomfort 
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: 85 kilograms, Height: 170 cm – 
Overweight (BMI-29) Ex-smoker – 1994 Mild osteoarthritis Mild asthma – 
no exacerbations within last 5 years Dyslipidaemia- (Raised cholesterol) – 
not treated 
Medications: NIL 
Occupation: Works as a taxi driver, mixed shifts 
Dietary Habits: Eats fast food- fries, hamburgers, doughnuts, ice 
cream, non-drinker 
Family History: Brother- Coronary artery bypass grafting (CABG) 
at 70 years Sister MI(Myocardial Infarction) at 60 years, Mother-angina 
Social History: Marital status: Married with one daughter 
Husband-Peter Weiss, 67 years, retired, aged pensioner 
 
Medical Treatment: Emergency Angioplasty performed 
ST Segment elevation on ECG – Direct stenting to proximal LAD 
Echocardiogram –Ejection fraction 35% Pain/Discomfort – managed Fasting 
Bloods (Lipids, Diabetes, TnI(proteins troponin), CBC(complete blood 
count), Biochem)- High Cholesterol levels Nil further pain/discomfort, 
Cardiac status stable Pt. seemed confused re diagnosis, reality of near death 
experience -Educated re event, MI diagnosis and modifications to risk factors 
(Cholesterol, wt. loss) R/v(review) by Physiotherapist – cardiac exercise 
program provided R/v by dietician – diet for weight loss & reduced 
cholesterol levels Concerned about being unable to manage home on her 
husband’s pension -S/W (Social Worker) input required 
09/07/2017 Preparing for discharge 
Discharge medications: 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 for 6 weeks. 
Refer to Cardiac Rehabilitation Nurse Specialist –compliance with risk factor 
management (wt. loss, low cholesterol diet), medications, education re about 
MI and its management 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 6 
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 7 
Using  the  information  in  the  case  notes,  write  a  referral  letter  to  Mr.  Barney 
Dyer,  Occupational  Therapist,  Home  Occupational  Therapy  Services,  85 
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 8 
Using  the  information  given  in  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. 
 
Writing Task 6 
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. 
Sample Answer 
09/07/2017 
Ms. Nina Gill Cardiac Rehabilitation Nurse Specialist Cardiac Rehabilitation 
Clinic 41 Jones Street Adelaide 
Re: Ms. Kylie Weiss; D.O.B: 21/05/1952 
Dear Ms. Gill 
I  am  writing  to  request  continuing  care  and  support  for  Ms.  Weiss  who  was 
admitted  to the hospital on 07/07/2017 for treatment of myocardial infarction. 
She  underwent  an  emergency  angioplasty  under  our  care  and  is  being 
discharged today. 
Her  medical  history is remarkable for previously untreated dyslipidaemia. 
Moreover,  she  has  a  family  history  of  heart  problems  in  both  of  her  siblings 
and  her  mother.  She  consumes  a  diet  that  consists  almost  exclusively  of  fast 
foods and is overweight. She is a non-drinker and quit smoking in 1994. 
Postoperatively, she responded well to the treatment and attained a good 
recovery. She has been commenced on a cardiac exercise program and 
advised 
 
on  a  low-fat  diet  to  reduce  her  weight  and  cholesterol  levels.  She  has  been 
educated  on  MI  and  had  a  reasonable  understanding  of  the  event  and 
subsequent diagnosis. 
It  would  be  greatly  appreciated  if  you  could  ensure  adherence  to  the 
recommended  medication  regimen,  diet  plan,  and  exercise  program.  Further, 
please  re-enforce  Ms.  Weiss’s  understanding  about  MI  and  management  of 
its risk factors for an improved quality of life. 
Enclosed you will find a copy of her current medications. Should you 
have any further inquiries, please do not hesitate to contact me. 
Yours sincerely (Your name here) Registered Nurse 
 
Writing Task 7 
Using  the  information  in  the  case  notes,  write  a  referral  letter  to  Mr.  Barney 
Dyer,  Occupational  Therapist,  Home  Occupational  Therapy  Services,  85 
Flinders  Street,  Adelaide  requesting  him  to  visit  Ms.  Weiss  at  home  and 
provide guidelines for returning to work, driving and normal daily activities. 
Sample Answer 
09/07/2017 
Mr. Barney Dyer Occupational Therapist Home Occupational Therapy 
Services 85 Flinders Street Adelaide 
Re: Ms. Kylie Weiss; D.O.B: 21/05/1952 
Dear Mr. Dyer 
This  letter  will  introduce  Ms.  Weiss  who  is  presently  recovering  from  a 
Myocardial  Infarction.  She  was  admitted  to  hospital  on  07/07/2017  and  is 
scheduled  to  be  discharged  today.  She  requires  home  visits  from  you  to 
instruct her on how she can resume independence of her daily routines. 
She lives with her husband in their own house and works as a taxi driver. 
Her risk factors include being overweight and elevated cholesterol levels. 
During  hospitalization,  she  underwent  an emergency angioplasty and was 
subsequently  reviewed  by  a  physiotherapist,  who  initiated  a  cardiac  exercise 
program, as well as a dietician, who advised her on a diet plan to promote 
 
weight-loss and decrease her cholesterol levels. 
She has been advised not to drive for six weeks and educated on MI and 
the lifestyle changes required for ongoing management of her condition. 
It  would  be  greatly  appreciated  if  you  could  provide  instructions  on 
returning  to  her  routine  activities,  work,  and  driving  to  ensure  a  smooth 
transition back to normal life. 
Thanking you in anticipation for agreeing to assist in this matter. Should 
you have any further inquiries, please do not hesitate to contact me. 
Yours sincerely (Your name here) Registered Nurse 
 
Writing Task 8 
Using  the  information  given  in  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. 
Sample Answer 
09/07/2017 
Ms. Linda Gold Social Worker Gold Social Services 478 Collins Street 
Adelaide 
Re: Ms. Kylie Weiss; DOB: 21/05/1952 
Dear Ms. Gold 
I am writing to request a home visit by you to Ms. Weiss’s home to assess her 
eligibility  for  receiving  a  sickness  allowance  or  other  benefits  that  the 
Department of Human Services provides. She was admitted to our hospital on 
07/07/2017 following a heart attack and is scheduled to be discharged today. 
Mrs.  Weiss  works  mixed  shifts  as  a  taxi  driver  and  lives  with  her 
husband,  who  is  an  aged  pensioner.  Her  recovery  has  been  encouraging  so 
far, yet she has been advised to refrain from driving until she has recuperated; 
as a result, she will not be returning to work for next six weeks. 
 
Ms.  Weiss  is  concerned  about  being  unable  to  manage  their  home  solely  on 
her  husband’s  pension.  A  home  visit  to  discuss  her  eligibility  for  receiving 
assistance from the government would be appreciated. 
She  has  been  referred  to  a  Cardiac  Rehabilitation  Nurse  and  an 
Occupational  Therapist  to  support  her  to  make  the  recommended  lifestyle 
changes. 
I have attached all the pertinent details for your perusal. Please do not 
hesitate to contact me in the case of any queries. 
Yours sincerely (Your name here) Registered Nurse 
You are a Registered Nurse at the Royal Brisbane Hospital were Anthony 
Nutt is a patient in your care. 
Read the case notes below and complete the case notes that follow. 
CASE NOTES: 
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 
post-operatively. 
• 
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 years old, unmarried – lives 30 minutes away 
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 - 14 pulse oximetry of 100% on room air 
BP - 162/88. a right-sided pedunculated 8 cm × 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 × 2.75 × 5 
cm with post-operative 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 evaluations by doctor 
• 
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 29/05/2017 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 
 
Writing Task 9 
Using  the  information  in  the  case  notes,  write  a  referral  letter  to  the  Ms. 
Carrie  Andrews,  Director  of  Nursing,  Queensland  Aged  Care  Centre,  52 
Albert  Street,  Brisbane  4101,  introducing  the  patient.  Using  relevant  case 
notes, give his background, medical history, and treatment required. 
Sample Answer 1 
29/05/2017 
Ms. Carrie Andrews Director of Nursing Queensland Aged Care Centre 52 
Albert Street Brisbane 4101 
Re: Mr. Anthony Nutt; 86-year-old man 
Dear Ms. Andrews 
I  am  writing  to  refer  Mr.  Nutt  who  has been diagnosed with stage 3 recurrent 
right-sided  breast  cancer.  An oncology evaluation has deemed him unsuitable 
for  curative  treatment,  and  he  is  being  transferred  to  your  facility  today  for 
hospice care. 
Pertinent  surgical  history  includes  a  right  total  mastectomy  20  years  ago 
due  to  right-sided  breast  cancer.  Postoperatively,  he  did  not  receive  any 
adjuvant radiation, chemotherapy, or hormone therapy and did not pursue any 
further  medical  follow-up.  He  lives  with  his  wife,  and  both  of  them  suffer 
from dementia. They have a son, Joseph, who lives 30 minutes away. 
 
While  hospitalization,  he  was  commenced  on  hormone  therapy  with 
tamoxifen  20  mg  daily  with  one  course  of  palliative  radiation.  A  family 
conference  was  held  on  28/052017  to  elicit  the  goals  of  care,  and  hospice 
care  was  found  ideal  for  the  patient  given  his  illness,  cognitive  state,  his 
wife’s debilitating health status, and Joseph’s hectic lifestyle. 
It  would  be  greatly  appreciated  if  you could take over the management of 
this  patient  and  provide  care  to  maintain  his  dignity  and  improve  his  quality 
of  life.  Worthy  to  note,  Mrs.  Nutt  will  be  transferred to your facility the once 
a bed comes available for her. 
Please contact with any questions. 
Yours sincerely (Your name here) 
Sample answer 2 
29/05/2017 
Ms. Carrie Andrews Director of Nursing Queensland Aged Care Centre 52 
Albert Street Brisbane 4101 
Re: Mr. Anthony Nutt; 86-year-old man 
Dear Ms. Andrews 
This  letter  will  introduce  Mr.  Nutt  who  is  suffering  from  stage  3  recurrent 
right-sided  breast  cancer  and  requires  hospice  care  to  improve  his  quality  of 
life. The doctor believes curative treatment is no longer an option for him. 
His  medical  history  is  remarkable  for  right-sided  breast  cancer  20  years 
ago  which  was  treated  with  right  total  mastectomy;  however,  he  did  not 
pursue  any  medical  follow-up  subsequently.  He  lives  with  his  wife,  and both 
are suffering from dementia. Their son, Joseph, lives 30 minutes away. 
While hospitalization, the diagnosis was confirmed with a biopsy, and he 
 
was  subsequently  commenced  on  hormone  therapy  with  tamoxifen  20  mg 
daily  with  one  course  of  palliative  radiation.  The  doctor  conferred  with  the 
patient’s  wife  and  son  and  advised  them  to  proceed  with  hospice  enrolment 
given the wife’s debilitating mental state and Joseph’s hectic lifestyle. 
It  would  be  greatly  appreciated  if  you could take over the management of 
this  patient  and  provide  care  to  improve  his  quality  of  life  and  maintain  his 
dignity.  His  wife  would  live  with  Joseph  until  a  bed  becomes  available  for 
her in your facility. 
Please contact with any questions. 
Yours sincerely (Your name here) 
Read the case notes below and complete the writing task that follows 
CASE NOTES: 
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 
Social Background: Married, Wife- Miranda Clarke, aged 58 years. 
Lives together Retired – Police officer Two daughters- elder daughter works 
in Sydney, younger daughter – Adelaide Quite active 
Medical History: Hypertension – 1985 
Did not seek treatment till 2000; now managed 
 
with Ramipril GERD -1999 
Surgical history: R Ankle dislocation surgery following a car 
accident- 1982, hospitalized for 3 weeks Septoplasty - 1985 Surgery for Anal 
Fistula - 1992 Eye replacement lens surgery -2007 
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,  moderate  joint 
effusion 
• 
Treatment – Sling to keep the elbow immobilized- 6 weeks, Capsule CM 
Plus, Panadol, Ibuprofen, hot compress for pain and 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 
 
Writing Task 10 
Write a referral letter to Amit Kumar, Physiotherapist, Suite 5, 379 Swanston 
Street, Melbourne requesting home visits from the physiotherapist. 
In your answer 
Do not use note form 
Expand the relevant case notes to explain his background and medical history 
and the assistance requested. 
Sample Answer 
01/11/2016 
Mr. Amit Kumar Physiotherapist Suite 5 379 Swanston Street Melbourne 
Re: Mr. Tom Clarke; DOB: 21/09/1954 
Dear Mr. Kumar 
I  am  writing  to  request  daily  home  visits  to  provide  rehabilitative  care  and 
support  for  Mr.  Clarke  who  is  recovering  from  a  fracture  of  the  coronoid 
process of the ulna and a radial head fracture of the left elbow. 
Initially,  he  presented  to  us  on  26/08/2016  with  an  injury  on  his  left 
elbow  following  an  accident,  and  the  diagnosis  was  confirmed  with  an 
X-Ray.  On  that  day,  he  was  advised  to  restrict  the  activity  of  the  impacted 
elbow with a sling 
 
for  optimal  healing  and  commenced  on  Ibuprofen,  Panadol, and Capsule CM 
Plus.  Additionally,  he  was  advised  to  use  warm  compresses  to  alleviate  pain 
and inflammation. 
On  his  subsequent  visit  six  weeks  later,  his  X-ray  was  reviewed  which 
showed progress in healing; therefore, the sling was removed, and an exercise 
program was initiated to promote healing. 
The  patient  was  seen  in  a  follow-up  today  when  he  complained  of 
stiffness  and  limited  range  of  motion  of  the  left  elbow;  consequently,  he was 
recommended  a  rehabilitation  program,  supervised  by  a  physiotherapist,  to 
restore movement and strength to the elbow. 
It would be greatly appreciated if you could visit him at home and assist 
him with regaining a full function of his elbow. 
Please contact with any questions. 
Yours sincerely Ramona Decosta Senior Nurse Helpline Hospital 
Sample 2 
01/11/2016 
Mr. Amit Kumar Physiotherapist Suite 5 379 Swanston Street Melbourne 
Re: Mr. Tom Clarke; DOB: 21/09/1954 
Dear Mr. Kumar 
I  am  writing  to  request  daily  home  visits  to  provide  rehabilitative  care  and 
support  for  Mr.  Clarke  who  presented  to  us  on  26/08/2016  with  an  injury  on 
his left elbow following an accident and was diagnosed with a nondisplaced 
 
fracture of the coronoid process of the ulna and a radial head fracture of the 
left elbow. 
On  that  day,  he  was  advised  to  restrict  the  activity  of the impacted elbow 
with  a  sling  for  optimal  healing  and  commenced  on  Ibuprofen,  Panadol,  and 
Capsule  CM  Plus.  Additionally,  he  was  advised  to  use  warm  compresses  to 
alleviate pain and inflammation. 
On  his  subsequent  visit  six  weeks  later,  his  X-ray  was  reviewed  which 
showed progress in healing; therefore, the sling was removed, and an exercise 
program was initiated to promote healing. 
The  patient  was  seen  in  a  follow-up  today  when  he  complained  of 
stiffness  and  limited  range  of  motion  of  the  left  elbow;  consequently,  he was 
recommended  a  rehabilitation  program,  supervised  by  a  physiotherapist,  to 
restore movement and strength to the elbow. 
It would be greatly appreciated if you could visit him at home and assist 
him with regaining a full function of his elbow. 
Please contact with any questions. 
Yours sincerely Ramona Decosta Senior Nurse Helpline Hospital 
You  are  a  Registered  Nurse  at  Pullman  Medical  Centre.  Ms.  Paula Anderson 
is a patient in your care who is being transferred to Holy Heart Hospital today 
for a colostomy scheduled on 05/02/2018. 
Patient name: Ms. Paula Anderson 
Today’s date: 02/02/2018 
DOB: 19/05/1954 
Marital status: Married 
Social background: Lives with husband - very supportive 
 
1 daughter-lives interstate Two sisters- live nearby Retired school teacher 
(English) Hobbies: playing badminton, watching movies Likes socialising, 
playing chess Sedentary lifestyle – Overweight since 30’s 
Medical background: appendectomy – 2003 
# left leg – 2007 pneumonia – 2015 arthritis in hands – uses Voltaren 
Diet: Red meat, processed meat 
Fast food Alcohol (Vodka, wine) – 4-5 days/wk. Ex-smoker – quit 15 years 
ago 
Nursing notes 
28/12/2017 Visit to GP, 2- 3 bleeding from rectum rectal 
exam- definitely palpable mass Fast track referral for suspected colorectal 
cancer 
11/01/2018 8 cm mass on left lateral wall of rectum likely to 
be carcinoma – referred for colonoscopy 
14/01/2018 colonoscopy- biopsies large bowel mucosa taken 
18/01/2018 CT & Local staging of primary tumour with MRI 
23/01/2018 Review of histology – colonoscopy report 
Diagnosis – Colon cancer R/v by colorectal and general surgery consultant 
CT – no evidence of metastatic cancer Recommended colostomy Pt. advised 
of diagnosis and surgery 
02/02/2018 
 
Prepare Identified 
for colostomy needs/problems: 
Eating and drinking: Potential problems of dehydration due to above Anxious 
about probs of stoma on home and social life. Involve family members in 
care 
Objectives minimise risk of post-op., wound infection from 
bowel contents Allow surgeons clear access to operation site i.e. free from 
faeces Complete pre-op. Care schedule Encourage patient to voice concerns 
Plan Rectal wash-out before bedtime for three days 
(daily) Purgatives as desired Low-residue light diet 02/02 Fluids only 
including soup and ice cream 02/03 Clear fluid 02/04 Charge Nurse to see the 
pt. to discuss practical problems at home Nil by mouth from 00.00 hours 
02/05 Standard pre-op procedure Ensure variety of acceptable drinks 
 
Writing Task 11 
Using  the  information  given  in  the  case  notes,  write  a  letter  to  Ms.  Meredith 
Stevens,  Charge  Nurse,  Holy  Heart  Hospital,  119  Red  Sparrow  Road, 
Docklands,  Melbourne  outlining  relevant  findings  and  patient  care  plan  to 
prepare Ms. Anderson for the surgery. 
Sample letter 
02/02/2018 
Ms. Meredith Stevens Charge Nurse Holy Heart Hospital 119 Red Sparrow 
Road Docklands Melbourne 
Re: Ms. Paula Anderson; DOB: 19/05/1954 
Dear Ms. Stevens 
I am writing to refer Ms. Anderson who has been diagnosed with colon 
cancer and is being transferred to your facility today for colostomy on 
05/02/2018. 
To  prepare  Ms.  Anderson  for  the  surgery,  she  needs  to  reduce  her  fluid 
and  diet  intake;  consequently,  there  is  a  possibility  of  the  patient  becoming 
dehydrated.  She  can  be  given  a  low-residue  diet  today  followed  by  fluids 
only  the  next  two  days,  and  you  are  requested  to  ensure  a  variety  of 
acceptable  drinks.  It  is  imperative  that  Ms.  Anderson  eats  and drinks nothing 
from midnight on the day of the operation. 
 
To  ensure  that  the  surgeon  can  have  clear  access  to  the  operation  site,  rectal 
wash-outs  should  be  given  each  evening  before  the  operation  so  that  her 
bowel  is  clear  of  all  faecal  matter.  Moreover,  Ms.  Anderson  is worried about 
the  consequences  of  colostomy;  hence,  you  are  requested  to  meet  her  on 
04/02/2018  to  discuss  anticipated  problems  at  home  following  the  surgery 
and  educate  her  on  managing at home. It is also advisable to guide her family 
on how they can be involved in Ms. Anderson’s care at home. 
The patient’s medical reports are attached to this letter. Please contact 
with any questions. 
Yours sincerely (Your name here) 
Today’s Date: 27/12/2017 
Notes 
You are a registered nurse in the Coronary Care Unit, St Vincent’s Hospital 
Melbourne. Derek Shepherd is a patient in your care. 
Patient Details 
Name: Derek Shepherd 
DOB: 13 September 1970 
Address: 108 Queen Street Melbourne 
Admitted: 20 December 2017 
Date of discharge: 27/12/2017 
Diagnosis Obstructive coronary artery disease 
Operation Coronary artery bypass grafts (x 4) 
Social History 
• 
Never married 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Lives alone in own home Works as a Business Development Manager at a 
bank 
Medical History 
Constipation occasionally- takes isabgol for relief Smokes 5-6 cigarettes/day 
Alcohol: 2 x 300 ml bottles beer/day Ht 185 cm Wt 102 kg (BMI- 29 
Overweight) 
Dietary habits: sausages, deep fried chips, pizzas, pastas, 
Allergic reaction to nuts 
20/12/2017 
History of presenting complaint: severe chest pain, extreme tightness in chest 
– felt like someone is standing on his chest, heaviness in both forearms, 
shortness of breath Chest pain started 3-5 months ago, has been increasing in 
intensity since, got worse on exertion Diagnosed with Obstructive Coronary 
artery disease 
Nursing Management and Progress 
21/12/2017 
Operation coronary artery bypass grafts (x4) Routine postoperative recovery 
Pain/Discomfort managed 
23/12/2017 
Constipation related to decrease response to urge to defecate secondary to 
surgical procedure – no stool for 2 days Pt. given isabgol for constipation 
Pain – 5/10 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
PT commenced- Rev. by Physio Position change every 4 qh 
24/12/2017 
Knowledge deficit re diagnosis, surgical procedure, seemed confused- 
educated regarding event PT – continued Low fat diet No complaints of 
constipation 
26/12/2017 
Pain 2/10 Pt. walking well – routine visits by PT Pt. explained post discharge 
instructions (resume work after 4 wks., avoid travelling/strenuous exercises 
till 6 wk., follow-up after 6 wks, medications) Pt. counselled on changes to 
lifestyle (cease smoking- referred to Quit line, decrease alcohol, reduce 
weight, low-fat diet, exercise regime) Pt. has knowledge and understanding 
of diagnosis, procedure, long term rehabilitation – worried about future as 
evidenced by patient verbalization “I don’t know how I will cope with my job 
and finances, I might be fired if I don’t go to work for a month” – refer to 
Cardiac Rehab. S/W for support Wound healing well – daily dressing change 
Pt. educated re smoking cessation – referred to Quit line Pt. educated re 
decreasing alcohol Low fat diet 
Medications: Aspirin 1⁄2 daily, Vicodin q4 
Discharge Plan 
 
• 
• 
• 
• 
• 
• 
• 
Returning Home – avoid strenuous activities, travelling till 6 wks., resume 
work after 4 wks. Follow-up visit after 6 weeks Refer to District Nurse – 
wound management, monitor medications, diet, temp. Call Hospital if wound 
swollen, temp rises above 101-degree F Local physiotherapist to continue 
rehabilitation exercise program- increase physical strength, gradually 
increase physical activity Low-fat diet after discharge – pt. Requested more 
information on simple low-fat recipes that can be prepared at home Refer to 
local Social Worker at Cardiac Rehab. for support to pt. for applying leave 
from work, financial assistance 
 
Writing Task 12 
Using  the  information  given  in  the  case  notes,  write  a  letter  to  Dr  Addison 
Burke,  Dietician,  Suite  1,  348,  5th  floor,  Church  Street,  Melbourne 
requesting  information  on  dietary  guidelines  for  Mr.  Shepherd.  The 
information should be sent to his home address. 
• 
Expand the relevant case notes into complete sentences 
• 
Do not use note form 
• 
The body of the letter should not be more than 200 words 
Sample letter: 
27/12/2017 
Dr Addison Burke Dietician Suite 1, 348, 5th floor Church Street Melbourne 
Re: Mr. Derek Shepherd; DOB: 13/09/1970 
Dear Dr. Burke 
The  purpose  of this letter is to solicit low-fat dietary guidelines for the above- 
captioned  patient  who  presented  to  us  on  20/12/2017,  was  diagnosed  with 
obstructive  coronary  artery  disease,  and  underwent  a  coronary  artery  bypass 
graft under our care. He is being discharged today. 
His risk factors include being overweight, due to a diet primarily 
consisting of fat-rich foods like sausages, pasta, pizzas, and deep-fried chips. 
 
His  height  is  185  cm,  and  he  currently  weighs  102  kg.  Moreover,  he  is  a 
smoker  and  smokes  about  5-6  cigarettes  a day. Further, he drinks two 300 ml 
bottles  of  beer  regularly.  His  medical  history  is  significant  for  intermittent 
bouts of constipation that is relieved with isabgol, and allergy to nuts. 
Mr.  Shepherd has progressed well after the surgery. He has been educated 
regarding  smoking  cessation  and  reducing  his  alcohol  intake.  Moreover,  he 
has  been  advised  to  lose  weight  through  exercise  and  diet;  therefore,  he  has 
requested  detailed  advice  on  simple  low-fat  recipes  that  can  be  easily 
prepared at home. 
Therefore, it would be greatly appreciated if you could send this 
information to his address, attached to this letter. 
Should you have any questions, please do not hesitate to contact me. 
Yours sincerely (Your name here) 
 
Writing Task 13 
Using  the  information  given  in  the  case  notes,  write  a  letter  to  Ms.  Christina 
Yang,  Senior  Social  Worker,  Cardiac  Rehabilitation  Program,  Elizabeth 
Hospital,  43-47  King  Street,  Melbourne  to  provide  support  service  to  the 
patient to help him re-adjust to normal life. 
Sample letter 
27/12/2017 
Ms. Christina Yang, Senior Social Worker Cardiac Rehabilitation Program 
Elizabeth Hospital 43-47 King Street Melbourne 
Re: Mr. Derek Shepherd; DOB:13/09/1970 
Dear Ms. Yang 
I  am  writing  to  refer  Mr.  Shepherd  who  is  recovering  from  a  heart  bypass 
surgery  and  requires  your  assistance  to  apply  for  financial  aid  and  4-week 
leave  from  work.  He  was  admitted  on  20/12/2017  and  is  being  discharged 
today. 
Postoperatively,  Mr.  Shepherd  has  progressed  well  and  made  an 
encouraging  recovery;  nevertheless,  he  has  been  advised to get sufficient rest 
and recommence work after four weeks. 
Mr. Shepherd works as a Business Development Manager at a bank and is 
 
worried  about  maintaining  his  employment  and  taking  time  off  work  for  a 
month.  Additionally,  he  is  concerned  about  experiencing  financial  strains 
owing to a potential reduction in income until he resumes work. 
Given  the  above,  it  would  be  highly  appreciated  if  you  could  inform  his 
employer  of  his  situation  and  arrange  a  4-week  employment  leave  for  him. 
Moreover,  please  assist  him  in  applying  for  financial  aid  to  minimize  his 
stress during the recovery period. 
Enclosed  herewith  is  the  supportive  documentation  regarding  patient’s 
medical  condition.  Should  you  have  any  further  queries,  please  do  not 
hesitate to contact me. 
Yours sincerely (Your name here) 
 
Writing Task 14 
Using  information  given  in  the  case  notes,  write  a  referral  letter  to  Ms. 
Patricia  Welsh,  Physiotherapist,  305,  Third  Floor,  Central  Park,  Melbourne 
requesting her to supervise the patient’s home-based exercise program. 
Sample letter 
27/12/2017 
Ms. Patricia Welsh Physiotherapist 305, Third Floor Central Park Melbourne 
Re: Mr. Derek Shepherd; DOB:13/09/1970 
Dear Ms Welsh 
This  letter  will  introduce  the  above-captioned  patient  who is recovering from 
a  coronary  artery bypass graft surgery and requires ongoing support from you 
to  continue  his  cardiac  rehabilitation  exercise  program  at  home.  He  lives 
alone and is being discharged today. 
He  presented  to  us  on  20/12/2017  and  underwent  an  uneventful  surgery. 
Postoperatively,  he  was  reviewed  by  a  physiotherapist  who  commenced  him 
on  an  exercise  program  to  promote  strength  and  healing;  consequently,  his 
ambulatory  status  has  improved,  and  he  can  mobilize  independently.  He  has 
attained  significant  recovery  and  has  been  recommended  to  lose  weight  to 
ensure  good  general  health.  His  height  is  185  cm,  and  he  currently  weighs 
102 kg. 
 
Given  the  above,  it  would  be  greatly  appreciated  if  you  could  visit  him daily 
to  ensure  his  compliance  with  the  recommended  exercise  regime  and  assist 
him  in  regaining  his physical strength. Of note, he has been advised to refrain 
from  strenuous  activities  for  six  weeks;  therefore,  please  ensure  that  he 
increases his physical activities gradually. 
Should you have any further queries, please do not hesitate to contact me. 
Yours sincerely (Your name here) 
 
Writing Task 15 
Using the information given in the case notes, write a letter to the Ms. Anna 
Thompson, District Nurse, requesting follow-up care for this patient. 
Sample letter 1 
27/12/2017 
Ms. Anna Thompson District Nurse Re: Mr. Derek Shepherd; 
DOB:13/09/1970 
Dear Ms. Thompson 
This  letter  will  introduce  Mr.  Shepherd  who  is  recovering  from  a  coronary 
artery  bypass  surgery.  He  was  admitted  to  hospital  on  20/12/2017.  He  lives 
alone and requires follow-up care from you following his discharge today. 
During  hospitalization,  the  patient  responded  well  to  the  adopted 
treatment  plan  which  focused  on  adequate  pain-relief,  postoperative 
physiotherapy,  patient  education  regarding  the  risk-factor  management,  and 
regular wound dressing. 
It  would  be  greatly  appreciated  if  you  could  monitor  his  progress  to 
ascertain  if  any  risks  are  present.  Kindly  call  us  immediately  if  his  body 
temperature  rises  above  101  degrees  or  the  wound  site is swollen or infected. 
Additionally,  please  continue  the  wound management and ensure compliance 
with  the  discharge  medications  and  low-fat  diet  plan.  His  medication chart is 
attached  to  this  letter,  and  the  diet  plan  will  be  sent  directly  to  his  house  by 
the dietician. 
 
Worthy  to  note,  he  needs  to  abstain  from  traveling  and  participation  in 
strenuous  activities  until  his  follow-up  appointment  scheduled  in  6  weeks’ 
time.  He will be able to resume work after four weeks, and he needs to ensure 
adherence  to  the  post-discharge  instructions  for  which  appropriate  referrals 
have been made. 
Should you have any further queries, please do not hesitate to contact me. 
Yours sincerely (Your name here) 
Sample letter 2 
27/12/2017 
Ms. Anna Thompson District Nurse 
Re: Mr. Derek Shepherd; DOB:13/09/1970 
Dear Ms. Thompson 
The  purpose  of  this  letter  is  to  request  regular  home  visits  for  the  above- 
captioned  patient  who  presented  to  us  on  20/12/2017  and  underwent  a 
coronary  artery  bypass  surgery  under  our  care.  He  is  being  discharged  today 
and lives on his own. 
He  has  made  remarkable  progress  in the hospital; nevertheless, additional 
medical  care  is  needed  from  until  his  follow-up  appointment  in  six  weeks’ 
time. 
His  wound  has  been  healing  well,  and  you  are  requested  to  change  the 
dressing  on  the  wound  site  daily.  Moreover,  please  monitor  him  closely,  and 
notify  us  immediately  in  case  his  wound  site  is  swollen  or  his  body 
temperature  exceeds  101  degrees.  Further,  please  ensure  adherence  to  the 
discharge  medications,  which  include  1/2  Aspirin  daily  and  Vicodin  every  4 
hours. 
Besides that, could you also ensure that the patient is compliant with the 
low-fat diet plan, which will be directly sent to his by the dietician? Of note, 
 
he  has  been  advised  to  refrain  from  traveling  and  rigorous  activities  for  six 
weeks,  but  he  will  be  able  to  resume  work  after  four  weeks.  He  has  been 
counseled  on  risk-factor  management  after  discharge,  and  appropriate 
referrals have made to support his recovery. 
Please contact me with any questions. 
Yours sincerely (Your name here) 
CASE NOTES: 
You are a Registered Nurse at Brockville Hospital, Melbourne. 
Today’s date: 15/02/2017 
Patient name: Ms Elizabeth Carmel 
Prefers to be addressed as: 
Izzie 
Address: 456, Francis Street, Brockville, Melbourne 
Next of kin: George Thompson (husband) 
BMI: 33 
DOB: 02/04/1975 
13/02/2017 
Source of assessment: Husband 
• 
Attended a party last night – complained of abdominal pain and vomiting 
after the party 
• 
Today - became unconscious after feeling unwell and increasingly drowsy at 
home 
• 
BIBA with husband to hospital 
• 
Unconscious on admission - Husband thinks she fainted due to diabetes 
 
• 
• 
• 
• 
• 
• 
• 
• 
Diagnosed with diabetes 2 years ago – poor management with diet and 
medication (misses insulin doses) Diet: pancakes, 3-4 cups coffee, cheese 
omelette, muffins, biscuits, Fish and chips, fried chicken, sweetened juices, 
drinks wine daily (1-2 glasses) , whiskey occasionally Irregular eating 
pattern, fasting for long periods of time/bingeing Underwent cataract surgery 
10 years ago Takes multivitamins at home daily Not very active – goes for a 
slow walk 1-2 times/week No hx of any allergies/no medications Nil relevant 
medical history 
Objective 
Breathing rate – 32/min 
Cough – Nil 
Colour – pale dry skin, lips pink 
BP- 90/45 mmHG 
P- 128/min 
Teeth- own 
Mouth- clean and dry 
Acetone breath 
Blood  gas  analysis  -  severe  metabolic  acidosis  (pH-  6.74,  bicarbonate  5 
mmol/L,  blood  ketones  -  >  8.0  mmol/L,  serum  glucose  –  400  mg/dL,  anion 
gap - 24) 
Other lab tests – abnormal 
Admission Dx- diabetic ketoacidosis 
Nursing Management: 
 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Aggressive IV Fluids, norepinephrine, bicarbonate, insulin, IV bolus No 
evidence of infection Regained consciousness K replacement administrated 
Intake/output accurately Oxygen sat. 
14/02/2017 
Blood glucose, Fluid, electrolyte, hydration status constantly monitored 
Mental status – normal Vital signs – normal Pt. urinating – renal function 
restored ECG reading – no sign of hyperkalaemia K+ values approaching 
normal Pt. tired – reports feeling “crampy and achey” Pt. educated re 
importance of taking insulin on time, importance of timely balanced meals to 
avoid emergency situations in future 
15/02/2017 
Pt. ready to be discharged home with husband 
Discharge plan 
Initiate referrals to dietician, outpatient diabetes education, physiotherapist, 
District Nurse, Physiotherapist – initiate exercises for weight-loss, increase 
physical activity Dietician – correct imbalanced nutrition related to food, 
low-fat diabetic diet schedule – pt. requests info on options when out – send 
to home address Diabetes education from Diabetes Specialist Nurse re 
diabetes 
 
• 
• 
(maintain metabolic control in future, bingeing, wrong foods & less physical 
activity hyperglycaemia, monitor urine –ketones) – to risk of future episodes 
– request home visit District nurse to monitor pt. -compliance with diabetes 
management, reinforce education re not missing insulin dose and mealtimes, 
educate re timing of insulin inj. & mealtime (30 minutes), monitor 
compliance with diet regimen and weight-loss program - Contact hospital 
immediately if unable to retain oral fluids Review after 15 days 
 
Writing Task 16 
Using  the  information  given  in  the  case  notes,  write  a  letter to Ms. Samantha 
Golden,  Diabetes  Specialist  Nurse,  Victoria  Health  Education  Centre,  Suite 
548,  4th  floor,  34  Collins  Street,  Melbourne  requesting  her  to  visit  your 
patient at home to provide instructions on continued self-care after discharge. 
15/02/2017 
Ms. Samantha Golden Diabetes Specialist Nurse Victoria Health Education 
Centre Suite 548 4th floor 34 Collins Street Melbourne 
Re: Ms. Elizabeth Carmel; DOB: 02/04/1975 
Dear Ms. Golden 
I  am  writing  to  refer  Ms.  Carmel,  a  diabetic  patient,  who  was  admitted  in  an 
unconscious  state  on  13/02/2017,  was  diagnosed  with  diabetic  ketoacidosis, 
and  is  being  discharged  today.  She  requires  a  home  visit  for  education  on 
diabetes management to reduce the risk of a future diabetic emergency. 
Her  husband  reported  that  she was diagnosed with diabetes two years ago 
but  is  poorly  compliant  with  timely  administration  of  insulin.  He  also  said 
that  she  consumes  fat-rich  diet  and  a moderate quantity of alcohol and has an 
irregular  eating  pattern.  Her  BMI  is  above  the  ideal  range  (33),  and  she 
engages in little physical activity. 
 
While  hospitalization,  she  responded  well  to  the  treatment  and  was  educated 
on  the  role  of  timely  doses  of  insulin  and  diet  to  control  her  diabetes.  Her 
condition has stabilized, and she will be reviewed after 15 days. 
Given  Ms.  Carmel’s  history  and  recent  emergency,  please  guide  her  on 
how  to  maintain  metabolic  control  in  the  future  as  well  as  the  dangers  of 
hyperglycaemia  resulting  from  excessive  food  intake,  eating  the wrong kinds 
of  food,  and  decreased  activity  levels. Further, she will also need to know the 
methods of testing urine for ketones. 
Please contact me with any questions. 
Yours sincerely (Your name here) 
 
Writing Task 17 
Using  the  information  given  in  the  case  notes,  write  a  letter  to  Ms.  Angelina 
Hobbs,  Dietician,  Salona  Health  Clinic,  Suite  404, 11th Floor, Bourke Street, 
Melbourne. 
15/02/2017 
Ms. Angelina Hobbs Dietician Salona Health Clinic Suite 404, 11th Floor 
Bourke Street Melbourne. 
Re: Ms. Elizabeth Carmel; DOB: 02/04/1975 
Dear Ms. Hobbs 
The  purpose  of  this  letter  is  to  request  low-fat,  diabetic  guidelines  for  Ms. 
Carmel,  a  diabetic patient, who was admitted to hospital on 13 February in an 
unconscious  state  owing  to  diabetic  ketoacidosis.  Her  condition  has 
stabilized, and she is being discharged today. 
Ms.  Carmel  has  had poorly-controlled diabetes for two years, and her risk 
factors  include  non-compliance  with  timely  administration  of  insulin  and 
consumption  of  a  fat-rich  diet  including  pancakes,  3-4  cups  of coffee, cheese 
omelette,  muffins,  biscuits,  fish  and  chips,  fried  chicken,  and  sweetened 
juices.  She  also  consumes  1-  2  glasses  of  wine  daily  and  whiskey 
occasionally.  Moreover,  little  physical  activity  compounded  with  the  wrong 
choice  of  foods  and  erratic  eating  patterns  have  led  her  to  become  obese 
(BMI 33). 
 
With  treatment, her condition has improved, and adequate referrals have been 
arranged  to  increase  her  knowledge  of  precipitating  factors  to  avoid 
recurrences in the future. 
It  would  be  greatly  appreciated  if  you  could  advise  a  low-fat,  diabetic 
dietary  timetable  for  Ms.  Carmel  to  correct  her  nutrition  imbalance.  She  has 
also  requested  information  on  meal  choices  outside  the  home.  This 
information needs to be sent directly to her home address. 
Please contact me with any questions. 
Yours sincerely (Your name here) 
 
Writing Task 18 
Using  the  information  given  in  the  case  notes,  write  a  referral  letter  to  Ms. 
Pamela  Wilkins,  District  Nurse,  requesting  her  to  visit  Ms.  Carmel  at  home 
for monitoring her condition. 
15/02/2017 
Ms. Pamela Wilkins District Nurse 
Re: Ms. Elizabeth Carmel; DOB: 02/04/1975 
Dear Ms. Wilkins 
I  am  writing  to  request  home  visits  to  monitor  Ms.  Carmel’s  condition 
following  her  discharge  today.  She  was  admitted  on  13  February  in  an 
unconscious state owing to diabetic ketoacidosis. 
Ms.  Carmel  has  had  diabetes  for  the  past  two  years  with  poor  adherence 
to  timely  insulin  administration.  Moreover,  she  consumes  a  fat-rich  diet with 
moderate  alcohol consumption and has irregular eating habits. She engages in 
little physical activity and is obese (BMI 33). 
While  hospitalization,  she  has  progressed  well  and  has  been  educated  on 
the  importance  of  diabetes  management.  The  referrals  to  the  dietician  for  a 
diet  schedule  and  the  physiotherapist  for  a  weight-loss  program  have  been 
arranged,  and  a  home  visit  by  a  diabetes  specialist  nurse  has  been  requested 
to educate the patient on self-care at home. 
Kindly reinforce the education already provided in the hospital regarding 
the necessity of not missing insulin doses, eating meals at regular intervals, 
and 
 
maintaining  a  gap  of  30  minutes  between  insulin  injections  and  mealtimes. 
Additionally,  please  ensure  that  the  patient  is  compliant  with  recommended 
diet  timetable  and  weight-loss  program.  In  case  she  is  unable  to  retain  any 
fluids, please contact us immediately. Of note, she is due for a review after 15 
days. 
Please contact me with questions. 
Yours sincerely (Your name here) 
 
Writing Task 19 
Using  the  information  given  in  the  case  notes,  write  a  referral  letter  to  Ms. 
Alka,  Physiotherapist,  GNB  Medical  Centre,  45-50  Sacramento  Road, 
Coburg requesting her to visit Ms. Carmel at home for initiating a weight-loss 
program. 
15/02/2017 
Ms. Alka Physiotherapist GNB Medical Centre 45-50 Sacramento Road 
Coburg 
Re: Ms. Elizabeth Carmel; DOB: 02/04/1975 
Dear Ms. Alka 
I  am  writing  to  refer  Ms.  Carmel,  an  obese  woman,  who  was  admitted  on 13 
February  in  an  unconscious  state  owing  to  a  diabetes-related  complication. 
She  is  being  discharged  today,  and  she  requires  home  visits  from  you  for  a 
weight- loss program. 
Up  until  now,  her  lifestyle  has  comprised  of  little  physical  activity  in  her 
routine.  She  goes  for  a  slow  walk  one  to  two  times  in a week. Moreover, she 
consumes  a  fat-rich  diet;  consequently,  she  is  obese,  and  her  current  BMI  is 
33.  Owing  to  these  lifestyle  habits,  she  has  had  poorly  managed  diabetes  for 
the past two years. 
With treatment, her condition has improved; however, she needs to lose 
weight and increase physical activity for better management of diabetes and 
to 
 
reduce  the  risk  of  diabetes-related  emergencies  in  the  future.  A  dietician  has 
been  requested  to  send  low-fat,  diabetic  guidelines  to  her  house  directly,  and 
she is due for a review in 15 days’ time. 
It  would  be greatly appreciated if you could visit Ms. Carmel at her house 
and  initiate  an  exercise  program  to  promote  her  weight-loss.  Moreover, 
please  assist  her  in  gradually  increasing  physical  activity  to  achieve  better 
diabetes control. 
Please contact me with any questions. 
Yours sincerely (Your name here) 
 
References 
http://slideplayer.com/slide/5293088/ 
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Information 
https://www.occupationalenglishtest.org/test-information/speaking/ 
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thing.html 
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https://quizlet.com/114769879/10-rights-of-medication-administration-flash- 
cards/ 
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http://thevirtualwolf.com/index.php/general-administration/ 
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- 3-managing-a-patients-dietary-needs-advanced-podcast/157048.article 
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http://www.travelvax.com.au/holiday-traveller/vaccination-requirements 
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- 2-taking-a-patients-medication-history-advanced-podcast/156911.article 
 
http://www.onestopenglish.com/esp/nursing/pdf-content/nursing-english-part
- 1-pain-assessment-advanced-podcast/156854.article 
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relief-for-minor-wounds-and-burns 
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umoreducation 
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walker-or-cane 
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coming-back.aspx 
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Professionals/netp/Documents/Powerpoint%20on%20MI%20Case%20Study
%20Pres%20F 
https://www.scribd.com/document/256718259/FreeTipstogetBGradeinOET 
 
https://casesjournal.biomedcentral.com/articles/10.4076/1757-1626-2-8357 
 
Gurleen  Khaira  is  a  nationally-acclaimed  OET  trainer,  entrepreneur,  and 
career  counsellor.  She  has  a  post-graduate  qualification  in TESOL (Teaching 
English  to  Speakers  of  Other Languages), and her purpose and passion lies in 
helping  students  with  their  English  language  skills.  She  has  received  four 
national  awards  for  her  work  in  the  education  sector and has been featured in 
national publications on numerous occasions. 
She  is  the  OET-course  leader  at  Khaira  Education,  India’s  first  Premium 
Preparation  Provider  for  OET  training.  To  date,  she  has  helped  hundreds  of 
health  professionals  in  passing  the  OET  with  an  A/B  on  their  first  attempt. 
She  has  been  involved  with  soft-skills  and  English  language  training  since 
2013,  following  her  return  to  India  from  Australia  where  she  attended  the 
University of Melbourne. 
This is her second book after her first book, OET Speaking and Writing 
Made Easy for Nurses. 

About the Author