The candidate card
Setting
Surgical ward
Candidate
You are a nurse on a surgical ward. Mr Daniel Brooks, aged 58, is on day 2 after an open bowel resection. He is charted regular paracetamol 1 g four times a day and oral oxycodone 5–10 mg every 4 hours as needed, plus regular laxatives. He has refused all oxycodone doses since his epidural was removed yesterday. Overnight staff noted he is reluctant to move, is taking shallow breaths and rated his pain 7/10 when sitting up. The physiotherapist wants him to walk this morning.
Task (interlocutor: patient)
- Assess Mr Brooks's pain (location, severity, effect on breathing, coughing and moving)
- Find out why he has been refusing the prescribed pain relief
- Explain why good pain control is important after surgery (deep breathing, coughing, walking; preventing chest infection and blood clots)
- Reassure him about his concerns regarding the pain medication
- Explain the pain relief plan and encourage him to take the medication before the physiotherapy session
In the test you get 3 minutes to read the card and plan, then about 5 minutes to talk. This card is original, written for this site; the interlocutor's card is not shown.
How to approach this card
- Open with a broad question about how he is feeling, then narrow down. The overnight notes mention reluctance to move and shallow breathing, so link your questions to what happens when he sits up, coughs or takes a deep breath.
- Ask about the refusals without hinting that he is wrong, and invite his own explanation. Likely worries include side effects, dependence or drowsiness, but let him say what is behind it. Also ask whether it began after the epidural came out.
- Explain pain control in terms of his own recovery: comfortable breathing, coughing and walking protect his lungs and circulation. Keep it brief and personal, because an early lecture can feel like pressure to take tablets.
- Deal with his specific concern before pushing the plan. Acknowledge it, give honest information about the medicines charted for him, including the regular paracetamol and laxatives, and do not promise he will have no pain at all.
- Tie the plan to the walk this morning: taking the medicine beforehand so moving is more manageable. If time is short, prioritise his reason for refusing, then the plan. Close by asking whether he agrees and how he will tell you if pain stays high.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- I can see sitting up is really uncomfortable for you. Tell me what it feels like.
- I noticed you have not wanted the oxycodone. Can you help me understand why?
- Many people worry about strong pain medicines, so I am glad you told me.
- Shall we plan the timing so the medicine is working before you walk with the physiotherapist?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| bowel resection | an operation to remove a section of your bowel |
| epidural | the small tube in your back that was giving you numbing pain relief |
| oxycodone | a stronger pain tablet your doctor has ordered for when you need it |
How this card is marked
Two assessors mark the recording on nine criteria: intelligibility, fluency, appropriateness of language and resources of grammar and expression (each 0–6), then relationship building, understanding and incorporating the patient's perspective, providing structure, information gathering and information giving (each 0–3). Grade B usually means 5 on each language criterion and 2 on each clinical one. See the AI Speaking practice guide for what each criterion looks for.
More Nursing role-play cards
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- Bronchiolitis: father wants antibiotics and to take his baby home Paediatric ward
- Discharge after a heart attack: medicines and recovery Cardiology ward
All sets: nurses, doctors, other professions. Your profession's guide: OET Nursing.
Questions about this role-play
What if he says he is afraid of becoming addicted?
Acknowledge it as a common and reasonable worry, then explain only what you know: it is ordered as needed and the team will review it. If he wants more detail, offer to ask the doctor to talk with him rather than guessing.
Should I bring up the epidural being removed?
Yes, gently, because the card links the refusals to the time since its removal. Ask whether his pain has felt different since then and whether that affected his decision. Do not assume the epidural is the reason.
What if he still refuses after my explanation?
Do not argue. Ask what would make him more comfortable, remind him the regular paracetamol is still charted, and say you will let the doctor and physiotherapist know. Respect his decision, and tell him he can change his mind at any time.
Sources
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