The task
Original independent practice. The patient details, observations and individual care arrangements are fictional. Assume that today's date is 3 November 2026. Mr Ropata is returning to his aged care facility today. Allow 45 minutes: 5 minutes reading and 40 minutes writing.
You are a registered nurse on the respiratory ward. Using the case notes, write to Ms Hinemoa Poutama, the residential care nurse, handing over Mr Ropata's changed sputum-clearance support needs and escalation plan. Address the letter to Ms Hinemoa Poutama, Residential Care Nurse, Residential Care Nursing Office, 26 High Street, SW19 1AA, United Kingdom. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Discharge letter.
Free · no sign-up · nursing
Which case notes belong in this letter?
Bronchiectasis after an exacerbation: discharge
You are a registered nurse on the respiratory ward. Using the case notes, write to Ms Hinemoa Poutama, the residential care nurse, handing over Mr Ropata's changed sputum-clearance support needs and escalation plan. Address the letter to Ms Hinemoa Poutama, Residential Care Nurse, Residential Care Nursing Office, 26 High Street, SW19 1AA, United Kingdom. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Hone Ropata
- DOB: 19/06/1942 (84 yrs)
- Admitted 21/10/26; discharge 03/11/26
- Resident: aged care facility, 26 High Street, SW19 1AA, UK
Social background and pre-illness routine
- Staff administer medicines and assist with washing
- Before illness: small amount pale sputum; coughed it up unaided
- Previously completed daily breathing exercises independently; no nursing prompts
- Daughter visits weekly; aware of planned return
- Prefers sitting in chair rather than lying for exercises
- Complained about another resident's visitors; asks nurse to confront them
Medical history
- Bronchiectasis diagnosed 2018; respiratory team follow-up
- Hearing impairment; hearing aids improve ability to follow instructions
- Cataract surgery 2021; no current eye symptoms
- Never smoked; no home oxygen
Admission and treatment
- 21/10: fever, ↑ breathlessness and ↑ sputum → admission
- Sputum sent for culture; antibiotic course completed 03/11
- Initially tired; struggled to cough sputum out without help
- 30/10: respiratory physiotherapist retrained active cycle of breathing technique
- Taught sequence: upright sitting → relaxed breaths → deeper breaths → relaxed breaths → huff/cough as needed
- Rest with relaxed breathing between active stages; avoid forceful repeated coughing
Current progress
- 02/11: clears sputum better with prompting; still omits steps independently
- 03/11: afebrile; breathlessness at baseline; no supplemental oxygen
- Sputum now smaller amount and paler than on admission
- Walking to dining room with frame; rests when tired
Documented individual discharge plan
- Discharge plan: nurse supervises/prompts exercises daily, including when cough improves
- Record sputum amount/colour and changes in breathlessness
- Urgent GP assessment if no ambulance criteria below: fever, ↑ breathlessness/sputum, or blood confined to a few spots/streaks in sputum
- Call ambulance: severe breathing difficulty; blood exceeding a few spots/streaks; any blood with breathing difficulty, chest/upper back pain or very fast heartbeat. Ambulance criteria take priority regardless of blood amount
- Physiotherapy review booked 10/11; facility to facilitate attendance
- No rescue antibiotics prescribed; seek medical assessment for deterioration
- Appetite improved; usual meals and drinks resumed
Who is reading, and what do they need?
Ms Poutama is the residential care nurse receiving Mr Ropata back into a familiar care setting. She needs to understand how his bronchiectasis care differs from his previous independent routine and organise daily support and review. His hearing aids help him follow instructions, so practical communication details can support supervision; unrelated residential complaints do not help her implement respiratory care.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Previously independent; now clears sputum better with prompting but still omits steps. | Defines the change in support needs that makes this discharge handover necessary. |
| Upright sitting, relaxed breaths, deeper breaths, relaxed breaths, then huff/cough as needed. | Allows the receiving nurse to prompt the actual taught sequence rather than an unspecified breathing exercise. |
| Rest with relaxed breathing between active stages; avoid forceful repeated coughing. | Provides useful technique safeguards alongside the exercise sequence. |
| Nurse supervises and prompts exercises daily, including when the cough improves. | Makes responsibility and continued frequency explicit despite apparent symptomatic improvement. |
| Record sputum amount/colour and changes in breathlessness. | Identifies the observations that support recognition of deterioration after return. |
| Urgent GP assessment if no ambulance criteria apply: fever, increased breathlessness/sputum, or blood confined to a few spots/streaks. | Identifies deterioration requiring urgent review while reserving emergency signs for the ambulance pathway. |
| Ambulance: severe breathing difficulty; blood exceeding a few spots/streaks; or any blood with breathing difficulty, chest/upper back pain or very fast heartbeat. These criteria take priority regardless of blood amount. | Prevents small-volume bleeding with emergency symptoms being mistaken for a GP-only problem. |
| Physiotherapy review 10 November; facility facilitates attendance. | Assigns the practical follow-up responsibility needed to reassess his clearance technique. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Staff already administer medicines and assist with washing. | These familiar, unchanged services do not explain the new respiratory support requirement. |
| Daughter visits weekly and knows about his return. | No new respiratory care or follow-up responsibility is assigned to her. |
| Complaint about another resident's visitors; request for confrontation. | The interpersonal complaint is unrelated to the requested clinical handover. |
| Cataract surgery in 2021 without current eye symptoms. | The resolved eye history does not affect the documented sputum-clearance plan. |
| Appetite improved; usual meals and drinks resumed. | This recovery detail can be omitted when current respiratory status and care needs are clear. |
| Never smoked; no home oxygen. | Compress if useful; these background facts must not displace the new supervision need or current oxygen status. |
A paragraph plan for this case
Open with his return following a bronchiectasis exacerbation and the request for daily supervised sputum clearance. Explain that he still omits steps independently despite improved clearance with prompting, then describe the taught sequence. Select useful supporting details such as hearing aids, current respiratory improvement or antibiotic completion without recounting the whole admission. Close with clear escalation instructions, making ambulance criteria take priority over urgent GP assessment. Monitoring and the physiotherapy review can support the continuing care plan; unrelated residential and historical details can be omitted.
Where candidates slip on this task
- Improved sputum clearance with prompts does not establish independent competence; baseline breathlessness and smaller, paler sputum also do not cancel the need for daily supervision.
- The antibiotic course finished on 3 November and no rescue antibiotics were prescribed; avoid implying ongoing treatment or authorising staff to start antibiotics when symptoms recur.
- Upright sitting matches his exercise preference; walking to the dining room with a frame and resting when tired may be compressed unless needed to organise practical support.
- Do not use blood quantity alone to choose the escalation pathway. Any blood accompanied by the listed emergency symptoms requires an ambulance, even if only a few spots or streaks are present.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Why describe his earlier independence?
Use a short contrast to show why the facility must now provide daily prompts and supervision. Previously he managed exercises independently; currently prompting improves clearance, but he still omits steps alone. The earlier routine supports this explanation without requiring a full account of his residential care.
What must the escalation explanation retain?
Make ambulance criteria take priority. Severe breathing difficulty, bleeding beyond a few spots or streaks, or any blood with breathing difficulty, chest or upper back pain or a very fast heartbeat requires an ambulance. If none of those criteria applies, fever, increased breathlessness or sputum, or bleeding confined to a few spots or streaks requires urgent GP assessment. Do not suggest starting unprescribed rescue antibiotics. See [NHS coughing-up-blood advice](https://www.nhs.uk/symptoms/coughing-up-blood/).
Sources
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