The task
Assume that today's date is 6 November 2026. Thad Nikolaus is being discharged from the paediatric follow-up service today. This is original independent practice material; the patient details, findings and individual treating-clinician plan are fictional.
You are a registered nurse in the paediatric follow-up service. Using the case notes, write a discharge letter to Ms Elenor Mraz, School Nurse, requesting support for Thad Nikolaus's staged return to school, symptom monitoring and continued activity restrictions. Address the letter to Ms Elenor Mraz, School Nurse, School Health Office, 18 School Road, BS7 8QP, 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.
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Which case notes belong in this letter?
Child recovering from concussion: discharge
You are a registered nurse in the paediatric follow-up service. Using the case notes, write a discharge letter to Ms Elenor Mraz, School Nurse, requesting support for Thad Nikolaus's staged return to school, symptom monitoring and continued activity restrictions. Address the letter to Ms Elenor Mraz, School Nurse, School Health Office, 18 School Road, BS7 8QP, 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: Thad Nikolaus
- DOB: 12/03/2014 (12 yrs); secondary-school pupil
- School nurse: Ms Elenor Mraz; mother consents to school handover
- Paediatric follow-up service discharge: 06/11/26
Social background
- Lives with mother; she can collect him if symptoms recur
- School football player; hopes to play in next week's match
- Enjoys collecting football stickers
- Mother complained that reception staff were unhelpful
- Mother disclosed an unrelated dispute with her sister
Medical history
- Appendicectomy aged 8; fully recovered
- No previous concussion; no regular medication
Initial assessment
- 01/11: head collision during football; immediately removed from play
- Emergency assessment: concussion diagnosed; no loss of consciousness or vomiting
- Discharged home with mother after assessment; written head-injury advice provided
- Mother supervised first 24 hrs; no further injury
Progress
- 02–03/11: headache, fatigue; stayed home from school
- 04–05/11: headaches ↓; tolerated brief reading and gentle walks
- 06/11: headache-free since yesterday; prolonged reading still causes fatigue
- Alert; speech, gait and neurological examination normal today
- Eating and sleeping normally; mother reports behaviour unchanged
- No analgesia needed today
Individual treating-clinician plan
- Clinician's individual school-return plan below; explained to mother and Thad
- 09/11: morning attendance if feeling well → increase towards full days only when each stage tolerated without symptoms
- Initially reduced workload, quiet rest breaks; defer timed tests
- School nurse: check symptoms on arrival/during lessons; recurrence → stop task, rest, contact mother; persistent symptoms → same-day GP advice
- Record attendance, symptoms and tolerated activities for GP
- No PE/rough play now; no contact sport before 22/11 or without medical clearance following graded return
- GP review booked 13/11: assess symptoms, school progress and further activity progression
Safety advice and school arrangements
- New vomiting → urgent NHS 111 advice
- Seizure, difficulty staying awake, new weakness, speech/balance difficulties → call 999
- Mother understands school return does not mean clearance for sport
- School nurse to coordinate agreed adjustments with teaching staff
Who is reading, and what do they need?
Ms Mraz needs a practical school handover for 12-year-old Thad after paediatric discharge on 6 November. Maternal consent permits this handover. She needs attendance limits, classroom adjustments, monitoring, escalation and sports restrictions to coordinate teachers and contact his mother. Brief recovery context is sufficient; earlier symptoms, normal examination findings and reassuring home observations are optional when current limitations and required actions remain clear.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 1 November football collision; concussion diagnosed. | Brief context explains the reason for school support without reproducing the emergency assessment. |
| Headache-free since 5 November; prolonged reading still causes fatigue. | The remaining reading limitation helps explain reduced academic demands despite headache resolution. |
| 9 November: mornings if well; progress towards full days only when each stage symptom-free. | The conditional start and progression criteria determine how the school should manage attendance. |
| Reduced workload, quiet rest breaks, deferred timed tests; nurse coordinates adjustments with teachers. | These practical measures translate the return plan into classroom arrangements. |
| Arrival/lesson checks; recurrence: stop task, rest, contact mother; persistent symptoms: same-day GP advice. | The nurse needs the monitoring schedule and complete response sequence to manage symptoms at school. |
| 13 November GP review: symptoms, school progress, activity progression; record attendance, symptoms and tolerated activities. | The review provides the next decision point, while school records can support assessment of recovery and progression. |
| No PE/rough play; contact sport requires 22 November or later, graded return and medical clearance. | The school must enforce current restrictions and understand that the date alone does not authorise contact sport. |
| New vomiting: urgent NHS 111; seizure, difficulty staying awake, new weakness, speech/balance difficulties: call 999. | The school needs both escalation routes and every listed trigger together, without relying on earlier written advice. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys collecting football stickers. | This hobby does not help the nurse implement attendance adjustments or monitor recovery. |
| Mother’s reception complaint and unrelated dispute with her sister. | Neither matter affects the school plan; sharing the family dispute would add unnecessary personal information. |
| Recovered appendicectomy at eight; no previous concussion or regular medication. | The resolved operation is unrelated; the negative history adds little to the nurse’s immediate school-management decisions. |
| Written advice supplied; mother supervised first 24 hours; no further injury. | These completed home-care arrangements add little to school management; previous written advice cannot replace explicit school escalation instructions. |
| No analgesia needed today. | This does not establish a school medication requirement or change the specified attendance and activity restrictions. |
| 2–3 November headache/fatigue; 4–5 November fewer headaches, brief reading and gentle walks tolerated. | Compress this earlier course if useful; current reading fatigue is more directly relevant to classroom demands. |
A paragraph plan for this case
Open with identification, discharge context and a brief account of the football-related concussion and current reading fatigue. Follow with the treating clinician’s staged attendance plan, classroom adjustments, teacher coordination and symptom-response instructions, including mother’s availability for collection. Finish with activity restrictions, the 13 November GP review and useful monitoring records; keep the complete listed NHS 111/999 escalation instructions together.
Where candidates slip on this task
- Keep 6 November discharge distinct from the conditional 9 November school return and 13 November GP review; do not imply that discharge authorises immediate full attendance.
- Thad’s hope of playing next week makes the restrictions particularly relevant: school attendance does not clear him for sport, and 22 November alone is insufficient.
- Retain every listed escalation trigger and distinguish urgent NHS 111 advice from calling 999; normal neurological findings and resolved headache do not establish unrestricted recovery.
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
How much of Thad’s recovery history belongs in this school handover?
Prioritise the current limitation: prolonged reading still causes fatigue despite being headache-free since 5 November. Earlier headaches, improving activity tolerance, normal examination findings and reassuring home observations may be compressed or omitted when the nurse can still understand and implement the school plan.
Should Australian emergency numbers replace those in these UK notes?
No. This school is in the United Kingdom, and the notes explicitly specify NHS 111 and 999. Preserve both pathways and every listed trigger together. Earlier written head-injury advice is background, not a substitute for stating the school’s escalation instructions.
Sources
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