The task
Assume that today's date is 23 October 2026. Mr Varley is being discharged home this afternoon.
You are a registered nurse on the surgical ward. Using the information in the case notes, write a letter to Ms Abena Upton, Nurse Unit Manager of the District Nursing Service, requesting continued care for Mr Varley at home. Address the letter to Ms Abena Upton, Nurse Unit Manager, District Nursing Service, 42 Mill Lane. 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.
Case notes
Patient details
- Name: Mr Ferdinand Varley
- DOB: 09/05/1950 (76 yrs)
- Address: 14 Orchard Street
- Admitted: 12/10/26 (via ED); discharge: 23/10/26
Social background
- Widower; lives alone in 2-storey house; bathroom upstairs
- Daughter lives 2 hrs away, phones daily; neighbour helps with shopping
- Retired carpenter; keen gardener, asking when he can return to his vegetable patch
- Daughter reports pt's brother 'hasn't spoken to him in years'
Medical history
- Diverticular disease (dx 2019)
- Hypertension: amlodipine 5 mg daily
- Osteoarthritis both hands: ↓ grip & dexterity; difficulty cutting & peeling stoma appliances
- Bilateral cataract surgery 2020; vision adequate with glasses
- Appendicectomy aged 12
- Allergies: penicillin (rash)
Admission
- Perforated sigmoid diverticulitis with peritonitis
- 12/10: emergency Hartmann's procedure (laparotomy) → end colostomy LIF
- Post-op IV antibiotics completed 19/10; afebrile; eating & drinking normally
- Complained food 'tasteless'; asked to speak to ward manager
Stoma
- End colostomy LIF: pink, moist, healthy; diameter 35 mm; mucocutaneous junction intact
- Peristomal skin intact, no redness
- Output: soft formed stool 1–2 x daily; passing flatus
- Appliance: one-piece drainable, cut-to-fit (currently cut to 35 mm); pt unable to cut aperture due to hand OA → nurse to cut & fit; change every 2–3 days or if leaking; switch to pre-cut once size stable
- Empties bag independently; needs assistance to remove & apply appliance
- Initially reluctant to look at stoma; now anxious but participating in care
Wound
- Midline laparotomy wound: clean, dry, healing; clips in situ
- Clips due for removal 26/10
- Advised no heavy lifting 6/52; gentle walking daily
Discharge medications
- Paracetamol 1 g QID PRN for pain; amlodipine unchanged
Discharge plan
- Stoma supplies for 2/52 given; registration with stoma supply scheme completed
- Community nursing 3 x/wk from 24/10 for 2/52: assist with appliance changes, check stoma & peristomal skin, review wound, remove clips 26/10; teach pt to change appliance; measure stoma at each change & adjust aperture (size ↓ over first weeks); once size stable, liaise with stoma nurse re pre-cut supply
- URGENT: new dusky/dark stoma → contact surgical team immediately for urgent assessment; if prompt surgical review not available → ED; no output + abdo pain/vomiting → urgent medical assessment; severe pain or deterioration → ambulance/ED. Routine: retraction, peristomal skin breakdown, signs of wound infection → stoma nurse/GP
- Stoma nurse phone review 30/10
- Surgical OPD 6/52; possible reversal to be discussed at review
Who is reading, and what do they need?
Ms Upton is a nurse unit manager who will allocate community nurses. She does not know Mr Varley, so she needs the reason for the stoma, its current state, who does what with the appliance, visit tasks with dates, and when to escalate. She does not need ward history or social detail beyond what affects home care.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Emergency Hartmann's 12/10 for perforated sigmoid diverticulitis; healthy 35 mm end colostomy, skin intact | Gives the reason for the stoma and the baseline against which community nurses compare each visit. |
| One-piece drainable cut-to-fit appliance cut to 35 mm; change every 2–3 days or if leaking | The nurses must know the product, current aperture size and change frequency to continue care without a gap. |
| Hand OA: cannot cut or peel appliances; empties bag independently; lives alone | Explains why a nurse must cut and fit the appliance and which tasks he can already do himself. |
| Community nursing 3 x/wk from 24/10 for 2/52; teach him; measure and adjust aperture | This is the actual request. It covers the schedule, the teaching goal and the size review as the stoma shrinks. |
| Wound clean, dry, healing; clips due out 26/10; no heavy lifting 6/52 | The clip removal date is a specific task for the visiting nurse, and the lifting advice affects home activity. |
| Urgent triggers (dusky stoma, no output with pain/vomiting, severe pain) and routine ones | Safety-netting must give every urgent and routine pathway with the correct destination for each, not a partial list. |
| Paracetamol 1 g QID PRN; amlodipine unchanged | The community nurse needs the discharge medicines, and stating that amlodipine is unchanged avoids confusion. |
| Supplies for 2/52; stoma nurse phone review 30/10; surgical OPD 6/52 | Shows the supply period and who else is involved, so the nurses can plan the pre-cut supply liaison once size is stable. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Brother 'hasn't spoken to him in years' | Family gossip from the daughter. It has no bearing on stoma or wound care and is a private matter. |
| Complained food 'tasteless'; asked to speak to ward manager | A ward complaint to be handled on the ward, not relevant to community nursing. |
| Keen gardener, asking about his vegetable patch | Hobby detail. The relevant point is the lifting restriction, which is already covered. |
| Bilateral cataract surgery 2020; vision adequate with glasses | Trap: it looks relevant to appliance handling, but vision is adequate and the problem is hand dexterity. |
| IV antibiotics completed 19/10; appendicectomy aged 12 | Completed or remote history the district nurse does not need to act on. |
| Daughter 2 hrs away; neighbour helps shopping | Background only. Compress to living alone at most, because the notes give no role for them in stoma care. |
A paragraph plan for this case
Open with the purpose and the request, then briefly give the diagnosis, surgery and current stoma status. Next cover the appliance, his hand limitations, the visit tasks and dates, and the wound. Close with escalation advice, medicines and follow-up.
Where candidates slip on this task
- Make clear the nurse cuts and fits the appliance because of his hand OA, while he empties the bag himself. Also state that the aperture is expected to shrink, so it is measured at every change.
- Calculate and state dates accurately: visits start 24/10 for two weeks, clips come out 26/10, stoma nurse phones 30/10, and surgical OPD is at 6/52. Do not blur them together.
- Give every urgent and routine escalation trigger with its correct contact. Describe reversal only as something to be discussed at review, not as planned. Do not shorten the lists.
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
More Nursing letter tasks
- Discharge to the community nursing service: new insulin and diabetic foot ulcer discharge letter
- Postnatal discharge to a child and family health nurse: feeding concerns after gestational diabetes discharge letter
- Discharge to the school nurse: child newly diagnosed with epilepsy discharge letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should possible reversal be mentioned?
The notes say only that possible reversal will be discussed at the surgical review. A brief mention with the OPD appointment is acceptable if worded as possible. It does not change the community nurses' tasks, so it is optional and low priority.
How much escalation detail is needed?
Include all the urgent and routine triggers from the notes and the correct destination for each: surgical team, ED, ambulance, stoma nurse or GP. A shortened list risks the nurse missing a trigger such as a dusky stoma.
Sources
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