The task
Assume that today's date is 21 October 2026. Mr Bates is being discharged home this afternoon.
You are a registered nurse on the medical ward at Lakeside Hospital. Using the information in the case notes, write a letter to Ms Jane Ellis, Nurse Unit Manager of the Community Nursing Service, requesting continued care for Mr Bates at home. Address the letter to Ms Jane Ellis, Nurse Unit Manager, Northside Community Nursing Service, 17 Station Road, Northside. 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 Harold Bates
- DOB: 04/02/1952 (74 yrs)
- Address: 9 Wattle Court, Northside
- Admitted: 13/10/26; discharge: 21/10/26
Social background
- Lives with wife (78), who has mild memory problems — unable to assist with insulin or dressings
- Retired postman; enjoys lawn bowls
- Son lives 30 min away, visits weekly
- Single-level home, 2 steps at front door
- Wife told staff that pt 'never listens to doctors and eats whatever he likes'
Medical history
- Type 2 diabetes (15 yrs); HbA1c 10.2% on admission
- Diabetic retinopathy — reduced vision; cannot read insulin pen dose window or small print
- Peripheral neuropathy both feet
- Hypertension — perindopril 5 mg daily
- Hypercholesterolaemia — atorvastatin 40 mg nocte
- L total knee replacement 2018
- Allergies: nil known
Admission
- Infected neuropathic ulcer R foot (under 1st metatarsal head) with cellulitis
- Foot X-ray: no evidence of osteomyelitis; wound swab: Staphylococcus aureus (methicillin-sensitive)
- IV cefazolin 5 days → oral cefalexin 500 mg QID until 28/10/26
- Cellulitis resolved; afebrile since 16/10
Diabetes management
- Insulin glargine commenced 15/10 — current dose 14 units at 08:00 daily
- Gliclazide ceased; metformin 1 g BD continued
- BGLs 6–11 mmol/L over last 48 hrs; target 6–10 mmol/L before meals
- Pt and wife educated about hypoglycaemia; uses meter with large display; hypo treatment at home
- Prefers to have breakfast at 07:30 after reading the newspaper
Wound
- Ulcer 1.5 × 1.0 cm, depth 0.3 cm; granulating; minimal exudate; surrounding skin intact
- Dressing: clean with sodium chloride 0.9%, non-adherent foam dressing — change daily
- Must wear offloading shoe when walking
- Physiotherapy: mobilising independently with offloading shoe
- Complained about noise from patient in next bed
Discharge plan
- Community nursing daily from 22/10: administer/supervise insulin, check BGL, wound care; if BGL < 4 mmol/L treat per hypoglycaemia protocol, recheck in 15 min and notify GP; report BGL > 15 mmol/L or signs of infection to GP
- GP review 28/10 — insulin titration
- High-risk foot clinic (podiatry) 29/10
- Diabetes educator 04/11
Who is reading, and what do they need?
Ms Ellis is a nurse manager who will allocate nurses to daily visits. She does not know Mr Bates or this admission. She needs to know what the nurses must do, when they start, the limits for calling the GP, and what stops the couple managing alone. Detail on tasks and thresholds is needed; hospital course can be brief.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Community nursing daily from 22/10 | This is the request itself and the start date, so it should frame the letter. |
| Glargine 14 units at 08:00; gliclazide ceased; metformin 1 g BD continued | Nurses will give or supervise the insulin, so they need the current dose, its time, and the medicine change. |
| Retinopathy: cannot read pen dose window; wife has memory problems | Explains why neither can safely self-administer insulin or do dressings, which justifies the daily visits. |
| BGLs 6–11 over 48 hrs; target 6–10; hypo and >15 actions | Gives the nurses a baseline, the target, and the exact actions and reporting limits they need. |
| Ulcer 1.5 × 1.0 cm, depth 0.3 cm, granulating; daily foam dressing | The wound description and dressing regimen are what the nurses will continue. |
| Neuropathy; must wear offloading shoe when walking | Protecting the neuropathic foot is part of ongoing wound care and needs checking at visits. |
| Cefalexin 500 mg QID until 28/10; cellulitis resolved | The antibiotic is still running at home and its end date affects what to monitor. |
| GP 28/10, foot clinic 29/10, diabetes educator 04/11 | Lets the service coordinate visits with follow-up, especially the GP insulin titration review. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife says he 'never listens to doctors' | A subjective remark from a third party; it is not clinical information and could prejudice the reader. |
| Retired postman; enjoys lawn bowls | Social detail that does not change the nursing care requested. |
| L total knee replacement 2018 | Remote history with no bearing on insulin or wound care; he is mobilising independently. |
| Complained about noise from next bed | A ward complaint that has no relevance to home care. |
| Foot X-ray and swab details | Compress or omit; the nurses need the outcome (infection treated, antibiotic continuing), not the investigations. |
| Prefers breakfast at 07:30; son visits weekly | Minor preference and family detail; at most it may help visit timing, but it is not core to the request. |
A paragraph plan for this case
Open with the request and start date, then the reason for admission and what changed in treatment. Follow with the home-care needs: insulin and glucose monitoring, then wound care and footwear, including the BGL actions. Finish with the antibiotic end date and the follow-up appointments.
Where candidates slip on this task
- The insulin change needs to be clear: glargine is new, gliclazide has stopped and metformin continues. Reporting only the new drug leaves the nurses unsure about the rest of his diabetes regimen.
- Include all of the stated BGL actions, both the hypoglycaemia steps and the high-BGL and infection reporting. Giving only one threshold would leave the instruction incomplete.
- Present the vision problem and the wife's memory problems as the reason for daily nursing, in neutral wording. Do not include the wife's remark about him not listening.
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
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- Discharge to the community nurse: new colostomy in an older man living alone 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 I mention the X-ray and swab results?
Only briefly if at all. The nurses need to know the infection has been treated and an antibiotic continues, because that is what they act on. Detailed investigation results add words without changing their care.
Is the 07:30 breakfast preference worth including?
It is optional. Insulin is at 08:00, so the preference could help the service plan visit times, but it is a minor detail. Choose it only if you have spare words after the essential care instructions.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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