The task
Assume that today's date is 23 October 2026. Mrs Twomey is being discharged home this afternoon.
You are a registered nurse on the oncology ward of the hospital. Using the information in the case notes, write a letter to Ms Ximena Rios, Clinical Nurse Boateng at the Community Palliative Care Service, requesting continued end-of-life care for Mrs Twomey at home. Address the letter to Ms Ximena Rios, Clinical Nurse Boateng, Community Palliative Care Service, Community Health Centre, 40 Main Street. 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: Mrs Caoimhe Twomey
- DOB: 14/03/1958 (68 yrs)
- Address: 12 Hill Street
- Admitted: 15/10/26; discharge: 23/10/26
Social background
- Lives with husband (71), main carer — willing but anxious about managing syringe driver & end-of-life care at home
- Daughter arrived from overseas; staying 4/52 to help
- Retired primary school teacher; sang in church choir for 30 yrs
- Son has not visited — daughter says long-standing family dispute over money
- Two-storey house; bed set up in ground-floor living room
Medical history
- Metastatic adenocarcinoma of pancreas (liver mets) dx 03/26
- Palliative chemo ceased 08/26 (poor tolerance); pt declines further active tx
- Biliary stent inserted 04/26
- Osteoarthritis both knees; appendicectomy 1979
- Allergies: penicillin (rash)
Admission
- Admitted with uncontrolled abdominal & back pain, nausea/vomiting; oral intake ↓
- Palliative care team review: oral opioid not tolerated (vomiting) → continuous SC infusion via syringe driver commenced 17/10
- Pain now controlled (2/10 at rest); nausea settled; no vomiting since 19/10
- Drowsy but rousable & oriented; sips fluids, small amounts of soft food
- Prognosis est. short weeks (palliative care team)
- Pt complained that night nurse was 'rough' when repositioning her
Symptom management
- Syringe driver over 24 h: morphine + metoclopramide — doses per signed palliative care medication chart (copy with pt)
- SC line L upper chest; site clean, no redness; next syringe change due 24/10 at 10:00
- Breakthrough pain: SC morphine PRN per chart; 2 doses required in last 24 h
- Anticipatory meds dispensed & charted: morphine, midazolam (agitation/distress), hyoscine butylbromide (resp. secretions), metoclopramide
- Bowels last opened 21/10; regular oral laxative while able to swallow
- Sacrum reddened but blanching; regular repositioning; barrier cream
Wishes
- Clear wish to die at home; husband & daughter aware and supportive
- Advance care directive in place; not for resuscitation — goals of care form signed by consultant (copy with pt); comfort care only
- Requests visits from parish priest
- Enjoys choral music; asked for radio beside bed
Equipment
- OT: hospital bed, pressure-relieving mattress & commode delivered 22/10
- Shower chair to be delivered 27/10
Discharge plan
- Community palliative care nursing: first visit 24/10 before 10:00 for syringe change; then daily — symptom review, site check, pressure care, family support
- Husband shown how to check syringe driver & line, and when to call; given 24-h palliative care phone line
- GP informed of discharge; agrees to home visits & ongoing prescribing
- Hospital palliative care team available for advice
Who is reading, and what do they need?
Clinical Nurse Boateng is a palliative care nurse who will make the first home visit and needs to act on the syringe driver, symptoms and the family's anxiety. She knows the clinical field, so give the practical handover facts and the specific request, not background explanations.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Clear wish to die at home; advance care directive; not for resuscitation; comfort care only | The goals of care guide every decision the visiting nurse makes, so they must be clear. The signed forms are with the patient. |
| Metastatic pancreatic adenocarcinoma with liver mets; declines further active treatment; prognosis short weeks | This gives the diagnosis, the patient's treatment choice and the expected timeframe, which define why end-of-life care is requested. |
| Syringe driver morphine + metoclopramide; next change 24/10 at 10:00; first visit before 10:00 | The date and time of the first visit is the most time-critical action. Doses are on the signed chart, so no figures are needed. |
| SC line L upper chest, site clean; 2 breakthrough morphine doses in last 24 h | The nurse needs the site location and current state, and how much breakthrough medicine has been used, as the starting point for symptom review. |
| Anticipatory meds charted: morphine, midazolam, hyoscine butylbromide, metoclopramide | Shows which medicines are in the home for agitation, secretions, pain and nausea, so the nurse can respond if symptoms change. |
| Pain 2/10, no vomiting since 19/10; drowsy but rousable; sips fluids, soft food | Gives the baseline symptom control and level of alertness that the daily reviews will be compared against. |
| Bowels last opened 21/10, oral laxative while able to swallow; sacrum reddened but blanching | Bowel care and pressure care are part of the daily visits requested. These details give the nurse the current starting position. |
| Husband anxious about syringe driver; shown checks and when to call; penicillin allergy (rash) | Directs family support to the main carer and records the allergy, which any nurse giving or responding with medicines should know. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Patient complained night nurse was 'rough' when repositioning | A complaint about hospital care does not help the community nurse plan care and belongs in a different process. |
| Son has not visited; family dispute over money | Family conflict is not needed for the clinical handover. Only the supports that are actually present (husband, daughter for 4/52) matter. |
| Retired teacher; church choir for 30 years | Personal history that does not affect the care being requested. |
| Osteoarthritis, appendicectomy, biliary stent, chemotherapy stopped 08/26 | Older history that does not change end-of-life care at home; the cessation of active treatment is covered by the patient's decision. |
| Shower chair to be delivered 27/10 | A later equipment delivery that does not affect the first visit; the equipment already delivered 22/10 is more relevant. |
| Parish priest visits; radio beside bed | Looks relevant to comfort, but it is secondary to clinical handover in a tight word limit; at most a very brief mention. |
A paragraph plan for this case
Open with the request and a one-line identification of the patient, diagnosis and wishes. Use a middle paragraph for symptom control, the syringe driver and the timing of the first visit, then bowel, skin and allergy. Close with the family's anxiety and the support available to the family.
Where candidates slip on this task
- The first visit must be before 10:00 on 24/10 because the syringe change is due then. Make that timing a clear request rather than burying it among other symptom details.
- Do not write out doses. The notes say doses are on the signed palliative care medication chart, which is with the patient, so refer to the chart.
- Keep the family's wishes proportionate: the husband's anxiety and the daughter's temporary help matter, but the son's absence and the dispute do not belong in this letter.
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 community nurse: new colostomy in an older man living alone discharge letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should I list the drug doses for the syringe driver?
No. The notes give no doses and say they are on the signed palliative care medication chart held by the patient. Name the two drugs in the driver and refer the nurse to the chart.
How much should I say about Mrs Twomey's wishes?
Give the essentials that guide care: dying at home, not for resuscitation, comfort care only, with the directive and goals of care form. The choir, radio and priest are lower priority in the word limit.
Sources
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