The task
Assume that today's date is 5 November 2026. You have reviewed Mrs Pacocha at home today. This is original independent practice material; the patient details, assessment findings and individual care arrangements are fictional.
You are a registered nurse in the home support team. Using the case notes, write a referral to Ms Dolly Emard, Community Dementia Nurse, requesting assessment of Mrs Pacocha's recent night-time distress, support for her daughter and coordination of replacement overnight support with social care. Communicate when replacement cover must start. Distinguish the recent change from Mrs Pacocha's longstanding preferences and accurately communicate the medical assessment already undertaken. Address the letter to Ms Dolly Emard, Community Dementia Nurse, Home Support Team, Community Nursing Service, 24 Station Road, SW1V 1AA. 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: Referral letter.
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Which case notes belong in this letter?
Dementia with night-time distress: referral
You are a registered nurse in the home support team. Using the case notes, write a referral to Ms Dolly Emard, Community Dementia Nurse, requesting assessment of Mrs Pacocha's recent night-time distress, support for her daughter and coordination of replacement overnight support with social care. Communicate when replacement cover must start. Distinguish the recent change from Mrs Pacocha's longstanding preferences and accurately communicate the medical assessment already undertaken. Address the letter to Ms Dolly Emard, Community Dementia Nurse, Home Support Team, Community Nursing Service, 24 Station Road, SW1V 1AA. 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: Mrs Mikaila Pacocha
- DOB: 14/03/1947 (79 yrs)
- Home: 9 Orchard Close, SW1V 1AA
Social background
- Lives with daughter; daughter manages regular medicines and meals
- Daughter exhausted by interrupted sleep; requests practical support
- Home-support worker each morning: washing and dressing
- Retired seamstress; collected decorative buttons
- Daughter asked about online booking for routine clinic appointments
- Daughter made critical remarks about brother's spending; he has no role in patient's care
Medical history
- Alzheimer's dementia diagnosed 2023
- Routine dental check-up earlier this year; no treatment needed
Usual preferences and function
- Lifelong preference: bedtime around 23:00, quiet radio; previously content
- Baseline: repetitive questions
- Usually walks independently indoors
Recent change
- Past 3/52: new night-time crying, asking to go home, trying front door
- No leaving home or falls reported
- Calmer with daughter's reassurance
- No recent change in usual carers
- Appetite unchanged
- No pain reported
Assessment and progress
- GP assessment 04/11: no acute illness or delirium identified; cause remains uncertain
- GP reviewed medicines; unchanged
- 05/11 nursing visit: daytime behaviour at usual baseline
- Mrs Pacocha agrees to referral; daughter supports home assessment
Agreed plan
- Request Ms Emard: home assessment this week → triggers, individual sleep strategies, carer support; coordinate replacement overnight support with social care
- Existing morning home-support service does not provide overnight cover
- Daughter available to discuss night-time episodes during home assessment
- Interim: daughter supervises through night of 09/11 only; replacement overnight cover required from night of 10/11; not yet arranged
- GP retains medical management
- GP safety advice: call 999 for new sudden confusion
Who is reading, and what do they need?
Ms Emard needs enough information to assess Mrs Pacocha at home without assumed prior knowledge. Identify the patient, optionally using DOB 14/03/1947, and provide the visit address. Prioritise the recent change, longstanding sleep preferences, GP assessment and uncertainty, and requested home assessment. Ask Ms Emard to coordinate replacement overnight support with social care from the night of 10 November, following the daughter's final night of supervision on 9 November. Select a few useful supporting details rather than describing every normal finding or routine care arrangement. Baseline repetitive questioning, independent indoor walking, the GP's medicine review with no changes and agreement to referral are optional context for assessment or planning the visit.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Mrs Mikaila Pacocha; home: 9 Orchard Close, SW1V 1AA. | The home-assessment referral needs an identifiable patient and a usable visit address. |
| Lifelong bedtime around 23:00, quiet radio; previously content. | These preferences establish her usual routine and distinguish it from the recent distress. |
| Past three weeks: new night-time crying, asking to go home and trying the front door. | The behaviours and duration define the change requiring assessment. |
| GP assessment 04/11: no acute illness or delirium identified; cause remains uncertain. | The reader needs to know what has been assessed without assuming that the cause is established. |
| Ms Emard: home assessment this week for triggers, individual sleep strategies and carer support; coordinate replacement overnight support with social care. | This identifies the assessment requested and assigns coordination of replacement support to the recipient. |
| Daughter exhausted; supervises through the night of 09/11 only; replacement overnight cover required from the night of 10/11, not yet arranged. | The final family-supervised night and replacement start date define the care gap Ms Emard must help resolve. |
| GP advice: call 999 for new sudden confusion. | Ms Emard needs the emergency instruction so that new sudden confusion prompts an immediate response. |
| Alzheimer's diagnosed 2023; daughter's reassurance helps; existing morning service provides no overnight cover. | These optional details give diagnostic context, an observed calming response and the limits of current support. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired seamstress; collected decorative buttons. | This may personalise assessment but can be omitted; neither detail is an established calming strategy. |
| Daughter asked about online booking for routine clinic appointments. | The administrative query does not help Ms Emard assess night-time distress or arrange overnight support. |
| Daughter criticised brother's spending; he has no role in the patient's care. | Unrelated private criticism would distract from the patient's needs. |
| Routine dental check-up earlier this year; no treatment needed. | The routine check-up has no documented connection with the current distress. |
| Appetite unchanged; no pain reported. | These supporting observations may be omitted when the GP assessment is summarised; they do not establish the cause. |
A paragraph plan for this case
Open with the home-assessment request and visit address. Describe the new night-time behaviours against the longstanding bedtime and radio preferences, then summarise the GP assessment and remaining uncertainty. Explain that the daughter can supervise through the night of 9 November only, and ask Ms Emard to coordinate replacement support with social care from the night of 10 November. Close with the GP's emergency advice. Add selected supporting details where useful, such as reassurance, existing morning care or retained GP medical management.
Where candidates slip on this task
- Do not describe the lifelong late bedtime or quiet radio as new symptoms; the recent change is night-time crying, requests to go home and front-door attempts.
- Report that no acute illness or delirium was identified at the GP assessment on 4 November while preserving uncertainty about the cause.
- The daughter's final night of supervision is 9 November. Ms Emard is being asked to coordinate replacement overnight support with social care from the night of 10 November; this has not yet been arranged. Morning home support does not provide overnight cover.
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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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Must every normal finding and routine care detail appear?
No. Choose supporting information that helps Ms Emard understand the change or the support gap. Appetite, reported pain, usual mobility, medicines and referral agreement may each be omitted. Preserve the longstanding preferences, recent change, GP findings and uncertainty, home-assessment request, visit address and sudden-confusion emergency advice. Make clear that Ms Emard should coordinate replacement overnight support with social care from the night of 10 November, after the daughter's final night of supervision.
Should the recorded emergency number be changed to 000?
Retain the GP's documented advice to call 999 for new sudden confusion in this UK-addressed case.
Sources
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