The task
Original independent practice. The patient details, observations and care chronology are fictional. Assume that today's date is 3 November 2026. You have assessed Ms Makoni during a community nursing visit. Allow 45 minutes: 5 minutes reading and 40 minutes writing.
You are a community registered nurse. Using the case notes, write to Ms Chipo Nyamadzawo, Stoma Specialist Nurse, requesting assessment of Ms Makoni's recurrent leakage, appliance difficulties and irritated skin. Address the letter to Ms Chipo Nyamadzawo, Stoma Specialist Nurse, Specialist Outpatient Clinic, 42 High Street, SW19 1AA, 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: Referral letter.
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Which case notes belong in this letter?
Peristomal skin irritation: referral
You are a community registered nurse. Using the case notes, write to Ms Chipo Nyamadzawo, Stoma Specialist Nurse, requesting assessment of Ms Makoni's recurrent leakage, appliance difficulties and irritated skin. Address the letter to Ms Chipo Nyamadzawo, Stoma Specialist Nurse, Specialist Outpatient Clinic, 42 High Street, SW19 1AA, 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: Ms Simudzai Makoni
- DOB: 25/01/1968 (58 yrs)
- Community nursing assessment: 03/11/26
- Home: 12 High Street, SW19 1AA, UK
Social background
- Lives with partner; manages pouch changes herself
- Receptionist; avoiding work because she fears leakage
- Partner willing to attend education session with her consent
- Complained previous nurse was careless; requests this allegation be repeated
- Disclosed sister's financial dispute; unrelated to her care
Medical history and earlier progress
- 18/08: end colostomy following perforated diverticulitis
- Abdominal wound healed; surgical review completed 29/09
- Uses one-piece cut-to-fit pouch; supply unchanged since discharge
- 12/10: peristomal skin intact; comfortable with usual appliance
- No previous diagnosed adhesive allergy
Recent symptoms and current assessment
- 27/10: recurrent leaks began beneath lower adhesive edge
- 30/10: burning soreness reported; appliance changes becoming difficult
- 03/11: stool seen tracking beneath lower edge on removal
- Skin immediately below stoma red and superficially broken; outer adhesive area unaffected
- Stoma pink/moist; output unchanged from usual
- Current opening leaves peristomal skin exposed; crease appears on sitting
- No abdominal pain, vomiting or fever; eating normally
- Unable to inspect lower seal without mirror; no mirror used previously
- Patient suspects adhesive allergy; cause unconfirmed, no allergy diagnosis
- Leakage now disrupts sleep; worried about further skin damage
Care provided and response
- 30/10 nurse remeasured stoma and refitted appliance
- Refitting reduced leaks briefly → leakage recurred by today
- Pouch replaced after each leak; spare supplies available
- Today: cleansed skin gently; replacement fitted; seal initially dry
- Advice: urgent medical assessment for severe abdominal pain, vomiting or markedly reduced output
Referral plan
- Consent given for referral; can attend next available clinic appointment
- Request specialist stoma/fit assessment in different positions; appliance and skin-protection advice
- Request practical fitting education, including mirror use to inspect lower seal
Who is reading, and what do they need?
Ms Nyamadzawo is a stoma specialist being asked to assess recurrent leakage, appliance fit and irritated skin after a community visit on 3 November. She needs concrete observations, the response to refitting and the practical inspection difficulty. Ms Makoni changes her own pouch; her partner's possible attendance is secondary and depends on consent, rather than replacing her fitting education.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| End colostomy after perforated diverticulitis, 18 August; unchanged one-piece cut-to-fit pouch supply. | Provides concise surgical and appliance context for assessing whether the current system meets her needs. |
| Stool tracked beneath the lower adhesive edge during today's appliance removal. | Supplies direct evidence of the leakage pattern rather than relying only on reported difficulty. |
| Red, superficially broken skin below the stoma; outer adhesive area unaffected. | Describes the location and extent of skin damage without assigning an unconfirmed cause. |
| Current opening exposes peristomal skin; a crease appears when sitting. | Identifies specific fit observations that justify assessment in different positions. |
| Cannot inspect lower seal without a mirror; no mirror previously used. | Explains a practical barrier that targeted fitting education can address. |
| Patient suspects adhesive allergy; cause unconfirmed and no allergy diagnosis. | Communicates her concern while preserving the distinction between suspicion and an established diagnosis. |
| 30 October remeasurement/refitting briefly reduced leaks; leakage recurred by today. | Shows that the first adjustment did not provide sustained control and supports specialist review. |
| Specialist assessment in different positions; appliance, skin-protection and practical fitting advice, including mirror use. | Makes the referral actionable by linking requested assessment and education to the documented problems. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Allegation that the previous nurse was careless; request to repeat it. | An unsupported allegation does not establish the cause or help the specialist assess the observed problem. |
| Sister's unrelated financial dispute. | This third-party disclosure has no care relevance and should not be transmitted. |
| Healed abdominal wound; surgical review completed 29 September. | Compress if needed for context; the completed wound episode is not the current referral problem. |
| Skin intact and usual appliance comfortable on 12 October. | A brief baseline can help date the change, but current findings and failed refitting already justify referral. |
| No previous diagnosed adhesive allergy. | Past allergy history may be omitted when current uncertainty is explicit; it cannot settle the present cause. |
| Pouch replaced after leaks; spare supplies available. | Routine replacement and stock availability are secondary unless needed to explain interim management. |
A paragraph plan for this case
Open with brief name and birth-date identification, the community assessment date and home contact details as needed, the request for specialist review, referral consent and next-available-clinic availability. Develop the recent course from lower-edge leaks on 27 October and burning soreness with difficult changes on 30 October to today's tracking, skin and fit findings, then describe the brief refitting response and today's gentle cleansing, replacement and initially dry seal. Close with the specific assessment and education requests; selectively compress unchanged output, a pink moist stoma, normal eating without abdominal pain, vomiting or fever, and the documented effects on work, sleep and concern about further skin damage.
Where candidates slip on this task
- Stool tracking and the distribution of skin damage are observations supporting specialist assessment; neither proves the cause, and the patient's suspected adhesive allergy must remain explicitly unconfirmed.
- Brief improvement after the 30 October refit and today's initially dry replacement seal do not establish lasting resolution; the recurrent leakage remains the reason for referral.
- If mentioning the recorded safety advice, retain all three triggers together: severe abdominal pain, vomiting or markedly reduced output require urgent medical assessment; do not reduce the list.
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
Should the referral identify adhesive allergy as the cause?
No. Attribute the allergy concern to Ms Makoni and state that the cause remains unconfirmed. The specialist needs the actual distribution of redness and superficial breakdown, stool tracking, exposed skin and sitting crease. These observations support assessment without establishing allergy or another definitive explanation.
Which requests make this more useful than a general stoma referral?
Specify assessment of the stoma and appliance fit in different positions, advice on the appliance and skin protection, and practical fitting education including mirror use for the lower seal. Connect these requests to recurrent leakage after brief refitting benefit, rather than adding an unsupported product recommendation.
Sources
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