The task
Assume that today's date is 10 November 2026. Mr Kerslake is being transferred to the rehabilitation unit this morning.
You are a registered nurse on the orthopaedic ward of a metropolitan hospital. Using the information in the case notes, write a letter to Ms Folake Ogden, Nurse Unit Manager of the Inpatient Rehabilitation Unit, who will be responsible for Mr Kerslake's ongoing care. Address the letter to Ms Folake Ogden, Nurse Unit Manager, Inpatient Rehabilitation Unit, 22 Grove 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: Transfer letter.
Case notes
Patient details
- Name: Mr Wayne Kerslake
- DOB: 12/06/1952 (74 yrs)
- Admitted: 03/11/26 (elective R total knee replacement); transfer to rehab: 10/11/26
- Allergies: nil known
Social background
- Lives with wife (72) in 2-storey house; bedroom upstairs, 14 steps, rail one side only
- Wife well, independent, keen to support; visits daily
- Retired carpenter; enjoys fishing
- Daughter overseas, phones daily; she and wife disagree about selling the house
- Wears hearing aids (both ears) and reading glasses
Medical history
- Osteoarthritis R knee — pain limiting walking for 2 yrs
- Hypertension — amlodipine 5 mg mane
- Benign prostatic hyperplasia — tamsulosin 400 microg nocte
- Bilateral cataract surgery 2019
- No previous cognitive impairment; independent with all ADLs before admission
Surgery and post-operative course
- 03/11: R TKR under spinal anaesthetic; surgery uncomplicated
- Day 2: acute delirium — agitated at night, disoriented to time/place, pulled out IV cannula; 4AT score 6
- Contributing factors: opioids, urinary retention, poor sleep, constipation; no infection found (FBC, urine culture, CXR NAD)
- Mx: opioids ↓; IDC inserted → removed 07/11, voiding well; non-drug strategies only, no antipsychotics required
- Now: alert & oriented during daytime assessments; brief mild confusion late evening on 07/11, 08/11 & 09/11, settles with reorientation; 4AT 4 on 08/11 & 09/11 (scored for fluctuation only)
- Helpful strategies: hearing aids & glasses on, clock/calendar visible, wife visits in evening, low lighting at night
- Complained hospital food tasteless; asked for meals from home
Pain and bowels
- Paracetamol 1 g QID regular; oxycodone IR 5 mg PO PRN, min 4 hrly, max 15 mg/24 hrs (as charted by surgical team); 1 dose in last 24 hrs. Before physio: give 30 min prior only if needed for pain AND ≥4 hrs since last dose
- Pain 3/10 at rest, 6/10 on exercise; ice pack after physio helps
- Macrogol sachet daily; BO 08/11
Wound and VTE prophylaxis
- Midline wound, clips intact; dry, no ooze or redness; waterproof dressing — change only if soiled or lifting
- Clips for removal 17/11 (day 14)
- Enoxaparin 40 mg subcut daily until 16/11
Mobility
- WBAT; mobilising 30 m with 4-wheeled frame, supervision of 1
- R knee flexion 70°, lacks 10° extension; aim ↑ ROM
- Stairs not yet attempted
- Falls risk: high (night-time confusion); bed alarm used overnight
- Pt says physiotherapist 'pushes too hard' — asked for a different therapist
Plan
- Rehab approx. 2/52: goals — independent walking with stick, safe on stairs, ↑ knee ROM
- Orthopaedic review 6/52 post-op
- Wife requests to be present for stair practice before discharge home
Who is reading, and what do they need?
Ms Ogden is the Nurse Unit Manager who will be responsible for Mr Kerslake's care. She has not met him and knows only what the letter tells her. She needs actionable nursing handover: delirium status, medication instructions, dates falling due during the stay, falls risk and goals. Background should 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 |
|---|---|
| Day 2 acute delirium, 4AT score 6; pulled out IV cannula | The main complication of the admission. The rehab unit needs to know it happened and how severe it was, so it can recognise any recurrence. |
| Contributors: opioids, urinary retention, poor sleep, constipation; no infection found | Shows what likely drove the delirium and what to watch for. Say only that no infection was found, nothing stronger. |
| Brief mild evening confusion 07/11–09/11, settles with reorientation; hearing aids, glasses, clock, low lighting help | Gives current status and the non-drug strategies to continue. Include that daytime assessments are alert and oriented, and no antipsychotics were needed. |
| Paracetamol regular; oxycodone PRN, min 4 hrly, max 15 mg/24 hrs; pain 3/10 rest, 6/10 exercise | Rehab nurses must administer the charted regimen accurately, including the condition for giving a dose before physiotherapy, and know pain levels with activity. |
| BPH on tamsulosin; IDC removed 07/11, voiding well; macrogol daily, BO 08/11 | Urinary retention and constipation both contributed to the delirium, so current bladder and bowel status is a key monitoring point for the receiving unit. |
| Clips intact, dry wound, waterproof dressing; clips out 17/11; enoxaparin until 16/11 | Both the enoxaparin stop date and clip removal fall during the rehab stay, so the receiving unit must act on them. |
| WBAT, 30 m with 4-wheeled frame, supervision of 1; flexion 70°, lacks 10° extension; high falls risk, bed alarm | Sets the baseline for rehabilitation and the safety precautions needed, including night-time confusion as the reason for the falls risk. |
| Rehab about 2 weeks; goals; ortho review 6/52; wife wants to attend stair practice | States what the unit is aiming for, the follow-up it must keep, and a family request relevant to discharge planning, with the home stairs setting context. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Complained hospital food tasteless; asked for meals from home | A minor comfort complaint with no clinical consequence in the notes, and it is not needed for safe handover. |
| Pt says physiotherapist 'pushes too hard' — asked for a different therapist | A trap: it looks like a handover issue, but it concerns a different unit's staff. The clinical point, pain on exercise, is already covered. |
| Daughter overseas; she and wife disagree about selling the house | Family conflict is not a nursing handover matter, and it could be seen as breaching privacy without a clinical purpose. |
| Retired carpenter; enjoys fishing | Personal background that does not change the care plan or help the receiving nurse act. |
| Bilateral cataract surgery 2019 | A trap: it looks like relevant history, but it has no bearing on current care. The reading glasses that matter are covered with the delirium strategies. |
A paragraph plan for this case
Open with the purpose, patient identification and the knee replacement on 03/11 with transfer today. Next give the delirium course, current status and strategies, then pain, bladder and bowel, wound and enoxaparin. Close with mobility, falls risk, rehab goals, follow-up and the wife's request.
Where candidates slip on this task
- Oxycodone instructions are conditional: a pre-physio dose is given only if needed for pain and at least 4 hours since the last dose. Do not turn this into a routine pre-physio dose or add doses.
- The 4AT of 4 on 08/11 and 09/11 was scored for fluctuation only. Do not call it ongoing delirium or resolved, and do not describe a trend. Report daytime orientation and brief evening confusion.
- Enoxaparin ends 16/11 and clips come out 17/11, so do not mix the two dates. Keep the dressing instruction accurate: change only if soiled or lifting, not routinely.
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 nursing service: new insulin and diabetic foot ulcer discharge letter
- Referral to pulmonary rehabilitation after a COPD admission referral letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Do I need to name the tests that found no infection?
Not necessarily. Within the word limit, stating that no infection was found is enough. Avoid saying infection was ruled out or that tests excluded other causes, because the notes only say no infection was found.
Should the complaint about the physiotherapist go in the letter?
It is better left out. It is a preference about staff, not a clinical handover item, and the rehab unit has its own therapists. The useful clinical information is pain on exercise, range of movement and supervision level.
Sources
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