The task
Assume that today's date is 21 October 2026. Mrs O'Brien will be transferred tomorrow morning.
You are a registered nurse on the stroke rehabilitation unit at Southbank Hospital. Using the information in the case notes, write a letter to Ms Grace Liu, Clinical Care Manager at Banksia Gardens Aged Care, who will be responsible for Mrs O'Brien's ongoing care. Address the letter to Ms Grace Liu, Clinical Care Manager, Banksia Gardens Aged Care, 60 Coastal Highway, Southbank. 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: Mrs Maureen O'Brien
- DOB: 19/01/1940 (86 yrs)
- Admitted: 02/09/26 (acute stroke unit); rehabilitation unit from 16/09/26
- Transfer to Banksia Gardens Aged Care: 22/10/26
Social background
- Widowed; previously lived alone; family agreed she cannot return home
- Daughter (Siobhan) is enduring guardian; visits every second day
- Retired seamstress; enjoys Irish folk music and crosswords
- Daughter asked whether Banksia Gardens has 'better staff' than the hospital
- Daughter travelling overseas 10–24 Nov — son-in-law will visit instead
Medical history
- L middle cerebral artery ischaemic stroke 02/09/26 → R-sided weakness, expressive aphasia, dysphagia
- Atrial fibrillation (diagnosed this admission)
- Hypertension; osteoarthritis
- Hysterectomy 1985
- Cataract surgery L eye 2015
- Allergies: sulfonamides (rash)
Current medications
- Apixaban 2.5 mg BD (reduced dose: age > 80, weight 52 kg)
- Atorvastatin 40 mg nocte; perindopril 2.5 mg mane; paracetamol 1 g TDS; macrogol 1 sachet daily
- All tablets crushed and given in smooth puree (pharmacist confirmed suitable); macrogol and supplement drink to be thickened to IDDSI level 2 with gum-based thickener (not starch-based)
- Current medication chart and pharmacist administration instructions accompany transfer
Swallowing & nutrition
- Speech pathology: minced & moist diet (IDDSI level 5); mildly thick fluids (IDDSI level 2)
- Supervision at all meals: sit upright 90°, small mouthfuls, remain upright 30 min after
- Aspiration pneumonia 20/09 — treated, resolved
- Weight 52 kg (55 kg on admission); high-protein supplement drink BD
- Prefers tea with one sugar
Mobility & skin
- Transfers: 2 staff with standing hoist; wheelchair for mobility; not walking
- Physiotherapy: maintenance exercise programme (copy attached)
- Stage 2 pressure injury sacrum (1.0 × 0.8 cm), improving — hydrocolloid dressing, change every 3 days (next due 23/10)
- Repositioning 2–3-hrly; pressure-redistributing mattress
Communication & continence
- Expressive aphasia: understands simple sentences; answers using yes/no gestures and picture board
- Urinary incontinence — continence pads; bowels open every 1–2 days
- Mood: occasionally tearful; enjoys music
- Pt's roommate frequently calls out at night — pt sleeps poorly
Who is reading, and what do they need?
Ms Liu is a Clinical Care Manager who will organise ongoing care but has not seen the patient. She needs clear, actionable handover on diet and fluids, medication preparation, wound care, mobility and communication. She does not need the full admission history or unrelated surgery, so detail should serve safe care from the first day.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| L MCA ischaemic stroke 02/09/26: R-sided weakness, expressive aphasia, dysphagia | Gives the reason for transfer and the deficits that drive every care need described afterwards. |
| Atrial fibrillation diagnosed this admission; apixaban 2.5 mg BD | New diagnosis and an anticoagulant the facility must continue; the reduced dose reason (age over 80, weight 52 kg) is on the card. |
| Tablets crushed in smooth puree; macrogol and supplement thickened to level 2 with gum-based thickener | Preparation method is a safety instruction for staff giving medicines; the gum-based, not starch-based, detail is easily missed. |
| Minced and moist (level 5) diet; mildly thick fluids (level 2); supervised meals, upright 90°, 30 min after | Core swallowing plan the facility must follow from the first meal. |
| Aspiration pneumonia 20/09 — treated, resolved | Relevant history showing why swallowing precautions matter; state it as resolved, not ongoing. |
| Stage 2 sacral pressure injury, improving; hydrocolloid every 3 days, next due 23/10 | Ongoing wound care with a date the receiving staff must act on, shortly after arrival. |
| 2 staff with standing hoist; wheelchair; repositioning 2–3-hrly; pressure-redistributing mattress | Determines staffing, equipment and pressure injury prevention needed on arrival. |
| Understands simple sentences; yes/no gestures and picture board; Siobhan is enduring guardian, son-in-law visiting 10–24 Nov | Staff need to communicate with her and know the guardian contact arrangement while Siobhan is away. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired seamstress; enjoys Irish folk music and crosswords | Background interests do not affect clinical handover; music could at most be compressed if mood is mentioned. |
| Daughter asked if Banksia Gardens has 'better staff' | A comment about the facility, not care information; including it is unprofessional and unhelpful. |
| Hysterectomy 1985; cataract surgery L eye 2015 | Remote history with no bearing on current care needs. |
| Roommate calls out at night; pt sleeps poorly | Relates to the hospital room, which the new facility will not share; a trap that looks like a care issue. |
| Prefers tea with one sugar | Minor preference; any tea would also need thickening, so it adds little and risks distracting from the plan. |
| Maintenance exercise programme (copy attached); medication chart attached | Attachments can be referred to briefly rather than having their contents repeated. |
A paragraph plan for this case
Open with the purpose, transfer date and diagnosis with main deficits. Then cover swallowing and medication preparation, followed by skin, mobility and communication needs. Close with the guardian contact arrangement, enclosures and an offer to provide further information.
Where candidates slip on this task
- Do not omit the gum-based, not starch-based, thickener or the instruction that tablets are crushed in puree; both are practical safety details for medicine administration.
- Date the next dressing change as 23/10 and keep tense accurate: the pneumonia is resolved and the pressure injury is improving, not healed.
- Do not omit the guardian's absence; state clearly who will visit instead and the dates, without adding contact details or reasons not in the notes.
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
- Transfer to a rehabilitation unit after knee replacement complicated by delirium transfer letter
- 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
Should I include the weight of 52 kg and the supplement drink?
Yes, briefly. The weight is already linked on the card to the apixaban dose, and the BD supplement is part of the nutrition plan. List them as separate facts and do not give a reason for the supplement that the notes do not state.
Is the daughter's overseas travel relevant?
Yes. Siobhan is the enduring guardian and will be away 10–24 Nov, so Ms Liu needs to know that the son-in-law will visit instead. Mention it concisely; her question about staff quality should be omitted.
Sources
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