CLASSICAL CORRECTIONS

QQ.NW.21. Mrs Jasmine Thompson – Right Total Shoulder Replacement – Dinesh Kumar - Limerick, Ireland | Hyderabad, India Ms Nita Roberts In-Home Nursing service 79 Beachside Street Bayview 15 July 2017 Dear Roberts, Re: Mrs Jasmine Thompson, DOB: 01 July 1942 I am writing to refer Mrs Jasmine Thompson, a 75-years old, who was diagnosed with right shoulder osteoarthritis. She requires assistance and management following the discharge today. Mrs Thompson underwent a surgical procedure of right total shoulder replacement and post-operatively made a excellent progress without any complications. Post-operative right shoulder x-rays confirmed the position of TSR and bloods are within normal limit. Pain was managed with analgesia and cold compression. Surgical and drain site was maintained clean and dry. Absolute compliance with the recommendations by the physiotherapist should be continued as per TSR protocol. Cryo cuff (cold compress) should be provided for 4 hours daily. Today, discharge education regarding post TSR has been provided. She has been advised to use right arm sling and avoid lifting heavy weight until four weeks. A follow-up appointment on the fifth day after operation in the Orthopaedic Joint Replacement Department has been scheduled. In case of any emergency the Nurse specialist can be contacted on week days. Twice weekly physiotherapy sessions and once weekly hydrotherapy sessions have been recommended. It would be greatly appreciated if you could assist with daily living activities and it is highly recommended to administer clexane subcutaneously for four day as deep vein thrombosis prophylaxis. Please do not hesitate to contact me if you require further information. Yours sincerely, Registered Nurse.

Ms Smith. The community nurse. community Nursing centre Lamington 20 october 2019 Re: Mrs Martha Brown, 78 years old Dear Ms Smith, I am writing to refer Mrs Martha Brown, who is being discharged today following dog bit. for ongoing community nursing care and continue support. Mrs Brown was admited to the emergency department today due to 4 puncture wounds on Right hand including deep wound near thenar muscles which was 2mm depth approxymatlly after dog bit. on admission mrs brown reported low grade fever since 3days and unable to move hand because of pain which was 6/10. Following investigation, her FBCs, U&Es, X-ray was normal. However, according to the urinalysis - positive to protein, leucocytes and nitrites: as well as some pain on micturition. suspected UTI condition. morover, her Blood sugar level was 9.7mmols. In terms of her medical history, she was diagnosed with Rhuematoid Artharitis in 2004 and Diabetes mellitus in 2018 for which, she takes, oral Metforming 500mg 3 times per day. According to management, wound cleaned with saline and iodin dressing applied, covered with padding and bandaging. Tetanus prophylaxis done and for the pain, oral paraceta -mol 1g 4 times per day as required was prescribed. As well as, for the UTI and wound, co-amoxiclav 500mg 3 times per day for 7 days was prescribed. Currently, Ms Brown is stabilised and read for discharge. according to pain Score, her pain is slightly decreased as 4/10. Still she has limited movement of L hand some fingers Her vital Signs is normal and is agreed to increase her fluid intake as usual intakes are 2 glasses per day. I would greatly appriciate, If you could provide wound and dressing care 2 to 3 times per week. for 14 days with Iodine- based dressing, padding and bandaging. pleace monitor her UTI symptoms and increase her fluid intake more than 8 glasses per day. finally, Monitor progress and report any problems to the family doctor as she lives along. pleace note that her follow-up appointment is due on 30 november. if you have any queries pleace contact me. yours Sincerely, Nurse Emergency department [318 Words – Exceeding word limit by 188 words]

1. BULLET POINT 1 — ESTABLISH THE PATIENT’S STARTING POINT CONFIRM → CONNECT → DISCOVER The candidate card requires the nurse to do two things at this stage only: (1) confirm the reason for the appointment, and (2) find out how the patient feels about starting insulin injections. The role-player is expected to say that they feel a little anxious and unsure about beginning insulin injections, particularly because they have managed their diabetes reasonably well until now. SAMPLE 1 — CLEAR & PROFESSIONAL Confirm the purpose → Invite the feeling Nurse: I understand that you’re here today because your doctor would like you to start insulin injections, and I’ll be helping you with how to give them yourself. Is that correct? Patient: Yes, that’s right. Nurse: Before we go any further, how are you feeling about starting insulin injections? Patient: I’m a bit anxious and unsure about it. I’ve been managing my diabetes quite well until now. Nurse: I see. Thank you for telling me that. SAMPLE 2 — WARM & PATIENT-CENTRED Orientate the patient → Give space for emotion Nurse: So, as I understand it, you’ve come in today to learn about giving yourself insulin injections and for me to guide you through the process. Have I got that right? Patient: Yes. Nurse: All right. Before we begin, I’d like to know how you feel about the idea of starting insulin. Patient: To be honest, I’m a little anxious and not completely sure about it because I’ve managed my diabetes well with tablets and diet until now. Nurse: I understand. It’s helpful for me to know how you’re feeling. SAMPLE 3 — POLISHED & CONVERSATIONAL Check understanding → Encourage openness Nurse: From what I understand, your doctor has recommended that you begin insulin, and today we’re going to look at how you can administer the injections yourself. Is that what you were expecting from today’s appointment? Patient: Yes, that’s right. Nurse: And how do you feel about moving on to insulin injections? Patient: I’m feeling a bit nervous about it. I’m not really sure about starting injections because I thought I was managing my diabetes quite well. Nurse: Thank you for being open about that. FOUNDATION FORMULA 1. CONFIRM PURPOSE “Am I right in understanding that you’re here today to learn how to give yourself insulin?” 2. CHECK AGREEMENT “Is that correct?” 3. INVITE FEELINGS “How are you feeling about starting insulin injections?” 4. LISTEN Allow the patient to express anxiety or uncertainty. 5. ACKNOWLEDGE “I see.” / “I understand.” / “Thank you for telling me that.” IMPORTANT BOUNDARY At Bullet Point 1, establish what the appointment is about and how the patient feels. Do not yet ask why the patient is anxious or begin discussing pain, needles, the injection process, reassurance, alternatives, technique, storage or disposal. Those belong to the later task stages.

A. INTRODUCTIONS — OPEN THE CONSULTATION WITH CONFIDENCE GREETING → INTRODUCE → IDENTIFY → SETTLE → BEGIN For this role-play, the candidate is the nurse meeting a 60-year-old patient in a medical clinic. The clinical task itself begins only after the introduction, so the openings below deliberately do not enter Bullet Points 1–5. SAMPLE 1 — PROFESSIONAL & NATURAL Warm, simple and examination-safe Nurse: Good morning. My name is [Name], and I’m one of the nurses here at the clinic. May I confirm your name, please? Patient: [Responds.] Nurse: Thank you, Mr/Ms [Surname]. It’s nice to meet you. Please make yourself comfortable. Shall we begin? SAMPLE 2 — WARM & PATIENT-CENTRED Friendly, reassuring and conversational Nurse: Good morning. I’m [Name], one of the nurses looking after patients here today. Could I just confirm your name, please? Patient: [Responds.] Nurse: Thank you, Mr/Ms [Surname]. It’s good to meet you. Please have a seat and make yourself comfortable. We can take things one step at a time. Is that all right? SAMPLE 3 — POLISHED & CLINICALLY CONFIDENT Controlled, courteous and fluent Nurse: Hello, good morning. My name is [Name], and I’m the nurse seeing you today. Before we get started, may I confirm your name, please? Patient: [Responds.] Nurse: Thank you, Mr/Ms [Surname]. Please make yourself comfortable. If you’re ready, we can get started. FOUNDATION FORMULA 1. GREET — “Good morning.” 2. INTRODUCE — “My name is … and I’m one of the nurses…” 3. IDENTIFY — “May I confirm your name, please?” 4. SETTLE — “Please make yourself comfortable.” 5. TRANSITION — “Shall we begin?” IMPORTANT BOUNDARY At the Introduction Stage, do not yet ask: why the patient has come; how the patient feels about insulin; what is causing the anxiety; whether the patient fears needles; whether there are alternatives. Those belong to the numbered task stages that follow.

OET SPEAKING PRACTICE FOR NURSES — FOUNDATIONS FROM RAPPORT TO READINESS: THE CLINICAL CONVERSATION FRAMEWORK Based on Candidate Card No. 1 — Medical Clinic — Insulin Injections, the speaking session can be compartmentalised into seven clearly controlled sections. The five central stages follow the five task bullets on the candidate card. A. INTRODUCTIONS — OPEN THE CONSULTATION WITH CONFIDENCE Subtitle: Introduce → Identify → Establish Purpose → Invite the Patient Open professionally, introduce yourself, confirm the patient, establish the purpose of the consultation, and create a comfortable beginning before moving into the task. --- 1. BULLET POINT 1 — ESTABLISH THE PATIENT’S STARTING POINT Subtitle: CONFIRM → CONNECT → DISCOVER Core focus: Confirm the reason for the appointment and find out how the patient feels about beginning insulin injections. Communication purpose: Understand before explaining. --- 2. BULLET POINT 2 — UNCOVER THE REAL CONCERN Subtitle: EXPLORE → CLARIFY → UNDERSTAND Core focus: Explore the reasons behind the patient’s anxiety, such as the injection process, pain, needles, or concern about being unable to self-inject. Communication purpose: Find the fear behind the words. --- 3. BULLET POINT 3 — REASSURE AND BUILD CONFIDENCE Subtitle: ACKNOWLEDGE → REASSURE → EXPLAIN Core focus: Reassure the patient that injections can become easier with clear instructions and practice, while explaining why insulin is important and effective. Communication purpose: Reduce anxiety while strengthening understanding. --- 4. BULLET POINT 4 — TEACH THE INJECTION WITH CLARITY Subtitle: JUSTIFY → DEMONSTRATE → PROTECT Core focus: Explain why insulin injections are the best available option, then describe the injection procedure and the importance of rotating injection sites. Communication purpose: Turn explanation into practical confidence. --- 5. BULLET POINT 5 — SECURE SAFE INDEPENDENT PRACTICE Subtitle: DISPOSE → STORE → DEMONSTRATE Core focus: Explain safe needle disposal, appropriate insulin storage, and establish whether the patient is ready to self-inject while being observed. Communication purpose: Move the patient from knowledge to safe action. --- Z. CONCLUSION — CLOSE WITH CONFIDENCE AND READINESS Subtitle: CHECK → CONFIRM → ENCOURAGE → CLOSE Bring the consultation together by checking understanding, confirming readiness, encouraging the patient, inviting any final concerns, and ending professionally. THE COMPLETE SPEAKING JOURNEY A. INTRODUCTIONS — OPEN THE CONSULTATION WITH CONFIDENCE 1. ESTABLISH THE PATIENT’S STARTING POINT — Confirm → Connect → Discover 2. UNCOVER THE REAL CONCERN — Explore → Clarify → Understand 3. REASSURE AND BUILD CONFIDENCE — Acknowledge → Reassure → Explain 4. TEACH THE INJECTION WITH CLARITY — Justify → Demonstrate → Protect 5. SECURE SAFE INDEPENDENT PRACTICE — Dispose → Store → Demonstrate Z. CONCLUSION — CLOSE WITH CONFIDENCE AND READINESS MASTER MOVEMENT OPEN → DISCOVER → EXPLORE → REASSURE → TEACH → SECURE → CLOSE