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

QQ.MW.20. Mr Willam McGuire - Deteriorated Respiratory Function - Dr Hala Sirelkhatim - London - United Kingdom | Khartoum - Sudan Dr Mandy Sutton Respiratory Physician Department of Respiratory Medicine Central Hospital Bay City 06 October 2018 Dear Dr Sutton Re: Mr Welliam Mc Guire DOB: 23 May 1953 I am writing to refer Mr Mc Guire, who has decreased respiratory function, requiring evaluation and treatment intensification along with home oxygen therapy. Mr Mc Guire has had COPD Since 2016, and was hopitalised twice following infective exace-pation of COPD. He was treated with IV antibio-tics and received pulmonary rehabilitation and physiotherapy on each admission. The current medications are 100mcg Salbutamol two puffs P.R.N, Salmeterol /fluticasone 500mcg/50mcg one puff b.d, and tiotropium bromide 18mcg one puff b.d. He also has gout for which he takes allopurinol 100mg one tablet b.d. He has a first degree family history of COPD, rheumatoid arthritis and bronchiectasis. On 06.10.18, Mr Mc Guire presented to complain of a gradually increasing dyspnoea for 3 months, anorexia and has become more anxious. Additionally, his activity of daily living has significantly decreased and has recently become depressed. He denied experiencing any paroxysmal noctornal dyspnoea or orthopnoea. Examination revealed a hyper inflated chest, increased resonance, decreased chest expansion and breath sounds. No crepitation or wheezes were detected. There was no elevation in the Jugular venous pressure and no dual heart's sounds murmer. Pathology report demonistrated no anaemia or troponin level elevation. The chest X-ray rouled out any pneumothorax or cancer. Peak expiratory flow rate was 320 FEV1 of 47%.. Accordingly, the assessment concludes a decreased pulmonary function, prompting treatment intensification with home oxygen therapy. I would appreciate it, if you could conduct a follow-up evaluation and management advice on Mr Mc Guire decreased pulmonary function. If you require any further information, please do not hesitate to contact me Yours sincerely (Name) General practitioner

QQ.MW.19. Ms Anne Hall - Gastro-Oesophageal Reflux - Dr Rabeea Komal - Dublin, Ireland | Lahore - Pakistan Dr Jason Roberts Gastroenterologist Newtown Hospital 111 High street Newtown 18/09/2026 Dear Dr Roberts Re: Ms Anne Hall, DOB 19.09.1972 I am writing to refer Ms Hall, 45 year old who presented with gastroesophageal reflux with possible stricture for further assessment and endoscopy if required. Ms Hall is a teacher. She has a positive family history for peptic ulcer and asthma. Kindly note that she is allergic to codeine, dust mites and sulphur dioxide and a social drinker. On 18/06/2018 Ms Hall presented with the complaint of dysphagia. This symptom started about two weeks ago following a post viral upper respiratory tract infection. Additionally, she has self medicated with over the counter and a herbal product. On her examination, at the level of T12, concomitant epigastric pain was noted which was radiating towards the back. She has experienced 1 to 2 kg weight loss. Recently she has increased coffee consumption and was taking Aspirin 2 to 3 times a month. Ms Hall has been advised to reduce caffeine and alcohol intake. She has been advised to stop taking over the counter product. In addition, Pantoprazole was prescribed. In view of her dysphagia, weight loss and possible oesophageal stricture, I would appreciate your further assessment and management including endoscopy If you have any queries please contact me. Yours sincerely Doctor

ROUND 1 — STAGE 1 — MANUSCRIPT SUBMISSION ============================================================ When the student’s handwritten or typed letter is submitted: Provide a faithful electronic typed copy exactly as written. STRICT RULES: 1. No additions. 2. No deductions. 3. No modifications. 4. No corrections. 5. No improvement of grammar. 6. No correction of spelling. 7. No correction of punctuation. 8. No correction of capitalisation. 9. No change to vocabulary. 10. No change to sentence structure. 11. No change to paragraphing. 12. No change to address, date, salutation, reference line, closing or designation. 13. Preserve every visible error exactly. 14. Mark a genuinely unreadable word as [unclear] rather than guessing. 15. Present the transcription in complete letter format. Do not assess, explain or correct at this stage.

*QQ.NW.2. Ms Mary Bell – Unstable Diabetes Mellitus – Arundhadhi Valsan – Maldives | India* 15 July 2017 Ms Jane Rudick Community Nurse Newtown Community Health Centre Newtown Re: Ms Mary Bell, aged 66 I am writing to refer Ms Mary Bell who requires an overall lifestyle plan and monitoring. She has been diagnosed with infected left foot ulcer secondary to unstable diabetes mellitus and is being discharged today. Ms Bell is a retired women who lives alone with a poor low income. She has no relatives, close friends and no outside interests. She is on Metformin, 850mg thrice daily and Glibenclamide, 5mg daily, which needs to be continued. Apart from, she reports increased alcohol intake and periodic problems with self-administration of hypoglycaemic medication since her retirement. On 24 June 2017, Ms Bell was admitted to the hospital with the present diagnosis. During hospitalization, she was treated with daily saline dressings and Augmentin Duo Forte, 875/125mg twice a day, which needs to be reviewed after the completion of current course. It would be appreciated if you could assess the wound margins for signs of complications and healing progress. For medication compliance, blood sugar levels, alcohol intake and diet. It would be beneficial if you could have involve a social worker to encourage her for moderate exercise programme and for the establishment of income-producing and social activities. Please do not hesitate to contact me if you have any queries. Yours faithfully, Registered Nurse

QQ.NW.1. Mrs Alison Greene – Palliative Care – Raghavendra Rao – Maldives | India Ms Joanna Simons Head of the Community Nursing Service 87 Amwell Road Newtown 3 September 2019 Dear Nurse, Re: Mrs Alison Greene DOB: 12 October 1951 I am writing to refer Mrs Alison Greene a 67-old, who required monitoring and administration of medication. Mrs Alison Greene is a retired teacher who is suffering from T4 metastatic breast cancer to bones and brain. For which, she needs sub-cutaneous morphine infusion inorder to control her pain. She was prepared upper left arm with butterfly needle and transparent dressing through syringe driven 20ml of morphine sulphate which is equivalent 15mg to administering daily. In addition, she has Type 2 diabetes mellitus since 2010, she has been on medication/metformin. However, recently her diabetes has been unsastablised. In August 2019 her HbA1c is 8.1%, for that she has been advised to start Insulin 12Units per day. Insulin administering by herself. Mrs Greene is travelling to her daughter’s home, which is Newton (5kms away from her home). She is visiting on 5th September to 7th September and her departure timing here 7am and return home on 7pm. In mean while, Please ensure to check her daily sugars pre and post meals. and also monitor her insulin administer required dose. It would be appreciated, if you can arrange a community nurse for daily visit. Could please make sure to check replenishing syringe driver daily needs to change along with loaded medication. Butterfly needle is-situ which is not required to be changed. If nurse unsure about this please feel free to contact Nethers’s hospice regarding Mckinley pump for advice on painmanagement. It is also required to be assess her glycemic control. If you have any queries, do not hesitate to contact me. Yours Sincerely, Community Nurse [288 WORDS]

F. BULLET POINT 5 Explain safe needle disposal + outline insulin storage + establish willingness to self-inject under observation Task focus: “Explain importance of safe needle disposal (e.g., suitable containers, proper care and handling, etc.). Outline insulin storage (e.g., refrigerating unopened insulin, not exposing to sunlight/high temperatures, checking expiration dates, etc.). Establish patient’s willingness to be observed self-injecting.” --- SAMPLE 1 — CLEAR & PROFESSIONAL NURSE: “After each injection, it’s very important to dispose of the used needle safely. You should place it straight away into an approved sharps container and avoid recapping or handling it unnecessarily.” PATIENT: “Right.” NURSE: “You also need to store your insulin correctly. Unopened insulin should usually be kept refrigerated, and it should never be exposed to direct sunlight or high temperatures. You should also check the expiry date before using it.” PATIENT: “All right, that’s clear.” NURSE: “Now that we’ve gone through everything, would you feel comfortable giving yourself an injection while I observe and guide you?” PATIENT: “Yes, I feel better about it now. I’m ready to try.” --- SAMPLE 2 — SUPPORTIVE & PATIENT-CENTRED Speaker Dialogue Nurse “One final safety point is how you dispose of the needle. Used needles should go directly into a proper sharps container so that no one is accidentally injured.” Patient “I understand.” Nurse “As for the insulin, unopened supplies should generally be kept in the refrigerator. Avoid leaving insulin in direct sunlight or anywhere very hot, and always make sure it is still within its expiry date.” Patient “Okay.” Nurse “You’ve taken in a lot of information today. Would you be happy to give yourself an injection now while I watch and support you?” Patient “Yes, I think I can do that.” --- SAMPLE 3 — NATURAL ROLEPLAY FLOW 👩‍⚕️ NURSE “Before you start doing this independently, there are two final things to remember.” ⬇️ 👩‍⚕️ NURSE “First, once you’ve used a needle, put it immediately into a suitable sharps disposal container. That helps prevent accidental needle injuries.” ⬇️ 👤 PATIENT “Okay.” ⬇️ 👩‍⚕️ NURSE “Second, insulin needs to be stored properly. Keep unopened insulin refrigerated, protect it from direct sunlight and excessive heat, and always check the expiry date before use.” ⬇️ 👤 PATIENT “That all sounds clear.” ⬇️ 👩‍⚕️ NURSE “Good. How would you feel about giving yourself an injection now while I observe you?” ⬇️ 👤 PATIENT “I feel much better about it now. Yes, I’m ready to try.” --- BULLET POINT 5 ENDS HERE. Next phase: G. CONCLUSION PHASE ONLY — conclusion and farewell, with no repetition of the five bullet points.