OET Nursing Knee Replacement Role-Play: Plan a Safe Discharge

Your goal: In this OET-style nursing role-play you will speak with a patient after knee replacement surgery. She wants to go home, but she lives alone and is worried about stairs, meals and pain. Your job is to understand her actual home situation, explain recovery simply and agree what the ward team must check before discharge.

Original nurse and patient role-play cards

These are original teaching cards, not an official OET role-play or a real discharge plan. Give the patient card to your interlocutor. Read your own card during preparation.

Practice: Allow three minutes to prepare and about five minutes to speak. The patient should reveal the meal difficulty only after the nurse asks about life at home. Do not hand the nurse the patient card in advance.

Understand knee replacement and the home-care problem

What has happened to the knee?

In a knee replacement, damaged parts of the knee joint are replaced with artificial parts. The aim is to improve pain and movement over time. It is surgery, so pain, swelling and reduced movement can be expected in the early recovery period. Mrs Ellis is only one day after her operation. Her discomfort when standing deserves assessment, but pain alone in this card does not prove a complication or tell you which medicine to give.

Recovery is gradual and individual. Ward staff assess pain, observe the wound and help the patient move safely. A physiotherapist guides walking, exercises and stair practice. An occupational therapist or discharge team can discuss everyday tasks and support needs. It would be misleading to tell Mrs Ellis that she will walk normally tomorrow, or that she must be discharged on a fixed day. The surgeon’s team has not given such a date.

Why is movement encouraged if it hurts?

After knee replacement, the team usually helps patients begin moving and walking early as appropriate. Movement and exercises support strength and knee mobility. But “move early” does not mean “walk through any pain” or “try the stairs alone.” The physiotherapist will assess how she uses the frame and whether she can manage the stairs safely. The nurse should ask what the pain feels like and when it occurs, check the prescribed pain plan, and raise uncontrolled or changing pain with the clinical team. Good pain control helps the patient participate in recommended activity. The exact exercises, walking aid and medicine schedule must come from her own team.

Why is living alone a clinical communication issue?

Being able to walk a few steps on a flat ward corridor is not the same as reaching a first-floor flat, using a bathroom, preparing food and collecting medicines. Mrs Ellis’s daughter cannot come until Saturday; the nurse cannot treat “family will help” as a complete plan for Tuesday. Ask whether the stairs have a rail, where the toilet and kitchen are, whether she has food and who might be available. The team can then assess stairs and daily activities and discuss suitable help or equipment if needed. You should not promise that a service is already arranged or that she must remain in hospital until Saturday.

Which symptoms change the urgency?

Some discomfort and swelling can occur after knee surgery, but new or worsening pain, increasing redness or discharge from a wound, a high temperature, or new calf pain and swelling should be reported promptly for assessment. Leg pain or swelling together with chest pain or breathing difficulty can be an emergency. The card says Mrs Ellis has not reported these symptoms. Give clear advice about what to report if they arise; do not describe them as facts about her current condition.

In plain English: “Your knee has just been operated on, so we expect recovery to take time. We need to check that your pain is managed well enough for the activities your team recommends. Before anyone confirms a plan for home, the physio and discharge teams need to look at your stairs and how you will manage everyday tasks.”

Work through the five nurse tasks

1. Find the specific barrier. Ask about the short walk and what happens when she stands, then ask what home is like. “What would be hardest when you get through your front door?” may reveal stairs, meals or bathroom access. If you only ask “Are you worried about pain?” you may miss the problem she actually needs help with.
2. Explain the operation and recovery. Tell her the team expects some early discomfort and will assess changes. Explain that guided movement and exercises are part of recovery. Avoid a fixed recovery date or “this pain is normal” before asking what the pain is like.
3. Turn worry into a team assessment. State what you will pass on: first-floor stairs, no lift, living alone, limited help until Saturday and difficulty preparing meals. Ask physiotherapy to assess stairs and walking, and involve the discharge or occupational therapy team for daily tasks. Do not claim those assessments have already happened.
4. Answer the pain medicine and safety questions. Ask when the pain is worst and whether her prescribed pain relief is helping. Do not advise an extra dose without checking the prescription. Tell her to call staff if pain becomes much worse or she develops new wound or calf symptoms; serious breathing difficulty or chest pain requires emergency help.
5. Close with an honest plan. You cannot promise she stays until Saturday. Say what you can do now: document her concerns, ask for team assessments and review her pain with the nurse in charge or prescriber. Ask Mrs Ellis to explain what will happen next so you can correct any false expectation about discharge.

Model response from the nurse’s viewpoint

One possible nurse answer in connected speech. Pause for the patient’s replies at the questions. Do not deliver this as an uninterrupted monologue; use the patient’s answers to choose what to say next.

“Mrs Ellis, it is good that you have started walking with the frame, and I can hear that standing made the knee hurt. Could you tell me where the pain is, how strong it feels and whether it settles when you rest? Have you noticed a sudden change or anything new around the wound? ... Thank you. We should review how well the prescribed pain relief is helping. I do not want you to take an extra dose on your own; let me check your chart and raise the pain with the team if it is not controlled.”

“You asked whether pain means the operation has gone wrong. After a knee replacement, some pain and stiffness can happen early on because the knee has just had surgery. But I would not dismiss your pain without assessing it. Movement usually starts with support, and the physiotherapist will show you which exercises and walking activities are right for you. We cannot judge your whole recovery from one painful attempt to stand. What is worrying you most about the next few days?”

“I see—the stairs and making meals at home concern you more than the short walk here. You are on the first floor without a lift, and your daughter cannot come until Saturday. Thank you for explaining that. Walking on a flat corridor does not show whether the stairs and everyday tasks will be manageable. I will tell the physiotherapist about the stairs and ask the discharge or occupational therapy team to discuss what you need for meals, the bathroom and support at home. We need their assessment and the wider team’s plan before anyone gives you a definite date. I cannot promise you will stay until Saturday, but I can make sure these practical concerns are heard before discharge is discussed.”

“While you are here, please tell us if your pain suddenly becomes worse, the wound becomes more red or starts leaking, or you notice a new painful, swollen calf. If you develop chest pain or serious breathing difficulty with leg symptoms, that needs emergency help. I am not saying these are happening now; they are changes to report. Could you tell me which part of the home plan still feels uncertain? ... Before I leave, can you put the next steps in your own words? Yes: we will review your pain, ask for stair and daily-activity assessments, and then discuss the discharge plan with you. What else would make going home feel safer?”

Speaking tips for a practical discharge barrier

• Use one question to uncover life at home. “What might stop you managing when you get home?” often gives more useful information than “Are you okay to go home?”
• Do not equate a good ward walk with safe stairs. Ask about stairs, food, bathroom and who is actually available to help.
• Separate explanation from promises. “The physiotherapist will assess this” is specific. “You will definitely manage alone by Thursday” is unsupported.
• Keep the nurse’s role clear. You can assess, explain, report, involve team members and check understanding. You cannot invent therapy findings or approve a discharge date from this card.
• Pause after a concern. If Mrs Ellis says her daughter cannot visit, allow the impact of that answer to change your plan before moving to the next task.

Model communication sentences to practise aloud

• “When you stood up, where did you feel the pain, and did it ease when you rested?”
• “The knee has just had surgery, so we will support you to move safely and manage your pain while it heals.”
• “Could you tell me about your stairs and what a normal day at home involves?”
• “I will ask the physiotherapist to assess the stairs and the discharge team to discuss everyday help.”
• “I cannot give you a date until the team has checked that plan with you.”
• “What will happen next, as you understand it?”

Practise saying these aloud in your own words. A good answer responds to Mrs Ellis’s reply; it is not a recital of six sentences in order.

Common mistakes and better alternatives

Complete practice and a changed-answer attempt

First attempt: Prepare for three minutes and record a five-minute role-play with a partner. Afterwards, write the barriers you heard: stairs, no lift, meals and limited family support. Did you ask enough to discover them, or did you simply assume the daughter could help? Did you assess pain before calling it expected? Did you explain who will review the home plan without promising a date?

Second attempt: Ask the interlocutor to change her answer about pain: “Now I have a new painful swollen calf.” The model must change. Stop the routine discharge discussion, ask relevant safety questions and arrange prompt clinical assessment for a possible clot. If she also reports chest pain or serious breathlessness, seek emergency help. A prepared speech is only useful while the facts remain the same.

Revision: Make a three-line note: pain assessment; home barriers; team plan. Give the role-play again without looking at the model. Ask your partner to tell you what would happen next and whether they felt heard. If they still think you promised a discharge date, revise the closing statement.

Explore OET Speaking for Nurses — Course 11 for related speaking practice. Online one-to-one OET students can propose lesson dates and times around shifts, subject to tutor availability.

This is an original illustrative lesson informed by the matching source book; it is not an official OET assessment and does not predict a score. Clinical details were checked against NHS knee-replacement recovery and NHS complications guidance. The individual surgical team’s instructions take precedence for a real patient.

Source: Exam Level OET Speaking for Nurses.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.