“I’m worried about my family” is an important starting point, but it does not tell you what help the patient wants. In this OET nursing MND role-play, a newly diagnosed patient worries that her teenage daughter will stop concentrating on school. The nurse needs to understand that concern before offering information or arranging support.
Read the two cards, understand motor neurone disease, then practise speaking as the nurse. This original exercise draws on Set 1 in Jobin Thomas’s Caring Through Words: OET Speaking Guide for Nurses and the neurological role-plays and communication toolkit in OET Speaking for Nurses — Course 22. It is a teaching example, not an official OET card or an independently graded performance.
1. Your MND role-play cards
Nurse role card
Setting: A neurology clinic, during a follow-up discussion after diagnosis.
Situation: Leena Hassan, aged 54, has recently been diagnosed with motor neurone disease. She has weakness affecting everyday hand tasks and sometimes finds her speech less clear when tired. She says that her main worry is the effect on her family. The card does not specify an MND subtype, medicine, individual prognosis or booked support appointments.
Your five tasks:
- Explore what Leena understands about the diagnosis and what “the effect on my family” means to her. Acknowledge her feelings and allow time to answer.
- Explain MND in plain English. Answer questions about cure and progression honestly, without predicting Leena’s individual timeline.
- Explore current difficulties, including communication and any swallowing or breathing changes. Explain relevant support according to the needs she describes.
- Discuss how Leena might prepare for a conversation with her family. Ask whom she wants involved and describe appropriate sources of support.
- Agree a manageable next step, check understanding and explain how to seek help if symptoms change, distinguishing urgent problems from routine follow-up.
Patient role card
Setting: The same neurology clinic.
Situation: You are Leena Hassan, aged 54. You have recently been diagnosed with MND. Fastening buttons and opening containers are becoming difficult; speaking takes more effort when you are tired. You currently report no swallowing difficulty or breathlessness. Your partner knows the diagnosis. Your 16-year-old daughter has noticed your weakness but has not been told the diagnosis.
Your five tasks:
- Begin with, “I’m worried about my family.” When asked, explain that you fear your daughter will stop focusing on school because she feels she must look after you.
- Say that reading “no cure” online frightened you. Ask whether MND shortens life and how quickly your own condition will change.
- Describe the difficulty with hand tasks and speech. Answer questions about swallowing and breathing using the situation above.
- Ask how to begin talking with your daughter without making promises you cannot keep. Say that you would like your partner involved in preparing for that conversation.
- Choose a useful next step with the nurse, ask what to do if symptoms change, and explain back the main points you have understood.
For the practice partner: Reveal the family concern when the nurse explores it. Your daughter’s future reaction is a fear, not something that has already happened. Do not invent a refusal to study, a financial crisis or a medical appointment that is absent from the card.
2. Understand MND before coaching the conversation
What are motor neurones?
Motor neurones are nerve cells that carry messages involved in controlling movement. In motor neurone disease, these cells stop working properly over time. Muscles then become weaker. This can affect activities such as walking, gripping objects, speaking and swallowing; breathing muscles may also be affected. Symptoms and the rate of change vary between people.
For Leena, link the explanation to the hand weakness she has described. You do not need to list every possible future difficulty immediately. A useful first explanation is that the nerves are no longer sending messages to the muscles as effectively. Check what she wants to know before adding detail. The NHS MND overview explains symptoms, assessment and treatment.
How can you explain progression honestly?
“Progressive” means the condition worsens over time. It does not establish which difficulty will appear next or give you a date for a particular change. There is currently no cure, and MND is usually life-shortening. A compassionate response should not hide these facts when the patient asks directly.
However, a general statement about the condition is not an individual prediction. Leena’s type of MND, assessments and clinical course are not supplied. Acknowledge the uncertainty and offer to help her raise specific prognosis questions with her specialist team. Avoid giving a number of months or years from memory, or telling her that progression “will be slow”.
What can treatment and support do?
Care can address symptoms, communication, daily activities and quality of life. Some treatments apply to particular forms of MND. For example, riluzole may be used for ALS, but this card does not establish Leena’s subtype or treatment suitability. Do not turn that example into a prescription or a promise that treatment will stop progression.
A multidisciplinary team means professionals with different skills working together. Explain those skills through the patient’s problem. An occupational therapist can assess everyday tasks and useful equipment. A physiotherapist can advise on movement and suitable activity. Exercise needs to be tailored to the individual; more effort is not automatically better when muscles are weak or fatigue is increasing. Leeds Teaching Hospitals describes individual symptom management.
Speech and language therapy can support communication and assess swallowing difficulties. Dietary support may help when eating or maintaining nutrition becomes difficult. Breathing problems need appropriate assessment and may lead to discussion of respiratory support. Naming these options should open a conversation, not imply that Leena needs every intervention now or that any particular appointment is already arranged.
Does difficulty speaking mean difficulty understanding?
Speech can become less clear because the muscles involved are affected. That alone does not tell you what someone understands. Some people with MND also develop changes in thinking, behaviour or how they process information. Neither assume impairment nor promise that thinking can never be affected. Ask about communication preferences, allow time and adapt your explanation to the person.
In this case, Leena can describe her concerns. Let her finish rather than answering for her or directing every question to her partner. The MND Association discusses emotional, thinking and behavioural changes.
Why does the family concern need its own assessment?
Family impact can mean fear of upsetting a child, uncertainty about caring tasks, changes to relationships, income worries or concern about inherited disease. These require different responses. The words “my family” do not give permission to assume the family structure, contact someone or decide who will provide care.
Leena is worried about her daughter’s education and sense of responsibility. First discover what her daughter knows and what Leena most wants help explaining. A preparation plan might identify a suitable time, agree who will be present and choose a few clear points. Information should be honest and appropriate to the young person’s understanding, with room for questions and further conversations. Do not promise that the child will be calm or immediately accept the news. The MND Association has resources for parents and guardians.
What does support for the family involve?
Changing family roles can bring emotional and practical pressure. Relatives may need information and support of their own. It is reasonable to explore available help with the care team; it is not reasonable to announce that Leena’s daughter will become her carer or that her partner can manage everything. Keep the patient involved in decisions and clarify what each person is able and willing to do.
Support can also include palliative care, which focuses on quality of life and relief of symptoms and distress. In MND, this can be relevant from diagnosis onwards; it does not mean there is no active care left to offer. Introduce it sensitively if relevant rather than using it as a frightening label. See the MND Association’s guidance on relationships and family and palliative care.
Which changes must not wait?
New swallowing difficulty, coughing during meals, difficulty maintaining intake or changes in breathing should be reported promptly for clinical advice. The response depends on severity and the person’s plan. Do not give generic food textures or swallowing manoeuvres in place of assessment, or suggest that all breathlessness is simply anxiety.
Severe difficulty breathing, such as gasping or being unable to get words out, is an emergency: call 999 in this UK scenario. Someone who is choking and cannot breathe also needs emergency help. For less immediate changes, use the agreed specialist contact or seek urgent advice if help is needed and the team is unavailable. Never wait for a routine appointment when symptoms are becoming urgent.
3. Translate the five tasks into a conversation
Task 1: Clarify the family concern
Start with an open invitation. “What worries you most about the effect on your family?” is more useful than choosing a relative and guessing the problem. Reflect the answer accurately: Leena fears her daughter may neglect school; the daughter has not said she will. This small distinction prevents you from constructing a family conflict that does not exist.
Task 2: Respond to a direct question directly
Find out what Leena has read and what she wants clarified. If she asks whether MND shortens life, answer gently and honestly, then pause. Do not use a long list of services to avoid the question. Explain that the individual course varies and that her specialist team can discuss what is known about her situation.
Task 3: Match support to current difficulties
Ask what has become difficult in daily life, then connect one relevant service with that difficulty. Check swallowing and breathing without suggesting she necessarily has a problem. The role card gives no current difficulty in those areas; this is different from guaranteeing that they will never be affected.
Task 4: Help prepare, without taking over
Ask what the daughter has noticed and what Leena wants her to understand. Offer to help prepare a conversation with her partner, as requested. Check what support is available rather than promise a family appointment. Do not contact relatives or a school as if a discussion about them were automatic permission to share information.
Task 5: Agree one useful next step
A first plan might involve preparing questions and asking the care team about support for a family discussion. Confirm Leena’s choice and what needs arranging. Check the explanation using her words, then ensure she knows how to seek help for changing symptoms. The close should leave room for emotion, not rush into a cheerful farewell.
4. An extended nurse-viewpoint model answer
The following paragraphs show possible nurse language throughout the encounter. They are deliberately fuller than a short script so you can study the choices. Do not deliver them as a continuous speech. The italic instructions mark opportunities to listen. Later wording depends on the patient revealing the details on her card.
“Hello, Leena. I’m the nurse speaking with you today. I understand you’ve recently received a diagnosis of MND. There may be a lot to take in. What would be most helpful for us to talk about first?”
Listen to “I’m worried about my family” before continuing.
“Your family is very much on your mind. When you think about how this may affect them, which part worries you most?”
“So you are particularly worried about your daughter feeling she has to look after you and losing focus on school. Has she said anything about that, or is it something you fear may happen when she hears the diagnosis?”
Pause. Preserve the distinction between the patient’s fear and the daughter’s actual words.
“Thank you for explaining. You want to be honest with her, and you also want her to be able to continue her education. We can think about how to begin that conversation. Before we do, what have you understood about MND from the appointment and what you have read?”
“Seeing the words ‘no cure’ must have been frightening. MND affects the nerves that carry messages to the muscles. As those nerves stop working properly, the muscles become weaker. That helps explain why tasks using your hands have become harder.”
“There is currently no cure. Treatments and support can help with symptoms and daily life, but they cannot promise to stop all the changes. Would you like me to explain that further, or would you prefer to pause for a moment?”
Allow a response. When Leena asks about life expectancy, answer her question.
“MND is usually life-shortening. I’m sorry; I know that is difficult to hear. How quickly it changes varies between people, and I cannot give you a reliable personal timeline from the information we have here. Your specialist team can discuss what your assessments mean and answer questions about your situation.”
“What feels most important for you to understand about that today?”
Do not hurry past emotion into a list of services.
“You mentioned that buttons and containers are becoming difficult. An occupational therapist can assess those everyday tasks and discuss equipment or ways of doing things that may help. A physiotherapist can advise on movement and activity suited to you, taking fatigue into account.”
“You also said speaking is harder when you are tired. Would it help if we took short breaks during our conversation? I will give you time to finish. Speech and language therapy can help with communication and discuss useful options as your needs change.”
“Have you noticed any difficulty swallowing food or drinks, or coughing when you eat? And have you noticed any change in your breathing?”
Ask separately, listen and respond. The supplied patient card reports neither problem at present.
“Thank you. If either changes, please contact your care team promptly so the problem can be assessed. Support is based on what you need; mentioning an option today does not mean you need every treatment now.”
“Coming back to your daughter, what has she noticed so far? What would you most want her to understand when you start talking about the diagnosis?”
“You’ve said you would like your partner involved in preparing. We could help you identify the questions you want to discuss with the team and look at information written for parents and young people. Would that be a useful starting point?”
“It may help to begin with a few clear points, find out what she already thinks is happening and give her space to ask questions. You do not have to explain every possible future change in one conversation. If you do not know an answer, it is all right to say that you will ask the team rather than promise that everything will stay the same.”
“Her reaction may be different from what you expect. She may need time and more than one conversation. The MND Association has resources for families and young people, and we can discuss which support would be appropriate for you. We should also look at practical care needs with the team, rather than assuming your daughter must take responsibility.”
“Would you like to begin by preparing the questions with your partner and asking what help is available for the family conversation? Or is there another concern that needs our attention first?”
Agree the next step from Leena’s answer. State what needs arranging, not what has already been booked.
“Before we finish, let’s make sure you know how to contact your team if things change. New swallowing or breathing difficulty needs prompt advice. If you have severe difficulty breathing, such as gasping or being unable to get words out, call 999. Please do not wait for a routine appointment in that situation.”
“I have given you quite a lot of information. Could you tell me the main next step you would like to take, and what you would do if your symptoms changed? That will help me check whether I have explained things clearly.”
“What question would you like us to return to before we finish today?”
5. Speaking tips for a difficult diagnosis
Leave space after important information. “There is currently no cure” should not be immediately buried under six treatment options. Pause, observe the response and invite a question. The patient may need acknowledgement before more information.
Keep uncertainty specific. Explain what is known about the condition and what is unknown about this person. “I cannot predict your individual rate of change” is clearer than “Nobody knows anything.” Uncertainty should lead to an appropriate next discussion, not an abrupt end to support.
Use the patient’s priority to organise the conversation. Leena wants help with her daughter. You still need to explain the condition and check relevant symptoms, but signpost a return to that concern. Otherwise, a medically detailed response may leave the patient’s main question unanswered.
Support speech without taking control. Ask whether a pause or another way of communicating would help. Do not finish every sentence for the patient or assume that speaking slowly means they cannot understand you. Give the person time to express preferences.
Avoid compulsory optimism. Encouraging a useful next step is different from telling someone to “stay positive”. Sadness and fear do not mean the patient is failing to cope. Your language can be hopeful about support while remaining honest about the illness.
6. Sentences that keep the conversation responsive
- Explore a broad concern: “Which part of the effect on your family worries you most?”
- Check attribution: “Is that something she has said, or something you worry she may feel?”
- Find out what is understood: “What have you taken from the information you have been given?”
- Respond to emotion: “We can pause here. There is a lot to take in.”
- Clarify information preferences: “How much detail would be helpful for you today?”
- Include family appropriately: “Who would you like involved in preparing for that conversation?”
- Offer a manageable step: “Would preparing those questions together help you get started?”
- Check the plan: “What would you like to happen next, and what still needs explaining?”
Choose the sentence that responds to what has just been said. Repeating a prepared empathy phrase after every answer can sound mechanical. A brief, accurate reflection is often more useful than a dramatic statement about understanding exactly how someone feels.
7. Common mistakes and how to repair them
- “Your daughter will understand.” You cannot predict her reaction. Try: “We can help you prepare and think about support if she finds the news difficult.”
- “Your family is not coping.” The card reports Leena’s fear, not an observed family response. Try: “You are concerned about how your family might cope.”
- “Physiotherapy will stop the weakness.” This overstates its purpose. Explain that advice and support can help with function and symptoms, tailored to the person.
- “There is nothing we can do.” No cure does not mean no care. Connect available forms of support with the difficulty the patient has described.
- “You need to tell everyone today.” This removes choice and ignores readiness. Help the patient consider whom to involve and how to begin.
- “I have arranged all the referrals.” No such actions are supplied. Say what you can discuss or help arrange, and distinguish that from a confirmed appointment.
8. Repeat the role-play with a different family concern
In your first attempt, use Leena’s concern about her daughter’s education. Afterwards, identify where you discovered the actual concern, where you answered the prognosis question and where you returned to the family discussion. Listen for assumptions about relatives who are not present.
Second attempt: family impact now means practical care
Replace the daughter-related priority with this answer: “My partner has back problems. I am frightened that he will have to lift me if I need more help.” Keep the diagnosis and current symptoms unchanged. This new detail is supplied for the second round; do not use it in the first.
Say your next question and reflection before opening the suggested response. Consider whether your original plan about talking to a teenager still addresses the worry you have just heard.
Read a possible response and why it fits
“You are worried about your partner’s health as well as your own care needs. Are you needing help with moving now, or is this a concern about what you may need in the future?”
Then respond to the answer: “We should not assume that your partner can safely provide physical help. This is something to discuss with the care team so that your needs and his abilities are assessed. An occupational therapist and other team members can advise about suitable support and equipment.”
Why this works: The nurse identifies whether there is an immediate difficulty or a future worry and avoids assigning a caring task to the partner. No lifting technique, equipment purchase, home adaptation or funded care package is promised without assessment. If a current safety problem emerges, it takes priority over continuing a rehearsed family-information script.
Review your communication
- Did I find out which family impact mattered instead of guessing?
- Did I distinguish the patient’s fear from a relative’s actual response?
- Did I explain the condition clearly and answer direct questions honestly?
- Did I offer support matched to the need, without promising an outcome or service?
- Did the changed answer lead to a different and relevant next step?
For more practice, explore OET Speaking for Nurses — Course 22. Its neurological scenarios and lessons on plain-English explanations, honest reassurance, chunk-and-check advising and closing provide further ways to work on this conversation. Pick one skill from your recording and improve it in the next attempt.
Source notes
The matched book’s introduction and complete Set 1 newly diagnosed MND cards, condition explanation, phrases and sample response were consulted, together with the full Course 22 curriculum. This article uses a new scenario, paired cards, teaching model and practice variation. Clinical wording was checked against the linked NHS, Leeds Teaching Hospitals and MND Association information, including the Association’s September 2026 MND overview and April 2026 palliative-care guidance. Emergency breathing advice follows the NHS shortness-of-breath guidance. This is communication practice; clinical care depends on the person’s assessment and agreed plan.
Your next step
OET Speaking for Nurses — Course 22
Explore the complete course outline and related practice topics.
Source: OET NURSE SP - 219-1.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.