A patient says, “I read that Addison’s disease can cause a crisis.” Before explaining, find out what the patient thinks that means. Are they worried about a sudden emergency, confused about their tablets or considering stopping treatment? This OET nursing Addison’s disease role-play helps you ask that question and turn a frightening online statement into a clear, practical conversation.
The original exercise develops the endocrine vocabulary and clarification skills in OET Speaking for Nurses — Course 23. It draws on the Addison’s disease scenario in Jobin Thomas’s Beyond Words: OET Speaking Excellence for Global Nurses. These are teaching cards and an extended study model, not official OET materials or a guaranteed-score script.
1. Your Addison’s disease role-play cards
Nurse role card
Setting: An endocrinology clinic in the UK.
Situation: Samira Khan, 34, was recently diagnosed with Addison’s disease after investigation of persistent tiredness, dizziness on standing and weight loss. She has started prescribed replacement treatment. She brings an online article mentioning adrenal crisis and asks whether she can safely return to her usual activities. The card supplies no medicine doses, blood results or individual activity restrictions.
Your five tasks:
- Ask how Samira is feeling now, explore the effect of symptoms and identify the exact online statement and her interpretation of it.
- Explain Addison’s disease and the purpose of hormone replacement in plain English, checking her understanding.
- Discuss daily treatment and why an individual sick-day plan matters. Explore what instructions and emergency training she has received without inventing doses.
- Explain warning signs of adrenal crisis and the need for emergency action. Discuss practical preparation for everyday life according to her concerns.
- Agree the next steps for clarifying her plan with the team, check understanding and invite remaining questions.
Patient role card
Setting: The same endocrinology clinic.
Situation: You are Samira Khan, 34. You have recently started treatment for Addison’s disease. You still tire more easily than before, but today you have no sudden deterioration, vomiting, severe abdominal pain, collapse or confusion. You have been taking the prescribed tablets. You have written information but are unsure which instructions apply when you become ill.
Your five tasks:
- Say, “I read that I could have an adrenal crisis.” When asked, explain that you interpreted this as meaning you could collapse at any moment, even when following treatment.
- Describe your recent symptoms and ask what your adrenal glands normally do. Ask whether the tablets cure the condition.
- Ask why you need treatment every day and what happens if you catch an illness. Explain that you have not yet demonstrated using an emergency injection kit.
- Ask how to recognise an emergency and how to prepare for going back to work without constantly checking symptoms online.
- Agree one practical next step and explain the routine and emergency parts of the plan back to the nurse. Ask for clarification if the instructions remain unclear.
For your practice partner: The original round is a stable education appointment. Do not introduce current severe illness unless practising the emergency variation below. Let the nurse discover your interpretation rather than immediately presenting every concern.
2. Understand Addison’s disease before explaining it
What are the adrenal glands?
The adrenal glands are small hormone-producing glands above the kidneys. Hormones are chemical messages that help the body regulate its functions. In Addison’s disease, the glands cannot produce enough of certain essential hormones. This is called primary adrenal insufficiency: the problem is in the adrenal glands themselves. It is different from assuming that every tired or stressed person has an adrenal disorder.
Cortisol helps the body manage energy, blood pressure and the demands of illness or injury. The body normally adjusts how much it makes. Aldosterone helps regulate salt and water balance, which also affects blood pressure. Addison’s disease can reduce both. A patient does not need to memorise those names before understanding the basic point: treatment replaces something the body needs but is not making adequately.
How do the symptoms connect with the condition?
Persistent tiredness, weakness, reduced appetite, weight loss and dizziness on standing can occur. Some people notice darker skin or cravings for salty food. Symptoms overlap with other conditions, so symptoms alone do not establish a diagnosis. Samira’s diagnosis has already been made after investigation; this exercise is about explaining and managing the conversation, not diagnosing anyone from a list.
Ask which symptoms affect her day. “How does the tiredness affect your work?” produces more useful information than “You must be unable to work.” The card provides no blood pressure number and no test results. Do not invent them to make the explanation sound more clinical. The NHS overview of Addison’s disease provides patient information about symptoms, treatment and emergency signs.
What does replacement treatment mean?
Replacement medicine supplies hormones the body lacks. A glucocorticoid such as hydrocortisone or prednisolone may be used to replace cortisol. Fludrocortisone has a different role, replacing the action of aldosterone when needed. These names are not interchangeable options for one identical job. Explain the purpose of the patient’s actual prescription rather than suggesting that they can choose between medicines independently.
Addison’s disease usually requires lifelong replacement. Feeling better does not show that the glands have recovered or that tablets are no longer needed. Abruptly stopping essential replacement can be dangerous. Concerns about side effects deserve review, but the response should not be an unsupervised pause in treatment. The Cambridge University Hospitals steroid-replacement leaflet explains why daily treatment and education matter.
In conversation, avoid turning “lifelong” into a rushed instruction. The patient may hear it as a loss of independence. Ask which part feels difficult: remembering doses, fitting treatment around shifts, fear of harm, or learning emergency actions. Each answer calls for a different kind of support. A useful explanation links the treatment’s purpose to the patient’s question before adding another fact.
Why can illness change the plan?
During illness, injury or procedures, the body may need more cortisol than usual. A person with adrenal insufficiency cannot reliably produce the required increase. They need an individual plan explaining when and how to adjust replacement and when to seek help. “Stress” here includes physical demands on the body; it does not simply mean feeling worried or needing to relax.
Sick-day instructions need to identify the actual medicine, the situation and the action. This card does not provide them, so the learner should arrange clarification of the written plan rather than invent a dose. Asking the patient to explain what they would do reveals whether the advice is usable. “Have you got a leaflet?” only establishes possession of paper.
Vomiting is particularly important because swallowed medication may not remain in the body or be absorbed reliably. Repeated vomiting or inability to keep replacement tablets down requires urgent action according to the emergency plan. Do not simply advise waiting until tomorrow, repeatedly taking unspecified extra tablets, or replacing medical care with fluids and rest.
What is an adrenal crisis?
An adrenal crisis is a potentially life-threatening shortage of cortisol for the body’s needs. Symptoms can deteriorate quickly. Severe weakness or dizziness, vomiting, severe abdominal pain, marked drowsiness, confusion or collapse are concerning, especially with sudden worsening. A crisis requires emergency treatment. In this UK scenario, suspected crisis means calling 999; a trained person should use prescribed emergency hydrocortisone as instructed without delaying the call. Emergency assessment is still needed after an injection.
An online warning may be accurate about a possible complication while leaving the reader unsure about its likelihood, signs or prevention. The nurse should take the danger seriously without saying that collapse is inevitable. Equally, the nurse cannot promise that careful treatment removes every risk. A better response explains the purpose of daily treatment, the illness plan and emergency preparation.
What preparation supports everyday life?
Practical preparation includes access to prescribed medicine, avoiding supply gaps, carrying appropriate steroid emergency identification and knowing how to contact the team. The patient and, with permission, a chosen supporter need suitable training in the emergency kit. Having a box at home is different from knowing when and how to use it. Check what has actually been taught and demonstrated.
Discuss work, travel and activity in relation to Samira’s needs and clinical advice. Do not impose a universal ban on work or promise unrestricted activity. Advice about salt, fluids, exercise and any other conditions should be individualised. The communication task is to help the patient identify a workable plan, including questions for the treating team, rather than prescribe a single lifestyle routine for everyone with Addison’s disease.
How should you handle the online information?
Ask to see or hear the relevant sentence. Then ask what the patient understood and whether it changed anything they planned to do. A headline about an emergency may have made Samira afraid to leave home; a forum post about steroid side effects might make a different patient skip tablets. Do not answer one concern while missing the other.
Look at who published the information, whether it applies to the same condition and treatment, and whether it explains the context. A personal story can describe a real experience without predicting Samira’s future. Offer a reliable resource and relate it to her own plan. Avoid shaming her for looking online: the fact that she brought the question creates an opportunity to correct a misunderstanding.
3. Turn the five tasks into a responsive conversation
Task 1: Establish safety and discover the meaning
Begin with how the patient feels today. If the answer suggests acute deterioration, urgent assessment takes priority over the planned lesson. In the stable scenario, ask which statement worried her and what she thinks it means. “What did you read?” and “What did that make you think might happen?” serve different purposes. Use both when needed, then reflect the actual fear.
Task 2: Explain the missing hormones simply
Use the sequence gland, missing hormone, effect, replacement. Start with two or three clear sentences, then check whether the connection makes sense. Explain medical vocabulary immediately. A long description of hormonal control pathways will not answer “Will I suddenly collapse?” unless you also address that concern directly and honestly.
Task 3: Check the treatment plan the patient can use
Ask what medication instructions Samira has received and what she would do when unwell. Avoid testing memory as if a wrong answer were a personal failure. Say that you are checking the explanation. If a step is uncertain, identify the gap and have it clarified with the team. Do not state that teaching has occurred simply because it appears on your preferred care checklist.
Task 4: Explain emergency action and practical preparation
Keep the emergency message short and explicit. Separate it from routine follow-up. Then explore the practical concern about work: what part feels unsafe, what support is available and what information needs clarifying? This keeps the discussion useful without giving a blanket fitness-for-work decision from an examination card.
Task 5: Agree and check a manageable next step
The immediate education gap is the unclear sick-day plan and lack of demonstrated injection training. Agree to clarify these with the appropriate team and establish the real contact arrangements. Ask Samira to explain one routine action and one emergency action. Close by returning to her original online concern, so the conversation has a clear thread.
4. An extended nurse-viewpoint model answer
This is a study model showing possible nurse language across the encounter. It is longer than a continuous role-play speech should be. Pause at the listening points and adapt to the patient’s answers. The nurse must learn the details before using them.
“Hello, Samira. I’m the nurse speaking with you today. Before we look at the information you brought, how are you feeling now? Have your symptoms suddenly become worse, or have you had vomiting, severe pain, unusual drowsiness or felt close to collapsing?”
Listen and assess the answer. This model continues only with the stable situation supplied on the patient card.
“Thank you. You mentioned something online that worried you. Could you show me the sentence, or tell me what it said? What did you understand might happen to you?”
“So you read about adrenal crisis and thought it meant you might collapse at any moment, even while taking your treatment. I can see why that interpretation would make returning to work feel worrying. Has it made you think about changing your tablets or anything else you do?”
Allow the patient to answer. Do not assume she has stopped treatment.
“Let’s separate what Addison’s disease means day to day from what to do in an emergency. First, what have you already been told about your adrenal glands?”
“They are small glands above your kidneys that make hormones your body needs. With Addison’s disease, they are not making enough. One of those hormones, cortisol, helps your body manage energy, blood pressure and the demands of illness. Another, aldosterone, helps control salt and water balance.”
“That can help explain symptoms such as tiredness and dizziness, although we should still review any symptoms that persist or change. Which difficulty is having the biggest effect on your day at the moment?”
Respond to the impact Samira describes before continuing.
“The prescribed treatment replaces the hormones that are missing. It usually needs to continue long term, generally for life. The tablets manage the shortage; they do not mean the glands have been cured. It is important not to stop them suddenly, even when you feel better.”
“Would you like me to go over the purpose of each medicine on your prescription? I would check the names and instructions with you so that we are discussing your actual treatment.”
“The crisis warning is something to understand and prepare for. It does not mean that collapse is certain. I also would not promise that there is no risk. The useful next step is making sure your daily treatment, illness instructions and emergency plan are clear.”
“What instructions have you been given for a day when you become unwell? Could you talk me through what you think you would do? This will help me see which parts need a clearer explanation.”
Listen. In this scenario, the patient has written information but is unsure which instructions apply.
“When your body is dealing with an illness or injury, it may need more cortisol. Your specialist plan explains when to change your replacement and what to take. We need to check that plan with your actual prescription rather than guess a dose from a general article.”
“If you are vomiting and cannot keep your replacement medicine down, that needs urgent action. It is not something to leave until the next routine appointment. Your emergency instructions should explain what to do, including use of your prescribed injection.”
“Have you been given an emergency kit, and has someone shown you how to use it and watched you practise? Is there someone you would want involved in that training?”
Clarify what is available and what has actually happened. Do not treat a promised teaching session as completed.
“You have not yet demonstrated using the kit, so that is an important gap for us to address with the team. We should also make sure you know where the kit is, have the correct written instructions and know how to get help.”
“If you suddenly become very unwell, particularly with severe weakness or dizziness, vomiting, severe tummy pain, confusion or collapse, an adrenal crisis is possible. Call 999. Use the prescribed emergency injection as you have been trained, without delaying the call. You still need emergency care after the injection.”
“Could you tell me what you would do in that situation? I want to make sure I have explained the action clearly.”
Pause for teach-back and correct any misunderstanding kindly.
“Thinking about work, which part concerns you most: managing your tablets, knowing what to do if you feel ill, or something else? We can use that answer to identify what needs planning with your team. I cannot decide your individual activity limits from this conversation alone.”
“Having your medicine available, arranging repeat supplies in time and carrying steroid emergency identification are useful parts of preparation. We can check the information you have and discuss a reliable resource to use when a new question comes up.”
“Would it help to begin by clarifying your written sick-day instructions and the emergency training with the team? We also need to confirm whom you should contact for advice, and what to do outside their usual hours.”
“Before we finish, how would you now explain the difference between your everyday treatment and an emergency? And which part of the online information still feels uncertain?”
5. Speaking tips for an online-information concern
Use a curious tone. “Where did you get that idea?” can sound accusatory. “Could we look at the part that worried you?” invites collaboration. The patient does not need to defend searching for information before receiving help.
Make the link audible. Explain that replacement treats a hormone shortage and that illness may change the body’s needs. Words such as “because” and “so” help the patient follow the reasoning. Accurate isolated facts are harder to remember than a short connected explanation.
Pause after the risk explanation. A patient who hears “medical emergency” may stop processing the next paragraph. Check what they understood, then explain the action. Your voice should communicate seriousness without becoming hurried or dramatic.
Choose precise uncertainty. You can explain general principles while saying that the individual dose must come from the prescription. This sounds more useful than either inventing an answer or saying, “I cannot tell you anything.” Identify the question and who can resolve it.
Practise responding to the answer. If the patient already understands daily replacement, do not repeat a memorised lecture. Spend time on the remaining gap. If they reveal current severe illness, change the priority immediately.
6. Useful sentences to adapt
- Find the claim: “Which sentence made you most concerned?”
- Find its meaning: “What did you think that meant for you personally?”
- Check its effect: “Has that changed how you are taking your treatment?”
- Explain replacement: “The medicine provides a hormone your body is not making adequately.”
- Clarify a gap: “Let’s check that against your own written instructions.”
- Check practical knowledge: “What would you do if you could not keep the tablets down?”
- Invite involvement: “Who, if anyone, would you like included in learning the emergency plan?”
- Return to the concern: “Does that answer the part of the article that frightened you?”
7. Common mistakes and repairs
- “Ignore everything online.” This dismisses the patient’s attempt to understand. Ask what they read, review its context and offer reliable information.
- “A crisis cannot happen if you take tablets.” This is an unsafe guarantee. Explain the daily, illness and emergency parts of the plan.
- “Take extra whenever you feel stressed.” This is too vague to use safely. Clarify the individual instructions and the situations they cover.
- “Fludrocortisone is just another name for hydrocortisone.” The medicines have different purposes. Check the actual prescription and explain each accurately.
- “You have a kit, so you know what to do.” Possession does not establish competence or understanding. Ask about training and demonstration.
- “You can definitely return to every activity tomorrow.” The card does not support this decision. Explore the concern and identify what requires individual review.
8. Repeat with a changed answer
Record the original conversation. Listen for the moment you discovered what “adrenal crisis” meant to Samira. Did you acknowledge that interpretation, explain it accurately and check the practical plan? Count explanations that followed a patient answer rather than a memorised sequence.
Second attempt: the concern reveals current illness
Change the opening answer to: “I have been vomiting repeatedly this morning and cannot keep my steroid tablets down. I feel much weaker now.” Keep the known Addison’s diagnosis. Say your immediate response before opening the explanation.
Read a possible response and why it fits
“Because you have Addison’s disease and cannot keep your replacement medicine down, we need urgent medical help now. I am concerned about a possible adrenal crisis. I will activate our emergency response immediately so you can be assessed and treated.”
Why this works: In this clinic scenario, the nurse stops the routine education conversation and follows the local emergency procedure. In a community situation requiring emergency help, call 999 and follow the prescribed emergency injection instructions without delaying the call. The nurse does not wait for the patient to finish discussing a website, invent a replacement-tablet dose or tell them to go home and rest.
After emergency action is underway, the relevant team can obtain further details, including treatment taken and the emergency plan. A polished speaking structure must remain responsive to a new safety priority.
Review your own performance
- Did I ask what the online statement meant to this patient?
- Did I distinguish a stable teaching appointment from current urgent illness?
- Did I explain replacement without confusing the different medicines?
- Did I check what the patient could actually do with the instructions?
- Did my second attempt change when the clinical situation changed?
Continue with OET Speaking for Nurses — Course 23 to develop endocrine vocabulary and consolidate clear explanations. Practise one short explanation, one clarification question and one understanding check, then combine them in a conversation that leaves space for the patient.
Source notes
The matched book’s complete introduction and Set 1 Addison’s disease cards, explanation, phrases and sample response were consulted alongside the full saved Course 23 curriculum. The course includes endocrine vocabulary; this article is a new teaching scenario using that foundation. Clinical wording was checked against the linked NHS and Cambridge University Hospitals information. No individual dose, test result, promised appointment or personal prognosis has been invented. This lesson supports communication practice; care follows the person’s assessment and agreed clinical plan.
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OET Speaking for Nurses — Course 23
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Source: OET NURSE SP - 219-2.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.