“I tried before, but I ended up smoking again.” A helpful nurse hears a starting point for assessment. A blaming question can hide the details that would make the next plan more useful. This OET nursing smoking cessation role-play teaches you to ask about previous attempts, explain nicotine dependence and respond to the particular barrier the patient describes.
The new case draws on Set 5 of Jobin Thomas’s Speaking with Confidence in OET Nursing: Structured Role-Plays and Case Explanations and the Smoking Cessation module in OET Speaking for Nurses — Course 30. It includes original paired cards and a nurse-viewpoint teaching model. It is independent practice material, not an official examination card or a prediction of a grade.
1. Your smoking cessation role-play cards
Nurse role card
Setting: A community health clinic in England.
Situation: Robin Malik, 46, wants help to stop smoking after returning to cigarettes during an earlier attempt. Robin smokes around 15 cigarettes daily and mentions a morning cough lasting five weeks that has not been assessed. Robin is comfortable speaking today. No examination findings, test results or treatment prescription are supplied. Explore the quit attempt and arrange appropriate assessment of the cough; do not assume its cause.
Your five tasks:
- Explore Robin’s current symptoms and reason for seeking help. Clarify the cough and explain why it needs clinical assessment.
- Ask about the previous quit attempt without blame, including what helped, what became difficult and what support was used.
- Explain nicotine dependence, withdrawal and the benefits of stopping in plain language, without promising complete reversal of damage.
- Discuss suitable support and treatment options, then connect possible strategies to Robin’s actual triggers and preferences.
- Agree a realistic next step, clarify cough safety advice and follow-up arrangements, and check understanding.
Patient role card
Setting: The same community clinic.
Situation: You are Robin Malik, 46. You smoke about 15 cigarettes a day and have smoked for many years. A morning cough has continued for five weeks; you have not had it checked. You have no blood in your sputum, chest pain, unexplained weight loss or breathing difficulty today. During your last quit attempt, you stopped without medicines or an adviser for six days. You became irritable, struggled with cravings on work breaks and smoked again after a difficult shift.
Your five tasks:
- Describe the cough and ask whether stopping smoking will make it disappear. Explain that you want help but dread being told to try harder.
- Describe the six-day attempt when asked. Explain that a short walk helped at home, but colleagues smoked during breaks and you had no plan for those moments.
- Ask why you felt irritable and whether needing support means you lack willpower. Ask what benefit quitting can still offer.
- Ask how nicotine patches differ from cigarettes, what other support exists and whether you must choose a treatment immediately.
- Choose one manageable next step. Say how you would seek help for a change in the cough and ask what to do if another quit attempt becomes difficult.
For the practice partner: Give the previous-attempt details gradually. Do not agree automatically to the first suggestion. Tell the nurse whether a proposed strategy fits your work breaks. The task is to build a responsive plan, not to obtain a promise that you will never smoke again.
2. Understand nicotine dependence and the clinical boundaries
Why can stopping feel difficult?
Nicotine is an addictive substance. With repeated smoking, the body becomes used to receiving it. When smoking stops, cravings, irritability, restlessness, poor concentration or disturbed sleep can follow. These symptoms help explain an earlier difficulty; they do not prove that the person was unwilling to try.
NHS guidance on nicotine withdrawal describes symptoms that can begin within hours, are often strongest early on and vary in duration. Do not promise that all discomfort will finish on a particular day. Ask what Robin experienced rather than assigning every symptom to withdrawal without checking.
How do habits and situations contribute?
Dependence is not the whole story. A cigarette can become linked to a work break, a drink, a stressful moment or spending time with particular people. These cues can bring on an urge even when the person sincerely wants to stop. The NHS guide to triggers and cravings explains why recognising these patterns matters.
In Robin’s case, a walk helped at home but did not become part of the work routine. That is useful information. “Try walking” alone repeats something already partly successful without addressing the difficult setting. A better conversation asks what breaks are like, whether leaving the smoking area is possible and which alternative Robin would actually use.
Does smoking relieve stress?
The person may experience a cigarette as calming, and dismissing that experience can make the conversation adversarial. Part of the relief can come from easing nicotine withdrawal between cigarettes. The routine may also provide a break from a demanding situation. Explore what the cigarette provides before offering an alternative.
For example, Robin may value ten minutes away from work as much as smoking itself. A suitable plan should preserve a real break while changing the smoking routine. Do not imply that a breathing exercise will solve workplace pressures or that distress reflects poor motivation. Ask what support is practical and welcome.
What causes the major harms of smoking?
Cigarette smoke contains harmful substances produced by burning tobacco. Smoking increases the risk of lung and cardiovascular disease and several cancers. Nicotine drives dependence, but it is not interchangeable with the mixture of toxic substances in smoke. This distinction helps explain why a licensed nicotine replacement product can support quitting.
Avoid frightening lists designed to force agreement. Link the explanation to Robin’s question, then check understanding. Equally, do not say nicotine is harmless in every circumstance or that a product is suitable for everyone. Choice and instructions require an individual review, especially when other conditions or medicines are involved.
What can be said about recovery after quitting?
Stopping provides health benefits even after years of smoking. Some changes begin relatively soon; risks of smoking-related disease reduce over time. The NHS quit-smoking guide describes this general pattern. Use it as encouragement, not as an individual countdown or a guarantee that every symptom will disappear.
Do not tell Robin that all lung damage is reversible or that it is already too late. Neither conclusion follows from these cards. There is no diagnosis or test result establishing the cause of the cough. Supporting a quit attempt and assessing a persistent symptom are both needed; one should not be made a condition of receiving the other.
Why does the cough need a separate plan?
A cough lasting more than three weeks needs medical assessment according to the NHS cough guidance. Smoking may contribute, but infections and other conditions can also cause coughing. “It is just smoker’s cough” would be an unsupported diagnosis. Ask about duration, change, sputum, blood, breathlessness, chest pain and other relevant symptoms.
Robin is over 40 and has smoked. NICE NG12 recommends an urgent chest X-ray for an unexplained cough in this group. Explain the need for prompt clinical assessment and appropriate investigation through the local pathway. An investigation checks for causes; it does not establish that the patient has cancer. Do not wait to see whether quitting makes the cough disappear.
What is nicotine replacement therapy?
Nicotine replacement therapy, or NRT, provides nicotine without burning tobacco. Products include patches, gum, lozenges, inhalators and sprays. A patch gives steadier delivery; a faster-acting product can help with a sudden craving. NHS NRT guidance describes combining forms and using professional advice.
Discuss the principle, then check the appropriate product, strength, instructions and duration with the adviser or prescriber. Do not assign a high-dose patch from a cigarette count alone or invent a tapering schedule. Ask whether any previous product was helpful or difficult to use. An earlier problem with one form does not establish that every option is unsuitable.
What other support can be considered?
Nicotine-free medicines include varenicline, cytisinicline, also called cytisine, and bupropion. They differ in their instructions, suitability and possible side effects. The NHS explanation of nicotine-free medicines introduces these options. In this role-play, describe choice without prescribing or guaranteeing availability for Robin.
Behavioural support helps the person plan for cravings, learn from earlier attempts and review difficulties. NHS stop-smoking services can offer advice and treatment support; arrangements vary by area. Find out what appointments or remote options actually exist before promising a particular timetable. A combination of suitable treatment and support gives a stronger basis than simply repeating “be determined”.
How should questions about vaping be answered?
For an adult who smokes, a nicotine vape can be one option to discuss for stopping cigarettes. NHS vaping guidance distinguishes the lower risk compared with smoking from being risk-free. The aim is to stop smoking completely; continuing cigarettes does not provide the full benefit of switching.
Do not introduce vaping as a requirement, recommend it to someone who does not smoke or promise that a particular device is suitable. Robin asks about patches, so begin there. A learner does not need to recite every available product to demonstrate clear counselling.
What if the person smokes again?
Respond promptly and constructively. Ask what happened, what support was available and what the person wants to do next. Avoid treating one cigarette as proof that all progress has disappeared. Also avoid saying a cigarette does not matter: it can make returning to regular smoking more likely.
The aim is to review and strengthen the plan with appropriate support. Do not punish honesty or insist that the patient must promise success before receiving help. A useful response keeps the goal of stopping visible while making it easier to disclose a difficult moment.
3. Task guidance: use the earlier attempt as information
Task 1: Address the symptom as well as the goal
Begin with Robin’s priorities, then clarify the cough and urgent symptoms. Explain that the persistent cough needs assessment now, alongside quit support. Do not let a long motivational speech replace a clinical next step. State what needs arranging without inventing examination findings or a confirmed appointment.
Task 2: Explore the sequence without judgement
Ask “Could you talk me through your last attempt?” before focused questions. Find out what was tried, how long it helped, what happened before smoking resumed and what assistance was available. Recognise the six smoke-free days without turning praise into pressure to perform better for you.
Task 3: Explain the difficulty without excusing inaction
Connect cravings and irritability with nicotine dependence. Explain why support can help. The message is neither “You failed” nor “You cannot do anything about it”. Use plain language to show that an understandable difficulty can be addressed with a more suitable plan.
Task 4: Match an option to the answer
Robin had no treatment support and found work breaks difficult. Discuss appropriate assessment for stop-smoking aids and a practical break-time strategy. Offer choices rather than imposing your favourite method. Ask what feels workable before suggesting a quit date.
Task 5: Make the next step specific and honest
Agree how Robin will obtain cough assessment and stop-smoking support. Confirm who will do what and which arrangements remain to be checked. Ask Robin to explain the next step and urgent symptoms in their own words. Do not finish by guaranteeing that this attempt will succeed.
4. Extended nurse-viewpoint model answer
Practise the nurse’s contributions as parts of a conversation. The model is deliberately fuller than one uninterrupted examination turn. Stop at the listening prompts, let your partner answer and adapt the wording. Avoid using facts from the patient card before Robin has disclosed them.
“Hello, Robin. I’m the nurse seeing you today. What would you most like help with?”
Listen to the request for quit support and the concern about the cough.
“We can talk about another attempt in a way that takes account of what happened before. First, could you tell me about the cough: when it began, whether it has changed and whether you bring anything up?”
“Have you noticed any blood, chest pain, difficulty breathing or unexplained weight loss? Have you felt unwell in any other way, and has anyone assessed this cough yet?”
Listen and respond to any urgent finding. The supplied answers describe a five-week cough without acute warning symptoms.
“Because this has continued for five weeks, it needs checking. I would not assume it is only caused by smoking. We should arrange prompt clinical assessment and the appropriate investigations. For an unexplained cough in someone over 40 who has smoked, the guidance includes an urgent chest X-ray.”
“That is a way of checking possible causes, not a diagnosis of cancer. We should not delay the assessment to see whether stopping cigarettes makes the cough go away. How do you feel about getting that checked?”
“You mentioned that you are worried about being told to try harder. Could you talk me through your last attempt: what you tried and how it went?”
Let Robin describe the six days without cigarettes. Ask about support only after hearing the initial account.
“You managed six days without smoking, and taking a short walk helped at home. What became most difficult before you started again? Did you have any stop-smoking treatment or support at that time?”
“So the cravings and irritability were difficult, and your work breaks put you around colleagues who smoked. You were trying to manage that without an adviser or treatment. Have I understood correctly?”
“Those details are useful. They suggest we need to plan for the withdrawal symptoms and for the breaks at work, rather than simply asking you to repeat the same approach.”
“Nicotine is addictive. When the body is used to it, stopping can bring strong urges to smoke, irritability and difficulty concentrating. Needing help with those symptoms does not mean you lack willpower. There are treatments and practical support that can make the attempt more manageable.”
“When you think about stopping now, what matters most to you? Is it your health, something in daily life, or another reason?”
Pause. Use Robin’s own reason instead of inventing a family responsibility or financial goal.
“There are benefits to stopping even after many years. It reduces exposure to the harmful substances in tobacco smoke and lowers health risks over time. I cannot promise that all previous damage will disappear or that the cough will resolve just from quitting. That is why we will address the cough separately.”
“You asked about patches. They supply nicotine through the skin without burning tobacco. A patch provides steadier delivery, and a faster-acting product may help with a sudden craving. The adviser or clinician can help choose a suitable option and explain exactly how to use it.”
“The main harms of cigarettes involve the smoke and the chemicals it contains, so using a licensed nicotine replacement product is different from continuing to smoke. We should still check your health, medicines and any previous reactions before deciding what is suitable for you.”
“There are also nicotine-free medicines and other options to discuss. You do not have to choose one before you understand it. What questions or concerns would you want answered before considering treatment?”
Listen. If the patient raises side effects, clarify which treatment and which concern rather than offering blanket reassurance.
“Let’s look at the break that was hardest. Where were you, what was happening and what did the cigarette give you at that moment? Was it mainly relief from the craving, a chance to step away from work, or being with colleagues?”
“Would a short break somewhere away from the smoking area be realistic? You found walking useful at home; perhaps we can think about whether a version of that fits work. If it does not, what alternative would you prefer?”
“We can plan for a craving before it happens, including your agreed treatment and something practical to do during the break. There is no need to pretend that every stressful shift will be easy. The plan should give you support during those moments.”
“A stop-smoking adviser can help review options and difficult situations. We can check what your local service offers and whether the appointment format fits your work. Once you have the information and support in place, you can discuss a quit date that feels realistic.”
“If you do smoke again, please be honest about it and seek support promptly. We can look at what led up to it and adjust the plan. It is a reason to review the support, not a reason to give up on yourself or avoid coming back.”
“For the cough, seek urgent GP or NHS 111 advice if you cough up even small streaks of blood, develop breathing difficulty, chest pain or become very unwell. Severe difficulty breathing, or more than a few spots or streaks of blood, needs emergency help through 999. Do not wait for a stop-smoking appointment.”
“Our next steps are to arrange the cough assessment and clarify the stop-smoking support you want. Which part would you like us to organise first, and is there anything that would make either difficult to attend?”
“To check I have made the plan clear, could you tell me what you will do about the cough and what you would like to be different in the next quit attempt?”
“What question have we not answered yet?”
5. Speaking tips for asking about earlier attempts
Ask for the story before suggesting the solution. “Talk me through what happened” leaves room for an unexpected barrier. A rapid list of closed questions may collect facts while missing the moment that matters most to the patient.
Use neutral verbs. “Started smoking again” describes an event. “Gave up trying” assigns an intention. Choose words that allow Robin to explain their own experience without having to defend their character.
Reflect something specific. “Walking helped at home, but breaks at work were harder” shows what you heard. Generic praise such as “Excellent effort” may sound pleasant without demonstrating that the answer influenced your thinking.
Make the link audible. Use “Because you said…” sparingly to connect information with an option. For example: “Because cravings were difficult, it would be useful to discuss treatment support.” Then ask whether the suggestion fits.
Keep questions open to refusal. “Would you like to discuss the options?” must permit “Not yet” or “I’m worried about them”. Explore the response rather than repeating the invitation until the patient agrees.
6. Useful sentences for a fresh attempt
- Invite the account: “Could you talk me through your last attempt?”
- Find what helped: “Was there anything that made those first days easier?”
- Explore the turning point: “What was happening just before you smoked again?”
- Check support: “What help or treatment did you have at that stage?”
- Reflect the contrast: “The routine worked at home, but work breaks were different.”
- Explain dependence: “Those urges can be part of nicotine withdrawal.”
- Offer a choice: “Which option would you like to understand better?”
- Check practicality: “How would that fit into a difficult shift?”
- Protect symptom assessment: “The cough needs checking alongside the quit plan.”
- Support honesty: “If it becomes difficult, contact the service so the plan can be reviewed.”
7. Common mistakes and repairs
- “Why did you fail?” This frames the attempt as a personal defect. Repair: ask what was tried and what happened when smoking resumed.
- “If you really wanted to stop, you would.” This ignores dependence and practical barriers. Repair: recognise the goal and explain available support.
- “Your cough is just your lungs cleaning themselves.” The cough began before the new attempt and has persisted. Repair: arrange assessment without assuming a cause.
- “Your lungs will be completely normal soon.” There are no findings to support this promise. Repair: discuss benefits while keeping the individual outcome uncertain.
- “Switch to light cigarettes first.” This is not a safe substitute for a quit plan. Repair: discuss evidence-based stop-smoking support and an agreed route to stopping.
- “Use this strength for exactly ten weeks.” The card supplies no prescription. Repair: confirm product choice, instructions and duration with the appropriate professional.
- “We will definitely see you every week.” The service arrangements are unknown. Repair: check available support and agree how Robin can access it.
8. Repeat when the previous attempt was different
In the first recording, identify the question that uncovered the work-break difficulty. Then find the sentence where that answer changed your suggestion. If no sentence changed, you may have listened politely while still delivering a fixed script.
Second attempt: a problem with patches
Replace the earlier detail about stopping without treatment with: “I did use patches. They helped the cravings, but the skin underneath became red and itchy, so I stopped using them.” The reaction has settled. There was no facial swelling or breathing difficulty. Keep the persistent-cough assessment plan. Ask about the experience and offer a suitable next step before reading the example.
Read a possible response and why it fits
“The patches helped with cravings, but the skin reaction made continuing difficult. Which patch were you using, how did you use it and did you get advice when the redness appeared?”
“We should review that reaction and the product instructions with the pharmacist or stop-smoking clinician before suggesting that you use the same patch again. There may be other forms of support or treatment to consider. Would you like help discussing alternatives?”
Why this works: The nurse recognises both benefit and difficulty. The answer does not diagnose an allergy, blame the patient for stopping or dismiss the reaction. It changes the next step from introducing treatment to reviewing a treatment experience. The cough still needs its own assessment.
Review your second attempt
- Did I notice that support had already been tried?
- Did I ask how the product was used and what happened?
- Did I recognise the useful effect as well as the difficulty?
- Did I avoid prescribing, diagnosing an allergy or promising a particular alternative?
- Did I keep the separate cough assessment and safety advice?
Continue with OET Speaking for Nurses — Course 30 to practise its consultation framework and smoking-cessation language. Aim to make the next suggestion depend on the patient’s answer. A previous attempt becomes useful when you understand what it involved.
Source notes
The complete matched-book Set 5 smoking-cessation cards, condition explanation, strategies and model were read alongside the full saved Course 30 curriculum. These cards and examples are newly written. Clinical checking used the linked NHS guidance and NICE’s indexed recommendation for unexplained cough in people over 40 who have smoked. The lesson corrects the source’s light-cigarette suggestion and avoids its assumed cough diagnosis, fixed treatment schedule and promises of complete recovery. For urgent blood-in-sputum advice, see the NHS guidance on coughing up blood. Individual treatment requires clinical assessment.
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Source: OET NURSES SP 101.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.