A good opening does more than announce the nurse’s name. It gives the patient a reason to speak and allows the answer to shape the consultation. In this OET nursing Addison’s disease role-play, a patient brings an emergency kit to a review but hopes the nurse will not ask about it. The important concern is not visible until the nurse invites it.
The lesson draws on the Addison’s disease cards, nursing approach and opening guidance in Jobin Thomas’s Mastering OET Speaking, matched to OET Speaking for Nurses — Course 45. The saved course outline covers an overview, scoring criteria and preparation; the condition example comes from the matched book. The following named case, paired five-task cards and extended nurse model are original teaching material. The book title’s success wording is not a guarantee of an examination result.
1. Your Addison’s disease review role-play cards
Nurse role card
Setting: An endocrinology outpatient clinic in England.
Situation: Lena Okafor, 44, was diagnosed with Addison’s disease six weeks ago. She attends a planned education review with her prescribed medicine list, written sick-day instructions, steroid emergency card and emergency injection kit. She is currently well. The card supplies no individual doses, kit formulation or injection instructions. Your role is to explore understanding and concerns, reinforce the specialist’s plan and arrange any needed practical teaching. Do not prescribe a new regimen or pretend that a device demonstration has already occurred.
Your five tasks:
- Introduce your role and the purpose of the review, invite Lena’s priority and check whether she is currently unwell.
- Explore what she understands about Addison’s disease, her replacement medicines and the situations that worry her.
- Explain the condition and why daily treatment and an individual sick-day plan matter, using plain language.
- Explore confidence with the emergency kit, explain the need for prompt emergency action and arrange teaching using the actual supplied kit and instructions.
- Agree a practical next step, check understanding of the daily, illness and emergency plans, and confirm how to obtain further advice or replacement supplies.
Patient role card
Setting: The same clinic. You are Lena.
Situation: You take the prescribed daily medicines and have not missed doses. You have no current vomiting, severe weakness, dizziness, confusion or other acute illness. You understand that the medicines are important but feel overwhelmed by the emergency information. You watched the injection demonstration once and are afraid you would freeze if you needed to use the kit. You have not told the team because you think they will be disappointed.
Your five tasks:
- Begin by saying you brought the kit but hope there will be no need to open it. Let the nurse explore what you mean.
- Describe your current wellbeing and daily medicine routine when asked. Do not invent a dose or change your prescribed treatment.
- Reveal that the practical steps, rather than the diagnosis alone, are your main fear. Ask whether needing another demonstration means you have failed.
- Ask whether using the emergency injection would mean you could stay at home and avoid calling an ambulance. Accept a clear correction.
- Agree to practical review with the appropriate clinician and ask whether your partner could also be taught, subject to your wishes and the service’s arrangements. Explain the next step in your own words.
Practice method: Prepare for three minutes, then aim for an approximately five-minute conversation. Keep Lena’s private concern hidden before the attempt. The partner should reveal it when asked a relevant question, not wait for a password. This is an exercise in explaining and arranging safe care, not a substitute for clinical assessment or hands-on injection training.
2. Understand Addison’s disease before explaining the plan
What do the adrenal glands do?
The adrenal glands sit above the kidneys and make hormones needed for everyday function. Cortisol helps the body respond to physical stress and supports functions such as blood pressure and blood glucose regulation. Aldosterone helps regulate salt and water balance and blood pressure.
In Addison’s disease, the adrenal glands do not produce enough cortisol and may also produce too little aldosterone. This is a form of primary adrenal insufficiency. It is different from simply feeling stressed or tired. The diagnosis in Lena’s card is established, but the underlying cause and test results are not supplied.
Why are replacement medicines important?
Treatment replaces hormones the body is not making adequately. A medicine such as hydrocortisone replaces cortisol; another medicine, such as fludrocortisone, may be needed for aldosterone replacement. The specialist selects the medicines and doses for the individual. Do not infer Lena’s exact prescription from these examples.
Replacement treatment is generally lifelong in Addison’s disease. It should not be stopped suddenly or skipped because the person feels better. Feeling well may reflect the treatment doing its job. If the patient has concerns about side effects or the routine, those need review rather than an unsupervised change.
What can symptoms look like?
Symptoms of insufficient adrenal hormones can include marked tiredness, weakness, reduced appetite, weight loss, abdominal symptoms and dizziness, especially when standing. Some people develop darker areas of skin. These symptoms vary and can overlap with other problems; a new symptom still needs appropriate assessment.
The first attempt supplies current wellbeing, so the discussion can focus on education. Do not diagnose a crisis merely because Lena says she fears one. Equally, do not dismiss actual vomiting, collapse or confusion as anxiety if the account changes. Clarify what is happening now.
Why is there a separate sick-day plan?
During illness, injury or other physical stress, the body normally increases cortisol production. A person with adrenal insufficiency may need extra prescribed steroid cover because their body cannot reliably make that adjustment. The specialist’s sick-day instructions explain what to do for the person’s treatment.
The plan should cover when to adjust medicine, when to seek advice and what to do if oral medicine cannot be retained. No dose, timing or taper is supplied in this card. Check and explain Lena’s actual instructions rather than inventing a universal “double everything” rule. Different medicines in a regimen do not automatically follow the same adjustment.
Why does vomiting matter?
Persistent vomiting can prevent essential tablets being absorbed or retained. It can therefore require urgent emergency treatment, not simply another routine appointment. The patient needs a clear plan before illness occurs and must know when oral treatment is no longer enough.
In a real conversation, ask about the timing, ability to keep medicine down and current symptoms, while obtaining urgent clinical help when indicated. Do not delay action by completing a lengthy educational interview. The changed-answer exercise below deliberately tests that change in priority.
What is an adrenal crisis?
An adrenal crisis is a medical emergency involving a severe shortage of cortisol for the body’s needs. It can cause rapid deterioration, very low blood pressure, severe weakness, vomiting, abdominal pain, confusion or collapse. It may be triggered by illness, injury, missed treatment or another major stress on the body.
For suspected crisis in this England-based example, call 999 immediately. Use the prescribed emergency injection as taught, if available, while emergency help is being obtained. The injection does not replace the ambulance call or hospital assessment. Do not wait to see whether it works before seeking help.
Why check the actual emergency kit?
Having a kit is different from knowing how to use it. Its medicine, formulation, components, expiry dates and written instructions need to be suitable and complete. Practical teaching should use the product supplied to that patient. Do not assume it is a ready-to-use pen or describe a generic injection method from memory.
NHS Specialist Pharmacy Service guidance updated in June 2026 highlights the importance of the correct components and instructions after a change in available hydrocortisone formulations. For this lesson, the practical conclusion is to check Lena’s kit and arrange appropriate training, including how to obtain replacements. The article is not an injection manual.
What is the steroid emergency card for?
The card alerts healthcare professionals to adrenal insufficiency and the need for time-critical steroid treatment. It should be carried and shown when seeking care, including before planned procedures. It supports communication if the person becomes too unwell to explain their history.
Carrying the card does not replace taking prescribed medicine, following the sick-day plan or calling for emergency help. Likewise, a medical alert item can support identification but cannot guarantee that a crisis will never happen. Explain how these parts work together.
What reassurance is realistic?
Many people manage Addison’s disease while living active lives, but ongoing treatment and preparation matter. Reassure through a practical response to Lena’s concern: another supported demonstration, a chance to practise and a plan for involving someone she chooses. Avoid promising that confidence will be immediate or that the kit will never be needed.
The question “Which part worries you most?” makes that support specific. Fear of the needle, confusion about the steps, uncertainty about when to act and difficulty obtaining supplies are different problems. The same opening can uncover any of them if the nurse allows the answer to guide the conversation.
3. Coach each task from the opening onwards
Task 1: Introduce a useful purpose
Keep the introduction brief and accurate. State your role and that you are reviewing how Lena is managing her condition and instructions. Invite her priority before beginning a lecture. “What would be most useful to go through today?” gives her permission to choose a starting point.
Check current wellbeing early. The phrase “I am worried about a crisis” may describe a future fear or symptoms happening now. Ask enough to distinguish them. If the concern is acute, the opening should move quickly into appropriate assessment and help.
Task 2: Follow the cue about the kit
“I hope we do not need to open it” is a cue, not an agreement to leave it closed. Ask what feels difficult about it. Give Lena time to explain and reflect the practical fear: “You are worried that you will not remember the steps when you need them.”
Do not assume she has stopped her medicines, fears all steroids or doubts the diagnosis. Those may be concerns in other cases, but the supplied patient has a different one. A good opening prevents the rest of the conversation from being built around an unsupported assumption.
Task 3: Explain only the foundation needed
Use the hormone-replacement explanation to make the daily and illness plans understandable. Avoid overwhelming the patient with every possible endocrine term. Ask what she already knows, add a short explanation and check the meaning before moving on.
When discussing the written plan, name the information that must be checked. “Let us review your actual sick-day instructions” is more useful than an invented schedule. You can show sound communication by recognising the limit and arranging the right clarification.
Task 4: Respond to uncertainty with practical teaching
Normalise the need for another explanation without minimising the importance of the skill. “One demonstration may not be enough to feel confident” opens the door. Ask which part is difficult and arrange practice with the appropriate clinician and equipment.
Correct the idea that the injection replaces emergency care. State the action clearly and ask Lena to apply it to a hypothetical situation. If she answers inaccurately, repair the explanation and check again. A nod is not enough evidence for a time-critical instruction.
Task 5: Agree the next action and verify its meaning
The immediate next step is a supported review of the kit and plan, not a newly prescribed regimen. Confirm who will arrange it and what needs checking before the visit ends. Ask about preferred involvement of a partner without assuming consent or availability.
Finish by distinguishing daily care, illness instructions and emergency response. The patient does not need to recite your whole explanation. She needs to understand what applies, where the verified instructions are and when to obtain help.
4. Extended nurse-viewpoint model answer
This is an expanded teaching model, longer than a timed attempt. The italic cues mark listening points. It assumes Lena is currently well, as supplied. It models discussion and preparation; the practical injection teaching must use her actual kit and clinical instructions.
Hello Lena, I am the nurse reviewing how you are getting on with your Addison’s treatment and the instructions you have been given. What would be most useful for us to go through today?
Pause for the cue about the kit. You have brought it with you, but you are hoping we will not need to open it. Could you tell me what feels uncomfortable about looking at it together?
Before we continue, how are you feeling today? Are you currently unwell, vomiting, very dizzy or unusually weak, or is this a worry about what might happen in the future?
Listen to the supplied current-wellbeing answer. Thank you. That helps me understand that we are discussing preparation today. We can take the questions one at a time rather than go through everything at once.
How has the daily medicine routine been for you? Are you able to take the medicines as prescribed and keep a reliable supply? I am asking so we can identify any practical difficulty, not to judge how you are managing.
Listen for the supplied consistent routine. You have been taking the prescribed medicines and have not missed doses. What do you understand about why they are needed?
The adrenal glands normally make hormones that your body needs. With Addison’s disease, they are not making enough of those hormones, so the prescribed medicines replace what is missing. Feeling better does not mean you should stop them.
Your specialist has chosen the treatment for you. We will use that medicine list and your written instructions rather than change anything from a general explanation. Is there a part of the daily plan you would like checked?
There is also a plan for illness because the body may need more cortisol during physical stress. Your sick-day instructions explain what changes apply to your medicines and when to get help. We should make sure those exact instructions are clear.
Pause for questions before moving on. Coming back to the kit, what do you remember from the demonstration you had? Which part would feel hardest if you needed to use it?
Lena explains that she fears freezing and disappointing the team. You are worried about remembering the steps under pressure, and you felt you ought to be confident after seeing them once. Thank you for telling me; that is precisely the sort of concern this review should address.
Needing another demonstration does not mean you have failed. Watching a practical skill once is different from feeling able to perform it. We can arrange a supported review with the appropriate clinician using the kit you have actually been supplied.
We need to check that the medicine and all the required components are present, in date and matched to the instructions. I would not assume that every emergency kit is prepared in the same way.
During that teaching, you should have the chance to ask questions and practise the relevant steps with suitable training materials. The clinician can check your understanding and help with the particular step that feels difficult.
You mentioned your partner. Would you like them involved in learning the emergency plan as well? We can discuss that with your agreement and check how the service can arrange it.
We should also make clear when the kit is needed and when to call for help. An adrenal crisis can cause rapid deterioration, severe weakness or dizziness, vomiting, abdominal pain, confusion or collapse. It needs emergency treatment.
If you suspect an adrenal crisis, call 999 immediately and use your prescribed emergency injection as you have been taught, if available, while help is being obtained. Do not wait for a routine appointment or for the symptoms to settle.
Lena asks whether the injection avoids the ambulance. That is an important question. You still need emergency help even after the injection. It provides urgent treatment, but it does not replace assessment and further care in hospital.
Could you tell me what you would do if you thought you were having a crisis and had used the injection? I want to check that I have made the emergency action clear.
Listen and correct any suggestion of waiting. Yes, the emergency call is still needed. It is useful to say that you have Addison’s disease, describe what is happening and tell the emergency team what treatment has been given.
Repeated vomiting matters because you may not be able to keep essential tablets down. Your written plan must make that situation clear. If it happens, obtain urgent medical help and follow the emergency instructions; do not try to manage a suspected crisis by waiting for a later dose.
Have you got your steroid emergency card with you? Carrying it and showing it when you need care helps the team recognise the condition and the importance of the treatment. It works alongside your medicines and plan.
Pause to check access to the supplied card and instructions. Where would you keep your kit and written plan so they are available when needed? And do you know how to obtain replacement medicines or kit components before they run out or expire?
We can confirm those arrangements with the team rather than assume every item comes through the same route. If any component or instruction is missing, we need to address that promptly and give you a clear contact route.
Let me check the priorities we have agreed: you want another practical review of the kit, clarification of the illness and emergency instructions, and information about involving your partner. We are not changing your prescribed doses in this discussion.
Could you explain the difference between your usual daily plan, the instructions for illness and the response to a suspected crisis? We can return to whichever part remains unclear and use the written plan as we do that.
Listen to Lena’s explanation and repair any gap. I will make sure we confirm the appropriate teaching and any outstanding checks before this visit ends. What concern have we not yet covered, or what might make the next step difficult for you?
5. Opening skills that change the conversation
Use the information you have without assigning an emotion
“You have come for a review of the treatment and plan” is supported by the card. “You are terrified of lifelong tablets” is not. Let the patient describe the emotional meaning. You can then acknowledge it specifically.
This does not require a long opening. A name, role, purpose and genuine invitation can be enough. The important next action is to listen, rather than use the invitation as a bridge into a prepared speech regardless of the answer.
Ask one useful question at a time
A list of six questions about medicines, symptoms, work, family and the kit can be difficult to answer. Start with the concern, clarify its meaning and then organise the discussion. The patient should know why a new topic is being introduced.
After a meaningful answer, allow a short pause and reflect the key point. “The uncertainty is about doing the steps under pressure” shows that you have heard the concern. It also gives the patient a chance to correct you before you explain the wrong thing.
Distinguish current symptoms from future worries
Time words matter. “If I become sick” is different from “I have been sick all morning.” When the timing is unclear, ask. Your response should change if the conversation becomes an urgent clinical situation.
In partner practice, keep the first-attempt facts stable. Do not introduce a surprise crisis halfway through just to test the learner. Use the planned variation below so the change is deliberate and the expected response can be reviewed.
Review the first response after the concern
After the attempt, ask your partner to identify the sentence that made it easier to explain the kit worry. Then review your first reply after hearing it. Did you address the practical uncertainty, or continue a general explanation of the condition?
A successful opening is visible in what follows. The learner discovers the concern, adapts the agenda and agrees a relevant next step. It is not measured by how many introductory phrases were included or how closely the words matched a model.
6. Useful sentences for an open, purposeful review
| Purpose | Possible wording |
|---|---|
| Invite a priority | “What would be most useful to go through today?” |
| Follow a cue | “What feels difficult about looking at the kit together?” |
| Clarify timing | “Is that happening now, or are you worried about it happening later?” |
| Reflect the specific concern | “You are worried about remembering the steps under pressure.” |
| Offer practical support | “Let us arrange a review using the kit you have been supplied.” |
| Preserve medicine boundaries | “We need to check your individual instructions before discussing a dose change.” |
| Check urgent meaning | “What would you do next, even after using the injection?” |
Use calm stress on the action words in urgent instructions. Avoid making an emergency action sound optional through phrases such as “perhaps, if you feel like it.” A respectful tone and a clear instruction can sit together.
7. Common mistakes and repairs
Turning the opening into a lecture. The patient has not yet explained what matters. Introduce the purpose, ask and listen before choosing the explanation.
Assuming every worry is about medicines. Lena takes her medicines consistently. Her concern is confidence with a practical emergency task. Reflect that distinction and arrange relevant teaching.
Promising that a crisis will not happen. Preparation reduces risk and supports prompt action, but it does not justify a guarantee. Reassure by explaining the next practical support.
Using a generic sick-day dose. The individual regimen is not supplied. Refer to the specialist’s instructions and get uncertainty clarified. Do not change every medicine in the list because one replacement medicine may need adjustment.
Calling the kit an automatic pen. Check the product and components. A familiar name does not establish how the supplied medicine is prepared or administered.
Suggesting the injection replaces emergency care. Correct this explicitly. A suspected crisis still requires an emergency call and assessment, even when the prescribed injection has been given.
Continuing routine teaching after a new acute symptom. If the patient is now repeatedly vomiting or deteriorating, the priority changes. Obtain urgent help and follow the appropriate clinical process.
8. Second attempt: the concern is happening now
For this planned variation, Lena says at the start, “I thought this was just a review, but I have been vomiting repeatedly this morning and cannot keep my tablets down. I feel very weak and dizzy.” She has Addison’s disease and is physically present in the clinic. Do not continue the routine kit-confidence conversation.
Your task: Give a brief initial response that recognises urgency, obtains immediate clinical help and explains what is happening in plain language. Do not delay escalation to complete all five routine tasks. Do not invent the emergency medicine dose or say that a normal observation has ruled out danger.
Open a suggested response and explanation
Possible nurse response: “Thank you for telling me straight away. Repeated vomiting, not being able to keep your steroid tablets down and feeling very weak and dizzy need urgent attention with Addison’s disease. I am getting emergency clinical help now because this could be an adrenal crisis. Please stay here with us while we act.”
“We need the urgent treatment pathway, including emergency hydrocortisone as appropriate under the clinical protocol, and emergency transfer or a 999 call through the clinic’s process. We should not delay help while we discuss the routine education plan. Tell us what medicine you have managed to take and whether any emergency injection has already been given, while the team obtains help.”
Why this works: The nurse recognises the changed situation and acts before returning to educational tasks. The wording explains the concern without declaring an unsupported final diagnosis. A suspected crisis needs prompt treatment and emergency care; it is not appropriate to ask the patient to wait for a later review.
Practice review: Did your first reply acknowledge the symptoms happening now? Did you obtain help promptly? Did you avoid an invented dose or false reassurance? Did you keep the communication brief enough to support action?
For another non-emergency attempt, return to the original current-wellbeing facts but change the private concern to difficulty obtaining replacement kit components. The learner should check what is missing and arrange prompt support through the appropriate team, rather than assume another demonstration solves a supply problem.
Continue with OET Speaking for Nurses — Course 45 for the matching preparation outline. Practise an opening that creates space for the patient’s actual concern and allows the next response to change.
Clinical reading for this teaching example
Clinical boundaries were checked against NHS Addison’s disease guidance, NHS hydrocortisone information, NIDDK’s condition explanation and treatment overview, Cambridge University Hospitals’ replacement-medicine guidance and the NHS Specialist Pharmacy Service’s emergency-kit guidance. Use the individual specialist plan and current local emergency procedures; this speaking lesson does not provide injection training or an individual prescription.
Your next step
OET Speaking for Nurses — Course 45
Explore the complete course outline and related practice topics.
Source: Mastering OET - jo.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.