“We are not sleeping” contains at least two possible concerns. Is the person with dementia awake and distressed, is the carer lying awake in anticipation, or are both happening? If the nurse responds with advice for the wrong person, even a kind answer can miss the problem. This OET nursing dementia-carer role-play teaches you to clarify whose experience is being described and plan support for both people.
The lesson draws on the dementia-care case and communication phrase bank in Jobin Thomas’s OET Speaking — 15 Role Plays — Competency Level High, matched to OET Speaking for Nurses — Course 41. The saved course outline focuses on scenario-phrase drills. This article uses the matched book’s case to develop those skills; it does not claim that the outline contains a separate dementia module. The cards and model below are original practice material.
1. Your dementia and carer-support role-play cards
Nurse role card
Setting: A community clinic in England.
Situation: Priya Desai, 51, cares for her mother, Leela, 79, who has an established dementia diagnosis. Priya has come to discuss night-time difficulties and the effect of caring. Leela is currently at home with Priya’s brother. No current assessment, medicine list, dementia subtype or confirmed support package is supplied. Listen to Priya’s account, distinguish her needs from Leela’s and explain appropriate review and support. A carer’s report does not replace assessment of Leela or establish Leela’s own wishes.
Your five tasks:
- Invite Priya’s main concern, clarify who is experiencing each difficulty and check for an immediate safety or sudden health change.
- Explore the night-time pattern, Leela’s possible needs and Priya’s sleep, wellbeing, responsibilities and existing support.
- Acknowledge both experiences and explain why changes need assessment rather than automatically attributing everything to dementia progression.
- Discuss a manageable communication or routine strategy and options for reviewing care needs and carer support, without promising medicines, funding or a service.
- Agree priorities and a practical next step, check understanding and explain how a sudden change or inability to manage safely changes the response.
Carer role card
You are: Priya Desai, 51. Your mother, Leela, lives with you and has dementia. You want to care for her well, but you are tired. Your brother is with her during this appointment; he can help occasionally, but no regular overnight arrangement exists.
Your five tasks:
- Begin with “We are not sleeping, and I do not know how much longer I can manage.” If asked directly, explain that you mean exhaustion and needing support. You and your mother are safe today, and you are not saying that you intend to harm yourself or her.
- Describe a gradual pattern over about two months: Leela sometimes wakes at night, asks repeatedly what is happening the next day and becomes unsettled. There is no sudden change today, new fever, fall or obvious new illness that you have noticed.
- Clarify your own experience: after helping Leela settle, you stay awake listening for movement. Sometimes she is asleep while you remain alert and worried. You feel guilty about asking anyone else to help.
- Say that you often repeat a long explanation of tomorrow’s plans, which does not seem to reassure her. You would welcome a clearer approach, a review of the night-time difficulties and information about a break from caring. You have no confirmed respite or care assessment.
- Ask whether asking for help means you are failing your mother. Be willing to discuss an assessment and a realistic immediate support plan. Explain which next step addresses your needs and which addresses Leela’s.
Practice method: Use three minutes to prepare and aim for an approximately five-minute conversation. One partner plays Priya; the other speaks as the nurse. Leela is not an additional speaking role in this version. Keep the distinction between Priya’s observations and Leela’s unreported perspective throughout the attempt.
2. Understand the condition and the caring situation
What does a dementia diagnosis tell you?
Dementia affects abilities such as memory, understanding, communication and everyday functioning. The pattern and progression vary. A person may repeat a question because they cannot retain the previous answer, or become distressed when a situation feels unfamiliar. The label alone does not explain every change or tell you exactly what the person can understand.
Leela’s diagnosis is supplied, but her subtype, current stage and individual treatment are not. Do not invent them. You can discuss general communication principles while recognising that her care team needs to assess a new or persistent difficulty.
Why might nights become difficult?
Dementia can affect the sleep-wake cycle. A person may wake at night and be unsure of the time or what is happening. Sleep can also be affected by discomfort, pain, toileting needs, the environment, medicines or another health problem. These possibilities need exploration rather than a single automatic explanation.
Ask what actually happens. Does Leela wake and ask a question, walk around, appear frightened or seem uncomfortable? When did the pattern start? What helps? “She does not sleep” may mean a short period awake, repeated waking or the carer’s fear of falling asleep. Clarification prevents advice being aimed at the wrong difficulty.
How is sudden confusion different?
A sudden change in confusion or alertness is not something to dismiss as normal dementia progression. Sudden confusion can have several causes, including acute illness or medicine effects, and requires immediate medical assessment. NHS advice in England is to go to A&E or call 999 if someone suddenly becomes confused.
Priya’s first-attempt account describes a gradual pattern without a sudden change today. That allows a planned discussion, but it does not rule out treatable contributors. If the history changes to a marked deterioration since this morning, the consultation must change too. A routine sleep diary or future support referral must not delay urgent care.
What can distress communicate?
A person who is restless may be trying to express a need they cannot explain easily. Noise, discomfort, being too hot or cold, a confusing task or a change in surroundings may contribute. Looking for a pattern can help, but the carer should not be expected to solve every cause alone.
A brief record of what happened before the distress, the response and what seemed to help can support a clinical review if keeping one is manageable. It is not a requirement to collect several weeks of evidence before asking for help. If the person is unwell or safety is in question, seek assessment rather than continue observation.
How can communication be adapted?
Use short, clear sentences and allow time for the person to respond. Reduce distractions where possible and use a calm, respectful tone. Repeating an increasingly long explanation may add information the person cannot retain. A simple response to the immediate feeling may be more useful than testing their memory.
For example, if Leela seems worried about tomorrow, Priya could try a brief explanation of the immediate plan and reassurance that she is not alone, then allow a response. The exact words should fit what Leela is expressing. Do not guarantee that one phrase, a clock or familiar music will settle every episode.
The person with dementia should continue to be involved in discussions as far as possible, using communication support suited to them. Hearing a relative’s account is valuable, but it does not automatically tell you the person’s preferences. In this case, Leela is absent, so the nurse should not claim she has agreed to a proposed service.
Why assess the carer’s needs separately?
Priya may remain awake after Leela has settled. Advice aimed only at Leela’s bedtime routine would leave Priya’s worry and exhaustion unaddressed. Ask about the carer’s sleep, health, work, social contact and what support is actually available. A person saying “I cannot manage” needs careful exploration, including whether care can continue safely today.
Do not translate tiredness into a diagnosis of depression, or assume that asking for help means the carer wants to stop caring. Priya may want a predictable break, a clearer response to night-time distress, support with her own health or an urgent change in arrangements. Let her describe the need.
What is a carer’s assessment?
In England, an adult carer can ask the local council’s adult social services for a carer’s assessment. It considers how caring affects the carer’s life and what support might help. It is separate from the care-needs assessment of the person being cared for, although the discussions can be coordinated.
An assessment is not a promise of a funded service. Eligibility, suitable options, costs and availability need clarification. For this role-play, explain the route and offer to clarify the local process. Avoid announcing that a care worker will arrive tonight or that the council will pay for a particular arrangement.
What does respite mean?
Respite means a break from caring while someone else provides appropriate care. Options can include help at home, a day service or a short stay elsewhere, depending on needs and availability. Planning should consider the person with dementia’s needs and preferences as well as the carer’s need for rest.
“Take a break” is not a complete plan if nobody can safely provide the care. Ask who might help, what they can realistically do and what remains unarranged. An occasional visit from a brother does not establish an overnight support package. Similarly, a leaflet about services is not a confirmed place.
What should not be offered as an automatic solution?
Do not promise sleeping tablets or other medicines to stop night-time waking. Medicine decisions require individual review of the problem, existing treatment, possible benefits and harms. Do not advise stopping current medicines without appropriate clinical advice.
Home safety also needs an individual approach. A blanket instruction to lock a person in a room or prevent all movement does not address the reason for distress and can create danger. If leaving the home or unsafe movement is a concern, seek a suitable safety assessment and plan. The aim is to support the person and carer, not simply suppress a behaviour.
3. Coach each task with the right person in mind
Task 1: clarify “we” and check the immediate situation
Ask, “When you say you are not sleeping, what happens for your mother, and what happens for you?” This is direct without being abrupt. It gives Priya permission to describe her own experience rather than speak only about Leela.
The phrase “I do not know how much longer I can manage” also needs a response. Ask whether she feels able to keep herself and her mother safe today and what she means by not managing. Do not assume either an emergency or a harmless figure of speech. The answer determines urgency.
Task 2: separate observation, interpretation and need
“Mum gets up and asks about tomorrow” is an observation. “She is trying to keep me awake” is an interpretation. “I need some uninterrupted sleep” is the carer’s need. Help the conversation move between these carefully rather than treating them as the same fact.
Useful questions include “What do you notice just before she becomes unsettled?” and “After she settles, are you able to sleep?” Ask about available help in concrete terms: who, when and what they can do. Avoid assuming that family proximity means family availability.
Task 3: validate both experiences
You can say, “Your mother seems unsettled at night, and you remain on alert even after she is asleep.” This summary gives each person a place in the plan. It avoids framing one as the problem and the other as merely responsible for fixing it.
Explain why review matters: persistent changes may have several contributors. A clear sentence such as “We should not assume that every change is simply the dementia getting worse” can relieve guilt without promising that an easily reversible cause will be found.
Task 4: offer a manageable step and a support route
Priya has described lengthy repeated explanations. Discuss trying a shorter, calm response to Leela’s immediate concern, while arranging a review of the night-time pattern. Ask whether that feels workable. Do not hand an exhausted carer a complex schedule and imply failure if it cannot be followed.
Then address Priya’s own needs: a conversation with her GP if her health is affected, information about a carer’s assessment and clarification of possible breaks from caring. These are options to explore, not arrangements already made. Check which would be most useful first.
Task 5: finish with two clear strands
Summarise one next step for Leela and one for Priya. For example: review Leela’s night-time distress with the care team, and clarify support for Priya’s sleep and caring responsibilities. Ask what can be managed tonight and whether any gap needs urgent attention.
Check understanding by asking the carer to describe the plan. “We will wait and see” would not capture the intended response if clinical review and support enquiries have been agreed. Repair the misunderstanding before closing.
4. Extended nurse-viewpoint model answer
This model follows Priya’s first-attempt account. The pauses show where she gives information. It is a teaching sequence, not a monologue to deliver in full. If the answer reveals a sudden change or an immediate safety concern, change the priority rather than continuing the routine model.
“Hello, Priya. I am the nurse meeting with you today. I understand that nights have been difficult. What would you most like help with?” [Pause and listen.]
“You have said that neither of you is sleeping and that you are not sure how much longer you can manage. That sounds exhausting. When you say ‘we’, could you tell me what happens for your mother and what happens for you?”
“Your mother sometimes wakes and asks about the next day, and after you help her settle, you stay awake listening for movement. So there are two related difficulties: her unsettled nights and your own difficulty getting back to sleep.” [Check the summary.]
“Before we discuss options, I want to check the situation today. Has there been a sudden change in her confusion or alertness, or a new illness, fall or other problem?” [Listen.]
“You are describing a gradual pattern over about two months, without a sudden change today. Is your mother with someone at the moment?” [Pause.]
“Your brother is with her while you attend. Thank you. When you say you cannot keep managing like this, do you feel able to keep yourself and your mother safe today, or are you worried that either of you could come to harm?” [Ask calmly and listen fully.]
“You mean that you are exhausted and need support, and you feel safe today. I am glad you have told me rather than trying to carry on without help. Let us look at what needs to change.”
“Could you talk me through a typical difficult night, starting with what happens before your mother wakes or becomes unsettled?” [Invite an example.]
“When she asks about tomorrow, does she seem frightened, uncomfortable or unsure where she is? Have you noticed anything suggesting pain, toileting difficulty or another need?” [Listen without diagnosing from the account.]
“Those observations will be useful for the care team. We should also review possible health or medicine-related contributors rather than assume everything is simply the dementia progressing.”
“What have you tried when she asks repeatedly, and what seems to help even a little?” [Pause.]
“You explain the whole of the next day, but she asks again, and the conversation becomes longer. That must be tiring, especially when you are trying to reassure her and do not feel it is working.”
“With dementia, it can be difficult to retain an answer. Repeating the question does not necessarily mean she is choosing not to listen. A shorter, calm response to the immediate concern may be easier for her to follow.”
“For example, you could briefly explain what is happening now and offer reassurance that you are there, then allow time for a response. The words should fit what she seems worried about. We cannot promise that one approach will settle every night.” [Pause.]
“Would trying a shorter response feel manageable, or is there something about the situation that would make that difficult?” [Listen.]
“We can also ask the team to review the night-time pattern, including comfort, routine and any treatment factors. If a short note of what happens would be easy to keep, it may help, but you do not need to produce a detailed diary before asking for support.”
“I also want to return to your sleep. When your mother is asleep, you are still listening for her. How much rest are you getting, and how is the tiredness affecting you during the day?” [Let Priya describe her own health.]
“Your needs matter as well. Advice for your mother alone would not address being on alert through the night. If this is affecting your health, I would encourage you to discuss it with your own GP, alongside reviewing the caring arrangements.”
“Who currently helps, and what can they realistically do? You mentioned your brother today; is that occasional help or something you can rely on regularly?” [Clarify.]
“He helps occasionally, but there is no regular overnight arrangement. I do not want to assume that he can take that on. We need to look at support that is actually available and suitable.”
“You have said that asking for a break makes you feel guilty. Needing rest does not mean you have stopped caring about your mother. It tells us that the current situation is affecting you and needs attention.”
“One option is a carer’s assessment through the council’s adult social services. It looks at how caring affects your life and what might help. That is separate from assessing your mother’s care needs, although the discussions can be coordinated.”
“A break from caring, sometimes called respite, means someone else provides appropriate care while you have time away from the caring role. The form it takes depends on needs, preferences and what is available. We would need to clarify arrangements and any costs; I cannot promise a particular service today.”
“Your mother’s preferences also matter. We should involve her in planning with communication support suited to her, rather than assume that this conversation tells us what she would choose.”
“Which would be most helpful to start with: clarifying the review of the night-time difficulties, or getting help with the assessment and support enquiries? We can keep both in the plan.” [Pause for Priya’s priorities.]
“For tonight, do you feel the current arrangements are manageable, or is there a gap that needs urgent help today? If you cannot safely continue, please say so; that changes how quickly we need to respond.” [Listen.]
“If your mother suddenly becomes much more confused or less alert than usual, seek immediate medical help rather than wait for a routine review. In England, go to A&E or call 999. A sudden change can have causes that need prompt assessment.”
“Could you describe the two main next steps as you understand them: one for your mother and one for you? I want to make sure the plan addresses both of your needs.” [Listen and clarify.]
“Yes: review the night-time pattern with her team and clarify support for your own health and caring role. We will confirm the appropriate contacts and what is being requested, rather than leave you with a list of unarranged possibilities. What would you like me to clarify before we finish?”
5. Speaking tips: keep two perspectives clear
Use names when pronouns become unclear. “When you say she is exhausted, do you mean Leela, or are you describing how you feel?” can prevent a wrong turn. Phrase the question gently; you are clarifying meaning, not correcting the carer’s grammar.
Reflect an observation without claiming the patient’s thoughts. “You have noticed that Leela becomes unsettled” is supported by the account. “Leela is afraid of being abandoned” may be an interpretation that needs exploration. Avoid treating an absent person’s feelings as confirmed facts.
Allow the carer to have a separate agenda. A question such as “How is this affecting you?” should not be a token gesture before returning immediately to the patient. Listen to the answer and identify a step that addresses the carer’s need.
Do not let guilt close the discussion. If Priya says “Other people cope better”, avoid a competition about who has the hardest caring role. Return to the actual situation: sleep, support, health and what is manageable now.
Clarify urgency without sounding accusatory. Explain why you are asking: “Because you have said you cannot manage much longer, I want to check whether you need urgent support today.” A calm direct question is more useful than either assuming risk or avoiding the subject.
6. Useful sentences for patient and carer concerns
- Clarify the speaker: “Is that something your mother has said, or something you have noticed?”
- Separate experiences: “What happens for her, and what happens for you?”
- Reflect both: “She seems unsettled, and you remain on alert even after she sleeps.”
- Check the time course: “Did this change happen suddenly, or has it developed gradually?”
- Explore a need: “What might she be trying to tell you at that moment?”
- Ask about actual help: “What support can you rely on, and what is only occasional?”
- Acknowledge guilt: “Needing a break does not mean you do not care.”
- Keep arrangements accurate: “We need to check what is suitable and available before calling it a plan.”
- Check immediate safety: “Do you feel able to manage safely today?”
- Close with both needs: “Which step is for your mother, and which is for you?”
Practise changing the names and relationships while preserving respectful language. A spouse, adult child or friend may describe a different caring role; do not assume that every family has the same responsibilities or resources.
7. Common mistakes and repairs
“This is just what happens with dementia.” This may dismiss a treatable or urgent change. Try: “Dementia can affect nights, but we should review what has changed and whether there are other contributors.”
“You need to sleep when she sleeps.” This ignores Priya’s stated difficulty remaining on alert. Try: “What stops you resting once she has settled, and what support might make rest possible?”
“Your brother can take over.” This invents an arrangement. Try: “What help can your brother realistically offer, and what else needs arranging?”
“We will give her something to keep her asleep.” This prescribes an outcome and treatment without assessment. Try: “The clinician should review the sleep difficulties and any treatment options individually.”
“Lock the bedroom door so she cannot wander.” This offers a blanket restriction that can create danger. Try: “Let us assess the particular safety concern and discuss a suitable plan with the team.”
“I understand; here is a support-group leaflet.” Information alone may not address immediate exhaustion. Try: “Would that resource be useful, and what practical help do you need before then?”
8. Second attempt: the apparent routine problem is sudden
Change Priya’s answer to: “No, this is not the usual night-time pattern. Since this morning Mum is much more confused and cannot follow me at all. My brother is with her now.”
Respond to the sudden change. Do not continue with a sleep routine, respite options or a diary. Clarify enough to arrange help without delaying it, and explain why immediate assessment is needed.
Open a suggested response and explanation
“Thank you for correcting that. A sudden increase in confusion is different from the gradual pattern we were discussing and needs immediate medical assessment. We should not assume it is simply her dementia.”
“Your brother is with her now. Let us arrange emergency medical help and make sure he knows what is happening. In England, sudden confusion is a reason to go to A&E or call 999. He should stay with her if it is safe, speak calmly using short sentences and have her medicine information available if possible.”
“The team will need to assess the cause. I cannot tell from this account whether it is an infection, a medicine effect or something else. Your own exhaustion still matters, but the sudden change in your mother’s condition needs attention first.”
Why this works: The nurse accepts the corrected history and changes urgency. The response does not diagnose a urinary infection simply because the person has dementia. It gives a concrete action and preserves the carer’s concern for follow-up after the immediate problem is addressed.
Another variation: Leela’s condition is unchanged, but Priya says, “My mother sleeps most of the night now. It is me who cannot switch off.” Focus the next questions on Priya’s health, worries and support. Do not repeat a long explanation of Leela’s sleep-wake cycle as though it answers Priya’s problem.
Review the recording: Mark each concern as Leela’s reported experience, Priya’s own experience or an interpretation needing clarification. Then check whether the plan contains an appropriate response to each confirmed need. This is a practical way to find statements that sound empathetic but are directed at the wrong person.
Continue with OET Speaking for Nurses — Course 41 and the matched source’s scenario phrases. Practise identifying whose concern you are addressing before choosing reassurance, advice or an assessment question.
Clinical reading for this teaching example
Background checks included NHS information on behaviour changes, communication, caring for someone with dementia and sudden confusion; Alzheimer’s Society information on sleep and restlessness; and NHS explanations of carer’s assessments and respite care. Local services, funding and individual treatment are not confirmed by this fictional conversation.
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OET Speaking for Nurses — Course 41
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Source: BOOK 4 - EPUB.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.