Linking words in OET Writing: how to connect ideas in a nursing letter
Use linking words in an OET letter to show the reader how facts relate (cause, contrast, time, addition), not to decorate the letter. A small set used accurately, such as 'as', 'however', 'following', 'since' and 'therefore', makes a letter easier to follow, while forced or wrong connectors ('Moreover', 'Furthermore' on every line, 'Although… but') make it harder to read.
What linking words do in a letter
Case notes are lists of facts. A letter turns those facts into a connected account: this happened, so this was done; the patient improved, but one problem remains. Linking words (also called connectors or cohesive devices) carry those relationships. Used well, they help the reader understand the patient's story without rereading.
They are not a scoring trick. A letter crowded with "Furthermore", "Moreover" and "In addition" reads like an essay, which works against the professional style described in the Genre & Style guide.
A practical set for nursing letters
You do not need a long list. These cover almost every relationship in a clinical letter:
| Relationship | Inside a sentence | At the start of a sentence |
|---|---|---|
| Cause or reason | as, because, due to (+ noun) | As…, Due to… |
| Result | so, which led to | Therefore, As a result, Consequently |
| Contrast | but, although, while | However, Although…, Despite (+ noun) |
| Time | when, after, following (+ noun), since, until | Following…, Since…, On (date)… |
| Addition | and, also | In addition, Also |
| Purpose | to, so that | To… |
Examples from clinical writing
- Cause: "She was admitted as she had become increasingly confused."
- Result: "His wound swab grew Staphylococcus aureus; therefore, he was started on oral antibiotics."
- Contrast: "Although her mobility has improved, she still needs help with showering."
- Time: "Following his surgery on 3 May, he developed a urinary tract infection."
- Addition: "She has been taught to check her blood glucose. In addition, her daughter will attend the first community visit."
- Purpose: "He has been referred to the dietitian to review his poor appetite."
Common errors
| Error | Example | Better |
|---|---|---|
| Double connector | "Although she improved, but she still needs help." | "Although she improved, she still needs help." |
| Wrong relationship | "He has diabetes. Therefore, he lives alone." | Remove the connector: there is no cause and effect. |
| "Despite" + clause | "Despite she was in pain, she walked." | "Despite her pain, she walked." / "Although she was in pain, she walked." |
| "Due to" + clause | "Due to she fell, she was admitted." | "Due to a fall, she was admitted." / "As she fell, she was admitted." |
| Heavy essay connectors | "Moreover… Furthermore… Additionally…" | Use "also" or "in addition" once, or nothing. |
| Comma splice with "however" | "She improved, however she needs help." | "She improved; however, she needs help." or a new sentence. |
| Every sentence starting with a connector | "Firstly… Secondly… Lastly…" | Let paragraph order show sequence; use time words only where needed. |
Errors such as "Despite she was" or "Although… but" are grammar mistakes and affect the Language criterion; see the Language guide.
Linking across paragraphs
Cohesion is also about how paragraphs connect. Good letters often link with:
- A time phrase: "Since her discharge, …", "During her admission, …"
- A topic phrase: "With regard to her medications, …", "In terms of mobility, …" (use sparingly)
- Reference words: "this", "these", "her condition", "the wound", pointing back to something already named.
Clear paragraph order does much of the work, as described in Organisation & Layout.
Before and after (invented case)
Notes (invented): Mr Samuel Adeyemi, 66. Fall at home 2 Sept. # L wrist, cast. Admitted. Lives alone. Unable to cook or dress himself with cast. OT assessment: needs home help. Pain controlled with paracetamol. Discharge 6 Sept.
Before (connectors missing or forced):
Mr Adeyemi had a fall at home on 2 September. He fractured his left wrist. A cast was applied. Moreover, he lives alone. Furthermore, he cannot cook or dress himself. Additionally, the occupational therapist assessed him. His pain is controlled with paracetamol.
After (relationships shown):
Mr Adeyemi was admitted on 2 September after a fall at home, in which he fractured his left wrist, and a cast was applied. As he lives alone and cannot cook or dress himself while the cast is on, he was assessed by the occupational therapist, who recommended home help. His pain is controlled with paracetamol.
The second version is about the same length but explains why home help is needed. That link is what the reader must understand to act.
A quick self-check
- Does each connector match the real relationship between the facts?
- Have you used "Moreover" or "Furthermore" more than once? Replace or remove.
- Is there any "Although… but" or "Despite + subject + verb"?
- Could a sentence be joined to the one before it with "as", "after" or "but" to make it clearer?
Practise it
Write a letter under time in practice and check your connectors, or upload a letter: medEmu marks problems on your own sentences with the corrected version and the reason. For other frequent errors, see common OET Writing mistakes.
Sources
This guide is medEmu's writing advice, not official OET guidance; the criterion names are OET's, and all patients and case notes are invented. The network used for this run could not reach oet.com, so no other OET test facts are stated. For OET's official Writing assessment information, see oet.com.