Objective Structured Clinical Examination (O.S.C.E.)
In nursing the Objective Structured Clinical Examination or O.S.C.E. is designed to test clinical skill performance and competence in skills such as communication, clinical examination, nursing procedures, and problem-solving.
For oversea nurses qualifying to work in England the O.S.C.E. is divided in 10 stations (designated assessment areas), 4 are assessment, planning, implementation and evaluation, 2 pairs of skills stations (4 in total), 1 values and behaviours station, and 1 evidence-based practice station. This web-page does not cover evaluation for oversea nurses.
For pre-registered in England is very different and it is upto the Univerisity to set the standards of the test. However, we can still take a pick on how an exam would look for pre-registered nurses.
OSCE for Pre-Registered Nurses in England (Probably...):
Part 1: Numeracy Skill Test
- Mode: Computer-based test (CBT).
- Description: This part likely tests the mathematical and numeracy skills of the nurse candidates.
We covered numeracy in the Pharmacology section, which you can find here → « Pharmachology »
2. Part 2: Objective Structured Clinical Examination (OSCE)
Scenario-based Assessment:
- Candidates receive written information about a patient and are given approximately 15 minutes to review it.
- During this time, they refer to the BNF (British National Formulary) hardcover book to look up drugs. (Note: Online versions are not used for this purpose).
Physical Examination:
- Examination of a simulated patient, which could be an actor or a mannequin.
Post-Examination:
- Candidates write a handover using the SBAR (Situation, Background, Assessment, Recommendation) format.
- They may also devise a care pathway for the patient based on the information and examination findings.
We covered SBAR here → « SBAR »
OSCE Exercise: Drug Dosage and Skin Assessment
Part 1. Numeracy Skill Test
Digoxin is commonly used in ward settings to treat various heart conditions, including atrial fibrillation and heart failure. Given its narrow therapeutic window, precise dosages are crucial.
You are given a prescription order for a patient that requires 37.5 µg (micrograms) of Digoxin. The Digoxin ampoule you have is labeled as containing 0.25 mg/mL. How many milliliters (mL) of the solution would you need to draw up to administer the correct dose?
Sample Answer:
To administer the required dose of 37.5 µg of Digoxin from an ampoule with a concentration of 0.25 mg/mL, you would need to draw up 0.15 mL (or 150 µL) of the solution. The soultion is explained below:
First we need to make sure all the measurements are equivalent, for this we need to compare in which format is the prescription and ask, is this the same format found in the ampoule?
The answer is no, the prescription is in micrograms and the ampule's information is in miligram.
The first step is to match the prescription's measurement to that of the ampule.
We know that 1,000µg is --------- 1mg
How much is 37.5µg -----------?
We multiply 37.5 by 1, and divided the result by 1,000, that give us 0.0375 mg. Thus, we need to give 0.0375mg (37.5 µg) to the patient. Then we need to think: how many mL are needed then?
This is one way to caluclate this:
We have 0.25 mg in ---------1mL of Digoxin
We need 0.0375mg ------------?
We multiply 0.0375mg by 1mL, which give us 0.0375 mg/mL, we devide that by 0.25mg, which is equal to 0.15mL
Remember, we covered numeracy in the Pharmacology section, which you can find here → « Pharmachology »
Part 2: OSCE Exercise: Dermatological Assessment using SBAR
Imagine you're a nurse in a dermatology ward. Think about how you would handle the following situation using the SBAR method. Use the SBAR format below and write your own in first person.
Situation
You've been assigned to assess Mrs. Johnson, a 45-year-old patient who came in with complaints of a rapidly spreading rash. The rash is located on her upper inner thigh, making it a sensitive area to examine. It's described as red, raised, and itchy.
Background
Mrs. Johnson mentioned that she started noticing the rash after a hiking trip a week ago. She has no known allergies and hasn't started any new medications recently.
Question: Approach and Tools
Considering the location and nature of the rash, how would you approach Mrs. Johnson for the examination? Which tools would you use to ensure a thorough and respectful assessment?
Sample Approach and Tool Usage:
Approach: I would first ensure Mrs. Johnson's privacy by using a private examination room or drawing the curtains around her bed. I'd explain the examination process to her, ensuring she understands why and how the examination will be conducted. I'd ask for her consent before proceeding and ensure she feels comfortable throughout the assessment.
Tools: I'd wear gloves for hygiene, use a penlight to better visualize the rash, and possibly a magnifying glass for closer examination. A ruler or measuring tape would be used to document the size and extent of the rash. Given the sensitive location, I'd be especially gentle and ask Mrs. Johnson for feedback throughout the examination to ensure her comfort.
Assessment
Upon your assessment, the rash appears to be more concentrated around areas where her clothing was tighter. There are no signs of infection, but the rash is warm to the touch. She reports a pain level of 3/10 and itchiness level of 7/10.
Recommendation
Write your own S.B.A.R., where you recommend that Mrs. Johnson be given an antihistamine to reduce the itchiness and inflammation. Additionally, a topical steroid cream might help with the redness and swelling. It would also be beneficial to keep the area clean and avoid scratching to prevent secondary infections.
Sample S.B.A.R. Communication:
Situation: I've just assessed Mrs. Johnson in Room 7. She has a rapidly spreading rash on her upper inner thigh that's red, raised, and itchy.
Background: The rash started after a hiking trip a week ago. She has no known allergies and hasn't been on any new medications.
Assessment: The rash is more concentrated around areas with tighter clothing. It's warm to the touch, but there are no signs of infection. She reports moderate itchiness and mild pain.
Recommendation: I suggest we start her on an antihistamine and consider a topical steroid cream. It's also important for her to avoid scratching and keep the area clean.
Remember, we covered SBAR here → « SBAR »