Evidence Based Practice – OSCE Silent Station
Evidence based Practice is a silent station in NMC OSCE like Professional Values and Behaviour station in NMC OSCE. This station is silent writing station of 10 minutes duration. Lets see how to tackle this station in this article
Cracking Evidence Based Practice Station
You would have read our Professional Values and Behaviour station. This station is similar to that station except of the fact that topics are different and you need to analyse studies given. Fortunately, you will be asked only about one of the following fourteen topics to be answered in the station. Number of topics is only five till November 2022. Afterwards, it will be increased to fourteen topics. You should make sure that you learn these marking criteria by heart and answer corresponding to question. The topics asked in Evidence based practice station are the following
– Diabetes
– Female Myocardial Infarction (MI)
– Pressure Ulcer Prevention
– Smoking Cessation
– Use of honey dressing for venous leg ulcers
As per NMC, the newly added topics from November 2022 are
– Ankle Sprain
– Asperger’s syndrome
– Bedside Handover
– Cervical screening
– Cranberry Juice and Urinary Tract Infections
– Dementia and music
– Fever in children
– Restraint
– Saline Vs Tap water
Framework of Question
You will given the following in your question,
– Topic
– Scenario involving a patient
– Three studies conducted and their result, along with a conclusion
– An answer sheet where you need to write in bullet points about the relevance of research findings and the advice you are giving to the patient
Now, lets look on the topics one by one.
Diabetes
Scenario is usually of a patient who is diagnosed of diabetes and is on tablets for the same. She is concerned about occurrence of hypoglycemia and what she should do in case her blood sugar drops.
You will be given 3 studies, which you need to analyze and summarize main findings
As the professional values station, you need the advice in future tense as well. Lets see how you will write the answer in this case
– You need to summarize the main findings from the article summary and draws conclusions, making recommendations for practice
– I will inform the patient that she is less likely to suffer with hypoglycemia as she is not prescribed insulin. However, hypoglycemia remains a serious concern and she should be vigilant to monitor her blood glucose levels and to recognize the signs and symptoms of hypoglycemia.
– I will advise the patient t that hypoglycemic episodes are often caused by diet-related factors, such as missing a meal or not eating enough carbohydrates emphasizing the importance of eating regular meals, and discusses the daily recommended amount of carbohydrates.
– I will advise the patient to observe for excessive sweating, feeling faint, light-headed, blurred vision, new confusion and/or nausea, and to call 999 if she experiences any of these symptoms.
– I will advise the patient to inform friends and family that, if she appears confused or loses consciousness, she may be having a hypoglycemic episode and will need emergency medical help by calling 999.
– I will inform the patient that an episode of acute illness may cause irregularities in blood glucose, so she will need to monitor her blood sugars more frequently and report any changes.
Download Diabetes Marking Criteria
Female Myocardial infarction (MI)
The scenario is usually like a patient gets admitted to hospital with chest pain suspecting a heart attack. MI diagnosis is ruled out. She is very worried about her condition and asks what she should do if she experience this again. Your answer should go like this
– You need to summarize the main findings from the article summary and draws conclusions, making recommendations for practice.
– I would tell the patient that early and correct recognition of MI symptoms is vital in order to seek medical care promptly for a better outcome.
– I will inform the patient that , as a female, she may or may not experience chest pain.
– I will inform the patient that she may experience nausea and back, shoulder, throat/neck, cheek/teeth and arm pain.
– I will emphasize on the importance of reporting any symptoms whether she considers them to be cardiac or not.
– I would encourage the patient to call 999 immediately if she experiences any of the above
Female Myocardial infarction Marking Criteria
Pressure Ulcer Prevention
Scenario will be like a patient had a laparotomy and is advised to stay in bed for couple of days and has developed a small pressure sore on the sacrum. TVN has seen the patient and has advised for foam dressing.q Patient is worried of worsening pressure ulcer as well as usage of foam dressing. You need to summarize research findings and give advise on pressure ulcer prevention. Your answer will be like
– You need to summarize the main findings from the article summary and draws conclusions, making recommendations for practice.
– I will inform the patient that a specific foam preventive dressing applied to a persons sacrum has been shown to reduce pressure ulcer development by 10 percent. However, even with a dressing, he may still develop a pressure ulcer, although it may occur later.
– I will explain that a very rare side effect of the foam dressing is mild skin irritation
– I will advise the patient that the patient that, being male, he may be at more risk of developing a pressure sore.
– I would explain to the patient that regular skin inspections, regularly changing position, staying well hydrated and maintaining a balanced diet will also help with the prevention of a pressure ulcer.
– I will inform the patient that there is a foam dressing that may aid in the prevention of a pressure ulcer and that this will be discussed further with the tissue viability team.
Pressure Ulcer Prevention Marking Criteria
Smoking Cessation
Usual scenario will be a patient under your care is undergoing nicotine replacement therapy for smoking cessation. He has got argument that use of e cigarettes is more helpful in smoking cessation than the nicotine replacement therapy. You will be given 3 studies comparing nicotine replacement therapy over use o e cigarettes. You need to summarize research findings and give advise on smoking cessation. Your answer will be like
– I will inform the patient that replacement therapies have not been found to achieve the same level of satisfaction as smoking. However, e-cigarettes have higher rates of satisfaction compared with nicotine replacement.
– I will discuss with the patient that studies show that stopping smoking is more likely when using e-cigarettes than nicotine replacement.
– I would inform that e-cigarettes are more likely to cause throat and mouth irritation, compared with nicotine replacement.
– I will advise that nicotine replacement therapies are more likely to cause nausea.
– I will emphasize that, without face-to-face support, there is low efficacy for both treatments,and recommends that the patient use a smoking cessation support service, signposting them to the local service.
– I would positively acknowledges the consideration of giving up smoking by offering support and encouragement.
Smoking Cessation Marking Criteria
Use of honey dressing for venous leg ulcers
Usual scenario is like a patient is undergoing treatment for leg ulcer which is treated as per current evidence based protocol. Patient has an argument that use of medical honey or honey dressing is beneficial for treatment of leg ulcer when compared to the treatment she is receiving. You will be given 3 studies which you need to summarize and advise the patient. Your answer should be like
– I will inform the patient that there is currently no conclusive evidence indicating that medical grade honey improves outcomes for patients with chronic venous leg ulcers.
– I will informs the patient that one large study found no reduction in size of ulcer or healing time with honey compared with standard treatment.
– I would advise that, in the same study, patients reported an increased rate of pain
– I would that another study suggests that honey may have anti-microbial properties and may help patients with chronic venous leg ulcers who have a methicillin-resistant Staphylococcus aureus (MRSA) infection. However, this was a very small study, and more research is required on the subject.
– I will Inform the patient that there is no evidence that medical-grade honey is cost-effective in the treatment of chronic venous leg ulcers.
– I will recommends that, until further robust research is conducted and the efficacy of honey to treat chronic venous leg ulcers is established, the dressing of the wound should be based on current evidence-based trust protocol.
Honey Dressing Marking Criteria
Now, we will see the newly added topics to evidence based practice station. Please note as per NMC these will be added to station from November 14th 2022.
Ankle Sprain
Scenario – Patient Xi who is a patient of yours has got ankle sprain. Doctor has prescribed paracetamol for the patient. Xi is wondering whether Ibubrufen is better in this case rather than Paracetamol. You will be given studies in relation to this. Your answer should be like,
– Summarize the main findings from the article summary and draws conclusions, making recommendations for practice.
– Inform Xi that both paracetamol and ibuprofen are equally effective analgesics.
– Explains to Xi that some clinicians prefer to prescribe ibuprofen but there is no clear evidence that it is superior.
– Advise that the current available research suggests that paracetamol is an effective analgesia for pain resulting from soft-tissue injuries.
– Explain to Xi that, although ibuprofen is safe, it can have more adverse effects and be contraindicated in patients who have bronchospasm, cardiac and renal failure.
– Recognize that Xi is asthmatic and advises that paracetamol would be more suitable.
Aspergers Syndrome
Scenario – Charlie concerned about his friend Leslie who has Asperger’s Syndrome. Charlie is complaining that health care professionals are not understanding Leslie’s problems. Leslie is having problems with Mental health and is showing self injury behavior.
Your answer will be,
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Explain to Charlie that healthcare professionals’ poor knowledge and lack of understanding of autism are likely to be a barrier to those people who have autism accessing mental health support and treatment.
– Consider that healthcare professionals may need additional training to communicate with people who have autism.
– Explain that people who feel disregarded by healthcare professionals are less likely to seek further help.
– Inform Charlie that a study reports that highly functioning patients who have Asperger’s Syndrome are affected by a mis perception that health workers believe that they are able to cope as they were employed or at university.
– Consider that mental health support and treatment may help Leslie’s overall well being and improve his self-injury behavior.
Bedside Handover
Scenario – Tanveer is a registered nurse who is concerned about doing handover at the patients bedside. He thinks it will leak the sensitive and confidential information. He also has the opinion that the patient won’t prefer bedside handover as well.
Your answer will be,
– Summarize the main findings of the article summary and draws conclusion, making recommendations for practice.
– Inform Tanveer that research has shown that adult patients and nurses both prefer handover at the bedside rather than elsewhere.
– Inform Tanveer that most patients find bedside handovers beneficial as they feel involved in their own care and it supports two-way communication.
– Advise Tanveer that patients prefer to have a family member/carer/friend present and to have two nurses rather than the nursing team present. However, having a family member/carer/friend present was not considered important by nurses.
– Explain to Tanveer that, while patients expressed a weak preference for having sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handing sensitive information over verbally away from the bedside.
– Advise Tanveer that developing the process and design of bedside handover can improve the implementation of this important patient-centred safety initiative in hospitals.
Cervical Screening
Scenario – One of your patient Roshni is worried about her current sexual behaviour and the risk for cervical cancer.
Your answer will be like,
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Explain to Roshni that the main cause of cervical cancer is human papillomavirus (HPV).
– Inform Roshni that it can take between 10 and 20 years for cervical cancer to develop from an HPV infection. Therefore, a woman’s current sexual behavior does not necessarily reflect her current risk.
– Explain that the peak age for developing cervical cancer is 30 to 45, but it can occur in anyone who has a cervix, irrespective of age.
– Discuss any concerns and/or fears about screening with Roshni.
– Advise Roshni that she should attend for screening every 3 years until she turns 49, when she should attend every 5 years. Women will be invited to attend after 65 only if they have previously received an abnormal result
Cranberry Juice and Urinary Tract Infection
Scenario – Freda has been diagnosed with UTI. She is asking you whether drinking Cranberry juice daily would prevent occurence of UTI in women.
Your answer will be like,
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Explain to Freda that there is some research that shows that cranberry juice may prevent a UTI occurring in healthy individuals, if drunk regularly.
– Consider that cranberry juice may be less likely to induce nausea than other sugary drinks, when taken regularly.
– Inform Freda that there is no evidence available that cranberry juice may prevent UTIs in individuals who have high-risk conditions or those with indwelling catheters as people in these groups were not included in the study.
– Explain to Freda that there is no evidence available to suggest that cranberry juice can be used to treat a UTI in place of antibiotics.
– Inform Freda that it is necessary to note that the research was funded by a leading cranberry juice manufacturer, indicating a potential conflict of interest.
Dementia and Music
Scenario – Bindu is one of the patient of yours who has got dementia. Bindu’s daughter is asking you whether music therapy is beneficial to improve symptoms in dementia.
Your answer will be like,
-Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Inform Bindu’s daughter that research trials have been conducted where music therapy has been introduced and that they have had some benefits for individuals who have dementia. The patients involved in the study had all had at least five music therapy sessions.
– Explain to Bindu’s daughter that there is a lack of evidence that music therapy can improve symptoms of agitation.
– Explain that the current research available suggests some evidence to show that music therapy can positively improve depression, and this may provide a rationale for implementing music therapy.
– Inform Bindu’s daughter that music therapy may have a positive effect on the overall quality of life of individuals who have dementia. However, this evidence is less reliable than the evidence on depression.
– Inform Bindu’s daughter that there is no clear evidence on how long the effects created by music therapy remain after the activity stops.
Fever in Children
Scenario – You have a patient (child) who has got a high temperature. Child’s mothers name is Selai and she is worried of giving Ibubrufen to her child as she has heard that there is many side effects associated with Ibubrufen.
Your answer will be like,
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Explain to Selai that the fever is an important immune mechanism in fighting the underlying infection and that it is recommended to treat a fever only if it is causing the child distress
– Consider that either paracetamol or ibuprofen can safely be used to treat the fever.
– Inform Selai that ibuprofen taken in the short term (up to 7 days) should not be take with food to gain the optimum effects from the medication.
– Consider whether the child has asthma, as both ibuprofen and paracetamol can exacerbate respiratory symptoms.
– Explain that healthcare professionals may perceive that ibuprofen has more adverse effects than paracetamol but that there is not the evidence to support this.
Restraint
Scenario – Bharva is one of the visitors of a patient in the ward and is seeing one agitated patient in the ward. He asks you why can’t you restrain the patient which will keep both patient and staff safe?
Your answer will be like,
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Explain to Bharva that compassionate communication may prevent the need to restrain patients.
– Considers that physical restraint may be necessary to promote the safety of staff and patients as a last resort after other options have been exhausted.
– Inform Bharva that physical restraint may promote fear in patients and distress among staff.
– Consider that physical restraint may be perceived as a demonstration of power that staff display over patients.
– Explain that the use of physical restraint may create a loss of trust and a breakdown in patient and staff relationships.
Saline Versus Tap water
Scenario – Fiona has wound which she thinks need to be cleaned with sterile saline rather than tap water. You are the nurse doing the wound assessment and dressing.
Your answer will be like
– Summarize the main findings of the article summary and draws conclusions, making recommendations for practice.
– Inform Fiona that trials comparing the occurrences of wound infections when cleaned with sterile saline or tap water have shown no difference between the two.
– Advise Fiona that there is a lack of available evidence on the effects of water or saline on wound healing.
– Make Fiona aware that there are no differences in patient satisfaction in either group. However, there was a lack of robust evidence on the instances of pain experienced by patients, or on adverse events.
– Highlight to Fiona that there were no standard criteria for assessing wound infection across the trials, which limited the ability to pool the data across studies and limited the results.
– Explain to Fiona that tap water has been recommended as a cost-effective option for wound cleaning.
Pros and Cons of Evidence based station
Pros
– You will be given the studies of which you need to summarize and recommend
– Only six advise/information/recommendation to be given
– Silent station and demands only writing
Cons
– Wordings of your advise should be appropriate and is topic specific
– Need to memorize your marking criteria
– Handwriting should be legible and neat.
– Need to practice writing within time
Conclusion
This station seems to be easy as a silent writing station and the topics are given in marking criteria. But, as a matter of fact there has been failures in this station mainly because candidates couldn’t memorize the topic specific interventions. So please make sure that you learn the marking criteria and practice it writing down within the given time frame of 10 minutes.
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