Midwife OSCE – Assessment Station overview
Assessment station in midwife osce is different to that of Adult Osce – assessment station. In this article we will give an overview of Midwife OSCE Assessment station.
Midwife OSCE – Assessment Station Overview
Things to do
Complete midwifery antenatal assessment including observation and urine analysis of women. Observation chart is provided and must be completed within the station.
Linda has presented today with raised blood pressure in the antenatal unit based in the GP midwifery clinic. Linda is gravida 1 para 0 and has been low risk currently 36 weeks gestations. Complete maternal observations and urine analysis. Calculate modified early obstetric warning score. Assume it is today and 1030 am.
As I enter the room, I check for scene safety, I ensure that scene safe to proceed.
I ensure that I wash my hands using seven steps of hand hygiene before approaching the patient.
I approach the patient, I make sure that I maintain the privacy of the patient by ensuring the doors, windows are closed including stopping the house keeping activities.
I introduce to myself to the patient by explaining that I am the midwife looking after her today and asks the patient what she likes to be called.
I check the id of the patient with the patients notes and confirm that both are the same. I also make sure that I check for any allergies if it is a red wrist band.
I explain to the patient the reason for my visit and make sure she is comfortable in the position and if she wants to use the washroom as it is going to take a few minutes.
I will assess the pain score of patient in a pain scale of 0 – 3 and record it in the MEWS chart.
I will also enquire about the fetal well being and gain consent for taking clinical observations and doing abdominal palpation as well as doing the urine analysis test.
I will explain that I am going to collect all the necessary equipments which includes the obs machine, measuring tape, fetoscope and come back to her as soon as possible.
I make sure that the examiner confirms that the obs machine has been cleaned and calibrated for use within the past 24 hours and make sure that I wear the appropriate gown and gloves to protect the patient from infection.
I do the hand rub, put the appropriate ppe and approach the patient.
I communicate with patient and finds out which arm can be used for blood pressure reading and takes bp cuff of appropriate size.
I explains to the patient when taking bp measurement, patient may feel bit tight over her arms.
I measure the heart rate and respiration for one minute each making sure that Linda is comfortable and that she is not talking or crossing her legs which might alter the readings.
Following which I do the temperature check and explain what the observations are for Linda and attends to any concerns. I documents all the recordings accurately on the MEWS chart. Also assessing the needs for any kinds of health education or additional support which Linda might require in the areas of health and well being, dietry habits and life style modifications.
Urine Collection and Analysis
Following this I provide a fully labelled specimen bottle for urine collection and explains how to collect the midstream urine and the significance of not touching the inner part of the urine bottle. Meanwhile as Linda moves on for the sample collection, I takes the time to document everything appropriately in the MEWS chart and also in patient record. As soon as Linda brings the sample back I check the urine sample with the reagent making sure that the reagent strip box is intact and within date and adhering to all infection control precautions.
I countercheck the urine strip with the control strip and check for any alterations in the urine sugar or any presence of ketones, informs this to Linda appropriately.
Abdominal Inspection, Palpation and Auscultation
Next step is to move forward to the abdominal palpation. Since Linda has already used the toilet, I confirms whether she is comfortable to proceed.
I explain that she might have to lay on her back on a semi – recumbent position which might be uncomfortable and the ideal position for the pregnant woman is left lateral.
I will make sure that before touching I will do hand hygiene and warm my hands before proceeding with the abdominal palpation.
I also gain consent from Linda to expose only the needed parts for abdominal palpation before I even start.
I start with abdominal inspection and check for the size and shape of the abdomen. Observe for any marks, cuts or wounds including striae gravidarum or linea niagra which are normal for a pregnant woman. I will confirm with the examiner that I will observe for any burns or wounds mark only to be concerned about the safeguarding issues if existing.
I communicate with Linda and constantly encourage her to stop if she is feeling unwell or uncomfortable at any point.
After inspection, I move onto abdominal palpation and I ask Linda about here gestational age and about the fetal movement.
I warm my hands and place the right arm over the lower part of the xiphisternum and palpate downwards till I feel upper part of fundus and use the measuring tape keeping the markings with inch measurement facing downwards and measure the symphysiofundal height and verbalise it to Linda expressing that normally it would be + or – 2 from her current gestational age which means that baby is of adequate size and growth.
I move on to the lateral palpation using the pads of my fingers to check which part occupies both the lateral sides and verbalise as I do the palpation. I ask Linda where she experiences kicking of the baby, the most. This helps to ascertain where the heart of the baby is located approximately.
Next I will be doing the pelvic palpation to assess the presenting part of the baby to what extent it is engaged. Complete the pelvic palpation and check for ballotment of foetus which completes the abdominal palpation and ascertain that Linda is still comfortable. Tell Linda the procedure is nearly done.
Next step is to auscultate the fetal heart rate using the fetoscope. I will check the fetal heart rate for one minute and maternal pulse for another minute to make sure that it does not coincide.
Verbalise the major findings including lye of baby, attitude, presenting part, position and fetal heart rate. Escalate to doctor for early intervention if women triggers one red or two amber scores at any one time.
Conclude the session by thanking Linda for her cooperation and assuring her that the health condition of her baby and herself seems satisfactory and to always contact antenatal assessment unit if she has any worries.