Planning Station NMC OSCE – Points to Remember

The answer sheet pattern in Planning station is as follows. First of all Nursing problem/need, then Aim of care, Re evaluation time frame, nursing interventions and then finally there will be space for writing your credentials and date.

Tips and Tricks for Planning Station in NMC OSCE

Many of you would have learnt about the nursing care plan format, which is nursing assessment, nursing diagnosis, Nursing Goal, Nursing intervention and Evaluation. That nursing problem was framed on NANDA diagnosis and all. But during your OSCE exam, Nursing problem is worded in simple words. There is no need to use NANDA diagnosis or something similar. For example, nursing problem for a patient John experiencing abdominal pain due to hernia can be worded as “Mr. John is experiencing abdominal pain due to abdominal hernia with a pain score of eight out of ten.It is as simple as that.

Aim of care should be worded in such a way that it should be specific and meashurable. For example, Mr. John will verbalize relief of abdominal pain with a pain score between 2 to 3 out of ten or less.

Re evaluation timeframe should be worded in three parts which means first part is where you put the date on, for example date today is 24/01/2022, you will write “Today, 24/01/2022”. Second part is the time period. This can be variable according to condition of the patient. It can be every four hours, every thirty minutes in case of pain and can be continous in case of respiratory distress. Third and last part of evaluation timeframe statement is “at the end of shift or if any clinical condition changes.” So basically, first and third part of evaluation timeframe statement remains the same regardless of the problem while middle part varies.

How to write your nursing interventions?

“EMATARID” is the accronym for nursing interventions regardless of the problem you have identified. Write Explain, Monitor, Assess, Teach, Administer, Refer, Intruct and Document one by one downwards in your answer paper and start completing the sentence later. Also while you write EMATARID don’t forget to put your name, signature and date in the specified coloumn as many people had to retake the exam just because the forgot to write their names or signature.

Always use name of the patient instead of calling them as patient or client while writing interventions.

Few interventions are always the same. First nursing intervention of all problems is “Explain plan of care to Mr. X (or name) and gain consent for all interventions. Also, second interventions is Monitor and record patient’s observations every as per NEWS score and escalate according to policy (please note that this intervention will change in case of neurological patient). Another intervention which can be used in almost all problems is Administer prescribed medications to patient and monitor for their effectiveness after 30 minutes.Second last one is usually Instructing the patient about use of call bell and to place within reach. Last intervention is “Document all aspects of care given to Mr. X (or name).”

Now we will see some commonly written nursing problems and what you should be careful while writing those interventions.

1. Pain

In case of any pain, you need to assess location, radiation and intensity using 0-10 pain scale utilizing pain assessment tool. Teach alternative pain management such as: diversional activities, deep breathing exercises, and relaxation techniques. Administer prescribed medication and monitor their effectiveness after 30 minutes. Refer to pain management team as well. If the patient is for surgery refer to surgical team.

2. Anxiety

In case if anxiety is your identified problem, Orient patient to immediate environment and offer self to show support, compassion and empathy. Encourage verbalisation of feelings and concerns regarding the cause of anxiety. Teach anxiety reduction exercises such as deep breathing exercises, positioning techniques and positive imagery. Administer prescribed medications and monitor for their effectiveness after 30 minutes.

If the problem identified is breathlessness, Assess patient’s breathing pattern and depth. Monitor for signs of respiratory distress such as cyanosis and laboured breathing. Teach patient about the use of deep breathing exercises and repositioning techniques for optimal lung expansion. Administer prescribed oxygen and medications and monitor for their effectiveness after 30 minutes. Refer to respiratory specialist nurse.

5. Risk of Infection

If the problem identified is risk of infection after a surgical procedure, Assess patients wound for signs of infection such as redness, pain swelling, pus and fever  Teach patient about importance of proper hand washing and wound care. Administer prescribed medications and monitor for their effectiveness after 30 minutes. Refer to surgical team or tissue viability nurse as needed.

7. Risk of Falls

In case of risk of falls, assess falls risk utilizing a falls risk assessment tool and implement fall precautions as needed. Provide a safe and clutter free environment and orient him to time, person and place belongings within reach. Provide proper non-slip socks for use when mobilizing and position bed to its lowest height. Refer to physiotherapy or occupational therapy for suitable ambulatory device.

7. Risk of Malnutrition

If problem identified is risk for malnutrition, then accomplish patient’s Malnutrition Universal Screening tool monthly, calculate BMI and MUST score and act as per guidelines. Provide a pleasant environment conducive for eating. Consider patient’s food choices for meal planning.  Administer prescribed medications and monitor for their effectiveness after 30 minutes. Refer to community dietician upon consent for evaluation. Encourage small frequent feedings and snacks. Instruct to communicate with GP and District Nursing Team if symptoms persist or condition changes.

8. Subdural Hematoma

If your given scenario is about Subdural hematoma, you should be very careful when you are writing the nursing intervention. We will tell you why? You have to do GCS assessment for the patient and there is a specific way about the frequency of your assessment which we will explain to you. Usually if a neurological condition is given for example like subdural hematoma, you can potentially identify two nursing problems. They are

If GCS 15, monitor every 30 minutes for the first 2 hours, every hour for the next for 4 hours and every 2 hours thereafter until stable and GCS maintains to 15 by 15 and escalate as per NEWS policy, Observe for signs of deterioration. If GCS 14 and below. Monitor every 30 minutes until stable and GCS reaches to 15 by 15 and escalate as per NEWS policy. Observe for signs of deterioration.

This is very important in planning station. Candidates have failed just because they didn’t write this intervention as specified. Along with this, you need to also write about assessing patient’s pain location, radiation and intensity using 0-10 pain scale utilizing  pain assessment tool. Teach alternative pain management such as: diversional activities, deep breathing exercises, and relaxation techniques. Assess patients skin integrity specifically the moisture lesion on his sacrum area using Waterlow Assessment tool. Administer to prescribed medications and monitor for their effectiveness after 30 minutes. Refer to pain management team upon consent as needed.

Also, in subdural hematoma scenario,  one of the other problem you have identified can be risk for deterioration, Then you need to re write the same intervention for NEWS2 assessment as given above including the one GCS monitoring exactly the same. Along with which  you can add, Assess for signs of deterioration such as restlessness, irritability and lethargy and escalate as needed. Provide a safe and clutter free environment and orient him to time, person and place and leave a written reminder on his bedside. Assess patients skin integrity specifically the moisture lesion on his sacrum area using Waterlow Assessment tool. Administer prescribed medications and monitor for their effectiveness after 30 minutes. Refer to the medical team for further management upon consent as needed.

Conclusion

You can now buy our OSCE guide from Amazon for which you need to search NMC OSCE for Overeas Nurses written by Lovelyn Joshi.

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