OSCE : APIE

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The OSCE (Objective Structured Clinical Examination) is the NMC’s (Nursing and Midwifery Council) test of competence, to ensure overseas and return to practice nurses meet the strict criteria in their clinical practice, abilities, knowledge and ethics to join the UK register.

Online training has accompanied MNL’s (My Nurse’s Life) classroom training for a long time now, with superb feedback and results from nurses who have completed it. For the best chances of passing, we encourage all our nurses to complete the online, before classroom training, and re-access it prior to their exam. Note – the course can be made available until the OSCE is sat.

We at MNL, have trained the OSCE to nurses from around the world for three and half years, and we are the first choice trainers for many hospitals and private healthcare organisations in the UK.

With training and guidance from the OSCE Test Centre examiners, and help from fellow NHS and UK university clinical educators, we have produced a completely up to date and comprehensive course, that we are simply jubilant about!

We have worked hard to ensure that the course is both insightful and practicable to all nurses, helping demystify the exam and its true contents. The standard is kept at the level that the NMC set for the OSCE – that of a newly qualified nurse in the UK, so not to convolute the imperative theory and practicals being set out.

All the materials are fact-checked, and we only use reliable published sources. The guidelines and protocols are therefore aligned with the UK’s NMC, NICE, NHS and Royal Marsden (9th ed) standards, and therefore that of the OSCE. The support we provide in assisting nurses in preparing for their exams has proved invaluable, with pass rates and confidence levels soaring since we developed it.

All other OSCE materials published, appear to give partial or even misleading information about the test. However, this course covers all the information required to pass, in a concise and comprehendible way.

Throughout the course nurses are made aware of the pass and fail criteria, and other qualities the examiners are looking for in a nurse entering the UK NMC register.

All common fails, exam etiquette, focussing on the OSCE criteria and insider information on what the examiners like to see from the nurse are covered.

Our hope is that all nurses heading for the UK, have this made accessible to them and can therefore familiarise themselves with the intricacies of the exam.

Clinical Skills videos

All the clinical skills that could possibly be encountered in the exam are covered in the course’s videos. They are produced by MNL’s lead trainer Helen Romnes, therefore the correct emphasis on the content is given.

There are several OSCE Training videos on Youtube, produced some time ago, by the UK’s Health Education England (HEE), but due to many changes in the OSCE criteria, these are actually now outdated and often misleading.

Also, we are aware of the many OSCE videos published by other ‘trainers’, who are not following the exam criteria, with apparent little OSCE training experience. We are concerned that these are potentially dangerous – as if followed they can lead to fails.

MNL have produced this exclusive set of videos that are only available through this platform.

Our Clinical Skills videos cover all the latest 10 updated skills, and all take less than 15 minutes each to watch.

Our own unique MNL mnemonics are included, to aid you to easily remember the approach steps and pass the OSCE.

Common themes throughout the skills must be demonstrated in order to pass, such as safe approach, hand hygiene, greeting the patient, checking their personal details, comfort levels and understanding. Providing privacy and gaining consent for any procedure.

Other examples include the nurse showing competence in checking items for their date of expiry, cleaning reusable equipment, disposing of waste appropriately. Effective communication with the patient, including verbalisation of further documentation and how to leave them safe, feeling informed and reassured.

The skills station can vary in length from 8 -15 minutes long, they include the following skills:

ANTT (aseptic non-touch technique) – which consists firstly of preparing a dressing trolley and checking all materials for the procedure.

The nurse must demonstrate on a manakin: cleansing a wound and applying a simple wound dressing. They must ensure non-contamination of the sterile field; correct donning of sterile gloves; wound cleansing technique; application of the dressing and appropriate disposal of the used items.

IM (intramuscular injection) this is another 15 minute station, where a drug is given into a manakin’s injectable port. Essentials include checking the patient’s identification and the medication chart, using the standard “6 rights” technique. Explaining the drug and its side effects, how to correctly prepare the drug, calculate and obtain the correct dose. How to assess the patient’s skin, identify the correct area and prepare the patient. Technique and proper administration are taught, and correct post-injection skin care and safe disposal of sharps. Completing the medication chart in a correct and timely manner and providing any information the patient requires.

SC (intramuscular injection) the processes are very similar to the IM described above. It is 15 minutes also. The differences between the procedures are made clear, with a heavier emphasis on post-injection management, related to the signs, symptoms and subsequent actions required.

BLS (Basic Life Support) An 8 minute station where nurses learn the exact scenario given in this station, and how to best respond. Checking scene safety, assessing for a response, summoning help, checking the airway and breathing. Essential time-saving tips of how and when to instruct the responder, and what to do next are all covered.

Effective cardiac compressions, including precise hand position, rate and depth, also how to answer questions regarding UK in-hospital resuscitation, are shown as per UK Resuscitation guidelines.

Peak Expiratory Flow Rate. A 12 minute station. Peak flow monitoring is a skill unfamiliar to many overseas nurses, so we give a thorough explanation of the procedure of measuring the PEFR (Peak Expiratory Flow Rate). The nurses’s explanation, gaining consent and asking the patient appropriate questions are all detailed.

Gathering the equipment, explaining the correct technique; accurate recording and comparing of the results on a standard UK PEFR graph, and how to interpret the results to the patient is all carefully explained.

Inhaled medication. A 12 minute station. It entails giving an inhaler with a spacer device. All the preliminary steps are given, from checking the patient’s identity, to explaining the medicine and its side effects. The “6 Rights” of medication checks; the preparation of the equipment and how to explain the full technique to a patient are shown.

Catheter Sample of Urine. A 12 minute station. We clearly set out, how to obtain a specimen from a catheter, and transfer it into a container in a sterile manner. How best to gain consent and how to maintain privacy throughout and collect the materials required. Preparing the patient and their catheter, with emphasis on how to preserve sterility throughout the procedure, using the non-touch technique is all covered. We teach correct use of the clamp and the best technique of transferring the urine into the specimen pot.

Removal of Urinary Catheter. A 12 minute station. How to prepare the patient for the procedure, and give proper post removal education is discussed and demonstrated. We talk about how to position them correctly, how to prepare the catheter and checks to be made, accessing the catheter removal port, while maintaining complete privacy. Familiarisation with a UK indwelling catheter is made, as this can vary in non-UK countries.

MSU (midstream urine) A 12 minute station. This involves providing a patient with information on how to obtain a clean midstream urine sample, and prepare the materials used for testing. We explain the actual testing, using a urine dipstick and appropriate disposal of the used materials. We reveal how they should record the results on the form, in a precise and timely way to ensure a pass.

Also, we go through how to explain the results obtained back to the patient, and check correct storage and transportation of the specimen to the laboratory.

Fluid Balance chart. A 15 minute station. This is an illustration of how to complete the fluid balance chart, and obtain the overall balance. Tips on how to avoid mistakes and what to and not to include on the chart. We go over how to ensure it is completely and accurately filled in, without wasting time to ensure a pass.

In the APIE section (Assessment, Planning, Implementation and Evaluation), candidates can meet different patients, and with our insider knowledge, we explain how the patient presents in the exam.

There are four modules per patient case study.

Assessment can be one of the most demanding stations, where the nurse encounters a real life actor, and is being marked on must communication, analytical, observation and safety awareness skills.

This is broken into easy to follow steps, allowing the nurse to concentrate on each aspect and stage of the assessment – then putting everything together into a logical order.

Included are images of completed paperwork, including the admission booklet and a case study scenario and the charts they will encounter.

They are shown how to assess the room for safety; the patient for signs of discomfort, distress or deterioration and how to appropriately respond to this.

Audios guide them through what is expected in the station, a series of videos demonstrate correct methods of the safe approach; hand-washing technique, introduction to the patient and checking of their personal details, comfort and concern.

The content shows how to express concern and compassion for the patient, through patient-centred care including active listening and also how to avoid wasting time in the exam.

We cover approaching the disorientated patient, and completing a full neurological assessment of the head injured patient, here the standard GCS assessment methods are taught.

Accurate taking and recording the of the obs (NEWS2) or GCS – in a timely and accurate manner are thoroughly covered and we delve into how to use that data. We look at when to escalate to the doctor and deciding on the frequency of monitoring, in accordance with the national protocols and clinical judgement.

We tackle how to assess the relevant Activities of Daily Living, and focus on offering simple solutions and referrals. We show how to discuss their current social situation and different circumstances, that may be a cause for concern.

Healthy lifestyle choices are addressed and information supplied. We explain how to leave a patient correctly, with expectations and reassurance.

Quizzes at the end are designed to emphasise the main learning points, and for the nurse to check if they are retaining important information.

Planning

This section guides them through how to construct a person-centred care plan, using the Roper, Logan, Tierney Model for Nursing, incorporating the 12 Activities of Daily Living. We relate this to their current admission, and how to achieve optimum health and independence for the patient.

They are taught the standard nursing language acceptable in a UK care plan, and how it works between staff, the patient and their family.

They are guided on how to choose relevant problems, aims, re-evaluation dates and structuring interventions – leading to maximum independence and patient participation. We define how to correctly word and define self-care interventions for the individual.

Audios, written text including example care plans and quizzes are also included.

Implementation

Videos, audios and written text are all part of the teaching tools for implementation, which involves administering tablets to a patient – which is a manakin in the OSCE.

They are taught correct approach, checking details and using 6 rights of medication administration. We emphasise checking for patient comfort and how to best assist the patient.

They will become familiar with the system used in the OSCE for documentation and coding for withheld drugs. Also, how and when to use the British National Formulary (BNF), for drug checking, is covered in detail.

A comprehensive look at the types of drugs – their indications, side effects and contraindications and common pitfalls are all are covered in the course. They are quizzed on these at the end.

Common traps and mistakes are demonstrated and tested, sample MARs (medication administration records) help them assess their current knowledge, and see the level at which they should be.

Evaluation

The evaluation part covers a transfer of care letter to another ward or department, and in the community a referral letter to a specialist nurse.

This section has a deep look into the requirements for the letter, where to find the information and crucial structuring. With completed examples of the form to refer to and an explanation of how to gain the greatest marks. Critical fails are addressed here too.  Learning is enhanced through audios, text, examples and quizzes to support learning.

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