Registered Nurse Objective Structured Clinical Examination (NMC OSCE) Assessment and Care Planning (APIE) Syllabus

How is Mean Arterial Pressure (MAP) estimated from systolic (SBP) and diastolic (DBP) blood pressure?

$$MAP \approx DBP + \frac{1}{3}(SBP - DBP)$$

Name three common risk-screening assessment tools used at admission in UK adult nursing.

Waterlow or Braden (pressure ulcer risk), MUST (malnutrition risk), and a falls risk assessment; VTE risk assessment is also routinely completed.

What does the MUST tool screen for and what are its three components?

MUST (Malnutrition Universal Screening Tool) screens nutrition risk using BMI score, unplanned weight loss score, and an acute disease effect score, summed to a 0–6+ risk category.

What does the Waterlow score assess, and does a higher score mean higher or lower risk?

It assesses pressure ulcer (pressure injury) risk; a higher score indicates higher risk.

What does a VTE risk assessment determine on admission?

A patient's risk of venous thromboembolism (DVT/PE) versus bleeding risk, guiding whether mechanical and/or pharmacological thromboprophylaxis is needed.

In care planning, what is the difference between an actual and a potential problem?

An actual problem is one the patient currently has (e.g. existing pressure ulcer); a potential problem is a risk that could develop if not prevented (e.g. risk of pressure damage).

How is a potential problem typically worded in a nursing care plan?

As a risk statement, e.g. 'At risk of...' or 'Potential for...', followed by the problem and its related/contributing factors.

What is the structure of a PES nursing diagnosis statement?

Problem (the diagnosis), Etiology ('related to' the cause/risk factors), and Signs/Symptoms ('as evidenced by' the defining characteristics).

When prioritising care needs, how does Maslow's hierarchy guide the order of nursing priorities?

Physiological needs (airway, breathing, circulation, nutrition, elimination) are met first, then safety, then love/belonging, esteem, and self-actualisation.

What is the difference between a high-priority and a low-priority problem when prioritising care?

High-priority problems are life-threatening or urgent (e.g. compromised airway/breathing); low-priority problems are important to wellbeing but not immediately life-threatening and can be addressed later.

What is a patient-centred (person-centred) goal?

A goal that reflects the individual patient's own values, preferences and desired outcomes, agreed with them rather than imposed by the nurse, and focused on what matters to the patient.

What does the SMART acronym stand for when writing care plan goals?

Specific, Measurable, Achievable, Relevant (Realistic), and Time-bound.

Give an example of converting a vague goal 'patient will mobilise better' into a SMART goal.

'Patient will walk $20$ metres with a frame and one assistant, unaided by pain above 3/10, within 5 days.' — specific, measurable distance, achievable, relevant, time-bound.

What is the difference between a short-term and a long-term goal in care planning?

A short-term goal is achievable within hours to days (an interim step); a long-term goal is the overall desired outcome achieved over a longer period (weeks to discharge).

What three components are usually documented in a written care plan for each problem?

The identified problem/need, the goal/expected outcome (SMART), and the planned nursing interventions/actions to achieve it (with evaluation date).

What is shared decision making in nursing care?

A collaborative process where the nurse and patient jointly make decisions about care, combining clinical evidence with the patient's preferences, values and informed choice.

What four ingredients are needed for valid informed consent to care?

The patient must have capacity, be given sufficient information, decide voluntarily (without coercion), and be able to communicate the decision.

What are the key principles of person-centred care according to UK frameworks?

Treating people with dignity, compassion and respect; offering coordinated and personalised care; and supporting people to recognise and develop their own strengths and abilities (enablement).

What does 'evidence-based practice' mean when selecting interventions for a care plan?

Integrating the best available research evidence with clinical expertise and the patient's values/preferences to choose interventions most likely to be effective and safe.

Rank the hierarchy of evidence from strongest to weakest for guiding interventions.

Systematic reviews/meta-analyses > randomised controlled trials > cohort studies > case-control studies > case series/reports > expert opinion.

Why should nursing interventions in a care plan be linked to national guidance such as NICE?

NICE guidelines synthesise current evidence into recommended practice, so linking interventions to them ensures care is evidence-based, standardised, defensible and up to date.

What is discharge planning and when should it begin?

The process of preparing a patient for safe transfer from hospital to home or another setting; it should begin at or soon after admission, anticipating ongoing needs.

List key elements to address when planning a safe discharge.

Medicines and TTOs, follow-up appointments, equipment and home adaptations, social/care package and support, patient/carer education, and clear communication with the GP/community team.

What does the 'Implementation' stage of APIE involve?

Carrying out the planned nursing interventions safely and competently, while continuing to observe the patient, and accurately documenting the care given and the patient's response.

Name three checks/safety steps a nurse must perform before delivering a planned intervention such as medication administration.

Confirm patient identity (e.g. two identifiers), check for allergies and contraindications, and verify the correct drug/dose/route/time against the prescription — applying the 'rights' of administration.

What are the commonly taught 'rights' of medication administration?

Right patient, right drug, right dose, right route, right time, right documentation (often extended to right reason, right response and right to refuse).

What does reassessment during implementation aim to detect?

Whether the patient is responding to the intervention as expected, or is deteriorating/developing new problems, prompting timely escalation and revision of care.

What is the difference between monitoring and evaluation in the nursing process?

Monitoring is the ongoing observation of the patient's status during care; evaluation is the structured judgement of whether the stated goals/outcomes have been achieved at the review point.

When evaluating a care plan, what three possible conclusions can be reached about each goal?

The goal was met (fully achieved), partially met (some progress), or not met (not achieved) — each then guiding whether to continue, revise, or discontinue the plan.

If a goal is evaluated as 'not met', what should the nurse do next in the APIE cycle?

Reassess the patient to find why, revise the nursing diagnosis/goal and interventions accordingly, then re-implement and re-evaluate — restarting the cycle.

What must be documented when evaluating care and revising a plan?

The evaluation findings (progress against each goal), the patient's response, any changes to the diagnosis/goals/interventions, the rationale, and the new review date — recorded contemporaneously, accurately and signed.

According to NMC standards, what are the key requirements for good nursing record-keeping?

Records must be accurate, factual, clear, legible, contemporaneous (completed as soon as possible after events), free of unnecessary abbreviations or opinion, dated, timed and signed/attributable.