Toni Flanagan

Advanced nursing practice: Objective structure clinical examination (OSCE) programme

Background

This project aimed to develop, run and evaluate an OSCE programme which assesses the competence and confidence of nurses using advanced nursing skills such as history taking, physical assessment and prescribing. An OSCE is a simulated assessment used widely in health care education and can be used to provide evidence of competence.

The above skills are currently taught as part of university programmes with an assessor in practice. Following completion of the university programmes there is no recognised way of assessing, maintaining or improving these skills. Research has shown that following the obtaining of physical assessment and prescribing skills, nurses in palliative care do not always go on to use these skills regularly and effectively, see Ryan-Woolley at al (2017) and Webb & Gibson (2011).

 

If community nurses were using their full range of clinical skills it would improve patient care and experience by ensuring timely assessment, prescribing and referral to other specialists

 

If community nurses were using their full range of clinical skills it would improve patient care and experience by ensuring timely assessment, prescribing and referral to other specialists. It could also potentially reduce the workload for community partners e.g. GPs would not have to be contacted to provide a prescription for a drug an advanced nurse practitioner recommends. There is also potential to reduce emergency admissions to hospital.

An OSCE programme has already been set up within a hospice which supports the learning and development of registered nurses with traditional clinical skills e.g. catheterisation. The OSCE programme has enabled nurses to feel more confident and competent in clinical care. It is hoped this programme will have the same effect on the community nurses therefore improving patient care. 

Aims and objectives

To develop, run and evaluate an OSCE programme which assesses the competence and confidence of nurses using advanced nursing skills such as history taking, physical assessment and prescribing skills.

Objectives: 

  • To have a better and clearer understanding of the competence and confidence of nurses using advanced skills
  • To highlight areas of learning for both individuals and across the cohort of those taking part
  • To have a better understanding of how the OSCE process itself can affect confidence and competence
  • To improve patient care by identifying areas of practice that require development

The objective structure clinical examination programme has enabled nurses to feel more confident and competent in clinical care

Activity to date

  • Completion of project plan and Gantt chart, project gained approval from director of
  • Questionnaire for pre and post OSCE’s developed and gained approval from director of nursing
  • Development of OSCE proformas for each body system
  • Dates for OSCE’s identified and rota of assessors developed
  • Volunteers identified to act as patients for the OSCE’s
nurses-women-checking-medication

Outputs to date

  • Development of an OSCE programme for advanced nursing skills which is to run from April 2018
  • Evaluation methods developed to measure the impact of the OSCE’s on the competence and confidence of registered nurses 

Lessons learned

Due to the number of projects taking place within the organisation at one time, other projects may take priority, therefore flexibility needs to be built into timelines to account for this. It is also important in a project such as this, to ensure that the assessors are the right people and have the requisite skills to undertake the role.

open book

Reflections on impact

The OSCE programme aims to improve the confidence and competence of registered nurses in using their advanced skills in practice. The hospice currently runs an OSCE programme which has shown an improvement in confidence and competence of nursing skills such as catheterisation and we would therefore expect to see the same improvement in nurses practicing advanced skills.

 

The objective structure clinical examination programme aims to improve the confidence and competence of registered nurses in using their advanced skills in practice

 

This impact will be measured through questionnaires completed by the registered nurses both prior to and after the OSCE programme. The assessments themselves will assess clinical competency. Audits could also be conducted on patient notes and the use of physical assessment skills. The number of prescriptions made and by whom could be regularly audited. Patient and carer complaints, concerns and incidents could also be used to monitor patient care and experience.


The way forward

The OSCE programme itself could be used by other organisations to maintain and improve confidence and competence of nurses using advanced clinical skills. Once the OSCE programme has run and data has been gathered which demonstrates its impact, an article for publication will be developed to aid dissemination. The project will also be submitted to conferences as a poster presentation to aid dissemination and uptake of the concept more widely.

 
The OSCE programme itself could be used by other organisations to maintain and improve confidence and competence of nurses using advanced clinical skills

 

Sustaining momentum

The project will be completed in 2018 and the OSCE programme developed will run annually to continually assess and maintain competence and confidence. From the evaluation, training will be developed to meet learning needs ensuring the advanced clinical skills are part of the nurse’s daily practice. 

References


Ryan-Woolley, B., McHugh, G., and Luker, K. (2007) Prescribing by specialist nurses in cancer and palliative care: results of a national survey. Palliative Medicine. 21 (4) p. 273-277.

Webb, W., and Gibson, V. (2011) Evaluating the impact of nurse independent prescribing in a weekend clinical nurse specialist service. International Journal of Palliative Nursing. 17 (11) p. 29-34.