How to Perform Correct A to E Assessment for the NMC OSCE

How to Perform Correct A to E Assessment for the NMC OSCE

The Nursing and Midwifery Council (NMC) Objective Structured Clinical Examination (OSCE) is a vital step for overseas nurses aiming to practice in the UK. One of the critical components of the OSCE is the A to E assessment, which ensures a systematic approach to evaluating and managing acutely unwell patients. Here’s a step-by-step guide to help you master this essential skill.

Step 1: Airway (A)

Start by assessing the patient’s airway to ensure it is clear and unobstructed.

1. Check for Obstructions: Look for any visible obstructions in the mouth or throat.
2. Listen for Sounds: Listen for any abnormal sounds like stridor or gurgling, which may indicate an obstruction.
3. Ask the Patient: If the patient is conscious, ask them to speak. Difficulty speaking can indicate airway issues.

Step 2: Breathing (B)

Next, assess the patient’s breathing to ensure they are getting adequate oxygen.

1. Observe: Look for chest rise and fall, and note the rate, rhythm, and depth of breathing.
2. Listen: Use a stethoscope to listen to breath sounds on both sides of the chest.
3. Measure: Check the respiratory rate and oxygen saturation levels using a pulse oximeter.

Step 3: Circulation ©

Evaluate the patient’s circulation to ensure adequate blood flow and perfusion.

1. Pulse Check: Assess the pulse for rate, rhythm, and strength.
2. Blood Pressure: Measure the patient’s blood pressure.
3. Capillary Refill: Check capillary refill time by pressing on a fingernail and observing how quickly color returns.
4. Look for Signs of Shock: Pale, clammy skin and altered mental state can indicate poor circulation.

Step 4: Disability (D)

Assess the patient’s neurological status to identify any disabilities.

1. Level of Consciousness: Use the AVPU scale (Alert, Voice, Pain, Unresponsive) to assess consciousness.
2. Pupil Response: Check the pupils for size, equality, and reaction to light.
3. Glucose Levels: Measure blood glucose levels if the patient shows signs of altered mental status.

Step 5: Exposure (E)

Finally, expose the patient to complete a thorough examination while maintaining their dignity and privacy.

1. Inspect the Body: Look for any signs of injury, rashes, or other abnormalities.
2. Temperature: Measure the patient’s body temperature.
3. Maintain Warmth: Ensure the patient is kept warm and covered as much as possible to prevent hypothermia.

Tips for Success

• Stay Systematic: Follow the A to E sequence methodically to ensure no step is missed.
• Communicate Clearly: Explain each step to the patient to keep them informed and reassured.
• Document Findings: Record all observations and measurements accurately for further evaluation.

By following these steps, you can perform a correct A to E assessment efficiently and accurately, ensuring patient safety and meeting the NMC OSCE standards.