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The nursing new graduate assessment clinical examination shall consist of 8 graded .... Assistant Secretariat for Postgr
NURSING LICENSING CLINICAL EXAMINATION

(2016)

I

Objectives a. Ensure that the candidate has the necessary clinical competencies relevant to a practicing nurse including but not limited to history taking, physical examination, documentation, procedural skills, communication skills, bioethics, patient assessment, investigation and data interpretation. b. Assessment of practice utilizing a valid model of core competencies evaluation for licensing nurses. This model is a multipurpose procedure because it enables global assessment of the nurse candidate’s knowledge, skills, values, and attitudes.

II Eligibility a. b. c.

Obtaining a score of (40-49) in the Saudi Nursing Licensing Exam (SNLE). Candidates are allowed a maximum of one attempt to pass the nursing clinical examination. A candidate who failed to pass the nursing clinical examination has to sit for SNLE again, after which he/she is allowed to sit the clinical examination only once if eligible. After exhausting above attempts candidate is not permitted to sit the nursing clinical examination.

III General Rules a. Nursing clinical examinations shall be held on the same day and time in all centers, however if multiple consecutive sessions are used, suitable quarantine arrangements must be in place. b. If examination is conducted on different days, more than one exam version must be used. IV Exam Format a. The nursing new graduate assessment clinical examination shall consist of 8 graded stations each with 10 minute encounters. b. The 8 stations are Objective Structured Clinical Exam (OSCE) stations with 1 examiner each and is assessed with a predetermined performance checklist. c. All stations shall be designed to assess integrated nursing encounters. Nurse examiners observe candidates interacting with standardized patients and provide ratings on up to five competencies relevant to the presented problem and nurse task. The competencies include: assessment, diagnosis, outcome identification & planning, implementation, and evaluation. d.

All venues in the Clinical Skills Testing Center (CSTC) are under closed circuit monitoring. Participants are expected to remain professional throughout the examination as all encounters are videotaped.

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V Final Clinical Exam Blueprint

DOMAINS FOR INTEGRATED NURSING ENCOUNTER

DIMENSIONS OF CARE

Nursing Process 5±1 Station(s) Patient Safety & Procedural Skills 1±1 Station(s) Communication & Interpersonal Skills 1±1 Station(s) Professional Behaviors 1±1 Station(s) Total Stations

Health Promotion & Illness Prevention 1±1 Station(s)

Acute 5±1 Station(s)

Chronic 1±1 Station(s)

Psychosocial Aspects 1±1 Station(s)

# Stations

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4

1

-

5

-

1

-

-

1

1

-

-

-

1

-

-

-

1

1

1

5

1

1

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VI Definitions Dimensions of Care Health Promotion & Illness Prevention

Acute

Focus of care for the patient, family, community, and/or population The process of enabling people to increase control over their health & its determinants, & thereby improve their health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor reduction but also arrest its progress & reduce its consequences once established. This includes but is not limited to encouraging periodic health exam, health maintenance, patient education & advocacy, & community & population health. Brief episode of illness, within the time span defined by initial presentation through to transition of care. This dimension includes but is not limited to urgent, emergent, & life-threatening conditions, new conditions, & exacerbation of underlying conditions.

Chronic

Illness of long duration that includes but is not limited to illnesses with slow progression.

Psychosocial Aspects

Presentations rooted in the social & psychological determinants of health that include but are not limited to life challenges, income, culture, & the impact of the patient`s social & physical environment.

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V

Definitions Domains

Focus of care for the patient, family, community, and/or population Nursing process; is a systematic , patient – centered, goal – oriented method of caring to Nursing Process provide a frame work for nursing practice. The five phases of the nursing process are assessment, diagnosis, planning/outcome, implementation, and evaluation. Patient safety emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. Procedural skills encompass the areas of care that Patient Safety & Procedural Skills require physical and practical skills of the nurse integrated with other competencies in order to accomplish a specific and well characterized technical task or procedure. Interactions with patients, families, caregivers, other professionals, communities, & populations. Elements include but are not limited to active listening, relationship Communication & Interpersonal Skills development, education, verbal, non-verbal & written communication (e.g. hand-over, documentation, informed consent). Attitudes, knowledge, and skills based on clinical &/or medical administrative competence, ethics, societal, & legal duties resulting in the wise application of behaviors Professional Behaviors that demonstrate a commitment to excellence, respect, integrity, accountability & altruism (e.g. self-awareness, reflection, life-long learning, & scholarly habits). Nursing Process Reflects the scope of practice & behaviors of a practicing nurse A nurse uses a systematic, dynamic, rather than static way to collect and analyze data about a patient, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain Assessment includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain medication. The nursing diagnosis is the nurse’s clinical judgment about the patient’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other Diagnosis problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example; respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan. Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition Planning/Outcome by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it. Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization Implementation and in preparation for discharge needs to be assured. Care is documented in the patient’s record. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

Evaluation

VI

Passing Score a. The pass/fail cut off for each OSCE station is determined by the exam committee prior to conducting the exam using a Minimum Performance Level (MPL) Scoring System. b. Each station shall be assigned a MPL based on the expected performance of a minimally competent candidate. The specialty exam committee shall approve station MPLs. c. At least one examiner marks each OSCE station. d. To pass the examination, a candidate must attain a score >/= MPL in at least 5 of the 8 stations.

VII Score Report a.

All score reports shall go through a post-hoc item analysis before being issued and approved by the SCFHS Assistant Secretariat for Postgraduate Studies within two weeks of the examination.

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X OSCE Station Sample

Nursing Clinical Exam

Station 1 Instructions to Nurse

Scene: Emergency Department Ahmed Saeed, a 55 year old male patient of Dr. Amer arrived to the ER with chest pain, and an order to rule out myocardial infarction (MI). He smokes two packs a day and is approximately 25 kilos over his ideal weight. Currently Mr. Saeed is on oxygen 3 L/min via nasal cannula, IV normal saline solution TKVO left hand and a saline lock in the right forearm. His physician`s orders are attached. YOU HAVE 10 MINUTES TO DO THE FOLLOWING: 1) CONDUCT CARDIO-PULMONARY ASSESSMENT. 2) CHECK PHYSICIAN ORDERS AND APPLY AS NEEDED.

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Performance Evaluation: Station 1 0 = not done, 1 = attempted but not done correctly/completely, & 2 = done correctly/completely Assessment 1.

2.

0

1

2

0

1

2

Performs appropriate cardio-respiratory assessment: a.

Chest pain (Site, severity, character, radiation, aggravating and relieving factors)

b.

SOB (severity, orthopnea, PND)

c.

Other cardiac/respiratory symptoms (palpitations, Nausea and syncope).

d.

Previous similar complaint

e.

Requests vital signs (no need to perform, they will be provided)

f.

Attempts to examine breath sounds

Demonstrates ability to quickly recognize and act upon a patient`s deteriorating condition (Assessment of chest pain/discomfort)

Implementation 3.

Performs 12-lead ECG

4.

Administers SL Nitroglycerin

Total marks:

Questioning Skills (ONE choice only)

Somewhat awkward; inappropriate terms; minimal use of open-ended questions

Awkward, exclusive use of closed-ended or leading questions and jargon

Professional Behavior with Patient

Offensive or aggressive; frank exhibition of unprofessional conduct

Negative attitude toward patient

Borderline unsatisfactory; moderately at ease; appropriate language; uses different types of questions

Borderline satisfactory; moderately at ease; appropriate language; uses different types of questions

At ease; clear questions; appropriate use of open and closed-ended questions

Confident; skillful questioning

(ONE choice only)

Borderline unsatisfactory; does not truly instill confidence

Borderline satisfactory; manner inoffensive, but does not necessarily instill confidence

Attempts professional manner with some success

Overall demeanor of a professional; caring, listens, communicates effectively

Overall Organization of Encounter (ONE choice only)

No logical flow; scattered, inattentive to patient's agenda

Counsels patient before taking history or doing physical

Minimal organization; scattered approach

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Appropriate approach to patient

Skillful approach to patient

Skillful, professional approach to patient and effective use of time

CSTC Hospital Patient Identification Ahmed Ali Saeed File Number: 213985 Physician`s Order Record Admitting Diagnosis: Myocardial Infarction Allergies: penicillin

Code Status: Full

Monitoring: Record VS q15 min until stable then q1h Continuous cardiac monitoring Full fluids IV: Total fluid to infuse TO KEEP VEIN OPEN (TKVO) hourly NS TKVO Hemodynamic lines to maintain patency with NS under pressure Chest pain protocol: If chest pain occurs, obtain stat ECG, Nitroglycerin 0.4 mg spray SL PRN for chest pain.

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References 1- American Heart Association (2015). 2015 Guidelines for Cardiopulmonary Resuscitation & Emergency Cardiovascular Care. Circulation. 2- Harding, M. (2015). Winningham's Critical Thinking Cases in Nursing: Medical-Surgical, Pediatric, Maternity, and Psychiatric, (6th Edition). Mosby. 3- Hinkle, J.L. & Cheever, K.H. (2013). Brunner & Suddarth's Textbook of Medical-Surgical Nursing, (13th edition). Lippincott Williams & Wilkins. 4- Lewis, S., Dirksen S., Heitkemper, M., & Bucher, L. (2013). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, (9th Edition). Mosby. 5- Morton, P. & Fontaine, D. (2012). Critical Care Nursing: A Holistic Approach, (10th Edition). Philadelphia: Lippincott Williams & Wilkins.

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