NMC ToC OSCE: Planning (APIE) Station

Introduction

The Test of Competence (ToC) is the assessment used by the Nursing and Midwifery Council (NMC) to determine whether internationally educated nurses (IENs) and returning-to-practice nurses possess the skills, knowledge, and values required to register and practise safely in the UK.

The planning station forms the second part of the APIE structure. The APIE stations are four scenario-based stations that relate to the four stages of the nursing care process:¹

• Assessment
• Planning
• Implementation
• Evaluation

This station is a silent written station, where nurses must write two care plans in 14 minutes. Candidates will use the same patient condition from the assessment station and are expected to utilise information gathered during that assessment to inform their care planning.¹

Care planning

Care planning is a fundamental aspect of nursing practice, ensuring the delivery of safe, effective, and person-centred care. Assessing needs and planning care is one of the core areas emphasised in Future Nurse: Standards of Proficiency for Registered Nurses (NMC, 2018a), comprising one of the seven platforms.²

The NMC stipulates that nurses must be able to assess needs, plan and deliver care, and evaluate outcomes in partnership with individuals, their families, and other professionals.²

When writing care plans in clinical practice or during the exam, nurses should consider the following core principles:

• Consider the whole person and be patient-centred
• Ensure patient consent and decision-making with the plan of care
• Be relevant to the patient’s condition
• Collaborate with other professionals
• Ensure goals are realistic and achievable
• Use safe and evidence-based interventions
• Be clear, specific, and measurable
• Follow best practice for record keeping and legal accountability³

An effective care plan promotes continuity, encourages collaboration, and supports the achievement of patient-centred care. The principles of care planning are transferable between hospital, home and care home settings.³

Within the context of the NMC ToC OSCE, the care planning station tests a candidate’s ability to demonstrate these skills under timed conditions. Candidates are assessed on their ability to:

• Identify actual or potential nursing problems based on their assessment
• Develop patient-centred aims that are measurable and achievable
• Include appropriate and safe evaluation timeframes
• Write relevant, evidence-based nursing interventions
• Complete accurate and professional documentation

Identifying the problem

The first step in the care planning station is to identify either an actual problem, such as shortness of breath or pain, or potential problems, such as the risk of falls or wound infection.

To do this, nurses must:

• Ensure the problems are relevant to the scenario and supported by clinical findings from the assessment station
• Focus on one problem per care plan – avoid combining multiple issues
• Ensure the problem is relevant to the timeframe stated in the station briefing

Identifying relevant problems in the OSCE station is directly linked to the nurse’s ability to appropriately assess the patient and listen to their concerns in the assessment station. Failure to carry out an adequate assessment may impact the nurse’s ability to complete the planning station.

Setting aims

After identifying the problems, the next step is to create specific aims or goals for each. Aims should seek to reduce or alleviate actual problems or minimise the risk of potential issues.

Effective goals should be:

• Patient-centred: reflecting the patient’s personal needs or preferences
• Specific: clearly related to the identified problem
• Achievable: realistic given the patient’s condition and circumstances
• Measurable: so that it can be determined whether the goal has been met

Evaluation timeframes

Every care plan must include a realistic timeframe for evaluation. This enables nurses to assess whether the goal has been achieved and if the care plan requires modification.⁴

When choosing a timeframe, candidates should consider:

• Safety: how long is safe to wait before reassessing the issue
• Evidence-based guidelines: e.g. the NEWS2 monitoring tool may guide re-evaluation timing for a patient with shortness of breath.

Timeframes should align with the severity of the issue:

• Acute issues (e.g. pain, bleeding, shortness of breath): 30 minutes to 1 hour
• Chronic or longer-term issues (e.g. malnutrition risk, reduced mobility): 24 hours to 7 days

Evidence-based interventions

Each care plan should include evidence-based nursing interventions, which are actions nurses take to address or prevent the problem and achieve the goal.

Interventions must:

• Be nursing-focused (not medical)
• Be based on best practice or national guidelines (e.g. NICE)
• Be relevant to the identified problem
• Be patient-centred and involve informed consent
• Include self-care and patient education where applicable

In the NMC ToC OSCE, candidates should focus on quality, problem-specific interventions as opposed to more generic interventions, which could be applied to any care plan.

Documentation

Care plans are legal documents and must be treated as such. Nurses should be aware of the need for legal accountability when documenting care plans.³ In the NMC exam, improper or incomplete documentation can result in a critical fail.

Documentation must be:

• Clear and legible
• Specific and detailed enough for any healthcare professional to implement
• Signed, with the nurse’s printed name, date, and time
• Corrected using a single line through any errors, which must remain readable, and countersigned

Conclusion

Care planning is a fundamental part of patient-centred nursing practice. The NMC ToC OSCE care planning station assesses a nurse’s ability to:

• Identify relevant patient problems
• Set patient-centred goals
• Establish safe and appropriate timelines for evaluation
• Implement evidence-based interventions
• Write a clear document of the patient’s planned care

Writing an effective care plan is integral in the communication of patients’ needs, care, and progress and supports high-quality, safe care.

Editor

Dr Jamie Scriven

References

1. NMC. Test of competence 2021: Nursing; Test specification for candidates. 2021. Available from: [LINK].
2. NMC. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. Available from: [LINK].
3. Ajibade B. Assessing the patient’s needs and planning effective care. British Journal of Nursing. 2021. Available from: [LINK].
4. Lister S, Hofland J, Grafton H, et al. The Royal Marsden Manual of Clinical Nursing Procedures. 10^th Edition. 2021. Oxford: Wiley-Blackwell.