• Preparation and Introduction:
• Ensure scene safety and privacy.
• Practice hand hygiene if necessary.
• Introduce yourself to the patient, state the purpose of your visit, and gain consent.
• Patient Comfort and Pain Assessment:
• Check if the patient is comfortable and assess their pain level.
• Dressing Removal and Examination:
• Explain the wound assessment process.
• Remove any dressing covering the wound.
• Assessment of Wound Area:
• Look for erythema (redness) around the wound.
• Describe the area around the wound, noting any oedema, scaliness, lesions, excoriation, maceration, or dryness.
• Exudate Examination:
• Describe any exudate, such as purulent, hemoserous, serous discharges, or offensive odour.
• Closure and Wound Bed Examination:
• Assess the closure of the wound, noting if it’s well closed or broken.
• Evaluate the condition of the wound bed, including its colour, presence of sloughy or necrotizing tissue, and epithelization status.
• Tenderness and Pain Assessment:
• Examine for tenderness and assess any pain experienced by the patient.
• Conclusion and Further Action:
• Conclude about the wound condition and state your awareness of the need to collect a swab if necessary.
• Mention sending the sample to the lab and referring the patient to the medical team for further evaluation and treatment.
• Provide health education as needed.
• Patient Comfort and Communication:
• Reiterate the importance of the patient’s comfort and their ability to use the call bell if needed.
• Address any concerns the patient may have.
• Hand Hygiene and Conclusion:
• Remove apron and gloves
• Practice hand hygiene again.
• Conclude by stating that you’ve completed the procedure, discarded used items according to hospital policy, documented as per NMC guidelines, and ensured the patient’s comfort.

ROLEPLAY

Nurse: I enter the room, looking for scene safety, and confirm that the scene is safe for me to approach my patient.

Nurse: I ensure privacy and dignity by closing the doors and drawing the curtains.

Nurse: I perform hand hygiene using hand rub, following the 7 steps of WHO.

Nurse: “Good morning, my name is Isaac Makponga, and I am a registered nurse here. I’m here to assess your wound at the surgical site. Is it the best time to proceed?”

Patient: “Yes, you can.”

Nurse: “What is your name and how may I call you?”

Patient: “My name is Elizabeth; you can call me Lizzy.”

Nurse: “Lizzy, do you have any pain?”

Elizabeth: “Yes.”

Nurse: “Could you please score it between 0 (the least) and 10 (the worst)?”

Elizabeth: “It’s 3.”

Nurse: “Oh, it’s mild. Do you need medication?”

Elizabeth: “No, I don’t. Thank you.”

Nurse: “Are you in a comfortable position?”

Elizabeth: “Yes, I am.”

Nurse: “Can I proceed with your wound assessment?”

Elizabeth: “Yes.”

Nurse: “(I perform hand rub, wear apron & gloves) Can I expose your wound?”

Elizabeth: “Yes.”

Nurse: “Are you okay for me to proceed?”

Elizabeth: “Yes.”

(Nurse removes old dressing prior to the assessment) “

Look for erythema around the wound

Nurse: “I can see mild redness around the wound.”

Describe the area around the wound

Nurse: “I confirm that the wound and its surrounding area look healthy. There is no oedema, excoriation, maceration, dryness, or scaliness around the wound.”

Describe any exudate

Nurse: I can confirm that there is no haemo-serous, serous or purulent discharge or any offensive odour from the wound

Describe the defect of the wound closure

Nurse: “I don’t see any defect in the wound closure; this wound is closing properly.”

Describe the condition of the wound floor

Nurse: “The wound bed appears pink in colour, indicating it is in the healing stage. It is epithelializing properly without any granulation, necrotizing, or sloughy tissue.”

Enquire about pain or tenderness on the wound

Nurse: “Lizzy, do you have any pain or tenderness when I am touching the wound?”

Elizabeth: “No, I am alright.”

Nurse: “So overall, the wound looks healthy. If any abnormality occurs, I will collect the wound swab and send it to the lab. The report will be escalated to the medical team.”

Elizabeth: “Ok.”

Nurse: “Lizzy, are you comfortable?”

Elizabeth: “Yes.”

Nurse: “Do you need anything before I leave?”

Elizabeth: “No.”

Nurse: “Excellent. If you require anything, please call me by pressing the buzzer.”

Elizabeth: “Ok.”

Nurse: “Remove the gloves and apron. Perform hand rub.”

Nurse: “Assessor, I have conducted a wound assessment for Ms. Lizzy. Now, I will document all the findings and discard the waste according to the NMC guidelines and policies.”

In the given situation, where a colleague has posted confidential information or pictures on social media, my course of action would be as follows: I will;

– Recognize that sharing sensitive information or posting pictures of patients/people receiving care without their consent is inappropriate.

– Understand my responsibility to report any safety concerns regarding public well-being or patient care. Failure to report such concerns could jeopardize my fitness to practice and put my registration at risk.

– Acknowledge that engaging with or commenting on someone else’s post can be perceived as endorsing or supporting their viewpoint.

– Approach my manager at the earliest suitable opportunity, either verbally or in writing, to raise my concerns.

– Document the incident by completing an incident report, outlining the events and the steps taken to address the issue, including the date and the person with whom the concern was shared.

– Adhere to the standards and values outlined in the NMC code, ensuring ethical conduct and professionalism in my actions.

SUBCUTANEOUS INJECTION

Entering the patient’s room, ensuring the safety of the surroundings before proceeding.

Nurse (N): Hello, I’m your attending nurse today. Can you please tell me your name? and how may I call you?

Patient (P): My name is John Smith. You can call me Smith

N: Thank you, Mr. Smith. And can you confirm your date of birth?

P: Sure, it’s January 15, 1965.

N: Great, I see your ID band matches the information you provided—your name, date of birth, and hospital number. Assessor please I can confirm, I am with the right patient. Now, I’m here to administer your insulin injection. Have you taken insulin before?

P: Yes, I have. I usually take it in my abdomen.

N: Alright, Mr. Smith. Do you remember when you last took insulin, and is there a specific spot you’d prefer for the injection this time?

P: I took it yesterday, and you can give it in my abdomen again.

N: Perfect. Before we proceed, let’s check the injection site for any signs of infection, inflammation, or lesions. And I will make sure I inject at least 2-3 cm away from the previous injection site. Also, can you recall your last recorded blood sugar level?

Assessor: The last reading was 9.8 mmol/L.

N: Thank you for sharing, that’s above the normal level. Your meal is on its way because insulin is administered before eating, usually about 30 minutes prior. Are you currently experiencing any pain? If so, could you rate it on a scale of 1 to 10?

P: No, I’m not in any pain.

N: Good to know. Do you have any allergies we should be aware of?

P: No allergies.

N: Alright, Mr. Smith, this procedure will take approximately 15 minutes. Would you like to use the restroom before we begin? Are you comfortable in your current position?

P: I’m fine, and I don’t need to use the restroom.

N: Very well. I’ll now gather the necessary supplies for your injection. Please don’t hesitate to call me or use the call bell if you require any assistance. I’m here to help.

[The nurse assembles the required items.]

N: I’ve completed the hand rub, put on an apron and gloves. I’ll confirm with the examiner whether the tray has been cleaned with soap and water in the past 24 hours.

[The nurse proceeds to clean the tray with alcohol wipe.]

N: The tray has been cleaned and dried, so I’ll remove the apron and gloves and perform proper hand washing following the seven steps recommended by the World Health Organization.

N: The tray is now dry, and I’ll put on an apron and read aloud the prescription, verifying the drug, dose, route, date, time, doctor’s name and signature, and bleep number. It all appears correct.

N: I’ll take the insulin, confirming that there’s no precipitate, not lumpy and it is not frosted, and it’s within the expiry date. I’ll call out the date and batch number as mentioned in the prescription.

[The nurse continues to assemble the articles.] here is alcohol wipes intact and in date, my insulin syringe intact and in date, sterile gauze intact and in date and a sharp container which is not filled more than 1/3 of the volume

N: I’ve loaded the insulin into the syringe, ensuring there are no air bubbles. I’ll keep the medicine ampule in the tray. Now, I’ll change the loading needle to the administration needle (if not insulin syringe) and dispose of the loading needle safely into the sharp bin.

[The nurse proceeds to the patient.]

N: After performing a hand rub, I’ll confirm your identity once again, can you tell me your name and date of birth. Are you comfortable proceeding with the injection?

P: Yes, my name is John Smith and DoB is January 15, 1965. Please go ahead.

N: Ok, I got the right patient

N: Alright, may I uncover your abdomen? (Expose the area) Assessor, I can verify that there are no indications of redness, swelling, infection, or any skin issues at the injection site. Next, I’ll cleanse the area with a 70% alcohol wipe for 30 seconds and wait for an additional 30 seconds for it to dry. I’m ready to proceed. Smith, this will only take a few moments. I’m going to gently pinch your skin and insert the needle, is that okay with you? Alright, you’ll feel a sharp scratch as I insert the needle. Now, I’ll slowly administer the medication over 10-30 seconds and then swiftly remove the needle. I’ll place a sterile gauze here and dispose of the syringe in the sharps container. Okay, Smith, I’ve completed the insulin dose administration. I’ll ensure your meal is on its way; it should arrive within the next 30 minutes. Are you feeling comfortable now? Is there anything you need before I leave? Call me or use the call bell when you need me

P: No, thank you

N: I’ll clean the tray (if it’s not disposable) and prepare it for future use.

N: I’ll document that you received insulin subcutaneously in the specified units, noting the date and time and sign

N: Let’s open the curtains for you.

[The nurse performs hand washing or hand rub before leaving the room.]

N: Assessor, please I have finished the administration of subcutaneous/intramuscular injection to Mr. Smith. Thank you.

IN CASE OF AN IM INJECTION (note the following;)

N: If we were administering an IM injection, two needles needed. Loading and administering needles, we would use an administering needle to check for blood aspiration before giving the injection at the dorsogluteal muscles, wipe the injection site for 30 seconds, and let it dry for another 30 seconds.

N: We’d spread the site using two fingers, hold the syringe like a dart, and administer the injection at a 90-degree angle leaving 1 cm of the needle out. Depress the plunger at least 1 ml every 10 sec. apply small gauze and plaster on the punctured site.

N: Before giving the injection, we’d also inform you of the medication’s use and possible side effects, ensuring your full understanding.

N: Lastly, double-check patient’s identity to ensure his safety.

– Once you’ve identified the patient and introduced yourself, engage in a discussion with them about the procedure and obtain their consent.

– Instruct the individual on how to conduct the MSU (for women, gently separate the labia and cleanse the meatus with soap and water from front to back; for men, retract the foreskin and clean around the meatus). Urinate a small amount and then halt the flow of urine. Position the specimen pot a few centimetres away from the urethra and urinate until the cup is roughly half full.

PROCEDURAL STEPS

– Cleanse your hands using alcohol-based hand rub or wash them with soap and water, adhering to WHO guidelines.

– Confirm that all necessary equipment for the procedure is accessible and, if applicable, sterilized (ensuring that packaging is intact, undamaged, and dry, and that sterilization indicators are present on sterilized items, with the appropriate colour change).

– Provide the individual with a clean specimen pot. (The assessor will then pass the sample to the candidate.)

– Put on disposable plastic apron and non-sterile gloves.

– Briefly immerse the reagent strip into the urine for no more than one second.

– Hold the strip at an angle at the container’s edge.

– Wait the specified duration before comparing the strip to the colour chart – verbal description is acceptable.

– Dispose of the equipment appropriately – verbal description is acceptable.

– Use alcohol-based hand rub to cleanse your hands following WHO guidelines – verbal description is acceptable.

– Interpret the potential significance of the findings, offer relevant health information based on the results, and explain the subsequent steps to the individual.

– Accurately record the readings in accordance with the reagent strip guidelines.

SCRIPT ROLEPLAY

Nurse: Hello Catriona, I’m here to collect a urine sample for a urinalysis test. Is now a convenient time for this?

Catriona: Alright.

Nurse: Great, Catriona. For this procedure, you’ll need to use the restroom and collect a urine sample in this container. Can you manage that by yourself?

Catriona: Yes.

Nurse: Perfect. Before you start, please remember to cleanse your meatus by gently washing from front to back after parting your labia with soap and water. Begin urinating a small amount, pause, then hold the specimen container a few centimeters from your urethra. Urinate until the container is about halfway full, and then stop. You can discard the rest. This is how we obtain a midstream urine sample. Is that clear?

Catriona: Yes.

Nurse: Excellent. Here’s your specimen container. Now, I’ll prepare the necessary items for the urinalysis. I have a kidney tray, the Multistix 8SG strips in intact and up-to-date packaging, a tissue paper, and a functioning FOB watch.

Now that I have your midstream urine sample, I’ll take one strip from the container, close it, and open the specimen bottle. I’ll wait for the second hand to reach 12 o’clock for easier timing.

I’ll dip the strip into the specimen and quickly remove it, ensuring no spillage. I’ll place it on the tissue paper and wait for 30 seconds to check for glucose. I’ll also remove my gloves, as I’ve touched the specimen bottle.

After 30 seconds, I found a glucose reading of 2+. At 40 seconds, ketones are negative, and the specific gravity is 1.005. I’ll wait until 60 seconds, during which I’ll note the ketone and specific gravity values.

At 60 seconds, I’ll check for negative results on blood, protein, nitrite, and pH. Then, I’ll wait another minute to check for leucocytes. After 60 seconds, I can confirm that blood, protein, nitrite, and pH are all negative, and the pH level is 5.0. Two minutes have passed, and the leucocytes are also negative.

Hello, Catriona, I have obtained some values from your urinalysis. It indicates a slightly elevated glucose level in your urine. I’ll inform the doctor, who will review the results and provide further guidance. In the meantime, please remember to drink 2-2.5 liters of water daily to stay hydrated and practice regular handwashing.

Catriona: Understood.

Nurse: Great, Catriona. I’ll be nearby for a little while longer. If you need any assistance, simply press the call button, and I’ll come right over.

Assessor, I have completed the midstream urinalysis for Ms. Catriona. Now, I’ll dispose of all waste materials, document the procedures in accordance with NMC guidelines and policies, and clean the tray to prepare it for the next use.