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Reflection on Objective Structured Clinical Examination (OSCE) performance
Description The OSCE is, to me, a vital assessment due to the practical element of the examination. This practical simulation
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reflects a clinical situation and is the closest a student can get to being assessed while interacting with a
deteriorating patient. I was given a patient by the name of Donald Baker, a 70-year-old male, who was being
treated for community acquired pneumonia. The assessment dictated the administration of a subcutaneous
injection and the identification of priority actions following the interpretation of Donald’s vital signs, with a marker
present. Donald’s observations showed that he was drastically deteriorating, with a low oxygen saturation, and a
high temperature, heart rate and respiration rate.
Feelings The anticipation upon waiting for the OSCE to begin and the state of nerves experienced are those that are
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paired commonly with an assessment before it commences. Once started, the nerves continued, evident with
shaking while aspirating heparin into a syringe. I also felt flustered if I became slightly distracted or overthought a
step. The marker present however, provided a sense of comfort and support. What was initially a feeling of relief
on completion, turned quickly to anxiety as I had finished with plenty of time. While self-assured that I had
passed, I was left with a feeling of ‘could I have done more?’ and fears of being too fast-paced.
Evaluation While I feel that my nerves played a part in my assessment, due to my shaking throughout certain skills, I made
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sure that my communication and body language was not affected. This was reflected in my marker’s voice
comment, stating that I achieved a high standard “despite nerves”. Communication and portraying confidence are
key strengths of mine, and I did my best to ensure that they were evident during my OSCE. Good clinical
communication is essential. By involving it in my examination and clearly presenting my interpretations to my
marker, it was confidence that was portrayed, instead of my nerves.
If I lose my train of thought during an assessment, I become a little unnerved and this is what lead to me missing
the allergy check before administrating Donald’s medication. Being such a vital step in safe medication
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administration, I felt a sense of dread upon realising my mistake. Something so simple which could be extremely
detrimental in a real-life situation.
Analysis Communication and medication errors both play a large, important role in patient safety and can make a big
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difference in a patient’s outcome. Clinical communication advocates for patient safety and is necessary when
handing over information about a patient’s situation and to encourage therapeutic relationships (ref). By using a
simulation of a clinical environment and processes which are common in the clinical setting, the OSCE allowed
me to practice my interpersonal communication and show it as one of my strengths. It is vital that this
interpersonal communication is continuously strengthened, as if there is a breakdown in communication it can
result in patient harm (ref). Being confident and presenting a professional demeanour establishes if the nurse is
competent and trustworthy (ref).
Medication errors, on the other hand, threaten patient safety and often lead to undesirable consequences (ref).
Nursing students have been highlighted as one of the groups to contribute to medication errors. However, they
are all preventable and the first step is to determine why (ref). The OSCE allowed me to see how easily an
adverse drug event could occur and how it possibly could cause harm or injury (ref).
Conclusion The OSCE allowed me to realise that anxiousness and nerves did not affect my communication, however it did
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lead to me getting flustered and forgetting specific actions that could be detrimental to a patient. While the nerves
can be attributed to the assessment element of the OSCE, it is something I need to take control of. Missing an
allergy check before administrating medication can easily lead to an adverse drug effect, meaning the patient
could be harmed (ref). However, a systematic approach is in place to stop its occurrence, for example the five
rights when checking medication and the patient (ref). The important nature of clinical communication was
highlighted by having to interact constantly with the marker. It became clear that it is something that can
constantly and should constantly be practiced and improved, as it will also be required in a clinical health setting
(ref). The OSCE provided the opportunity for us, as students, to identify those areas which need to be
strengthened and improved before we move onto clinical practice. We need to further develop our skills which
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relate to patient safety (ref).
Action Plan In my future clinical practice, it is vitally important that I use the five medication rights when administering
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medication, and that I also complete an allergy check directly before the patient receives their medication. It is
also essential that clinical communication be continued at all times when in a clinical environment. All of these
actions contribute to enhancing patient safety.
Nursing Action Rationale
Medication errors are preventable and to avoid any
Practice the 5 Medication Rights when administrating
adverse drug effects, we need to thoroughly check if it
all medications
is the right patient, drug, time, dose, and route, to
ensure that any possible errors are noticed and
therefore, prevented (ref).
Nursing Action Rationale
Clinical communication is essential when handing over
Demonstrate effective interpersonal communication
information, to enhance therapeutic relationships, and
when communicating with the patient and health care
when working with other healthcare professionals (ref).
team.
It prevents errors being made in patient care due to
poor communication (ref).
References