4.5 Nursing Process, Care Plans, Care Study & the Practical Examination

4.5 Nursing Process, Care Plans, Care Study & the Practical Examination

Quick Answer: The N&MC practical examination tests the nursing process in action. The Council's FAQ says the care plan is paper-based, the case study is written and submitted, and examiners score component tasks on tablets. Use the five steps—Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE)—write nursing diagnoses in problem–aetiology–signs (PES) form, set SMART objectives, give a rationale for every nursing order, and perform procedures the way the Council's Nursing and Midwifery Procedure Manuals describe them.

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The Nursing Process (ADPIE)

Writing a Nursing Diagnosis (PES format)

A nursing diagnosis names a problem nursing can treat—not a medical diagnosis.

• P – Problem: e.g., Hyperthermia
• E – Etiology (related to): related to the inflammatory response to Plasmodium falciparum infection
• S – Signs and symptoms (as evidenced by): as evidenced by axillary temperature of 39.4°C, hot dry skin and a pulse of 118 bpm

Potential (risk) problems have no signs yet: Risk of injury related to convulsions secondary to high fever.

[!IMPORTANT] Exam Alert: "Severe malaria" or "pneumonia" is a medical diagnosis. The nursing diagnosis is the patient's response—fever, ineffective airway clearance, fluid deficit, anxiety, knowledge deficit.

SMART Objectives

Objectives are written from the patient's point of view and must be Specific, Measurable, Achievable, Realistic and Time-bound.

• ✅ "Patient's axillary temperature will fall to 37.5°C or below within 2 hours."
• ❌ "Nurse will reduce the fever." (nurse-centred, no measure, no time)

A Sample Care-Plan Entry

In the practical, examiners look for logical links: each nursing order should address the aetiology or the signs, each has a rationale, and the evaluation uses the same measure as the objective.

Writing the Care Study

The care study follows one patient you nursed through admission to discharge. A commonly used structure is:

1. Introduction and patient's particulars (use initials to protect confidentiality);
2. Admission details and the reason for admission;
3. History: presenting illness, past medical and surgical history, family and social history, lifestyle;
4. Assessment: physical examination, vital signs, investigations with normal values;
5. Review of the condition: definition, causes, pathophysiology, signs, complications and treatment, compared with what your patient actually showed;
6. Medical treatment, with the action, dose, side effects and nursing implications of each drug;
7. Nursing care plan and implementation day by day;
8. Evaluation, complications prevented or managed;
9. Discharge planning, health education and follow-up;
10. Termination of the nurse–patient relationship, summary and references.

Obtain the patient's (or guardian's) consent, keep facts accurate and write in your own words. Examiners can recognise copied care studies.

Component Tasks: Performing a Procedure the Examiner Can Score

The Council's procedure manuals cover General Nursing, Midwifery, Community Psychiatric Nursing, Mental Health Nursing, Public Health Nursing, Paediatric Nursing and Pain Management. Whatever the procedure—wound dressing, urethral catheterisation, medication administration, nasogastric feeding, bed bath, vital signs, admission or discharge, last offices—examiners score the same framework:

Before the procedure

• Check the doctor's order or care plan and the patient's identity;
• Explain the procedure and obtain consent; provide privacy (screens);
• Perform hand hygiene; assemble and check equipment on a clean trolley (top shelf sterile/clean, bottom shelf for used items);
• Position the patient for comfort and access.

During the procedure

• Maintain asepsis or clean technique as required;
• Talk to the patient, observe their reaction and stop if they deteriorate;
• Handle sharps and waste safely (section 3.2).

After the procedure

• Make the patient comfortable and leave the call bell within reach;
• Dispose of waste, decontaminate reusable items and perform hand hygiene;
• Document and report findings (what was done, the patient's response, anything abnormal).

Candidates often describe the examination as a mix of procedures they perform and procedures they explain (verbalise). Practising aloud—saying the step and the rationale—helps in both.

Practical-Exam Checklist

• Arrive in the prescribed uniform with your own watch (second hand), pen and notebook.
• Know your assigned patient: diagnosis, drugs, investigations and today's plan.
• Prioritise safety (ABC, falls, infection prevention) before comfort tasks.
• If you make an error, stop, make the patient safe and say what you would do—do not hide it.

Exam Traps at a Glance

• Assessment comes before diagnosis; evaluation closes the loop and can restart assessment.
• Objectives are patient-centred and measurable.
• Every nursing order needs a rationale.
• Documentation is part of the procedure, not an optional extra.