NMBA OBA OSCE cheat sheet

NMBA Code of Conduct domains: legal compliance; person-centred practice; cultural practice and respectful relationships; professional behaviour; teaching, supervising and assessing; research.

Registered nurse scope of practice is determined by four elements: education, competence, authorisation, and the context of the practice setting.

Delegation rule: the delegating nurse retains accountability for the decision to delegate and for monitoring the outcome; the delegate accepts accountability for the task performed.

Informed consent requires four elements: capacity, voluntariness, adequate disclosure of information, and specific consent to the proposed intervention.

An adult is presumed to have decision-making capacity unless there is evidence otherwise; capacity is decision-specific and time-specific, not global.

Substitute decision-makers act under guardianship or enduring power of attorney legislation; they cannot consent to unlawful interventions or refuse lawful necessary treatment for a minor.

Mandatory notifications to AHPRA cover impairment, intoxication, significant departure from accepted professional standards, and sexual misconduct; treating practitioners have separate obligations.

Confidentiality exceptions include serious threat to life or health, mandatory reporting of child abuse, court orders, and statutory notification requirements.

Advance care directives are legally binding when they are valid, applicable to the current situation, and made by a person with capacity at the time of writing.

Person-centred care principles: respect for values and preferences, coordination and integration of care, information and education, physical comfort, emotional support, family involvement, continuity and transition, access.

Health literacy is the capacity to obtain, process, and understand basic health information to make appropriate decisions; low health literacy correlates with poorer self-management.

Teach-back method: the clinician asks the patient to explain the information in their own words; a correct explanation confirms understanding, an incorrect one triggers re-teaching.

Therapeutic communication techniques include open-ended questions, reflection, paraphrasing, silence, clarification, and summarising; closed questions are used to obtain specific facts.

Interpreters must be professional and trained; family members, especially children, should not be used as interpreters for clinical consent or sensitive information.

Cultural safety requires the nurse to examine their own cultural bias and power; it is defined by the recipient of care, not by the provider.

Active listening components: attention, acknowledgement, reflection of content and feeling, and appropriate non-verbal cues such as eye contact and open posture.

Motivational interviewing uses open questions, affirmation, reflection, and summarising; it aims to elicit the patient's own reasons for change rather than to advise.

Primary survey sequence: Danger, Response, Airway, Breathing, Circulation, Disability, Exposure (DRSABCDE); life threats are treated before history is taken.

ABCDE assessment should be repeated after every intervention and whenever the patient's condition changes.

A structured clinical reasoning cycle: consider the patient, collect cues, process information, identify problems, establish goals, take action, evaluate outcomes, reflect.

Normal adult respiratory rate is 12-20 breaths per minute; a rate above 25 or below 8 is a red-flag finding requiring escalation.

Normal adult resting heart rate is 60-100 beats per minute; normal systolic blood pressure is approximately 100-140 mmHg, and a systolic below 90 mmHg suggests hypotension.

Glasgow Coma Scale: eye opening 1-4, verbal response 1-5, motor response 1-6; total 3-15; a score of 8 or less indicates consideration of airway protection.

Pain assessment tools: numeric rating scale for adults who can self-report, Wong-Baker FACES for children, and PAINAD or Abbey for patients with dementia who cannot self-report.

Pulse oximetry measures oxygen saturation, not ventilation; a normal SpO2 does not exclude hypoventilation or hypercapnia.

Focused respiratory assessment includes inspection of work of breathing, palpation of chest expansion, percussion, and auscultation of breath sounds in a systematic pattern.

The rights of medication administration: right patient, right drug, right dose, right route, right time, right documentation, right reason, and right to refuse.

The five moments of medication safety: before prescribing, before dispensing, before administering, after administration, and during monitoring and review.

High-risk medications include anticoagulants, insulin, opioids, chemotherapy, and concentrated electrolytes; these require independent double-checking at the bedside.

Insulin is measured in units and must be checked by two nurses against the prescription; abbreviations such as 'U' or 'IU' are prohibited in medication orders.

Nurse-initiated medications are limited to those approved by the health service and within the nurse's scope; they do not replace the need for prescription for other drugs.

An adverse drug event is harm caused by a medication; an adverse drug reaction is a harmful, unintended response at normal doses; both require reporting.

Scheduled medicines with a narrow therapeutic index (e.g., digoxin, warfarin, phenytoin) require therapeutic drug monitoring and vigilant observation for toxicity.

The enteral route requires checking tube placement and flushing before and after administration; not all tablets are suitable for crushing or dispersing.

Medication errors must be reported through the incident reporting system regardless of whether harm occurred, to enable system learning.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, personal protective equipment, safe sharps handling, cleaning, and waste management.

The five moments for hand hygiene: before touching a patient, before a procedure, after a procedure or body fluid exposure, after touching a patient, and after touching the patient's surroundings.

Alcohol-based hand rub is effective against most organisms but not against bacterial spores such as Clostridioides difficile; soap and water is required in that case.

Transmission-based precautions: contact for MRSA and C. difficile, droplet for influenza and pertussis, airborne for tuberculosis, measles, and varicella.

Airborne precautions require a negative-pressure room and a fit-tested P2/N95 respirator; droplet precautions require a surgical mask and a single room where possible.

Personal protective equipment order of donning: gown, mask or respirator, goggles or face shield, then gloves; doffing removes gloves first, then goggles, gown, and mask.

Sharps must never be recapped by hand; they are disposed of immediately into a puncture-resistant sharps container filled to no more than three-quarters.

Sterile field principles: sterile items contact only sterile items; the field is contaminated by moisture, by reaching over it, and by contact with non-sterile objects.

Aseptic technique is required for invasive procedures such as intravenous cannulation, urinary catheterisation, and wound dressing changes.

Early warning scores such as the National Early Warning Score (NEWS) aggregate vital signs; a rising score or a single red-zone parameter triggers escalation.

Escalation should follow the local clinical escalation protocol; the nurse must escalate and document the concern even if the patient appears stable.

Sepsis screening: suspected infection plus two or more systemic inflammatory response criteria (e.g., temperature, heart rate, respiratory rate, white cell count) warrants urgent review.

Risk assessment tools include falls risk, pressure injury risk (Braden), malnutrition (MST or MUST), and venous thromboembolism risk.

Pressure injury staging: stage 1 is non-blanchable erythema of intact skin; stage 2 is partial-thickness loss; stage 3 is full-thickness loss; stage 4 exposes fascia, muscle, or bone.

Falls prevention: bed in lowest position, brakes on, call bell within reach, non-slip footwear, adequate lighting, and regular rounding for high-risk patients.

Delirium is an acute, fluctuating disturbance of attention and awareness; it is distinguished from dementia by its acute onset and fluctuating course.

The nurse must not leave a deteriorating patient alone; call for help, stay with the patient, and initiate basic life support if required.

Documentation of deterioration should include time of observation, vital signs, clinical concern, who was notified, and the response received.

Before any procedure: confirm patient identity with two identifiers, verify consent, check allergies, and perform hand hygiene.

Venous access: select the smallest gauge appropriate to therapy; check patency, site, and dressing at every shift; remove peripheral cannulae as soon as no longer required.

Intravenous fluid administration requires checking the prescription, the fluid, the rate, and the site; signs of infiltration include swelling, coolness, and pain at the site.

Urinary catheterisation: use an aseptic technique, select the correct catheter size, inflate the balloon only after confirming urine flow, and document the procedure.

Nasogastric tube placement must be confirmed by pH testing of aspirate (pH 5.5 or less) or by X-ray; auscultation of injected air is not a reliable confirmation method.

Oxygen therapy: titrate to the target saturation range specified for the patient; humidification is required for high-flow or prolonged therapy.

Wound care: assess wound bed, exudate, and surrounding skin; select a dressing that maintains a moist wound environment and matches the exudate level.

Blood transfusion: two-person identity check at the bedside, commence slowly and observe closely for the first 15 minutes, and monitor vital signs per protocol.

Specimen collection: label at the bedside in the patient's presence, use the correct container and transport medium, and document the time of collection.

Documentation must be contemporaneous, accurate, objective, and legible; late entries are marked as such with the actual time of writing.

The clinical record is a legal document; it may be used in legal proceedings and must reflect the care provided and the patient's response.

ISBAR handover structure: Identify, Situation, Background, Assessment, Recommendation.

Handover should be structured, include the patient's goals and concerns, and be confirmed by the receiving clinician with the opportunity to ask questions.

Documentation of a refusal of care must include what was refused, the information given, the patient's stated reason, and that the refusal was respected.

Never document interventions before they are performed; documentation of care not given is a professional conduct issue.

Teamwork principles: clear role allocation, closed-loop communication, and speaking up when a concern arises (psychological safety).

Incident reports are not part of the clinical record; they are quality improvement tools and should not be referenced in the patient's notes.

Delegation within the team requires matching the task to the delegate's competence, providing clear instructions, and following up on the outcome.

Reflection models include Gibbs' reflective cycle (description, feelings, evaluation, analysis, conclusion, action plan) and Kolb's experiential learning cycle.

Continuing professional development (CPD) requirements for NMBA registration include a minimum of 20 hours of CPD per year, with at least 5 hours related to the nurse's context of practice.

Recency of practice requires a minimum of 450 hours of practice in the previous five years for registration renewal.

Reflective practice links experience to learning; it is most effective when it identifies a specific change in future practice.

Professional development planning should align with the nurse's scope of practice, career goals, and identified learning needs.

Clinical supervision and mentoring provide structured support for reflective practice and are distinct from performance management.

Self-assessment against the NMBA standards for practice informs goal setting and identifies gaps in competence.

Evidence-based practice integrates the best available evidence, clinical expertise, and patient values and preferences.

A portfolio of CPD evidence should record the activity, the date, the hours, and the relevance to practice.