Every Gulf exam tests how you think like a safe nurse: what you do first, what you record and how you hand over. This lesson gives you the three tools behind most "first action" and "priority" questions.
The nursing process: ADPIE
| Step | What happens | Exam key point |
|---|---|---|
| Assessment | Collect subjective data (what the patient says) and objective data (what you observe or measure) | Always the first step. A pain score is subjective, even though it is a number |
| Diagnosis | Name the problem (NANDA-I nursing diagnoses) | Actual problems come before risk ("potential") problems |
| Planning | Set outcomes and choose interventions | Outcomes are SMART and patient-centred: who, what, how much, by when |
| Implementation | Carry out the care | You may delegate tasks, but never assessment, teaching or evaluation |
| Evaluation | Was the outcome met? | Leads back to reassessment |
When two answers both look right, choose the one that assesses before it acts, unless the patient is in immediate danger.
Writing a good outcome
- Wrong: "The nurse will help the patient walk." (about the nurse, not the patient)
- Wrong: "The patient will understand the diet." (cannot be measured)
- Right: "The patient will walk 50 metres with a walker by post-operative day 3." (patient-centred, measurable, time-limited)
Setting priorities
- 1ABC first: Airway, then Breathing, then Circulation. A sudden airway problem beats everything else.
- 2Maslow: physiological needs first, then safety, then love and belonging, esteem and self-actualisation.
- 3Acute and unstable before chronic and stable. Actual problems before potential ones. Unexpected findings before expected ones.
Four patients: pain 6/10 after surgery; COPD with SpO2 90%; new stridor 10 minutes after IV antibiotics started; diabetic with glucose 180 mg/dL before breakfast.
See the stridor patient first: a new airway sound after a drug suggests anaphylaxis. SpO2 90% is near the usual COPD target, and the others are stable.
Documentation
- Record facts objectively, at the time of care. Use the patient's own words when quoting. Never chart in advance.
- Paper error: draw one line through it so it stays readable, write "error", initial, date and time. Never erase or use correction fluid.
- Late entry: label it "late entry", with the current date and time and the time the care happened. Never squeeze it between earlier entries.
Communication: SBAR
| Letter | Means | Example |
|---|---|---|
| S | Situation | "Mr Ali in bed 4 is short of breath." |
| B | Background | "Day 2 after hip surgery, history of heart failure." |
| A | Assessment | "RR 28, SpO2 89% on 2 L, crackles at both bases." |
| R | Recommendation | "Please see him within 30 minutes; he may need a chest X-ray." |
Consent and verbal orders
- Informed consent: the doctor explains the procedure, risks and alternatives. The nurse may witness the signature. If the patient has questions or seems unsure, stop and call the doctor before signing.
- Verbal and telephone orders: emergencies only. Write the order down and read it back to the prescriber.
Key points
ADPIE starts with assessment. ABC, then Maslow. Unstable before stable. One line through an error. SBAR for every call. Questions about consent go back to the doctor. Read back every verbal order.