OSCE APIE Scenario: Homelessness

The homelessness scenario tests whether your nursing changes when the patient has nowhere to go, and it should: not in respect, which stays identical, but in what you assess, plan and arrange. The station watches for two failures: judgement leaking into care, and a discharge plan written for a patient with a fridge, an address and a front door.

Assessment. Everything you’d normally assess, plus the risks his situation concentrates. Feet and skin: rough sleeping’s signature pathology (maceration, trench-foot changes, infestations, untreated wounds). Nutrition and hydration, with a MUST score likely scoring. Substance and alcohol history taken matter-of-factly, because a dependent drinker abruptly admitted is a withdrawal risk needing anticipation, not judgement. Mental health, asked with the same directness as the mental health scenario. Respiratory symptoms with TB awareness. And missed care: chronic conditions unmonitored, medications lapsed, screenings skipped.

Planning. The admission plan looks conventional: wound, nutrition, withdrawal management, obs. The distinctive planning is discharge, and it starts on day one: where will he actually go, and the statutory answer in England is the duty to refer: with his consent, the trust refers him to a housing authority under the Homelessness Reduction Act. Add the specialist assets where they exist: hospital homeless health teams, Pathway teams, local outreach.

Implementation. Clinical care delivered without shortcuts: wounds dressed properly, feet washed, dried and treated, meals and snacks actually offered (and red-tray-level attention to whether they’re eaten), withdrawal scoring and prescribed management if indicated. Practicalities are interventions here: dry socks, replacement clothing via the ward’s routes, a shower offered with dignity. And the tone throughout: his name, his choices, no lectures; consent sought for every referral, because autonomy doesn’t reduce with circumstances.

Evaluation. The wound and the numbers, yes, but the station’s real evaluation is the discharge test: does the plan work for a man with no fridge, no address, no money for prescriptions? Medication regimens simplified where possible and supplied realistically, follow-up somewhere he can actually attend (drop-in clinics beat appointment letters), dressings and supplies in hand, referrals confirmed rather than assumed. Discharge to the street with an unusable plan is the documented failure this scenario exists to screen out, and saying the safeguards aloud is how the marks land.

Five questions below, then Part B closes with the subdural haematoma scenario, where the neuro obs do the talking.