Registered Nurse Objective Structured Clinical Examination (NMC OSCE) Safety, Safeguarding and Legal-Ethical Practice Syllabus

Safety, Safeguarding and Legal-Ethical Practice syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Safety, Safeguarding and Legal-Ethical Practice in Registered Nurse Objective Structured Clinical Examination (NMC OSCE), not a summary of it.

1. 1

   Consent and Capacity

   4 topics

   • Valid consent: informed, voluntary and capacitous
   • Mental Capacity Act and assessing capacity
     • Two-stage capacity test
     • Best interests decisions and IMCAs
   • Gillick competence and consent for children
   • Deprivation of Liberty Safeguards principles
2. 2

   Safeguarding Adults and Children

   3 topics

   • Recognising types and signs of abuse
     • Physical, emotional, sexual, financial and neglect
   • Responding to and reporting concerns
     • Local safeguarding referral routes
   • Mental Health Act awareness and least restrictive practice
3. 3

   Confidentiality and Information Governance

   3 topics

   • Data protection and patient confidentiality
     • When disclosure is justified
   • Accurate, contemporaneous record keeping
   • Consent for sharing information
4. 4

   Risk Management and Patient Safety

   4 topics

   • Incident reporting and a just culture
     • Near misses and learning from errors
   • Infection prevention and control standards
   • Moving and handling and falls prevention
   • Recognising and escalating the deteriorating patient

Safety, Safeguarding and Legal-Ethical Practice flashcards for Registered Nurse Objective Structured Clinical Examination (NMC OSCE)

23 of 51 cards from the Safety, Safeguarding and Legal-Ethical Practice deck — real questions with worked answers.

1. What three elements must all be present for consent to a treatment or examination to be valid?

   Consent must be informed (the person has sufficient information), voluntary (free from coercion or undue influence), and given by a person with capacity to make that decision.

2. Define 'informed' consent.

   The person has been given, and understands, sufficient information about the nature, purpose, benefits, risks and reasonable alternatives of the proposed intervention, including the option to do nothing.

3. What does 'voluntary' mean in the context of valid consent?

   The decision is made freely by the person themselves, without pressure, coercion or undue influence from healthcare staff, family or others.

4. Can consent be given non-verbally, and is it still valid?

   Yes. Consent may be expressed verbally, in writing, or implied through cooperative behaviour (e.g. rolling up a sleeve for blood pressure), and is valid provided it is informed, voluntary and capacitous.

5. Under the Mental Capacity Act 2005, what are the five statutory principles?

   1) Assume capacity unless proven otherwise; 2) support the person to make their own decision; 3) an unwise decision does not mean lack of capacity; 4) any decision/act for someone lacking capacity must be in their best interests; 5) choose the least restrictive option of their rights and freedom.

6. What is the two-stage test of capacity under the Mental Capacity Act 2005?

   Stage 1 (diagnostic): is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional): does that impairment mean the person is unable to make the specific decision at the time it needs to be made?

7. What four abilities must a person demonstrate to be assessed as HAVING capacity (the functional test)?

   They must be able to: understand the information relevant to the decision, retain it (long enough to decide), use or weigh that information as part of the process, and communicate their decision (by any means).

8. Is capacity assessed as a global, permanent state or per-decision?

   Capacity is decision-specific and time-specific. A person may lack capacity for one decision but retain it for another, and capacity can fluctuate over time.

9. From what age does the Mental Capacity Act 2005 generally apply?

   It applies to people aged 16 and over.

10. What is Gillick competence?

    A legal principle that a child under 16 can consent to their own medical treatment if they have sufficient maturity and intelligence to fully understand the proposed treatment, its purpose and implications, without needing parental consent.

11. What are Fraser guidelines specifically used for?

    They set the criteria for providing contraceptive or sexual health advice and treatment to under-16s without parental consent (the child understands the advice, cannot be persuaded to inform parents, is likely to continue/begin sexual activity, their health would suffer without it, and it is in their best interests).

12. Can a competent child's REFUSAL of life-saving treatment always be relied upon in England?

    No. While a Gillick-competent child can consent, a refusal of treatment by a child under 18 can in some circumstances be overridden by a person with parental responsibility or by the court if it is in the child's best interests.

13. What do the Deprivation of Liberty Safeguards (DoLS) protect?

    They provide a legal framework to lawfully deprive a person (aged 18+) of their liberty in a care home or hospital when it is necessary and in their best interests because they lack capacity to consent to those arrangements.

14. What is the 'acid test' for a deprivation of liberty (Cheshire West)?

    A person is deprived of their liberty if they are under continuous supervision and control AND are not free to leave, and they lack the capacity to consent to these arrangements.

15. Which two professionals must complete the six DoLS assessments before an authorisation is granted?

    A Best Interests Assessor and a Mental Health Assessor (a doctor), who between them complete the age, mental health, mental capacity, best interests, eligibility and no-refusals assessments.

16. List the recognised categories of abuse a nurse should be able to identify.

    Physical, sexual, psychological/emotional, financial/material, neglect and acts of omission, discriminatory, organisational/institutional, domestic, modern slavery, and self-neglect.

17. Give three possible physical signs that may indicate physical abuse.

    Unexplained bruising (especially in clusters or at different healing stages), injuries inconsistent with the explanation given, burns or marks in unusual sites, fractures, and frequent unexplained injuries.

18. What signs may indicate neglect in an adult or child?

    Poor hygiene, malnutrition or dehydration, untreated medical conditions, pressure ulcers, inadequate or inappropriate clothing, weight loss, and an unsafe or unsanitary living environment.

19. What behavioural signs might suggest emotional or psychological abuse?

    Withdrawal, anxiety, fearfulness around a particular person, low self-esteem, becoming passive or resigned, changes in sleep or appetite, and being unusually reluctant to speak in front of a carer.

20. What should a nurse do FIRST if a patient discloses abuse to them?

    Listen, stay calm and non-judgemental, reassure them, do not promise to keep it secret (explain you must share to keep them safe), avoid leading questions, and accurately record what was said in the person's own words.

21. What is the correct action when you have a safeguarding concern about a patient?

    Report it promptly to the designated safeguarding lead/manager, document the concern factually, escalate within your organisation's safeguarding policy, and refer to the local authority safeguarding team where required; never delay because you are unsure.

22. Does a nurse need the patient's consent before raising a safeguarding concern?

    Ideally consent is sought, but where there is risk of serious harm to the person or others, or the person lacks capacity, information can and should be shared without consent in their best interests and in the public interest.

23. What is the purpose of the Mental Health Act 1983 (amended 2007)?

    It provides the legal framework for the assessment, detention and treatment of people with a mental disorder, in the interests of their own health or safety or for the protection of others.

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