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

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.

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.

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.

Compare a Section 2 and a Section 5(2) under the Mental Health Act.

Section 2 is detention for assessment (and treatment) lasting up to 28 days, requiring two doctors and an Approved Mental Health Professional. Section 5(2) is a doctor's holding power for an already-admitted inpatient, lasting up to 72 hours to allow a full assessment.

How long can a patient be detained under Section 3 of the Mental Health Act, and what is its purpose?

Section 3 is for treatment and lasts up to 6 months initially (renewable). It requires two doctors and an Approved Mental Health Professional.

What does 'least restrictive practice' mean?

Always choosing the option that imposes the least restriction on a person's rights, freedom and autonomy while still keeping them and others safe; restraint or restriction is used only as a last resort, proportionate to risk, and for the shortest time necessary.

What is the nurse's holding power and which section provides it?

Section 5(4) of the Mental Health Act gives a registered mental health or learning disability nurse the power to detain an already-admitted, voluntary psychiatric inpatient for up to 6 hours (or until a doctor arrives) to prevent them leaving.

Which UK legislation primarily governs data protection and how personal data is handled?

The Data Protection Act 2018 and the UK GDPR (General Data Protection Regulation).

What is the common-law duty of confidentiality in nursing?

Information disclosed in a confidential relationship (patient to nurse) must not be shared with others without consent, except where there is a legal requirement or an overriding public interest justifying disclosure.

Name circumstances in which patient confidential information may lawfully be disclosed WITHOUT consent.

Where required by law/court order, for safeguarding a child or vulnerable adult, to prevent serious harm to the patient or others, for notifiable diseases, or where there is an overriding public interest.

What does the Caldicott principle of 'need to know' require?

Confidential patient information should only be accessed and shared with those who need it to provide care, and only the minimum necessary information should be used for the specific purpose.

What does 'contemporaneous' record keeping mean?

Records are made at the time of, or as soon as possible after, the event or care delivered, so they accurately reflect what happened without reliance on later recollection.

List four key requirements of good nursing records under NMC standards.

Records must be accurate, factual, clear and legible, completed contemporaneously, signed/dated/timed and attributable, free of jargon/abbreviations and unnecessary opinion, and never falsified or altered.

How should an error in a written nursing record be corrected?

Draw a single line through the error so it remains legible, write the correction alongside, and sign, date and time it. Never use correction fluid, erase, or obliterate the original entry.

Why must records be signed, dated and timed?

To make every entry attributable to a specific author and to establish an accurate chronology of care, supporting accountability, continuity of care and legal/professional defensibility.

What is 'consent to share' information, and when is explicit consent best practice?

It is the patient's agreement that their information may be shared with named people or organisations. Explicit consent should be sought before sharing with relatives, carers or third parties not directly involved in their care, unless an overriding legal or safeguarding reason applies.

What is an incident (or near-miss) report and why is it completed?

A formal record of an event that caused, or could have caused, harm to a patient, visitor or staff member. It is completed to enable investigation, learning and system improvement so the event is less likely to recur.

Define a 'just culture' in healthcare.

An organisational culture that focuses on learning from errors rather than blaming individuals, encouraging open reporting of incidents while still holding people accountable for reckless or wilful behaviour.

What is the professional Duty of Candour?

The professional and statutory duty to be open and honest with patients (or their families) when something goes wrong that has caused, or could cause, harm: explaining what happened, apologising, and putting things right where possible.

What are the '5 moments for hand hygiene' defined by the WHO?

1) Before touching a patient; 2) before a clean/aseptic procedure; 3) after body fluid exposure risk; 4) after touching a patient; 5) after touching the patient's surroundings.

What are 'standard precautions' in infection prevention and control?

The basic infection-control measures applied to ALL patients regardless of diagnosis: hand hygiene, appropriate PPE, safe sharps handling and disposal, respiratory hygiene, environmental cleaning, safe waste and linen management, and aseptic technique.

In what order should personal protective equipment (PPE) be removed (doffed)?

Gloves first, then apron/gown, then eye protection, and finally the mask/respirator, performing hand hygiene after removal (gloves are removed first as they are the most contaminated).

What is the recommended minimum duration for hand washing with soap and water?

Around 40 to 60 seconds total for the full technique; alcohol-based hand rub takes about 20 to 30 seconds. Soap and water must be used when hands are visibly soiled or after caring for patients with diarrhoea (e.g. C. difficile).

What does the acronym TILE/TILEO stand for in a moving and handling risk assessment?

Task, Individual (handler's capability), Load, Environment, and Other factors (e.g. equipment/PPE). It structures assessment of any manual handling activity.

State the general principle of safe manual handling posture when lifting.

Keep the load close to the body, maintain a stable base with feet apart, bend the knees (not the back), keep the back's natural curve, avoid twisting, and move smoothly while looking ahead.

Name three key interventions to prevent inpatient falls.

Multifactorial falls risk assessment, medication review (especially sedatives/antihypertensives), ensuring call bell and mobility aids are within reach, appropriate footwear, good lighting, addressing continence needs, and lying/standing blood pressure checks.

What is the purpose of a 'lying and standing' (postural) blood pressure measurement in falls prevention?

To detect orthostatic (postural) hypotension. A drop of $\geq 20$ mmHg systolic or $\geq 10$ mmHg diastolic on standing indicates postural hypotension, a significant falls risk factor.

What does NEWS2 stand for and what is it used for?

National Early Warning Score 2; a standardised tool that aggregates physiological observations to detect and grade clinical deterioration in adults and trigger an appropriate escalation response.

Which six physiological parameters are scored in NEWS2?

Respiratory rate, oxygen saturation (with a separate scale for hypercapnic/COPD patients), use of supplemental oxygen, systolic blood pressure, pulse rate, level of consciousness (ACVPU), and temperature.

What NEWS2 aggregate score triggers an urgent or emergency response, and what does a score of 3 in a single parameter mean?

An aggregate score of 5 to 6 triggers an urgent review (medium risk); a score of $\geq 7$ triggers an emergency response (high risk). A score of 3 in any single parameter prompts urgent review by a clinician, even if the total is low.

What structured communication tool is used to escalate a deteriorating patient, and what does it stand for?

SBAR: Situation, Background, Assessment, and Recommendation. It provides a concise, structured handover when escalating concerns.