NMC OSCE Communication and Consent 2 — Questions and Answers
Question 1: A patient who has been assessed as lacking mental capacity requires a medical procedure. Under the Mental Capacity Act 2005, on what basis should the decision be made?
- In the patient's best interests, considering their past and present wishes, beliefs, values, and consulting relevant people (Correct answer)
- Based solely on what the medical team considers clinically appropriate
- The next of kin makes the decision
- The procedure cannot be performed without capacity
Correct answer: In the patient's best interests, considering their past and present wishes, beliefs, values, and consulting relevant people
Under the Mental Capacity Act 2005, decisions for patients lacking capacity must be made in their best interests. This includes considering the patient's past and present wishes, feelings, beliefs, and values; consulting anyone named by the patient, carers, family, and any donee of lasting power of attorney or court-appointed deputy. A best interests meeting may be required for significant decisions.
Question 2: You need to break bad news to a patient about a cancer diagnosis. Which evidence-based communication framework is recommended?
- The SPIKES protocol: Setting, Perception, Invitation, Knowledge, Emotions, Summary/Strategy (Correct answer)
- Simply tell the patient the diagnosis directly and quickly
- Write the diagnosis in a letter and leave it by the bedside
- Ask a family member to tell the patient
Correct answer: The SPIKES protocol: Setting, Perception, Invitation, Knowledge, Emotions, Summary/Strategy
The SPIKES protocol is an evidence-based framework for breaking bad news: Setting up the interview (privacy, seating, tissues), assessing the patient's Perception (what do they already know?), obtaining an Invitation (how much do they want to know?), giving Knowledge (information in clear language), addressing Emotions empathetically, and providing a Summary and Strategy for next steps.
Question 3: A nurse discovers a colleague has been diverting controlled drugs for personal use. What action must the nurse take according to the NMC Code?
- Report the concern immediately to the nurse in charge, follow the organisation's incident reporting policy, and if necessary escalate to the NMC as this represents a fitness to practise concern (Correct answer)
- Ignore it as it is not their responsibility
- Confront the colleague privately and ask them to stop
- Wait to see if it happens again before reporting
Correct answer: Report the concern immediately to the nurse in charge, follow the organisation's incident reporting policy, and if necessary escalate to the NMC as this represents a fitness to practise concern
The NMC Code requires nurses to raise concerns immediately if they believe patients are at risk. Drug diversion is a serious criminal offence and fitness to practise concern. The nurse must report to their manager/nurse in charge, follow the organisation's raising concerns (whistleblowing) policy, and may need to report to the NMC if the organisation does not act. Failure to report could constitute professional misconduct.
Question 4: When documenting in patient records, which of the following meets NMC standards for record-keeping?
- Entries should be factual, consistent, accurate, made as soon as possible after the event, signed, dated, and timed, with no abbreviations that could be misinterpreted (Correct answer)
- Brief notes in pencil are acceptable if time is limited
- Only significant events need to be documented
- Records can be completed at the end of the week from memory
Correct answer: Entries should be factual, consistent, accurate, made as soon as possible after the event, signed, dated, and timed, with no abbreviations that could be misinterpreted
NMC standards require records to be completed as soon as possible after an event, be factual and not include unnecessary abbreviations or jargon. Entries must be signed, dated, and timed. Records should be legible (if handwritten), attribute any information from others, and not be altered retrospectively without a clear audit trail. Good record-keeping is a professional responsibility.
Question 5: A patient's family member asks to see the patient's medical records. The patient is conscious and has capacity. What is the correct response?
- The patient's consent is required before sharing their records with family members, as the information is confidential to the patient (Correct answer)
- Family members have an automatic right to see records
- Show the records to anyone who asks
- Refuse under all circumstances as records are never shared
Correct answer: The patient's consent is required before sharing their records with family members, as the information is confidential to the patient
Medical records are confidential to the patient. Under the Data Protection Act 2018 (UK GDPR) and the NMC Code, explicit patient consent is required before sharing information with family members. The nurse should ask the patient privately whether they wish to share information with their family. If the patient lacks capacity, information may be shared on a best interests basis.
Question 6: During a clinical handover, a nurse uses the term 'the appendicitis in bed 4' to refer to a patient. Why is this unacceptable practice?
- It depersonalises the patient, reducing them to a diagnosis rather than treating them as an individual, which contravenes NMC standards of person-centred care (Correct answer)
- It is too informal for a clinical setting
- It reveals confidential diagnosis information
- There is nothing wrong with this approach
Correct answer: It depersonalises the patient, reducing them to a diagnosis rather than treating them as an individual, which contravenes NMC standards of person-centred care
Referring to patients by their diagnosis or bed number rather than their name depersonalises them and is inconsistent with the NMC Code's requirement to treat people as individuals and uphold their dignity. Person-centred care requires recognising the individual behind the condition. Using a patient's preferred name demonstrates respect and promotes a therapeutic relationship.
NMC OSCE Communication and Consent 2
A patient who has been assessed as lacking mental capacity requires a medical procedure.
Under the Mental Capacity Act 2005, on what basis should the decision be made?