NMC OSCE Communication and Consent — Questions and Answers
Question 1: A patient who speaks limited English requires consent for a surgical procedure. What is the most appropriate way to ensure informed consent?
- Use a professional interpreter service (in person or telephone) to ensure the patient fully understands the procedure, risks, benefits, and alternatives (Correct answer)
- Ask a family member to translate
- Use hand gestures and simple words
- Proceed without consent as treatment is needed
Correct answer: Use a professional interpreter service (in person or telephone) to ensure the patient fully understands the procedure, risks, benefits, and alternatives
Professional interpreters should always be used rather than family members, who may filter or misinterpret information, may have conflicts of interest, or may not understand medical terminology. The patient must understand what the procedure involves, its risks and benefits, and alternatives (including no treatment) to give valid informed consent.
Question 2: According to the NMC Code (2018), what does the duty of candour require when something goes wrong with a patient's care?
- Being open and honest with the patient, telling them what has happened, apologising, and explaining the likely effects and what actions will be taken (Correct answer)
- Discussing the incident only with colleagues
- Waiting for a formal investigation before telling the patient
- Apologising only if the patient asks what happened
Correct answer: Being open and honest with the patient, telling them what has happened, apologising, and explaining the likely effects and what actions will be taken
The NMC Code requires nurses to be open and honest with patients when things go wrong. This includes telling the patient (or their family) what has happened, offering an apology, explaining the likely effects, and outlining remedial steps. This is consistent with the statutory duty of candour under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Question 3: A 17-year-old patient wants to consent to treatment but their parents disagree. Under UK law, can this patient give valid consent?
- Yes — a 16 or 17-year-old is presumed to have capacity to consent to treatment under the Family Law Reform Act 1969 (Correct answer)
- No — only parents can consent for anyone under 18
- Only if a judge approves
- Only for non-surgical treatments
Correct answer: Yes — a 16 or 17-year-old is presumed to have capacity to consent to treatment under the Family Law Reform Act 1969
Under the Family Law Reform Act 1969, a person aged 16 or 17 is presumed competent to consent to surgical, medical, or dental treatment. Their consent cannot be overridden by parental refusal (though parents may consent if the young person refuses, subject to best interests). For under-16s, Gillick competence applies.
Question 4: When handing over patient care using the SBAR communication tool, what does each letter stand for?
- Situation, Background, Assessment, Recommendation (Correct answer)
- Symptoms, Blood results, Actions, Review
- Status, Breathing, Airway, Response
- Summary, Baseline, Allergies, Results
Correct answer: Situation, Background, Assessment, Recommendation
SBAR is a structured communication framework: Situation (what is happening right now), Background (relevant clinical history), Assessment (what you think the problem is), and Recommendation (what you think needs to be done). It is widely used in NHS handovers and escalation calls to ensure clear, concise, and complete communication.
Question 5: A patient with capacity tells you confidential information about plans to harm another specific person. What are your obligations regarding confidentiality?
- Confidentiality may be breached in the public interest to protect an identifiable person from serious harm; inform the nurse in charge and follow local safeguarding policy (Correct answer)
- Patient confidentiality is absolute and can never be breached
- Immediately call the police without telling the patient
- Document it in the notes and take no further action
Correct answer: Confidentiality may be breached in the public interest to protect an identifiable person from serious harm; inform the nurse in charge and follow local safeguarding policy
While patient confidentiality is a fundamental principle, it is not absolute. The NMC Code and common law recognise that disclosure may be justified in the public interest where there is a risk of serious harm to an identifiable person. The nurse should inform the patient of their intention to disclose (unless doing so would increase risk), escalate to senior colleagues, and follow local safeguarding and information governance policies.
Question 6: What are the three key elements required for consent to be legally valid?
- The patient must have capacity, consent must be given voluntarily (without coercion), and the patient must be sufficiently informed (Correct answer)
- The form must be signed, dated, and witnessed
- The patient must agree, the doctor must agree, and the family must agree
- The patient must be over 18, be of sound mind, and sign a form
Correct answer: The patient must have capacity, consent must be given voluntarily (without coercion), and the patient must be sufficiently informed
Valid consent requires three elements: capacity (the patient can understand, retain, weigh, and communicate their decision), voluntariness (the decision is free from undue influence or coercion), and information (the patient has been given sufficient information about the treatment, risks, benefits, and alternatives to make an informed decision).
NMC OSCE Communication and Consent
A patient who speaks limited English requires consent for a surgical procedure.
What is the most appropriate way to ensure informed consent?