Legal and Ethical Issues –
Guidance from NMC
Cervical Screening QARC
Training School
October 2012
Legal & Ethical Issues
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Accountability
Confidentiality
Consent
Record keeping
Protocols
Accountability
• For your own clinical
practice/professional conduct
• To the patient
• To the NMC for actions and
omissions
• To your employer
The role of the nurse
• The nurse’s role is to educate and
facilitate within this area of health
care and to provide information and
support for women: it is not to
provide a diagnosis or to imply that
the nurse can in any way define
whether a woman may or may not
have cervical cancer
Confidentiality
• You must respect people’s right to
confidentiality.
• You must ensure people are informed about
how and why information is shared by
those providing their care.
• You must disclose information if you believe
someone may be at risk of harm, in line
with the law of the country in which you
are practicing.
NMC The Code, Points: 5,6 and 7. 1st May 2008 Updated May 2012
Consent
• The patient must understand –
• What & why
• Nature of treatment
• Risks
• Consequences of refusal
• Options available
• Incompetent adults
Consent cont…
• Consent should be obtained by the nurse carrying
out the test / examination
• Consent should be informed or it is not valid
• Women should be made aware of the associated
risks & benefits of screening
• These risks & benefits should be given in an
information leaflet
• Consent can be withdrawn at any time during the
procedure
• Consent does not have to be written – self referral
by the patient shows implied consent
Record keeping
• Records should be factual and not include
unnecessary abbreviations, jargon, meaningless
phases or irrelevant speculation.
• You should use your professional judgement to
decide what is relevant and what should be
recorded.
• You have a duty to communicate fully and effectively
with your colleagues, ensuring they have all the
information they need about the people in your care.
• The principles of good record keeping apply to all
types of records, regardless of how they are held.
NMC Record Keeping, A Guidance for Nurses April 2010.
Records should be
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Factual
Accurate and relevant
Abbreviations
Legible
Dated and timed
Signed
Alterations & additions made correctly
Computer records
What do I write in the notes / on the
computer / lab forms ?
• Remember – If is not written
down, then it did not happen!
• Remember – Your Sample Taker
(ST) number is unique to you –
please do not share with
anybody else – you are
accountable for your practice!
Protocols
• Give clear guidance as to why, when,
where and by whom a procedure will
be carried out
• are a draft of terms signed by all
parties involved in the care of the
patient
• a procedure is the how : a guideline to
the practical implementation of a task
• Protocols therefore guide procedures
Reducing the risk - 3 questions
to ask?
• Do I have AUTHORITY? Does the
law allow me to do this?
• Do I have ABILITY? Am I
competent and up to date?
• Do I have AGREEMENT? Have I
my employer’s permission and the
patient’s consent?
From: Legal and Ethical Issues- Bridgit Dimond. 2005.
CASE FOR DISCUSSION
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The practice had a clinic run by the practice nurse. Mrs Brown
had never been to the clinic before but she had regular cervical
sampling taken by her GP. Mrs Brown had noticed an offensive
PV discharge but knowing that she was attending for her cervical
screening, decided to leave it until her appointment.
Mrs Brown told the nurse that she had a smelly discharge that
she was worried about.
The nurse informed Mrs Brown that she would need to take
some swabs to see if the patient needed any treatment prior to
her sample being taken.
The nurse did not discuss with the patient the possible reasons
for the vaginal discharge or treatment options.
Nor did she discuss with her the reason why she could not
undertake the cervical sample at this appointment and the
possibilities of passing on infections and precautions that she
needed to take – i.e. condom use and antibiotic treatment.
How would you have handled this situation? Was it the
correct way?
CASE FOR DISCUSSION
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A 27 year old single woman attended her surgery following
an invitation for routine cervical sampling. Two weeks after
the routine examination the GP received the following letter.
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Dear Doctor, On Nov 29th I attended your surgery for a
cervical sample as I had received an invitation letter. This
was done by your nurse. She gave no explanation of why
this was being done. She did not ask me any questions
about my personal life. Until I spoke to a friend of mine I did
not realise that I did not need a cervical sampling at all as I
have never had a sexual relationship with anyone. The test
itself was very painful and I think that the nurse should have
found out more about me before doing it. I will not be
coming back for another test.
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What are the main issues raised here?
CASE FOR DISCUSSION
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Mrs Jones was 29 and her youngest child was three. She was
generally good about doing the things she was meant to do,
like having cervical sampling and going to the dentist, so when
she received her reminder for her 3 yearly sample she went
ahead and had it done. She was advised that if she had not
received a result letter in 2 weeks to contact the surgery. She
rang 2 weeks later as the nurse suggested.
The receptionist said that the results had not come back yet
and she should try again in a few days.
When they did come back they showed mild dyskaryosis and
suggested that the smear was repeated in 6/12. The results
were filed. Mrs Jones tried phoning again several times but the
line was always busy. She decided that if there was bad news
the surgery would ring her.
After about 18/12 Mrs Jones went to see her GP because she
had intermenstrual bleeding and an unpleasant discharge. The
GP found her cervix to be abnormal and immediately referred
to gynae. She was found to have inoperable ca. cervix from
which she died at the age of 31.
Could this happen in your practice? What responsibility
did the patient have?