Module 2: Communication, Teamwork and Documentation

• Unit 01

  Unit 2.1: Therapeutic Communication

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  180 questions · 4 topics
• Unit 02

  Unit 2.2: Record Keeping and Documentation

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  180 questions · 4 topics
• Unit 03

  Unit 2.3: Leadership, Delegation and Teamwork

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  140 questions · 4 topics
• Unit 04

  Unit 2.4: Escalation and Deteriorating Patients

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  183 questions · 4 topics

A few questions from this module, with the answer and a full explanation. The complete bank is available when you start practising.

1. A nurse documents the following after a deterioration episode: 'Patient appeared anxious and not their usual self. Doctor reviewed.' A senior colleague identifies two documentation problems. What are they?

   • A
     The problem is that the nurse documented the doctor's involvement, which should be the doctor's responsibility to document in their own notes
   • B
     The two problems are that the entry lacks a signature and a date; the content itself meets the required documentation standard
   • C
     Both phrases are subjective and non-specific: 'appeared anxious' should be replaced with measurable findings (e.g. heart rate, respiratory rate) and 'not their usual self' with objective comparison to baseline; 'Doctor reviewed' should include the doctor's name, grade, time, and the plan agreed
     Correct answer
   • D
     The problems are spelling and punctuation only — the clinical content is adequate for professional documentation standards
   Explanation

   Both phrases fail the objective documentation standard: 'appeared anxious' is a subjective interpretation rather than a measurable observation (document heart rate, respiratory rate, ACVPU if applicable). 'Not their usual self' is similarly vague — document what specifically changed (e.g. 'patient was previously conversational but now responds only with single words'). 'Doctor reviewed' is critically deficient: the doctor's name, grade, the time of review, and the management plan are all required. Together these deficiencies create an inadequate record of the clinical event.

2. A nurse is asked to represent her ward's perspective at an ICB consultation event on service redesign. What is the most accurate description of what an ICB does that the nurse should understand before attending?

   • A
     An ICB is responsible for staffing levels across NHS trusts and can mandate changes to nursing establishment numbers
   • B
     An ICB plans and commissions NHS services for the local population, manages the NHS budget, and decides which services are funded and how they are delivered — directly affecting resources available to the ward
     Correct answer
   • C
     An ICB regulates the clinical standards that nurses on the ward must meet and can impose sanctions if these are not met
   • D
     An ICB is only relevant in community settings; acute hospital services are commissioned directly by NHS England
   Explanation

   ICBs plan and commission the health services available to a local population — including hospital, community, mental health, and primary care services. Their decisions about which services are funded, how they are configured, and what outcomes are expected directly affect the resources, staffing, and service delivery context of NHS wards. Representing a ward's perspective at an ICB consultation is therefore meaningful and directly relevant to frontline nursing practice. ICBs do not manage daily ward operations (that is the trust) and do not regulate nursing standards (that is the NMC), but their commissioning decisions shape the environment in which nurses work.

3. A nurse raises concerns through the Freedom to Speak Up Guardian about systematic falsification of patient records on their ward. The Guardian advises the nurse that the concern will be escalated. Three months later, the nurse discovers no action has been taken and the falsification is continuing. What escalation pathway does the nurse's professional duty under the NMC Code require?

   • A
     The nurse must wait for the internal escalation process to complete before considering external escalation; it is premature to contact the NMC or CQC after only three months
   • B
     The NMC Code Section 16 requires the nurse to escalate concerns to the next available level if internal escalation has been ineffective; this may include the NMC itself, the CQC, or other prescribed regulators under the NMC Raising Concerns guidance
     Correct answer
   • C
     Falsification of records is a criminal matter only; the nurse should contact the police directly and does not need to escalate through professional or regulatory channels
   • D
     The nurse's only remaining option is to resign from the trust; the NMC Code does not require nurses to escalate concerns beyond the Freedom to Speak Up Guardian
   Explanation

   NMC Code Section 16 requires nurses to act without delay when patient safety is at risk and to escalate concerns if internal routes have been ineffective. The NMC's Raising Concerns guidance specifically addresses what nurses should do if internal escalation (including to Freedom to Speak Up Guardians) has not resolved the concern: they should escalate to an external body. Prescribed external bodies include the NMC itself, the CQC, NHS England, and potentially the ICO if the concern involves data issues. Falsification of records that remains unaddressed after three months of internal escalation requires the nurse to use external routes to ensure patient safety is protected.