Professional Nursing Practice and Ethics
This domain tests whether you can reason as a registered nurse rather than recite values. Stems are usually scenarios: a competent adult refusing treatment, a colleague practising outside scope, a relative demanding information, or a doctor's order you believe is unsafe. The exam wants the option that protects the patient, stays within the Nurses Registration Ordinance (Cap. 164) and the Code of Ethics and Professional Conduct, and would survive scrutiny by the Nursing Council of Hong Kong.
Establishing liability
- Negligence requires four elements proved together: a duty of care owed, breach of the standard of a reasonably competent nurse in that post, causation, and actual damage. Missing any one defeats the claim.
- The standard is not the best possible care; it is what a reasonably competent nurse with similar training would give in that situation.
- Documentation is the legal record. If it is not dated, timed and signed, it effectively did not happen.
Consent
- Valid consent needs capacity, adequate information and voluntariness. Capacity is decision-specific, not global.
- A competent adult may refuse even life-saving treatment, and a refusal is as valid as a consent.
- In Hong Kong the age of consent to medical treatment is 18. A patient detained under the Mental Health Ordinance (Cap. 136) does not automatically lose capacity for unrelated treatment.
Confidentiality
- Disclosure without consent is justified only where statute requires it (for example certain notifiable diseases), where a court orders it, or where there is a serious and identifiable risk to a specific person that cannot be managed otherwise.
- Share on a need-to-know basis. In the patient's best interests is not a blanket authority to inform relatives.
Worked example
A man with newly diagnosed HIV refuses to tell his wife. What is the correct action? Reasoning: confidentiality is not absolute, but the threshold for breaching it is high. First explore why he refuses and offer to disclose together or to support disclosure by the team. If he still refuses and the wife is at identifiable risk, escalate to the senior clinician and ethics committee; any decision to warn must be a documented team decision limited to the minimum necessary information. Disclosing to the wife yourself is wrong because it is not your unilateral call, and doing nothing at all is also wrong because the risk is real.
Traps that cost marks
- Choosing follow the doctor's order when the order is clearly unsafe. You remain accountable for what you administer.
- Treating advocacy as disobedience. Advocacy means escalating through the chain of command, not silently refusing care.
- Confusing a do-not-attempt-resuscitation order with withdrawal of all care.
- Assuming a family member can consent for a competent adult.