Legal Framework / Ethics

Question 1

pre-disposing risk factors for child abuse

Answer 1

Disability
Learning difficulties
Behavioural problems
adoption 
Looked after children
parental mental health issues
parental drug / alcohol issues
domestic violence
parental previous abuse as a child
socio-economic deprivation  
parental unemployment

Question 2

What components are required for valid consent in medicine

Answer 2

provision of information
capacity
consent given voluntarily / non-coerced

Question 3

five key principles of the mental capacity act

Answer 3

1 - presumption of capacity
2 - Individuals should be given all practicable help before treating them as not being able to make their own decisions
3 - People have the right to make decisions that others might regard as unwise or eccentric
4 - act in their best interests
5 - least restrictive option

Question 4

Who has parental responsibility for a child?

Answer 4

A mother automatically has parental responsibility from birth

A father has parental responsibility if he’s either:

• married to the child’s mother at birth
• listed on the birth certificate (after 15/4/2002)

Question 5

what is Gillick Competence

Answer 5

A test to determine if a child <16yo can consent to treatment or investigation

Question 6

Components of Gillick competence

Answer 6

They must have
- sufficient understanding / intelligence to understand the proposed treatment or investigation 
Including:
- purpose 
- nature
- effects
- risks
- likelihood of success
- availability of other options

Question 7

Can Gillick competence be applied to <13yo

Answer 7

yes - no lower age limit

However, rarely appropriate or safe for <13yo to consent to treatment without parental involvement

Question 8

Age of sexual consent in UK

Answer 8

16 yrs

E, S + W

Question 9

what is the law regarding statutory rape

Answer 9

<13yo cannot consent to any sexual activity

Must be passed on to safeguarding regardless of Gillick competence

Question 10

What are the Fraser Guidelines

and what are they for

Answer 10

Used in relation to contraception and sexual health only

1) YP can understand the nature and implications of treatment
2) YP cannot be persuaded to tell their parents / doesn’t agree for the HCP to inform them
3) Likely to begin or continue sexual activity regardless of treatment
4) physical / mental health likely to suffer unless advice or treatment is received
5) advice / treatment is in the YPs best interests

Question 11

What are the main elements of clinical governance

Answer 11

Risk management
Education / training / CPD
Clinical audit
Clinical effectiveness
Information management and communications
patient / public involvement
strategeic leadership / workforce planning

Question 12

define public health

Answer 12

The science of: 
preventing disease 
prolonging life
promoting health
preparing for disaster
via organised efforts and education of individuals, societies, organisations and groups

Question 13

What is epidemiology

Answer 13

study of distribution and determinants of health related states
among specific populations
and applying that to control of health problems

Question 14

define clinical governance

Answer 14

A systematic approach to safeguarding and maintaining quality in healthcare

• accountability
• integrated approach
• creating and enabling environment

Question 15

Define clinical audit

Answer 15

a quality improvement process
seeks to improve patient care and outcomes
through systematic review of care
against explicit criteria or standards 
and implementing change

Question 16

Explain the difference between research and audit

Answer 16

Research = finding an answer to a question - often by comparing groups

audit = ensure practice meets existing standards set by existing knowledge

Research = finding the right thing to do
Audit = ensuring the right thing is done

Question 17

Steps of the audit cycle

Answer 17

1) identify problem
2) set standards
3) assess or measure quality
4) identify change needed
5) implement change
6) monitor effects of change

Question 18

How can healthcare be measured

Answer 18

• Efficacy (does it work)
• Effectiveness (how well does it work)
• Efficiency
• Equality / equity
• Accessibility
• Acceptability
• Appropriateness (meeting needs)

Question 19

criteria for screening programmes

Answer 19

disease is important in severity or consequences
natural history is known
acceptable treatment exists
suitable test with high sensitivity and specificity
test is acceptable
identifiable ‘at risk’ population to screen
Cost of screening
conintinuning process + good participation

Question 20

Define domestic abuse

Answer 20

An incident or pattern of incidents
of controlling, coercive, threatening, degrading or violent behaviour.
Including sexual violence, honour based violence and FGM.

By a partner / ex-partner / family member / carer

Question 21

Define discriminatory abuse

Answer 21

Ill treatment or harassment based on a persons

• age
• sex
• sexuality
• disability
• religious beliefs
• race
• marriage / civil partnership
• Gender reassignment
• Pregnancy and maternity

Question 22

define financial abuse

Answer 22

Theft / fraud / coercion over finance or will

Misuse of someones money / property / belongings without their agreement

Question 23

Define institutional abuse

Answer 23

Lack of dignity and respect for service useers

Through rigid regimes / systemic poor care / poor organisational culture / lack of resources / denial of choices

Question 24

Define physical abuse

Answer 24

Hitting / pushing / burning / kicking / biting / hair pulling / rough handling / unreasonable restraint / locking someone in a room

Question 25

define neglect

Answer 25

acts of omission by people giving care
including ignoring medical needs / physical needs / emotional needs
failure to provide access to appropriate healthcare / education
withholding necessities such as nutrition / heating / medication

Question 26

define sexual abuse

Answer 26

rape / inappropriate touching / forcing someone to take part in or witness any sexual act against their will

Question 27

define psychological / emotional abuse

Answer 27

intimidation / bullying / shouting / swearing / threatening / taunting / humiliating

Question 28

what proportion of all violent crime reported in the UK is due to domestic abuse

Answer 28

1 / 4

90% affects women and children

Question 29

Impact of domestic abuse on women

Answer 29

Physical injuries / death 
STIs 
Gynae issues / miscarriage / stillbirth / IUGR
poor nutrition
fatigue
chronic pain
psychological - anxiety / depression / suicidality PTSD / poor sleep 
Isolation 
low self worth
drug and alcohol issues

Question 30

Impact of domestic abuse on children

Answer 30

developmental delay
poor educational attainment / truancy / disrupted schooling
poor concentration  / poor memory 
difficulties relating to others
physical injuries
enuresis / encopresis 
running away / homelessness
psychological 
self harm
teen pregnancy

Question 31

Screening question examples for asking about domestic violence

Answer 31

Are you ever afraid at home
Has your partner ever hit you
Have you ever been forced to do anything sexually which you didn’t want to

Question 32

safety plan suggestions for victims of domestic abuse

Answer 32

Avoid the kitchen / potential weapons when violence starts
provide info of people to go to if in danger
ask neighbours to call 999 if they hear anything which sounds like they are in danger
have a place to hide important phone numbers
teach children 999
keep passport / documents together somewhere accessible
let someone know about the abuse so it can be documented (e.g if going to court)
emergency bag in safe place
try to get proof of abuse e.g photos - if safe to do so