Professional Duties, Records, and Speaking Up

Capacity work relies on clear professional conduct. Dental nurses should follow local policy, provide accurate observations to the dentist, maintain confidentiality, keep factual records, and speak up if a patient's autonomy or safety may be at risk.

Useful records may include

• Which decision was being considered.
• What communication support was used.
• What the patient appeared to understand, retain, weigh, or communicate.
• Any fluctuation, distress, carer input, legal documents, or best-interests discussion.
• Who was informed, what was escalated, and what next step was agreed.

Records should be respectful and precise. Avoid wording such as "confused patient refused" when a clearer note would state that the patient became distressed, did not understand the explanation despite support, or asked for the discussion to stop. Accurate factual notes support safer later review.

Speaking up can be difficult when a dentist, owner, or senior colleague wants to proceed. Use prepared, calm phrases such as "Can we pause and check capacity for this decision?", "The patient seems to understand better with the carer explaining familiar words", or "I am concerned the son is answering for her before she has had a chance."

Dental nurses can also support the team after the appointment. A short debrief may show that reception needs a capacity flag, the medical history form needs clearer carer details, appointment lengths should be adjusted, or the practice needs a simpler route for checking legal documents.

Practice governance and inspection

Speaking up about capacity is not challenging a colleague for the sake of it. It protects the patient's right to decide where possible, and ensures appropriate protection where they lack capacity.