Elements of Informed Consent in Children’s Healthcare

Working with children of different ages brings in a set of challenges for every nursing professional. It has been seen that healthcare problems have severe effect not only on the development of the child but also results in huge amount of stress on the patient as well as the families. This assignment will mainly show how nursing professionals need to follow the ethics of taking informed consent and follow the professional guidelines of effective mandatory reporting while treating such patients so that effective care is ensured for them and their families.

The main concept of informed consent in the healthcare system states that the service users should be given proper allowance for making the final decision regarding their treatment. The different necessary elements that need to be fulfilled are the proper competence, disclosure of the information ability to express the choice, understanding as well as appreciation of the information that should be disclosed and even voluntariness in decision-making (McKinney et al. 2017). The standard two of the NMBA standards of Practice for the registered nurses is seen to state that the nursing professionals should engage in effective therapeutic as well as professional relationships.  This relationship should ensure collegial generosity in the matter of mutual trust and respect between the healthcare professionals and the child patients or the parents according to the age. In the Australian healthcare system, it is seen that the parents or the legal guardians are given the sole authority to take decisions on the behalf of the child and as soon as the child reaches the age of majority like around 18,  the later acquires the greater autonomy for the decision making power. In NSW and in Southern Australia, children are given the authority to consent for their children at 14 and 16 respectively (Citizen Child: Australian law and children’s rights 2018).

It is the duty of the nursing professionals to provide important information about the health condition of the children to the patients in details as this helps in managing the anxiety of the parents helping them to understand what exactly had happened with the child. The nursing professionals also need to disclose the available diagnostic and treatment options along with the risks, benefits, consequences as well as costs attached with each of the options. These help the parents to take the proper decisions and prevent the nursing professionals in engaging in any form of legal obligations. They try to suggest to them the best options for the better health of the children and discuss with them the option of non-treatment that involves informed refusal and its implications. Following these, the professionals seek for consent about the intervention that they need to undertake and accordingly document them (James et al. 2014).  The process of consent should be conducted in the language of the young patient or that of the parents of infants and smaller children and in a procedure that would be according to the level of literacy of the patient or that of the parents. This would help the nurses to maintain the standard two where they would be able to establish, sustain and conclude a relationship that would be based on mutual trust and respect (Standard of practice, Nursing and midwifery board of Australia 2018).

Role of Nursing Professionals in Maintaining Effective Therapeutic Relationships

The parents of the children or the young patients would be able to confide on the nurses and would believe that the nurses are genuinely trying to help them by relieving them from their suffering. With taking informed consent, nurses will help the patient or the family members feel that they are experts of their own lives and this would help in maintaining their autonomy and dignity of patients and their caregivers (Tam et al. 2015). In this way, safe and quality care can be given that satisfies them.

Maintaining of all the information of the child patient helps to record the data about the improvement of the patient in each of the stages and thereby help to maintain a record that will help to treat the patient in the next visits (Doenges, Moorhouse and Murr 2016). One of the most important outcomes of effective manual reporting is the effective delegation to other healthcare workers caring for the same patient but in another shift (Prang and Jelsness-Jørgensen 2014). Effective manual reporting helps in the creation of the means of communication between the providers and between the providers and members about the health status, preventive health services, planning, treatment as well as delivery of care. Therefore, mandatory reporting can be described in the broad sense about the written information that helps in describing the care or the service provided to a particular child patient or even groups of clients to another set of professionals about what interventions had been already given and what interventions are still needed to be taken.

Mandatory reporting can be of four types such as change of shifts when the professionals are ending a shift and giving the information of patients to other caregivers who would be handling the next shift. Another is the transfer reports (when transferred from one department to another department for change of level of care), incident reports (when incidents have occurred that are not consistent with routine of operation of the healthcare unit) and telephone reports (information conveyed on phone about health of patients to other members of the team..

Mandatory reporting needs to be always documented as it helps by acting as medical charts that provide valuable information in the event of different legal actions or concerns and can thereby help in acting as a proof of the initiatives taken for the betterment of the young patient (Djikers 2015). In such cases, other professionals cannot blame that the reporting had not been done or that the reporting done to them were wrong. Researchers are of the opinion that purpose of complete and accurate mandatory reporting is to foster quality and continuity of the different care interventions provided to the patient.

Significance of Mandatory Reporting in Nursing Practice

This role of the nurses can be well associated with the standard six of the registered nurses standards of practices for NMBA. It states that nursing professionals need to provide and delegate quality as well as ethical goal-directed practices (Moher et al. 2014). In this regard, the nursing professionals need to delegate different aspects of practice to the enrolled nurses and well as to other according to the latter are scope of practice. Therefore, in order to do so effectively, mandatory  reporting is very important as the documents can help the enrolled nurses about the aspects of care to be put significance on, the pattern of care interventions that need to be followed, the medications already provided and the new medications that need to be given. This would help in maintaining the standard six as it would help in providing timely direction and supervision effectively in order to make sure that the delegated practices is safe and correct (Stavraoulou et al. 2015). Keeping up with the habit of mandatory reporting would also help to provide quality care for the young patients.  It would help in noting down important interventions that are taken and would become extremely helpful to understand whether the practice is “in accordance with relevant policies, guidelines, standards, regulations and legislation” (Standard of practice, Nursing and midwifery board of Australia 2018). This would be also the best procedure for identification and reporting of the actual as well as the potential risk related system issues and the different areas where the practice would be below the expected standards.

Conclusion:

It can be a very scary situation for the children and for the patients and therefore care and support should be provided to them right from the start in a way that would help them to cope with the situation. The nurses should ask for consent from parents to ensure patient and family member satisfaction, avoid legal obligation and maintain autonomy and dignity of patients and caregivers. Mandatory reporting also helps to ensure prevention of legal obligation, best error-free delegation and quality and safe care to patients.

References:

Citizen child: Australian law and children’s rights, Australian Institute of family Studies  Retrieved from: https://aifs.gov.au/publications/citizen-child-australian-law-and-childrens-rights/8-medical-procedures-children

Dijkers, M.P., 2015. Reporting on interventions: issues and guidelines for rehabilitation researchers. Archives of physical medicine and rehabilitation, 96(6), pp.1170-1180. https://doi.org/10.1016/j.apmr.2015.01.017

Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2016. Nursing diagnosis manual: planning, individualizing, and documenting client care. FA Davis.retrieved from: https://books.google.co.in/books?hl=en&lr=&id=T6tqCwAAQBAJ&oi=fnd&pg=PR3&dq=manual+reporting+in+nursing&ots=0_24Pn-1sB&sig=nnkMt2YcTgnIHuGywEeANxFHMRc#v=onepage&q=manual%20reporting%20in%20nursing&f=false

James, S.R., Nelson, K. and Ashwill, J., 2014. Nursing care of children-E-book: principles and practice. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=AER1BAAAQBAJ&oi=fnd&pg=PP1&dq=informed+consent+from+child+patient+and+parents+in+nursing&ots=gaijVjs2Ff&sig=hFzDkRNlLTQsJuJpYz584ziVJaM#v=onepage&q=informed%20consent%20from%20child%20patient%20and%20parents%20in%20nursing&f=false

McKinney, E.S., James, S.R., Murray, S.S., Nelson, K. and Ashwill, J., 2017. Maternal-Child Nursing-E-Book. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ieAsDgAAQBAJ&oi=fnd&pg=PP1&dq=informed+consent+from+child+patient+and+parents+in+nursing&ots=XcMdOK3xX1&sig=iA6NnzhOXx8oAH2ghECQSu5_-bg#v=onepage&q=informed%20consent%20from%20child%20patient%20and%20parents%20in%20nursing&f=false

Moher, D., Altman, D.G., Schulz, K.F. and Simera, I., 2014. How to develop a reporting guideline. Guidelines for reporting health research: a user’s manual, pp.14-21. https://doi.org/10.1002/9781118715598.ch2

Prang, I.W. and Jelsness-Jørgensen, L.P., 2014. Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes. Geriatric Nursing, 35(6), pp.441-447. https://doi.org/10.1016/j.gerinurse.2014.07.003

Standard of practice, Nursing and midwifery board of Australia. 2018. Retrieved 1 auguts 2018, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Stavropoulou, C., Doherty, C. and Tosey, P., 2015. How effective are incident?reporting systems for improving patient safety? a systematic literature review. The Milbank Quarterly, 93(4), pp.826-866.

Tam, N.T., Huy, N.T., Thoa, L.T.B., Long, N.P., Trang, N.T.H., Hirayama, K. and Karbwang, J., 2015. Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis. Bulletin of the World Health Organization, 93, pp.186-198H. https://doi.org/10.2471/BLT.14.141390 

Citizen child: Australian law and children’s rights, Australian Institute of family Studies  Retrieved from: https://aifs.gov.au/publications/citizen-child-australian-law-and-childrens-rights/8-medical-procedures-children

Dijkers, M.P., 2015. Reporting on interventions: issues and guidelines for rehabilitation researchers. Archives of physical medicine and rehabilitation, 96(6), pp.1170-1180. https://doi.org/10.1016/j.apmr.2015.01.017

Doenges, M.E., Moorhouse, M.F. and Murr, A.C., 2016. Nursing diagnosis manual: planning, individualizing, and documenting client care. FA Davis.retrieved from: https://books.google.co.in/books?hl=en&lr=&id=T6tqCwAAQBAJ&oi=fnd&pg=PR3&dq=manual+reporting+in+nursing&ots=0_24Pn-1sB&sig=nnkMt2YcTgnIHuGywEeANxFHMRc#v=onepage&q=manual%20reporting%20in%20nursing&f=false

James, S.R., Nelson, K. and Ashwill, J., 2014. Nursing care of children-E-book: principles and practice. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=AER1BAAAQBAJ&oi=fnd&pg=PP1&dq=informed+consent+from+child+patient+and+parents+in+nursing&ots=gaijVjs2Ff&sig=hFzDkRNlLTQsJuJpYz584ziVJaM#v=onepage&q=informed%20consent%20from%20child%20patient%20and%20parents%20in%20nursing&f=false

McKinney, E.S., James, S.R., Murray, S.S., Nelson, K. and Ashwill, J., 2017. Maternal-Child Nursing-E-Book. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ieAsDgAAQBAJ&oi=fnd&pg=PP1&dq=informed+consent+from+child+patient+and+parents+in+nursing&ots=XcMdOK3xX1&sig=iA6NnzhOXx8oAH2ghECQSu5_-bg#v=onepage&q=informed%20consent%20from%20child%20patient%20and%20parents%20in%20nursing&f=false

Moher, D., Altman, D.G., Schulz, K.F. and Simera, I., 2014. How to develop a reporting guideline. Guidelines for reporting health research: a user’s manual, pp.14-21. https://doi.org/10.1002/9781118715598.ch2

Prang, I.W. and Jelsness-Jørgensen, L.P., 2014. Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes. Geriatric Nursing, 35(6), pp.441-447. https://doi.org/10.1016/j.gerinurse.2014.07.003

Standard of practice, Nursing and midwifery board of Australia. 2018. Retrieved 1 auguts 2018, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Stavropoulou, C., Doherty, C. and Tosey, P., 2015. How effective are incident?reporting systems for improving patient safety? a systematic literature review. The Milbank Quarterly, 93(4), pp.826-866.

Tam, N.T., Huy, N.T., Thoa, L.T.B., Long, N.P., Trang, N.T.H., Hirayama, K. and Karbwang, J., 2015. Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis. Bulletin of the World Health Organization, 93, pp.186-198H. https://doi.org/10.2471/BLT.14.141390