The Importance of Consent in Relation to Adult Nursing - Essay Example

 Introduction Heightened emphasis on patient consent has come to characterise modern health care with the nursing professionals at the centre of the debate. However, the debate on adult consent has predominantly inclined to patient’s perspective. This essay is focused on discussing the importance of patient consent in relation to adult nursing. In particular, the essay intends to highlight the perspective of nursing professionals concerning patient consent. First, an overview of patient consent in relation to adult nursing practice will be provided. Secondly, the implications of adult consent on mental health nursing will also be discussed. Lastly, the essay will further compare and contract issues pertaining to adult consent between adult nursing and mental health nursing. Nursing and Midwifery Code of Conduct According to Johnstone (2009), while adhering to bioethics of consent, nurses are required to observe the codes of conduct stipulated by the Nursing and Midwifery Council. Nurses are mandated to regard the care of people as their primary concern. In doing so, they must consider patients as being individuals, thus respecting their dignity. Nurses are also expected to involve all relevant parties in their efforts to protect and maintain health while caring for their patients. These include positive interactions with family, doctors and the immediate community. They should also exercise high standards of professionalism concerning nursing. In addition, professional nurses are required to practise openness, honesty and integrity to uphold positive reputation of the nursing profession. Consent in Adult Nursing According to Fix (2007), consent refers to the provisions of approval or permission that is preceded by utmost consideration and decision-making. It relates to patient consent which Leino-Kilpi (2000) defined as ‘the principle that a person must give their permission before they receive any type of medical treatment’. The prime objective of patient consent is the empowerment of patients’ rights in a given healthcare system. Adult nursing and patient consent are intricately related through a comprehensive framework of legal and ethical obligations. According to Edwards (2008), patient consent may be categorised into the following forms: informed consent, expressed consent, implied consent, surrogate consent and advance consent. For the purposes of practicality, the essay will be focused on informed consent while discussing adult nursing and implied consent in psychiatric nursing. Referring to Brooker and Waugh (2013), informed consent refers to voluntary permission given by a patient or patient’s official proxy for participation in medical treatment after being informed of the procedures, methods and consequences pertaining to the proposed surgical operation. Issues relating to informed consent are thus prevalent in the adult nursing practice where nurses frequently interact with adult patients. Adult nurses are hence required to adhere to the standard procedures of informed consent while administering their services. However, cultural diversity has been identified as the core barrier in the administration of consent (Nmc-Uk.Org, 2014). Culture defines an individual’s core beliefs and practices. Therefore, the decision making process of individuals tends to be culturally biased. Consequently, individual’s language is also an aspect of culture. Based on a study by Melnyk and Fineout-Overholt (2011), 73% of health care professionals indicated that misunderstanding of consent or medical procedure was due to the language barrier, and 71% of the nurses attributed the ineffective patient–nurse relationship to language difference, hence hindering informed consent. Informed consent has far-reaching implications in the field of adult nursing. Reforms in the sector of healthcare have led to formulation and implementation of guidelines that have mutated the patient–nurse relationship into a contractual relationship. The implications of these emergent relationships have been development of legal and ethical obligations of nurses to their patients. Although the perspective of patients has been the centrality of most literature on informed consent, it is currently evident that nursing practice has also gained significantly from contractual provisions of consent. First, Daly (2005) argued that the legal framework has been instituted to demarcate the distinctive boundaries of the nurse–patient relationship. Through informed consent, nurses are no longer liable for any occurrences of consequences mentioned during the signing of the consent. This has the effect of lowering and further eliminating lawsuits against nurses and parties related to adult nursing. The legality of the informed consent shields the nurses from breaking the law by stipulating guidelines to be followed. Adult nurses are further educated on the rightful criteria for establishing a valid consent. The consent is thus as important to the patient as to the nursing community. Another significance of informed consent to the nursing practices is the organisational and individual development of a professional ethical culture. Heated debate on patient consent and ethical code of conduct for nurses has underpinned the magnitude attached to the code of conduct observance in nursing. Administration of an effective and valid informed consent dictates for a stringent code of conduct in the nursing community. This has greatly imparted professionalism in the discipline of adult nursing. Adult nurses exhibit professionalism by observance of patient autonomy and administration of informed consent to adult patients. Positive implications as result of implementing patient consent have further asserted the importance of consent in adult nursing. Consent in Psychiatric Nursing Unlike adult nursing, patient consent is never straightforward in psychiatric nursing. According to Keltner et al. (2007), mental or psychiatric nursing is a specialised branch of nursing profession focused on promoting mental health through the assessment, diagnosis and treatment of individual’s response to mental health problems and psychiatric disorder. Nurses are faced by a daunting task while caring for the mentally challenged. Psychiatric nurses frequently encounter the dilemma of upholding patient’s rights, on the one side, and maintaining public safety, on the other. Neeraja (2008) noted that this could be attributed to lack of proper legislation or ambiguity of laws. In contrast to adult nursing where nurses are predominantly situated in health facilities, psychiatric nurses work in patient’s homes, residential houses and local health facilities. According to Elder et al. (2009), following types of commitment in relation to patient consent may define operations of mental nursing. These include voluntary commitment, involuntary commitment, emergency involuntary commitment and outpatient commitment. These commitments primarily define the form of patient admission to hospitals. Long et al. (1995) wrote that the formal context of admission involves voluntary commitment where the patient seeks medical treatment by himself/herself, while the informal context pertains to involuntary admission of mentally ill patients following a request by other parties, but not the patient. Compared to adult nursing, the principles of bioethics cannot be plainly implemented without alteration either for the welfare of the community or for the benefit of the patient. Benjamin and Curtis (2010) recommended that psychiatric nurses while caring for the mentally distressed adhere to the core values of bioethics that includes beneficence, autonomy and justice. There is also the Mental Act of 2005, which focuses on safeguarding mentally distressed patients biases of the decision making process (Legislation.Gov.Uk, 2014). The act indicates parties to represent mental patients in the decision-making process and in which circumstances it should happen. However, psychiatric nurses often tend to employ implied consent as opposed to informed consent or a combination of the two while nursing the patients. Castledine and Close (2009) defined implied consent as an agreement that has been inferred directly or indirectly from one’s facts, actions or signs. The patient may be considered legally incompetent, hence losing his/her legal ability to determine legal and ethical issues. Consequently, the patient’s consent on medical treatment may be overlooked. In such scenario, the psychiatric nurse will administer medication based on the implied state and condition of the patient. The Mental Capacity Act 2005 asserts that even the mentally ill patients are entitled to health rights. Although the framework of consent in psychiatric nursing presents a classic dilemma of balancing individual’s autonomy and enhancing patient’s mental health, the legality of implied consent empowers nurses to emphasise patient’s health. By advocating implied consent, legal provisions facilitate the administration of medications and execution of therapies that improve the quality of the nursing procedure and promotion of mental health of patients. Daniels (2004) noted that the existence of legal consent in psychiatric nursing further absolves the nursing community from liability for any consequences if nurses act in accordance with standard procedures. The existence of legal consent further serves as a frame of reference for psychiatric nurses faced with mental cases that lack applicable legislation or regulating laws. The implications of legal consent are extremely sensitive in psychiatric nursing in comparison to adult nursing. Therefore, psychiatric nurses are mandated to primarily establish therapeutic relationships with their patients (Lachman, 2006). In doing so, the nurse will be expected to act in the best interest of the patients even without their consent, thus referring to implied consent. Nevertheless, psychiatric nurses are further expected to grant mentally ill patients informed consent in cases where patient incompetence has not been legally declared (Killion and Dempski 2006). The framework of patient consent has led to eradication of prejudice and misconception of mental illness by psychiatric nurses. The consent promotes effective communication between the nurses and the mentally distressed patients. Kraszewski and Mcewen (2010) stated that communication is employed as an instrument of fostering a therapeutic relationship between the nurses and their patients. Comparison of Consent in Adult and Psychiatric Nursing Adherence to legal and ethical dimensions of consent is paramount to both adult and mental nursing. The roles and implications of consent are similar in both fields. The patient is legally entitled to a valid consent whether he/she is an adult or mentally distressed patient. Consequently, nurses are expected to exercise bioethics while administering their services. Furthermore, direct or indirect negation of consent provisions results in legal consequences. Therefore, the consent enhances professionalism in both fields of nursing. The consent has further established a continuum of code of conduct which extends across all forms of nursing professions. However, the approach to administering consent varies in psychiatric and adult nursing. Studies by Fry and Veatch (2006) indicated that in adult nursing, informed consent is prevalently used while due to mental imbalance of patients, psychiatric nurses administer implied consent. Furthermore, psychiatric nurses are legally permitted to violate patient’s rights in cases where the patient has been declared incompetent. Conclusion The Nursing and Midwifery Council requires that all nurses be conversant with the guiding principles of consent. However, adult nursing has emerged as the primary domain of patient consent debate. Consequently, the integration of the consent in the practice of adult nursing has led to both legal and ethical implications. Predominance of informed consent in adult nursing has established a legal and ethical framework that has redefined adult nursing. From the perspective of nurses, the legal framework has absolved nurses from being liable and further legally defined the patient–nurse relationship. The ethical dimension of consent has facilitated formulation of bioethics that has enhanced professionalism in adult nursing. However, the implications of consent have also been noted in psychiatric nursing where implied consent as opposed to informed consent takes precedence. Nevertheless, the implications of consent in psychiatric nursing have been termed as analogous to those in adult nursing. However, integration of consent in adult and mental nursing has led to equivalent gains in both fields. References Benjamin, M., & Curtis, J. (2010). Ethics in Nursing: Cases, Principles, And Reasoning. Oxford, UK: Oxford University Press. Brooker, C., & Waugh, A. (2013). Foundations of Nursing Practice Fundamentals Of Holistic Care. Oxford, Mosby Publications Castledine, G., & Close, A. (2009). Oxford Handbook Of Adult Nursing. Oxford, UK: Oxford University Press. Daly, J. (2005). Professional Nursing Concepts, Issues, and Challenges. New York, Springer Publications. Daniels, R. (2004). Nursing Fundamentals Caring & Clinical Decision Making. Australia, Delmar Learning. Edwards, M. (2008). The Informed Practice Nurse. Chichester, England, John Wiley & Sons. Elder, R., Evans, K., & Nizette, D. (2009). Psychiatric And Mental Health Nursing. Sydney, Mosby Elsevier. Fix, R. M. (2007). Informed Consent. Orange Park, FL: Frontline Publication Company Fry, S. T., & Veatch, R. M. (2006). Case Studies in Nursing Ethics. Sudbury, Mass, Jones and Bartlett Publishers. Johnstone, M. J. (2009). Bioethics A Nursing Perspective. Sydney, N.S.W., Churchill Livingstone / Elsevier. Keltner, N. L., Schwecke, L. H., & Bostrom, C. E. (2007). Psychiatric Nursing. St. Louis, Mo, Mosby-Elsevier. Killion, S. W., & Dempski, K. (2006). Legal and Ethical Issues. Sudbury, Mass, Jones And Bartlett. Kraszewski, S., & Mcewen, A. (2010). Communication Skills For Adult Nurses. Maidenhead, Mcgraw Hill Open University Press. Lachman, V. D. (2006). Applied Ethics In Nursing. New York, Springer Publication. Leino-Kilpi, H. (2000). Patient's Autonomy, Privacy And Informed Consent. Amsterdam, Ios Press Legislation.Gov.Uk, (2014). Mental Capacity Act 2005. [Online] Available At: Http://www.Legislation.Gov.Uk/Ukpga/2005/9/Contents [Accessed 27 May. 2014]. Long, B. C., Phipps, W. J., & Cassmeyer, V. L. (1995). Adult Nursing: A Nursing Process Approach. London, Mosby. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-Based Practice In Nursing & Healthcare: A Guide To Best Practice. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins. Neeraja, K. P. (2008). Essentials Of Mental Health And Psychiatric Nursing. New Delhi, Jaypee Brothers Medical Publishers. Nmc-Uk.Org, (2014). Consent | Nursing And Midwifery Council. [Online] Available At: Http://Www.Nmc-Uk.Org/Nurses-And-Midwives/Regulation-In-Practice/Regulation- In-Practice-Topics/Consent/ [Accessed 27 May. 2014]. Read More