CNA340 Developing Professional Nursing

Introduction:

The National Safety and Quality Health Services (NSQHS) has been implemented to improve the quality of health service provision, protect the public from any harm and establish minimum standard of safety in health care organization. It provides evidence based improvement strategies to meet the needs of healthcare consumers. There are 10 standards proposed by NSQHS and the standard 2 (Partnering with consumers) gives an idea regarding the importance of partnering with consumers in care to provide more accessible care to patient (ACSQHC 2017). Different actions have been proposed in standard 2 to engage in partnership with consumers. The main purpose of this paper is to discuss about action 2.4 mentioned in the criteria ‘partnering with patients in their own care’ and find out how the resource ‘informed consent form’ relates to the action 2.4. The critique of the chosen resource will help to understand whether it can meet the action mentioned in 2.4 or not.

Resource:

As per the action 2.4 of the standard 2, it is necessary for health care organization to ensure that is informed consent complies with legislation and best practice. As per this action, it is necessary that health care organization formulate appropriate protocol to implement informed consent process (National Safety and Quality Health Service Standards 2018). Informed consent forms are short informative document that makes patient aware of pros and cons in treatment and increase patient engagement in care too (Krishnamurti and Argo 2016).

While being placed in a mental health care setting, I had to use a resource very often while providing care to patients with mental illness. The resource was the use of consent form before providing Clozapine medication to patient. Clozapine is an atypical antipsychotic medication that is most commonly given to patients with schizophrenia for treatment of severe symptoms and reducing rate of suicidal behaviors in patient (Delikanli et al. 2018). The Medicine and Healthcare Products Regulatory Authority has put many restrictions on its prescribing because of the need to monitor several parameters before giving the drugs to patient and chances of harm to patient if correct procedure is not followed (NHS Foundation Trust 2018). Hence, whenever there was a need to initiate Clozapine treatment, I had to take informed consent from the patient. The main purpose of informed consent was to reach agreement regarding the need to comply with treatment procedure and comply with blood monitoring routine after taking the medication (Hall, Prochazka and Fink 2012). This action also helps to fulfill the values of patient centered care by allowing patient to make an informed decision and consider all preference while deciding final treatment for themselves (Braithwaite  and Caplan 2014). Taking informed consent also helps to respect human rights and dignity while providing care. As per the facets of patient centered care, it is imperative that patient received adequate information about choices and risk they can face while taking decision making regarding treatment (Paul 2016).

Importance of partnership with consumers and its impact on patient outcome:

As per standard 2 of NSQHS, great emphasis has been given to engaging in partnership with consumers. The main aim of the standard is to implement systems in health care organization that partnering with patients and achieving better patient experience by reducing length of hospital stay, reducing readmission rates and improving functional status of patient (National Safety and Quality Health Service Standards 2018). Saulnier (2016) gives the insight that partnering with patients and families help to advance the patient centered care practice. Patient centered care is dependent on effective partnership with patients and health care providers and incorporation of core concepts like respect, dignity, participation, collaboration and information sharing during care. Partnering with patients promotes interaction with nurses and other care providers (Haywood et al. 2015). Effective communication is integral to service quality and by means of patient engagement, patient satisfaction with care increases and complaints about care decreases. Partnering with consumers also increases the possibility of providing responsive care in accordance with patient’s preference, needs and values. Health care organizations aiming to achieve high quality care consider patient engagement as one of the pillars of their service (Newell and Jordan 2015).

Critique of the resource:

The resource informed consent form for Clozapine medication has the capability to meet the action 2.4. This can be said because the consent form has been prepared after it was mandated to restrict prescription of the medicine by The Medicine and Healthcare Products Regulatory Authority (NHS Foundation Trust 2018). Hence, after understanding the need to be informed about all risk and extra precautions needed during the process, the informed consent form was prepared. A complete informed consent is one which discloses all information related to nature of the decision, reasonable alternative to the proposed intervention and relevant risk, benefits to the decision (Parsons and Kennedy 2007). In accordance with this requirement, the informed consent form gave all details regarding side effects, serious side effect, need for regular blood test and white blood cells monitoring and disclosure of blood counts to the concerned authorities (ICH 2018). Hence, the document and the information presented are capable of giving detailed information to patient about the treatment and fulfill patient’s right to information and autonomy in care. However, the resource alone cannot fulfill action 2.4. The informed consent process in health organization and compliance with the protocol also needs to be monitored to find out whether the resource is suitable for action 2.4 or not.

During my placement and training at the mental health hospital, I was informed regarding the informed consent process and the board which has taken the mandate to take regulatory steps to establish informed consent process in the hospital. The hospital’s informed consent protocol mentioned about the regulatory requirements and the IRB’s written approval of the written informed consent form was also available at the hospital. Hence, this ensured that the resource (informed consent form) was in accordance with legal standards and requirements. Written approval from concerned authority gives the opinion about transparency and utility of the process in clinical practice (Van Belle et al. 2015).

In addition, before the implementation of the protocol, all the staffs were distributed the informed consent protocol and a short session was also held regarding the need for taking such approval from patient. While working at the hospital, I found that staffs were complying with the process and they were using at all applicable situations.  Staffs were responsive to the need for informed consent and they had good communication skills to communicate the message to those patients who could not understand English. Hence, I realized that training regarding informed consent process was one element that helped in the proper utilization of the informed consent form. Lentz et al. (2016) supports the fact that training modules and training sessions are important elements that make staffs aware about the main principles of informed consent, legal and patient safety implications of the informed consent process and understanding the patient capacity for decision making. Training process enables staffs to comply with best practice while engaging in informed consent process (Nusbaum et al. 2017). Hence, the resource chosen is found useful to complete the action 2.4 of the standard 2. The resource can promote patient engagement and improve health outcomes too.

Reflect on own professional practice:

While reflecting on my own experience in using the consent form, I would like to say that despite training and awareness regarding the informed consent process, I faced difficulty in completing the process. This was because the patient was incapable of taking the decision and the family member who was supposed to sign the form did not approved for the drug. I knew the drug was important for patient. However, I struggled to understand whether beneficence or patient beneficence should be followed while completing informed consent process. This is one of the ethical concerns in informed consent process (Sutrop 2011). Hence, in the future, I would like to learn about ways to overcome this type of difficulties while using the resource for engaging with health consumers.

Conclusion:

The report gave a critical insight into the importance of patient partnership in care and the utility of the informed consent form in relation to the action 2.4. The evaluation of resource and the process used to implement informed consent process indicated that training and written legal approval are best steps to complete action 2.4. In the future, all challenges encountered during the completion of the process should be evaluated and advice should be given to staffs accordingly to enhance patient care experience.

References:

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2017, ‘National Safety and Quality Health Services Standards’, ACSQHC, Sydney, NSW, viewed 2^nd October 2018, < https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf>.

Braithwaite, RS and Caplan, A 2014, ‘Does patient-centered care mean that informed consent is necessary for clinical performance measures?’, Journal of general internal medicine, Vol. 29, no. 4.  pp.558-559.

Delikanli, L., Tuncturk, M., Karakus, O.B., K?l?coglu, A.G. and Karacetin, G., 2018, ‘The role of clozapine in early-onset schzopherina: a case report’, Klinik Psikofarmakoloji Bulteni, 28, pp.259-260.

Hall, DE, Prochazka, AV and Fink, AS 2012, ‘Informed consent for clinical treatment’, Canadian Medical Association Journal, Vol. 184, No.5,  pp.533-540.

Haywood, K Brett, J Salek, S Marlett, N Penman, C Shklarov, S Norris, C Santana, MJ and Staniszewska, S 2015, ‘Patient and public engagement in health-related quality of life and patient-reported outcomes research: what is important and why should we care? Findings from the first ISOQOL patient engagement symposium’, Quality of Life Research, 24(5), pp.1069-1076.

ICH 2018, ‘Informed Consent of Trial Subjects’, Viewed on 2^nd October 2018, <https://ichgcp.net/48-informed-consent-of-trial-subjects>

Krishnamurti, T and Argo, N 2016, ‘A patient-centered approach to informed consent: results from a survey and randomized trial’, Medical Decision Making, Vol. 3., No. 6 , pp.726-740.

Lentz, J Kennett, M  Perlmutter, J and Forrest, A 2016, ‘Paving the way to a more effective informed consent process: Recommendations from the Clinical Trials Transformation Initiative’, Contemporary clinical trials, Vol. 49, pp.65-69.

National Safety and Quality Health Service Standards 2018, ‘Sharing decisions and planning care’. [online] Viewed 2^nd October 2018, Available at: https://www.nationalstandards.safetyandquality.gov.au/2.-partnering-consumers/partnering-patients-their-own-care/sharing-decisions-and-planning-care

Newell, S and Jordan, Z 2015, ‘The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol’, JBI database of systematic reviews and implementation reports,  Vol. 13, No. 1, pp.76-87.

NHS Foundation Trust 2018, ‘Procedure and Guidance for the use of Clozapine’, <https://www.sussexpartnership.nhs.uk/sites/default/files/documents/clozapine_full_guide_trust_v22_-_1011_321_2.pdf>

NHS Foundation Trust 2018. Procedure and Guidance for the use of Clozapine. 2^nd October 2018, <https://www.sussexpartnership.nhs.uk/sites/default/files/documents/clozapine_full_guide_trust_v22_-_1011_321_2.pdf>

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Nusbaum, L., Douglas, B., Damus, K., Paasche-Orlow, M. and Estrella-Luna, N., 2017, ‘Communicating risks and benefits in informed consent for research: a qualitative study’, Global qualitative nursing research, 4, p.2333393617732017.

Parsons, B and Kennedy, M 2007. ‘A review of recorded information given to patients starting to take clozapine and the development of guidelines on disclosure, a key component of informed consent’, Journal of medical ethics, 33(10), pp.564-567.

Paul, T 2016, ‘Nothing about us without us”: toward patient-and family-centered care’, AMA journal of ethics, Vol. 18, No. 1, pp.3-5.

Saulnier, L 2016, ‘Partnering (with Patients and Families) to Advance the Practice of Patient-Centred Care’, The Canadian journal of hospital pharmacy, Vol. 69, No. 6, p.510.

Sutrop, M 2011, ‘How to avoid a dichotomy between autonomy and beneficence: from liberalism to communitarianism and beyond’, Journal of internal medicine, 269(4), pp.375-379.

Van Belle, G., Mentzelopoulos, S.D., Aufderheide, T., May, S. and Nichol, G., 2015, ‘International variation in policies and practices related to informed consent in acute cardiovascular research: results from a 44 country survey’, Resuscitation, Vol. 91, pp.76-83.