The recording and documenting of consent checklist (Adapted from Cox et al. 2017)
Learning Point Summary
The nurse should always ensure the checklist is fully completed in the first conversation about consent for each specific intervention.
If it is not recorded, it will not be deemed as completed in a court of law.
Whilst the first recording of consent is more detailed, this will support the nurse in future conversations about consent as this can be referred to and only changes to the consent need to be documented in detail; the rest can be agreed as remaining unchanged.
Ensure that you revisit consent regularly and who has capacity and competence and document any relevant changes, including withdrawals of consent.
11.9 Nursing and Midwifery Council (NMC) Code of Conduct and Consent
The current conduct which was published by the NMC (2015) and can be found at this web address (www.nmc.org.uk/standards/code/read-the-code-online/) has four main sections within it ‘prioritise people, practise effectively, preserve safety and promote professionalism and trust’. All four sections have aspects within them that would impact on an aspect of gaining, recording or documenting consent. It is helpful for the nurse to be mindful that they are not only upholding legal rights when involving CYPs in decision-making and consent processes, they are also upholding their professional rights too.
This last section will offer a range of resources to help with facilitating consent for CYPs. These are for the nurse to use to support the CYP and their families in understanding the information and establishing capacity and competence.
11.11 Circles of Compromise
The circles of compromise are a helpful tool that can be used with CYPs and their parent, caregiver or family to come to a compromise about treatment options. This tool does not negate the position of competence or capacity but is helpful to use if there is a concern that the CYP will be at an increased risk of distress in returning home due to the competing agendas or differences of opinion. As previously highlighted, it is important to ensure that the CYP is not further distressed due to the decisions agreed within CAMHS. On using the circles of compromise, the nurse can draw these circles on a big sheet of paper or a white board to use to support the intervention. By making the drawing visible to everyone, this helps with a collaborative approach to the intervention. Start off by adding in the CYP’s views on treatment in circle one and the parental and caregiver’s views in circle two; some example have been added in Fig. 11.2 to offer some ideas. Then you use circle three to draw up a compromise and an agreement between both competing views. How might you negotiate the compromise in circle three in this situation detailed in Fig. 11.2?
An evidenced based therapy will be offered to begin with This would be evidence-based therapy detailed in the National Institute of Health and Care Excellence (NICE) guidance (NICE 2019). Education about treatments is extremely helpful for both CYPs and the parents and caregivers in order for them to make informed choices; this would include evidence-based therapies and pharmacological treatments. Many CYPs and caregivers do not fully understand the concepts and structures of evidence-based therapies, or understand the side effects or pharmacokinetics of medication. For example, when being prescribed some mainstream anti-depressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) with examples such as fluoxetine and sertraline, there is not much knowledge around the potential side effects of suicidal ideation and that they can take up to 12 weeks to have full impact. Many believe that all medication work with immediate effect (NHS 2019).
It will take place in school, but on alternative lessons. To understand the CYP’s and parent/caregivers’ perspective in why they do or do not want it to take place in school is an important understanding for the nurse. In this instance, the CYP struggled with transport and found it difficult to get to CAMHS premises and wanted to support themselves under their own volition; parents did not want the CYP to miss any lessons due to upcoming exams and concerns about the CYP missing too much of the same lesson. Therefore, a compromise was made about having the sessions in school, but swapping the times and dates to ensure there was minimal disruption to the CYP’s curriculum. In situations like this is maybe helpful to discuss with the school, (with the CYP’s permission) to ascertain when the appointment can take place that will cause the least disruption.
Medication to be discussed at timely review of therapeutic intervention. It was agreed that at the review of the evidence-based therapy, which is usually every five sessions, a conversation could be had about the use of medication. This compromise helped keep the parent or caregiver onside, knowing that it had not been forgotten, but also enables the CYP to have the evidence-based therapy they had requested. The discussion about medication does not mean that it will necessarily be prescribed, it would be hoped that the impact of the evidence-based therapy would be observable by all and medication may not needed at this point.
Parents/caregivers will be given a general update after each meeting. It was agreed that a 5-min update will be given to parents in a very generalised way after each meeting. This again helped keep parents on side but allowed for privacy and empowered the CYP.
Whilst the above points offer an example of compromise, this could have been compromised differently. The importance is ensuring that both the CYP and the parent or caregiver are happy with the agreement. Using the circles of compromise demonstrates that the CYP and the parent or caregiver have been heard, listened to and validated, which are important attributes in establishing a compromise that will work for all parties. The circles of compromise are transferable to many different aspects of negotiation within many different settings.
11.12 Child Involvement and Participation Resources
www.minded.org.uk (Health Education England 2019) accompanies the CYP-IAPT strategy and offers training, advice and guidance for CYP, parents/caregivers and professionals. This website is also embedded within the e-learning for health website.