It’s fundamental to health care that the person receiving the care or treatment – the patient/client – agrees to receive it. That is, that he or she provides informed consent to receiving the care or treatment. By ‘informed’ we mean that the patient/client understands exactly what is going to happen because you or a senior colleague have explained it in a way that he or she can easily understand.
We can see that this is important when it relates to ‘big’ things like operations, for which the patient needs to sign a form saying he or she gives informed consent. But it’s not so well understood that informed consent is needed for everything we do with and to patients/clients, even the relatively ‘small’ things like taking a temperature or a blood pressure.
Now that doesn’t mean we need written consent for everything we do with or to patients/clients. The system couldn’t work if we needed to get the patient to sign a form every time we adjusted his or her pillows!
Verbal consent will probably be sufficient for all of the procedures you are involved in as a health care assistant – if that’s not the case, you’ll be informed by your manager or supervisor before you carry out the procedure.
The important issue here is the need for you to make sure the patient/client is happy for you to do what you propose to do. We must never assume that because we are part of a health care team, or because we wear a certain uniform, that we have the authority to do things to or for people without seeking their permission.
Everything we do for the people in our care – whether it is checking a blood pressure, helping someone to eat, changing a dressing or cleaning a set of dentures – requires their consent.
So how does a patient/client give consent? The first step is to ask the question, such as: ‘Mr Brown, is it OK if I check your blood pressure now?’ The following responses are considered as offering ‘consent’:
- the patient saying ‘yes’ or something similar (‘all right’, ‘OK’, etc.)
- the patient nodding assent
- the patient rolling his or her sleeve up to receive the cuff.
If you don’t receive any of these, you don’t have permission – consent – to carry out the procedure.
But that doesn’t mean you just walk away and forget about it! A patient’s/client’s refusal of consent for a particular procedure might suggest that there is a problem elsewhere in his or her life. Refused consent offers an opportunity for you to explore with the patient/client if there is something worrying, upsetting or discomforting him or her. Discussing or resolving the other problem will often mean that consent for the original procedure is granted.
What happens when a patient/client is unable to give consent? This leads us to consider the concept of ‘capacity’, which we will now look at in a little detail.