Martha’s rule recognises strength of nurse-patient relationships

The trust placed in nurses will be central to new process designed to enable patients and families to seek a second opinion

Martha Mills, smiling, with hills and a body of water in the background. Martha’s rule for securing a second clinical opinion will be introduced in her memory
Martha Mills Picture: PA

Martha Mills should have celebrated her 16th birthday this month, instead, September marks the announcement of a rule in her name that will empower patients and their families in the care decision-making process.

‘Martha’s rule’ gives patients the legal right to a second opinion and is the result of campaigning by the teenager’s parents following their daughter’s avoidable death from sepsis after a fall from her bike.

A coroner ruled last year that Martha, aged 13 when she died, would probably have survived, had doctors heard her mother’s concerns about potential sepsis and moved her to intensive care.

The power of the nurse-patient relationship

The rule, which the NHS in England is working to introduce as soon as possible, looks likely to recognise the uniquely personal and powerful relationship nurses build with patients and their families.

It will be similar to Ryan’s law in Queensland, Australia, where a three-step escalation process recognises nurses’ central role in supporting and guiding patients and relatives who want a second opinion.

Under this law, patients and families can raise their concerns with a nurse, escalate to the nurse in charge of a shift and, in the final step, ask a nurse to request a clinical review of care.

Nurses are often the patient’s confidant and advocate thanks to the rapport built by the continuity of care and close monitoring they provide. Trust is at the heart of this therapeutic relationship.

Meanwhile, studies suggest the quality of the nurse-patient relationship enables a greater understanding of a person’s clinical need and, in turn, better outcomes.

There will, naturally, be concerns about potential misuse of Martha’s rule and more detail is needed. However, the rule is designed to strengthen processes for raising concerns when all other mechanisms have failed.

And it recognises the pivotal importance of the nurse-patient relationship.