There was nothing wrong with the patients care...the notes say so!

Now, a little while back I wrote about political unspeak would never work for me. Now, I was saying then how there was absolutely no way on earth we (the nurses) would get away with saying such a load of rot as found elsewhere in politics. Over on the Dr Rant blog, I have been having a rather good discussion regarding how patients and their relatives have their say with one thing that came out being the fact that quite often relatives never really have a say on how they think their relatives are receiving care.

Granted, there are some legal issues in discussing a case of a patient with relatives and of consent issue. The Nursing and midwifery council (NMC) in the Code of Conduct state in clause 5 "As a registered nurse, midwife or specialist community
public health nurse, you must protect confidential information.
5.1 You must treat information about patients and clients as confidential and use it only for the purposes for which it was given. As it is impractical to obtain consent every time you need to share information with others, you should ensure that patients and clients understand that some information may be made available to other
members of the team involved in the delivery of care. You must guard against breaches of confidentiality by protecting information from improper disclosure at all times". So, in effect, all patients must give consent before the nurse tell their relatives anything, which is of course not fully practical as relatives will always like to know what is happening to there loved ones. So, in practice we make sure the patient is happy for us to give out this information and keep people happy. One of the big problems with this is giving information over the phone as there have been times when there has been a patient in a hospital where the wife phones up, the nurse tells the information only for the husband to say the they were getting divorced and he did not want to have the wife know what was happening. So, we get consent.

While on the issue of consent the NMC state that in clause 3.4 You should presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can use it to make an informed choice.

3.5 Those who are legally competent may give consent in writing, orally or by co-operation. They may also refuse consent. You must ensure that all your discussions and associated decisions relating to obtaining consent are documented in the patient’s or client’s health care records.
3.6 When patients or clients are no longer legally competent and have lost the capacity to consent to or refuse treatment and care, you should try to find out whether they have previously indicated preferences in an advance statement. You must respect any refusal of treatment or care given when they were legally competent, provided that the decision is clearly applicable to the present circumstances and that there is no reason to believe that they have changed their minds. When such a
statement is not available, the patients’ or clients’ wishes, if known, should be taken into account. If these wishes are not known, the criteria for treatment must be that it is in their best interests.

Which leaves the relatives in the dark. Which is a problem as we then never seem to gauge the opinions of the relatives until you find somebody who ends up having bad treatment. Then, and very rightly so, they make their views known. What will then happen? Will there be a white steed riding onto the ward (using the hand gel first) to sort everything out to turn the ward into a beacon of care?

Erm... no, not really. The TV show scrubs has twice portrayed what I imagine both the public and myself see the complaints system as. Once it was a bin, the second time the complaints were fed through a letterbox which leads straight to a paper shredder. Of course, if the aggrieved relatives DO get a reply, you can guarantee it will be a great fob off.

It is true that relatives will be the ones who will make the complaints on behalf of their relatives, but one thing the system seems very bad at is getting the views of the relatives known as they are the ones who will know the patient to give staff information on, and also more likely to expose the weaknesses of the ward that staff cannot see.