Nhs students and lack of consent.

I am a nurse I dont mind students being present for some things but as my job involves me teaching students I dont want any present when I have to expose myself so gynae or maternity I have all over any medical records no students.

My maternity notes had a big label on stating it (in hospital post natal I had no issue except for any personal care) so home and needed treatment/checks for me so daily midwife one rocks up I am asleep mum wakes me and says there is 2 of them (they were due late afternoon came mid morning) walking down the stairs a midwife I had never met says "I know your notes say no student but brought her anyway as thought once here you wouldn't say no" - erm yep I will my mum saw my face and hid in the kitchen

My reply " As with any consent No means no so please remove your student from my home" she still tried to argue saying but its winter and she will be cold in the car!!! I didnt back down and opened the door for the student. Had I not needed the treatment from the midwife I would have made her leave also.

It's so so wrong I have students working with me I ask in advance of an appointment not when the patient is sat there as its much harder for them to say No. My patients are children and I love it when one of them says No because it teaches them they have a voice and are listened to and hopefully take that into adulthood.

Not read the full thread.

The student should be introduced to you snd you should be asked (always) if a student is able to be present for your consult/examination. This is best practice.

You can always inform reception to message the GP/nurse at time of appt check-in that you don't want students present during your consult.

PS Work in GP practice and these ^^are standard practice.

Never had a problem I have epilepsy so end up at hospital a lot my local one is a teaching hospital so there's always students with the doctors it was a student who stitched up my head last time I had a seizure they need to learn somehow

I always say yes to medical students because I personally have no reason not too. But that doesn’t mean everyone should say yes because we are all different.

Ds is 12 now so if when asked he wasn’t happy with having someone in then I would respect that (he has a complex medical history so is often a magnet for students!)

Not overly impressed with the "medical-student mums" coming onto this thread and advising OP and others about how we should feel about medical students being present without proper consent at our most vulnerable moments.

Hopefully some medical students are reading this and reflecting, but no one needs or has asked for a little lecture from the parents.

My medical school daughter is on a placement at the moment at a GPs. She is enjoying being put with the nurses best of all as they have taught her so much. She of course is too young (grrrrrrr, another issue!) to have ever had a smear test herself and now she's seen several tricky ones and has learnt an enormous amount, including being able to witness the professional attitude of the staff there in conversing with patients.

I think sadly, you have had a duff run of people who haven't properly asked you for consent. And you haven't felt confident enough to ask them to leave, probably because of the atmosphere?

I am not sure logistically asking NOT in the presence of the student is feasible in the modern NHS though. They barely have time to go to the loo, let alone be constantly going in and out of a room for people to ask without them there.

Sorry you've had bad experiences. But it's been bad enough the effect of Covid on medical schools and teaching of the next level of doctors. Half DDs year group are doing "virtual placements".

Thank you @Orangesox your posts have been very insightful and interesting.

Sorry I'm not sure what you mean, mental health nurses wouldn't be doing smear tests? Yes I agree that everyone should be given a choice without any coercion, but the poster was saying about mental health nurses and placements.

@JennieTheZebra I think what I’m having trouble with is that some people on this thread have implied that MH settings should have no student involvement at all. I know that some of the skills I have I couldn’t have learned in any other setting, but I also don’t want to jeopardise consent. It’s really tricky.

I completely agree that that is preposterous; one cannot be expected to gain sufficient experience in their field in order to be able to qualify as a RMN / RNMH without having gained a broad based experience. I think the key factor is that there are degrees of involvement, and a blanket ban would be detrimental to both ongoing patient care and practitioner education.

I personally feel that if you have been open and honest with service users that you are a student, and you have respected their wishes if they directly state that they do not want you there or to be involved if the person has capacity to consent, and you have considered whether the privacy, dignity and autonomy of the person has been maintained as far as possible if they do not have capacity to consent, then you're not jeopardising consent. As you will know, many service may not be able to fully advocate for themselves on admission, particularly to PICU, so it's all a balancing act. You might find it helpful to spend some time with an IMCA as part of your studies if this is something that you're interested in.

Also.

Patient with a history of trauma and anxiety. Theres no automatic way to flag a patient as unsuitable for training. So patient turns up for a smear and gets put in a situation which should never have occurred in the first fucking place.

Hmmm.

I think what I’m having trouble with is that some people on this thread have implied that MH settings should have no student involvement at all.

Yeah I'm not sure how that would work either, surely it would be a huge risk to have nurses first enter a ward upon qualification and have the responsibility of their pin etc!

@Orangesox

I largely agree with you. I think that service users should be assisted/encouraged to express their opinions on their care as much as possible and that respect and dignity is something that everyone is entitled to-and of course this includes consent to all aspects of care including student involvement. I think what I’m having trouble with is that some people on this thread have implied that MH settings should have no student involvement at all. I know that some of the skills I have I couldn’t have learned in any other setting, but I also don’t want to jeopardise consent. It’s really tricky.

@MarbleQueen I'm surprised too- I really, really struggle with the dentists. I'd rather have a smear test, I hate it that much! But again that's me- I really struggle with medical stuff in general though. Sometimes gynae I can cope with purely because I have never not had the option to be seen by a female HCP. And have only managed smear tests/colposcopies because of choosing a female HCP. Had male consultants do a colposcopy and LLETZ treatment before and it was awful. Never again. I'm putting off going to the GP about something really difficult for me atm because if I need to go to the hospital I don't think there are any female consultants who work in that area. I can't contemplate certain investigations etc being done by anyone other than a female HCP and no way could I deal with students observing.

I agree with all of @RedToothBrush posts.

If your starting point is about the staff, you miss the point*

It's broken and wrong.

[quote JennieTheZebra]@Orangesox

How do you think we should manage students in areas where very few patients have capacity (say PICU or a forensic ward)?[/quote]
Interesting question - thank you for asking! Having working on PICU and long-term BPD rehab prior to training as an adult nurse, I think there's a time and a place for student intervention and all the nurses that I worked with seemed to feel the same way based on my interaction with them. I also returned to my old wards whilst undertaking my alternative placement during my RNA training - even though I had worked on those wards, and knew some of the patients still, I still asked for their consent as to whether I could observe deeply intimate and personal aspects of their care.

Our students joined us initially undertaking a HCA capacity to get the lay of the land, ward routines, observed ward round if patients were happy for them to sit in, or discussed the ward round afterwards if they weren't present, before becoming more involved in the individual care of specific patients. As you will know, capacity is not binary, and whilst someone may be detained under the MHA and therefore have limited capacity to make decisions about the place of their care or treatment, they should still be involved in decisions about their care wherever possible, and usually will have the capacity to decide if they're happy for a student to observe their 1:1 sessions with their named nurse, to make their feelings known about whether they're happy for a student to be involved in close obs or accompanying them on S17 leave if applicable for instance.

I know my views are quite contentious though... so I'd be really interested to hear your views on it if you haven't already expressed them? If you have, my apologies I will go back and read through the rest of the replies.

Honestly, for me personally, they can have a whole room of students in there, they have to learn, much as the medical staff before them did.

How you frame a question matters. It will elicit certain responses if you constrain it or set up certain limitations of thought.

[quote Promleafyus]@RedToothBrush no I am not, if anything you are twisting things and not reading posts properly. You are obviously ignorant to mental healthcare settings and the training nurses do who go on to qualify as nurses in this speciality, so perhaps just don't comment on stuff you don't have a clue about :)[/quote]
Yeah whatever. Im just a patient.

I've already said its about trust and a failure on the part of the nhs to build that up from the ground up.

Many mental health patients are the result of systematic failure and a breakdown of trust much earlier in the NHS system than when they reach a ward.

Patients continue to have rights over consent even when incapacitated. If your answer to consent not being duely considered, obtained and part of a due process of assessing whether a patient is in a state to feel able to object or because you think training is more important than rights, then you are asking the wrong questions and aren't taking the problem seriously. Freely given consent remains just an inconvenience to you that can be ridden rough shot over. As I say I find it disturbing that rights (and consent is a right rather than a desire or want) are deemed lesser than medical students. If your culture is to ignore the issue and use emotional blackmail to say 'well if you don't put up with the way things are then there will be no doctors', then your entire culture isn't right.

And beside that I certainly don't trust you.

Think about how you regain trust and rebuild it. Its certainly not through 'questions' like the ones you've been asking. Your 'questions' are actually closed statements because instead of saying 'how can we improve the situation for patients?' you immediately through in the barrier of 'but what about the staff needs?' which sets up a particular chain of conversations which centre the doctor not the patient.

What you need to do is say 'what does this patient need? What are their rights?', first and foremost without cavets or conditions and then work backwards from that and say 'this is a patient with trauma - are they suitable for students at all? Do we think they would be ok with a build up to that over time and how would we guide them through that? Etc etc.

If your starting point is about the staff, you miss the point.

You balance competing rights against each other. You dont balance rights versus desires. If a patient just isnt up to a student then their right trumps everything.

Even when it comes to mental health there will be people who just aren't arsed. But you also have others for whom putting the educational needs of a student first can ultimately be harmful.

I don't know why this is a difficult concept to get.

A patient with systematic distrust of hcps isn't the person to be training on. Full stop.