Nhs students and lack of consent.

[MarbleQueen]

I’m wondering if something has changed within the Nhs. At one time you were asked if you minded having a student being present.In my area they are present at every appointment without any discussion and I’m getting fed up with it.

In the last two years these things have happened.

A student midwife was brought into my room and participated in my delivery without any discussion. She was instructed to break my waters and deliver my baby without any discussion with myself. The midwife focused on talking her through things instead of supporting me. I was alone because of covid restrictions. I later discovered it was the first baby she delivered. I felt like a piece of meat.

I went for a smear and when I walked in the room there was a nurse and 3 very young women present. When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

I had a dentist appointment for my first ever dental treatment. I told them I was nervous. Again when I went in, I was told, not asked that the 2 people present were dental students and would only be observing. The dentist focused on explaining things to them and actually allowed one to place the filling. I didn’t agree to this.

I went to a gp apointment for something intimate to find a man around 18 years old sat in the room. Again I had to ask who he was and was told he was a student. I had to ask for him to leave and it was really uncomfortable.

I had an apointment to have a very unpleasant procedure. There was the usual student perched in the corner without any discussion. Again I had to ask who they were and was told, not asked, that they would be observing. The doctor focused on explaining things to them and when the procedure was finished I actually realised 3 more students had been brought in to watch without me noticing.

I have previously had a type of abdominal cancer. I have checks with scans and have seen the same consultant for years. On my last visit there was the usual student perched in the corner without any discussion. On this occasion, and this occasion only, the surgeon suggested doing a VE. I asked him what information he was hoping to get from this considering he had a recent MRI scan in front of him and he simply dropped it. I strongly suspect this was going to be for the students benefit because it certainly wasn’t going to benefit me.

Each of these places have standard notices in their waiting rooms informing you that a student might be present but this is not consent. I think this is now something you have to actively opt out of instead of opting in.

Has anyone else noticed this happening? I worry about what these students are learning about consent in these circumstances.

@RedToothBrush

A student MH nurse will have max 1 semester (so 12-16 weeks) of lectures before being placed in a MH setting, so a community MH team or a ward. Student MH nurses at my uni start their placement after 6 weeks of lectures. MH nursing IS a speciality so they don’t learn anything else so there’s no other areas to “build up” in. As for restraint training, this is learnt “as and when” and tends, due to insurance, to only be done by qualified nurses unless it’s a real emergency but, at night for example, a final year student nurse might be the most senior person immediately around, especially if acting as “nurse-in charge”. This way of training MH nurses is standard around the world, not just in the NHS. Would you do it differently?

@RedToothBrush what do you think of HCAs/support workers who start work on the ward their first day more or less, potentially with zero experience in this type of work? Where do you propose mental health student nurses (yes it is specialised and the course is one in its own right) gain experience?

All the posters saying you dont understand why OP is being so precious about it... dont you understand consent? OP has a right to be as "precious" as she wants. If she doesnt feel comfortable then thats it, no consent. There are plenty who will consent, plus others who will consent because they feel obligated to (not true consent). OP is likely to be in the minority so the students will still learn.

Realistically putting a trainee on a mental health ward before they are fully trained elsewhere isn't really appropriate. Its a speciality and should be treated as such.

It is. That’s why mental health nurses have completely separate training. Paediatric nurses do too.

@JennieTheZebra

It isn’t the job of patients to come up with a solution to the problem of how medical students are supposed to get enough hands-on training. I don’t understand why you think it is.

@JennieTheZebra - I think you're being disingenuous. Many people have not suggested that people with MH difficulties should never have students. There is a difference between someone with MH difficulties objecting to bring treated like a piece of meat during intimate examinations and objecting to students being involved in their MH treatment. Numerous posters have in fact said that they would welcome students interacting with them and treating them like fellow human beings rather than gormless staring at them.

For me personally if I was having outpatient mental health treatment I would have less of a problem with my doctor introducing a student after we had built up a relationship of trust and if said student introduced themselves properly and interacted with me like another human.

I don't have the answer to where it's inpatient treatment and patient can not fully consent due to lack of capacity. I can only talk from my experience.

@RedToothBrush - your post at 10.01 is amazing. You summarised the issue very well.

The NHS is a teaching service so students being taught on placement is just what happens, if they cannot learn practically in addition to lectures how on Earth are they going to practice on their own?!?

I work with the ambulance service and most crews have students attached but you'd be unlikely to know who was who unless you're reading everyone's epaulets, it's certainly not normal practice to point out the student and ask if they remain in the room, they're there to assist and learn, and they're part of the team. I suppose that's the difference between in/out of hospital services as they wouldn't be standing/gawping, they'd be getting involved taking observations etc from the first day of placement. The only time it would be mentioned that they were a student would be if they were to undertake a procedure i.e. "Mark is one of our student paramedics, would it be ok for him to place your cannula..."

Of course our bodies are precious to ourselves, given the choice we'd all choose to be seen by the top consultant/most experienced member of staff. However some of us will be a brand new surgeons first patient, have the wound the nurse practitioner closes for the first time, the first patient a paramedic performs CPR on.

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

The NHS is a teaching service so students being taught on placement is just what happens, if they cannot learn practically in addition to lectures how on Earth are they going to practice on their own?!?

Again for those at the back, it’s not the responsibility of patients to come up with solutions as to how medical students should get enough training.

@Warmduscher

The NHS is a teaching service so students being taught on placement is just what happens, if they cannot learn practically in addition to lectures how on Earth are they going to practice on their own?!?

Again for those at the back, it’s not the responsibility of patients to come up with solutions as to how medical students should get enough training.

I agree, but anyway, there are enough patients who are happy for students to be present/treat them.

What is needed is an easy and non confrontational way for the few who don't want students present to be able to say so, preferably in advance to avoid embarrassment. Ideally it should be something the receptionist sorts out when checking in, with a note on the records to signifiy consent or non consent.

Students also need to be trained/prepared to accept when a patient doesn't want them present without feeling awkward or taking it as some kind of personal insult. It needs to be accepted as a normal choice and not personal.

@Warmduscher

No it’s not (although the NHS constitution says that service users should be consulted) but, to be frank, you’ve made it an impossible circle to square. It’s not about whether you, personally, would turn down medical care from a student or otherwise but what the rules should be in general, especially for sensitive situations or for those who lack capacity. Service users have a right to respect and dignity but at the same time students have to learn-and there are some things that you can’t learn through role play/video. Somewhere the line has to be drawn and it does help to know what service users think, even if it isn’t their “job” to solve.

[quote Promleafyus]@RedToothBrush what do you think of HCAs/support workers who start work on the ward their first day more or less, potentially with zero experience in this type of work? Where do you propose mental health student nurses (yes it is specialised and the course is one in its own right) gain experience?[/quote]
I think that students do a different job to health care workers.

A health care worker certainly shouldn't be there for intimate examinations nor deeply private conversations.

Does that help?

@SleepyRich

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

An emergency situation is completely different. If you'd already been occupied with another call, it could well have been delivered by a taxi driver, or someone with a St John's or other first aid certificate (if in a workplace or shop etc), or even a random passer by or neighbour.

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

What is needed is an easy and non confrontational way for the few who don't want students present to be able to say so, preferably in advance to avoid embarrassment. Ideally it should be something the receptionist sorts out when checking in, with a note on the records to signifiy consent or non consent.

Which is EXACTLY what some here are saying. I have personally done this. And I'm STILL asked or put into situations I have explicitly in writing have said I'm uncomfortable with.

I don't feel respected precisely BECAUSE its ignored.

Thats not consenting to things. Thats being put under pressure to 'comply'.

@SleepyRich

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

Then they need to make sure that students are only learning from the (apparently very, very many) people who have no issues whatsoever with giving consent, in any occasion, to being observed, used as a demonstration model, practiced on, etc.

My OH has long term incurable cancer and has regular blood tests and infusions. He always refuses a trainee or HCA if one is allocated to take blood or place the canula. That's simply because his veins are absolutely shot at due to years of needles etc and even the most experienced nurse can struggle to successfully insert the needle into a vein.

He's finally managed to get it written into his notes and most times he can now avoid the embarrassment of having to ask for a more experienced nurse (and he goes so often, the staff at the day treatment centre now know him!). He's even managed to get his GP practice to write it into their notes too so he now gets put on the list of their more senior nurses rather than their HCAs!

@SleepyRich

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

Plenty of people are happy to consent, i.e. those without health anxieties, mental health issues, etc. I would imagine it's a minority who don't want trainees/students present. All that is needed is a simple method of consent, which is best obtained by the receptionist when booking in.

[quote user1497207191]@SleepyRich

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

An emergency situation is completely different. If you'd already been occupied with another call, it could well have been delivered by a taxi driver, or someone with a St John's or other first aid certificate (if in a workplace or shop etc), or even a random passer by or neighbour.[/quote]
Whilst I completely agree there are a number of differences between planned and emergency procedures, there are also very different expectations placed on a Paramedic from a taxi driver.

I think there's another issue too, which is the level of the trainee/student.

After all, even a junior doctor or registrar is still officially "training" and under the control of the consultant. But few people would object to being treating by a registrar!

A medical school student on a placement is a very different matter to, say, a qualified nurse "training" in a specific specialism.

@SleepyRich

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

Absolutely, but I still want to be asked each time.

The day that I went into hospital to deliver my deceased baby, I was fine with having a student nurse site a cannula. It took four goes, both arms and ended up in my elbow crease rather than my hand, but it was OK.

Five days later, when I had a raging womb infection, a high temperature and felt like I was on the edge of collapse, I wasn't in the mood to be a pin cushion for someone practising.

I’m not disputing that. In fact it doesn’t surprise me in the slightest. What did surprise me was the PP who stated she wouldn’t allow a student in any of her gynae appointments.

Why?

@SleepyRich

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

Actually people have repeatedly asked the question, “So how do you expect students to learn?”

Unless it’s a hypothetical question, which I doubt it is, people definitely are expected to provide a solution, especially if they don’t want to consent. Some people have even used the word “duty”.

I have no idea how you “square the circle”. When I’m receiving medical care I won’t be thinking about whether a medical student’s training is adequate and if it isn’t, what I can do to resolve that problem.

Unacceptable that it hasn't been discussed with you. I know students must learn but I'll always ask them to leave if it's anything personal.

When I trained as a nurse, both as a General and psychiatric nurse, we were NHS employees and did most of the hands-on, basic nursing care from our very first ward, as there's never be more than 2 trained nurses on duty, often only one. Having said that, all patients should be asked for permission for students to observe procedures and examinations, especially intimate ones and the focus should always be more on the patient. We were taught to explain to our patients what we were doing- it's part of treating them as whole persons, not just their conditions!!!
One thing that has baffled me is why on Earth do trainee HCAs need to observe a cervical smear? I was never even brought to observe one when I was training to be a Registered General Nurse! It's a procedure done by Practice Nurses who have completed post -Reg speciality training and only needs to be observed by those undergoing such training and are already Registered, or so I would have thought.
You were perfectly within your rights to ask all of them to leave (it's your body and there will be other patients who do not mind. That said they should always BE ASKED!!) but especially in this case and the trained nurse was out of order to imply it was "silly" of you as HCAs do NOT do smears! (Hell in my day even RGNs didn't do smears, one had to have had the post Reg training!) Not as far as I'm aware anyway! Not unless even THAT'S changed since I was practising but feckin' hell, I HOPE not!!!

Are there really people who don't understand why some women might not want students observing their gynae appointments?

If I were at such an appointment, I'd be panicky and probably in tears at the thought of getting undressed in front of a stranger. I'd insist that the practitioner was female. I'd be consenting to the examination/procedure, but very distressed by it. Can you see why I might not want extra onlookers, be they students, experienced doctors or anyone else?

I can understand that women with different views and life experiences from me would be totally fine and not mind at all who was there. Is it so hard to imagine that not everyone is like you?