Abstract:
OBJECTIVES:to determine the extent and nature of the decisions individuals are asked to make as in-patients, and whether doctors, nurses, other health care practitioners, and housekeepers engaged in routine (non-emergency) medical assessments, investigations and treatments, or acts of personal care observe the Reference Guide to Consent for Examination or Treatment, the principles of the Mental Capacity Act (England and Wales) 2005, and the guidance from the Dignity in Care Campaign. METHODS:hospital staff working on a general medical ward and a ward for older people in a large teaching hospital in England were observed for over 50 hours carrying out acts of medical and personal care. The observations were recorded using a semi-structured record sheet, complemented by unstructured field notes. Observations were subsequently categorized, coded and counted. RESULTS:a total of 206 acts were observed, 127 (62%) of which were acts of medical care and 79 (38%) were acts of personal care. Patients approached for acts of personal care were generally presented with choices and options (78%). In contrast, when approached for acts of medical care, they were rarely presented with a choice (6%); instead, health care practitioners either requested permission to perform a procedure (29%) or informed patients that they were about to perform a procedure (50%). Irrespective of the way in which health care practitioners approached patients about acts of medical care, in the overwhelming majority of instances, patients complied (80%, 99 cases), either by giving permission for the act to be performed, or by complying and/or cooperating with the health care practitioner. In only a minority of cases did patients either refuse or resist a proposed procedure (9%). CONCLUSIONS:patients were asked to make many varied decisions and the approaches taken by hospital staff differed depending on the nature of the decision and/or act in question. In contrast to personal care decisions, when health care practitioners approached patients in order to undertake routine acts of medical care, they generally did so in a manner that did not acknowledge that the patient had a right to exercise a choice. This is contrary to current law, policy and guidance. It seems to be rooted in the practical demands of running a hospital ward and uncertainties as to the purpose of securing patient consent before undertaking routine acts of medical care.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Redley M,Keeley H,Clare I,Hinds D,Luke L,Holland Adoi
10.1258/jhsrp.2010.009148subject
Has Abstractpub_date
2011-01-01 00:00:00pages
13-20issue
1eissn
1355-8196issn
1758-1060pii
jhsrp.2010.009148journal_volume
16pub_type
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
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更新日期:2007-04-01 00:00:00
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更新日期:2018-01-01 00:00:00
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abstract:OBJECTIVES:To compare the cost-effectiveness of four third molar guideline implementation strategies. METHODS:Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline....
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-07-01 00:00:00
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更新日期:1997-10-01 00:00:00
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更新日期:2004-10-01 00:00:00
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更新日期:2007-07-01 00:00:00
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更新日期:2014-07-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章,评审
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更新日期:1997-07-01 00:00:00
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更新日期:2011-04-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2003-07-01 00:00:00
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更新日期:2008-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:1999-01-01 00:00:00
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更新日期:1998-01-01 00:00:00