Annex A > Chapter 17 - Communication Between Healthcare Professionals and Patients > Calculating risks and informing parents about them > Nurses
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Nurses
Sister Woodcraft
117 Joyce Woodcraft, Senior Sister, BRHSC ICU 1985-1994, indicated in her written evidence to the Inquiry that, whilst nurses did not generally play an active role in obtaining consent from parents, they were present during discussions between the clinicians and parents.
`In relation to Mr Dhasmana and Mr Wisheart, I have sat in with them many times whilst they explained to parents and family members the operation required. In my professional opinion they explained carefully and showed a great deal of empathy with the family. They drew diagrams to explain the surgery to the families. They were always careful to fully explain the risks involved.' [142]
Sister Disley
119 On the role of nurses in the discussions about consent and the risks of surgery, Sister Disley, Ward Sister, BRI, told the Inquiry:
`Q. You say that you had no role in discussing with families what the risks and benefits of the operation were. Whose role was it?
`A. Possibly the cardiologists must have been involved.
`Q. The cardiologist, would he normally be involved?
`A. Yes, they would. They would see the children in the initial stages.
`Q. For adults, the cardiologist would be in the same building as the surgeons?
`Q. Was there any difficulty in having these discussions in the case of children when the cardiologists were based elsewhere? Did the cardiologists come down to the BRI to take part in this discussion?
`A. This particular discussion, I would have imagined would have taken place at the Children's Hospital before the children were admitted for surgery.
`Q. Do you remember witnessing the risk discussion, if I can put it like that, between the surgeon and the cardiologist and parents of a child at the BRI?
`Q. So when you say that you attended discussions in supporting role -
`A. I think what I am referring to is discussions that probably happened maybe one or two days pre-operatively. I think they were discussions to just clarify issues that had been discussed several times before with the parents about the risks and benefits.
`Clearly, the day before surgery is not the day to be identifying those risks and benefits. That is the stage to which I am referring.
`Q. Would your role at this stage have been to provide essentially reassurance to the parents, to the patients?
`A. I think so. I think parents were probably very anxious and had questions to ask afterwards. It was useful if you had been there to explain.
`Q. Let us take parents of a child. The child is going to have surgery tomorrow or the next day. What kind of questions would the parent ask of you, as the Sister, as opposed to the cardiologist or the consultant surgeon?
`A. I think they would be asking things about the pattern of the post-operative recovery, how long the child might be on a ventilator, how long they might have chest drains, where they could eat, at what stage they might be expected to wake up, that sort of thing.
`Q. Would they ever ask you about the surgeon himself? Would they ever say, "Is X good?"
`A. I do not recall anybody asking me that.
`Q. Would you provide reassurance by saying things like, "Your child is in good hands with Mr X"?
`A. I might have done. It is very difficult to remember.
`Q. Is that the sort of reassurance that you might well have provided?
`A. I think the reassurance that I am talking about refers to their post-operative recovery in the intensive care, explaining that route that the child would go down.
`Q. Do you ever remember attending one of these discussions and hearing a risk or a benefit quoted to a patient, or a parent of a patient, that you disagreed with?
`A. I do recall such an occasion, but it was actually after the child had had surgery.
`A. It was an occasion where the child was - I cannot even recall the surgery he had. He had made slower than expected progress, and was beginning to fit, if I can recall.
`Q. What was said that you disagreed with?
`A. I cannot recall the details of the discussion, but I felt that it seemed optimistic.
`Q. The chances of survival being quoted? What was being quoted that was optimistic?
`A. The recovery that the child would make.
`Q. What did you do when you heard this being quoted that you thought was optimistic? How did you react?
`A. At the time, I did not do anything - at the time, no, I did not do anything.
`Q. When was this incident that you recall?
`Q. Who was the clinician who was giving what you thought was an optimistic prognosis?
`Q. If you had a similar experience tomorrow at work with a patient and a clinician, would you react differently now?
`A. Yes, I think there are occasions perhaps when we are discussing the care of long-term patients, and - yes, I would.
`Q. Who would you go and talk to? Would you go to Fiona Thomas or Rachel Ferris or a clinician?
`A. I would probably talk about it with a clinician.
`Q. The one who had given the advice?
`Q. Can we go to WIT 85/35, please? This is again Dr Bolsin's comments on your statement. He has given a comment on this particular paragraph. He said he would be surprised if a senior ward manager of long-standing, which I think is a reference to you, did not enquire of the surgeons whether the figures being quoted to relatives were correct or not.
`First of all, is that something that you did before 1995, to enquire of the surgeons in that way?
`A. As I have said earlier, these discussions, talking about figures being quoted, were undertaken pre-operatively, and not commonly undertaken in the ward for the first time.
`Q. As far as you were aware, were you alone in not questioning them, or was that common practice among ward sisters?
`Q. Do you know of anyone who did enquire of the surgeons whether the figures quoted were correct or incorrect?
`A. No, I do not.' [143]
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Footnotes
[142] WIT 0121 0009 Ms Woodcraft