Obtaining Consent for Student Involvement 

BACKGROUND

Kendra is an occupational therapist (OT) who is currently supervising a student, Jamie, on her first clinical placement in an acute general medicine unit. During their initial visit with Kendra’s client Mrs. Patel, Kendra asks and receives verbal consent to have Jamie observe the visit while Kendra conducts a physical assessment and transfers Mrs. Patel from her bed to a chair.

Following the assessment, Kendra and Jamie debrief, and write up their analysis and recommendations for Mrs. Patel. Kendra documents her assessment, and that she received consent from Mrs. Patel for Jamie to observe.

During their second visit with Mrs. Patel, Kendra asks Jamie to transfer Mrs. Patel from her bed to a chair as she had demonstrated during their initial visit. Jamie, who appears nervous, begins to transfer Mrs. Patel into the chair. As Jamie begins the transfer, Mrs. Patel becomes very upset and screams “She doesn’t know what she’s doing! I’m going to fall!” In response, Kendra quickly takes charge of the transfer, while Jamie steps back. 

Later, Mrs. Patel tells Kendra that she was sorry about what happened earlier, however she did not feel comfortable working with a student due to her nervousness. Mrs. Patel states that she did not give consent for the student to touch her.  After the encounter, Jamie appears distraught and withdrawn and Kendra reflects on what went wrong.

CONSIDERATIONS

  • Kendra reflects on Jamie’s level of competence, experience, and confidence in performing the transfer. She realizes she did not discuss the transfer with Jamie prior to involving her.
  • Kendra reflects whether she obtained informed consent for Jamie to perform the transfer with Mrs. Patel.

  • Kendra reviews the Standards for the Supervision of Students. 

OUTCOME

3.3 Evaluate and ensure that the duties assigned are appropriate to the student’s knowledge, skills, clinical reasoning, level of education, and experience.

4.1 Prior to involving students, obtain informed consent from clients or their substitute decision-makers (SDM) for the student to provide occupational therapy service.

4.2 Clarify the responsibilities of the OT and the student and provide clients/SDM with specific information about the role and activities the student will perform.

8.4 Manage, communicate and discuss the risks for each client, before assigning service. 

  • Kendra returns to Mrs. Patel and apologizes for not obtaining consent for Jamie’s involvement in the transfer. She reviews the occupational therapy treatment goals and the OT’s role and responsibilities in overseeing the care provided by students. 
  • Kendra has a discussion with Mrs. Patel about informed consent and determines that Mrs. Patel consented to having the student observe the occupational therapy assessment, however she did not have the opportunity to consent to the student transferring her.
  • Kendra confirms consent from Mrs. Patel for the components of the occupational therapy treatment plan that are to be assigned to Jamie. She documents these in the clinical record.
  • Kendra apologizes to Jamie stating that she should have had a discussion with her to discuss her competence and experience with transfers. Kendra formulates a plan to practice transfers with Jamie and provide feedback to improve Jamie’s competence and confidence.


DISCUSSION

When supervising students, OTs are expected to consider:

  • The student’s progression within their educational program

  • The student’s learning needs and style

  • The student’s previous clinical experiences

  • The student’s clinical knowledge

  • The student’s strengths and weaknesses

  • The level of risk associated with the practice area and the activities that are assigned to a student

When involving a student in any form of occupational therapy service, informed consent must be given by the client or their substitute decision maker. Consent is an ongoing process throughout service delivery. OTs should ensure they obtain informed consent for the involvement of students as well as for the specific activities that the student will carry out with the client.
  

REFERENCES

  • Standards for the Supervision of Students

  • CONTACT

    If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org

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