Promoting Children's Access to Health Care: Nurses' Perceptions and Practices in Obtaining Consent from Children

Purpose: Children should not be deprived of their right to access health services. The ability to consent promotes access to health services. Consent laws and requirements related to health services vary amongst countries.  In the light of children’s rights and the number of children who do not live with their biological parents, progressive law reform was implemented in South Africa to promote children’s access to health services through lowering the age of consent. Nurses are required to know and apply these legal, ethical and professional requirements when obtaining consent from children. Central to obtaining consent from children is the ability to assess and arrive at a clinical judgment about the child’s maturity and mental capacity.  Various factors influence a child’s mental capacity, one of them being the health care provider’s attitude, competency to share information and respect for children’s views and perspectives.  The purpose of the study is to determine nurses’ working in a specific context’s perceptions and practices in obtaining consent from children who access health services.

Methods: A qualitative, explorative, descriptive research design was used and the study was contextual.   Professional nurses working at a hospital and primary health care clinics in Tshwane, Gauteng Province in South Africa were purposively sampled until data saturation was reached. Data were collected from October 2013 – November 2014.   A semi-structured interview schedule was followed and data analyzed using qualitative content analysis. Measures to ensure ethical research and enhance trustworthiness were implemented.  

Results: Nurses’ current practice and perceptions about obtaining consent from children and assessing their capacity to consent revealed inconsistency in implementation of the consent laws and the methods to assess maturity and mental capacity. The barriers to obtaining consent and assessing maturity and mental capacity related to nurses knowledge and interpretation of the consent laws, personal frame of reference, resource limitations, lack of guidelines and limited multidisciplinary support to assess maturity and mental capacity of children.

Conclusion: The inconsistent practice has bearing on children’s access to health care services. Multidisciplinary support, education and guidelines are required for health care providers to effectively implement the consent laws pertaining to children. Through uncovering the current perceptions and practices, action can be taken to empower nurses to act in the best interest of the child.