What is involved in informed consent?
Legally, this requires that the patient, or his/her surrogate, is informed of the risks, benefits, and alternatives to a treatment. A signature on the consent form provides legal documentation of consent.
Ethically, consent is about patient autonomy, meaning the patient understands and freely agrees to the treatment.
Consent may be withdrawn at any time. Healthcare providers must accept and support refusal or withdrawal of consent even if they disagree with the patient.
The consent process can be affected by complexity of the treatment, patient condition and ability to understand information, and if treatment is emergent or elective.
What can nurses do to improve informed consent?
Think about consent as a process to assure patient understanding and agreement, not just signing a form.
Informed consent should be a collaborative activity between the physician, nurse, and patient. The physician should have obtained consent before the nurse has the patient sign a form.
Nurses can offer what we do best—patient teaching, as we check patient understanding and obtain written consent. Where possible, use the teach-back method, asking the patient to repeat back what he/she understands. However, our teaching cannot take the place of prior physician / patient shared decision-making.
Assess for paternalism – from the physician, from yourself. We understand so much more than the patient and are trying to help, but we cannot pressure or tell a patient what to do.
Consenting to treatment is scary. As much as possible, obtain consent in a quiet and calm setting, with time to answer questions.
Because nurses do not perform surgery or direct medical procedures, in most situations, obtaining clients’ informed consent does not fall within the nursing duty. Even though the nurse often assumes the responsibility for witnessing the client’s signature on the consent forms, the nurse is not legally responsible for obtaining the informed consent.
What that means is you, as the RN, are merely collecting the signature, not responsible for the information included on the form or provided by the physician. You are like a notary when you sign it yourself. You are simply verifying that the patient signed the consent voluntarily.
That’s the legal standard, but the ethical standard, the moral standard is a little more complicated. When you hand the patient that form you should ask, “Do you understand the procedure you are agreeing to?” If they say no, or provide a description that is fuzzy, or if, as the nurse, you suspect they don’t really get it, you must notify someone. Call the physician, talk to your nursing supervisor, let someone else know that there is a lack of understanding on the patient’s part and don’t let them sign until that has been clarified.
The reality is lots of people, healthcare workers included, get lost in the explanations. As they teach us all in nursing and medical school, the worst time to talk to a patient is right after they have been given a diagnosis. They often just don’t hear you because their minds are wrapping around the fact they have kidney disease, or cancer or whatever else. They nod, they agree to things, but they don’t really hear.
While the nurse is not technically, or even legally, responsible for providing the information necessary for informed consent there is an ethical responsibility to look out for the patient’s best interest. The nurse’s role is both as a witness and as the patient’s advocate. As patient advocate, it is our responsibility to ask questions of the patient to determine whether he or she has received sufficient information to make an informed decision. That is a significant role and one we should never take lightly.
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