● Reducing fear and anxiety : Fear and anxiety can significantly interfere with patient comprehension and the informed consent process. The nurse should work to identify and address the source of anxiety and to relieve or reduce it. The nurse should make sure that all information is provided and documented, including that the patient knows they have the right to withdraw consent at any time without repercussions. Some healthcare providers have a template for certain types of informed consent such as a written explanation of specific chemotherapeutic drugs, their names, doses, how the drugs will be administered, and on what schedule, as well as anticipated adverse effects. It is especially important that patients and families know what to do when adverse effects occur and how to recognize when an adverse effect is typical and when it could lead to a serious complication. One of the biggest areas of concern in any type of informed consent or patient education process is assessment of the patient’s understanding of the information presented. Did the patient acquire the appropriate knowledge to give an informed consent? How was this assessed? How was this documented? For example: It is not sufficient to simply ask John and his wife, “Do you understand the side effects this chemotherapy can cause?” Questions that can be answered with a yes or no should be avoided. Some people will simply say “yes” because they are nervous and want to move along or because they do not want to admit that they do not understand. A more appropriate way of assessing knowledge acquisition regarding side effects would be for the healthcare provider to say, “Please tell me the side effects of the drugs you will be receiving and what to do if you experience them.” This requires the patient to explain what they know. The healthcare provider can then assess just how much knowledge the patient actually gained and what information needs to be presented again. The nurse should ensure that the patient’s explanation is then documented. For example: “Patient was able to state that the medication (insert the name of the actual medication) typically causes nausea and vomiting the second day after administration. He states that if he is unable to drink and retain fluids for more than 12 hours, he should telephone his physician. He described the signs and symptoms of dehydration: dizziness; hot, dry skin; parched lips; and confusion. He states that if these occur, he or his wife will seek immediate medical assistance.” It is impossible to anticipate all potential problems regarding informed consent. But if appropriate informed consent is obtained and documented, these problems should be reduced in number and desired patient outcomes facilitated. Implied consent Implied consent is consent which may be inferred (Wacko Guido, 2020). An example of this would be a nurse letting the patient know an intravenous catheter is needed and the patient extends an arm without comment. Related to this is emergency consent (Wacko Guido, 2020). In this situation the patient is unable to make their wishes known and a delay in care would result in an adverse situation or poor outcome (Wacko Guido, 2020). Self-Assessment Quiz Question 5# Which of the following would be a correct question to assess if the patient truly understood the informed consent they are asked to sign? a. “You understand the risks of the procedure, correct?” b. “Do you have any questions?” c. “Please tell me the risks of the procedure in your own words.” d. “Let me know if you have any questions.”
Informed consent Informed consent is the voluntary consent a healthcare agency or healthcare provider requires to provide care for the patient. This can be given by the patient themself or a legal representative (Wacko Guido, 2020). One needs to remember that informed consent is not just a piece of paper, but a process. The patient must understand what they are agreeing to. The information needs to be provided in a manner the patient understands. Many factors influence a patient’s ability to give informed consent. Mental status, the ability to comprehend information provided that is necessary for informed consent, the ability to understand the terminology used when treatments or procedures are explained, understanding of the language being spoken, and fear and anxiety are just some of the factors that influence informed consent. The nurse has a legal and ethical obligation to facilitate the patient’s ability to give consent as well as the same obligation to support a patient’s decision to refuse to give such consent. Sometimes patients sign a blanket consent to treatment form that allows the healthcare team to provide general care. A specific procedure will need another consent form. Examples of this would include invasive procedures (insertion of a central catheter) and surgery. To ensure the patient is actually providing informed consent, the patient should be asked to explain the procedure back to the healthcare provider. Even though a blanket consent form has been granted, the nurse should ask permission before conducting any nursing care such as bathing, turning, and insertion of an intravenous catheter. Nurses are often asked to witness the written informed consent process. What the nurse is signing to is that the patient’s signature was given freely and without coercion. The nurse is not attesting that the patient understands the care provided (Wacko Guido, 2020). An informed consent must include the following: 1. Brief but complete explanation of the treatment or procedure. 2. Name and qualifications of the person performing the treatment or procedure and any assistants. 3. Explanation of potential risks/harms that may occur, including death if it is a potential outcome. 4. Explanation of alternatives to the therapy or procedure, which should also include the risks of doing nothing. 5. Explanation that the patient can refuse the procedure or therapy without having other therapies or alternatives discontinued. 6. Explanation that the informed consent can be removed, even if the procedure has started (Wacko Giodo, 2020). Here are key points of the ANA Code of Ethics (American Nurses Association, 2015). The nurse’s role in the informed consent process may include the following: ● Providing patient education : One of the most important roles of the nurse is that of patient educator. Nurses can facilitate the informed consent process by providing accurate, objective, and supportive patient education. Initiating patient education can trigger important patient questions and concerns, which if addressed appropriately, can facilitate the decision-making process and alleviate some anxiety. ● Facilitating patient comprehension : Patients may have difficulty understanding the plethora of information that accompanies diagnostic procedures and treatment options. Nurses can help with comprehension by asking patients to explain what they understand about proposed treatment and procedures. Common issues that require further explanation or information include the disease being treated, coping with anxiety, dealing with pain, and the impact of other treatment measures already in place on proposed treatments and procedures.
Page 95
EliteLearning.com/Nursing
Book Code: ANCCUS2423
Powered by FlippingBook