Nurses in my facility are being asked to witness signatures from patients (or their substitute decision-makers) for the purpose of obtaining consent for a procedure. The physicians tell us that we are only responsible for witnessing the signature and not for getting the informed consent. Is this true or are we accountable for determining that an informed consent was obtained?CNO believes that whoever requires the informed consent should also obtain the patient's signature. Some employers, however, require nurses to obtain the patient's signature on consent forms as part of their role. Show
The most important part of the consent process is informing the patient about the proposed treatment and what to expect. This includes informing the patient about:
Patients also should have the opportunity to ask and receive answers to questions they have about the treatment. A patient's signature is meaningless if the patient is not informed. Nurses are often told that when they obtain a patient's signature on a consent form, they are only witnessing the signature and not verifying that informed consent was obtained. However, nurses have ethical and professional accountabilities to ensure the patient is fully informed and capable of giving consent. Nurses should ask patients if they understand what it is they are consenting to and if their questions about the proposed treatment have been answered. If the nurse believes the patient has less than a full understanding of the proposed treatment, the nurse must act as a patient advocate to ensure the patient receives the necessary information. Nurses' accountabilities exist regardless of employer policies about the role of the witness. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of informed consent in order to:
As previously discussed with the section “Client Rights“, all clients have the right to be fully informed about their medical condition and they also have the innate right to knowledgeably consent to or reject all care and proposed treatments. What is Informed Consent?Informed consent is defined as the patient's choice to have a treatment or procedure which is based on their full understanding of the treatment or procedure, its benefits, its risks, and any alternatives to the particular treatment or procedure. All clients have the legal right to autonomy and self-determination to accept or reject all treatments and interventions. The three basic types of consent are implicit consent, explicit consent and opt-out consent, as previously detailed with Client Rights. RELATED: What Does it Mean for a Nurse to Sign a Consent for Surgery Form? Identifying the Appropriate Persons to Provide Informed ConsentInformed consent can only be obtained from an adult patient who is mentally competent to do so except under some circumstances and situations. When consent, for any reason including the lack of majority, mental incompetence, and unconsciousness, cannot be obtained, other people can provide legal consent for the patient. These people include the parent or legal guardian of a minor and unemancipated minor child, a legally appointed representative for a developmentally disabled adult, for example, an emancipated minor, and the person who has been appointed as the client's durable power of attorney for healthcare decisions or their health care surrogate or proxy. In other situations, the courts have guardianship and the right to give informed consent for a client who is not able to consent on their own. With the exception of emergencies, informed consent must be obtained. Providing Written Materials in the Client's Spoken Language, When PossibleAs more fully discussed and described with the “Integrated Process of Teaching and Learning“, clients must be given oral and written educational material and content at the level with which the client can understand this education. At times, written material in the client's spoken, the native language is beneficial for patients and significant others and, at other times, the assistance and services of a professional translator may be indicated. Describing the Components of Informed ConsentThe components of informed consent include the person's knowledgeable consent to a treatment or procedure after they have been given, and understand, complete, unbiased information about:
Again, all clients have the legal right to autonomy and self-determination to accept or reject all treatments, procedures, and interventions without any coercion or the undue influence of others. Participating in Obtaining Informed ConsentThe physician, or other licensed independent providers, the nurse and the client have roles and responsibilities in terms of informed consent. The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. They also confirm that the patient has sufficient knowledge to make a knowledgeable decision. The physician, or another licensed independent practitioner such as a nurse practitioner or a physician's assistant, provides the client with complete information about the treatment or procedure, the potential risks including pain and complications, the benefits of the treatment or procedure, who will perform the planned treatment or procedure, and any possible alternatives to the treatment or procedure including their benefits and risks. The patient or their legal representative must give consent voluntarily and without any coercion by others. They must also ask questions and clarify things until they are certain about the procedure, the benefits, the risks, and possible alternatives. Verifying that the Client or Representative Comprehends and Consents to Care and/or ProceduresThe recognition that informed consent was obtained is based on the legality and completeness of the written consent and the required processes for obtaining consent including the client's legal ability to sign it and the client's understanding of the procedure or treatment that they are consenting to. There are also times, such as during the preoperative period of time, which nurses must recognize, identify and confirm that a complete surgical consent was obtained and placed in the patient's medical record. RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:
SEE – Management of Care Practice Test Questions
Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.  Latest posts by Alene Burke, RN, MSN (see all) When a nurse witnesses a client's signature on an informed consent the nurse is witnessing which of the following?2) CORRECT — By witnessing a client's signing of an informed consent, the nurse verifies that the client is mentally competent and that the signature is that of the client.
Which of the following actions should the nurse take first?Assessment is the first step of the nursing process and takes priority over all other steps.
Which should the nurse include when teaching a client with Clostridium difficile?Contact Precautions. Use gloves and gown when entering patients' rooms and during patient care. Remove PPE and perform hand hygiene when exiting the room.. Change gloves and gowns and perform hand hygiene when moving from one patient to another when patients are cohorted, and before leaving patient room.. How many questions are on the ATI fundamentals proctored exam?ATI Fundamentals Proctored Exam 100 Questions and Answers.
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A nurse is caring for a client who requires an informed consent for a surgical procedure
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