Informed consent: an ethical approach to nursing

As nurses, we take care of informed consent – upon admission to a hospital/clinic or before a procedure/surgery. Nurses are typically assigned the duty of obtaining and certifying written consent to treatment. I’ll always remember the admission to our busy psychiatric ward of a young mother who was found unconscious from a drug overdose. She was taken to the emergency room to stabilize and her toddler was placed in protective custody. Now, in a closed psychiatric ward, she was afraid to sign the consent form for admission and treatment, fearing for herself and her child, whose whereabouts she didn’t know. I repeatedly explained what I knew about her baby, the treatment plan, and the consent process, including that she didn’t must sign a consent form. However, if she doesn’t sign, her receiving psychiatrist will apply for and receive “court permission” to compulsorily admit her. If she signed off on a “voluntary” admission, it might suggest she was cooperating with the treatment process.

I knew it was in her best interest to sign the contract, but I understood it was a choice. The purpose of informed consent is to make sure. My patient had no alternative in alternative treatments, but she did have the alternative of being admitted voluntarily or involuntarily. I felt ethically obliged to keep up this alternative.

After almost an hour of listening, supporting and explaining, I had to manage medications to other patients. My plan was to supply the lady a hot shower to calm her down and provides her time to process what was happening. Then, if she still cannot sign the consent form, I’ll explain that I would like to tell her psychiatrist and we are going to proceed with a court detention.

Leaving the room, I presented my plan to my superior. She hurried as much as the patient, gave her the shape and a pen, and said, “My patient agreed, and tears were streaming down her face.

Since then, I actually have thought rather a lot about informed consent. I actually have worked in medicine, cardiac rehabilitation, intensive care, medical research and psychiatry. In all settings, nurses are on the front lines ensuring that patients actually consent.

What does informed consent include?

this requires that the patient or his/her surrogate learn concerning the risks, advantages and treatment alternatives. The signature on the consent form constitutes legal documentation of consent.
consent refers back to the meaning that the patient understands and voluntarily consents to treatment.

Consent could also be withdrawn at any time. Healthcare providers must accept and support refusal or withdrawal of consent, even in the event that they disagree with the patient.

The consent process could also be influenced by the complexity of the treatment, the patient’s condition and talent to grasp the data, and whether the treatment is emergency or elective.

What can nurses do to enhance informed consent?

Think of consent as ensuring the patient’s understanding and agreement, not only signing a form.
Informed consent needs to be given between the doctor, nurse and patient. The doctor must have obtained consent before the nurse had the patient sign the shape.

Nurses can offer what we do best – checking the patient’s understanding and obtaining written consent. If possible, use the teach-back method by asking the patient to repeat what she or he has understood. However, our teaching cannot replace prior shared decision-making between physician and patient.

Evaluate – from the doctor, from yourself. We understand way more than the patient and we attempt to help, but we cannot pressure or tell the patient what to do.

Consenting to treatment is terrifying. If possible, obtain approval on time, with time to reply questions.

What about informed consent?

Although we don’t typically obtain written consent for nursing interventions resembling holistic care using mind-body practices or spiritual therapy, we still must ensure informed consent from patients.

A key topic we frequently discuss is spiritual care. How can we assess spiritual needs and respond accordingly? What ethical guidelines needs to be followed when offering spiritual care? For a comprehensive article that discusses informed, ethical, and non-coercive spiritual care that will be applied to other holistic nursing interventions, see “Spiritual Care: Evangelism at the Bedside?” by Elizabeth Johnston Taylor, nurse and spiritual care expert. Read this text and discover the principles of ethical nursing interventions.

This Nurses Week, keep in mind that informed consent is a requirement that every of us must implement when offering ethical practices and high-quality nursing care to our patients!

Bibliography:
Barry, M. J. (2012). Shared decision-making: informing and fascinating patients to do the fitting thing in health care. 2), 90 – 98.
Cook, WE (2014). “Sign here:” Nursing Value and the Informed Consent Process
(1), 29-33.
Menendez, J. B. (2013). Informed consent: Basic legal and ethical principles for nurses. (4), 140-144.