Informed consent

Emancipation may be considered in any of the following situations, depending on the state's laws

Membership in a branch of the armed services Marriage Court-determined emancipation Financial independence and living apart from parents Pregnancy Mother less than 18 years of age

What are the nurse's responsibilities related to informed consent?

The nurse's responsibilities related to informed consent include: Determining whether the client or parents or legal guardians understand what they are signing by asking them pertinent questions. Ensuring that the consent form is completed with signatures from the client (or parents or legal guardians if the client is a child). Serving as a witness to the signature process.

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client?

"I'll put together the information that you will need." The nurse should not respond to this client with any judgment or biased information. The client does not have to notify the father, and the other responses show the nurse's personal bias. If a nurse has an ethical issue with this procedure, she should address it with her managers, not the client.

Special Considerations Related to Informed Consent

Child not living with biologic or adoptive parents: Legally appointed guardian must provide consent. Verify authority and include documentation of legally appointed guardian in child's medical record. Parent consent after divorce: Ability to give consent for health care rests with parent who has legal custody by divorce degree. Determine if the parents have joint custody or if there is sole custody by one parent. May need to seek court involvement if there is joint legal custody but parents disagree on care. Consent for organ donation: Legal guardian or parent consents to organ donation. For a minor to donate, the parents must be aware of the risks and benefits and must provide emotional support to the child. The minor must agree to donate without coercion in live organ donation. Potential donors should be referred to local organ procurement organization. Educate family about policies related to organ donation. Consent for medical experimentation: Requirements include consent of parents, assent of child, and a perceived benefit to the child. Comply with all federal regulations if federal funds are received (refer to section on assent).

What is the responsibility of clinicians in obtaining informed consent?

Clinicians have a clear ethical and legal responsibility to obtain informed consent for tests, treatments, and procedures. They must provide the patient with information about the risks and benefits of the treatment, procedure, or test, and obtain the patient's voluntary and informed agreement to undergo it.

What is informed consent?

Informed consent is the process in which a healthcare provider informs a patient about the risks and benefits of a medical treatment, procedure, or test, and the patient gives their voluntary and informed agreement to undergo the treatment, procedure, or test.

The nurse is teaching a birthing class to expectant fathers. A father wants to know how he can directly help his partner. How should the nurse respond? Select all that apply.

"Providing a back rub helps with pain and provides relaxation." "Be aware that hormonal changes may make your partner have some behavior changes temporarily." "Involving yourself in infant care provides for better family bonding." "You can be supportive by encouraging your partner during labor."

When utilizing a doula during labor, the client would expect which services to be included? Select all that apply.

A doula is a nonmedical birth companion who provides continuous emotional, physical, and educational support to the woman and family during childbirth and the postpartum period. Doulas do not perform clinical or medical tasks; they are there to comfort and support the mother and to enhance communication between the mother and medical professionals.

What does it mean for an emancipated minor to have legal capacity? Can an emancipated minor make their own health care decisions?

An emancipated minor is considered to have the legal capacity of an adult, which means they have the right to make their own decisions and take responsibility for their own actions. This includes making their own health care decisions.

A chronically ill child attends school regularly. The parents have signed a do not resuscitate (DNR) order for the child and presented it to the school nurse. What action should the school nurse take first?

Determine the parents wishes if death should occur at school Children who are chronically or terminally ill can still go to school. If the parents sign and present the school nurse with a DNR order, the nurse should devise a plan for what will happen if the child should die at school. To do this, the school nurse should first talk with the parents about their wishes and write a plan of action. The teacher, the principal, and the legal team will all need to be involved so that all legal and ethical decisions can be made to honor the parents wishes.

Why are exceptions made in some states to allow minors to seek certain types of care in a confidential manner without including their parents or legal guardians?

Exceptions are made in some states to allow minors to seek certain types of care in a confidential manner without including their parents or legal guardians because it can encourage children to seek help in situations where they might otherwise avoid care if they were required to inform their parents or legal guardian

Who can legally provide consent for health care?

Generally, only people over the age of majority (18 years of age) can legally provide consent for health care.

How is consent obtained for minors in health care settings?

In cases involving minors, the process of consent involves obtaining written permission from a parent or legal guardian.

In which situations can a mature minor give consent to medical treatment?

In some states, a mature minor may give consent to certain medical treatment if the health care provider determines that the adolescent (usually over 14 years of age) is sufficiently mature and intelligent to make the decision for treatment. The provider also considers the complexity of the treatment, its risks and benefits, and whether the treatment is necessary or elective before obtaining consent from a mature minor. It is important for nurses to be aware of the laws and policies surrounding mature minor consent in their state to ensure that they are providing care that is both legally and ethically sound.

What is covered by the initial consent for treatment in a healthcare setting?

Most care given in a healthcare setting is covered by the initial consent for treatment signed when the person becomes a client at that office or clinic, or by the consent to treatment signed upon admission to the hospital or other inpatient facility.

Why is it important for nurses to be familiar with state laws and health care agency policies related to informed consent?

Nurses must become familiar with state laws as well as the policies and procedures of the health care agency to ensure that they are providing care that is legally and ethically sound. Informed consent is an essential aspect of ethical care, and nurses play a critical role in the process. Treating children without obtaining proper informed consent violates their rights, and the physician and/or facility may be held liable for any damages. By understanding the laws and policies surrounding informed consent, nurses can ensure that they are providing care that is in the best interest of the child while also protecting the legal and ethical rights of the child and their family.

What types of procedures require informed consent in the United States?

Procedures that require informed consent in the United States include major and minor surgery, invasive procedures such as amniocentesis and lumbar puncture, treatments placing the person at higher risk such as chemotherapy or radiation therapy, procedures or treatments involving research, application of restraints, and photography involving the person.

What is the informed consent process and who is responsible for it?

The informed consent process involves informing the person, in this case the child and their family, about a procedure or specific care. It originates from the right of the child and family to direct their care and the ethical responsibility of health care providers to involve the child and family in health care decisions. Nurses play a role in the process by involving children and adolescents in the decision-making process to the extent possible, though the parent is still ultimately responsible for giving consent. The physician or advanced practitioner providing or performing the treatment and/or procedure is responsible for informing the child and family about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, the potential risks and benefits, and alternative methods available.

What is the purpose of obtaining informed consent?

The purpose of obtaining informed consent is to ensure that the patient is fully informed about the risks and benefits of a medical treatment, procedure, or test, so they can make an informed decision about whether to proceed with it. It also serves to protect the patient's autonomy and right to make decisions about their own healthcare.

What is the rationale behind allowing minors to provide their own consent for certain types of health care?

The rationale behind allowing minors to provide their own consent for certain types of health care is to ensure that minors have access to essential health care services without needing to involve a parent or legal guardian, who may not be supportive of the minor's decision to seek treatment. This is especially important in cases where seeking treatment may be stigmatized or dangerous for the minor, such as in cases of substance abuse or reproductive health.

What types of care may be provided to minors in a confidential manner, without requiring consent or notification of parents or legal guardians in some states?

The types of care that may be provided to minors in a confidential manner, without requiring consent or notification of parents or legal guardians in some states include pregnancy counseling, prenatal care, contraception, testing for and treatment of sexually transmitted infections and communicable diseases (including HIV), substance abuse, and mental illness counseling and treatment.

What are some special situations related to informed consent that nurses should be aware of?

There are special situations related to informed consent that nurses should be aware of, including If the parent is not available, then the person in charge (relative, babysitter, or teacher) may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. Two witnesses must be listening simultaneously and will sign the consent form, indicating that consent was received via telephone. Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian. In urgent or emergent situations, appropriate medical care should never be delayed or withheld due to an inability to obtain consent. Certain federal laws, such as the Emergency Medical Treatment and Labor Act (EMTALA), require that every client who presents at an emergency department is given a medical examination regardless of informed consent or reimbursement ability. It is important for nurses to understand these special situations and the laws and policies surrounding them to ensure that they are providing care that is both legally and ethically sound. These guidelines are in place to ensure that children receive appropriate medical care in emergency situations, while still respecting their legal and ethical rights.

A parent brings a foster child to the clinic for immunizations. What is the first responsibility of the nurse?

Verify legal documentation When a child is placed in foster care the foster parents are given legal documentation of this placement and of their ability to seek and consent to treatment. This documentation should be confirmed before any treatment is rendered. A child placed with a foster parent is not required to have a case manager present at medical visits. The foster parent can take the child for care whenever needed. The authorization to treat is part of the legal documentation provided the foster parent, so it is not necessary to obtain a new consent at every clinic visit.

Are there any situations where a minor can provide their own consent for health care?

Yes, there are certain situations where a minor can provide their own consent for health care, such as in cases of reproductive health, substance abuse treatment, and mental health treatment.

A prenatal nurse is developing a plan of care for a black woman who is at 34 weeks' gestation and visiting the community health clinic for the first time. Which factor would be a priority for the nurse to incorporate into the plan of care?

the ethnicity of the client In the United States, black women suffer maternal mortality ratios far higher than any other ethnic group. The risk of maternal mortality has remained about three to four times higher among black women when compared to white women during the past six decades. Black women had higher degrees of hypertension and lower hemoglobin levels on admission and had presented for prenatal care much later, than white women or not at all. The marital status of a client is not as important as her ethnicity. The socioeconomic status is a factor, but the client's ethnicity will give the nurse more background on the potential complications that the ethnicity might bring. Her education is important, but that is not the priority for the nurse at this time.

Key elements of informed consent

• The decision maker must be of legal age in that state, with full civil rights, and must be competent (have the ability to make the decision). • Present information that is simple, concise, and appropriate to the level of education and language of the individual responsible for making the decision. • The decision must be voluntary, and without coercion, force, or influence of duress. • Have a witness to the process of informed consent. • Have the witness sign the consent form.