Informed Consent

Informed consent based on

-Autonomy -beneifience

Major charge of lack of consent charges

-Battery (unconsented touch) -assault (threat) -negligently informed

How to follow ways for informed consent

-Follow institutional policy re informed consent -Educate the patient through discussion, videotapes, literature, and questions and answers -Assess patient's health literacy skills (incl. people with ESL, neuro & cognitive impairments, -Use plain (living room) language; eliminate medical jargon -Use medical interpretor as necessary -Teach-Back: Have patient repeat what she or he understands from teaching provided -show the nurse how he or she would take meds and when -Know the informed consent requirements related to office and surgery procedures

advance directives

-Instructions given about the healthcare a person wants given when the time comes that person is too ill to decide -Makes a declaration regarding future health care he or she will accept or refuse (a living will) -Designates another person to make health care decisions if he or she becomes incompetent in the future (a durable power of attorney for health care or proxy decisionmaker)

Common dilemmas for DNR

-Lack of documentation in the medical records, especially the progress notes, indicating how the DNR decision was made -No DNR form on the chart -Interpreting DNR orders when a no-code order has been qualified as a "chemical code only" or "resuscitate but do not intubate" -family conflict with DNR -transfer of pt. (Should DNR transfer as well) -family has lack of knowledge on DNR and Do not treat

What does the healthcare provider have the duty to disclose

-Name of person or persons, with qualifications -providing treatment or procedure -diagnosis or suspected diagnosis of the patient -Conflicts of interest -nature and purpose of the proposed treatment or procedure

Necessary components of Informed consent

-Patient must be competent -Patient must be fully informed through effective communication -Consent must be voluntary

Duty to disclose

-Potential risks; possible complications, side effects, and consequences of the proposed treatment or procedure -Benefits and anticipated outcome of the proposed treatment or procedure -Available alternatives, if any -Consequences if the proposed treatment or procedure is refused; client has right to refuse the procedure or treatment without discontinuing other supportive care. -Presents an opportunity for shared decision-making between patient and healthcare provider

Informed consent

A compentent adult or legal representive thats a voluntary agreement to allow something to happen in her or his care or treatment. E.g. -surgey with full disclosure of risks, benefits, alternatives and consequences outlined by physician or other healthcare provider; power of choice rests with patient

When is consent needed

Any time a nurse (or health care provider) intends to touch the patient E.g. -bathing -giving medications -obtaining blood glucose -taking vitals -surgeys

Healthcare providers role as the nurse

Facilitating patient autonomy through comprehension implications of consent E.g. -Pt. Who refuse treatment -pt. With compromised intellectual capacity -pt. With surrogate decision markers

Consent

Indicates patients comprehend basics E.g. "yes" "no"

Expressed consent

Oral or written

Documenting consent (nurses role)

Witnessing a patients signature on consent form

Implied consent

inferred by patient's actions or in emergency situations E.g. -holding out ones arm for Iv -agreeing

Legal documents for Health Care Agents

●Durable power of attorney for health care ●Health care representative form ●Medical durable power of attorney ●Medical power of attorney ●Proxy appointment

Exceptions to duty to disclose

●Emergency situations (implied consent until patient or someone on behalf of the patient provides informed consent) ●Therapeutic privilege: if disclosure detrimental to patient's health e.g. patient with severe emotional disturbance ●Patient waiver of right to receive information ●Medical judgment that information would be harmful to the patient ●Obvious risk ●Public health requirement