July 24th, 2007 | Penlight
I remember working on the floor and needing to get a consent signed by the patient. Usually, the doctor would leave the consent filled out on the chart, with the assumption that the physician had gone over the pertinent information with the patient. The nurse would then go in and get the patient’s signature. Why the doctor couldn’t get the patient to sign and another person to witness was a mystery. As a new nurse, I had concerns:how could I tell if the patient was really giving an informed consent? Could I or couldn’t I witness their signature? What if they weren’t able to sign or weren’t competent?
The impetus for informed consent is a patient’s right to participate in their care. In 1990, as part of the Omnibus Budget Reconciliation Act, the Patient Self-Determination Act was passed. The act states that all persons recieve written information about their care and infomation, for their state, on accepting or refusing care. Recieving information on advanced directives is also included in the act and it applies to all facilities that accept Medicare reimbursement. According to the American Nurses Association, nurses are crucial to the implementation of this act. It is imperative that nurses know the laws of the state in which they practice and are familiar with their institution’s policies.
For a consent to be considered informed, the following should be discussed with the patient:
1. The nature of the decision/procedure
2. Reasonable alternatives
3. The relative risks, benefits and uncertainties related to the alternatives
4. Assessment of patient understanding
5. The acceptance of the intervention by the patient
(from the University of Washington School of Medicine website)
According to the ANA’s Code of Ethics, nurses have a responsibility to ensure that patients understand their options to help them make an informed consent. After the doctor has spoken with the patient, ask them open ended questions to ascertain their understanding. “What did the doctor tell you about the procedure?” If you think there are unanswered questions or you think the patient has misconceptions about what they were told, it is your responsibility as the nurse to alert the doctor prior to them signing.
As for witnessing the consent, Dr. Jane C. Rothrock, DNSc, answers a nurse’s question here about witnessing a consent. Key it that the doctor must explain the procedure and involve the patient in a discussion before the consent is signed. The nurse can then assess the patient’s understanding and have them sign. The nurse in this instance is witnessing the person’s identity, that they did indeed sign for themselves.
The most important element in all this is communication. By facilitating open communication between all the healthcare providers, nurses can insure that patients are making the best decision.