Question

Please respond to ONE of the following prompts.

What type of role should nurses have securing informed consent? In assisting with research studies? In assisting with genetic testing?

OR

When a nurse reports abuse, should the accused be able to know the identity of his or her accuser? Should a nurse be sanctioned for reporting abuse if it proves to be false?

Answer 1

Informed consent has become the primary paradigm for protecting the legal rights of patients and guiding the ethical practice of medicine. It may be used for different purposes in different contexts: legal, ethical or administrative.

Informed consent is the patient’s agreement to permit healthcare providers to perform any invasive procedures or medical surgeries in awareness of the risks, benefits, alternatives treatment and consequences of refusing consent. As nurses are often indirectly involving in the process of obtaining consent and exchanging detailed information concerning the treatments or procedures as they spend the most time with patients. Thus, it is crucial for nurses to better understand the role they play in obtaining informed consent from patients.

Get consent from the right person

• The first step in getting informed consent is to identify the right person to obtain the consent from. In the context of informed consent, a competent patient is described as one who is able to understand the nature and consequences of the illness, the proposed treatment or procedure, alternative treatment and the ability to make a rational decision.
• Nurses need to note that patients have the right to consent or refuse treatment when they are competent and aged 18 years and above.
• In some cases involving paediatric patients, parents can provide consent as their legal guardians. For psychiatric patients, consent is needed to undergo some treatments, such as the electroconvulsive therapy (ECT). However, due to their inability to make an informed decision, it may fall to their closest relative to give consent in their stead.
• An exception to obtaining consent is during emergencies, where it may be impossible to obtain consent from the patient or authorised party due to their medical condition. In this case, the law assumes that the patient would wish to be treated,thus a healthcare provider is allowed to perform the procedures for the sake of patient’s benefit and save their life. Another exception is an acutely psychotic patient who is harming themselves or assaulting others. These patients are permitted to be medicated and restrained without obtaining consent.

Document the informed consent

• As a nurse, your signature in witnessing the consent indicates that the patient is competent, voluntary in giving their consent, and that they can understand the information related to the treatment. After witnessing and getting the patient’s consent, this form should be kept properly in the patient’s medical record, and goes to the operating or treatment room with the patient.
• In your nursing note, you should also clearly document the obtaining of the signature, as well as the date and time it was obtained.

Address any questions the patients have

• After you have explained the procedure's risks and benefits, ask and verify that the patient understands the information. Your explanation should be brief and precise so that it would be more effective in conveying the significant information to the patient and help them to process it better. Be aware of the patient’s reaction and responses when you clarify these things.
• If the patient is still confused about the procedure and requests for additional information, it falls to you as a nurse to address their questions. By answering their questions and concerns, you can help to reduce their anxiety and worry with a better understanding of their treatment. Nevertheless, if you suspect that the patient does not understand the situation, you should quickly notify the physician, healthcare provider, or nursing supervisor.
• The nurse’s role in obtaining the patient’s informed consent is not restricted to being a witness. As a nurse, your biggest responsibility in this process is to ensure that patients are getting sufficient information about the procedures. If the patient refuses treatment, there must be a reason behind it, be it the lack of understanding of the treatment or the anxiety that festers from incomplete understanding.
• Before getting the patient’s informed consent, ensure you have ample knowledge of the proposed treatment so that you are ready for any questions that arise, and able to make them feel less doubtful and more confident about accepting the treatment.

In assisting Research study

In nursing researchinvolving human participants, the investigator must obtain the informed concent of the propspective participant or in the case of an individual who is not capable ofgiving informed consent, the consent of a legal guardian. Informed consent protects the individual's freedom of choice and respect for individual's autonomy and is given voluntarily to participate in research or not.

Responsibilty of an investigator in obtaining informed consent :

• The nurse researcher must provide all the neccessary and desired information to the participant.
• It must be ensured investigator that none of the participant is unduly influenced or intimidated.
• Investigator should ensure that preferably informed written consent is obtained only after adequate information given to participant.
• A verbal informed consent may be obtained, when participant refuses to sign or give thumb impression or can not do so. It should be documented through audio or video.
• Investigator must ensure that none of the way patient-clinician relationship is affected and treatment or care is influenced by the decision of individual to participate or not in a particular research study.

In assisting genetic testing

The role of nurses in obtaining informed consent prior to a prenatal genetic test is a critical time of interaction with the prospective parent(s). This discussion must include the benefits and risks for the parent(s) and offspring, the decisions that will be present in the face of a genetic test that indicates risk of disease/disability, the potential for a result that leaves uncertainty to the degree of risk for the offspring, and the recognition that connecting genetic test results (genotype) indicating potential disease with actual symptoms (phenotype) of the disease is not yet possible in most cases. Whether the prospective parent(s) accept or decline prenatal genetic testing and/or termination it is important that nurses put aside their personal values in the face of such difficult decisions and provide accurate and sensitive information to their patients.