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A: Voluntary and written informed consent protects the patient from unsanctioned procedures and the health care provider from claims of an unauthorized procedure. In an emergency, the health care provider may need to intervene as a lifesaving measure without the patient's consent; however, every effort must be made to contact her family.

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Informed consent is necessary for:


* invasive procedures


* procedures requiring sedation or anesthesia


* nonsurgical procedures that carry more than a slight risk to the patient


* procedures involving radiation.



Before the patient signs the consent form, the health care provider must provide a clear and simple explanation of what the procedure entails. He must also inform the patient of the benefits, alternatives, risks, and possible complications of the procedure and what to expect postop. You may be asked to have the patient sign the consent form and witness her signature, but the person who will perform the procedure must inform the patient and obtain her consent.


If the patient has doubts and hasn't had the opportunity to investigate alternative treatments, she may request a second opinion. Never pressure a patient to give consent. Refusing to undergo a procedure is her legal right. If a patient refuses or withdraws consent, you must document her refusal and relay the information to her health care provider.


The patient must sign the consent form before psychoactive premedication is administered because consent may not be valid if it's obtained while she's under the influence of medications that can affect her judgment and decision-making capacity. The patient personally signs the consent form if she's of legal age and is mentally capable. If she's a minor, neurologically incapacitated, or incompetent, permission must be obtained from a surrogate (usually a responsible family member, preferably next of kin) or legal guardian. An emancipated minor (married or independently earning her own living) may consent for herself. Follow state regulations and your facility's policy.


Remember to make sure that the patient understands what she's signing. Have the consent form available in multiple languages or have a trained medical interpreter available. Alternative formats of communication, such as Braille, large print, or a sign interpreter, may be needed if the patient is elderly or has a hearing or vision disability. If you have doubts that the patient understands, notify the health care provider immediately.


Witnessing a consent form

Before witnessing a patient's signature on the consent form:


* Make sure the patient is competent, awake, alert, and aware of what she's doing. She shouldn't be under the influence of alcohol, illicit drugs, or prescribed medications that impair her understanding or judgment.


* Ask her whether the health care provider explained the diagnosis, proposed treatment, and expected outcome to her satisfaction. Also ask if she understands all that was said.


* Ask her whether she has been told about the risks of the procedure, the possible consequences of refusing it, and alternative treatments.


* Ask her whether she has any concerns or questions about her condition or the treatment. If she does, help her get answers from the health care provider.


* Tell her that she can refuse the treatment without having other care or support withdrawn and that she can withdraw her consent after giving it.


* Notify the health care provider immediately if you suspect that the patient has doubts about her condition or the procedure, hasn't been properly informed, or has been coerced into giving consent.



Learn more about it


Smeltzer SC, et al. Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 11th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2007:484-485.