As nurses, we deal with informed consent a lot
—on admission to a hospital/clinic or before a procedure/surgery. Nurses typically are assigned the task of obtaining and witnessing written consent for healthcare treatment. I’ll never forget admitting to our busy psychiatric unit a young mother who’d been found unresponsive after a drug overdose. She’d been taken to the emergency room to stabilize, and her young child taken into protective custody. Now on the locked psych unit, she was terrified to sign the consent form for admission and treatment, afraid for herself and her child whose whereabouts she did not know. I repeatedly explained what I knew about her child, treatment plan, and consent process, including that she did not have to sign the admission consent. However, if she did not sign, her admitting psychiatrist would request, and be granted, a “court hold” to admit her involuntarily. If she signed as a “voluntary” admission, it would suggest she was cooperating with treatment.
I knew it was in her best interest to sign, but understood it was her
decision. The goal of informed consent is to assure patient autonomy
. My patient didn’t have a choice of treatment alternatives, but she did have a choice to be admitted voluntarily or involuntarily. I felt ethically compelled to preserve that choice.
After almost an hour of listening, supporting, and explaining, I needed to give medications to other patients. My plan was to offer this woman a hot shower to help calm her and give time to process what was happening. Then, if she still could not sign the consent, I would explain I had to inform her psychiatrist, and we would proceed with a court hold.
When I stepped out of the room, I told my supervisor my plan. She hastily went to the patient, stuck the form and a pen in front of her, saying, you need to sign this NOW!
My patient complied, tears streaming down her face.
I’ve since thought a lot about informed consent. I’ve worked in med-surg, cardiac rehab, intensive care, medical research, and psychiatry. In all settings, nurses are on the front lines of assuring patients truly are giving informed
What is involved in informed consent?
, this requires that the patient, or his/her surrogate, is informed of the risks, benefits, and alternatives to a treatment. A signature on the consent form provides legal documentation of consent.
, consent is about patient autonomy,
meaning the patient understands and freely agrees to the treatment.
Consent may be withdrawn at any time. Healthcare providers must accept and support refusal or withdrawal of consent even if they disagree with the patient.
The consent process can be affected by complexity of the treatment, patient condition and ability to understand information, and if treatment is emergent or elective.
What can nurses do to improve informed consent?
Think about consent as a process
to assure patient understanding and agreement, not just signing a form.
Informed consent should be a collaborative activity
between the physician, nurse, and patient. The physician should have obtained consent before the nurse has the patient sign a form.
Nurses can offer what we do best—patient teaching,
as we check patient understanding and obtain written consent. Where possible, use the teach-back method, asking the patient to repeat back what he/she understands. However, our teaching cannot take the place of prior physician / patient shared decision-making.
Assess for paternalism
– from the physician, from yourself. We understand so much more than the patient and are trying to help, but we cannot pressure or tell a patient what to do.
Consenting to treatment is scary. As much as possible, obtain consent in a quiet and calm setting
, with time to answer questions.
What about informed consent for nursing interventions?
Although we normally don’t obtain written consent for nursing interventions, such as holistic care using mind-body practices or spiritual therapeutics, we still must assure patients’ informed consent.
A critical topic we discuss frequently in Journal of Christian Nursing
is spiritual care. How do we assess for spiritual needs and appropriately respond? What ethical guidelines must be followed when offering spiritual care? A comprehensive article discussing informed, ethical, and non-coercive spiritual care that could be applied to other holistic nursing interventions is, “Spiritual Care: Evangelism at the Bedside?,”
by nurse researcher and spiritual care expert, Elizabeth Johnston Taylor. Take a look at this free
article and discover principles for ethical nursing interventions.
This Nurses Week, remember that informed consent is a way of nursing
each of us needs to live out as we offer our patients ethical practice and quality nursing care!
Barry, M. J. (2012). Shared decision making: Informing and involving patients to do the right thing in health care
. Journal of Ambulatory Care Management, 35(
2), 90 – 98.
Cook, W. E. (2014). “Sign here:" Nursing value and the process of informed consent
Plastic Surgical Nursing, 34
Menendez, J. B. (2013). Informed consent: Essential legal and ethical principles for nurses. JONA's Healthcare Law, Ethics, and Regulation, 15
Kathy Schoonover-Shoffner, PhD, RN
Editor, Journal of Christian Nursing