A client in a preoperative holding area is preparing for an elective cholecystectomy. As the practical nurse (PN) presents the informed consent document for a signature, the client puts the pen down and states, "I changed my mind. I am too scared and I do not want this surgery anymore." In which order should the PN take the following actions? (Arrange the actions from first to last.)
- 1Remove the consent document and affirm the client's right to refuse the procedure.
- 2Ask open-ended questions to explore the client's specific fears regarding the surgery.
- 3Notify the operating surgeon of the client's decision and current concerns.
- 4Document the client's verbal refusal and the provider notification in the medical record.
Answer
The correct sequence is to first remove the document to protect the client's right to refuse, then explore their fears to gather data, notify the surgeon who is legally responsible for discussing risks/alternatives, and finally document the event.
The nursing process and prioritization principles dictate that the PN must first address immediate safety and client rights (stopping the consent process). Next, the PN collects data (exploring fears) to inform the next intervention. The intervention is to communicate outside the PN's scope (notifying the surgeon to explain risks/alternatives). Finally, the PN documents the entire sequence of events to maintain legal records.
Step-by-Step Solution
Key Concept
The practical nurse's role in informed consent is limited to witnessing the signature and verifying it is voluntary. If a client revokes consent, the PN must stop the process, gather data, and notify the provider.