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Difficulty: MediumAdvance Directives and Informed Consent

A practical nurse (PN) is admitting a young adult client to an ambulatory surgery center for an elective upper endoscopy. The client has already signed the informed consent document. While the PN is taking the client's vital signs, the client suddenly becomes tearful and states, "I cannot go through with this. I want to cancel the test right now." In what order should the PN perform the following actions? Arrange the steps from first to last.

  1. 1Cease all preoperative physical preparations immediately.
  2. 2Ask open-ended questions to determine the reason for the client's change of mind.
  3. 3Notify the healthcare provider and the supervising registered nurse.
  4. 4Observe as the healthcare provider discusses the implications of refusal with the client.
  5. 5Document the client's verbal refusal and the provider's intervention in the health record.

Answer

The correct sequence is to first immediately cease all physical preparations to respect the client's autonomy. Next, the practical nurse should ask open-ended questions to explore the client's concerns. Following this data collection, the nurse must notify the healthcare provider and supervising registered nurse. The practical nurse then observes while the healthcare provider discusses the implications of refusal. Finally, the nurse documents the entire event in the health record.
The nursing process and client advocacy dictate the sequence of actions when a client revokes informed consent. The most immediate priority is to ensure the client's autonomy and physical safety by halting any further preparation. Once the procedure is paused, the practical nurse (PN) must collect data by exploring the client's concerns to understand the situation fully. After gathering this information, the PN must promptly communicate the client's decision to the supervising RN and the healthcare provider, as it is the provider's legal responsibility to address the refusal. The PN then remains to support the client while the provider explains the risks and consequences of canceling the procedure. Finally, the PN must provide a comprehensive legal record of the entire event, including the client's exact words and the actions taken, in the medical chart.

Step-by-Step Solution

1
Cease all preoperative physical preparations immediately.
The client's right to refuse is respected and physical preparation is halted.
Continuing with preparations after a client withdraws consent constitutes battery; immediate cessation is required.
2
Ask open-ended questions to determine the reason for the client's change of mind.
The PN gathers crucial information about the client's sudden anxiety or concern.
Data collection follows immediate safety interventions in the nursing process, helping to clarify the root cause of the refusal.
3
Notify the healthcare provider and the supervising registered nurse.
The care team and the acting physician are alerted to the client's decision.
The provider must be notified immediately as it is their legal responsibility to address procedure cancellations and informed consent issues.
4
Observe as the healthcare provider discusses the implications of refusal with the client.
The client receives the necessary medical information regarding their refusal.
Explaining the risks and alternatives of refusing a procedure falls strictly under the provider's scope of practice, not the PN's.
5
Document the client's verbal refusal and the provider's intervention in the health record.
A legal and accurate account of the incident is created.
Documentation should occur only after the client's immediate needs and safety have been fully addressed.

Key Concept

Client's Right to Revoke Consent and the Nursing Process
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Topics

Advance Directives and Informed Consent

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