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Difficulty: MediumAdvance Directives and Informed Consent

A client with progressive dementia resides in a subacute rehabilitation facility and is scheduled for the surgical placement of a percutaneous endoscopic gastrostomy (PEG) tube. The healthcare provider discussed the procedure with the client's legally designated healthcare proxy the previous day. The proxy arrives at the facility to sign the consent form. As the practical nurse (PN) presents the document, the proxy asks, "I know the doctor explained it yesterday, but could you quickly remind me of the alternative options if we decline the feeding tube?" Which action should the PN take?

  1. A
    Review the healthcare provider's progress notes with the proxy to clarify the alternative treatments.
  2. B
    Explain the available alternative methods for providing artificial nutrition before witnessing the signature.
  3. Withhold the consent form and contact the healthcare provider to address the proxy's questions.Answer
  4. D
    Request that the registered nurse (RN) explain the alternative treatment options to the proxy.

Answer

Withhold the consent form and contact the healthcare provider to address the proxy's questions.
The practical nurse's legal role in informed consent is to witness the signature, confirm the client or proxy is competent, and verify that consent is voluntary. Explaining the procedure, its risks, benefits, and any alternative treatments is solely the responsibility of the healthcare provider. Because the proxy expressed a need for clarification regarding alternatives, the nurse must withhold the consent form and notify the provider to answer these questions before the signature is obtained.

Step-by-Step Solution

1
Identify the practical nurse's legal role in the informed consent process.
The nurse's role is strictly to act as a witness to the signature, verify the person signing is competent, and ensure consent is given voluntarily.
This establishes the legal boundaries of the nursing scope of practice.
2
Evaluate the healthcare proxy's statement.
The proxy is asking for clarification regarding alternative medical options to the PEG tube.
Determining the nature of the proxy's question indicates whether valid informed consent has been achieved.
3
Determine the appropriate intervention based on scope of practice.
Because explaining risks, benefits, and alternatives is exclusively the healthcare provider's responsibility, the nurse must halt the consent process and notify the provider.
Answering medical questions about alternatives falls outside the nursing scope of practice, and valid consent cannot be obtained until the provider directly answers the proxy's questions.

Key Concept

The practical nurse's role in informed consent is limited to witnessing the signature and verifying voluntary agreement; any questions about the procedure, risks, or alternatives must be directed to the healthcare provider.
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Topics

Advance Directives and Informed Consent

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