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Difficulty: MediumAdvance Directives and Informed Consent

A practical nurse is providing home health care for a client with severe dysphagia. The client's spouse, who is the designated healthcare proxy, is preparing to sign a consent form for a percutaneous endoscopic gastrostomy tube placement. Right before signing, the spouse pauses and asks the nurse, "What are the exact chances of a site infection, and are there any other feeding methods we should try first?" Which action should the nurse take next?

  1. A
    Provide an overview of the infection risks and describe the available nutritional alternatives.
  2. B
    Contact the supervising home health registered nurse to answer the spouse's specific questions.
  3. Withhold the document and contact the healthcare provider to speak with the spouse.Answer
  4. D
    Document the spouse's verbalized concerns in the client's medical record and proceed with obtaining the signature.

Answer

The correct action is to withhold the document and contact the healthcare provider to speak with the spouse.
The correct answer involves halting the signing process and contacting the provider. Obtaining informed consent is the sole responsibility of the healthcare provider who will perform the procedure. This duty involves thoroughly explaining the risks, benefits, and alternatives. The practical nurse's role is strictly limited to acting as a witness to the signature and verifying that the individual understands the procedure and is signing voluntarily. Because the proxy expressed hesitation and asked specific clinical questions about risks and alternative options, the nurse must ensure the provider addresses these knowledge gaps before allowing the legal document to be signed.

Step-by-Step Solution

1
Identify the practical nurse's legal role in the informed consent process.
The nurse's role is solely to witness the signature and verify that the client or proxy is signing voluntarily with full comprehension.
Scope of practice guidelines prohibit nurses from primarily explaining procedural risks, benefits, or treatment alternatives.
2
Evaluate the spouse's statements prior to signing.
The spouse is asking clinical questions about infection likelihood and alternative feeding methods.
This indicates a lack of complete understanding, meaning informed consent has not truly been achieved.
3
Determine the appropriate intervention based on the lack of comprehension.
The nurse must stop the signing process and contact the primary healthcare provider to address the spouse's questions.
Only the healthcare provider performing the procedure is legally authorized to explain risks and alternatives to achieve informed consent.

Key Concept

The practical nurse's role in informed consent is limited to witnessing the signature and verifying voluntary comprehension; any questions regarding risks, benefits, or alternatives must be directed to the healthcare provider.
Estimated Time:1m 0s
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Topics

Advance Directives and Informed Consent

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