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Difficulty: MediumAdvance Directives and Informed Consent

A practical nurse (PN) is working in a specialized wound care clinic. A client is scheduled for a complex surgical debridement of a lower extremity ulcer. The healthcare provider has just left the room after discussing the procedure. As the PN presents the informed consent document, the client hesitates and states, "I forgot to ask the doctor what happens if we just use antibiotics instead of doing this surgery." Which action should the PN take first?

  1. A
    Explain the differences in outcomes between intravenous antibiotic therapy and surgical debridement.
  2. B
    Reassure the client that surgery is the most effective choice and proceed with obtaining the signature.
  3. C
    Request that the registered nurse (RN) come into the room to discuss the alternative treatments with the client.
  4. Withhold the consent document and contact the healthcare provider to return and address the client's questions.Answer

Answer

Withhold the consent document and contact the healthcare provider to return and address the client's questions.
Informed consent requires the client to fully understand the procedure, its risks, benefits, and alternative treatments before agreeing. Explaining medical alternatives is strictly the legal responsibility of the healthcare provider. If the client has unanswered clinical questions about the procedure or its alternatives, the practical nurse must advocate for the client by withholding the consent form and contacting the provider to return and complete the educational component.

Step-by-Step Solution

1
Evaluate the client's statement regarding the informed consent document.
The client's question indicates a lack of understanding regarding alternative treatments to the proposed surgery.
Valid informed consent requires the client to fully comprehend the procedure, risks, benefits, and available alternatives.
2
Determine the appropriate scope of practice for addressing the client's knowledge deficit.
Explaining medical alternatives is identified as the legal responsibility of the healthcare provider, not nursing personnel.
The practical nurse's role in informed consent is strictly limited to witnessing the signature and verifying that the consent is voluntary.
3
Select the safest, most legally sound nursing intervention.
The consent process is suspended, and the provider is notified to return.
This action protects the client's rights and ensures the legal requirements of informed consent are properly fulfilled by the appropriate practitioner.

Key Concept

Informed Consent and Practical Nurse Scope of Practice
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Topics

Advance Directives and Informed Consent

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