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Difficulty: HardAdvance Directives and Informed Consent

A registered nurse (RN) delegates a practical nurse (PN) to obtain a client's signature on a surgical consent form for an upcoming wound debridement. The RN states, "The surgeon just finished explaining the procedure, so you only need to witness the signature." As the PN hands the client the form, the client states, "I am ready to sign, but I honestly cannot remember what the doctor said about the chances of getting an infection." Which action should the PN take?

  1. Withhold the consent document and notify the surgeon that the client requires clarification regarding the procedural risks.Answer
  2. B
    Review the documented surgical risks in the medical record and summarize them for the client before witnessing the signature.
  3. C
    Return the consent form to the delegating RN so the RN can provide the necessary education about the surgical risks.
  4. D
    Advise the client to sign the document now to avoid delays and assure them the surgeon will answer questions in the preoperative area.

Answer

The PN must withhold the consent document and notify the surgeon that the client requires clarification regarding the procedural risks.
The provider performing the procedure is legally responsible for obtaining informed consent, which includes explaining the risks, benefits, and alternatives. The role of the practical nurse (PN) is solely to witness the signature and verify that the client is signing voluntarily with full understanding. Because the client explicitly stated they do not remember the risks, the consent is no longer informed. The PN must halt the signing process and notify the provider to re-educate the client.

Step-by-Step Solution

1
Evaluate the client's statement regarding their understanding of the procedure.
The client explicitly states they do not remember the risks of infection associated with the surgery.
A valid informed consent requires the client to have a clear understanding of the procedure, including its risks, benefits, and alternatives.
2
Determine the practical nurse's legal scope of practice regarding informed consent.
The PN's role is strictly limited to witnessing the signature and verifying that the client is signing voluntarily with full comprehension.
Explaining surgical risks or clarifying the details of a medical procedure falls outside the PN and RN scope of practice; it is the legal duty of the provider.
3
Select the appropriate intervention based on legal requirements.
The PN must refuse to witness the signature and contact the surgeon to return and re-educate the client.
Allowing the client to sign while confused, or attempting to explain the risks themselves, would violate informed consent laws and nursing scope of practice.

Key Concept

Advance Directives and Informed Consent
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Topics

Advance Directives and Informed Consent

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