An older adult client with advanced dementia arrives at the emergency department requiring urgent surgical repair for a traumatic injury. The client's adult child, who holds a verified Durable Power of Attorney for Healthcare (DPOA-HC), is present. The operating provider has not yet evaluated the client or spoken to the family. An admissions clerk hands the surgical consent form to the adult child, who states to the practical nurse (PN), "I read the informational literature about this surgery in the waiting room, so I am ready to sign this now." Which action should the PN take first?
- AClarify the surgical risks and treatment alternatives for the proxy using the provided literature prior to signature.
- BProvide a pen and witness the proxy's signature, as their legally designated status grants them immediate signing authority.
- Instruct the proxy to pause the signing process and contact the operating provider to initiate the informed consent discussion.Answer
- DEvaluate the proxy's comprehension of the literature to verify that their decision is adequately informed.
Answer
Instruct the proxy to pause the signing process and contact the operating provider to initiate the informed consent discussion.
The informed consent process mandates that the provider performing the procedure must explain the risks, benefits, and alternatives directly to the client or their legal proxy. Reading informational literature does not substitute for this legal requirement. The PN's responsibility is to act as an advocate by preventing the proxy from signing an invalid consent form and notifying the provider to fulfill their duty.
Step-by-Step Solution
Key Concept
The PN's role in informed consent is limited to advocating for the client or proxy by ensuring the provider has explained the procedure, and then witnessing the voluntary signature. The PN cannot explain the procedure or witness a signature prior to the provider's explanation.