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Difficulty: HardAdvance Directives and Informed Consent

A practical nurse (PN) is assisting an adult client in preparing for a scheduled bedside thoracentesis. The client previously signed the informed consent document with the physician. While the PN is helping the client into the correct seated position, the client becomes visibly anxious and states, "I have changed my mind. I cannot go through with this needle stick." Arrange the following PN actions in the correct chronological sequence from first to last.

  1. 1Cease any ongoing procedural preparations and assist the client into a comfortable resting position.
  2. 2Clarify the client's statement to confirm their definitive intent to revoke the previously given consent.
  3. 3Promptly inform the supervising registered nurse (RN) and the performing physician about the client's decision.
  4. 4Record the client's exact words of refusal and the time of provider notification in the electronic health record.
  5. 5Provide continuous supportive presence while the client awaits the physician to discuss treatment alternatives.

Answer

The correct chronological sequence is to first stop the physical preparations, verify the client's intent to withdraw consent, notify the RN and physician, document the exact refusal, and finally remain with the client to provide support.
When a client revokes consent, the PN must prioritize client autonomy and safety by immediately stopping any preparations. Next, the PN verifies the client's intent to ensure it is a definitive refusal rather than just transient fear. The provider and RN must then be notified immediately because the provider is legally responsible for discussing the risks of refusal with the client. Documentation follows the clinical actions to provide an accurate legal record. Finally, the PN provides ongoing emotional support.

Step-by-Step Solution

1
Cease any ongoing procedural preparations and assist the client into a comfortable resting position.
The procedure is immediately halted.
Stopping the physical preparation ensures client safety and protects their legal right to refuse treatment at any time, even after initial consent was signed.
2
Clarify the client's statement to confirm their definitive intent to revoke the previously given consent.
The PN determines if the client is formally withdrawing consent.
The PN must assess whether the client is truly refusing the procedure or simply expressing fear that might be alleviated with therapeutic communication.
3
Promptly inform the supervising registered nurse (RN) and the performing physician about the client's decision.
The healthcare team is alerted to the revoked consent.
It is outside the PN's scope of practice to explain the medical consequences of refusing a procedure; the provider must be notified to fulfill this legal responsibility.
4
Record the client's exact words of refusal and the time of provider notification in the electronic health record.
A legal record of the event is created.
Thorough documentation protects the client and the facility, but it is prioritized after direct client care and team communication.
5
Provide continuous supportive presence while the client awaits the physician to discuss treatment alternatives.
The client receives ongoing psychosocial care.
Remaining with the client reduces anxiety and demonstrates advocacy while waiting for the provider to arrive.

Key Concept

A client has the legal right to revoke informed consent at any time. The practical nurse's role is to immediately halt the procedure, verify the refusal, notify the provider so they can explain the consequences, and accurately document the event.
Estimated Time:2m 0s
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Topics

Advance Directives and Informed Consent

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