During a home health visit, a practical nurse (PN) is evaluating an older adult client who recently experienced a severe ischemic stroke, resulting in significant cognitive deficits. The client's adult child, who holds a legally activated Durable Power of Attorney for Healthcare (DPOA-HC), is present. The agency's supervising provider has recommended the surgical placement of a gastrostomy tube and faxed the procedural consent documents to the home. The adult child asks the PN, "I am leaning toward signing this, but what exactly are the long-term nutritional risks if I refuse this procedure on my parent's behalf?" Which action should the PN take?
- Defer obtaining the signature and arrange for the prescribing provider to discuss the consequences of refusal with the proxy.Answer
- BOutline the potential nutritional deficits using the agency's standardized educational materials to help the proxy make a decision.
- CPerform a comprehensive neurological assessment to determine if the client has regained sufficient capacity to participate in the consent process.
- DWitness the proxy's signature on the document immediately to prevent surgical delays, noting their specific questions in the client's chart.
Answer
The correct action is to defer obtaining the signature and arrange for the prescribing provider to discuss the consequences of refusal with the proxy.
In the informed consent process, the practical nurse's role is strictly limited to witnessing the signature, verifying that the client or proxy is competent to sign, and ensuring the decision is voluntary. It is the sole responsibility of the prescribing provider to explain the risks, benefits, and alternatives of a procedure, which includes the medical consequences of refusing treatment. Because the proxy holding the DPOA-HC has unanswered questions regarding the risks of refusal, the consent process is incomplete. The PN must halt the signing process and arrange for the provider to speak with the proxy.
Step-by-Step Solution
Key Concept
The practical nurse's role in informed consent is limited to witnessing the signature and verifying voluntary agreement. Answering questions about procedural risks or consequences of refusal is the sole responsibility of the provider.