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Difficulty: HardInformed Consent

A client was admitted to the emergency department with a complex femur fracture. Initially, the client was disoriented due to hypovolemia, and the client's legally authorized representative (spouse) signed the informed consent for an open reduction and internal fixation (ORIF). After receiving intravenous fluids, the client becomes fully alert and oriented. As the transport team arrives to take the client to the operating room, the client states, 'I changed my mind. I am not having surgery; I just want a splint.' Place the following nursing actions in the correct chronological order.

  1. 1Instruct the transport team to hold the transfer to the operating room.
  2. 2Assess the client's orientation, cognitive status, and rationale for refusing the procedure.
  3. 3Assure the client that their right to withdraw consent will be respected.
  4. 4Notify the orthopedic surgeon of the client's refusal so they can explain the risks of not having surgery.
  5. 5Document the client's return of capacity, the revocation of consent, and the provider notification in the medical record.

Answer

The correct order of nursing actions is to first halt the transport, then assess the client's capacity and rationale, assure the client of their rights, notify the surgeon, and finally document the event.
The correct sequence follows the nursing process and prioritizes immediate safety. Stopping the transport (implementation) prevents battery. Assessing capacity (assessment) ensures the refusal is legally sound. Assuring the client (advocacy) supports autonomy. Notifying the surgeon (communication) allows for medical counseling on risks. Documenting (administrative) creates the legal record.

Step-by-Step Solution

1
Instruct the transport team to hold the transfer to the operating room.
The client remains in the emergency department, and the surgical preparation is paused.
The immediate priority is to prevent battery by ensuring an invasive procedure is not performed on a client who is actively revoking consent.
2
Assess the client's orientation, cognitive status, and rationale for refusing the procedure.
The nurse confirms that the client is fully alert, oriented, and capable of understanding their medical decisions.
A client who regains decision-making capacity regains the right to make their own healthcare choices, which legally supersedes a surrogate's previous authorization. This capacity must be assessed before proceeding.
3
Assure the client that their right to withdraw consent will be respected.
The client feels supported and their autonomy is validated.
This fulfills the nurse's ethical obligation to act as a client advocate, especially when the client's wishes conflict with a previously signed consent form.
4
Notify the orthopedic surgeon of the client's refusal so they can explain the risks of not having surgery.
The surgeon is informed of the cancellation and comes to evaluate the client.
While the nurse advocates for the client's decision, it is the provider's legal responsibility to explain the risks, benefits, and alternatives of refusing the surgery.
5
Document the client's return of capacity, the revocation of consent, and the provider notification in the medical record.
A clear chronological timeline of events is recorded in the client's chart.
Documentation provides a legal and professional record of the client's change in clinical status, the nursing interventions, and interdisciplinary communication.

Key Concept

When a temporarily incapacitated client regains decision-making capacity, their autonomous healthcare choices legally supersede any previous consent provided by a surrogate.
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Topics

Informed Consent

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