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Difficulty: HardInformed Consent

A young adult client with a history of schizophrenia is admitted to a medical-surgical unit with acute appendicitis. The client is oriented to person, place, and time, but is currently experiencing auditory hallucinations. The surgeon explains the proposed appendectomy, and the client agrees to the surgery, stating, "The voices told me this operation will finally remove the alien tracking device from my stomach." The surgeon leaves the consent form at the bedside for the nurse to witness. Which action should the nurse take?

  1. A
    Challenge the client's belief by explaining the surgery is for an infected appendix, then obtain the signature.
  2. B
    Witness the client's signature because the client is oriented to person, place, and time and is voluntarily agreeing to the procedure.
  3. Withhold witnessing the signature and notify the surgeon that the client's capacity to consent is impaired by delusional reasoning.Answer
  4. D
    Assume the client is incompetent based on the schizophrenia diagnosis and independently contact the next of kin for consent.

Answer

The correct action is to withhold witnessing the signature and notify the surgeon that the client's capacity to consent is impaired by delusional reasoning.
The correct answer involves halting the consent process and notifying the provider. For informed consent to be legally valid, the client must possess the cognitive capacity to understand the nature of the procedure, its risks, and its benefits. Although the client is willing to undergo the surgery, their reasoning is based entirely on a psychotic delusion. This indicates a profound inability to appreciate the medical reality of the situation. As a patient advocate and witness to the consent process, the registered nurse has a legal and ethical duty to ensure the client is truly competent. Therefore, the nurse must withhold their signature and inform the surgeon, who must then formally assess the client's capacity and potentially seek surrogate consent.

Step-by-Step Solution

1
Evaluate the client's understanding of the proposed surgical procedure.
The client voluntarily agrees to the surgery, but does so to remove an 'alien tracking device', which is a delusional belief.
The nurse's role in informed consent includes verifying that the client comprehends the true nature of the intervention.
2
Determine if the client meets the legal criteria for informed consent capacity.
The client lacks the capacity to appreciate the actual medical reality, risks, and benefits of the appendectomy.
Competency and capacity require rational decision-making abilities, which are currently compromised by active psychosis.
3
Identify the appropriate nursing intervention based on the scope of practice.
The nurse must stop the consent process and communicate the findings to the healthcare provider.
The registered nurse cannot witness an invalid consent and must advocate for the client by ensuring the provider is aware of the impaired capacity so appropriate legal and ethical steps can be taken.

Key Concept

Informed Consent and Capacity Assessment in Psychiatric Clients
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Informed Consent

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