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Difficulty: MediumInformed Consent

An 82-year-old client on the orthopedic unit is scheduled for a total hip arthroplasty later today. While holding the un-signed surgical consent form, the client states, 'The surgeon spoke with me yesterday, but my memory is failing me. I cannot remember if there were other options besides having this surgery.' Which action should the nurse take to ensure the criteria for informed consent are met?

  1. A
    Assume the client's cognitive lapse is a normal physiological change of aging, educate the client on the non-surgical alternatives, and witness the signature.
  2. B
    State, "Do not worry, everything will go perfectly because you have an excellent surgical team," and ask the client to sign.
  3. Contact the surgeon to clarify the alternatives to the procedure before the client signs the document.Answer
  4. D
    Request that the unlicensed assistive personnel (UAP) obtain the client's signature while the nurse contacts the operating room.

Answer

Contact the surgeon to clarify the alternatives to the procedure before the client signs the document.
For informed consent to be legally valid, the client must fully comprehend the procedure, including its risks, benefits, and alternatives. It is strictly the responsibility of the primary healthcare provider (such as the surgeon) to explain these elements. If a client demonstrates a knowledge deficit—such as forgetting the surgical alternatives—the nurse must act as a client advocate by pausing the consent process and notifying the provider to return and clarify the information.

Step-by-Step Solution

1
Assess the client's current understanding of the planned procedure, its risks, benefits, and alternatives.
The client explicitly states an inability to remember the alternatives to the surgery.
Valid informed consent requires the client to have a clear understanding of the procedure, including alternative treatments, at the time of signing.
2
Identify the boundaries of the nurse's scope of practice regarding informed consent.
The nurse determines that explaining surgical alternatives is the responsibility of the healthcare provider, not the nurse.
The nurse acts as a witness and an advocate but cannot legally provide the primary explanation of medical risks, benefits, or alternatives.
3
Implement the appropriate advocacy intervention based on the assessment.
The nurse halts the signing process and notifies the surgeon.
The provider must return to ensure the client is fully informed before the client can legally grant consent.

Key Concept

The nurse's role in informed consent is to act as an advocate by witnessing the signature, ensuring the client is competent and acting voluntarily, and notifying the primary provider if the client demonstrates a knowledge deficit regarding risks, benefits, or alternatives.
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Informed Consent

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