A client is in the preoperative unit awaiting an elective percutaneous transluminal coronary angioplasty (PTCA). The client has not received any premedication. As the nurse prepares to witness the informed consent signature, the client states, 'I am not sure I want to go through with this if there is a risk I could have a heart attack during the procedure.' Arrange the following nursing actions in the correct chronological sequence.
- 1Instruct the client not to sign the consent form.
- 2Ask the client to elaborate on their specific concerns regarding the procedure.
- 3Contact the cardiologist to return and provide further clarification to the client.
- 4Witness the client's signature once the cardiologist has addressed the concerns.
- 5Document the client's questions, the provider notification, and the final consent in the medical record.
Answer
The correct sequence is to instruct the client not to sign, assess their specific concerns, contact the cardiologist, witness the signature after clarification, and finally document the event.
When a client expresses doubts or a lack of understanding about a procedure, the nurse must act as an advocate. The immediate priority is to stop the consent process to prevent an invalid signature. Next, the nurse assesses the client to understand exactly what needs clarification. The nurse then contacts the healthcare provider, as it is the provider's legal duty to explain risks and benefits. Once the provider has answered the client's questions and the client is ready, the nurse witnesses the signature. Finally, comprehensive documentation of the delay, the provider's intervention, and the completed consent is entered into the medical record.
Step-by-Step Solution
Key Concept
Informed Consent and Nurse Advocacy