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Difficulty: MediumInformed Consent

An older adult client is scheduled for a total hip arthroplasty. The orthopedic surgeon previously discussed the procedure, risks, benefits, and alternatives with the client. When the registered nurse (RN) presents the informed consent document for signature, the client expresses anxiety and states, "The doctor explained everything this morning, but I completely forgot what was said about the risk of blood clots. Should I be worried?" Which of the following actions by the RN are appropriate? (Select all that apply)

  1. Delay the signing of the consent form until the client's questions are adequately addressed.Answer
  2. Contact the surgeon to return and reinforce the information regarding the surgical risks.Answer
  3. Document the client's statement and the subsequent notification of the healthcare provider in the medical record.Answer
  4. D
    Instruct the unlicensed assistive personnel (UAP) to remain with the client and obtain the consent signature once the surgeon clarifies the risks.
  5. E
    Reassure the client by stating, "There is no need to worry; blood clots are very uncommon with this type of surgery."
  6. F
    Assume the client's forgetfulness is an expected cognitive decline of aging and request that the designated health care surrogate sign the form.

Answer

The appropriate actions are to delay the signing of the consent form, contact the surgeon to provide further clarification, and document the client's statements and the nurse's interventions.
The informed consent process legally requires the healthcare provider performing the procedure to explain the risks, benefits, and alternatives. The registered nurse's role is to act as a client advocate by witnessing the signature, verifying that the client is competent, and ensuring that the client fully understands the provided information. Because the client explicitly stated they forgot the risks, the consent is no longer considered 'informed.' Therefore, the RN must advocate for the client by withholding the signature, notifying the surgeon to return and re-educate the client, and thoroughly documenting the interaction.

Step-by-Step Solution

1
Assess the client's understanding of the proposed procedure.
The client admits to forgetting the specific risks associated with the surgery.
The RN must ensure the consent is truly 'informed' before obtaining a signature as a witness.
2
Determine the scope of practice regarding explaining surgical risks.
The healthcare provider (surgeon) is legally responsible for explaining the risks, not the RN.
RNs witness the signature and advocate for client understanding, but they do not initiate the primary explanation of medical or surgical risks.
3
Select the nursing actions that legally and ethically protect the client's rights.
Delaying the signature, notifying the provider, and documenting the event are the correct advocacy steps.
These actions uphold the legal and ethical standards of the informed consent process by ensuring the client receives the necessary information from the appropriate provider.

Key Concept

Informed Consent: RN versus Provider Responsibilities
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Topics

Informed Consent

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