A nurse is preparing to witness a client's signature on an informed consent document for a scheduled lumbar laminectomy. The nurse places the document on the bedside table and hands the client a pen. The client hesitates and states, "The doctor said this will fix my back, but I am terrified of being paralyzed. Maybe I should just try physical therapy instead." Arrange the following nursing actions in the correct chronological sequence.
- 1Instruct the client to pause and withhold their signature from the consent document.
- 2Explore the client's specific fears about paralysis and their understanding of physical therapy as an alternative.
- 3Notify the operating surgeon that the client is expressing uncertainty and requires further medical explanation.
- 4Verify that the surgeon has returned to discuss the procedural risks, benefits, and alternatives directly with the client.
- 5Witness the client's voluntary signature on the consent form after confirming all of their questions have been answered.
Answer
The correct sequence is to first stop the client from signing, assess their specific concerns, notify the surgeon of the knowledge deficit, verify the surgeon has addressed these concerns, and finally witness the signature once the client is ready.
Informed consent requires the client to fully understand the risks, benefits, and alternatives of a procedure before signing. When a client expresses doubt or asks about alternatives, the nurse's immediate priority is to stop the signing process. Next, the nurse assesses the specific concerns to communicate them effectively. Because explaining medical risks and alternatives is outside the RN scope of practice, the nurse must advocate by notifying the surgeon. Once the surgeon has fulfilled their legal duty to re-educate the client, the nurse can safely resume their role as a witness and authenticate the voluntary signature.
Step-by-Step Solution
Key Concept
The nurse's role in informed consent is to act as an advocate and witness, halting the process and notifying the provider if the client demonstrates a lack of understanding or expresses a desire for alternative treatments.