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Difficulty: MediumInformed Consent

A client is in the preoperative holding area awaiting an elective lumbar laminectomy. When the registered nurse presents the informed consent document for a witness signature, the client states, "I am really scared. I don't think I want to have this surgery anymore." Arrange the following nursing actions in the correct priority order.

  1. 1Explore the client's specific concerns and reasons for wanting to cancel the surgery.
  2. 2Inform the client of their right to refuse and withhold the witness signature.
  3. 3Contact the operating surgeon to report the client's hesitation and decision not to sign.
  4. 4Document the client's exact statements, the halted consent process, and the provider notification.

Answer

The correct sequence is to first explore the client's concerns, then halt the consent process, followed by notifying the operating surgeon, and finally documenting the event.
The standard nursing prioritization framework requires the nurse to first Assess (explore concerns), then Intervene to protect client safety and rights (withhold signature), then Escalate to the appropriate provider (contact surgeon), and finally Document the entire sequence of events.

Step-by-Step Solution

1
Explore the client's specific concerns and reasons for wanting to cancel the surgery.
The nurse gathers assessment data regarding the client's anxiety.
Assessment is always the first step in the nursing process. Understanding the client's fear is necessary before taking further action.
2
Inform the client of their right to refuse and withhold the witness signature.
The client is reassured of their autonomy, and the consent process is safely halted.
The nurse acts as a client advocate, protecting their legal right to refuse treatment at any time.
3
Contact the operating surgeon to report the client's hesitation and decision not to sign.
The surgeon is made aware of the situation and can intervene.
The surgeon owns the responsibility for obtaining informed consent and must address the medical concerns with the client directly.
4
Document the client's exact statements, the halted consent process, and the provider notification.
A legal record of the event is established in the electronic health record.
Accurate and timely documentation legally protects the client, the nurse, and the facility after the immediate clinical needs are met.

Key Concept

Informed Consent and Patient Advocacy
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Topics

Informed Consent

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