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Difficulty: MediumInformed Consent

A client with newly diagnosed severe coronary artery disease is scheduled for a coronary artery bypass graft. The nurse brings the informed consent document to the client's room for a signature. The client states, "The doctor said I need this surgery, but I do not really understand what the alternative treatments are or what will happen if I refuse it. I will sign it anyway because I want to get better." Which of the following is the most appropriate action by the nurse?

  1. A
    Explain the available alternative treatments and the potential risks of refusing the surgery to ensure the client is fully informed.
  2. B
    Document the client's knowledge deficit in the electronic health record and proceed with witnessing the signature.
  3. Inform the client that the form should not be signed yet and notify the surgeon to return and answer the client's questions.Answer
  4. D
    Reassure the client that the surgeon is highly experienced with this procedure and allow the client to sign the document.

Answer

Inform the client that the form should not be signed yet and notify the surgeon to return and answer the client's questions.
The nurse's role in informed consent is to act as an advocate, witness the signature, verify that the client is competent, and confirm that the client comprehends the procedure. Because the client explicitly states a lack of understanding regarding alternatives and the risks of refusal, the consent is not truly informed. The nurse must halt the signing process and notify the healthcare provider, whose legal responsibility is to explain the risks, benefits, and alternatives.

Step-by-Step Solution

1
Assess the client's understanding of the planned surgical procedure.
The client expresses a lack of understanding regarding alternative treatments and the consequences of refusing the surgery.
The nurse must verify that the client has received and understands the information provided by the surgeon before witnessing the signature.
2
Determine the appropriate nursing intervention based on the client's knowledge deficit.
The nurse identifies that the client cannot legally give informed consent at this time.
Informed consent requires the client to fully comprehend the procedure, its risks, benefits, and alternatives.
3
Implement the correct advocacy action.
The nurse stops the consent process and contacts the healthcare provider.
It is the healthcare provider's legal responsibility to explain the procedure and its alternatives. The nurse acts as a client advocate by ensuring the provider returns to address the knowledge deficit.

Key Concept

The nurse's role in informed consent is to witness the signature and advocate for the client by ensuring they fully understand the information provided by the healthcare provider.
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Informed Consent

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