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Difficulty: HardInformed Consent

A client is scheduled for a cardiac catheterization in 30 minutes. The healthcare provider has already obtained signed informed consent. While the nurse is preparing to administer the prescribed pre-procedure sedative (midazolam), the client states, "I changed my mind. I do not want this procedure. The doctor said I could have a stroke." What is the priority sequence of nursing actions? Arrange the actions in the order they should be performed, from first to last.

  1. 1Withhold the administration of the prescribed pre-procedure midazolam.
  2. 2Inquire about the client's specific concerns regarding the risk of a stroke.
  3. 3Notify the healthcare provider of the client's statement of refusal.
  4. 4Document the client's exact words, the withheld medication, and the provider notification.

Answer

The correct sequence is to first withhold the sedative, second assess the client's specific concerns, third notify the healthcare provider, and fourth document the event.
When a client explicitly revokes consent, the nurse's immediate priority is to halt any interventions related to the procedure, particularly mind-altering medications like sedatives that would impair decision-making capacity. Next, the nurse assesses the client's specific concerns. Then, the nurse acts as an advocate by notifying the provider, who holds the responsibility for addressing medical risks and re-evaluating consent. Finally, the nurse thoroughly documents the entire sequence of events.

Step-by-Step Solution

1
Withhold the administration of the prescribed pre-procedure midazolam.
The preoperative process is halted, and the client's cognitive status remains unaltered.
Administering a sedative after a client expresses a desire to withdraw consent would violate their autonomy and render them legally incompetent to make further decisions regarding the procedure.
2
Inquire about the client's specific concerns regarding the risk of a stroke.
The nurse gathers specific data about the client's fears and knowledge deficit.
Assessment is the next sequential step in the nursing process to understand the root cause of the refusal before communicating with the provider.
3
Notify the healthcare provider of the client's statement of refusal.
The provider is informed of the change in the client's consent status.
The nurse cannot independently resolve medical concerns or re-establish informed consent; the provider must address the risks (e.g., stroke) and determine if the client still wishes to proceed.
4
Document the client's exact words, the withheld medication, and the provider notification.
A legally sound medical record is established.
Accurate and timely documentation protects the client's rights and the nurse's legal liability, but it should only occur after immediate safety and communication needs are met.

Key Concept

Revocation of Informed Consent and Nurse Advocacy
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Topics

Informed Consent

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