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Difficulty: HardInformed Consent

A registered nurse is preparing to witness the signature on an informed consent document for an older adult client scheduled for a cardiac procedure. The client is alert and oriented but states, 'The physician explained the surgery, but I still do not understand what my other treatment options are. I am only signing this because my daughter said she will stop taking care of me if I refuse.' Which of the following actions should the nurse take? Select all that apply.

  1. Refrain from witnessing the client's signature on the informed consent document.Answer
  2. Notify the healthcare provider that the client requires further explanation of the treatment alternatives.Answer
  3. Report the daughter's statements to social services or the appropriate adult protective agency.Answer
  4. D
    Instruct the unlicensed assistive personnel (UAP) to witness the client's signature after the provider returns to re-explain the procedure.
  5. E
    Assure the client that relying heavily on family members and feeling pressured is a normal part of the aging process.
  6. F
    Delay reporting the potential abuse to protective services unless there is tangible proof of physical neglect.

Answer

The nurse should refrain from witnessing the signature, notify the healthcare provider to explain the alternatives, and report the daughter's threat to the appropriate protective agency.
The correct actions prioritize client safety, legal rights, and clinical advocacy. Because the client does not understand the alternatives and is being coerced by their daughter's threat of abandonment, the consent is neither informed nor voluntary. Therefore, the nurse must withhold their signature as a witness, notify the provider to fulfill the medical duty of explaining alternatives, and fulfill mandatory reporting laws by contacting protective services regarding the potential elder abuse.

Step-by-Step Solution

1
Evaluate the client's statements for the elements of valid informed consent.
The client lacks understanding of alternatives and is experiencing coercion, meaning the criteria for informed and voluntary consent are not met.
Valid informed consent requires the client to be legally competent, fully informed of all options, and acting voluntarily without external coercion.
2
Determine the appropriate nursing intervention for the halted consent process.
The nurse must refuse to witness the signature and notify the provider to clarify the treatment options.
The nurse's role is to act as a client advocate and witness that the client understands the provider's explanation. The provider must be the one to supply the missing medical information regarding alternatives.
3
Address the psychosocial safety concern raised by the client.
The nurse must report the daughter's threat of abandonment to adult protective services or the facility's social work department.
Threatening to withhold care is a form of elder abuse. Nurses are legally mandated to report suspected abuse immediately to protect vulnerable populations.

Key Concept

The nurse's role in informed consent involves validating client comprehension, ensuring voluntariness, halting the process if criteria are unmet, and acting as a mandatory reporter for suspected coercion or abuse.
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Topics

Informed Consent

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