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Difficulty: MediumInformed Consent

A non-English speaking client on the acute medical-surgical unit is scheduled for a percutaneous liver biopsy. The healthcare provider has just finished discussing the procedure with the client via a hospital-approved remote video interpreter. The nurse enters the room to facilitate the signing of the informed consent document. Which of the following actions by the nurse are legally and ethically appropriate? Select all that apply.

  1. Assess the client's cognitive status to ensure they are not impaired by recently administered sedativesAnswer
  2. Act as a legal witness that the client's signature is authentic and provided voluntarilyAnswer
  3. Notify the healthcare provider to return to the unit if the client asks about alternative treatmentsAnswer
  4. D
    Delegate the task of witnessing the client's signature to the unit's unlicensed assistive personnel (UAP)
  5. E
    Provide a detailed explanation of the potential procedural complications if the client expresses uncertainty
  6. F
    Ask the client's bilingual family member to translate the written consent document into the client's native language

Answer

The legally and ethically appropriate actions are to assess the client's cognitive status, act as a legal witness to the voluntary signature, and notify the provider if the client asks about alternative treatments.
The nurse's legal and ethical duties during the informed consent process involve verifying that the client is competent (not influenced by sedatives), acting as a witness that the signature is authentic and voluntary, and acting as a patient advocate by pausing the process and notifying the provider if the client has questions regarding risks, benefits, or alternatives.

Step-by-Step Solution

1
Identify the nurse's specific legal role in the informed consent process.
The nurse's role is to act as a witness, ensure the client is competent, and verify the signature is voluntary.
Differentiating between provider and nursing responsibilities prevents practicing outside the scope of nursing.
2
Evaluate the option regarding cognitive assessment.
Assessing that the client is not impaired by sedatives is a mandatory nursing action.
A client cannot legally sign a consent form if their judgment is impaired by medications like opioids or benzodiazepines.
3
Evaluate the option regarding client questions about alternatives or risks.
The nurse must notify the healthcare provider to return and re-explain.
Providing primary education about the procedure's risks or alternatives falls strictly under the healthcare provider's scope of practice.
4
Evaluate the options regarding delegation and translation.
Witnessing cannot be delegated to a UAP, and family members cannot be used as official medical interpreters for legal documents.
Witnessing requires nursing judgment, and relying on family for translation risks misinterpretation and violates standards for culturally and linguistically appropriate care.

Key Concept

The nurse's role in informed consent is to witness the signature, confirm the client is competent and acting voluntarily, and advocate for the client by notifying the provider if further clarification is needed. The nurse does not provide primary education about the procedure or delegate the witnessing assessment.
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Informed Consent

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