Patient Education

• Several factors related to the nature of the illness, the severity of symptoms, and the treatments required can interfere with a patient's capacity to fully understand and voluntarily agree to medical procedures. These factors include pain, fatigue, cognitive impairment, and psychological factors such as anxiety, shock, and denial
• Nurses should closely monitor the patient's mental status to determine if they have the capacity to make informed decisions. If there is doubt, involving a healthcare provider with expertise in assessing decision-making capacity (e.g., neurologist, psychiatrist) may be necessary.
• Nurses should assess patients’ knowledge of their condition and provide education when needed. Nurses spend more time educating patients than most other healthcare disciplines. Nurses fill trusted roles as patient caregiver, advocate, educator, and steward.
• During bedside care, nurses may be asked by both the patient and family to answer questions related to upcoming procedures, tests, and surgeries.

Informed Consent

• At its core, informed consent requires patients to be aware of the risks, benefits, and alternatives of the proposed surgery, intervention, or treatment and be given an opportunity to ask questions.
• The process of informed consent is complex, may require the participation of multiple parties, and usually begins well in advance of the point of obtaining a signature on a form.
• The signed and witnessed informed consent form is the legal obligation of the physician or advanced practice provider performing the procedure in question.
• Nurses are usually charged with verifying the informed consent paperwork has been obtained just prior to surgery or procedures.
• Consent should never be considered a waiver of liability.
• Patients have the right to know who is performing their procedure, as well as how many times the person has successfully completed this procedure.
• If the nurse believes the patient has not been fully informed or has less than a full understanding of the proposed treatment, the nurse must act as a patient advocate to ensure that the patient receives the necessary information.
• In emergencies where the patient is unable to give consent and immediate treatment is necessary, healthcare providers may proceed without consent under the doctrine of implied consent, provided that there is a reasonable expectation that the patient would have consented if able to do so.

Refusal of consent

• It is within the rights of the autonomous patient to refuse a recommended treatment.
• A competent patient may verbally withdraw consent at any time, and refuse to continue a treatment pathway, even in the presence of a signed consent form.