Informed Consent

[HopefulRN4144]

I had a practice question regarding informed consent. I would appreciate further explanation on it! Thank you!

The nurse has administered Demerol IM to a client. Thirty minutes later, the physician arrives and asks the client to sign a consent for an invasive procedure. The client is groggy and seems confused, but she signs the form. The physician asks the nurse to witness the client's signature. Legally, what does the nurse's signature represent?

1. The client signed the form at the stated date and time
   
2. The client has given implied consent
   
3. The physician has explained the procedure to the client
   
4. The client was fully alert and aware of what she was signing
   

Answer: D

Rationale: If the nurse knows of a situation that can render the consent form invalid, the nurse is responsible for reporting it according to agency policy. The nurse's signature implies that the client was fully alert and aware of what she was signing. The date and time are included, but the question focuses on the nurse's responsibility.

I was always taught that when the nurse is involved in the informed consent process, the nurse is witnessing ONLY the signature of the pt on the informed consent form. I was always taught that when witnessing informed consent, you are simply doing that - witnessing the signature on the form.

It is the person performing the procedure's responsibility to explain the procedure. Of course, as a nurse, you should be the pts advocate and ensure that they understand what was explained to them and speak up if the pt does not understand. I was taught that in situations where the physician explains the procedure, but then the physician leaves and the pt tells you that he/she doesn't really understand the procedure, the nurse should not explain it - the nurse should get the physician and inform him/her that the pt needs more explanation.

I also know that when a pt has been medicated with a sedating med or any other med that might affect the pts cognitive abilities should not be asked to sign a consent form. So, as a nurse, being your pts advocate, you should speak up and say that the pt has been medicated and is unable to provide consent.

I knew that the answer was either A or D. I thought it might be A because, as I was taught, a nurse witnessing informed consent is witnessing the pts signature on the form. I remember it was drilled in our heads that with informed consent, the nurse is witnessing the signature on the form. However, I believe by witnessing that signature, the nurse would be acknowledging that the pt is signing because he/she understands the procedure? Again, I know that a pt should NOT sign a form when medicated on anything that can alter the pts cognitive abilities.

But what I get stuck in in the question is "Legally, what does the nurse's signature represent?"

From what I was taught, the nurse's signature just means that the nurse witnessed the pt signing the form? In which case, the answer would be A. But, does it mean that the nurse witnessed the pt acknowledge he/she understands the procedure and witnessed the pt sign the form? In which case, it would be D.

[Sour Lemon]

D is the correct answer. I think when they say you're only witnessing the signature, they mean you're not responsible for explaining the procedure to the patient.

Doctors used to write orders for surgeries and other things without even stopping by to notify the patient when I was a new grad (eight years ago). Since then, things seem to have become more strict. The MD obtains consent and the nurse gets/witnesses the signature. We're not able to get/witness "just the signature" if the patient is impaired, though.

[HopefulRN4144]

Ok! Great! Thank you so much!

[Double-Helix, BSN, RN]

Think of it this way: a patient who has been recently given narcotics is not capable (actually they may be, but for the purposes of this question they aren't) of signing their own consent form. Their signature is as invalid as if someone else had signed their name for them.