About Consent Form

rn/writer, RN · Nov 3, 2005

i am confused about signing consent form.
under what situation client don't or do need to sign consent form: emegercy young adult under 18 or adult, confusion client.
can some one explain to me?
please answer following question
confused client for surgery. need to patient sign consent
what is initial action?
a)document/monitor
b)notify anesthesiology
c)determine when pt confused
d)ask relative

your first reference was to a young person under 18. if a parent cannot be reached and the situation is emergent/life threatening, there is what is referred to as "implied consent." this assumes that if a parent were available, they would want you to proceed in a manner that would save the life and/or limb of their child. implied consent goes forward until and unless someone with legal standing offers a negative vote.

implied consent would also apply to a confused adult in an emergent situation in that they cannot give an informed consent, and it is assumed that if they could, they, too, would opt to save life and limb.

to address your multiple choice question, for non-emergent situations, if the patient has a healthcare poa, they may give consent, but that person may not be a relative. and relatives may not have poa, so that option is out.

although the anesthesiologist is a doctor, the surgeon is the one responsible for informing the patient and obtaining consent.

before contacting the surgeon, i'd try to determine when the patient became or becomes confused. is this a new occurence or does the patient "come and go" on a regular basis? what are the possible causes of the confusion? meds? hypoxia due to poor oxygenation or perfusion? dehydration? these are important considerations, not only for obtaining consent, but for determining fitness for the surgery itself. any conditions which can be corrected should be given proper attention and treatment. to do this, you'll probably need new orders from the doc. and he ought to ask the questions at the beginning of this paragraph.

even if the patient has a history of confusion, you still need to determine that fact and ascertain whether there is a pattern that includes periods of lucidity. informed consent can still be obtained if appropriate questioning determines that the patient is, at a particular moment, alert and oriented and capable of understanding what is being explained to him and asked of him.

in either scenario of confusion, recent onset or longer term, your job is to paint the picture for the surgeon and the only way you can do that is to determine when the patient becomes confused.

of course, you would then document and continue to monitor, but in this case, those actions are follow-up for figuring out what's going on with the patient and contacting the surgeon.

don't know if nclex would agree, but that's my rationale. i'd be interested in finding out what the "correct" answer is for this quesiton.

Leda · Nov 3, 2005

I agree with the above response. Remember NCLEX is a test to determine safe and effective nursing care, this means that you need to identify the most important, priority nursing response to deliver safe care.

The question does not imply that this is an emergency situation, it only indicates that a confused client is scheduled for surgery. In addition to obtaining consent it is paramount that the nurse make sure that this patient is "safe" for surgery. This means the nurse needs to assess the situation to determine more about this client's confusion/altered level of consciousness as it may (or may not) indicate a serious physiological problem in the patient.

Following this the nurse can then continue with the preop care of the patient which would include making sure that the consent form is signed. Remember informed consent is not obtained by the nurse, it is obtained by the person performing the procedure. A nurse can witness the consent, but cannot obtain informed consent. The nurse evaluates the client's understanding (i.e. can the person make a true informed consent, which of course the confused patient could not). If the patient can't consent due to their condition, then legal consent would be obtained from the next of kin, the legal guardian, etc.

So it seems that the first response should be C, determine when the patient became confused.