Informed Consent- What does the patient really understand?

  1. Did anyone watch this on the news last night?

    http://www.cbsnews.com/stories/2009/...Health_5075694

    It is a story about what patients really understand or more importantly dont understand about the procedures they are consenting to . An example was : with a CP patient who underwent diagnostic angioplasty the patients believed that even if there was no blockage found that by simply undergoing the procedure had added 10 years to their life. It was very interesting. The most impressive thing for me was how the doctors at this one medical facility had a computer program that required you to input the age, sex, suggested procedure and comorbidities of the patient...then the computer gives the patient a reasonable benefit result for patients JUST LIKE HIM/HER that had underwent the same procedure. Like the MD was able to say " when patients in your age group and health status underwent this procedure less than 1% suffered complications....or 35% suffered complications and this is a list of what those complications were: XXXXX.
    Does anyone use this program in your ED or hospital and if so what is it called?
  2. Visit Keysnurse2008 profile page

    About Keysnurse2008

    Joined: Sep '00; Posts: 581; Likes: 164
    MICU

    18 Comments

  3. by   GoalsInTransition
    Wow- I could really use that program, too!

    I'm sorry I can't give you the information you're looking for, but I am really excited to hear what you had to say.

    I am not a nurse yet. I am a clinical research coordinator who has applied to a nursing program. As a coordinator, however, I obtain informed consents routinely. It is amazing how individuals can misinterpret what is printed in the consent form, and/or what is said to them during the discussion of the consent form.

    Obviously a computer program cannot likely address all of these communication deficits (in the patient or the professional), but it is pretty exciting to know that such a program exists!

    Stacy
  4. by   Chisca
    I brought up the issue of informed consent (nurses obtain consent at my hospital) in a staff meeting and was told I am only witness to the patient's signature. If the patient had any questions it was between the patient and the doctor. Maybe the doctor should get the consent and leave nursing out of the loop.
  5. by   pennyaline
    Quote from Chisca
    I brought up the issue of informed consent (nurses obtain consent at my hospital) in a staff meeting and was told I am only witness to the patient's signature. If the patient had any questions it was between the patient and the doctor. Maybe the doctor should get the consent and leave nursing out of the loop.
    Obtaining informed consent for medical and surgical procedures is solely the responsibility of the physicians and NPs involved in those procedures. It is not to be done by staff RNs. Staff nurses can sign as witnesses for consent, but I would do that only if the patient had no family or other support present to witness.
  6. by   Keysnurse2008
    Quote from Chisca
    I brought up the issue of informed consent (nurses obtain consent at my hospital) in a staff meeting and was told I am only witness to the patient's signature. If the patient had any questions it was between the patient and the doctor. Maybe the doctor should get the consent and leave nursing out of the loop.
    Legally the docs are suppost to be getting the consent signed, but...I understand what you are saying. This computer program is being used at the bedside by the doc's. They were able to input the pt's detailed medical hx in there, age , sex etc etc and then tell the patient " In our database patients in your age group and your health status experienced a complication about 13% of the time and these are the complications they had". Each new patients dats is entered thereby increasing the "pool" of patients in which they are deriving these numbers from. It was really neat,...and allowed the patients to get a better grasp of the benefit vs risk.
  7. by   Chisca
    Thanks Pennyaline for your response but it is done every day at this facility and others I have worked at in Tennessee. Again, when management is confronted they claim I am only witnessing the signature. I even encounter orders "obtain consent for blah blah procedure" written by the MD. The wording on the consent makes it appear a conversation has occured between the patient and a physician but I know in many instances that is not the case.
  8. by   cardiacmadeline
    RN's at my facility obtain consent also. We are told that we are only witness to the signature. I always make sure the patient has spoke with the physician first and if they have any questions about the procedure. If they haven't spoke to the physician or if they have any questions, I won't let them sign it. However, I have never liked the idea of nurses obtaining consent, that should be the physicians job. One more thing, when I do have them sign it, I verbally explain everything on the form (that the MD has explained the risks and benefits, that you consenting to receive blood products, etc.) because patients don't read it before they sign it. Most nurses just hand them the form and have them sign it. Even when I explain what is on the form, I don't think half the patients really listen to what I am saying, but they sign it anyways.
  9. by   pennyaline
    oh my god. when will we learn? what will it take?

    fellow nurses, please:

    stop letting them walk all over you!!
  10. by   ElvishDNP
    I definitely ask my patients to read over the form and ask questions, or if they prefer, I read it to them myself. Most of the consents I witness are for
    1) c/section
    2) circumcision
    or
    3) induction of labor/D&E

    #1 and #3 are generally adequately explained by the docs. #2, not so much, and I am always on the docs to come back and talk w/ moms about this.
  11. by   GoalsInTransition
    Institutional policies seem to vary greatly as to who is responsible for obtaining informed consent. legally, at least in the state of New York, I am able to obtain informed consent. The document must be signed by a study investigator, but that physician need not have even met the patient at that point.

    I think that many institutions that delegate this to nurses, in the case of non-research clinincal procedures, do so out of convenience (the physician is not always at hand). Those who choose only to allow physicians to obtain consents likely are inconvenienced by their policy, but feel safer from litigation in doing so.

    In my personal opinion, most RNs that I have met are infinitely capable of obtaining informed consent, and often have a connection with the patient that makes for a more sincere information exchange. In my experience as a research coordinator, patients will ask me questions they were too shy/nervous/insecure to ask the physician. If I feel confident that I know the right answer, I am happy to help.

    Are there major differences in nursing? Is the liability factor more prominent than I might be aware of?

    Stacy
  12. by   pennyaline
    Quote from StacyGwatura
    Institutional policies seem to vary greatly as to who is responsible for obtaining informed consent. legally, at least in the state of New York, I am able to obtain informed consent. The document must be signed by a study investigator, but that physician need not have even met the patient at that point.
    It sounds as though you are working in research, and that is a different animal.



    Quote from StacyGwatura
    I think that many institutions that delegate this to nurses, in the case of non-research clinincal procedures, do so out of convenience (the physician is not always at hand). Those who choose only to allow physicians to obtain consents likely are inconvenienced by their policy, but feel safer from litigation in doing so.
    That is precisely the case. I can't imagine a hospital or clinic administrator that would be stupid enough to trade convenience for a huge increase in risk.



    Quote from StacyGwatura
    In my personal opinion, most RNs that I have met are infinitely capable of obtaining informed consent, and often have a connection with the patient that makes for a more sincere information exchange. In my experience as a research coordinator, patients will ask me questions they were too shy/nervous/insecure to ask the physician. If I feel confident that I know the right answer, I am happy to help.
    It isn't that I disagree with you. I feel that staff nurses are capable of obtaining informed consent, too. But staff nurses are not leading the procedures. Physicians through their own words and actions are insisting that THEY are at the top of the health care food chain and are in charge of everything because no one else is capable of it, so let them take the consequences of their high falutin' yadda yadda and go and get their own signatures from the patients they dominate.


    Quote from StacyGwatura
    Are there major differences in nursing? Is the liability factor more prominent than I might be aware of?
    When I worked in acute care and especially in OR, the docs tried to palm getting consent for procedures and major cases(!) off on us all the time. This made hospital administration livid and they would call the doctors on the carpet for doing it. Unfortunately, it only made the doctors angry when we refused to get informed consent, and they would stomp all over the place ranting about how we were holding up procedures and yelling at administration that we should be suspended, demoted, transferred to other departments, fired, etc. Big babies. Let them get their own bottles.
  13. by   Chisca
    Quote from pennyaline
    oh my god. when will we learn? what will it take?

    fellow nurses, please:

    stop letting them walk all over you!!
    i wish it were that easy but tennessee, as is most southern states, a "right to work" state. i have been fired for refusing to accept an unsafe assignment and have also experienced harrassment for pointing out unsafe working conditions. not one nurse stood with me so i quickly learned to pick my battles. if it threatens my licensure i do fight but management holds all the cards here.
  14. by   Batman24
    The doctor should obatin consent as they are the ones performing the surgery/procedure. The nurse can act as witness but should never be the ones obtaining the actual consent. Your facility should back you on this and it seems most do. I would call Risk Management if anyone is trying to strong arm you into obtaining consent. Chances are more than good that Risk Management will back you as this can become a HUGE liability issue if there is a lawsuit down the line.

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