01.02 Informed Consent

Hey guys today I'm going to talk to you a little bit about informed consent!

So what exactly is informed consent? So guys, basically anytime a patient is going to have a surgery or procedure there is information that the provider or surgeon must give to the patient so that the patient can decide whether or not they want to have the surgery or procedure.  So in other words the consent given by the patient has been one that is informed and knowledgeable.  It's definitely important to mention that the patient must able to understand and comprehend any information given and also have decision-making skills, meaning they are competent and that the final decision is one they have made on their own.  The surgeon or provider should make sure the patient is in fact competent.  If the patient decides to have the surgery they will then give their written consent.

So here are a few examples of the elements or information that should be given that results in informed consent.  When a surgeon or provider is speaking with their patient they should definitely be sure to tell the patient why they need surgery or the necessity.  they're also going to make sure that the patient knows what the risks and side effects are of the procedure, and of course the benefits.  Guys, alternatives to other options to the procedure or surgery should most definitely have been discussed.

Okay so I want to talk just a little bit about the perioperative nurse and their role with informed consent.  The perioperative nurse plays a critical role when it comes to informed consent.  We want to make sure that before the patient goes under anesthesia and can no longer advocate for themselves that they have a full picture of what is about to happen.  So basically the perioperative nurse will make sure that the patient has been given all of the elements that I just talked about on the previous slide, risks, benefits, alternatives, etc.  Patients will give you a ton of information just by listening to them and you are going to figure out quickly what they know and if they have been informed properly.  For instance, the other day I had a patient who was scheduled for an abdominoplasty,  I quickly realized that this patient needed to have another conversation with their surgeon as they asked me if they would have pain and if they could workout by the weekend.  I’m sure you all know anytime you are cut into there is a component of pain, especially with an abdominoplasty and working out is out of the question for quite some time.  Anyway, this to me was a huge red flag and this patient in my opinion could not truly provide informed consent.  So guys listen to your patients and be their advocate if they are lacking important information!  So the final step of informed consent is the written consent that the patient will give, often times the perioperative nurse will witness this.  Be sure to check out your state laws and facility policies on witnessing consents.  Check out our additional lesson on the different perioperative nursing roles for more info!

Here are just a few different examples of when informed consent is required.  Surgery obviously probably the most common or most thought about, also invasive procedures, things like cardiac caths, injections, endoscopy and colonoscopy.  Anesthesia, radiation, chemotherapy, and some blood tests also could require informed consent as there are definitely risks, side effects, benefits, and possibly different options associated with each of them.  

So what happens when your patient isn't able to make a decision or you know they don’t have proper decision-making capabilities?  So in these instances, like a patient in a coma that needs a procedure or someone with dementia or Alzheimer’s, someone else must be involved with the informed consent process like a surrogate decision-maker, next of kin or medical power of attorney.  Kids are not legally able to make their own medical decisions so they will fall into this category too.  Also guys, impaired people cannot give informed consent.  This is something that I have to always keep in mind as a perioperative nurse because once a patient receives any type of relaxing medication like Versed before surgery they can no longer legally give consent.  So the signing of the consent form must be completed before the patient is medicated.  Make sure you check out the additional lessons we have on advanced directives and medical power of attorney.

With emergency situations, where a patient’s life is dependent on a certain surgery or procedure and the patient is unable to consent (for example, unconscious)  and no other decision-maker is around, there would be “implied consent” meaning it’s assumed if the patient could consent they would.

Okay so with informed consent the most important thing to teach your patient is that they can and they should ask questions.  It is their right to know what is about to happen to them and it's your responsibility and privilege to be their advocate.  I see it everyday with surgical patients, they are very nervous, they are very anxious, and especially with elderly patients they do not want to question their provider or surgeon so really it so important that we help our patients through this process so that they are in control of their own health.  One more thing I want to mention, you might occasionally run into a little bit of pushback from the provider or surgeon when you do request that they speak with the patient again. You might hear “I already talked to them,” “ I told them this three times” and that's okay maybe the patient needs to hear it one more time to get it and that is their right.  Be your patient’s advocate!

Okay so nursing Concepts that we definitely could apply to the process of informed consent would be patient-centered care because informed consent is focusing on the rights of the patient.  When we think about all the elements that are involved with informing a patient, safety is definitely at the center of it all. Finally, ethical and legal practice is a very important nursing concept as informed consent is the legal right of each and every patient.

Okay guys, so a few key points to focus on with this lesson.  First off with informed consent all surgery elements or information is going to be given to the patient by the provider.  Elements that are included would be things like risks, benefits, alternatives, and the reason and need.  Remember the patient must be competent, they must be a decision-maker, and their decision must be on their own.  The RNs role will be making sure that the patient is informed successfully and they will also witness the written consent.  And last but not least, patient education, we want to encourage our patients to ask any question that they might have.

Okay guys I hope you enjoyed this lesson on informed consent!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!