Informed Consent: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of informed consent in order to:
- Identify an appropriate person to provide informed consent for the client (e.g., client, parent, legal guardian)
- Provide written materials in the client's spoken language, when possible
- Describe components of informed consent
- Participate in obtaining informed consent
- Verify that the client comprehends and consents to care and procedures
As previously discussed with the section “Client Rights“, all clients have the right to be fully informed about their medical condition and they also have the innate right to knowledgeably consent to or reject all care and proposed treatments.
Informed consent is defined as the patient's choice to have a treatment or procedure which is based on their full understanding of the treatment or procedure, its benefits, its risks, and any alternatives to the particular treatment or procedure. All clients have the legal right to autonomy and self-determination to accept or reject all treatments and interventions.
The three basic types of consent are implicit consent, explicit consent and opt-out consent, as previously detailed with Client Rights.
Informed consent can only be obtained from an adult patient who is mentally competent to do so except under some circumstances and situations. When consent, for any reason including the lack of majority, mental incompetence, and unconsciousness, cannot be obtained, other people can provide legal consent for the patient.
These people include the parent or legal guardian of a minor and unemancipated minor child, a legally appointed representative for a developmentally disabled adult, for example, an emancipated minor, and the person who has been appointed as the client's durable power of attorney for healthcare decisions or their health care surrogate or proxy.
In other situations, the courts have guardianship and the right to give informed consent for a client who is not able to consent on their own.
With the exception of emergencies, informed consent must be obtained.
As more fully discussed and described with the “Integrated Process of Teaching and Learning“, clients must be given oral and written educational material and content at the level with which the client can understand this education. At times, written material in the client's spoken, the native language is beneficial for patients and significant others and, at other times, the assistance and services of a professional translator may be indicated.
The components of informed consent include the person's knowledgeable consent to a treatment or procedure after they have been given, and understand, complete, unbiased information about:
- The proposed treatment or procedure
- Who will perform the treatment or procedure
- The purpose of the proposed treatment or procedure
- The expected outcomes of the proposed treatment or procedure
- The benefits of the proposed treatment or procedure
- The possible risks associated with the proposed treatment or procedure
- The alternatives to the particular treatment or procedure
- The benefits and risks associated with alternatives to the proposed treatment or procedure
- The client's right to refuse a proposed treatment or procedure
Again, all clients have the legal right to autonomy and self-determination to accept or reject all treatments, procedures, and interventions without any coercion or the undue influence of others.
The physician, or other licensed independent providers, the nurse and the client have roles and responsibilities in terms of informed consent.
The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. They also confirm that the patient has sufficient knowledge to make a knowledgeable decision.
The physician, or another licensed independent practitioner such as a nurse practitioner or a physician's assistant, provides the client with complete information about the treatment or procedure, the potential risks including pain and complications, the benefits of the treatment or procedure, who will perform the planned treatment or procedure, and any possible alternatives to the treatment or procedure including their benefits and risks.
The patient or their legal representative must give consent voluntarily and without any coercion by others. They must also ask questions and clarify things until they are certain about the procedure, the benefits, the risks, and possible alternatives.
The recognition that informed consent was obtained is based on the legality and completeness of the written consent and the required processes for obtaining consent including the client's legal ability to sign it and the client's understanding of the procedure or treatment that they are consenting to.
There are also times, such as during the preoperative period of time, which nurses must recognize, identify and confirm that a complete surgical consent was obtained and placed in the patient's medical record.
RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:
- Advance Directives
- Assignment, Delegation and Supervision
- Case Management
- Client Rights
- Collaboration with Interdisciplinary Team
- Concepts of Management
- Confidentiality/Information Security
- Continuity of Care
- Establishing Priorities
- Ethical Practice
- Informed Consent (Currently here)
- Information Technology
- Legal Rights and Responsibilities
- Performance Improvement & Risk Management (Quality Improvement)