Key Takeaways
- The provider (physician or surgeon) is solely responsible for explaining the procedure, risks, benefits, and alternatives to the patient
- The nurse's role is to witness the signature and verify that the patient is signing voluntarily, is competent, and understands the procedure
- If a patient asks specific questions about the procedure while signing, the nurse must stop and notify the provider to return
- Informed consent requires the patient to be competent, informed, and signing voluntarily without coercion
- Emergency situations may allow treatment without consent under the doctrine of implied consent when a life-threatening condition exists
Informed Consent Protocols
Informed consent is the process by which a patient gives permission for a procedure or treatment after receiving adequate information to make an educated decision. The division of labor regarding informed consent is a frequent NCLEX testing point.
Components of Valid Informed Consent
For consent to be legally valid, all three elements must be present:
| Element | Requirement |
|---|---|
| Capacity | Patient has decision-making ability (competent) |
| Information | Patient received adequate explanation |
| Voluntariness | Decision is made without coercion or manipulation |
Provider's Responsibility
The physician or surgeon is solely responsible for:
- Explaining the procedure in terms the patient understands
- Describing the expected benefits
- Disclosing material risks and potential complications
- Discussing alternatives (including doing nothing)
- Answering patient questions
Key Point: This is the provider's legal obligation and cannot be delegated to the nurse.
The Nurse's Role in Informed Consent
| Responsibility | Action |
|---|---|
| Witness signature | Verify the patient is the person signing |
| Verify voluntariness | Ensure no coercion or pressure |
| Assess competency | Patient is not impaired by medications or conditions |
| Advocate for patient | If patient has questions, notify provider |
| Document | Record consent process in medical record |
Critical Action: When Patients Have Questions
If a patient asks a specific question about the procedure while the nurse is witnessing the form:
The nurse must NOT answer. The correct action is to:
- Stop the signing process
- Notify the provider to return and answer questions
- Document that the provider was notified
Example: Patient asks, "How long will the incision be?" or "What are my chances of complications?" These are questions for the provider, not the nurse.
Who Can Give Consent?
| Patient Population | Consent Authority |
|---|---|
| Competent adult | Patient gives own consent |
| Minor (under 18) | Parent or legal guardian |
| Emancipated minor | Patient gives own consent |
| Incapacitated adult | Healthcare proxy or legal guardian |
| Emergency (life-threatening) | Implied consent doctrine applies |
Emancipated Minors
An emancipated minor can consent to their own medical treatment. Emancipation may occur through:
- Marriage
- Military service
- Court order
- Financial independence (varies by state)
Special Situations Allowing Minor Consent
Even non-emancipated minors can often consent to treatment for:
- Sexually transmitted infections
- Pregnancy-related care
- Substance abuse treatment
- Mental health services
- (Specific provisions vary by state)
When Consent Is NOT Required
| Situation | Rationale |
|---|---|
| Life-threatening emergency | Implied consent when patient cannot consent |
| Court-ordered treatment | Legal mandate overrides consent |
| Danger to others | Public safety (e.g., infectious disease) |
Implied Consent
Implied consent applies in emergency situations when:
- A life-threatening condition exists
- The patient cannot give consent (unconscious, altered)
- No surrogate decision-maker is available
- A reasonable person would consent to treatment
Refusal of Treatment
Competent adults have the absolute right to refuse treatment, even if refusal will result in death. The nurse's role:
- Ensure patient understands consequences
- Notify provider of refusal
- Document refusal clearly
- Have patient sign "Against Medical Advice" (AMA) form if applicable
Documentation Requirements
| Element | Documentation |
|---|---|
| Consent obtained | Date, time, who obtained, witness |
| Questions asked | Any questions and provider response |
| Patient understanding | Statement that patient verbalized understanding |
| Refusal | What was refused, consequences explained, patient signature |
On the NCLEX
Expect questions testing:
- Who is responsible for obtaining informed consent
- When the nurse should stop the consent process
- Which patients can give their own consent
- When implied consent applies
Exam Tip: If the question involves a patient asking about specifics of a procedure, the answer is ALWAYS to notify the provider. The nurse does not explain procedures.
While witnessing a surgical consent form, the patient asks the nurse, "What exactly will the surgeon remove during this procedure?" The nurse should:
A 16-year-old married patient requires emergency surgery. Who can provide consent?
An unconscious trauma patient arrives in the emergency department requiring immediate surgery. No family is available. The surgical team should: