I read in the blog some discussion of informed consent. As a consumer
of medical services I rarely get much out of the informed consent
documents, and will admit that I rarely read them in much detail.
Granted, if we were talking about more than just a general doctor’s
visit I would take a little more notice.
I have also participated on several research studies and have written a
number of IRB applications, including drafts of the informed consent
documents that are given to participants. While I have tried to make
these the most accessible to the participant as I can, the university I
worked for required certain headings and certain, stock legal language.
The purpose of the documents from the IRB’s side didn’t seem to be
“make the participant aware” and the purpose from the principal
investigator’s perspective was “get it through IRB” (and typically
after the research activity had already begun).
I won’t even go into the issues around working with a non-English
speaking population, where while translation is required actually
putting time and resources into achieving a translation that actually
communicates meaning is definitely not the priority. Rather, the
priority is having a document where the written word is in the language
desired regardless of the meaning communicated.
As a massage therapist, I am working directly with clients to provide a
service. There are legal concerns to be addressed, definitely, with the
informed consent. There are also scope of practice issues to be
clarified. Finally, and most interesting to me, are the issues around
getting the client to understand what the purpose of the service is and
how s/he may contribute. I found the one poster’s comments about a
“teach-back” approach intriguing, and will look more into this. While
not brain surgery, a client has the right to understand what they are
about to participate in and having them tell me “in their own words”
what it is–the legal issues, the scope of practice issues, and their
contributions to the outcome–sounds like a great strategy.
Original Post:
February 6, 2009
Informed Consent: Is it really understood?
I find the articles regarding informed consent exceedingly interesting.
It was a subject that was recently brought to my attention regarding
Radiography Techs and consent for IV contrast. For years, RT’s were
able to witness consent, then all of a sudden they could not. Being the
only RN in a busy Imaging Department, this became a huge burden. I did
some research recently and found articles from ARRT that describes the
RT Scope of Practice. Their scope of practice specifically states that
they are to “verify” that consent was obtained. Now comes another
wrench. There is no definition of “verify” and in our department, it
had become a bone of contention among the Radiologists that the
ordering provider was responsible for “Informed Consent”, to include
risks, benefits, options, etc. Now comes the fun part: Some
practitioners don’t even order the proper tests. Try convincing a
steadfast NP that by ordering a CT Thorax WITH CONTRAST, they were
actually prescribing the contrast. She did not appear to get what I was
trying to explain to her. (She must have finally, because she began to
order tests without contrast, which is a questionable practice because
it may not always be the best exam for a patient and they have a delay
in care or another CT with contrast) I even went so far as to go to the
ANA website and download the RN Scope of Practice, which explains
consent is again “verified”, not witnessed like we do. Both the NYS DOH
and DOE do not specifically state whether an RN or an RT respectively
can or cannot witness consent forms. It has come down to many crucial
conversations between patient and staff and the knowledge of the
patient regarding testing. If this wasn’t my job, I would find it
rather humorous and ironic, all these issues that arise that are truly
not addressed in the RT or RN Scope of Practice.
Original Post:
February 2, 2009
Informed Consent: Is It Really Understood?, comment
I
work in a Liver Failure Clinic and have end stage liver failure
patients. I perform paracentesis procedures to remove fluid from some
of these patients peritoneum. The patients are in pain need fluid taken
of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent.
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
All of this is before the procedure is done.
Never
has a patient not wanted the procedure even when death, bleeding, pain
and infection were mentioned in the informed consent.
I agree
that it is important to have an informed consent. It takes time and
sometimes the patient’s signature is almost unrecognizable.
There is
pressure on the patient and staff to get this signature. I agree that
sometimes the patient does not really know what is going to happen
because they are in need of the procedure now. We explain the entire
procedure to them before the procedure but just how much is really
understood is questionable.
Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
It
is good to see the topic of informed consent included in the text book
Health Promotion Throughout the Lifespan. As a nurse, who practiced for
twenty plus years in the acute care field, this topic is of vital
interest to me. It was not often enough that I felt patients fully
understood what they were agreeing to. Now, with mounting concerns
about patient safety and lawsuits arising out of botched
communications, the area of informed consent is drawing national
attention. Informed consent is one aspect of patient autonomy. Informed
consent occurs when with “substantial understanding” and without
substantial control by others an individual authorizes a professional
to do something. As a witness to the typical “informed consent”
process, in the acute care setting, it is no wonder that breeches in
patient autonomy are realized and being awarded financial remuneration
following legal action. In my opinion, critical flaws in the current
system include; the patient condition at the time information is being
provided, lack of complete information including treatment
alternatives, lack of patient education prior to procedures including
the recovery phase, lack of time to process information, cumbersome
written consent documents, language and other communication barriers.
The Centers for Medicare and Medicaid Services have now called upon
hospitals to design patient-friendly informed-consent processes. Theses
processes are now required to include treatment alternatives and the
consequences of declining recommended therapies. The Joint Commission,
which accredits hospitals, is advocating the use of easy-to-read forms
and the use of “teach-back” methods, which involve asking patients to
repeat back what they have been told about the proposed treatment,
risks and benefits. The Department of Veterans Affairs (VA) hospital
system is conducting several new studies in the area of informed
consent utilizing the “teach-back” method to determine patient
understanding. It is the beginning of what I believe to be a long
overdue focus in healthcare delivery. Hopefully, the inf
ormation gained
will be utilized in a standardized approach to increase patients
understanding of proposed treatments with the outcome of preserving
patient autonomy.
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