Forensic Nursing Chronicles

In regards to the article Informed Consent:  Is it really understood? Thursday, July 10,2008.  I appreciated the topic and readings which brought forth important education issues that must be addressed to the patient prior to any procedure or treatment.  As professionals to understand the treatment or procedure being performed in order to assist the patient with questions he or she may have.  In view of the hospital setting where surgeries must happen quickly, I view education performed by the health care system as short.  With our main focus is making sure the patient signs the consent form. Shock is the first sign I see from the patient and families.  An inability to absorb very little.  I agree with an easy-to-read form and a teach back method.  In order for the patient/family to reinstate as to what they heard and for us nurses to be a patient advocate in this situation.  To report any doubts about the patients understanding or any concern.

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 information 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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