Forensic Nursing Chronicles

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 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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