21 Dic importance of informed consent in nursing
Pain, medication and some medical conditions can affect judgment and understanding, so doctors must consider these factors when seeking consent from a patient. Box 1. This article explores the importance of communication in clinical research, and how more effective communication with patients during the informed consent process can ensure they are fully informed. It may not provide a valid legal defence if, for example, the patient felt obliged or was persuaded by others to accept treatment. It is also an important ethical consideration for doctors and healthcare providers. When this case was first heard, the Scottish Court of Session followed the approach taken in Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital  AC 871 and concluded there was insufficient risk of significant harm to Mrs Montgomery to warrant a warning. Individuals are supported, facilitated and enabled to contribute to their care through shared decision making, equality of communication and mutual respect” (Mitchell and Agnelli, 2015). When miscommunication occurs, or patients sign consent forms but still pursue legal action, physicians and surgeons need strong medical malpractice coverage in place to protect themselves and allow them to deliver the best possible care to their patients. This means that, beyond the potential negative impact on patient care, they may be in breach of the law without knowing it. With excellent communication about risks and options, patients can make choices which are best for them and physicians face less risk of legal action. In some situations, these decisions are made quickly if there is an emergency. No one can guarantee positive outcomes in healthcare settings, but informed consent at least ensures patients understand the risks they undertake with treatment. The act of securing an informed consent is to protect clients’ rights which resemble the ethical principle of autonomy and avoid any legal ramification to the nurse (Wilhite, 2010). In the past, there was a paternalistic approach to healthcare: doctors decided not only what treatment would best fit their patients’ needs, but also what information to give to them. To avoid further complications of Medcio-Legal cases, every Dr. should follow the Principles relating to consent as envisaged by Hon. Why is it important? Many times Doctors do not pay importance to this fundamental aspect. Other than in exceptional circumstances, nurses have both a legal and a professional obligation to ensure: Consent will only be valid if that information has been given. Citation: Taylor H (2018) Informed consent 1: legal basis and implications for practice. A most important way in which these rights are upheld is through the process of informed consent which can be oral or written and must be stated in each participant document or chart (American Nurses Association, 1985). Informed consent creates trust between doctor and patient by ensuring good understanding. Nurses should be aware that they will be accountable for the decisions they make about disclosure, and should ensure that they carefully record the decision-making process and the information shared. 29, 10, 45-48. doi: 10.7748/ns.29.10.45.e9443 It is useful to start by considering consent from an ethical perspective and how it relates to the principle of autonomy. Our expert agents negotiate pricing and compare medical malpractice insurance solutions with all major A-rated carriers and alternative markets on your behalf, providing you with the best possible option available in the insurance marketplace. 8) and ensuring its comprehension (Federal Register, 2017). Non-consensual touching may breach both civil and criminal law. Sign in or Register a new account to join the discussion. In any medical setting, decisions are made often. Explain the meaning and importance of the doctrine of informed consent. Some patients may be particularly vulnerable to pressure from others so nurses need to be alert to the possibility of coercion and make every effort to ensure patients are supported to reach their own decision (General Medical Council, 2008). Informed consent is based upon the ethical principle of autonomy. The law not only protects a person from any unwanted touch, but also from the fear of being touched. Although not all patients want, or are able to, participate in decision making, there has been a shift towards the active involvement of patients in this area. Influence of consent to the nursing The NMC Code Conduct states nurses must advocate people's rights to be fully involved in decisions about their care. Patients no longer have unquestioning faith in their doctors and nurses. It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. The health professional would be found negligent if they have not given the patient enough information to make an informed decision. Oxygen deprivation during birth resulted in severe and permanent disability for Mrs Montgomery’s son. The courts considered that patients needed to be protected from making irrational decisions so the House of Lords extended the Bolam test – used to assess negligence – to the information doctors were required to give or disclose to patients. Think about consent as a process to assure patient understanding and agreement, not just signing a form. This article – the first in a series of two – discusses why informed consent is fundamental to the provision of person-centred care and explores the legal principles behind it. It will also discuss situations in which treatments and interventions may be given lawfully in the absence of consent. Generally, patients are no longer passive recipients but, rather, active partners in their care. This must be done on the basis of an explanation by a clinician. Informed consent is the patient’s agreement to permit healthcare providers to perform any invasive procedures or medical surgeries in awareness of the risks, benefits, alternatives treatment and consequences of refusing consent (Black, 2004). This means medical professionals must offer enough information to patients to enable them to make a choice and provide enough time, where possible, so patients don’t feel pressured. | The physician should have obtained consent before the nurse has the patient sign a form. Some of the key legal principles of the NMC Code are highlighted in Box 1. Importance of Informed Consent in Nursing and Nursing Research Informed consent is one of the means by which a patient's right to autonomy is protected. The trust-promotion argument for informed consent , as Eyal terms it, states (1) that trust in medical practice is necessary to ensure that people seek and comply with medical advice and participate in medical research, (2) that as a result it is ‘usually wrong to jeopardise that trust’, (3) that violations of informed consent jeopardise that trust, and (4) that standard informed consent requirements are … The Code emphasises the need for nurses to “keep to all relevant laws about mental capacity that apply in the country in which [they] are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process”. If there is doubt as to whether consent was sufficiently informed, a decision will be made by the court (Montgomery v Lanarkshire Health Board  UKSC 11; Chester v Afshar ). That full knowledge and understanding is the necessary factor in whether an individual can give informed consent. Chester v Afshar  does not specify the extent of the information doctors must provide, other than saying there is a “legal duty to a patient to warn him or her in general terms of possible serious risks involved in the procedure”. 4. Discuss why we have this doctrine and what would happen if we did not. Person-centred care implies the centrality of the patient, who is seen as a key participant in care, rather than the passive recipient of it. In civil cases, the claimant (usually the patie… From these, most of prospective clinical studies (87.5%) discussed informed consent. It appears we are still not doing it properly. Patients are now more aware of their treatment options, more aware of their rights as consumers of healthcare, and prepared not only to complain about care they consider substandard but also to take legal action (McCrae, 2013). She sued the NHS trust, arguing that she should have been advised of the risks of vaginal delivery and that, if she had been aware of those risks, she would have opted for an elective Caesarean section. Sometimes person-centred care is not defined but, instead, is simply described in terms of patient autonomy, holistic care and primacy of patient need (Hayes, 2014). Evidence-based practice is considered fundamental to the delivery of good-quality person-centred care (Banner et al, 2016). It is important to give adequate information to enable them to accept or refuse their treatment. Nursing Standard. What is informed consent? The Supreme Court disagreed and upheld Mrs Montgomery’s appeal, recognising that there had been a shift in the relationship between patients and health professionals. Generally speaking, obtaining informed consent means that a patient who agrees to undergo a treatment or procedure does so only after being made aware of the associated benefits, risks, and alternative treatments. Informed consent alone is not enough. Practitioners are not required to share information if the patient, after having been given the opportunity to receive it, makes clear their wish to remain uninformed. Shoulder dystocia occurred and made vaginal delivery impossible, so an emergency Caesarean section had to be performed. This article, the first of two on informed consent, explains how the law has evolved and how it applies to nursing practice. Box 1: The importance of informed consent Among the possible arguments for informed consent are: – That it safeguards patient autonomy. The Montgomery case has a number of implications for nursing practice, which are outlined in Box 3. Informed consent means that a person understands their health condition and what the proposed treatment is. Apex court of India in the case of Ms. Samira Kohli V/s Prabha Manchanda (2008) 2 SCC 1. Practitioners will be deemed negligent if they fail to give patients the information they need to decide whether they want to accept the risks that a particular treatment may present (Montgomery ). Before starting treatment adequate information to enable them to accept or refuse treatment! To bring you affordable coverage need to reach a diagnosis, then decide treatment. How the law, codified by the 1914 Schloendorff vs occurred and vaginal! Fundamental to the principles of person-centred care if they have not given lecturer at University... About a clinical trial before deciding whether to take part questioned, a patient ’ needs! 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