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The reality is lots of people, healthcare workers included, get lost in the explanations. As they
teach us all in nursing and medical school, the worst time to talk to a patient is right after they
have been given a diagnosis. They often just dont hear you because their minds are wrapping
around the fact they have kidney disease, or cancer or whatever else. They nod, they agree to
things, but they dont really hear.
Informed consent is NOT the form. It is the explanation leading to understanding of the
proposed procedure or treatment by the patient. What defines reasonable and what steps a
nurse may take to ensure patient comprehension differs from place to place. It is defined by
individual states nursing scopes of practice and by each facilitys scope of practice and standard
protocols for nurses.
Who May Give Informed Consent?
If the patient is competent, the patient has the right to consent to, or refuse, the treatment.
Generally, it is assumed that an adult patient presenting for treatment is competent, unless
there is evidence to the contrary. Competency is generally defined as the ability to
understand the nature and consequences of the illness and the proposed treatment and
alternative to treatment and the ability to make a reasoned decision in this regard. The law
presumes the competency of every person 18 years of age or older.
Parents are usually the legal guardians for pediatric patients and will sign the consent
forms. If the parents are divorced the parent with legal custody must give consent.
Sometimes, getting informed consent is difficult, for example, the client is unconscious.
Then, consent can be obtained from a person legally authorized to give it on the patients
behalf, like a wife or husband.
In emergency situations, if it is impossible to obtain consent from the client or an
authorized person, the procedure required to benefit or save the patients life may be done
without liability for failure to obtain consent. In such cases the law assumes the client
would wish to be treated.
Psychiatric clients must also give consent. They retain the right to refuse treatment until a
court has legally determined that they are incompetent to decide for themselves.