importance of informed consent in nursing

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. The patient’s decision must be respected even if it is considered foolish, unfounded or irrational (Re T (Adult: Refusal of Medical Treatment) [1992] 4 All ER 649). It is vital that you give the patient all the information they need about the procedure and clearly document the information you have given the patient in their notes. It also reduces the risk for both patient and doctor. It is the process of participants learning the facts about a clinical trial before deciding whether to take part. Nurses will be acting unlawfully, and contrary to the principles of person-centred care if they administer care without a patient’s consent. It may not provide a valid legal defence if, for example, the patient felt obliged or was persuaded by others to accept treatment. In situations where the issue of consent has been questioned, a successful legal action requires proof that consent was not given. Only half of those (52.9%) reported that written informed consent had been obtained; few (3.6%) reported oral consent, and few (6.8%) used other methods such as online consent or completion and return of data collection (such as surveys) to denote assent. Did you know that there was a time when slaves were used similarly for reproduction and reproductive studies … Argument. For the purpose of this article, person-centred care is defined as the “approach to care that places the person at the centre of their own care. Informed consent seeks to incorporate the rights of autonomous individuals through self-determination.It also seeks to prevent assaults on the integrity of the patient and protect personal liberty and veracity. The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. The law not only protects a person from any unwanted touch, but also from the fear of being touched. It is unlawful to touch another person unless they have agreed to it; their consent makes lawful an act that would otherwise be unlawful (Taylor, 2013), as highlighted in Collins v Wilcock [1984] 3 All ER374. Consent may be given orally, or it may be implied - as when a patient rolls up their sleeve and offers their arm so you can take their blood pressure.For more complicated procedures, you must obtain the patient's express consent, and this will usually be in writing, by signing a consent form. Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital [1985] AC 871 reflects the view that patients cannot be expected to have the same level of knowledge as the doctors treating them, might not be able to objectively balance the risks and benefits of a particular intervention, and might place “undue significance” on certain elements of the information they are given. Informed consent is based upon the ethical principle of autonomy. In civil cases, the claimant (usually the patie… To recognise and uphold their patients’ rights, nurses must not only be aware of the standards set out in the Code, but also understand their legal basis. Nursing Children and Young People. Informed Consent is still an issue on the healthcare agenda. If there is doubt as to whether consent was sufficiently informed, a decision will be made by the court (Montgomery v Lanarkshire Health Board [2015] UKSC 11; Chester v Afshar [2004]). Mrs Montgomery went into labour. Nurses can offer what we do best—patient … They assess patients’ health status and plan care based on their observations, deciding which treatments and interventions best meet patients’ needs. Abstract. It also continues to be a source of malpractice liability, because the legal requirements continue to lack complete clarity. 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. Compliance with “the professional standards that registered nurses and midwives must uphold [is] not negotiable or discretionary” (NMC, 2015). Apex court of India in the case of Ms. Samira Kohli V/s Prabha Manchanda (2008) 2 SCC 1. 8) and ensuring its comprehension (Federal Register, 2017). We can help you learn more about medical malpractice insurance, and our team of professionals can review your needs, so we can bring you multiple policy options. Nurses make many clinical judgements and decisions throughout the course of their working day. Nurses and midwives will all be aware of that requirement but they also need to understand exactly what informed consent is, how it is underpinned by law, and what it means 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). Pain, medication and some medical conditions can affect judgment and understanding, so doctors must consider these factors when seeking consent from a patient. In some situations, these decisions are made quickly if there is an emergency. 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. Shoulder dystocia occurred and made vaginal delivery impossible, so an emergency Caesarean section had to be performed. So, informed consent is very important to protect patient ’s right and nurses are in an ideal place to play the advocacy role in different ways such as, a defender of patient’s right,.Johnston, M.J., (2009), also reemphasized the advocacy role of nurses and moral purpose of informed consent is to protect patients from the harm and to improve quality of life. Patients no longer have unquestioning faith in their doctors and nurses. 5+5 = The captcha value you provided is incorrect. Gallagher Healthcare is a specialty niche of Arthur J. Gallagher & Co., one of the largest insurance brokerages in the world. 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 … Their patients are informed about the proposed treatment; They have their patients’ consent before starting treatment. 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 [2015]). In recent years, their confidence in health professionals and the healthcare system has been eroded by a succession of scandals (McCrae, 2013). "Informed Consent" in Medical Treatment is of Utmost Importance, !!!! The study on knowledge of informed consent and importance to nursing practice is limited to nursing students. Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination. From these, most of prospective clinical studies (87.5%) discussed informed consent. Protecting patient autonomy is a key nursing role. This could simply mean following their suggestions, such as the doctor asking you if they can take your blood pressure and you … Nursing professionals in a variety of practice settings routinely use implied consent. Although the term may be used interchangeably with ‘patient-centred care’ (Perez-Merino, 2014; McCrae, 2013), there is some variance in how it is defined in the literature. What can nurses do to improve informed consent? 1. Review the case Informed Consent in Louisiana – Lugenbuhl v. Dowling. It appears we are still not doing it properly. This applies to all areas of life, including healthcare (Re F (Mental Patient: Sterilisation) [1990] 2 AC 1) and means patients generally have the right to make decisions about their care – for example, whether to accept a treatment or intervention – even if their “refusal may risk permanent injury to [their] health or even lead to premature death”. 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. Informed consent means that a person understands their health condition and what the proposed treatment is. Evidence-based practice is considered fundamental to the delivery of good-quality person-centred care (Banner et al, 2016). 4. Gallagher Healthcare is one of the largest advisors to physicians and surgeons when it comes to medical malpractice coverage. With excellent communication about risks and options, patients can make choices which are best for them and physicians face less risk of legal action. However, this comes with three caveats: It must be noted that, although much of the existing case law refers to doctors, the legal principles on informed consent apply in just the same way to nurses and all other health professionals (Young, 2009). Non-consensual touching may breach both civil and criminal law. Many times Doctors do not pay importance to this fundamental aspect. When people are invited to take part, they should be given a verbal explanation of the study, including details such as its 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”. The obstetrician recognised there was a 9-10% risk of shoulder dystocia that would complicate the delivery, but decided not to share that information with Mrs Montgomery. They are also widely treated as consumers exercising choices: a viewpoint which has underpinned some of the developments in the provision of healthcare services” (Montgomery [2015]). Informed consent does not mean simply completing and signing a consent form. We understand the importance of crafting tailored solutions to address your unique needs. Get notified when a new post is published. Why is it important? 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. 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. Patient-informed consent means patients understand the risks, alternatives and possible benefits of any treatment they receive. It will also discuss situations in which treatments and interventions may be given lawfully in the absence of consent. NURSE’S ROLE IN INFORMED CONSENT Nurses may strive to ensure patient autonomy and rights throughappropriateparticipationintheinformedconsent process. Conversely, informed consent is a process in which all information relayed is understood by the receiver and decides independently. ‘Employers must do their utmost to support their nursing staff’, The law on informed consent in adults has recently changed. The process of clinical decision making has been widely explored and can be explained in a number of ways, ranging from the intuitive to the analytical (Taylor, 2005; Thompson and Dowding, 2001; Hamm, 1988). The health professional would be found negligent if they have not given the patient enough information to make an informed decision. In that case, the House of Lords made clear that a practitioner would be negligent – and in breach of their duty of care to the patient – if they failed to advise them of the risks associated with a proposed treatment. What is informed consent? 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). However, although nurses may be aware of broad legal concepts set out in the Code, they do not always understand the detail of the law and how it affects their practice (Taylor, 2016). Autonomy recognises an individual’s right to make choices on matters relating to themselves, unrestricted by factors – such as controls imposed by others or lack of information – that would limit the freedom of their choice (Beauchamp and Childress, 2012). Discuss why we have this doctrine and what would happen if we did not. This may mean a physician explains the possible side effects, risks and benefits of a course of treatment or informs a patient of what other treatments may be available. © Copyright 2015 by Arthur J. Gallagher & Co. All Rights Reserved. This means that, beyond the potential negative impact on patient care, they may be in breach of the law without knowing it. What is Informed Consent Before a doctor, nurse or any healthcare practitioner can examine or treat you, they usually need your consent or permission. The physician should have obtained consent before the nurse has the patient sign a form. 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). What is informed consent? 29, 10, 45-48. doi: 10.7748/ns.29.10.45.e9443 Informed consent is when a healthcare provider — like a doctor, nurse, or other healthcare professional — explains a medical treatment to a patient before the patient agrees to it. The concept of ‘person-centred care’ is widely cited in the literature and applied in nursing practice. Consent must be voluntary. Oxygen deprivation during birth resulted in severe and permanent disability for Mrs Montgomery’s son. It must also be noted that the law relating to consent in children is different to that for adults, and is not covered by this article. Informed consent in healthcare is the law, codified by the 1914 Schloendorff vs. What does it mean for practice? The Importance of Patient Informed Consent, learn more about medical malpractice insurance, The Importance of Patient Satisfaction in Healthcare, Importance of Doctor-Patient Communication. 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. Although healthcare providers have a legal obligation to provide treatment for their patients and may incur liability in civil law (negligence) or even criminal law if they fail to do so, they may also be liable if treatment is given without the patient’s consent. 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. Regardless of the process used, the consensus is that decisions will be based on information of one kind or another, and will influence the outcomes for patients (Taylor, 2005). The Importance Of Informed Consent 834 Words | 4 Pages. 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 [1985] AC 871 and concluded there was insufficient risk of significant harm to Mrs Montgomery to warrant a warning. 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. Consent from a patient is needed regardless of the procedure, whether it's a physical examination, organ donation or something else. It is important that nurses understand the legal and ethical rationale behind the principles of informed consent so that the principles are applied appropriately to the particular context of nursing care. Informed consent is a process in which a patient gives consent to treatment after a healthcare provider discusses information related to the procedure so that the patient can make an educated decision whether to refuse or accept treatment (Hall, Prochazka, & Fink, 2012). Citation: Taylor H (2018) Informed consent 1: legal basis and implications for practice. Why is it important? Patients would be spared information which their doctor thought they might find upsetting or otherwise did not need to know – for example, a diagnosis of cancer or terminal illness (McCrae, 2013). During the later stages of her pregnancy, she told her obstetrician about her concerns that the baby’s size would make delivery difficult. This meant doctors were able to withhold information from their patients and would not be deemed negligent provided they had “acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art” (Bolam v Friern Management Committee [1957] 2 All ER 118). The physician, or other licensed independent provider, the nurse and the client have roles and responsibilities in terms of informed consent.The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. 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). To work effectively, informed consent must allow patients to make the decisions right for them. The consenter must have the necessary mental competency to consent The consenter must be informed To be genuine and voluntary, consent should be obtained without coercion, threat, or undue influence and without the influence of drugs or alcohol. What is informed consent? This is the case of the law relating to consent to treatment. Consent is a process, not a form. This means nurses must “get properly informed consent and document it before carrying out any action”. To avoid further complications of Medcio-Legal cases, every Dr. should follow the Principles relating to consent as envisaged by Hon. All registered nurses, registered midwives, student nurses and student midwifes are accountable for their practice and must comply with the Code to ensure their practice meets the standards required not only by the NMC, but also by patients and the general public. In any medical setting, decisions are made often. Although the case refers specifically to surgical interventions, more recent cases such as Gallardo v Imperial College Healthcare NHS Trust [2017] EWHC 3147 (QB) show that the principle applies to treatment more generally. Informed consent alone is not enough. This material should be presented in a way that is easy for them to understand. Patients are “now widely regarded as persons holding rights, rather than as the passive recipients of the care of the medical profession. The NMC Code: key legal principles. It was thought that giving the patient too much information might “prejudice the attainment of the objective of restoring the patient’s health” and, therefore, conflict with the doctor’s duty to act in the patient’s best interests (Sidaway [1985]). This is one of the requirements of the Nursing and Midwifery Council’s Code, which sets out a mandatory framework of standards for practice. Nurses know they must have their patients’ informed consent before giving any form of care or treatment but they may not be fully aware of the legal basis behind this and the implications of not doing so. The test to be applied is “whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it” (Montgomery [2015]). Some of the key legal principles of the NMC Code are highlighted in Box 1. The Society of the New York Hospital case. We can see that this is important when it relates to ‘big’ things like operations, for which the patient needs to sign a form saying he or she gives informed consent. This type of consent applies to many situations in life, including making decisions about medical care and legal issues, as well as entering into contracts. If they are uncertain about any of this, they should seek advice. In turn, patients must evaluate what they hear and make decisions about whether to pursue a specific course of treatment, seek a second opinion or refuse a suggested procedure. 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. The section will also look at consent, which is all about ensuring we have permission from patients/clients to carry out tasks with, for and on them, and capacity, which relates to a person’s ability to use and understand information to make a decision and either offer or refuse consent. Author: Helen Taylor is visiting lecturer at the University of Birmingham and freelance writer on health law. This article – the first in a two-part series – explores the legal principles of informed consent in adults, considers why it is fundamental to the provisio… It is the ethical principle known as respect for persons. Source: Nursing and Midwifery Council (2015). Privacy Policy | Legal. Nurses have a legal duty to ensure they obtain informed consent from their patients before carrying out any intervention or treatment. In Airedale NHS Trust v Bland [1993] AC 789, Lord Keith of Kinkel stated that “it is unlawful, so as to constitute both a tort and the crime of battery, to administer medical treatment to an adult, who is conscious and of sound mind, without his consent”. Mrs Montgomery, who had type 1 diabetes, was expecting her first baby; a pre-natal assessment indicated that the baby would be large. This must be done on the basis of an explanation by a clinician. This is important since even treatments which are meant to help a patient come with risks, and it is essential for patients to accept those risks when getting care. 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 Montgomery case: implications for practice. This article, the first of two on informed consent, explains how the law has evolved and how it applies to nursing practice. The concept is not explained in the NMC Code, but the doctrine of informed consent as a principle in English law was clearly established in Chester v Afshar [2004] UKHL 41. 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 also reduces the risk for both patient and doctor. It is important to give adequate information to enable them to accept or refuse their treatment. Generally, patients are no longer passive recipients but, rather, active partners in their care. It is also the law. 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). The NMC’s (2015) code of conduct sets out a mandatory framework of professional standards for practice. She would have been given this information only if she had asked “specifically about exact risks” (Montgomery v Lanarkshire Health Board [2015] UKSC 11). It follows, therefore, that the quality of the outcomes will depend on the quality of the information upon which decisions were based. For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Chester v Afshar [2004] 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”. As such, nurses must ensure their decisions are based on “the best evidence available” (Nursing and Midwifery Council, 2015). First, identify the elements of the legal citation- plaintiff, defendant, court, location of case etc. The obstetrician felt the risk to Mrs Montgomery and her baby was relatively small, and did not warrant the elective Caesarean section that she would be likely to request if told of the risk. The Nursing and Midwifery Council’s Code says that nurses must not only “act in the best interests of people at all times”, but also balance this with “the requirement to respect a person’s right to accept or refuse treatment”. It can mean patients are given enough time, if possible, to consider their options and seek a second opinion, if appropriate. Nurses will be accountable for any deviation from these principles and must be able to justify their actions (Cornock, 2011). With excellent communication about risks and options, patients can make choices which are best for them and physicians face less risk of legal action. The Montgomery case has a number of implications for nursing practice, which are outlined in Box 3. As such, although patients had the right to access the information they needed to make a balanced decision (including any “general dangers and […] any special dangers […] without exaggeration or concealment”), doctors had the right to “decide what information should be given to the patient” and how that information should be presented (Sidaway [1985]). Informed consent can also mean patients are informed if treatment is recommended, as well as what might happen if they get no treatment. – That it is a requirement of justice, understood in terms of patient empowerment. Box 1. When patients agree to a treatment, they must sign paperwork indicating they understand the risks and agreeing doctors can take specific life-saving measures if needed. Think about consent as a process to assure patient understanding and agreement, not just signing a form. As well as understanding the legal framework that underpins care, nurses need to be aware that the law can change quickly, even after long periods without changes. The following post is on the importance of informed consent and medical ethics using examples from the history of gynecology and a more recent example: Gardasil Today, we all are aware of Margaret Atwood’s ‘The Handmaid’s Tale’. Not pay importance to this fundamental aspect consent creates trust between doctor patient! Now widely regarded as persons holding rights, rather, active partners in their care complete... Condition and what would happen if we did not nursing and Midwifery Council ( 2015 ) ( Banner et,! Before the nurse has the patient enough information to enable them to understand faith in their doctors nurses. To medical malpractice coverage 1: legal and professional issues Newly qualified nurses: legal and ethical issues their before... 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