Nurses in my facility are being asked to witness signatures from patients (or their substitute decision-makers) for the purpose of obtaining consent for a procedure. The physicians tell us that we are only responsible for witnessing the signature and not for getting the informed consent. Is this true or are we accountable for determining that an informed consent was obtained?
CNO believes that whoever requires the informed consent should also obtain the patient's signature. Some employers, however, require nurses to obtain the patient's signature on consent forms as part of their role.
The most important part of the consent process is informing the patient about the proposed treatment and what to expect. This includes informing the patient about:
- the nature of the treatment,
- risks and side effects of the treatment
- alternative courses of action
- potential consequences of not having the treatment
Patients also should have the opportunity to ask and receive answers to questions they have about the treatment.
A patient's signature is meaningless if the patient is not informed. Nurses are often told that when they obtain a patient's signature on a consent form, they are only witnessing the signature and not verifying that informed consent was obtained. However, nurses have ethical and professional accountabilities to ensure the patient is fully informed and capable of giving consent.
Nurses should ask patients if they understand what it is they are consenting to and if their questions about the proposed treatment have been answered. If the nurse believes the patient has less than a full understanding of the proposed treatment, the nurse must act as a patient advocate to ensure the patient receives the necessary information.
Nurses' accountabilities exist regardless of employer policies about the role of the witness.
A nurse who is leading a team of nurse managers is planning to make a major announcement. The nurse should use
which of the following nonverbal communication techniques to enhance the importance of the announcement?
Sit in front of the group for the meeting and stand for the announcement
A nurse is working with a team of nursing personnel within a facility. Which of the following are necessary task
performance roles that members of the group or the leader must perform? (Select all that apply.) -Coordinator
-Evaluator. -Energizer
A nurse is rehearsing assertive communication approaches to use when declining leadership of a nursing department
committee. Which of the following statements should the nurse make?
"I decline the opportunity at this time."
A nurse leaves the unit an hour early without permission or notification of the charge nurse. The clients in the nurse's
care are stable. Which legal torts applies to this situation?
Negligence
A nurse is reviewing a provider's prescriptions for four clients. Which of the following prescriptions is outside the
legal scope of practice for the nurse?
Insert a tunneled central venous catheter for a client.
A nurse administers an incorrect medication to a client. Following an assessment of the client, the nurse determines
that the client has experienced no untoward effects as a result of the medication. The nurse does not complete an
incident report because no harm came to the client. Which of the following ethical principles did the nurse violate?
Veracity
A nurse is preparing an educational program for a group of newly licensed nurses about client confidentiality. The
nurse should explain that nurses may share a client's protected health information with which of the following
groups?
Health care team members caring for the client
A nurse is giving a presentation about client confidentiality to a group of newly licensed nurses. Which of the
following actions is an example of a violation of confidentiality?
Reporting laboratory findings to a member of the client's family
A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a
newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further
instruction?
"Information about a client can be disclosed to family members at any time"
A nurse is caring for a client with a health care proxy (durable power of attorney for health care). The client requests
clarification about this type of advance directive. Which statement by the client indicates a need for clarification?
"I have to choose a family member as my health proxy."
A nurse is caring for a client who has a history of dementia. The client is alert and oriented to person, place, and
time, and has advance directives. The client is scheduled for a procedure that requires informed consent. Which of
the following persons should sign the informed consent?
The client
A nurse is teaching a class on torts. The nurse should instruct the class that administering a medication to a
competent client after the client refuses it is an example of which tort?
Battery
A nurse is teaching a class on torts. The nurse should include which of the following situations as an example of
negligence?
A nurse identifies the absence of peripheral pulsation in a casted extremity in the early morning and reports it to the
provider in the early afternoon.
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