Consent may be implicit or explicit. Holding out an arm to have a blood pressure taken is implicit consent, whereas an ECG or blood gases may require explicit consent. The main types of consent in the health care setting are general consent as required for admission to and basic care in a health care facility and specific consent for particular procedures or therapies to be performed. Consent must be valid and must not have been revoked or
withdrawn.1 Signing a consent form is not sufficient. Six criteria for valid consent have been identified by Canadian courts: 2 To be genuine and voluntary, consent should be obtained without coercion, threat, or undue influence and without the influence of drugs or alcohol. Following the administration of a pre-operative sedative, a patient may not have the capacity to give
consent. What is legal capacity?Legal capacity is the ability to understand and appreciate the nature and consequences of decision making. A person who has reached the legal statutory age can consent to treatment. Some provinces/territories have enacted legislation which may reduce the age for consent. At common law, minor children have been permitted to consent to treatment or refuse treatment if they can demonstrate an appreciation for the nature and consequences of a particular treatment. 3 Where the minor does not have legal capacity, a parent, guardian or substitute decision maker may be empowered to make the decision. How is mental competence determined?Mental competence is the ability of an individual to understand and process information. When authorised professionals assess the competence of an individual, the following factors may be considered: age, disease, level of consciousness, and the presence of drugs or other substances. What is required for consent to be informed?The mere giving of consent to be treated is not sufficient; the consent must also be informed. For consent to be informed, sufficient information about material risks should be relayed to the client. 4 This information should be disclosed in easily understood terminology, and should include the consequences of refusing treatment and an explanation of possible alternatives. Who is responsible for obtaining the consent?Any touching of a client requires verbal and in some cases, written consent. Legal experts suggest that the person carrying out the treatment should provide the relevant information to the client. 5 This means that a physician should provide the information and obtain consent for medical or surgical interventions. A nurse carrying out an invasive nursing procedure should provide an explanation and document that the explanation was given and consent obtained. Nurses who administer immunizing agents should be aware of disclosure and consent requirements in their particular province/territory. Who may witness a consent form?A nurse or other designated person may witness the signing of the consent form even when the physician has explained the procedure elsewhere. Institutional policies should be followed regarding the duration of a previously signed consent form. Witnessing a signature is not a declaration that the witness provided information about risks and alternatives. Special circumstances:a) Life Threatening Emergencies b) Research c) HIV Testing What are the legal implications of treatment without consent?Failure to obtain consent can result in professional sanctions, civil liability and/or criminal charges. To minimize these legal risks consent should be: informed, sought by the care giver providing the treatment, documented and obtained by ethical means. CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
December 1994 Reviewed June 2018 THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE. Which of the following actions should the nurse take first?Assessment is the first step of the nursing process and takes priority over all other steps.
What steps should the nurse follow when admitting a client with tuberculosis ATI?Patients suspected of having active tuberculosis should be admitted to an airborne precautions isolation room. A separate area and a negative pressure air handling system that exhausts to the outside are required for airborne precautions. The door must be kept shut.
Which of the following cleansing agents should the nurse use for hand hygiene?Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Hand rubs are generally less irritating to hands and, in the absence of a sink, are an effective method of cleaning hands.
What action should a nurse implement to prevent clogging of the NG tube after medication administration?Clogging can occur with any size tube but is more likely with smaller-bore tubes. Regular flushing with water can help prevent clogging not caused by medications. Flush the tube every 4 hours with 30 mL of water during continuous feeding, or before and after each intermittent bolus feeding.
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A nurse is caring for a client who requires an informed consent for a surgical procedure
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