Perceptions of autonomy,privacy and informed consent in the care of elderly people in five European countries: general overview

Ethical issues in the care of elderly people have been identified in many countries. We report the findings of a comparative research project funded by the European Commission, which took place between 1998 and 2001. The project explored the issues of autonomy (part I), privacy (part II) and informed consent (part III) in nursing practice. Data were collected from elderly residents/patients (n = 573) and nursing staff (n = 887) in five European countries: Finland, Spain, Greece, Germany and the UK (Scotland). Questionnaires were used as the data collection tool (self-completion questionnaires for staff, structured interviews for the elderly participants). Four basic nursing interventions in the care of elderly people were targeted: hygiene, fluid intake and nutrition, medication, and elimination. The data were analysed statistically. The results indicated differences within all five countries between staff and patient perceptions of autonomy, privacy and informed consent. There were also similar differences between individual countries. Conclusions were reached concerning practice, education and research. This is the first of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.     

Autonomy,privacy and informed consent 4: surgical perspective

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n = 282) and their nurses (n = 260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked difference in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.     

Perceptions of informed consent in the care of elderly people in five European countries

The focus of this article is on elderly patients' and nursing staff perceptions of informed consent in the care of elderly patients/residents in five European countries. The results suggest that patients and nurses differ in their views on how informed consent is implemented. Among elderly patients the highest frequency for securing informed consent was reported in Finland; the lowest was in Germany. In contrast, among nurses, the highest frequency was reported in the UK (Scotland) and the lowest in Finland. In a comparison of patients' and nurses' perceptions, nurses had more positive views than patients in all countries except Finland. Patients with less need for nursing interventions in Greece and Spain gave their consent less often. The German and Greek patients were older, and the results also point to an association between this and their lower frequency of giving consent. In Spain, patients who were married or who had a family member or friend to look after their personal affairs were more likely to be included in the group whose consent was sought less often. This is the fourth of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.     

Informed Consent: Ethical and Legal Considerations for Advanced Practice Nurses

The ethical principles of self-determination and autonomy govern the practice of informed consent. A patient’s right to shared decision-making and assent prior to invasive procedures, therapeutic interventions, and research projects is protected by law. Foundational nursing roles of communication, education, and patient advocacy compel advance practice nurses to formulate methods that safeguard patients’ rights. Legal implications of informed consent may vary, leaving nurse practitioners juxtaposed between judicial and ethical responsibilities. The goal of this study is to examine legal and ethical components of informed consent and to assist nurse practitioners in developing proactive practice strategies related to informed consent.     

Autonomy,privacy and informed consent 3: elderly care perspective

Despite the growing interest in clinical healthcare ethics, there is a dearth of empirical studies investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third in a four-part series, reports the results of a Scottish Study that formed part of a multi-site comparative study funded by the European Commission. It explores patient autonomy, privacy and informed consent in the care of elderly people in long-stay care facilities (i.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n = 160) participated in the study. Data were collected by means of a self-completion questionnaire for staff and a structured interview schedule for elderly residents. Results indicate marked differences between staff's and residents' responses on three of the four dimensions explored: information-giving, and opportunity to participate in decision-making about care and consent. There was much closer agreement between staff's and residents' responses regarding protection of patient privacy. From the results of this study there is indication of a clear need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day nursing care of older people. Findings to date suggest there is still a significant need to educate staff concerning ethical awareness and sensitivity to the dignity and rights of patients.     

Autonomy and clinical practice. 3: Issues of patient consent

In this, the last in a three-part series considering how the concepts of autonomy, privacy and informed consent are articulated in nursing and the related literature, the authors focus on the notion of consent. Definitions of consent are considered, as are the legal elements of valid consent. Obtaining a patient's consent to treatment has several important functions. This article looks at some of these functions, such as safeguarding patient autonomy and encouraging patient participation in health care. Finally, a number of the difficulties in obtaining an informed consent from patients are considered. Some empirical studies which consider patients' understanding of the information and consent process are also discussed. From a review of the literature it appears that the issue of informed consent is very much tied up with the perceived power struggle between doctors and nurses and doctors and their patients.     

Perceptions of privacy in the care of elderly people in five European countries

The focus of this article is on elderly patients' and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients' privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses' perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.     

Autonomy and informed consent in surgical care-patients' and staff perceptions

The aim of this study was to describe autonomy and informed consent in surgical care. The study is a part of the international BIOMED 2 project "Patients' Autonomy and Privacy in Nursing Interventions" (BIOMED2, BMH4-CT98-3555; 1998-2001) supported by the European Commission. For this study, data of patients (n = 254) and nurses (n = 205) in eleven Berlin hospitals and three hospitals outside Berlin were collected by means of a structured questionnaire. The findings of the study indicate, that information-giving was more positive than decision-making. Patients perceived they were more frequently informed about their surgery than about their care. According to the perceptions of nurses the case was reversed. The perceptions of both groups differed, since from the point of view of nurses, patients' autonomy was more frequently heeded and their consent was sought more often than from the point of view of the patients. Patients admitted as emergencies and in multi-bed rooms perceived their autonomy more negatively than those with a planned surgery or in single rooms. Elderly nurses were more frequently than younger nurses of the opinion to grant patients autonomy. Nurses with a longer working experience in nursing care perceived that patients were more frequently asked their consent. Further, nurses with a higher educational qualification and with a higher occupational status perceived decision-making more negatively. The findings of the present study give implications for clinical practice, nursing education, and for further research.     

Autonomy,privacy and informed consent 1: concepts and definitions

This article is the first in a four-part series that explores the concepts of patient autonomy, privacy and informed consent in the context of the provision of nursing care. In this first article an overview of the concepts is provided, and some of the difficulties with definitions of these concepts are considered. The dearth of empirical exploration of the operationalization of the concepts of patient autonomy, privacy and informed consent within nursing practice is highlighted. The second, third and fourth articles report a series of empirical studies carried out with patients and staff in postnatal care, in continuing care of elderly people and in acute surgical care within Scottish NHS settings. These studies are part of a concerted effort to address the lack of empirical investigation of the ethical dimension of nursing care provision and clinical nursing practice.     

Autonomy,privacy and informed consent 2: postnatal perspective

The nursing and healthcare ethics literature over the past 10 years has focused on issues of patient autonomy and patient rights. Despite the growing volume of literature exploring such topics, there is little empirical work investigating what is actually happening in clinical nursing or midwifery practice in relation to patient autonomy, privacy or informed consent, from the perspective of either patients or staff. This four-part series reports the results of a Scottish study that formed part of a multisite comparative research project funded by the European Commission, investigating issues of patient autonomy, privacy and informed consent. This article, the second of four, explores the issues of autonomy, privacy and informed consent in maternity care. The research questions asked were: (1) What is the perception of mothers' autonomy, privacy and informed consent in Scottish NHS hospitals, from the point of view of both mothers and midwives? (2) Are there differences in the perceptions of mothers and midwives on these issues? Data were collected by a self-completion questionnaire for mothers (n = 243) and staff (n = 170) on postnatal units in both district general and university teaching hospital. Results indicated that there are differences between the perceptions of mothers and midwives in relation to mothers' autonomy, privacy and informed consent. Most differences were found in the information-giving and decision-making elements of autonomy.     

尊重患者自主性原则及其实践方式知情同意的临床伦理分析

法律及伦理层面对医疗知情同意的要求日益严格,本文从伦理学角度剖析尊重患者自主性和医疗知情同意原则,以期为临床实践和临床伦理学相关研究和教学提供参考。首先分析尊重患者自主性的伦理学概念,在此基础上论述知情同意是落实尊重患者自主性原则的实践应用,梳理国内外关于医疗知情同意原则的确立历史和目前公认的知情同意实施过程,并由此得出如下结论:临床医疗知情同意存在共识尚待完善、培训不足、规范形成落后于新技术应用等挑战,未来应加强培训、开展相关研究并形成指南/共识,以帮助医务工作者在临床诊疗中更好地实施知情同意。     

The requirement for informed consent prior to nursing care procedures

AIM OF THE PAPER: The aim of this paper is to examine the extent to which there is a requirement to obtain informed consent prior to nursing care procedures. RATIONALE: The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. 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. ARGUMENT: The ethical and legal rationale behind the concept of informed consent and its relevance to nursing practice are examined. In this paper, it is argued that the function of informed consent is to protect patient autonomy and to promote meaningful decision-making. Given the potential for nursing care procedures to infringe patient autonomy, consent is clearly a relevant concept in nursing. Furthermore, in law, any touching without consent is a potential battery. Informed consent is often associated as a rigid procedure, only relevant to surgical or research procedures. Consent should be obtained prior to nursing care procedures whenever patient autonomy is at stake. However, information-giving should be determined by the needs of the patient and approached in such a way as to facilitate meaningful decision-making. Given the individual nature of infringements to patient autonomy, it is difficult to predetermine all those care procedures that require consent; any list of procedures would fail to be comprehensive. CONCLUSIONS: The principles of informed consent should underpin our approach to nursing care procedures, which should not be mechanistic but determined by the needs of individual patients.     

尊重患者自主性原则及其实践方式知情同意的临床伦理分析

法律及伦理层面对医疗知情同意的要求日益严格,本文从伦理学角度剖析尊重患者自主性和医疗知情同意原则,以期为临床实践和临床伦理学相关研究和教学提供参考。首先分析尊重患者自主性的伦理学概念,在此基础上论述知情同意是落实尊重患者自主性原则的实践应用,梳理国内外关于医疗知情同意原则的确立历史和目前公认的知情同意实施过程,并由此得出如下结论:临床医疗知情同意存在共识尚待完善、培训不足、规范形成落后于新技术应用等挑战,未来应加强培训、开展相关研究并形成指南/共识,以帮助医务工作者在临床诊疗中更好地实施知情同意。     

基于"四主题理论"的临床实践教学伦理问题分析——以患者拒绝医学生操作为例

临床实践教学过程中经常遇到棘手的伦理问题,如医学生的受教育权与患者"最佳利益"之间的冲突。正确认识这一临床伦理问题,并制定恰当的应对方案,有助于临床带教医师、医学生从容应对该矛盾,并提高患者满意度。本文以"患者拒绝医学生操作"为例,从临床伦理学角度,基于医疗适用性、患者偏好、生命质量及情境特征"四主题理论"模式进行评估,提炼核心伦理问题,并结合国内外文献及自身经验提出应对策略和建议,以期为临床教学提供参考和帮助。     

Ethical issues in clinical research. Informed consent and risks versus benefits in the treatment of primary hypertension

Clinical research involves a number of ethical issues for the nurse researcher and clinician. When new treatments, such as experimental drugs, are used in patient care, the issues of informed consent to treatment and the balancing of risks and benefits may be especially difficult to resolve. By understanding the functions and elements of informed consent, nurses can assist their patients to ask for and to comprehend the information they need to be truly and fully informed about treatment choices. Likewise, assessing the risks and benefits of an experimental treatment option, such as an experimental drug for the treatment of primary hypertension, may be important to the long-term health of patients. Nurses assist patient decision making and the assessment of relevant risks and benefits by being fully informed about the planned research and by applying knowledge of ethical principles to patient care. When nurses incorporate this type of ethical reflection and moral skill into nursing practice, they meet minimal moral obligations to patients.     

Perceptions of autonomy in the care of elderly people in five European countries

The focus of this article is perceptions of elderly patients and nurses regarding patients' autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.     

The meaning of autonomy in Chinese culture: obtaining informed consent for operation

The purpose of gaining the patient's informed consent is ethical, lying in respect for his or her autonomy, and such consent forms the foundation for the performance of clinical medical treatment. In order to respect the patient's autonomy, for example, during decisions about operations, doctors have the obligation to clearly explain that patient's medical condition to him/her. A thorough briefing should be given prior to the obtaining of the patients' consent. In fulfillment of their duties as medical professionals, both doctors and nurses should be involved in clinically informing patients as well as in obtaining their signature for operation and anesthesia. Although informing patients about their physical state is not the responsibility of nurses, it remains absolutely necessary for nurses to understand how people in Asian cultures understand autonomy. This paper begins with a discussion of autonomy in ethics, and then outlines the differences between the Eastern and Western concepts of autonomy, before discussing the obtaining of the signature of consent, a process performed by the nursing staff during clinical treatment, and resulting in the provision of such signatures by patients with the legal capacity to provide them.     

Informed consent: ethical and legal implications for nursing practice

The informed consent "process" is a significant dimension of ethical and legal nursing practice. Ethical and legal nursing practices are derived through an understanding of informed consent and knowledge of related nursing responsibilities. Awareness of the historical context, ethical underpinnings, and legal requirements related to informed consent are also important. Nursing practices that speak to these facets of informed consent are in the best interest of clients and nurses.     

A historical perspective of informed consent in clinical practice and research

OBJECTIVES: To review the historical perspective of informed consent in clinical practice and research as it pertains to human subjects. DATA SOURCES: Published professional journals, books, case law, and the internet pertaining to the historical development of informed consent. CONCLUSIONS: The history of informed consent is complex. Informed consent as a fundamental principle of clinical ethics has developed within the past 50 years. Full disclosure and shared decision making have not come naturally to clinicians. Consequently, respecting the autonomy of patients and research subjects requires a conscious, sustained effort by clinicians. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the history of informed consent is important for practicing cancer nurses to ensure they understand the significance of preserving patient autonomy and advocate for the patient and research subject.