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.     

The patient who is unable to consent to nursing care

The aim of this paper is to examine the way in which nurses manage patients who are unable to consent to nursing care procedures. This paper reports on a qualitative study using focus groups and critical incidents collected through in-depth interviews to explore the way in which nurses obtain consent prior to nursing care procedures. The finding indicate that nurses are uneasy about administering care to a patient who cannot consent. When complicating factors are present this unease is exacerbated and sometimes the appropriate delivery of care is withheld.     

心内科护理工作中获得患者知情同意的实践

目的探索建立适用于心内科护理工作的护患知情同意程序。方法①加强护士法律意识的培养,使之依法施护;②强化护士的服务理念、沟通技巧,真实告知患者与护理相关的信息,并征得其理解和同意;③建立护理告知制度,规范护理记录,真实记录有关信息。结果护理服务实现规范化,体现了对患者人格和个性化权利的尊重,提高了患者的满意度。结论知情同意是患者的权利和护士的责任,建立并实施临床护理工作中知情同意程序,是依法施护,保护护患双方的合法权益,减少医疗纠纷,提高护理服务质量,开展人性化护理的关键。     

Informed consent prior to nursing care procedures

It is largely undisputed that nurses should obtain consent prior to nursing care procedures. This article reports on a qualitative study examining the way in which nurses obtain such informed consent. Data were collected through focus group discussion and by using a critical incident technique in order to explore the way in which nurses approach consent prior to nursing care procedures. Qualified nurses in two teaching hospitals in England participated in the study. An analysis of the data provides evidence that consent was often not obtained by those who participated in the study and that refusals of care were often ignored. In addition, participants were often uncertain how to proceed with care when the patient was unable to consent. Consent prior to nursing care procedures is an essential but undeveloped concept, for which a new ethos is required.     

Process consent: a model for enhancing informed consent in mental health nursing

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting.     

告知、签字制度在防范护患纠纷中的运用

目的减少临床护理工作中护患纠纷的发生。方法针对发生纠纷的原因,建立、健全相应的告知、签字制度,以减少护理缺陷。结果护士的工作责任心、法律意识增强,加强了护患沟通,保证了病人的知情权,有效减少护患纠纷的发生。结论告知、签字制度可以减少护患纠纷的发生,提高病人对医院的满意度,在临床上可以推广运用。     

Informed consent: a study of the OR consenting process in New Zealand

The outcome of the informed consenting process should be that patients are knowledgeable about their future procedure, but there is no guarantee that signing the informed consent form means that patients have understood the information that their health care providers have given to them. To evaluate the informed consenting process in an OR direct admissions department of a city hospital in New Zealand, we interviewed 18 surgical patients. We transcribed the audiotaped interviews and analyzed the data using a general inductive approach derived from Grounded Theory. Our analysis indicated that educational information was not always based on patients' previous knowledge or understanding, although most patients understood the surgical consenting process to be complete after they met with the physician and signed the form. Our study highlights that although patients spoke with their physicians and nurses, there was still a lack of understanding. Perioperative nurses are in a prime position to reinforce informed consent. They should actively support the consenting process and be proactive in collaborating with patients and physicians to ultimately ensure that the patient has every opportunity to make an informed decision.     

履行病人知情同意权的实践与体会

护士在为病人提供护理服务时,告知医疗护理措施实施的原因及方法、医院环境与制度、医疗风险、病人的病情及自我护理方法并征得病人的同意,减少了医疗纠纷的发生,保护了护患双方的合法权益;培养护士的法律意识,建立良好的护患关系,建立护理告知监督制度是履行告知义务、病人知情同意的基本素质。     

Consent to transfusion: patients' and healthcare professionals' attitudes towards the provision of blood transfusion information

Background: Patients should be informed about the risks and benefits of blood transfusion and their consent should be documented. However, this is not routinely practised in the UK, and there have been few studies to investigate patients' and healthcare professionals' attitudes towards this process. Objectives: To investigate patients' and healthcare professionals' attitudes towards the information patients are provided with about transfusion and obtaining consent for transfusion. Measures: A cross‐sectional qualitative survey design was employed. Attitudes towards transfusion‐related information and consenting to transfusion were assessed using a patient survey and healthcare professional survey. Participants: One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 males and 50 females) and 123 healthcare professionals (doctors, nurses and midwives) involved in administering transfusions. Results: Sixty‐one patients recalled consenting transfusion. The majority said they were just told they needed a transfusion (N = 67) and only 1 patient said a full discussion about the risks and the benefits of the transfusion took place. However, although 82 patients said they were satisfied with the information, 22 patients reported they would have liked to have been given more details. The majority of healthcare professionals (N = 83) felt that patients were often not given sufficient information about transfusion. Conclusion: Greater efforts should be made to provide information to patients about the risks and benefits of blood transfusions. Future research should explore the most effective ways of delivering this information to patients in an appropriate and timely manner.     

Informed consent and patient understanding of blood transfusion

Background: Obtaining separate informed consent for blood transfusion is mandatory in some countries. Although patients should be informed about risks and benefits of transfusion, studies suggest this does not happen routinely in the UK and the patient perspective is lacking in the current literature. Aim: To explore provision of information and the consent process for patients receiving blood transfusions at our hospital. Objectives: To assess patient recall of the consent process, information conveyed, ease in understanding discussions and perceived knowledge of transfusion afterwards. Methods: All 342 adult patients for whom blood was cross‐matched between 1 March 2008 and 30 April 2008 were sent postal questionnaires. Results: One hundred and sixty‐four questionnaires were returned. Overall, 59·1% of patients said someone explained they might need a transfusion; of those 86·7% felt the reason had been explained. Only 58·8% of patients felt informed of what transfusion involves, with 67·0% told of the benefits and 27·8% informed of risks. Overall, 51·5% of patients said this information was easy to understand, but only 26·8% were aware of a transfusion information leaflet. Of those receiving leaflets, all said they read it and had no questions. Despite this, 61·9% were satisfied overall with the information received. Conclusion: Information leaflets could increase the information available to patients, with minimal impact on health care professionals' time. Leaflets are available, free of charge, from the National Health Service Blood and Transplant website. These have been introduced at each bedside, in pre‐op packs and in outpatient clinics, with re‐assessment planned in 6 months.     

癌症病人的临终关怀与护理

简要阐明了临终关怀护理的发展及其服务机构的形式 ,综述了癌症病人临终关怀护理的重点是控制症状、给予病人及其家属心理支持 ,提出护理人员有责任开展和宣传临终关怀的意义 ,提高临终关怀的护理质量。     

Practical application and evaluation of a care model for informing and reassuring children undergoing medical examinations and/or procedures (part 2): Methods of relating and practical nursing techniques that best bring out the potential of children*

Aim: Based on previous surveys, we developed a care model for informing and reassuring children undergoing medical examinations and/or procedures that respects the dignity of pediatric patients and their parents and aims to realize the potential of children. Method: We enlisted the cooperation of nurses working in eight pediatric wards in five hospitals in the Kanto and Kansai areas in applying the care model on a trial basis and evaluating its effect in monthly meetings. Results: Analysis of the 82 case reports received produced four categories. Here, we will concentrate on the second category, “bringing out the potential of children: methods of relating and nursing techniques attempted and used”, and eight subcategories. Five subcategories are related to the care model. Children tolerated procedures best when: they were provided with an explanation; were allowed to make choices related to the procedure; continuous explanations were given during procedures; the timing of the procedure suited the child; and distraction techniques were used. Three subcategories are not related to the care model and were newly identified as it was applied: negotiation with the child; cooperation of the mother and family; and the influence of first impressions. Conclusions: We found that nurses were best able to bring out the potential of children while protecting patient dignity by combining and continuing these various techniques.     

基于案例分析解读《侵权责任法》中的患者知情同意权

<侵权责任法>实施已近一年,该法医疗损害责任部分中有关患者知情同意权的规定实施效果还不尽如人意.从该法实施后发生的两桩具有一定影响力的案例入手,通过对具体案情的分析,探寻医务人员有关患者知情同意方面意识和行为上存在的洪区,评价<侵权责任法>相关条款的实施效果,通过发现和剖析问题以期使<侵权责任法>在医疗领域获得更深...     

知情同意在护理实践中存在的问题与对策

为减少和避免知情同意在护理实践中的矛盾，笔者分析了知情同意在护理实践过程中出现的问题：知情同意与医疗保护的矛盾；与医患双方医疗知识不平等的矛盾；与正常医疗护理行为不一致的矛盾；告知病人知情权时医与医、医与护不一致。并针对问题提出相应对策：增强法律知识学习；处理好知情权与医疗保护；与患者沟通的过程中用简洁明了、浅显易懂的语言描述问题；尊重病人的自主权；维护病人知情权中的医护一致性。     

Adherence to clean intermittent self-catheterization procedures: determinants explored

Aims & objectives. The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self‐catheterization (CISC) procedures in adults. Background. Clean intermittent self‐catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature. Methods. Relevant factors were explored in two studies. The first study (n = 10) addressed mastery and short‐term adherence, whereas the second study (n = 20) addressed long‐term adherence in these patients. Determinants of patient adherence were derived from pre‐structured interviews with patients, using a content‐analysis procedure. Results. A list of 16 determinants of mastery and short‐term adherence and a list of 12 determinants of long‐term adherence was found. Most of these determinants were found in both older (≥65 years of age) and younger patients. However, five determinants of mastery and short‐term adherence and six determinants of long‐term adherence were specific to patients under the age of 65. Conclusion. Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence. Relevance to clinical practice. Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow‐up care should be improved to include re‐evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.     

Is the Italian consent to transfusion really informed? A medico-legal analysis between old ghosts and new evidence

In healthcare systems of developed countries, obtaining informed consent is a necessary and fundamental requirement for the administration of any medical treatment. In Italy, for the administration of the recipient's informed consent for a blood transfusion, a pre-printed form is used in line with the Decree of the Ministry of Health dated 2 November 2015. This paper aims to analyse this form in light of the European legal provisions and following the enactment of Italian Law No. 219 of 2017 on informed consent and advance treatment directives.Our review shows that the structure of the form can be improved in light of the new direction provided by Italian law, the scientific advancement on transfusion risks, and the potential to reduce the use of blood components. Revising this form could be the opportune time to include written information on Patient Blood Management strategies. Though not exhaustive, this proposal may stimulate debate on the point and produce further contributions.     

Hindrance for patient participation in nursing care

THE STUDY'S RATIONALE: Patients' influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession. AIMS AND OBJECTIVES: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants' perspectives in depth. METHODOLOGICAL DESIGN AND JUSTIFICATION: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach. ETHICAL ISSUES AND APPROVAL: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives. RESULTS: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes. CONCLUSIONS: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients' participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its' evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.     

Informed consent to healthcare interventions in people with learning disabilities – an integrative review

Title. Informed consent to healthcare interventions in people with learning disabilities – an integrative review. Aim. This paper is a report of an integrative review of informed consent to healthcare interventions in people with learning disabilities. Background. Consent to treatment lies at the heart of the relationship between patient and healthcare professional. In order for people with learning disabilities to have equity of access to health care, they need to be able to give informed consent to health interventions – or be assessed as incompetent to give consent. Data sources. The British Nursing Index (BNI), CINAHL, MEDLINE, Social Care Online, ERIC and ASSIA and PsycINFO databases were searched using the search terms: Consent or informed choice or capacity or consent to treat* or consent to examin* AND Learning disab* or intellectual* disab* or mental* retard* or learning difficult* or mental* handicap*. The search was limited to papers published in English from January 1990 to March 2007. Review methods. An integrative review was conducted and the data analysed thematically. Results. Twenty‐two studies were reviewed. The main themes identified were: life experience, interaction between healthcare professionals and participants, ability to consent, and psychometric variables. A consensus seemed to emerge that capacity to consent is greater in people with higher cognitive ability and verbal skills, but that the attitudes and behaviour of healthcare professionals was also a crucial factor. Conclusion. The findings support use of the functional approach to assessing mental capacity for the purpose of obtaining informed consent. Future research into informed consent in people with learning disabilities is needed using real life situations rather than hypothetical vignettes.     

Quality of nursing home care assessed by competent nursing home patients

Interviews were conducted with 60 chronically ill but cognitively competent nursing home patients with a mean age of 80 years, living in 13 nursing homes in the county of Stockholm, Sweden. Quality of nursing home care was assessed through discrepancy between individual priorities (i.e. degree of perceived personal autonomy) and institutional possibility. The results show that there was a high degree of satisfaction with quality of care with regard to meal and shower routines, as well as with the possibilities to watch television, listen to the radio and feel secure. Social relations, on the other hand, was a subject which exposed large discrepancies. Most respondents believed in the importance of social relations whereas results point to a lack of intimacy in the daily living.