Informed consent
Obtaining consent is the provider's responsibility; the nurse's role is advocacy and witnessing.
| Situation | Who can consent |
|---|---|
| Competent adult | The client |
| Adult lacking capacity | Health care agent or legal surrogate, per state law |
| Minor | Parent or legal guardian, with exceptions such as emancipated minors and certain services defined by state law |
| Client medicated with opioids or sedatives before signing | Consent may not be valid; notify the provider |
| Interpreter needed | Use a qualified medical interpreter, not family members |
A client can withdraw consent at any time, even after signing.
Advance directives and client rights
Advance directives let clients direct their care if they later lose capacity.
- Clients may refuse any treatment, including life-sustaining treatment; the nurse ensures they understand the consequences and documents.
- Leaving against medical advice: notify the provider, explain risks, ask the client to sign the facility form, and document; the nurse cannot hold a competent client against their will.
- A do-not-resuscitate order does not mean "do not treat"; all other care continues.
Confidentiality, documentation, and torts
Most legal errors on the exam involve privacy, documentation, or touching or restraining a client without justification.
| Term | Meaning | Example |
|---|---|---|
| Negligence/malpractice | Duty, breach, causation, and harm | Failing to report a critical lab that leads to injury |
| Assault | Threat of harmful contact | Threatening to restrain a client who refuses medication |
| Battery | Touching without consent | Giving an injection the client refused |
| False imprisonment | Unjustified restraint or confinement | Restraining a competent client to prevent discharge |
| Breach of confidentiality | Unauthorized disclosure | Discussing a client in an elevator or on social media |
HIPAA permits sharing information for treatment and certain required purposes; otherwise, the client's authorization is needed.
Ethical principles
Ethics questions ask which principle applies or how to resolve a conflict between principles.
NGN-style case
Consent and advocacy appear together.
A client scheduled for surgery in 30 minutes has signed the consent form. While the nurse completes the checklist, the client says, "I'm still not sure what they are going to remove." What should the nurse do?
- Recognize cues: the client does not understand the procedure.
- Analyze: consent is not truly informed.
- The nurse does not explain the surgery in place of the surgeon.
- Notify the surgeon so they can clarify before the procedure, and document.
Answer. Notify the surgeon before the procedure begins. Informed consent requires understanding, and explaining the procedure is the provider's responsibility.