Reply to the student’s discussion post below…please elaborate on what the student is talking about and cite any sources used
In healthcare, informed consent, decision-making capacity, and legal competence are important in following ethics in healthcare.
Strini et al. (2021) define informed consent as the process in which a patient decides freely and independently whether to start or continue treatment after receiving specific information in which the patient has a complete understanding of the treatment course such as risks and benefits. As a nurse, informed consent occurs daily; when providing care to a patient rather for a surgical procedure or for obtaining lab work, or even when performing a head-to-toe assessment. As for a surgical procedure, Strini et al. (2021) indicated that a nurse can be integral to the process of informed consent by ensuring comprehension of the treatment, facilitating documents of consent, addressing patient anxiety, and helping identify appropriate surrogate decisions maker when needed.
Amaral et al. (2022) state decision-making capacity is a person’s ability to understand the medical problem, the purpose of treatment, its risk and benefits, and reasoning. I have actually assessed one of my patient decision-making capacities recently before having a surgical intervention to an infected abdominal wound, such as a wound vac change, and washout performed at the site. I remember walking into the patient’s room just minutes after the surgeon had discussed the treatment plan and asking the patient what type of surgery he was having and if he was okay with the treatment plan. The patient’s responded, “I am not sure, he said something about my stomach. Yes, I am okay; it is just another surgery”. In the scenario, the patient did not understand the reason for the surgery nor was he well informed or had a clear understanding of the treatment plan. Therefore, causing the patient to have the poor capacity in his decision. This was followed up by having the surgeon explain the treatment course again in terms that the patient could understand.
“Legal competence is presumed – to disprove an individual’s competence requires a hearing and presentation of evidence. Competence is determined by a judge” (Libby et al., 2022). I have seen legal competence take place in patients with dementia or patients that have experienced Wernicke’s encephalopathy related to alcohol or drug abuse that has caused irreversible brain damage and led to confusion and a decrease in a person’s physical activities.
Therefore, a patient’s decision-making capacity should always be assessed before obtaining informed consent to assure the patient understands the treatment plan. As healthcare professionals, we have probably all experienced this through our profession.
Amaral, A. S., Afonso, R. M., Simões, M. R., & Freitas, S. (2022). Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia. Psychiatric Quarterly, 93(1), 35–53. https://doi.org/10.1007/s11126-020-09867-7
Libby, C., Wojahn, A., Nicolini, J. R., & Gillette, G. (2022). Competency and capacity. National Library of Medicine. Retrieved September 5, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK532862/
Strini, V., Schiavolin, R., & Prendin, A. (2021). The Role of the Nurse in Informed Consent to Treatments: An Observational-Descriptive Study in the Padua Hospital. Clinics & Practice, 11(3), 472–483. https://doi.org/10.3390/clinpract11030063
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