week 4 informed consent

Question 1

What does RHPA do?

Answer 1

1. Defines actions that can be done by health care professional,
2. Defines how professions are designated and governed
3. Defines how the profession registers its members
4. Title protection

Question 2

What does RN regulation do?

Answer 2

Permitted Reserved Acts, Licensing. Education
-uofm just got re-accredited so we’re good

Question 3

What does CRNM do?

Answer 3

protects the public

Reserved acts

standards of practice

list of registered nurses

support/education/courses

Question 4

What do associations do?

Answer 4

support nurses

Question 5

what do unions do?

Answer 5

protect labour laws, layoffs, seconding
- not nursing practice-discipline

Question 6

What are the two types of consent?

Answer 6

1. General consent - admission and basic care
2. Specific consent - specific therapies like meds, IV etc

Question 7

What are the principles of informed consent?

Answer 7

1. person agreeing to allow medical actions to happen to them
2. full disclosure of risks & benefits
3. alternatives to that therapy
4. consequences of refusal

Question 8

what is the purpose of informed consent?

Answer 8

1. legal and ethical care
2. respects the principles
3. promotes dignity and inherent worth of each person
4. treatment aligned with values & care plan goals
5. opportunity to prepare for risks and minimize harms
   - ie) NPO to prevent aspiration

Question 9

What are the 3 elements of informed consent?

Answer 9

1. capacity to consent
2. information - provided with enough info to make decision
3. Voluntariness - no coercion or undue influence

Question 10

Is consent binding?

Answer 10

no! the person CAN change their mind even at the last moment to the point of when they are put unconscious

Question 11

Does a signed consent imply that consent obtained was fully informed?

Answer 11

No
teach back is a good way to help identify understanding

Question 12

What are the 4 CRNM practice expectations?

Answer 12

1. professional practice
2. Ethical practice
3. Competent practice
4. Professional communication

Question 13

Is getting consent a process, a task, or a moment in time?

Answer 13

It’s a process - and it’s ongoing

whoever is doing the treatment/procedure needs to get continued consent

Question 14

When a nurse is a witness, what is it they are actually witnessing?

Answer 14

1. that the signature is infact that patient
2. that the signature was in fact voluntary

Question 15

Aside from being a witness what are the 2 things nurses must do regarding consent?

Answer 15

1. follow-up on any questions or concerns
2. raise concerns about the patient’s understanding or voluntariness

Question 16

what are the 3 types of consent?

Answer 16

1. Expressed
2. Implied
3. Inferred/Deemed

Question 17

What is expressed consent?

Answer 17

verbal
signing the form
repeat back
patients understands risks, benefits, alternatives

Question 18

What is implied consent?

Answer 18

patient behaviour
- puts arm out for injection
- swallows meds when provided
- attends dialysis , etc
- failure to resist

Question 19

What is inferred or deemed consent?

Answer 19

we presume agreement unless the patient has otherwise previously expressed non-consent/refusal
- emerg. situations where implied consent is not possible but not treating would cause harm/death

Question 20

What are the similarities between competence and capacity?

Answer 20

1. presumed default in adults
2. questioned when choices are risky, unusual, seem not in best interest
3. assessed more frequently and thoroughly when decisions are higher risk. Life/death vs inconvenient

Question 21

What is Capacity?

Answer 21

The degree to which a person can UNDERSTAND INFORMATION relevant to a treatment decision
- it’s a clinical judgement
- can vary over time
- understand consequences of the action/inaction
- delirium falls under here

Question 22

Is delirium a compentency issue or capacity issue?

Answer 22

capacity issue - varies

Question 23

What is competency?

Answer 23

• it’s about mental status/state perminantly
• does the mental condition affect ability to appreciate the consequences of the medical decision
• falls under the MMHA
• determination is made by physician
• needs approval of medical director of psychiatry (in MB)
• we examine competency when figuring out if we intervene against patient wishes

Question 24

Does a physician and medical director determine someone to lack capacity or incompetent?

Answer 24

Incompetent (issue of compentency)

Question 25

Which falls under the MMHA, capacity or competency?

Answer 25

Competency

Question 26

Which does delirium fall under, competency or capacity issue?

Answer 26

capacity

Question 27

which is mental status/state on a more permenent basis considered, capacity or compentency?

Answer 27

competency

Question 28

from a clinical perspective, when wondering if someone can understand the consequences of action/inaction regarding medical treatment, which would we be questioning, capacity or competency?

Answer 28

Capacity

Question 29

When wondering if someone can appreciate the consequences of making a treatment decision regarding medical treatment and they have an SDM, which would we be questioning, capacity or competency?

Answer 29

both but first Competency and then capacity cuz they might for that decision

Question 30

How do we assess for capacity when seeing if consent is valid?

Answer 30

it's like a dimmer swtich (the light's not permanently off necessarily ) -can they UNDERSTAND and APPRECIATE the decision presented in that moment - to what degree

Question 31

how do we determine if consent is valid?

Answer 31

1. Assess capacity 2. Assess understanding 3. Assess Voluntariness

Question 32

how do we assess understanding to determine if consent is valid?

Answer 32

- they must be capable of understanding : - their condition - what the treatment is and why - risks/benefits of going ahead with it - risks/benefits of not going ahead with it - nurses should feel satisfied that there is evidence of reasoned choice made from capacity to do so.

Question 33

How do we understand voluntariness when determining if consent is valid?

Answer 33

1. observe interactions and relationships 2. careful attention to patient's body language and questions 3. watch for nudging and coercion 4. talk to the patient alone if needed

Question 34

What is the mature minor rule?

Answer 34

- a minor who has capacity to fully apprecatie the nature and consequences of medical treatment - has the maturity to make their own decisions

Question 35

What is the emanicpated minor rule?

Answer 35

a minor can consent to medical treatment if they are married, living on their own or shown independence from parents

Question 36

What is a health care directive?

Answer 36

1. gives instructions if the person can't speak for themselves 2. names a proxy or decision maker 3. used only when person no longer COMPETENT 4. providers follow instructions unless not consistent with accepted health practices

Question 37

What 3 things are required in a health care directive in manitoba?

Answer 37

1. capacity to make a directive 2. age 16+ 3. HCD in writing, signed by maker and dated

Question 38

What do we do when a person doesn't have a health care directive?

Answer 38

we consider what is in the person's best interests

Question 39

How do we determine best interest according to substituted judgement?

Answer 39

1. direct evidence - like a written HCD, video, other person describing their wishes 2. conversations with SDM or others and the patient 3. patient's previous choices & lifestyle 4. what the SDM would want if in their position 5. What the SDM thinks the patient needs

Question 40

How do we determine best interests according to the MMHA?

Answer 40

1. will patient condition be improved by treatment? 2. will patients condition deteriorate without treatment? 3. do benefits of treatment outweigh the risks of harm? 4. is treatment least restrictive and least intrusive to improve the condition?