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law and ethics nurs 3560 > week 4 informed consent > Flashcards

week 4 informed consent Flashcards

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1
Q

What does RHPA do?

A
  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
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2
Q

What does RN regulation do?

A

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

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3
Q

What does CRNM do?

A

protects the public

Reserved acts

standards of practice

list of registered nurses

support/education/courses

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4
Q

What do associations do?

A

support nurses

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5
Q

what do unions do?

A

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

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6
Q

What are the two types of consent?

A
  1. General consent - admission and basic care
  2. Specific consent - specific therapies like meds, IV etc
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7
Q

What are the principles of informed consent?

A
  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
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8
Q

what is the purpose of informed consent?

A
  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
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9
Q

What are the 3 elements of informed consent?

A
  1. capacity to consent
  2. information - provided with enough info to make decision
  3. Voluntariness - no coercion or undue influence
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10
Q

Is consent binding?

A

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

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11
Q

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

A

No
teach back is a good way to help identify understanding

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12
Q

What are the 4 CRNM practice expectations?

A
  1. professional practice
  2. Ethical practice
  3. Competent practice
  4. Professional communication
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13
Q

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

A

It’s a process - and it’s ongoing

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

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14
Q

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

A
  1. that the signature is infact that patient
  2. that the signature was in fact voluntary
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15
Q

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

A
  1. follow-up on any questions or concerns
  2. raise concerns about the patient’s understanding or voluntariness
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16
Q

what are the 3 types of consent?

A
  1. Expressed
  2. Implied
  3. Inferred/Deemed
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17
Q

What is expressed consent?

A

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

18
Q

What is implied consent?

A

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

19
Q

What is inferred or deemed consent?

A

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

20
Q

What are the similarities between competence and capacity?

A
  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
21
Q

What is Capacity?

A

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

22
Q

Is delirium a compentency issue or capacity issue?

A

capacity issue - varies

23
Q

What is competency?

A
  • 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
24
Q

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

A

Incompetent (issue of compentency)

25
Q

Which falls under the MMHA, capacity or competency?

A

Competency

26
Q

Which does delirium fall under, competency or capacity issue?

A

capacity

27
Q

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

A

competency

28
Q

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?

A

Capacity

29
Q

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?

A

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

30
Q

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

A

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

31
Q

how do we determine if consent is valid?

A
  1. Assess capacity
  2. Assess understanding
  3. Assess Voluntariness
32
Q

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

A
  • 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.
33
Q

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

A
  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
34
Q

What is the mature minor rule?

A
  • a minor who has capacity to fully apprecatie the nature and consequences of medical treatment
  • has the maturity to make their own decisions
35
Q

What is the emanicpated minor rule?

A

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

36
Q

What is a health care directive?

A
  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
37
Q

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

A
  1. capacity to make a directive
  2. age 16+
  3. HCD in writing, signed by maker and dated
38
Q

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

A

we consider what is in the person’s best interests

39
Q

How do we determine best interest according to substituted judgement?

A
  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
40
Q

How do we determine best interests according to the MMHA?

A
  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?

law and ethics nurs 3560 (6 decks)

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