week 4 informed consent Flashcards
What does RHPA do?
- Defines actions that can be done by health care professional,
- Defines how professions are designated and governed
- Defines how the profession registers its members
- Title protection
What does RN regulation do?
Permitted Reserved Acts, Licensing. Education
-uofm just got re-accredited so we’re good
What does CRNM do?
protects the public
Reserved acts
standards of practice
list of registered nurses
support/education/courses
What do associations do?
support nurses
what do unions do?
protect labour laws, layoffs, seconding
- not nursing practice-discipline
What are the two types of consent?
- General consent - admission and basic care
- Specific consent - specific therapies like meds, IV etc
What are the principles of informed consent?
- person agreeing to allow medical actions to happen to them
- full disclosure of risks & benefits
- alternatives to that therapy
- consequences of refusal
what is the purpose of informed consent?
- legal and ethical care
- respects the principles
- promotes dignity and inherent worth of each person
- treatment aligned with values & care plan goals
- opportunity to prepare for risks and minimize harms
- ie) NPO to prevent aspiration
What are the 3 elements of informed consent?
- capacity to consent
- information - provided with enough info to make decision
- Voluntariness - no coercion or undue influence
Is consent binding?
no! the person CAN change their mind even at the last moment to the point of when they are put unconscious
Does a signed consent imply that consent obtained was fully informed?
No
teach back is a good way to help identify understanding
What are the 4 CRNM practice expectations?
- professional practice
- Ethical practice
- Competent practice
- Professional communication
Is getting consent a process, a task, or a moment in time?
It’s a process - and it’s ongoing
whoever is doing the treatment/procedure needs to get continued consent
When a nurse is a witness, what is it they are actually witnessing?
- that the signature is infact that patient
- that the signature was in fact voluntary
Aside from being a witness what are the 2 things nurses must do regarding consent?
- follow-up on any questions or concerns
- raise concerns about the patient’s understanding or voluntariness
what are the 3 types of consent?
- Expressed
- Implied
- Inferred/Deemed
What is expressed consent?
verbal
signing the form
repeat back
patients understands risks, benefits, alternatives
What is implied consent?
patient behaviour
- puts arm out for injection
- swallows meds when provided
- attends dialysis , etc
- failure to resist
What is inferred or deemed consent?
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
What are the similarities between competence and capacity?
- presumed default in adults
- questioned when choices are risky, unusual, seem not in best interest
- assessed more frequently and thoroughly when decisions are higher risk. Life/death vs inconvenient
What is Capacity?
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
Is delirium a compentency issue or capacity issue?
capacity issue - varies
What is competency?
- 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
Does a physician and medical director determine someone to lack capacity or incompetent?
Incompetent (issue of compentency)
Which falls under the MMHA, capacity or competency?
Competency
Which does delirium fall under, competency or capacity issue?
capacity
which is mental status/state on a more permenent basis considered, capacity or compentency?
competency
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?
Capacity
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?
both but first Competency and then capacity cuz they might for that decision
How do we assess for capacity when seeing if consent is valid?
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
how do we determine if consent is valid?
- Assess capacity
- Assess understanding
- Assess Voluntariness
how do we assess understanding to determine if consent is valid?
- 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.
How do we understand voluntariness when determining if consent is valid?
- observe interactions and relationships
- careful attention to patient’s body language and questions
- watch for nudging and coercion
- talk to the patient alone if needed
What is the mature minor rule?
- a minor who has capacity to fully apprecatie the nature and consequences of medical treatment
- has the maturity to make their own decisions
What is the emanicpated minor rule?
a minor can consent to medical treatment if they are married, living on their own or shown independence from parents
What is a health care directive?
- gives instructions if the person can’t speak for themselves
- names a proxy or decision maker
- used only when person no longer COMPETENT
- providers follow instructions unless not consistent with accepted health practices
What 3 things are required in a health care directive in manitoba?
- capacity to make a directive
- age 16+
- HCD in writing, signed by maker and dated
What do we do when a person doesn’t have a health care directive?
we consider what is in the person’s best interests
How do we determine best interest according to substituted judgement?
- direct evidence - like a written HCD, video, other person describing their wishes
- conversations with SDM or others and the patient
- patient’s previous choices & lifestyle
- what the SDM would want if in their position
- What the SDM thinks the patient needs
How do we determine best interests according to the MMHA?
- will patient condition be improved by treatment?
- will patients condition deteriorate without treatment?
- do benefits of treatment outweigh the risks of harm?
- is treatment least restrictive and least intrusive to improve the condition?
