Running head: Accountability of Nursing Professionals

Accountability of Nursing Professionals for Patient Safety Practices Related to Informed Consent
Lavonia Deanne Bishop
Grand Canyon University
NURS-430V Professional Dynamics 23-Aug-2010 (0106)
September 19, 2010

Accountability of Nursing Professionals for Patient Safety Practices Related to Informed Consent Accountability in nursing can be defined as the state in which the nurse is responsible for upholding a professional agreement with the patient to provide services and be held answerable for the outcomes of behaviors related to these services (Hood, 2010). One of the main areas we are held accountable for as professional nurses is the safety of our patients. After an evidence-based review of patient safety practices, the Agency for Healthcare Research and Quality has identified numerous opportunities for quality improvement. The practices identified were rated by strength of evidence, with the highest rated being listed first. This paper will examine practice number five, asking patients to recall and restate what they have been told during the informed consent and the responsibility of the professional nurse in this process.
The Informed Consent Process According to Terry (2007) informed medical consent occurs when a patient autonomously and expressly permits a professional to perform a medical act on that patient or include the patient in a research project. Patients are now encouraged to be more informed consumers and take an active part in their own healthcare. Terry (2007) has acknowledged that this process takes time and merely having a patient sign a consent form does not mean true informed consent was obtained. The process of obtaining informed consent requires that the patient and the healthcare practitioner have open, honest two-way communication. This discussion should lead the patient to understand the risks and benefits of the treatment being presented and any alternative options available.

Informed Consent as a Patient Safety Issue

When practitioners fail to obtain adequate informed consent, they can be held liable for

negligence, battery or charged with malpractice. Pizzi, Goldfarb, and Nash (2001) noted that

consents for procedures are often obtained during an informal interaction between physicians,

nurses, and patients and do not often include all of the necessary information to be considered

informed. When practitioners fail to obtain true informed consent, they miss the opportunity to

receive information from the patient or representative that could affect care, even leading to a

medical error. Examples might include allergies, reaction to anesthesia, correct medications, or

correct medical procedures.

Evidence-Based Practice: Areas for Improvement

Although the process of obtaining informed consent has been established as a standard of

practice, it often fails to meet it’s stated goals (Pizzi et al., 2001). Pizzi et al. (2001) also

indicated there are several areas for improvement in the process including improving readability

of forms and written materials, structured discussions between patients and providers, asking

patients for recall, use of audio-visual aids, and providing written information to patients. One of

the simplest methods to determine patient understanding of information is asking patients to

recall and recount what they have been told.

The Role of Nurse In Informed Consent

Sims (2008) noted that as nurses one of our many roles is to obtain and or witness

patients giving a signed informed consent for a medical procedure. Another instance in which a

nurse may be involved in the informed consent process is when a patient is consenting to be a

participant in research or a clinical investigation. If it is a nursing research study, the nurse may

even be the primary investigator. In all cases the nurse should act as an advocate for the patient

especially one who may be vulnerable, or impaired (Sims, 2008).

Promoting Patient-Centered Care

Krumholtz (2010) suggests that patient-centered care should be respectful and responsive

to the preferences, needs, and values of patients, and that these values should guide all clinical

decisions. Also that there should be dialogue between providers and patients, and that the care

decided on should be evidence-based. In order to be successful in promoting patient-centered

care especially in terms of obtaining true informed consent, nurses should strive to include the

wishes of the patient and or advocate in the process. This often puts the nurse in the role of

educator or facilitator. According to Hood (2010) patient education concludes with the patient

receiving feedback from the nurse that they have effectively developed new ideas and

knowledge. Furthermore the results of the effective learning become apparent when the

patient can recall key information that was given by the provider.

Demonstrating Accountability as a Patient Advocate

Bu and Jezewski (2006) have theorized that patient advocacy is a process consisting of

taking specific actions for preserving and safeguarding patient rights, interests and values in the

healthcare system. They suggest that to effectively advocate for patients, nurses should know

when to advocate, what the best interests of the patient are and what actions need to be taken.

Terry (2007) related the following example of how informed consent was obtained by a physician

and witnessed by a nurse. In this case a pulmonologist seeing a patient in an outpatient clinic

recommends a bronchoscopy. The physician hands the patient a detailed consent form that

includes the risks, benefits and alternatives to the procedure and asks him to read over it. The

pulmonologist leaves the room and returns a few minutes later and asks the patient if he has any

questions. The patient voices no questions and signs the consent form which is witnessed by a

nurse. Did the physician obtain informed consent? Technically yes, from the legal perspective.

Did the nurse act in the role of patient advocate? No, a patient advocate would have made sure

the patient had the opportunity to engage in a meaningful two-way discussion regarding the

procedure. If the nurse had been using evidence-based practice, the patient would have at

minimum been asked to recall and recount his understanding of the benefits, risks, and

alternatives to bronchoscopy in this situation. According to MacDonald (2006) the role of patient

advocate is considered an ethical and moral obligation in nursing practice. Therefore as

professional nurses we should be careful not to abdicate our responsibility as the nurse in this

case study appears to have done.

Conclusion The nurse can play a vital role in the process of obtaining informed consent. The nurse can be more than just a passive witness to the interaction between provider and patient. Nurses are professionally accountable to act as advocates for their patients, providing them with the opportunity to gain knowledge and make informed decisions. Evaluation of our effectiveness in this role can be measured in part by using the simple evidence-based technique of having the patient recall and recount the information that has been given. Regarding patient safety Hood (2010) suggests that nurses are accountable for working to protect patients against potential harm and protect the aspects of healthcare that belong to professional nursing.

References
Bu, X. & Jezewski, M.A. (2007). Developing a mid-range theory of patient advocacy through concept analysis. Journal of Advanced Nursing 57(1), 101-110.
Hood, L.J. (2010). Leddy & Pepper’s conceptual bases of professional nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Krumholz, H. M. (2010). Informed consent to promote patient-centered care. The Journal of the American Medical Association 303(12), 1190-1191.
Pizzi, L. T., Goldfarb, N. I., & Nash, D.B. (2001). Procedures for obtaining informed consent. In A critical analysis of patient safety practices (48). Retrieved from http://archive.ahrq.gov/clinic/ptsafety/chap48.htm
Sims, J. M. (2008). Your role in informed consent. Dimensions of Critical Care Nursing 27(3), 118-121.
Terry, P. B. (2007). Informed Consent in Clinical Medicine. CHEST 131, 563-568. doi: 10.1378/chest.06-1955