A nurse is preparing an adult client for an open cholecystectomy and is reviewing the informed consent process. Which actions are within the registered nurse's responsibility for informed consent? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
The RN assesses orientation and the client's ability to understand and weigh information and reports concerns about decision-making capacity (Choice 1), confirms that consent is voluntary (Choice 2), witnesses the client's signature after verifying identity according to policy (Choice 3), and uses teach-back to verify understanding, stopping the process and notifying the surgeon if understanding is incomplete (Choice 4). The surgeon or other qualified procedural provider is responsible for explaining the detailed risks, benefits, and alternatives; the nurse should not substitute for that discussion (Choice 5). The nurse must not sign on behalf of a competent client (Choice 6). State law and facility policy govern the exact consent and witness process.
Informed Consent — Who Does What Surgeon/Provider: explains diagnosis, procedure, risks, benefits, alternatives, consequences of refusal. RN role: witness signature, verify identity, confirm understanding, assess capacity, ensure voluntariness.
Capacity Criteria (4 elements) 1. Communicate a choice 2. Understand the information 3. Appreciate consequences 4. Reason through the decision
Memory Tip "VICA-V": Voluntary, Identity, Capacity, Acknowledged understanding, Vitness signature.
Caution If client received pre-op opioids/benzodiazepines, capacity may be impaired — STOP and notify surgeon. Telephone consent allowed only with two RN witnesses listening on the line.
ScenarioAdult client, scheduled open cholecystectomy. Surgeon spoke with client 30 min ago. Client now states "I am not sure what they are going to do — something with my gallbladder?"
Nurse Action Path1. Do NOT have client sign yet2. Document specific gaps in understanding3. Notify surgeon to return for additional discussion4. After surgeon clarifies, reassess understanding5. Witness signature when client can describe procedure in own words
Red Flags Requiring Stop- Pre-op sedation given- Capacity concern (dementia, intoxication, severe pain)- Family pressuring client- Language barrier without certified interpreter
Informed consent (legal elements) — Required elements: disclosure of nature, purpose, risks, benefits, alternatives; client capacity; voluntariness; understanding. The provider performing the procedure has the legal duty to disclose; the RN witnesses signature and verifies the elements are met.
Decision-making capacity — Clinical, not legal, determination. Four abilities: communicate a choice, understand information, appreciate consequences, reason through options. Capacity can fluctuate (delirium, sedation) and is decision-specific.
RN role in consent — Witness signature, verify two identifiers, confirm client's understanding in their own words, assess capacity, ensure voluntariness, document any gaps and notify provider. RN may NOT obtain consent or explain medical/surgical specifics.