Situation: A 60-year-old man is admitted the day before an elective open abdominal operation under general anesthesia. He has type 2 diabetes mellitus and hypertension. He has no history of delayed gastric emptying, no gastrointestinal symptoms, and no known drug allergies. The surgeon explained the operation, and the client signed the consent form an hour ago. As the nurse reviews the form with him, he says, "I signed it, but I still do not know if they will remove part of my intestine or only take a sample." What should the nurse do?

The surgeon, as the person performing the procedure, obtains informed consent; the nurse confirms that the client understands and witnesses the signature. A client who does not understand what will be done has not given valid informed consent, so the nurse notifies the surgeon before surgery and before any preoperative sedation.

Core issue The client signed the consent form, but his statement reveals he does not understand the planned procedure. This means the ethical and legal requirements for informed consent have not been met.

Why the signature alone is not enough Informed consent is not simply a signature on a document. It is a process that requires three fundamental elements: the patient must be competent, adequately informed, and free from coercion ^[1][2]. When the client says he does not know whether part of his intestine will be removed or only a sample will be taken, he is demonstrating that the “adequately informed” criterion is absent. A signature obtained without genuine understanding does not constitute valid informed consent.

Role of the nurse versus the surgeon The person performing the procedure—the surgeon—holds the primary responsibility for obtaining informed consent. The nurse’s role is to confirm understanding and witness the signature, not to provide new procedural information that the surgeon has not already explained. In this situation, the client has a specific question about the surgical plan that only the surgeon can properly clarify. The nurse must notify the surgeon so the client’s questions are answered before surgery and before any preoperative sedation is given.

Why the other options are unsafe Describing the operation using the chart goes beyond the nurse’s witnessing role and risks giving incomplete or inaccurate information. Proceeding because the signature exists ignores the client’s clear lack of understanding. Asking the wife to explain the plan shifts responsibility away from the person who will perform the procedure and does not guarantee accurate information.

Option	Problem
1. Describe the operation using the chart	Nurse is not the proceduralist; risks providing incomplete or incorrect details
2. Proceed based on signature	Signature without understanding is not valid informed consent
3. Notify the surgeon	Correct—surgeon must address the client’s questions before surgery
4. Ask the wife to explain	Does not ensure accurate information from the responsible provider

Key point! A client who cannot state what procedure will be performed has not given valid informed consent, regardless of a signed form. Watch out! Preoperative sedation must not be given until the surgeon has clarified the plan and the client confirms understanding, because sedation can impair the client’s capacity to make an informed decision ^[2].

Informed consent is rooted in respect for patient autonomy and is incorporated into a process of shared decision making between the patient and the physician ^[2]. The nurse’s ethical duty is to protect that process by recognizing when understanding is incomplete and acting to correct it before the procedure proceeds ^[1].