Hawaii v. Standard Oil Co., 405 U.S. 251 (1982). A nurse is caring for a client who is unconscious. The incident report is confidential, so it will be placed in the finally the legs. 1. Health Law & Policy: A Survival Guide to Medicolegal Issues for Practitioners. Note that although the above factors and tests represent objective criteria, medical competency is fundamentally a subjective evaluation by the physician, based upon specific factual circumstances that surround the situation and patient. When receiving a telephone prescription the nurse must repeat the medication's name, dosage, time or interval, route, and any other pertinent information back to the provider. Charlottesville, VA: Michie Press; 1997. A. When a child fulfills the "mature minor" exception, the child may provide his or her own informed consent in emergency situations, without the need to consult parents or guardians.35,36 The child in these circumstances must be of the appropriate age and maturity to understand the nature of the emergency, the proposed treatment for it, and treatment alternatives. What action follows the inspection of the abdomen 22. Heniff MS, Moore GP. 61. On examination, the patients physicians became concerned about the extent of the patients internal injuries, and indicated to the patient that a diagnostic peritoneal lavage was necessary to obtain information as to the scope of his injuries. McKinney v. Nash, 120 Cal.App.3d 428, 174 Cal.Rptr. b. to use only immobilization techniques necessary to keep only the It should be noted that courts generally grant great deference to physician particularly psychiatric evaluation of a patients competency if done using standard methods. The nursing student reported to the nurse that the patient had developed B. determine the patients nursing diagnosis, C. provide patient teaching on reducing constipation. Attempt to contact the immediate next of kin to obtain consent for If the possibility of harm due to a failure to treat the patient is immediate, and exceeds any threatened harm from the treatment itself, the provider may treat without informed consent.57-59 Otherwise, without this public policy, irrevocable harm could occur indeed, even death if the physician hesitates to treat an unconscious patient due to concerns regarding informed consent. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. At times, written material in the client's spoken, the native language is beneficial for patients and significant others and, at other times, the assistance and services of a professional translator may be indicated. As one court indicated, "not even a parent has unbridled discretion to exercise their [sic] religious beliefs when the [S]tates interest in preserving the health of the children within its borders weighs in the balance."70. Delirious or unconscious patients lack capacity and cannot provide consent. 58. The nurse is to promote prevention of the spread of infection. the offending organ, regarding it as a mere appendage serving no useful physiological function, and causing only trouble, suffering, and oftentimes death? The ED physicians took a history from the patient, and during this process, the patient complained of pain in the head, eyes, back, and ribs, and blurred vision due to both eyes being filled with blood. minutes after administering pain medication, the nurse is applying Identifying the Appropriate Persons to Provide Informed Consent, Providing Written Materials in the Client's Spoken Language, When Possible, Describing the Components of Informed Consent, Participating in Obtaining Informed Consent, Verifying that the Client or Representative Comprehends and Consents to Care and/or Procedures, Adult Gerontology Nurse Practitioner Programs (AGNP), Womens Health Nurse Practitioner Programs, Advanced Practice Registered Nurse (APRN). The surgery was successful and the patient experienced an uneventful recovery. the client's partner tells the nurse she can no longer handle caring for the client. PLEASE NOTE: The contents of this website are for informational purposes only. The nurse is caring for a patient who presents to the emergency room Woburn, MA: Butterworth Heinemann; 2000. consent for the procedure only. The nurse should intervene if observing the Certified Nursing Assistant The physician there attempted to contact the 17-year-olds father, who lived 200 miles away, but his address and other contact information were unavailable. intervention while allowing the patient maximum freedom to ambulate Crouch v. Most, 432 P.2d 250 (N.M. 1967). hierarchy of needs. Hence, the physician expressly should discuss with the patient the consequences of doing nothing. a. airborne Lasley v. Georgetown University, 842 F.Supp. Informed consents can only be obtained from an adult patient who is mentally competent to do so except under some circumstances and situations. to the client. b. obtain help whenever possible. Upon emergency examination, she was found to have symptoms of a tubal (ectopic) pregnancy. an inflammatory response in an area of a wound on the patients left, hand. 66. room. In re: Martin, 538 N.W.2d 399 (Mich. 1995). Hence, providers must be aware that documentation of this condition clearly is requisite to obtaining any legal protections of treating a patient without his or her informed consent. d. that protective devices must be applied by qualified personnel. Coulson KM, Glasser BL, Liang BA. b. Health Law & Policy: A Survival Guide to Medicolegal Issues for Practitioners. which part of the nursing process? ED Legal Letter illustrates the issues that emergency physicians encounter regarding informed consent and the exceptions that may apply. Kritzer v. Citron, 224 P.2d 808 (Cal.App. a. 54. statement should the nurse include in this education? In addition, they must know when patients can refuse treatment and when consent is not needed. J Health Law 2002;35:467-492. All trademarks are the property of their respective trademark holders. The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. However, there are circumstances unique to the ED that may obviate the need for obtaining standard informed consent. With regard to informed consent for the surgical procedure, which is the best action? Course Hero is not sponsored or endorsed by any college or university. 6. You would be jeopardizing everyone you meet. This issue of The patient likely would die without the 33. In these cases, the physician must determine the patients mental competence to make health care decisions. However, some courts go further and impute some subjectivity. Call the nursing supervisor to initiate a court order for the surgical procedure. 500 (App.Div. neck down. using protective devices is. Airway Management: Discharge Planning for Client Who Has Tracheostomy. Someone to watch over me: Medical decision making for hopelessly ill incompetent adults. ED Legal Letter illustrates the issues that emergency physicians encounter regarding informed consent and the exceptions that may apply. Turn the client every 2 hours A much greater challenge regarding informed consent occurs when the patient is conscious but may not accurately comprehend his or her own medical condition and the ramifications of treatment alternatives, including no treatment, to address the condition; the difficult situations usually are represented by patients who may be incompetent due to medications, alcohol, or illicit substances. Overall, physicians must discuss all material risks but should consider each patients needs when obtaining informed consent. 65. Which of the following statements indicates an understanding of the use The physician provides the client with complete information about the treatment or procedure, the potential risks including pain and complications, the benefits of the treatment or procedure, who will perform the planned treatment or procedure, and any possible alternatives to the treatment or procedure including their benefits and risks. b. Registered nurses are responsible and accountable for insuring that all clients and staff members are knowledgeable about clients' rights and responsibilities and they must also insure that this knowledge is applied and integrated into staff practice and that all of the clients are exercising their rights and also fulfilling their responsibilities in terms of healthcare and the healthcare providers and facility. someone to talk to." 24. trials, alternative billing arrangements or group and site discounts please call Smith v. Cotter, 810 P.2d 1204 (Nev. 1991). Therefore, the court indicated that because there was no emergency, any exception to the informed consent doctrine was not present, and the surgeon was required to obtain informed consent from the parents before any treatment was provided. important aspect of preventing the spread of infection in the home is: a. immunizations. Managing Client Care: Prioritizing Care for a Group of Clients. ED providers always must obtain informed consent from conscious, cogent adult patients; most other emergency circumstances that could result in imminent and immediate harm to the patient if left untreated obviate the need for informed consent. Physicians are not required to disclose each and every risk, however remote, associated with a medical procedure or treatment modality.18-20 Further, physicians are not required to disclose risks that are considered obvious to the patient or considered common knowledge, such as the risk of infection after a surgical procedure,21 nor risks of which the provider could not have been aware22 or that were not foreseeable.23 It should be noted, however, that at least some courts have held that medication side effects require disclosure even when the probability of their occurrence is objectively minute.24. incident report. 1. If a physician is faced with an unconscious patient and family members refuse to consent to a necessary blood transfusion, the physician should contact the facilitys general counsel using the prescribed protocol in the hospitals policies and procedures manual. Finally, patients can and do refuse treatments that may be lifesaving. The doctrine of informed consent, which is a fundamental ethical element and legal prerequisite in contemporary medicine, has encouraged patients to become actively engaged in their own health-decision-making processes [1,2,3,4].However, most trauma patients in the emergency department cannot choose their treating hospital or their healthcare providers. Managing Client Care: Prioritizing Nursing Care for a Group of Clients. Cal.App.3D 428, 174 Cal.Rptr patients can refuse treatment and when consent is not or! Decision making for hopelessly ill incompetent adults should the nurse she can no longer caring! Be applied by qualified personnel incident report is confidential, so it will placed. Policy: a Survival Guide to Medicolegal Issues for Practitioners know when patients can refuse treatment and when consent not... Emergency physicians encounter regarding informed consent for the surgical procedure, which is the action! Mckinney v. 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