a. all family members should wear gloves at home. A. Deerings California Codes Annotated. indicate that further teaching is needed? Case #4: The Conscious Patients Refusal of Life-Saving Treatment. consent for the procedure only. Which statement identifies an appropriately written desired outcome d. assess the clients swallowing ability. Kennedy Mem. McMahon v. Finlayson, 632 N.E.2d (Mass.Ct.App. The nurse understands that: a. All microorganisms can cause disease. 1971). make sound medical decisions at the relevant time. does not require an incident report. a. to use the least amount of immobilization needed for the situation. Consequences of declining or refusing treatment. Blood transfusions in emergency circumstances represent a special case for emergency informed consent situations. The nurse is caring for a client with a Do Not Resuscitate (DNR) order. Some states allow young adults under 18 to play a more active role in their medical care and treatment, including the process of informed consent. Finally, patients can and do refuse treatments that may be lifesaving. if it is an adjective clause. Surgery is required immediately to save the client's life. b. with all clients who are immunosuppressed. incident report. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Associations task force on competency and education for the nursing team members. The nurse is providing oral care to an elderly client. The client requires immediate surgery. RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT: SEE Management of Care Practice Test Questions. 30. As such, providers may be liable to the patient for unauthorized treatment, or even battery,14-17 which may include punitive damages against the provider.10, Limits. Become Premium to read the whole document. c. that protective devices are mandated for behavioral use only. When consent, for any reason including the lack of majority, mental incompetence, and unconsciousness, cannot be obtained, other people can provide legal consent for the patient. d. to frequently damp dust and vacuum to decrease microorganisms. On the basis of this examination and conclusion, the physicians amputated the patients arm. You would be jeopardizing everyone you meet. There are also times, such as during the preoperative period of time, which nurses must recognize, identify and confirm that a complete surgical consent was obtained and placed in the patient's medical record. which of the following actions, A nurse working in the emergency department is assessing several clients. 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. Of course, it should be emphasized that in all circumstances, if informed consent can be obtained from a guardian or family member and it is possible to do so without harm to the patient, providers should make every effort to obtain this consent even if the law would allow treatment without it.72 Practically speaking, such an effort will avoid any issues of hindsight bias associated with a potential adverse event or suboptimal outcome associated with care. Usually, a parent or guardian provides informed consent on the behalf of a minor child.31,32. 69. Liang BA. Kun JM. 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. The incident report is confidential, so it will be placed in the 2. first? However, the court noted that "a patients intoxication may have the propensity to impair the patients ability to give informed consent."56. b. 58. Upon emergency examination, she was found to have symptoms of a tubal (ectopic) pregnancy. 9. Cooper v. Roberts, 286 A.2d 647 (Pa.Super.Ct. Clinical description of the injury requiring of an ineffective breathing pattern to a patient with pneumonia. However, there are circumstances unique to the ED that may obviate the need for obtaining standard informed consent. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. 2. It should be noted that courts generally grant great deference to physician particularly psychiatric evaluation of a patients competency if done using standard methods. 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. It should be noted that in emergency circumstances, all material information should be provided to an adult, conscious patient, but not all information regarding the specific diagnosis and treatment must be disclosed. 12. It is important that the physician in any informed consent discussion provide information on medically recognized alternative measures that could be performed other than the proposed treatment or diagnostic strategy, even if the physician feels these alternatives are less desirable. In re: Brown, 478 So.2d 1033 (Miss. c. apply a personal alarm. The court dismissed the claims against the providers for lack of informed consent. c. Keep the noise to a minimum 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. the role of the Health care provider (HCP)? with a new onset of abdominal pain and fever. c. You must be feeling bored being shut up in here. The nurse clarifies to the worried family that the guiding principle for c. contact She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. Charlottesville, VA: Michie Press; 1997. Medically recognized alternative measures. A client who is unconscious and has extensive internal injuries arrives via ambulance to the emergency Department the staff cannot reach the client's family which of the following permits the staff to proceed with emergency surgery? According to the American Hospital Association, all patients have the right to: Some of these American Hospital Association's Bill of Rights are further amplified and clarified with the Patient Self Determination Act and the Health Insurance Portability and Accountability Act (HIPAA). This information must be provided in a manner that assures patient comprehension.7, If the patient then knowingly consents to the modality, the provider has obtained valid informed consent and may perform the test or procedure on him or her. The DNR will withdraw all medical treatment being provided with The court held for the providers. Hosp. 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. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. The court held for the patient. 15. A gown is part of standard precautions when you are likely to The physicians then indicated to the patient that in this type of situation, the hospitals policy was Following a motor vehicle accident, a patient was brought to the ED to obtain treatment. In re: Fosimire, 551 N.E.2d 77 (N.Y. 1990). Fear of the unknown Crouch v. Most, 432 P.2d 250 (N.M. 1967). Case #6: Emergency Situation with an Unconscious PatientTreatment Allowed. neck down. 1. 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. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. It should be noted here that merely to refuse treatment that would be beneficial does not constitute mental incompetence. Health Law & Policy: A Survival Guide to Medicolegal Issues for Practitioners. ED Legal Letter illustrates the issues that emergency physicians encounter regarding informed consent and the exceptions that may apply. 39. The court noted that although the surgeon did have authorized, informed consent for the appendectomy, the clinical findings upon surgery did not constitute an emergency. The court noted that the patient had a constitutional right to privacy that entitled him to "decide his own future regardless of the absence of a dim prognosis. Univ. After induction and anesthesia was performed on the patient, the surgeon discovered that, in fact, the patient did not have an ectopic pregnancy, but instead the symptoms arose from acute appendicitis. The nurse is educating a nursing student about microorganisms. In other situations, the courts have guardianship and the right to give informed consent for a client who is not able to consent on their own. The law generally requires only disclosure of those factors and risks that are deemed "material," usually judged by the severity or seriousness of the potential harm and the chance of its occurrence.25,26 In one case, material information for informed consent purposes was noted to be: "[T]hat which the physician knows or should know would be regarded as significant by a reasonable person in the patients position when deciding to accept or reject the recommended medical procedure. Legally, once this informed consent is obtained, the doctrine of volenti non fit injuria (to one who is willing, no wrong is done) applies. Your only role is as a witness to the person putting his or her signature on the form and dating the form. These further actions, as well as additional actions that would have been required, would have placed the patient at additional risk of other potential complications, particularly shock, due to a necessary second anesthesia induction. c. The data gathered from the EHR is used to discipline the staff for 36. Hand washing with soap and water after cleansing and changing a After the amputation, recovery, and discharge, the child and his parents brought suit against the treating physicians on the theory that the procedure was performed without their informed consent. d. activate the fire alarm system immediately. b. At a minimum, the following information should be documented in the chart: In addition, any and all attempts at proxy informed consent that were unsuccessful also should be noted in the patients chart to maximize provider protections for treating the patient without informed consent. Once the medical provider determines there is no immediate and imminent harm, the provider should seek parental informed consent.34. e. a patient with pneumonia and a closed leg injury.. She reported previous sexual intercourse and that she was pregnant. 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