Informed consent in nursing: what makes consent valid
A signed form only records that someone agreed. Valid consent is capable, informed, voluntary and for this procedure, and the client can withdraw it.
- A signature only records that someone agreed.
- Valid consent is capable, informed, voluntary, and for this procedure.
- A capable client can withdraw consent at any time.
Informed consent is valid when the client is capable, is informed, agrees freely, and agrees to this procedure. A signed form only records that someone agreed, so a practical nurse looks behind the signature. This guide follows one client on the morning of her knee replacement.
A signed form is not the whole answer
Your client is booked for a knee replacement, and her son tells you, “She's signed the form, so just take her in.” The form in her chart is signed. So you sit down beside her and ask her to tell you the plan in her own words.
Look behind the signature
| Check | What you look for |
|---|---|
| Capable | She can understand the decision when she makes it. A client who is too drowsy to tell you the plan may not be. |
| Informed | She can tell you the plan in her own words. |
| Voluntary | She agreed freely, and nobody pushed her into it. |
| For this procedure | The form names the procedure on today's list. |
When the client says she had no choice
Your client can tell you the plan, so she is capable and she is informed. Then she says quietly, “My son told me I have no choice.” Consent has to be voluntary, and someone who feels she has no choice may not have agreed freely.
- Tell her that this is her decision.
- Make sure she does not go to the operating room yet.
- Tell the surgeon and the nurse in charge that the surgery has to wait, and why.
- Document what she said, in her words.
Do not ask her to sign again, and do not explain the surgery in the surgeon's place. A new signature does not repair a consent. See your part in consent.
A drowsy signature or a different procedure
- She signed after her sedative and was too drowsy to tell you the plan. You doubt that she was capable when she signed, so you hold the surgery the same way.
- The form names a different procedure from today's list. Consent for one procedure does not cover another, so you report it.
The client can change her mind
Every check passes, and at the operating room door she changes her mind. A capable client can withdraw consent at any time. So you stop and tell the surgeon.
When a client cannot decide, someone else may give consent. See who can give consent, or read the whole topic. Consent law differs between provinces. Follow your regulator and your agency's policy.