Theatre Nurses Role in Patients Consent for Surgery - Essay Example

This paper critically analyses consent and the theatre nurse's role. The paper also discusses why consent is needed prior to surgery and goes on to discuss the entire process including problems and issues. Theatre nurse's role in patient's consent for surgery A patient is required by law to give consent before any surgical (or non surgical) procedure can take place. Consent as defined by the Oxford English Dictionary is to "Express willingness, give permission, agree." (Concise Oxford Dictionary pg 244). It can be verbal or nonverbal but in a court of law written/signed consent is usually allowed as valid evidence. It is well recognized that nurses should obtain the consent of a patient prior to nursing care procedures (Calder 1989, Hewetson 1994, United Kingdom Central Council for Nursing, Midwifery and Health Visiting [UKCC] 2000). The reason for consent is pretty straightforward, most simple put it conveys to the patient the details of what medical procedures will be performed upon him while conveying to the concerned authority that the patient is aware and mentally prepared for the procedure/ treatment to be performed on him and has given his permission. The UKCC advises that all care procedures should be undertaken within a framework of informed consent. Informed consent serves to protect patient autonomy (Beauchamp & Childress 1994). If there is some ambiguity regarding the treatment, warning signals are usually present. In many cases, someone will know of this and may have the opportunity to correct the situation Informed consent can be written, oral or given by implication (Department of Health 2001). Kennedy and Grubb have argued "Consent is expressed when the patient explicitly agrees to what is proposed by the doctor. It need not have been set out in any specific form and it need not be in writing." (pg 95) When a patient is admitted to hospital for a surgical procedure (under anaesthesia), he/she places complete trust in the doctors/nurses who are responsible for his/her care. If such a patient senses the possibility that treatment that was previously agreed upon could be exceeded, will typically be nervous and anxious and ask to see the surgeon/theatre nurse pre-operatively and seek reassurance from them. For example, the reason given by the patient for admission may not tally with the details on their consent form, or the nursing history may disclose that a patient's understanding of the nature of their illness differs from the procedure the operating room has been booked for. An Irish mother was traumatized in 2000 after discovering that a doctor had removed one of her ovaries without her consent in a routine operation in 1991 (Smith). A patient who senses the possibility that treatment previously agreed to could be exceeded, will typically be nervous and anxious, ask to see the surgeon pre-operatively and seek reassurance from nursing staff. The legality of consent varies from country to country. In the United Kingdom there is a common law structure to consent; that is, there are few statutes or Acts of Parliament which have a bearing on this issue. Most of UK consent law has been developed over the years based on courts adjudicating on cases that came before them. These are those cases where consent has been unclear or disputed between parties. Broadly, the law mirrors the moral structure given above but is necessarily more precise. The final decision should be up to the individual, acting freely, and should be taken by individuals who are of legal capacity. Capacity as per England and Wales requires a positive response to the following questions: Is the patient able to comprehend and retain the treatment information Is the patient able to believe it Is the patient able to weigh the information in the balance to arrive at a choice Sutton (2003) highlights four basic principles that are used when making ethical decisions as a theatre nurse which include autonomy, beneficence, non-maleficence and justice. In addition to these four principles, several authors include veracity as one of the basic nursing ethical principles (Chally & Loriz 1998, Schroeter 2002). Autonomy is the principle that ensures that every individual has the right to make decisions about their own life - the principle of self-determination (Schroeter 2002). The NMC Code of Conduct states that a nurse "must recognise and respect the role of patients and clients as partners in their care and the contribution they can make to it. This involves identifying their preferences regarding their care and respecting these within the limits of professional practice, existing legislation, resources and the goals of the therapeutic relationship" (NMC 2002). Where it can be determined that an intellectually disabled patient is capacious, then consent can be sought and taken in the usual way. Where the patient is found not to be capacitous, that is where confusion arises for healthcare professionals. The principle to note under English law is that one person may not consent for another, even if capacity is absent. Any intervention must be performed in the best interests of the patient, and may proceed without formal consent. Any pre-operative concerns should be documented and the nurse should note down his or her response documented in the integrated progress notes. If a theatre nurse is not satisfied that the patient's concerns have been met by the surgeon, nursing administration should be informed so that the matter can be taken up again with the surgeon before surgery proceeds. In preparing an operating room, staff and equipment, a hospital is deeply involved. If, through its staff, a hospital is put on notice on what appears to be a misunderstanding about a procedure and the hospital does nothing to correct this then the hospital could well be a co-defendant in a case such as this. The theatre nurse needs to ensure that all instructions are followed with respect to patients consent for surgery and if for any reason the opportunity for consent was not available then all alternatives need to be weighed and the best option selected. The theatre nurse has to play the role of a guardian cum chaperone and play this role to its fullest extent possible. Works Cited 1. Betsy Adams, Eric Ball, Cynthia Cassell, Alex Krasny, Douglas C. Mccrory, Donald Powell, Jeremy Sugarman ;Empirical Research on Informed Consent; The Hastings Center Report, Vol. 29, 1999 2. Beauchamp T. & Childress J. (1994) Principles of Biomedical Ethics, 4th edn. Oxford University Press, Oxford. 3. Benjamin M. & Curtis J. (1992) Ethics in Nursing, 3rd edn. Oxford University Press, Oxford. 4. Calder K. (1989) Beyond informed consent. Canadian Nurse 90, 23-26. 5. Department of Health (2001) Good Practice in Consent Implementation Guide. Department of Health, London. 6. DoH. Reference guide to consent for examination or treatment. London: DoH. Also available from www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Consent/ConsentGeneralInformation 7. Freund P. Social performances and their discontents: The biopsychosocial aspects of dramaturgical stress. In: Bendelow G, Williams S (eds). Emotions in Social Life: Critical Themes and Contemporary Issues. London: Routledge, 1998; 268-294 8. Hewetson G. (1994) Ignorance is not bliss. Informed consent. British Journal of Theatre Nursing 4, 14-16. 9. Kennedy I. & Grubb A. (2000) Medical Law: Text and Materials, 3rd edn. Butterworths, London. 10. Littlejohn JE 1999 Ethics Corner Lying, Deceit, Fraud ...do they ever belong in your nursing practice Maryland Nurse 18 (3) 5-6 11. Marks-Maran D. Rose P 1997 Reconstructing Nursing London. Balliere Tindall 12. Nursing and Midwifery Council 2002 Code of Professional Conduct London. NMC 13. Nursing and Midwifery Council- record keeping, consent, professional code of conduct available online at http://www.nmc-uk.org [accessed on 19th January 2007] 14. Schroeter K 2002 Ethics in Perioperative Practice - principles and applications AORN Journal 75 (4)818-824 15. Skipper J.K. (1965) Communication and the hospitalised patient. In Social Interaction and Patient Care (Skipper J.K.& Leonard R.C. eds). JB Lippincott, Philadelphia, pp. 61-82. 16. Smith, Justine; I was never told; Irish Mum Speaks of Heartache at Having Her Ovary Taken Out ; The Mirror (London, England), February 18, 2000 17. Sutton J: The ethics of theatre nurse practice under the microscope. British Journal Of Perioperative Nursing: The Journal Of The National Association Of Theatre Nurses [Br J Perioper Nurs], 2003 Oct; Vol. 13 (10), pp. 405-13; 18. The Concise Oxford Dictionary; seventh reprint, Oxford University Press, England (1993) 19. United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) (2000) Nursing Competencies. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 23 Portland Place, London W1N 4JT. 20. Waterworth S. & Luker K.A. (1990) Reluctant collaborators: do patients want to be involved in decisions about their care Journal of Advanced Nursing 15, 971-976. Read More