Dissertation: Role of Perioperative Nurse in Informed Consent Process

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¶ … patients with relevant information required to make an informed decision preparatory to a medical intervention is an established ethical and legal responsibility of the healthcare community. Although specific requirements vary from jurisdiction to jurisdiction, it has become well established that certain procedures must be followed in any healthcare setting in order to ensure that patients fully understand the need for a proposed treatment, as well as its implications and possible alternatives, including doing nothing at all. In some cases, healthcare professionals have a formal set of procedures they are required to follow for this purpose, which is the case with nurses practicing in the United Kingdom. The purpose of the study proposed herein is to critically assess the current and expected knowledge and application of informed consent procedures by perioperative nurses and operating department practitioners in the United Kingdom today. To accomplish this purpose, a review of the relevant secondary literature is combined with an analysis of the primary data the results from the administration of a custom questionnaire to representatives from these two groups of healthcare professionals to assess their level of understanding and awareness of their legal and ethical rights as they relate to the provision of informed consent.

TABLE of CONTENTS

CHAPTER 1: INTRODUCTION

Statement of the Problem

Purpose of Study

Importance of Study

Rationale of Study

Overview of Study

Definition of Key Terms

CHAPTER 2: REVIEW of RELATED LITERATURE

CHAPTER 3: METHODOLOGY

Description of the Study Approach

Data-gathering Method and Database of Study

Subjects

Evaluating the Role of the Perioperative Nurse in the Informed Consent Process

Informed consent is at the heart of all medical decisions. -- Joyce Robins, co-director of Patient Concern in the United Kingdom

CHAPTER 1: INTRODUCTION

Statement of the Problem

The epigram above makes it clear that clinicians in all settings have a fundamental responsibility to their patients to ensure that they understand what medical procedures are being offered, what the risks of those procedures might be, and any alternatives -- including no intervention at all -- are disclosed in full. Given its legal and ethical imperative, it is not surprising that there has been a great deal of attention paid to the issue of when, where and why informed consent must be obtained. In this regard, Wear points out that, "Clinicians often respond to ethical issues by first inquiring as to what the relevant law dictates. The instinct is a prudent one. It is not very sensible to discuss ethical options that the law prohibits, or attempt to fashion a response when the law has already provided one and insists upon it" (1999: 9). The laws and regulations concerning informed consent, though, differ significantly from place to place and time to time, making across-the-board analyses difficult or even impossible. As Wear emphasizes, "The law regarding informed consent varies across jurisdictions and countries, so in a global sense there is no single and settled sense of the law to explicate, not even on the level of basic principles and criteria" (1999: 9).

Notwithstanding the paucity of uniformity in informed consent approaches, obtaining the informed consent of patients is an expected component of clinical practice around the world (Sugarman, McCrory, Powell, Krasny, Adams, Ball & Cassell 1999). According to Sugarman and his associates, "In concert with strong theoretical justifications, an array of laws, regulations, court cases, policy statements, and professional guidelines emphasize the need for obtaining meaningful informed consent. Moreover, strong popular reactions to alleged failures to obtain consent, such as those in response to human radiation experiments conducted during the Cold War, underscore this professional, legal, and philosophical expectation" (1999: 1). The expectations and responsibilities of clinicians that are associated with informed consent counseling, then, are firmly based on ethical and legal grounds that are common to all treatment settings that emphasize the fundamental right of humans to decide for themselves what is in their best interests, even if such a decision runs contrary to evidence-based practice and the experience of the healthcare treatment team. In this regard, Wear emphasizes that, "The new ethos of patient autonomy, for its part, enjoys broad societal consensus regarding many of its basic prescriptions. Further, like the law, the new ethos seems to presume that certain needs as well as patient abilities are usually present in the same form and degree. But such univocal presumptions regarding patient abilities and needs clearly run afoul of clinical experience and its supporting empirical literature" (1999:66). Moreover, there are some powerful cross-cultural differences that can affect the informed consent counseling process in ways that may prevent patients from making the decision they would prefer as the result of coercion on the part of the counseling clinician. In this environment, identifying current levels of knowledge of informed consent requirements and procedures among perioperative nurses and operating department practitioners represents a timely and valuable enterprise, which is the purpose of this study as described further below.

Purpose of Study

The overarching purpose of the proposed study is to critically assess the current and expected knowledge and application of informed consent procedures by perioperative (anesthetic) nurses and operating department practitioners (ODPs) in the UK today. To achieve this purpose, the proposed study will combine a review of the relevant secondary literature with the primary data that emerges from the administration of a custom questionnaire to approximately 300 to 350 perioperative nurses and operating room practitioners to gauge their current levels of understanding and awareness of their legal and ethical rights as they relate to the provision of informed consent. The results of this analysis may identify trends in knowledge gaps that can be used to develop educational initiatives that target these areas of deficiency among these clinicians.

Importance of Study

The importance of the proposed study relates to the fundamental right of all patients to be adequately informed concerning any treatments, procedures, and surgical interventions that are proposed by healthcare practitioners so that they can make an informed decision, a process that is a patient's legal right and an ethical responsibility of clinicians (Lea & Thomas-Lawson 2001). According to Lea and Thomas-Lawson, "Informed consent is the voluntary permission that a client, or someone acting on the client's behalf, gives to the health care provider to do something to or for that client after disclosure of adequate information to make a decision. Founded on the principles of respect for autonomy (the right to self-determination) and beneficence, the obligation of informed consent is both ethical and legal" (2001: 146). It is important to note, though, that the informed consent process involves far more than simply providing patients with a "laundry list" of medical descriptions and alternatives, but rather involves the formulation of a therapeutic alliance between clinician and patient that can provide the framework in which a truly informed decision can be made by the patient. In this regard, Lea and Thomas-Lawson add that, "The goal of actualizing client choices, including the right to accept or refuse interventions, is protected by the process of informed consent. The process is characterized by mutual participation, respect, and shared decision making between the client and healthcare provider, not merely by giving information or persuading the client" (2001: 146). Although specific requirements vary according to geographic setting, a common feature that characterizes the nurse-patient relationship in any setting is the need for nurses to understand the tenets of informed consent and recognize their legal and ethical responsibilities. In this regard, Lea and Thomas-Lawson emphasize that, "It is not surprising that the topic of informed consent and the attending principles appear in all current medical and nursing texts regardless of specialty focus (2001: 146).

Because perioperative nurses and operating department practitioners are important components of the overall healthcare team, it is important for them to thorough understand their responsibilities with regards to informed consent as well. Although some clinicians have argued that operating room practitioners "have little or no influence on direct care," Corbett emphasizes that, "This is not solely true in all operating rooms since people respond in amazing ways when given some control over what they do. The more ownership they feel, the more interest they will have, and the harder they will try and do a good job" (emphasis added) (2009: 38). Consequently, perioperative nurses and ODP are in a particularly well suited position to assist patients with informed consent counseling throughout the surgical process. In this regard, Corbett adds that, "All patients have common care needs worldwide during their preoperative, intraoperative and postoperative journey. To facilitate these needs, we have an obligation to ensure that organizational issues relating to our practice are delivered efficiently and that the educational needs of the team are identified and addressed" (2009: 38). Although the principles of informed consent have been codified and are articulated in a professional code of conduct for healthcare professionals in the UK, innovations in medicine and surgery are making the provision of "truly informed" informed consent more difficult all of the time. A good example of this can be found in a report from… [END OF PREVIEW]

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