The document discusses informed consent and its importance. It defines informed consent as communication between a patient and physician that results in the patient authorizing agreement to a medical intervention. Informed consent is required by law, ethics, and regulations. It helps ensure patient safety, satisfaction, and reduces litigation risks. The clinician is responsible for obtaining informed consent, but a team approach is needed. Informed consent is required for invasive or complex procedures and includes discussing diagnosis, treatment options, risks and benefits, and alternatives. Consent can be provided by a competent patient or their healthcare representative. Improving informed consent involves simplifying language, allowing questions, and ensuring understanding.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
Lecture 13 privacy, confidentiality and medical recordsDr Ghaiath Hussein
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Ethical Issues in Obtaining Informed Consent.pptxAhmed Mshari
Medical ethics is a set of moral principles, beliefs and values that guide decisions about patient care.
It is an integral part of good medical practice.
The health care professional uses knowledge, experience, and judgment and considers the ethical principles to make decisions on management recommendations.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
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HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
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Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
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Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
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Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
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Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
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Objective: Contribute to improving the quality of care for children by participating in research initiatives.
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Attending workshops and conferences on pediatric nursing.
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Implementing evidence-based practices into their daily routines.
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3. What is Informed Consent ?
• The process of communication between a patient
and physician that results in the patient’s
authorization of agreement to undergo a specific
medical intervention
(American Medical Association)
• Failure to obtain informed consent renders any
physician liable for negligence or battery and
constitutes medical malpractice.
4. Why Do We Need Informed Consent?
The Short Answer:
• It’s the ethical thing to do
• It’s a safety and quality of care issue
• It’s the law
• Regulatory Requirement
• Hospital Policy
5. Why Do We Need Informed Consent?
The Slightly Longer Answer:
• Greater patient safety and satisfaction
• Attainment of higher ethical standards and
organizational morale
• Closer adherence to legal requirements and
reduced risk of litigation
• Increased levels of institutional quality (e.g.
compliance with accreditation standards)
• Potential time and money savings related to
reduced litigation
6. Who is Responsible for Informed Consent?
The clinician has core responsibility…but…a team
approach is required with contributions from:
• Entire clinical staff
(clinician, nurse, technologist)
• Administrative and clinical leadership
• Legal counsel
7. When is Informed Consent Required?
In most institutions, for:
• Surgery
• Anesthesia
• Other invasive or complex medical or radiologic
procedures
8. What is considered an invasive procedure?
• Any penetration of the skin, use of radiation for
treatment, or comparable invasive procedure
involving interference with the body tissues.
• Also can be any other procedure that entails
substantial risk to the patient.
– Angiographic procedures
– Anything with scalpels, needles
– Injection of diagnostic substances into body cavities,
internal organs, etc.
9. What’s Needed for Informed Consent?
• The diagnosis, if known
• The nature and purpose of a proposed treatment or
procedure
• The risk and benefits of proposed treatment or
procedures
• Alternatives (regardless of costs or extent covered
by insurance)
• The risk and benefits of alternatives
• The risks and benefits of not receiving treatments or
undergoing procedures
10. Who Can Consent?
• Patient, if adult and competent
– Impaired due to injury, ETOH or medications of drugs
• Healthcare Power of Attorney or legal guardian
• In the absence of a legally authorized
representative, a “statutory surrogate” may give
consent.
11. Statutory Surrogates
Statutory Surrogates Include, in order of priority, the following:
1. Patient's spouse, unless legally separated.
2. Adult child of the patient. If more than one child, consent of a
majority who are reasonably available
3. Parent of the patient.
4. If the patient is unmarried, the patient's domestic partner if no
other person has assumed any financial responsibility for the
patient.
5. Brother or sister of patient.
6. A close friend of patient who is familiar with the patient's health
care views and desires and is willing to become involved in
the patient's healthcare and to act in the patient's best
interest.
12. • The sad part is that, many studies reveal that
physicians often fail to observe the practice and the
spirit of informed consent.
13. Why Do We Need to Improve Informed
Consents?
Even after signing a consent form, many patients still
do not understand basic information about the risks
and benefits of their proposed treatment options.
14. What are the Potential Consequences of
Lack of True Informed Consent
• Increased chance of a patient safety incident or
medical error
• Increased chance for malpractice cases
• Violation of professional and ethical obligations to
clinicians to communicate clearly
15. What Can We Do to Improve Our Informed
Consent?
• Simplify our language
• Allow time for questions
• Make sure the patient understands
• Plan for language assistance in advance of
appointment
• Train support staff
16. Use of Interpreter
• Information must be verbally provided to patient in
their native language; consent must be written in
English.
• If patient/family refuses hospital interpreter and
chooses to use a friend or family member; if must
be noted in the medical record.
• If translation services are used the interpreter
should sign as a “witness” and specify their name,
title, date and time.
17. Signing and Witnessing the Consent
• The patient (or the patient’s health care decision
maker) should sign the consent along with two
persons should witness the patient’s signature.
These witnesses are attesting to the fact that the
patient signed the form only and need not witness
the full consent discussion between the patien and
the physician.
18. Misc.
• The identify and professional status of individuals
responsible for authorizing and performing
procedures or treatments must be on consent.
• Discussion…..
Editor's Notes
Process not a form
Mutual understanding of what will happen
Setting reasonable expectations
Acceptance by patient
Per Radiologist BE and UGIs do not require an consent
(American Medical Association)
If adult, look at whether person is of sound mind and body; is conscious, mentally unimpaired and physically able to read and/or hear and understand; and has not been declared to be legally incompetent.
7. If the list has been exhausted or a reasonable effort has been made and a surrogate has not been found, the attending Physician may become the surrogate and make decisions after consulting with the Bioethics Committee or after consulting with a 2nd Physician who agrees with the attending Physician decisions.
Low health literacy
Limited English proficiency
Patient Factors:
Cognitive impairments
Confusion about the purpose of consent process
Feeling of intimidation, and stress or time pressure
Provider Factors:
Lack of time for up-front patient education
Overly complex or overly broad written materials
Lack of support with interpreters
Wrong assumptions about the patients comprehension
For example. If a tech is performing a PICC placement; they must include their name and creditials on the consent form.
1. Important to understand and observer what the procedure entails including anatomy…that is the key. That way you can explain it in lamens terms to the patient as what we are doing. Anything you stick inside the patient, any needle that goes inside the patient there is risk of bleeding and risk of infection. Tell patient that everything is done sterile to decrease that risk.
2. Be knowledgeable in contrast reaction. Understand where the dye is going and the reaction to it. Tell patient we will be putting dye into you system and you could have a mild reaction (itching) to severe (tongue swelling, difficulty breathing). Any other questions you can ask Radiologist.