Surgical conscience, also known as operative permit, is essential component of perioperative care for patient safety

1. November 6, 2021 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (BSc, MSc-EMCCN)
SURGICAL CONSCIENCE --- 2 HRS
1

2. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Outline
❑ Objective
❑ Definitions
❑ Purposes
❑ Circumstances Requiring Consent
❑ Essential Elements of Informed Consent
❑ Requisites for Validity of Informed Consent
❑ Situations that undermine surgical conscience
❑ Areas affected by surgical conscience
❑ Legal aspects of surgery
❑ Nursing responsibility

3. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Objective
❑ At the end of this Session, learners will be able to:
►Describe Surgical conscience
►Consent
►Identify Areas affected by surgical conscience
►Legal aspects of surgery
►Common areas of negligence
►Identify major Nursing responsibility
►Describe Circumstances Requiring Consent
►Discuss Situations that undermine surgical conscience
►Differentiate Essential Elements of Informed Consent
►Identify Requisites for Validity of Informed Consent

4. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
SURGICAL CONSCIENCE & INFORMED CONSENT
• is a surgical ethics, principles, or a sense of right & wrong
Surgical
Conscience
• is operative permit or surgical consent
• is permission obtained from a patient to perform a specific test or procedure.
• is permission necessary before surgery obtained from a patient to perform a
specific procedure.
• PURPOSES:
• to ensure the client understands the nature of the treatment including
potential cxns & disfigurement (explained by the Attending Physician)
• to indicate the client’s autonomy/decision without pressure
• protect the clients against unauthorized procedure
• protect the surgeon & hospital against legal actions, if claimed
• prevent unauthorized procedures.
Informed
Consent

5. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
INFORMED CONSENT
❑ AKA OPERATIVE PERMIT or SURGICAL CONSENT
❑ necessary before non emergent surgery can be performed
❑ permission obtained from a patient to perform a specific test or procedure
❑ PURPOSES:
►to ensure that the client understands the nature of the Tx including the potential cxns &
disfigurement (explained by AMD)
►to indicate that the client’s decision was made without pressure
►to protect the client against unauthorized procedure
►to protect the surgeon & hospital against legal actions by a client who claims that an
unauthorized procedure was performed.

6. Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
March, 2024 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
• any surgical procedures requiring the use of a scalpel, scissors,
and/or sutures
• any invasive procedure such as surgical incision, biopsy,
cystoscopy, or paracentesis.
• a non-surgical procedure such as arteriography.
• any procedures
• involving radiation, esp. if wz contrast.
• requiring sedation and/or anesthesia
• requiring GA, local, and/or regional infiltration or block.
• requiring entrance into the body cavity.
CIRCUMSTANCES
REQUIRING
A
CONSENT:

7. Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
March, 2024 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
• Description and explanation of
• diagnosis & disease condition
• procedures planned to be done
• risks, consequences & benefits.
• alternative treatment or procedure.
• consequences/prognosis, if refused.
• an offer to answer questions about the procedure.
• the right to withdraw consent at any time.
• what if the protocol differs from the usual procedure?
ESSENTIAL
ELEMENTS
OF
INFORMED
CONSENT

8. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
• written permission is best and is legally acceptable
• signature is obtained with the client’s complete understanding of what is to
occur
• adults sign their own operative permit
• obtained before sedation
• Secured without pressure or duress and threat.
• a witness is desirable – nurse physicians or authorized persons
• in an emergency, permission via telephone or telefax is acceptable
• for minor (below 18), unconscious, psychologically incapacitated,
permission is required from responsible family member (parent/legal
guardian)
• For mentally ill and unconscious patients, consent must be taken from the
parents or legal guardian.
• If the patient is unable to write, an “X” mark is accepted if there is a witness
to his mark.
REQUISITES
FOR
VALIDITY
OF
INFORMED
CONSENT

9. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
REQUISITES FOR VALIDITY OF INFORMED CONSENT
►For minors, parents, or someone standing on their behalf, give consent.
▪ Note: for a married emancipated minor parental consent is not needed anymore, the spouse is accepted.
❑Implied consent?
►When an emergency situation exists,
▪ no consent is necessary because inaction at such time may cause greater injury.
▪ the surgeon may have to operate without consent, others, however, makes every effort to
obtain consent by telephone, or fax.
▪ permission via telephone/cellphone or telefax is acceptable but must be signed within 24 hrs.

10. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
INFORMED CONSENT
❑Informed Consent Should Contain the Following:
►explanation of procedure and its risks
►description of benefits and its alternatives
►an offer to answer questions about procedure
►instructions that the patient may withdraw consent
►a statement informing the patient if the protocol differs from customary
procedure

11. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Nursing responsibility
❑The nurse is responsible for ensuring that all necessary parties have
signed the consent form and that it is in the client’s chart before the
client goes to OR.