Informed Consent in the Operating Room

INFORMED CONSENT IN RELATION TO OPERATING ROOM PROCEDURES

This research reviews the issues associated with the concept of patient informed consent in relation to the performance of operating room procedures. These issues are addressed in discussions of the basic character of informed consent, physician-nurse dichotomies related to the concept of patient informed consent, and the role of informed consent with respect to actions on do-not-resuscitate (DNR) orders within the operating room.

The Basic Character of Informed Consent

Surgical patients frequently are asked to make important decisions related to operating room procedures on the basis of minimal or confusing information (Owen, 1995, p. 864). Most patients are unfamiliar with medical terminology, and if such terminology is not explained in lay terms, a question exists as to whether informed consent can be given by the patient. The ethical principal involved is patient autonomy (Kokiko & Watts, 1995, p. 220). In relation to operating room procedures, a patient has the right to make decisions about her or his own welfare, and such decisions cannot be made effectively in the absence of all of the necessary information on which to base such decisions--informed consent.

Most frequently, the decision makers in surgery settings are physicians and nurses (Haddad, 1991, p. 151). There is at a general level, however, an acknowledgment that the patient or a substitute decision maker representing the patien

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onal information to a preoperative patient. All patients entering the operating room area must be accompanied by valid surgical consent forms signed either by themselves or their surrogates (Keffer & Keffer, 1994, p. 645). These consents are based on "the presumption that patients or their surrogates possess decision-making capacity . . . and that the consents are informed" (p. 645). When a perioperative nurse evaluates a patient in the operating room holding area, the nurse "looks for indications that the patient has made a knowledgeable choice in signing the OR consent form" (p. 645). In the absence of such indications, the perioperative nurse must take actions to assure herself or himself that the patient or surrogate both possesses decision-making capacity and is sufficiently informed. Depending on the character and outcomes of the nurse-initiate actions, conflict may develop between physician and nurse in the operating room area. The perioperative nurse encounters patients "during what may be the most vulnerable period of their hospitalization" Jacobson, 1994, p. 449). Because patients during surgical and anesthetic procedures "are least able to make decisions autonomously . . . the perioperative nurse's role as pati

Category: Medical - I