Consent is a principle that empowers an individual to grant permission before they receive any form of medical examination or treatment. Ideally, consent is required from a patient regardless of the nursing intervention in question, right from physical examinations to complicated medical procedures (Department of Health, 2001). Patients are thus not bound to medical procedures merely based on the recommendations of a nursing practitioner. It is undeniable patients have the right and discretion to choose to take part in a medical process that can manipulate their bodies through therapy.
From a legal perspective, failure to gain consent before undertaking nursing interventions amounts to trespass against an individual. In the English Law, a nursing professional is liable for the crime of battery if he/she touches a patient without consent in any form of physical examination (Department of Health, 2001). Thus, nursing practitioners have a responsibility of ensuring that they obtain consent from their clients before proceeding with medical procedures.
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Notably, consent assumes two perspectives that include expressed and implied consent. Expressed consent occurs when a patient orally agree to a request by a nurse to undertake treatment or any other form of medical intervention (Department of Health, 2001). On the other hand, implied consent has a basis on the actions and behaviours of the client about a request from a nursing practitioner. For instance, if a patient extends his/her arm for the recording of blood pressure on the request of a practitioner, the gesture is assumed to imply consent from the client. In case a patient is unconscious, implied consent is assumed on the admission of a subject to the emergency department. However, nursing practitioners are bound to demonstrate that the interventions undertaken for such patients are clinically essential and not just convenient to the practitioner. Ideally, if an element of necessity cannot be proven, then the professional in question may be legally liable for his/her actions (Department of Health, 2001).
Clinical observation is an integral part of the nursing practice since it serves as the initial procedure for diagnosing clinical symptoms. Nursing practitioners employ observation to obtain clues and lead for further diagnostic procedures. However, often these activities are often assumed as casual processes with little clinical meaning. The fact that a significant portion of nursing observation methods is non-invasive makes them susceptible to abuse by the practitioners. Employing consent in nursing observation is important since it allows it facilitates professional conduct as well as ensures the patients are knowledgeable of the medical procedures they undertake (Barry and Edgman-Levitan, 2012). The law stipulates that valid consent is necessary before a nursing practitioner can proceed with any clinical procedure. Similarly, that consent ought to be informed in the sense that the client has the right to given sufficient information regarding the process and allowed to make a voluntary decision without any form of coercion (Hobbs, 2009). Thus, as a nursing professional it will be my responsibility to explain to my clients all information concerning the procedures I intend to perform and seek their approval before commencing.
As a nurse practitioner seeking informed consent will be part of my responsibility before undertaking nursing observation procedures as part of ensuring patient-centred care. It is worth noting that consent is not limited to just seeking approval since some patients tend to agree blindly to clinical procedures that they do not comprehend. Thus, I will emphasise the aspect of informed consent rather than just seeking mere approval from my clients. In that light, before any form of observation be it recording temperature or assessing a rash I ought to give a detailed explanation of the particulars of the procedure. In that light, I will explain to the patients the objective of the process and what he/she stands to gain or lose from the same. As well as outline the rights of patients in a clinical environment to ensure informed consent. That way, the clients will be equipped with relevant information that will facilitate informed decisions.
Ideally, a majority of the healthcare establishments undertake nursing observation as a pre-diagnostic procedure before the patient can see the physician. However, a majority of the patients do not understand the significance of this process since they assume it is a protocol procedure that requires compliance. In that regard, my intention will not be limited to seeking approval from the clients before I proceed with the process but also to enlighten them on the importance of these observatory procedures (Melnyk and Fineout-Overholt, 2011). For instance, before recording a patient’s blood pressure, I will make the patient understand the importance of maintaining a healthy blood pressure level and its implications on his/her overall well-being. Such an approach will empower the client with information that will help in formulating informed consent but also facilitate healthy living. It is worth noting that nursing is a holistic practice with the objective of general wellbeing of the patient. Thus, my nursing observation procedure will not be limited to recording particular parameter but ensure the clients accrue maximum benefits from the service (George, 2011).
Nursing practice has a foundation on relationship-centred care focused on the individual needs of the patients. Nursing observation processes are no exception since as a practitioner I will be obliged to create an enriched environment for my clients to ensure they feel secure with the manner in which I handle them as well as develop a sense of belonging to my model of care (Kozier, 2008). It is typical that the manner which I will handle the patients will determine whether I obtain consent or not to continue with the therapeutic procedures.
Some of the observational process may tend to be scary to the patients a factor that might create fright thus jeopardising informed consent. As a practitioner, I will employ autonomy and individuality in the mode I implement nursing observation procedures by ensuring the clients take control of the mode of treatment they desire while maintaining their personal identity (McCance, McCormack, and Dewing, 2011). For instance, before recording pulse rhythm, blood pressure or even temperature it is essential to inform the client that these procedures are not mere protocol processes but serve an important role in ensuring he/she obtains holistic care premised on individual needs (Dewar and Nolan, 2013).
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Manifestations of diseases tend to vary from one subject to another, and thus the treatment processes need to be customised to meet the immediate clinical needs of each patient. Thus, when handling my clients, the objective will be to the patient but not the disease itself (Wolf et al. 2008). Ideally, by focusing on the patient, I am likely to develop a relationship centred therapy that will meet the immediate needs before starting to treat the underlying condition (Barry and Edgman-Levitan, 2012). This way, the client will develop a sense of belonging since he/she will be integrated into the therapeutic process of choosing the preferred treatment. Ultimately, while implementing nursing observation, the principle of consent should not be used as a protocol procedure, but as an element that empowers the patients to be knowledgeable of their condition to enable them to take control of the therapeutic process.
- Barry, M.J. and Edgman-Levitan, S., 2012. Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), pp.780-781.
- Department of Health, London (United Kingdom);, 2001. Reference guide to consent for examination or treatment.
- Dewar, B. and Nolan, M., 2013. Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting. International Journal of Nursing Studies, 50(9), pp.1247-1258.
- George, J.B., 2011. Nursing Theories: The Base for Professional Nursing Practice, 6/e. Pearson Education India.
- Hobbs, J.L., 2009. A dimensional analysis of patient-centered care. Nursing research, 58(1), pp.52-62.
- Kozier, B., 2008. Fundamentals of nursing: concepts, process and practice. Pearson Education.
- McCance, T., McCormack, B. and Dewing, J., 2011. An exploration of person-centredness in practice.
- Melnyk, B.M. and Fineout-Overholt, E. eds., 2011. Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
- Wolf, D.M., Lehman, L., Quinlin, R., Zullo, T. and Hoffman, L., 2008. Effect of Patient‐Centered Care on Patient Satisfaction and Quality of Care. Journal of nursing care quality, 23(4), pp.316-321.