Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
The authors confirm that the data supporting the findings of this study are available within the article. Raw data or tables omitted in this article that support the findings of this study are available from the corresponding author, upon reasonable request.
Background: The process to obtain valid informed consent in healthcare reflects many aspects. Healthcare professionals that take care of the patient must provide him all the necessary information and verify his understanding, considering individual characteristics. Nurses are one of the main participants in this process. Objective: This study assesses nurses’ perceptions of their role in the informed consent process. Material and Methods: An observational study involving 300 nurses operating in 13 wards of the Padua Hospital, through the submitting of a questionnaire in the period November–December 2018. Results: The final sample is made up of 206 nurses—27 males (13.11%) and 179 females (86.89%). Work experience, on average 15 years, is significant in determining the answers to questions about opinions and experiences. Age is significant in determining how often nurses provide information to the patient’s family members about the actions to be taken after discharge. The ward was decisive in the responses related to information provided to patients on the nursing care level and the actions to be taken after discharge, and the definition of the nurse’s duties. Conclusions: The data collected show the need for interventions to reduce the causes of difficult that the nurse has in informing patients.
Keywords: informed consent, nurse role, nursing procedures, patient consent, hospital wardsInformed consent in healthcare is the process throughout patient decides freely and independently whether to start or continue the planned health treatment, after receiving specific information and made understandable to him by the doctor or health team based on their respective skills [1]. Information and informed consent play an essential role from a legal, as well as ethical point of view [2], as patients have the right to know their state of health, the diagnosis, and treatments available, the risks and probable benefits, and consequently choose any alternative [3]. Informed consent should be a process of mutually shared responsibility by the patient and the physician, ensuring adequate and relevant information that is well comprehended by the individual patient, and is used correctly for their decision-making [4]. It is very important to illustrate to the patient the possible risks in relation to complications and benefits, the presence of reasonable alternatives to the procedure, and the right of the patient to withdraw his consent at any time [5]. The accuracy of healthcare professionals in informing the patient should provide the necessary elements to make the most convenient and appropriate decision for his well-being [6]. Disclosure of information and informed consent are relatively new concepts in the patient–physician relationship. They are based primarily on the principle of autonomy, and they have many favorable practical advantages. However, the practical implementation of these requirements is fraught with difficulties, some of which can cause harm to the patient or be obstacles in fulfilling the moral obligation of beneficence [4]. There are numerous limitations in this process included: Patient understanding, potentially alterations by factors, such as age, training, cognitive level, loss of control and level of anxiety, patient autonomy, how patients use information disclosed by healthcare professionals, and the time required to fully inform patients [7]. A central reference for the ethics of the health professions is represented by therapeutic self-determination, defined as the individual’s right to decide on their own health, as a guarantee of their identity and dignity [8]. Information, in the past, has been considered as an exclusively medical aspect, but today must be considered as clinical, because it is common to many professions, integrated and focused on clinical-care pathways, rather than on individual services [9]. The practice of informed consent is multifaceted and presents complex legal and ethical challenges. Without a clear understanding of the underlying concepts and legal requirements that guide the process, informed consent may fall short of its goals. Nurses can be integral to the process while still practicing within their defined scope of practice. Nurses may serve to ensure patient comprehension, facilitate documentation of consent, address patient anxiety, and identify the appropriate surrogate decision-maker when needed [10]. Patient understanding and safety is the responsibility of all healthcare professionals [11].
The ideal completion of the informed consent process may be achieved if surgeons and knowledgeable nurses collaborate for the patient’s good. With a broadened knowledge base on the realities and requirements of the informed consent process, nurses and surgeons may each contribute within their legal scope of practice to reduce the risk of litigation by fully meeting the legal obligations imposed by informed consent statutes [10].
For the nursing profession, the core-interest is the person and to respond effectively and competently to their nursing care needs, through a true involvement of individuals and families in the care processes that concern them [12]. Practices related to informed consent and the roles of nurses in the process are strongly influenced by the model of relationships between the different actors: Patients, their families, and healthcare professionals [13]. Nurses, who have intense interaction with patients, family members, and doctors, can ensure that patients’ right to making an informed decision is respected. In daily practice, it is unclear whether nurses perform these roles in line with their professional service, or more doing the task of assisting doctors in providing patient care [13].
Although the literature argues that nurses should be advocates for this role, there is limited evidence that nurses are adequately prepared for this role, and that their role is adequately valued. To identify what nurses in preparation, need to be able to skillfully and confidently participate in the informed consent process in a highly hierarchical context, we explored the perception that nurses have regarding their involvement in different contexts of the same hospital, allowing comparative evaluations. In detail, nursing in Italy has reached important milestones in terms of training, decision-making autonomy, and responsibility, and in 2001 the university degree for nursing became the only path to access the profession. In recent years, a new generation of young university-trained nurses have been admitted into the world of work.
A primary reference for Italian nurses is the Code of Ethics for Nurses, and only a previous study has explored their practical adherence to the above standards [14] and the perception of the nursing role in this particular aspect.
To evaluate the perception of nurses regarding their role in informed consent to treatments.
This is a prospective descriptive observational study.
The sample is made up of nursing staff operating in 13 wards of an Italian hospital: Cardiology, neurology, neurosurgery, hematology, general surgery, thoracic surgery, general medicine, Medical Clinic 1, Medical Clinic 5, geriatrics, urology, plastic surgery, and the specialized medical area ward. The final study sample is composed of 206 nurses.