Fundamentals of the Perioperative Environment for Registered Nurses

Caring for all patients

🧠 Graded Activity

Navigate back to Blackboard, complete the Graded Activity: Caring for all Patients.

Consent

Informed consent to treatment is founded in ethical, legal, and professional practice. As the patient advocate, the perioperative nurse ensures the patient has documented informed consent prior to commencing any procedures. Nurses must understand the components of consent as they apply to professional practice and their role in obtaining consent.

Tenets of informed consent:

  1. Consent must be voluntary and informed and is a prerequisite to providing care.
  2. Obtaining surgical consent is the responsibility of the surgeon.
  3. Patients giving consent for treatment must have the legal capacity and mental competency to do so. There is no age of consent.
  4. Patients must know the purpose, risks, and type of procedure, as well as alternatives to surgery.
  5. Patients who are incapable of consent may have consent signed by next of kin or an alternate designated person as in advance directives.
  6. Consent for surgery is obtained in writing.
  7. Written consents are valid indefinitely but may be revoked by the patient at any time.
  8. Implied consent occurs in an emergency life or limb-threatening situations where the patient is unable to consent, such as unconsciousness. In those cases, physicians sign consent on the patient’s behalf as per institutional policy.
Risk Management for Perioperative Nurses

In healthcare today, patients who require care may experience an unintended outcome with lifelong consequences.  It has been shown that a patient or family’s dissatisfaction with the care received is a primary indicator that the client will sue.

Avoid pitfalls by:

  1. Communicating clearly between nurse/physician and nurse/client.
  2. Knowing hospital policies and procedures and the nursing role thoroughly.
  3. Upgrading skills continuously as the patient’s survival may depend on nursing judgment.
  4. Anticipating foreseeable patient risks from equipment. Be proactive with maintenance and repair.
  5. Ensuring decontamination/sterilization processes in your institution meet standards, as nurses may be liable for the transmission of organisms.
  6. Ensuring you are capable of the expected work. Trust your judgment.
  7. Question doctor’s orders if they do not seem right to you.
  8. Acting in the best interests of the patient.

(ORNAC, 2021).

📁 Documentation Highlight

The patient chart demonstrates the continuity of care and who is accountable for care. This private, confidential document can become a very public document if admitted in a court proceeding.

The best jury defence in a malpractice suit is charting accurately and contemporaneously. Perioperative care is not complete until it is charted, and the Supreme Court of Canada interprets that nothing charted means that nothing was done. The Canada Evidence Act states that there must be original documentation in legal proceedings. Retrospective charting is not permissible, so any untoward events should be documented thoroughly on the patient chart.

Summary

Perioperative nurses are exposed to risks and consequences of ethical and legal decision-making in surgical practice. Ethics encompasses personal morals, cultural expectations, religious beliefs, and professional codes of behaviour. Law reflects society’s determinations of right and wrong behaviours based on norms that society chooses to enforce.