Nurses’ roles in informed consent in a hierarchical and communal context

Abstract

Although the main responsibility for informed consent of medical procedures rests with doctors, nurses' roles are also important, especially as patient advocates. Nurses' preparation for this role in settings with a hierarchical and communal culture has received little attention. We explored the views of hospital managers and nurses regarding the roles of nurses in informed consent and factors influencing these roles. We conducted a qualitative study in a private, multispecialty hospital in Indonesia. Semi-structured interviews were conducted with seven managers. Two rounds of focus group discussions with nurses (n = 27) were conducted. Constant comparative approach was used in the analysis. Nurses can act as manager, witness, information giver, and advocate in the informed consent process. These roles are influenced by nurses' preparedness, hospital culture and policy, patients' understanding, family involvement, and cost-related issues. In preparation for these tasks, nurses should acquire communication skills, clinical knowledge, and legal and ethical knowledge.

Informed consent and nurses’ roles

“…13,16,19 While nurses view their role of ensuring that patients have made an informed decision as belonging to their professional domain, they feel challenged by the hierarchical relation with physicians in performing this role. 13,16 On the contrary, physicians would favor improvement in their collaboration with nurses especially if nurses' involvement would be helpful for the physician. 13 Such different perceptions of roles are also found in other areas of healthcare and play a role in the interprofessional collaboration between physicians and nurses.…”

“…13,16 It has been reported that research influences the behavior of the persons involved. In participatory research, this effect is desired.…”

“…14 In healthcare, the strong involvement of families may override patient autonomy since patients, although sufficiently competent to make a decision, are often underrepresented in the discussion between family and health professionals. 12,13,15,16 Cost is also influential in decision making because patients are often uninsured with care being selffinanced. 16 The out-of-pocket financing system is dominant 17 meaning that many people pay for their own healthcare.…”

“…13,15 In turn, nurses often discover that patients require additional information and convey the patients' concern to their physicians. 16,21 How nurses perform their roles is influenced by the physicians' support of their collaboration when obtaining informed consent. 16,19 We argue that nurses' roles should be supported to improve the informed consent process.…”

Difficulties and practices regarding information provision among Korean and Italian nurses

“…; Susilo et al. , ). However, studies on nurses’ delivery of information to patients, a prerequisite of their consent, remain scarce (Ingravallo et al.…”