This standard applies to LPNs, NPs, RNs, and RPNs.
Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the BC College of Nurses and Midwives, and all legislation relevant to nursing practice.
Consent is
the voluntary agreement to some act or purpose made by a capable individual. Clients and their substitute decision makers have the legal right to agree to, refuse or revoke permission for proposed care, service, treatment or research provided by a health care professional, at anytime.
Nurses1 have both legal and ethical obligations regarding consent for proposed care, service, treatment or research. The specific legislation that applies to a nurse’s practice depends on the work setting and the nature of the work. Some related legislation are listed in the
Resources section at the end of this practice standard. The ethical obligations of nurses are to recognize, respect, and promote the client's right to be informed and make informed choices, including to refuse or revoke permission.
Valid, informed consent2 generally requires
that:
- The consent is given voluntarily.
- There is no fraud or misrepresentation used to obtain consent.
- The client is capable of giving or refusing consent, or consent is obtained from a substitute decision maker (as allowed or required bylaw).
- The client or substitute decision maker has the information needed to make a decision about the proposed care, service, treatment or research, including:
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Informed consent is the formal consent sought by the health professional responsible for directing care. Nurses are responsible for obtaining consent when initiating care, and reviewing consent before providing the care ordered by another health care professional.
Employers provide the organizational supports and systems necessary for nurses to meet consent requirements and the standards of practice.
Principles
1. | Nurses recognize, respect, and promote a client's or substitute decision maker's right to be informed and to make decisions about care, including their right to give, refuse, or revoke consent. | |
2. | If necessary, nurses identify the person who is authorized and able to make health care decisions on the client's behalf. | |
3. | Nurses are knowledgeable about and follow the requirements of legislation that relate to consent, within their practice. | |
4. | Nurses obtain or verify consent before providing care, unless legislation allows an exception to obtaining or verifying it. | |
5. | Nurses who are acting within autonomous scope of practice (including giving a client-specific order) are responsible for obtaining informed consent from the client or their substitute decision maker before providing care or issuing an order, and for documenting that consent in the client's record. | |
6. | Nurses who participate in the delivery of care proposed or provided by other health professionals: | |
| a. | Assist the client and/or substitute decision maker to understand the information provided by others. |
| b. | Take action when there are concerns about informed consent. |
7. | Nurses assess the client's capacity to give, refuse or revoke consent. Clients are seen as capable unless there is evidence that shows the client is not. | |
8. | Nurses inform the client about any care before it is provided, even if a client has been deemed incapable of consenting. | |
9. | Nurses provide information to clients and substitute decision makers appropriate to their needs, skills and abilities, to enable them to make informed decisions about care. This includes the use of qualified interpreters or translations, as appropriate. Nurses give clients and substitute decision makers an opportunity to ask questions and receive answers. | |
10. | Nurses are aware that the ability of clients to make decisions about giving, refusing or revoking consent may vary. Nurses facilitate the client's decision-making when the client is able and re-evaluate the client's ability to consent on an ongoing basis. | |
11. | Nurses identify and, when possible, take action to address barriers affecting a client's ability to consent to care. | |
12. | Nurses respect both the right of clients to seek further information or other opinions, and to involve others in the decision-making and consent process. |
Applying the principles to practice
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Footnotes
1 | "Nurse" refers to all BCCNM nursing registrants, including: licensed practical nurses, nurse practitioners, registered nurses, registered psychiatric nurses, licensed graduate nurses, employed student nurses, and employed student psychiatric nurses. |
2 | Adapted from the Health Care (Consent) And Care Facility (Admission) Act, RSBC 1996, c. 181. |
3 | Health Care (Consent) and Care Facility (Admission) Act, R.S.B.C. 1996, c. 181, section 9(1). |
4 | Robertson, G.B. & Picard, E.I. (2017). Legal liability of doctors and hospitals in Canada (5th ed.).Toronto, Ontario: Thomson Reuters. |
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