Editing Management of Care (section)

== Informed Consent ==

Informed consent is a process, not a signature. It rests on the ethical principle of autonomy and on the legal principle that touching a competent adult without permission is battery.

=== Elements ===
Valid informed consent requires that the patient receives a description of the '''procedure''', its '''risks''' and '''benefits''', reasonable '''alternatives''' including doing nothing, the '''consequences of refusal''', and who will perform it; that the patient is '''competent''' and of legal age; and that consent is given '''voluntarily''' and free of coercion.

=== Who does what ===
'''The provider performing the procedure''' is legally responsible for disclosing the information and obtaining consent. '''The nurse's role''' is to witness the signature, to verify that the signature is voluntary and that the patient is competent to sign, and to confirm that the patient understands what was explained. The nurse also serves as the patient's advocate.

'''The single most tested point in this section:''' if the patient expresses confusion, cannot describe the procedure, or asks a question about risks or alternatives, the nurse '''stops the process and notifies the provider''' to return and complete the disclosure. The nurse does not explain the procedure to fill the gap, and does not have the patient sign and sort it out later.

=== Consent for those who cannot consent ===
* '''Minors''' generally require a parent or legal guardian. Exceptions vary by state and commonly include '''emancipated minors''' (married, in military service, or court-declared) and minors seeking care for pregnancy, sexually transmitted infection, substance use, or mental health.
* '''Emergencies''' involving an immediate threat to life or limb, when the patient cannot consent and no surrogate is reachable, proceed under '''implied consent'''.
* '''Adults who lack decision-making capacity''' are represented by a health care proxy or durable power of attorney for health care if one exists, and otherwise by a legally recognized surrogate in the order set by state law.
* '''Language barriers''' require a '''qualified medical interpreter'''. Family members, especially minor children, should not interpret for consent.

'''A competent adult may refuse any treatment, including life-sustaining treatment, for any reason or no reason.''' The nurse documents the refusal, ensures the patient understood the consequences, notifies the provider, and does not treat over the refusal.