Clinical knowledge-base
Given the contemporary commitment to evidence based practice the nurse should
be aware of what has been shown to be good practice in her field. The information
which informs her own work should then be shared with patients in a manner
which will assist in their decision making. However, there might be situations in
which the nurse's understanding of the situation will differ from the view offered
to the patient by others involved in his or her care. In such cases it is important that
these differences are resolved between the professionals, so that the patient is not
given conflicting or contradictory messages.
Support
The nurse has an important supportive role in helping those who are unable or
unwilling to engage in the consenting process. This might entail acting as the
patients' advocate, or it might often entail facilitating the patient in getting their
own views heard, sometimes in situations where the patient is in conflict with both
their family members and other professionals. To perform this role effectively the
nurse may need to develop and enhance her professional autonomy, and thereby
increase her power to represent the patient's view to her medical colleagues. She
might also have to be non-judgemental and non-directive, acting simply as a
rapporteur for the patient.
7.11 Conclusion
The nursing profession has a valuable contribution to make in ensuring that
patients understand the significance of the consent they are asked for, and the
obstacles that might lie in the way of their giving it. Individual nurses can help
patients to exercise their autonomy, and provide them with the information they
need to make choices consistent with their interests and goals. They can support
their patients in what is often an alien and intimidating environment, and where
necessary can act as their advocates. The nursing profession can challenge those
aspects of the health care delivery system which work against the patient body
being able to participate meaningfully in the decision making processes which
affect their care.
7.12 Notes and references
- Beauchamp, T. & Childress, J. 62001)Principles of Biomedical Ethics, 5 edition.Oxford
University Press, Oxford. - Gillon, R. 61985, reprinted 1996)Philosophical Medical Ethics,p.113. John Wiley and
Sons, Chichester. - See Cullinan, T. Other societies have different concepts of autonomy. Letter to the BMJ
republished in Len Doyal and Jeffrey S. Tobias 6eds) 62001)Informed Consent in Medical
Research.BMJ Books, London. - Rapp Rena,
Testing Women Testing Fetuses', and Wolf, Susan.Erasing difference:
Consent and the Capable Adult Patient 129