OPIANA, CHRISTIAN JOSEPH I.

BSN 4 BLOCK 6
N036 NCM 118N
CHAPTER 1 CASE STUDY

Allen Hale, 27 years old, was admitted to ICU after running a red light in his car and
colliding with another car. He is being evaluated for evacuation of a left parietal
subdural hematoma. His concomitant injuries include a flail chest with pulmonary
contusions for which he is being ventilated and a fractured femur. His blood alcohol
level was 200 mg/dL on admission, and there was evidence of marijuana on his
toxicology screen. Currently, he is receiving propofol 30 mcg/kg/minute for sedation.
He responds to noxious stimuli by withdrawal, and his pupils are equal and reactive
to light. The healthcare team is unable to obtain consent for treatment from him and
is unable to reach a next of kin or anyone with healthcare proxy.

1. How should they proceed?

If the team is unable to obtain informed consent in situations where emergent care
is required, consent is assumed due to the urgency of the situation. Treatment
should be provided by the healthcare team.

2. How can the nurse help her to decide?

We deal with informed consent a lot as nurses, whether it's on admission to a

hospital/clinic or before a procedure/surgery. Nurses are typically tasked with
obtaining and witnessing written consent for healthcare treatment.

Legally, the patient or his or her surrogate must be informed of the risks, benefits,
and alternatives to a treatment. A signature on the consent form serves as legal
proof of consent.

Consent is about patient autonomy, which means that the patient understands and
freely agrees to the treatment.

Consider consent as a process to ensure patient understanding and agreement,

rather than simply signing a form.

Informed consent should be a team effort between the physician, nurse, and patient.
Before the nurse has the patient sign a form, the physician should have obtained
consent.

Nurses can provide what we do best: patient education, as we assess patient

comprehension and obtain written consent. Use the teach-back method whenever
possible, asking the patient to repeat back what he or she understands. However,
our instruction cannot replace prior physician/patient shared decision-making.

Examine oneself and the physician for paternalism. We know so much more than the
patient and want to help, but we cannot put pressure on or tell a patient what to do.
During the third week of Mr. Hale's hospitalization, Angela Gibbons is assigned to
care for him. For the previous 2 weeks, Angela has been providing care to the only
person in the other car who survived the crash. Angela believes that she should not
be required to care for Allen at this time.

3. Is he justified in her belief? If so, what should she do now?

OPIANA, CHRISTIAN JOSEPH I.
BSN 4 BLOCK 6
N036 NCM 118N
No because an effective teamwork can have an immediate and positive impact on
patient safety and outcome. The need for effective teams is growing as comorbidities
and the complexity of care specialization increase. This will aid in the formation and
development of an effective team capable of providing exceptional care to patients.
In order to achieve goals and overcome challenges, team members' motivation
should be backed up by strategies and practical skills. This article highlights team
values and principles and provides team members with a practical approach to
providing quality patient care.