Confidentiality Case 1: Nurse's Role

An 82-year-old female patient with congestive heart failure and moderate dementia requires
elective hip replacement surgery. Surgeon A and anesthesiologist A, however, considered her to
be too high of a risk for surgery. Later in the week, surgeon B, who practices with surgeon A,
has an anesthesiologist approve the patient for surgery even though the patient’s attending
physician expresses extreme concern regarding the patient.

On the morning of surgery, the patient suffers premature ventricular contractions, which the
nurse in the preoperative waiting area notes in the chart. The nurse also notes that the patient’s
husband is wary of the entire surgical process, stating that “everything had better go okay.” After
speaking with the patient’s husband, the nurse realizes that he is unaware of the conflict
between the surgeons involved with the case. Surgeon B is scheduled to leave town for a month
the next day, so he is adamant about performing the surgery before leaving.

The nurse discusses the patient’s unstable cardiac status with the surgeon. The surgeon listens
attentively, but proceeds with the surgery anyway. The patient suffers a cardiac arrest during
surgery. She is resuscitated and transferred to the intensive care unit, but she dies two days
later.

A. What is the obligation of the nurse in this case?

The nurse does not have the obligation to explain the procedure to the patient and patient’s
family since this is the duty of the attending physician/surgeon. However, it is one of the nurse’s
main roles to be a witness of the patient being given the right to informed consent regarding the
procedure as well as if they have any questions regarding the procedure or post-operative case.
Furthermore, since the patient has moderate dementia and is an aged individual, a
representative must be present regarding decisions and discussions about the operation. The
nurse is obligated to ensure that proper informed consent has been done prior to the operation.

B. Was informed consent present in the case?

Informed consent was not present in this case. The husband, who is the guardian and family
member of the patient, was not informed regarding the various complications that occurred
throughout the surgery. In fact, he was not even aware of the changes with his wife’s surgeons
nor the commotion that occurred prior to the surgery.

C. Who decides if the surgery is too risky?

The surgeons in charge as well as the attending physician of the patient all have a say
regarding the surgery. However, the patient has the final say whether or not they will continue on
with the procedure after knowing the risks and benefits of the operation. That being said, the
surgeons will provide information and explain why they believe a surgery may be too risky.
D. Is the patient capable?

I do believe the patient is not capable of making decisions regarding her treatment due to the
fact that she is 82 years old and has moderate dementia. Both factors considered, she may not
be in the right mind to make such decisions regarding her own health. In this case, she has
congestive heart failure which could cause severe complications during surgery and as
expected, things did go wrong which eventually led to her death. Perhaps if informed consent
had been rightly done by the physician and surgeons, the outcome might have been different.