BACHELOR OF NURSING SCIENCE WITH HONOURS

SEMESTER MAY 2023

NBNS 1223

CONCEPT OF NURSING

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 TABLE OF CONTENT

CONTENT PAGE

1.0 Introduction 3-4

2.0 Discussion on Two Ethical Issues Related to The

Inform Consent in Nursing 5-7

3.0 Discussion on the Ethical Issue Related to the Inform Consent

and Explanation on the Nurses’ Role as an Advocator in Assisting
Patient to Understand the Treatment and Care Process 8 - 11

4.0 Conclusion 12
5.0 References 13 - 14

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1.0 Introduction

Nursing ethics is a subfield of applied ethics concerned with nursing-related activities.

Nursing ethics and medical ethics share many principles, such as beneficence,
nonmaleficence, and respect for autonomy. It is characterized by its emphasis on
interpersonal interactions, human dignity, and collaborative care. The definition of ethics as
defined by (Peter, S., 2023), ethics also known as philosophy and it is the study of what is
ethically beneficial and detrimental, right and wrong. Every individual has their own set of
personal ethics and morals and these values are very important in nursing that always apply
in nursing care such as sympathy and empathy in nursing practice. For example, intensive
care nurses sometimes fight with internal perception of patient’s relatives and moral when
has to do a procedure of patient’s end-of-life that need the nurses to explain and inform the
relative about the procedure.

Supported by (Darby, F., 2023), when caring for patients, nurses frequently face moral
dilemmas. Moral dilemmas can arise for a variety of reasons and the main reasons why
nurses encounter ethical quandaries in nursing such as first and foremost, patients and their
loved ones must make life-or-death decisions. Second, the patient refuses to get treatment.
Third, nursing duties may be incompatible with cultural or religious convictions. Fourth,
nursing peers display incompetence, and finally, there is insufficient personnel to get help in
deliver nursing care or treatment.

Inform consent is one of the most common ethics in nursing technique and procedure. In
healthcare, many factors influence the process of getting real informed consent. Healthcare
staff who care for the patient must present all essential information and ensure full
comprehension, which includes the side effects, dangers, and percentage damage in all
surgeries and treatments, as well as the implications for the patient. Nurses play a crucial role
in this process and are always present.

According to (Timothy, J. L., 2019), informed consent happens when a healthcare

provider, such as a doctor, nurse, or other healthcare professional, explains a medical therapy
to a patient before the patient agrees to it. The patient could use this method of
communication to ask questions and accept or refuse the treatment. Supported by
(International Council of Nurses, 2021), nurses must ensure to informed consent for nursing
and medical care. This includes the patient’s right to choose or refuse treatments. The consent
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process, by definition, offers patients the authority to decide what happens to their bodies and
allows them to be fully engaged in their medical care. In brief, no one should conduct
medical tests, surgeries, or research on people without your consent.

Additionally, according to (Alireza & Mahboobeh, 2017), informed consent requires that
a patient be knowledgeable and capable before providing voluntary consent. Furthermore,
nurses must inform consent to the patient who is conscious and good mental state and also to
the patient relatives if the patient not conscious or sub conscious. In order to gain patient and
relatives cooperation prior to nursing procedures or treatment, it is necessary to inform both
patients and relatives about the anticipated side effects of the treatment. There are steps in
procedure to informed consent to patient. Based on (Tenenbaum, E. M., 2022), the law
emphasizes on five legally required elements of informed consent, including a discussion of
the patient’s health status as it relates to the procedure, a description of the procedure itself,
and a discussion on the benefits of, alternatives to, and risks of the procedure.

According to (Parth, S., Imani, T. & Danielle , 2022), there has a proper documentation of
all the elements of informed consent such as in a form, progress notes or elsewhere in the
record. The required elements for documentation of the informed consent discussion is firstly,
the nature of the procedure, secondly, the risks and benefits and the procedure, thirdly,
reasonable alternatives, fourth, risks and benefits of alternatives, and fifth, assessment of the
patient's understanding of elements first through fourth. So, in this assignment, will be
discuss about the ethical issues related to the inform consent and will be further explain the
nurses’ role as an advocator in assisting patient to understand the treatment and care process
when patient is in the hospital.

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2.0 Discussion on Two Ethical Issues Related to The Inform Consent in Nursing

Based on the scenario given in this assignment, the ethical issues found on Nurse A while
accompanying Doctor B taking consent from Mr. C for an invasive procedure is the nurse is
not with the patient when the doctor taking consent to do an invasive procedure because the
nurse was call to assist for another procedure. The role of nurses as patient advocates is to
ensure that patients understand the procedures involved in their treatment. However, the
nurse leaving the patient without complete the process of informed consent. Nurses have both
ethical and legal responsibility when it comes to gaining consent. According to (Malaysian
Medical Council, 2019), the Code of Conduct practice standard discusses the professional
obligation to consent. A nurse may be held accountable for professional negligence if a
patient is harmed as a result of a nurse's failure to give adequately advise or deliver true
information the patient of the risks and benefits of the proposed procedure, or if the nurse's
conduct infringes on the physician-patient relationship when nurses informed consent to
patient or relatives.

The legal consequences of informed consent can differ, leaving nurse practitioners torn
between judicial and ethical obligations. A nurse receives an instruction from another
medical officer to assist for another procedure in the middle of the informed consent
procedure. According to (Axson, S.A., Giordano, N.A., Hermann, R.M. et. al., 2019), the
nurse must be able to participate in the informed consent process competently and
confidently in a highly hierarchical framework. According to a study by (Veronica, et. al.,
2021), nurses in their practice must inform and obtain the patient's agreement before signed
as a witness in informed consent for the invasive procedures.

The second mistake is the nurse completing the consent form without saw and head the
full conversation between doctor and patient regarding explanation of the invasive procedure
and sign it as the witness. The result from this pitfall, the patient claims he lack of
understanding regarding the procedure and refused for the procedure. From this situation, Mr.
C's refusal to undergo the operation in the scenario shows that his autonomy has been
violated. Even if a patient's decision is contrary to what a healthcare professional believes is
the best course of action, healthcare providers must accept the patient's decision. The doctor
and nurse must respect for patient autonomy and decision-making. According to (Julian
Sheather, 2018), respecting patient autonomy is a crucial component of moral healthcare

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practice. Patients have the right to accept or refuse treatment based on their personal values,
worldviews, and knowledge of the facts provided to them.

Nurses are frequently caught in the middle of overlapping tasks or several orders from
doctors. Nurses also aim to complete the doctor's orders as quickly as possible, thus they have
to hold or stop what they are doing to carry out all of the latest orders. Based on (Amanda,
G., 2023), nursing ethical issue is a circumstance in which the nurse must choose between
two correct decision but conflicting values which is the nurse's values and the values of the
other parties such as the patient, patient's family, other healthcare professionals, or any
combination. The decision thus creates a quandary because it eventually does not correspond
with someone's ideals. Nurses always exposed to ethical issue or high risk in legal action
such as sued by a patient because of misunderstanding information given to patient.

The nurse signs the invasive operation consent form without asking the patient if he
understands the procedure completely or not. Nurses, on the other hand, are not accountable
for the patient's last-minute decision to cancel the procedure on the day of the invasive
procedure. According to (Amanda, B. C., 2023), some nurses have voiced concerns that they
are being asked to provide informed consent and therefore must know everything about the
form and the surgery. However, the nurse is only tasked to ensure that the patient or legal
representative signs the form. If the patient doesn't understand the intended surgery, or there
is any discrepancy with the site of the surgery, it is the responsibility of the clinician
performing the procedure to clear up any questions. The term informed consent is reserved
only for those clinicians usually a surgeon who are performing the surgery. This is specific
information that must be documented in the patient's bed head ticket, patient’s file, or chart
prior to invasive procedure or surgery and needs to include verbiage that the patient was
informed of the risks, benefits, and alternatives to the planned procedure.

According to (Mary, J. & Roberta, H. , 2018), although a physician may try to delegate
informed consent to a nurse, nurse still at the risk of liability. The nurse needs to understand
his or her role in obtaining informed consent is limited to the patient advocate role and a
witness to the patient's signature. After the details of the procedure are explained adequately
to the patient and the patient signs the informed consent form, the nurse simply witnesses that
the patient is giving consent voluntarily, the patients appear lucid and competent to give
consent, and also the patient's signature is authentic. In addition to being a witness to the
patient's signed informed consent, the nurse must also know the patient's status of

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understanding the proposed procedure. The nurse must also evaluate the patient's response to
the information informed by the doctor and offer to the patient to ask again or further
questions about the procedure if still not understanding.

Additionally, based on (Veronica, S., Roberta, S. & Angela, P., 2021), the practices
related to informed consent and the roles of nurses in the process are strongly influenced by
the model of relationships between the different group of people such as the patients, their
families, and healthcare professionals. Nurses, who have frequent contact with patients,
family members, and doctors, help ensure that patients' right to make an informed decision is
upheld. In daily practice, it is crucial of all nurses to perform these responsibilities in
accordance with their professional service or primarily assist doctors in providing patient
care.

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3.0 Discussion on the Ethical Issue Related to the Inform Consent and Explanation on
the Nurses’ Role as an Advocator in Assisting Patient to Understand the Treatment
and Care Process

The role of nurse as patient’s advocator in assisting patient to understand the treatment
and care process according to (Mohammad Abbasinia, et. al., 2019) is to help patients
comprehend the treatment and care process, such as tracking medical errors and protecting
patients from the incompetence or misconduct of coworkers and other members of the
healthcare team. Apart from this, nurse also responsible for delivering information regarding
the patient's diagnosis, treatment, and prognosis, as well as recommending alternative
healthcare options and providing information about discharge programs. The nurses also
operate as value providers by retaining self-control and allowing patients to make their own
decisions.

Furthermore, nurse as patient’s advocate role during the informed consent are gather by
surgeon or medical officer, nurses must accompany patient in the whole process of informed
consent to be a witness. Supported by (Steinberg, A., 2019), the nurse must be with the
patient from the beginning to the end of the informed consent process, especially while the
doctor takes the patient's signed consent to perform an invasive procedure to ensure adequate
and relevant information is well understood by the individual patient and is used correctly for
their decision-making. patient’s or family’s wrong perception to the procedure, patient
emotional state such as anxiety, the patient's level of readiness in receiving information and
etc. Supported by (Tomasz, P. & Katarzyna, S., 2023), there have many factors that
influenced in process informed consent, the factors are associated to the underlying sickness,
such as fatigue, depression, cognitive status, and emotional factors, may influence patients'
comprehension. The extent to which this interferes with patients' ability to comprehend the
full meaning of some informed consent.

According to (Gerber Lois, 2018), patient advocate in perspective of a nurse define when
a nurse, says, acts, or behaves in a way that benefits their patient, who may be unable to
support or promote their own needs or interests, this is referred to as patient advocacy. Nurses
who advocate for patients may work with decision-makers such as legal representatives or
doctors to provide medical solutions or solve treatment problems. Nurses help patients by

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showing compassion and understanding. They build mutual trust by exchanging knowledge,
managing emotional situations, communicating effectively, and fostering proximity.
Furthermore, nurse advocates must build trust with patients and their families in order to be
effective. Nurses must be regarded by other health care practitioners, who may look to them
for insight into true patient requirements, concerns, and views. Nurses can discuss concerns
with diagnosis, accommodations, drugs, and patient self-care while working with other health
providers.

Effective communication is crucial for ensuring that patients understand their treatment
and care plans. Because of the delay in the consenting process caused by Nurse A's other
obligations, the scenario may have impacted the continuity of treatment and communication
with Mr. C. To avoid misunderstandings and ensure patient comprehension, nurses should
strive to maintain continuous and focused communication with patients during critical
procedures such as obtaining informed permission. For example, nurse reexplain the invasive
procedure as doctor inform early to the patient. However, patient does not agree and refused
to do the invasive procedure. So, in this situation, as patient advocates, if the patient does not
want to do a surgical procedure, the nurse can communicate with the doctor on the patient’s
behalf.

In the other hands, nurses must know the condition of patient whether stable and
permitted to do a decision or not. Supported by (Jennifer Whitelock, 2020), a patient may
refuse surgery as long as they comprehend the option, the consequences of that decision, and
act in their own best interests. Apart from this, the competent patient has the right to refuse
any kind of treatment, even if it would shorten their life, and instead choose the choice that
will give them with the highest quality of life. Rather having the medical team choosing for
them, the individual can decide what they consider to be the optimum quality of life.

Nurses as patient’s advocate, must help the patient to do a correct decision for good sake
of patient. Nurses must together with the physician explain to patient the consequences if not
doing the invasive procedure, such as can cause patient condition deteriorate and so on. After
details explanation include the steps of pre, during and post-procedure, patient still do not
want to do the procedure, nurses will know there is the best decision that patient choose for
her or himself. If a patient understands the repercussions of refusing therapy, as well as the
benefits and dangers of the treatment recommended by their doctor, they have the freedom to
refuse some or all operations, drugs, or therapies (Jennifer Whitelock, 2020).

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 So, after patient make decision, nurses and other healthcare workers must respect
patient’s decision and rights. The role of nurse is more focus on patient mental well-being
and also provide supportive and comfortable care such as give mental support and if
necessary, nurse can give motivation and counselling service. According to (Vaartio, H.,
Leino-Kilpi, H., Salantera, S. et. al., 2023), patient advocacy nurse responsibilities include
client empowerment, informing, valuing and honoring, protecting, continuity of care, follow-
up, empathy with patients, counseling, responding, shielding, and whistleblowing.

However, there is difficulty in accepting the patient's decision unanimously. Sometimes

the patient's decision is entirely opposed by the patient's relatives, and sometimes the patient
makes the decision in order to terminate their own life sooner. According to (Mark, C. N.,
2021), in the patient-physician relationship, knowledge disclosure and informed consent are
relatively new notions. They are primarily founded on the notion of autonomy and offer
numerous practical advantages. Eventually, the practical implementation of these conditions
is riddled with complications, some of which can hurt the patient or obstruct the fulfillment of
the moral imperative of beneficence. The dilemma of ethical issue will occur for seek the best
treatment and respect patient willingness. In this situation, the surgeon, specialist and nurse
will seat together and family conference to achieve unanimity which is agreement by all
people involved include the consensus.

Stated by (Aveyard, H. , 2018), courts have supported the nurse’s duty to disclose based
on the fiduciary quality of the nurse-patient relationship. A fiduciary relationship is a unique
relationship in which the law imposes specific liabilities and duties. A fiduciary duty includes
a duty to act for someone else's benefit, while subordinating personal interests to the interests
of the other person. In the case of health care relationships, the patient is untrained in medical
science and consequently depends completely on the education, training, skill, and experience
of the physician, health care workers or nurses to provide information to the patient that can
use to make an informed decision. Usually, as patients’ advocators, patients pot or give 100%
trust in nurses' knowledge, skill, and clinical experience when making choices about
treatment or nursing care options.

According to (Nina, N., 2020), the Malaysia Nurses Code of conduct stated that the
nurses is expected to provide a good standard of nursing care such as intervenes appropriately
and promptly to prevent complications and also the nurse assumes responsibility and
accountability for her own nursing judgments and action. The very important is the nurse acts

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to promote and protect the interest of the patient when the patient’s incapable of
communicating their needs and protecting patients. So, in this case, in an emergency situation
where consent cannot be obtained, the nurse act in the best interest of the patient within the
scope of training and competency.

The nurse should remind the doctor to give correct process in informed consent and
reinform the patient once more about the procedure's purpose, the procedure's method and
steps, whether the patient's condition requires anaesthesia, the procedure's adverse effects,
and the procedure's benefits. According to (Marsha Ryan, 2023), informed consent is a
process gathering consent from patient which the doctor gives a generalized information
about the summary of diagnosis, treatment or medication information. It is not meant to be
comprehensive and should be used as a tool to help the patient understand the purpose of
procedure invasive or assess potential diagnostic and treatment options. Supported by (Mayer
Brezis, et. al., 2018), most patients don't remember getting explanations about risks or
procedure alternatives, and physicians are resistant to attempts to improve informed consent
from time to time.

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4.0 Conclusion

The conclusion of this case in this assignment, nurses should consider engaging in the
following activities to address the ethical concerns raised and fulfill their duty as advocates,
such as putting the patient's needs and understanding at the forefront of care by prioritizing
patient-centered care. In addition, nurses should communicate openly and honestly with
patients, listen to their problems, and answer any questions or concerns they may have.
Nurses must be skilled in obtaining informed consent and aware of their moral and legal
responsibility. This is includes being aware of the information that must be provided, the
importance of patient comprehension, and the importance of patient autonomy.

Nurses must always support patient rights as advocates by ensuring that patients are
informed of their rights and have the opportunity to make decisions about their care by
actively promoting patient autonomy. Furthermore, nurses can encourage patients to use their
freedom to accept or reject medical care based on their knowledge and values.

Aside from that, nurses should follow the proper reporting processes within their
healthcare institution if they encounter situations in which a patient's autonomy or knowledge
is jeopardized. This will enable them to deal with the situation and avoid future problems.
Finally, nurses must improve communication and collaborate with other members of the
healthcare team, such as doctors, to provide thorough and dependable patient communication.
To ensure that patients are completely informed, nurses can assist with any information or
comprehension gaps.

3113 words counts

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5.0 References

Amanda, B. C. (2023). What Does it Mean for a Nurse to Sign a Consent for Surgery Form?
Journal of Registered Nurse, 1.

Amanda, G. (2023, July 6). Common Ethical Issues in Nursing Practice. Retrieved from
nursingeducation.org: https://nursingeducation.org/degrees/bachelor-of-science-in-
nursing-bsn/

Aveyard, H. . (2018). The Patient Who Refuses Nursing Care. Journal of Medical Ethics,
346-350.

Axson, S.A., Giordano, N.A., Hermann, R.M. et. al. (2019). Evaluating nurse understanding
and participation in the informed consent process. Journal of Nursing Ethics, 1050-
1061.

Darby, F. (2023, June 20th). 20 Common Examples of Ethical Dilemmas in Nursing + How
to Deal With Them. Retrieved from www.nursingprocess.org:
https://www.nursingprocess.org/ethical-dilemma-in-nursing-examples.html

International Council of Nurses. (2021, April 13). The ICN Code of Ethics for Nurses.
Retrieved from www.icn.ch:
https://www.icn.ch/system/files/documents/2020-10/CoE_Version%20for
%20Consultation_October%202020_EN.pdf

Mark, C. N. (2021). Three Kinds of Decision-Making Capacity for Refusing Medical

Interventions. America: The American Journal of Bioethics.

Mary, J. & Roberta, H. . (2018). Informed Consent: Who Duty to Inform? Journal of
Medical Surgocal in Nursing, 189.

Mayer Brezis, et. al. (2018). Quality of informed consent for invasive procedures.
International Journal for Quality in Health Care, Volume 20, Issue 5, Pages 352–
357.

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Mohammad Abbasinia, et. al. (2019). Patient advocacy in nursing: A concept analysis. The
Journal of School Nursing, 27.

Nina, N. (2020, May 4th). NURSING BOARD MALAYSIA CODE OF PROFESSIONAL

CONDUCT FOR NURSES FIRST EDITION APRIL 1998 Code of Professional
Conduct For Nurses Registered With The Nursing Board Malaysia. Retrieved from
www.academia.edu:
https://www.academia.edu/7762945/NURSING_BOARD_MALAYSIA_CODE_OF_
PROFESSIONAL_CONDUCT_FOR_NURSES_FIRST_EDITION_APRIL_1998_C
ode_of_Professional_Conduct_For_Nurses_Registered_With_The_Nursing_Board_
Malaysia

Parth, S., Imani, T. & Danielle . (2022). Informed Consent. USA: StatPearls Publishing.

Peter, S. (2023, June 8th). Ethics. British: Encyclopedia Britannica. Retrieved from
www.britannica.com: https://www.britannica.com/topic/ethics-philosophy

Steinberg, A. (2019). Disclosure of information and informed consent: Ethical and practical
considerations. Journal of Child Neurology, 1568.

Tenenbaum, E. M. (2022). Revitalizing informed consent and protecting patient autonomy:

An appeal to abandon objective causation. Oklahoma: Albany Law School.

Timothy, J. L. (2019, October 11th). What You Need to Know About Informed Consent.
Retrieved from www.healthline.com: https://www.healthline.com/health/informed-
consent

Tomasz, P. & Katarzyna, S. (2023). The reality of informed consent: empirical studies on
patient comprehension - systematic review. Journal of Biomed Central, 22.

Vaartio, H., Leino-Kilpi, H., Salantera, S. et. al. (2023). Nursing advocacy: how is it defined
by patients and nurses, what does it involve and how is it experienced? SciHub
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Veronica, S., Roberta, S. & Angela, P. (2021). The Role of the Nurse in Informed Consent to
Treatments: An Observational-Descriptive Study in the Padua Hospital. PubMed
Central , 472 - 483.

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