Much of what we do in healthcare is very similar to what we do in our personal lives. I have a hunch that you would not just sign a document for anyone just because they asked you to. The same principle applies to aspects of healthcare. We work with and should be familiar with many different consent forms.

The consent for treatment is a document signed early on in the admission process. It is customarily executed by someone in the billing department. The consent for treatment informs the client that the services will be billed and that the client is responsible for paying for the services they receive. The document also indicates that the client agrees to allow members of the healthcare team at the healthcare "entity" to treat them. This document is included in the medical chart along with the admission documents.

Informed consent is very different, hence the word" "informed." This document requires the healthcare provider to walk through a process with the client or designee as legally defined to determine that the client is informed about a specific treatment or procedure that is recommended. The person giving consent must be able to fully comprehend the procedure being performed, the risks involved, the expected or desired outcomes, expected complications or side effects that may occur as a result of the treatment or procedure, and available alternative treatments.

This is why informed consent is to be obtained by a physician in most cases; the physician is the one who has the training, skill, and knowledge to discuss the risks, benefits, and alternatives to the treatment and/or procedure that is being recommended. I am not speaking about the informed consent "document." I am talking about the "process" of obtaining informed consent from the client. When the nurse gets a client's signature on the informed consent document, you are not simply signing as a witness that the signature was made by the hand attached to the client. You are, in fact, witnessing that the client can verbalize that they are informed regarding five aspects of the informed consent process:

Disclosure—The client is able to discuss with you, using their own words, what will happen to them should they consent to what is entered or written on the consent form.

Understanding—this is similar to disclosure but with a little more personal application. The client is able to share with you, in their own words, what the results or outcomes are expected to be for them personally. This may include a number of risks that they may also be taking into consideration as they make their decision to consent.

Voluntary—This seems pretty self-explanatory, but did the client walk in on their own, or was someone coercing them to be there? Is the client speaking for themselves, or is a family member talking over them, interjecting their opinion or wishes? (Sometimes, it is important to speak with the client alone if this occurs.) Most of the time, voluntary is not the issue.

Competence refers to the client's ability to communicate their needs without concern for their understanding of the treatment or procedure. It does not refer to mental capacity, such as that of a client with dementia or traumatic brain injury. A physician must manage these cases.

Consent – happens when the client signs the consent form.



The legal requirements or hierarchy regarding who can provide informed consent may vary from state to state. I recommend you check with the facility's risk manager or the current policy to verify what is acceptable for your situation. Generally, the person who is qualified to provide informed consent includes a competent adult, a legal guardian or individual holding the durable power of attorney, an emancipated or married minor, a mature minor (varies by state), a parent of a minor child, or a court order.