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Editorial
Nurses at the forefront of informed consent and autonomous healthcare decision-making
Las enfermeras a la vanguardia del consentimiento informado y la toma de decisiones autónomas en salud
Estela Morales-Valdivia
Orthopaedic Theatre Department, Croom Hospital, UL Hospitals Group, Limerick, Ireland
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is a fact that in the last two decades healthcare systems have undergone transcendental changes at all levels&#46; The inclusion of technology in the area of health has been a turning point&#44; achieving scientific advances in healthcare equipment&#44; in surgical techniques and procedures and even contributing to improving clinical safely&#46; However&#44; the recognition of the individual as an autonomous and active agent in decision-making about their own healthcare has led to an even more profound but less tangible transformation of the healthcare model<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The people we care for have not only become the protagonists and are at the centre of the health system&#44; but we also seek to offer quality services that address the complexity of the individual&#46; This holistic and integral vision of the human being implies discarding the concept of the passive patient&#46; On the contrary&#44; the healthcare team is faced with people with specific customs&#44; cultures&#44; religions&#44; ideologies and values&#44; with the potential to learn&#44; develop and continually evolve&#46; A paradigm that implies abandoning the paternalistic model of health care and&#44; through informed consent&#44; advocating the right of citizens to make autonomous decisions regarding their health&#44; care and treatment<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Informed consent is defined as a gradual process of counselling and dialogue which takes place within therapeutic relationships&#44; its ultimate goal being to ensure informed&#44; conscious&#44; and non-coerced healthcare decision-making<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; The consent process will only be ethically and legally valid when it meets four essential criteria&#58; the amount of information&#44; comprehension of the message&#44; competence and voluntariness<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Information is considered to be &#8220;sufficient&#8221; provided it allows the person to be aware of their health-disease status and to evaluate the different therapeutic alternatives offered to them&#46; This will enable them to assess the impact the health procedure will have on their life&#44; in terms of risks&#47;benefits and to take a decision in keeping with their values&#44; beliefs&#44; and life project<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The second criterion&#44; comprehension&#44; is the corner stone of consent&#46; It is understood that without comprehension of information there is no freedom to choose or make a conscious decision&#46; The patient who is unaware of the situation they are facing is shipwrecked and drifting down a path full of uncertainties where the vulnerability and fragility of the individual prevails&#46; An invalid consent will be the one in which the complexity of the language&#44; the technicalities&#44; long or convoluted expressions predominate&#44; preventing the decision from being informed<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Conversely&#44; however simple a message may be&#44; it cannot be understood if the person has lost their capacity to understand the severity of their health status&#44; the possible therapeutic alternatives and the consequences derived from the same&#46; The fact that an individual is incompetent&#44; however&#44; does not exempt professionals from the ethical responsibility to involve the patient in the decision-making and to enhance the development of their competence<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The fourth and final criterion for the validity of consent&#44; voluntariness&#44; encompasses respect for the freedom and autonomy of individuals to express their acceptance or rejection of health actions&#44; and it is unacceptable for consent to have been obtained under conditions of manipulation or coercion&#46; When information is presented in a biased or distorted manner this is manipulation&#46; Coercion is when someone is pressured or forced to make an unwanted decision&#44; either through threats or by causing them harm<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Unfortunately&#44; and despite the fact that informed consent for any type of healthcare procedure is regulated and contemplated in Spanish legislation<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; there are still circumstances in clinical care today where one or more of these validity criteria are not met&#44; and there is disconnection between theory and practice<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Valid informed consent&#58; a challenge for the healthcare system</span><p id="par0040" class="elsevierStylePara elsevierViewall">Currently&#44; healthcare organisations&#44; healthcare professionals and the people being cared for are faced with an amalgam of barriers and obstacles that interfere with the quality of the consent process&#46; Factors that lead to consent that should be considered &#8220;invalid&#8221; from an ethical-legal point of view are&#44; on the contrary&#44; being accepted as &#8220;valid&#8221; in healthcare practice<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At the organisational level&#44; we find a health system with a tendency to overcrowding of hospital wards and overcrowding in the emergency department&#46; So much so&#44; that the time constraints and high levels of stress to which health professionals are subjected end up becoming the usual &#8220;modus operandi&#8221;&#44; with unfavourable repercussions on the information offered to the patient&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Added to this is the fact that the paternalistic model of care is still deeply rooted in the healthcare culture&#44; with widespread resistance to change&#46; This can lead to omissions in the information message&#44; the use of excessively technical language and the bureaucratisation of the consent process&#44; among other issues<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7</span></a>&#46; The patient&#44; for their part&#44; may face additional obstacles such as a low level of education and health literacy&#44; and a high anxiety threshold that compromises the understanding of the message&#44; thereby leading to misunderstandings or misinterpretations of the message<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Nurses&#58; advocates for patients and their right to consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nurses play &#40;or should play&#41; an essential and indispensable role in the consent process&#44; acting as advocates for patients&#8217; rights&#44; representing the voice of the most vulnerable patients and advocating for patient autonomy&#44; particularly if their will&#44; dignity or physical integrity is infringed<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Nurses also &#8220;translate&#8221; into simple language the information which the doctor explains in an overly technical language&#44; adapting it to the information needs of the person and personalizing the message in keeping with the individual&#8217;s level of education and health situation<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the person being cared for the fact that the nurses are present 24&#8201;h a day favours the explanation of the message and the resolution of doubts about care&#44; diagnosis and treatment&#46; In fact&#44; this continuous presence places the nurse in a privileged position to be able to identify any attacks on the voluntariness of the users&#44; caused by their relatives or people with emotional ties&#44; and to intervene accordingly to resolve the situation<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Furthermore&#44; the irreplaceable work performed by perioperative nurses must be highlighted&#46; They act as reference professionals&#44; agents promoting the health of users and their families during these moments of special vulnerability and fragility&#44; personalising information and care&#44; using health education as the medicine against anxiety&#44; fears&#44; false beliefs and unfounded myths&#46; Similarly&#44; in the intraoperative period&#44; surgical nurses lead the hospital implementation of the WHO surgical checklist&#44; ensuring patient safety&#44; preventing the incidence of surgical complications and adverse events<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7</span></a>&#46; In this sense&#44; nurses act as protectors of the rights of individuals in decision-making&#44; verifying that the anaesthetic and surgical procedures to which patients undergo are those to which they have previously consented&#44; with the written record in terms of type of anaesthesia&#44; surgery and laterality being consistent with the verbal confirmation offered by these patients&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">However&#44; despite all that has been achieved&#44; much remains to be done to establish a more visible&#44; defined and structured role&#46; It is urgent that nurses&#44; as health professionals with a high social impact&#44; join forces to advocate for the protection of patients&#39; right to autonomous health decision-making&#46; Nurses need to lead the development of healthcare strategies where patients&#8217; rights are a priority&#44; and empowerment in health and innovation in care is at the forefront&#46; These strategies must be realistic&#44; measurable and quantifiable in order to induce direct improvements in healthcare practice and&#44; ultimately&#44; in quality and user satisfaction&#46;</p></span></span>"
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ISSN: 24451479
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos