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Pilar Rodríguez-Soberado, Belén Martin-Gil, Mercedes Fernández-Castro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M. Pilar" "apellidos" => "Rodríguez-Soberado" ] 1 => array:2 [ "nombre" => "Belén" "apellidos" => "Martin-Gil" ] 2 => array:2 [ "nombre" => "Mercedes" "apellidos" => "Fernández-Castro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S113086212200136X" "doi" => "10.1016/j.enfcli.2022.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113086212200136X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445147922001369?idApp=UINPBA00004N" "url" => "/24451479/0000003300000002/v4_202311111158/S2445147922001369/v4_202311111158/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Nurses at the forefront of informed consent and autonomous healthcare decision-making" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "79" "paginaFinal" => "81" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Estela Morales-Valdivia" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Estela" "apellidos" => "Morales-Valdivia" "email" => array:1 [ 0 => "estelamova@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Orthopaedic Theatre Department, Croom Hospital, UL Hospitals Group, Limerick, Ireland" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las enfermeras a la vanguardia del consentimiento informado y la toma de decisiones autónomas en salud" ] ] "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. The inclusion of technology in the area of health has been a turning point, achieving scientific advances in healthcare equipment, in surgical techniques and procedures and even contributing to improving clinical safely. However, 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>.</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, but we also seek to offer quality services that address the complexity of the individual. This holistic and integral vision of the human being implies discarding the concept of the passive patient. On the contrary, the healthcare team is faced with people with specific customs, cultures, religions, ideologies and values, with the potential to learn, develop and continually evolve. A paradigm that implies abandoning the paternalistic model of health care and, through informed consent, advocating the right of citizens to make autonomous decisions regarding their health, care and treatment<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</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, its ultimate goal being to ensure informed, conscious, and non-coerced healthcare decision-making<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. The consent process will only be ethically and legally valid when it meets four essential criteria: the amount of information, comprehension of the message, competence and voluntariness<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Information is considered to be “sufficient” provided it allows the person to be aware of their health-disease status and to evaluate the different therapeutic alternatives offered to them. This will enable them to assess the impact the health procedure will have on their life, in terms of risks/benefits and to take a decision in keeping with their values, beliefs, and life project<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The second criterion, comprehension, is the corner stone of consent. It is understood that without comprehension of information there is no freedom to choose or make a conscious decision. 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. An invalid consent will be the one in which the complexity of the language, the technicalities, long or convoluted expressions predominate, preventing the decision from being informed<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Conversely, however simple a message may be, it cannot be understood if the person has lost their capacity to understand the severity of their health status, the possible therapeutic alternatives and the consequences derived from the same. The fact that an individual is incompetent, however, 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>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The fourth and final criterion for the validity of consent, voluntariness, encompasses respect for the freedom and autonomy of individuals to express their acceptance or rejection of health actions, and it is unacceptable for consent to have been obtained under conditions of manipulation or coercion. When information is presented in a biased or distorted manner this is manipulation. Coercion is when someone is pressured or forced to make an unwanted decision, either through threats or by causing them harm<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Unfortunately, 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>, there are still circumstances in clinical care today where one or more of these validity criteria are not met, and there is disconnection between theory and practice<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Valid informed consent: a challenge for the healthcare system</span><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, healthcare organisations, 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. Factors that lead to consent that should be considered “invalid” from an ethical-legal point of view are, on the contrary, being accepted as “valid” in healthcare practice<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">At the organisational level, we find a health system with a tendency to overcrowding of hospital wards and overcrowding in the emergency department. So much so, that the time constraints and high levels of stress to which health professionals are subjected end up becoming the usual “modus operandi”, with unfavourable repercussions on the information offered to the patient.</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, with widespread resistance to change. This can lead to omissions in the information message, the use of excessively technical language and the bureaucratisation of the consent process, among other issues<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7</span></a>. The patient, for their part, may face additional obstacles such as a low level of education and health literacy, and a high anxiety threshold that compromises the understanding of the message, thereby leading to misunderstandings or misinterpretations of the message<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Nurses: advocates for patients and their right to consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nurses play (or should play) an essential and indispensable role in the consent process, acting as advocates for patients’ rights, representing the voice of the most vulnerable patients and advocating for patient autonomy, particularly if their will, dignity or physical integrity is infringed<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Nurses also “translate” into simple language the information which the doctor explains in an overly technical language, adapting it to the information needs of the person and personalizing the message in keeping with the individual’s level of education and health situation<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,9</span></a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the person being cared for the fact that the nurses are present 24 h a day favours the explanation of the message and the resolution of doubts about care, diagnosis and treatment. In fact, this continuous presence places the nurse in a privileged position to be able to identify any attacks on the voluntariness of the users, caused by their relatives or people with emotional ties, and to intervene accordingly to resolve the situation<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Furthermore, the irreplaceable work performed by perioperative nurses must be highlighted. They act as reference professionals, agents promoting the health of users and their families during these moments of special vulnerability and fragility, personalising information and care, using health education as the medicine against anxiety, fears, false beliefs and unfounded myths. Similarly, in the intraoperative period, surgical nurses lead the hospital implementation of the WHO surgical checklist, ensuring patient safety, preventing the incidence of surgical complications and adverse events<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a>. In this sense, nurses act as protectors of the rights of individuals in decision-making, verifying that the anaesthetic and surgical procedures to which patients undergo are those to which they have previously consented, with the written record in terms of type of anaesthesia, surgery and laterality being consistent with the verbal confirmation offered by these patients.</p><p id="par0070" class="elsevierStylePara elsevierViewall">However, despite all that has been achieved, much remains to be done to establish a more visible, defined and structured role. It is urgent that nurses, as health professionals with a high social impact, join forces to advocate for the protection of patients' right to autonomous health decision-making. Nurses need to lead the development of healthcare strategies where patients’ rights are a priority, and empowerment in health and innovation in care is at the forefront. These strategies must be realistic, measurable and quantifiable in order to induce direct improvements in healthcare practice and, ultimately, in quality and user satisfaction.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Valid informed consent: a challenge for the healthcare system" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Nurses: advocates for patients and their right to consent" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioética para Clínicos, Consentimiento informado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. 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