Surgical Conscience and Informed Consent

Surgical conscience, also known as operative permit, is essential component of perioperative care for patient safety

1. November 6, 2021 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (BSc, MSc-EMCCN)
SURGICAL CONSCIENCE ---2 HRS
1

2. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Outline
❑Objective
❑Definitions
❑Purposes
❑Circumstances Requiring Consent
❑Essential Elements of Informed Consent
❑Requisites for Validity of Informed Consent
❑Situations that undermine surgical conscience
❑Areas affected by surgical conscience
❑Legal aspects of surgery
❑Nursing responsibility

3. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Objective
❑At the end of this Session, learners will be able to:
►Describe Surgical conscience
►Consent
►Identify Areas affected by surgical conscience
►Legal aspects of surgery
►Common areas of negligence
►Identify major Nursing responsibility
►Describe Circumstances Requiring Consent
►Discuss Situations that undermine surgical conscience
►Differentiate Essential Elements of Informed Consent
►Identify Requisites for Validity of Informed Consent

4. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
SURGICAL CONSCIENCE & INFORMED CONSENT
•is a surgical ethics, principles, or a sense of right & wrong
Surgical
Conscience
•is operative permit or surgical consent
•is permission obtained from a patient to perform a specific test or procedure.
•is permission necessary before surgery obtained from a patient to perform a
specific procedure.
•PURPOSES:
•to ensure the client understands the nature of the treatment including
potential cxns& disfigurement (explained by the Attending Physician)
•to indicate the client’s autonomy/decision without pressure
•protect the clients against unauthorized procedure
•protect the surgeon & hospital against legal actions, if claimed
•prevent unauthorized procedures.
Informed
Consent

5. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
INFORMED CONSENT
❑AKA OPERATIVE PERMIT or SURGICAL CONSENT
❑necessary before non emergent surgery can be performed
❑permission obtained from a patient to perform a specific test or procedure
❑PURPOSES:
►to ensure that the client understands the nature of the Tx including the potential cxns &
disfigurement (explained by AMD)
►to indicate that the client’s decision was made without pressure
►to protect the client against unauthorized procedure
►to protect the surgeon & hospital against legal actions by a client who claims that an
unauthorized procedure was performed.

6. Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
March, 2024 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
•any surgical procedures requiring the use of a scalpel, scissors,
and/or sutures
•any invasive procedure such as surgical incision, biopsy,
cystoscopy, or paracentesis.
•a non-surgical proceduresuch as arteriography.
•any procedures
•involving radiation, esp. if wzcontrast.
•requiring sedation and/or anesthesia
•requiring GA, local, and/or regional infiltration or block.
•requiring entrance into the body cavity.
CIRCUMSTANCES

REQUIRING A CONSENT:

7. Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
March, 2024 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
•Description and explanation of
•diagnosis & disease condition
•procedures planned to be done
•risks, consequences & benefits.
•alternative treatment or procedure.
•consequences/prognosis, if refused.
•an offer to answer questions about the procedure.
•the right to withdraw consent at any time.
•what if the protocol differs from the usual procedure?
ESSENTIAL

ELEMENTS

OF
INFORMED CONSENT

8. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
•written permission is best and is legally acceptable
•signature is obtained with the client’s complete understanding of what is to
occur
•adults sign their own operative permit
•obtained before sedation
•Secured without pressure or duress and threat.
•a witness is desirable –nurse physicians or authorized persons
•in an emergency, permission via telephone or telefax is acceptable
•for minor (below 18), unconscious, psychologically incapacitated,
permission is required from responsible family member (parent/legal
guardian)
•For mentally ill and unconscious patients, consent must be taken from the
parents or legal guardian.
•If the patient is unable to write, an “X” mark is accepted if there is a witness
to his mark.
REQUISITES FOR VALIDITY OF
INFORMED CONSENT

9. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
REQUISITES FOR VALIDITY OF INFORMED CONSENT
►For minors, parents, or someone standing on their behalf, give consent.
▪Note: for a married emancipated minor parental consent is not needed anymore, the spouse is accepted.
❑Implied consent?
►When an emergency situation exists,
▪no consent is necessary because inaction at such time may cause greater injury.
▪the surgeon may have to operate without consent, others, however, makes every effort to
obtain consent by telephone, or fax.
▪permission via telephone/cellphone or telefax is acceptable but must be signed within 24 hrs.

10. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
INFORMED CONSENT
❑Informed Consent Should Contain the Following:
►explanation of procedure and its risks
►description of benefits and its alternatives
►an offer to answer questions about procedure
►instructions that the patient may withdraw consent
►a statement informing the patient if the protocol differs from customary
procedure

11. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
Nursing responsibility
❑The nurse is responsible for ensuring that all necessary parties have
signed the consent form and that it is in the client’s chart before the
client goes to OR.