Surgical Conscience and Informed Consent

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

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)
INFORMED CONSENT & SURGICAL CONSCIENCE
 Informed Consent
►AKA 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 test or procedure.
Surgical Conscience
►is a surgical ethics, principles, or a sense of right & wrong

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
PURPOSES:
►ensure the client understands the nature of the treatment including potential cxns
& disfigurement (explained by the Attending Physician)
►indicate the client’s autonomy/decision without pressure
►protect the clients against unauthorized procedure
►protect the surgeon and hospital against legal actions, if claimed
►prevent unauthorized procedures.

6. 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.

7. July, 2021 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Introduction to OR Technique
By:- Ame Mehadi (BSc, MSc)
CIRCUMSTANCES REQUIRING A CONSENT:
 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 procedure such as
arteriography.
any procedures
►involving radiation, esp. if wz contrast.
►requiring sedation and/or anesthesia
►requiring GA, local, and/or regional
infiltration or block.
►requiring entrance into the body
cavity.

8. November 6, 2023 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Operation Room Technique
By Ame Mehadi (Assist.prof. of EMCCN)
ESSENTIAL ELEMENTS OF INFORMED CONSENT
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?
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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
Written permission is best and legally accepted.
Signature of the client after complete understanding
►adult patients sign their own operative permit.
►obtained before sedation.
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.

10. 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 ………
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.
Secured without pressure or duress and threat.
A witness is desirable –a nurse, physician, or authorized person.

11. 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 ……..
 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.
 Implied consent?
 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.

12. 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
 REQUISITES FOR VALIDITY OF INFORMED CONSENT
►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
►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)

13. 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