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Post by katevaughn on Apr 28, 2018 13:25:00 GMT -5
This month’s journal club is presented by Soo-Ok Kim. She chose an excellent article that delves into informed consent. Informed consent is something that we do on a daily basis and most of us have a certain narrative that we provide with specific tweaks concerning case considerations. This article takes a qualitative analysis of narratives and helps identify barriers that can make informed consent challenging. A great article to help us all improve on such an important part of our practice! Here is a link to the article. The questions to encompass within your response: 1. According to this article, what are the 3 main challenges identified during obtaining informed consent and what is most common among them? 2. If you may, would you describe your main challenge of getting informed consent, especially with a SRNA? How would you guide a SRNA to resolve the issue that arises during the consenting process?
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Post by LarSharVeA Bennett on May 1, 2018 7:35:09 GMT -5
According to the article, the three main challenges in obtaining informed consent are ethical, practical, and relational challenges. The most common amongst them are ethical challenges.
Personally my greatest challenge has been practical. I have vacillated between giving too much information and feeling that I may have given too little. For instance, when discussing the risks of anesthesia for a spine case, I usually state that the risks associated with general anesthesia are heart attack, stroke, death, and minor things like damage to your lip, teeth, gum, nausea, vomiting. However, I often times walk away wondering should I have mentioned the risk of post-operative vision loss associated with the prone position? As a student, I have witnessed the ethical challenges. I was on a rotation at a small community hospital when I witnessed the electrophysiologist pressure a 90 year patient into getting a TEE. The patient did not want the TEE because he felt that whatever the findings, he would not want intervention. As time went on, I realized that it was common practice at this facility to strongly encourage procedures to generate case volume. Much like everything else, I think experience will shape the consenting process. As time moves forward, I will hone the things I like to share.
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Post by BrittneyKeating on May 2, 2018 20:05:40 GMT -5
This article categorizes the three main challenges that anesthesia providers face when obtaining informed consent into ethical, practical and relational challenges. The most common set of challenges is identified as being ethical in nature, which the article describes as: patient wishes not being honored, patient/family wishes conflicting with medical judgement, patient decision-making capacity, and upholding professional standards.
The main challenge that I find when obtaining informed consent would be considered a 'practical' challenge, and that is, providing the patient with enough information (particularly in regard to risks of anesthesia) without provoking too much anxiety or fear from the patient. The article offers a providers narrative in which he describes a time when the patient requested very specific statistics on complication rates. I struggle with this myself, as statistics for the same risk/complication can differ in various research studies and textbook information.
One of the main challenges I face in getting informed consent when working with an SRNA, is that I just do not work with the same SRNA frequently enough to know their experience with obtaining informed consent (i.e. for what surgical patient populations, and patient acuity). For this reason, I like to obtain informed consent myself when working with a SRNA for the first time. If I have the chance to work with the same SRNA repetitively, or have done multiple cases and therefore consents in the same day, then I allow the SRNA to obtain informed consent. Often times, the SRNA will present a risk or statistic in a way that I find very professional and this starts a discussion on the informed consent process.
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Post by Jocelyn Datud on May 7, 2018 9:40:28 GMT -5
After the analysis of 39 narratives, the three main challenges in obtaining informed consent are: ethical challenges, practical challenges, and relational challenges. The most common challenge is the ethical challenge which includes patient wishes not honored, conflict between patient and family wishes and medical judgment, patient decision-making capacity, and upholding professional standards.
Personally, the greatest challenge I have is making sure that the patient understood the whole plan, risks and benefits of anesthesia. Most of our patients are anxious or overwhelmed with the surgery and the information and questions that they are receiving that sometimes they tend to sign the consent without fully understanding the whole procedure. As much as possible I try to explain the anesthetic plan in a simpler way without using a lot of medical jargon but still including the necessary components. I remember as a student, I would listen to how my preceptors would consent and try to put myself in the patient's shoes and start taking pieces that I find to be good. Since I am still a new provider, I am still in the process of building good rapport and trying to find a good balance between hitting the important points but still being able to reassure them about the anesthetic plan.
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Post by krechti1 on May 7, 2018 13:35:42 GMT -5
As stated in the previous answers, the 3 main challenges faced by anesthesia providers when obtaining informed consent are ethical, practical and relational challenges. Most commonly ethical challenges.
I find one of the main challenges to be time constraints. If I am consenting a patient between cases, there is usually a push to get the patient back to the room for a quick turnover. Another challenge is knowing the right amount of detail to give to a patient. Some patients want to hear about every complication and detail, and some patients don't want to hear any of them. You have to get to know your patient during the interview to understand the appropriate amount of details to give. This is difficult to teach to an SRNA. I think it is good for SRNA's to listen to many different providers and how they approach the discussion. That way they can learn what works best for them, while making sure to include all pertinent details.
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kty67
New Member
Posts: 22
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Post by kty67 on May 10, 2018 14:24:24 GMT -5
1. the 3 main challenges to obtain informed consent are ethical challenges, practical challenges, and relational challenges and the most common challenge is the ethical. 2. Personally, I filled challenged when I go to consent a patient for next day and patient had never discussed a surgery or procedure with surgeon. I become a 1st person to let him or her know in addition I am not the one will anesthetize the patient. I always fill uncomfortable and sometimes I tell them that anesthesia consent can be signed later after they discuss procedure with attending physician or surgeon.
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Post by emedina1 on May 12, 2018 15:43:41 GMT -5
As mentioned previously, the three main challenged are ethical , practical and rational challenges. When I consent a patient( this is when I am the anesthesia provider for the case, ) I tend to be the direct of what I am going to do. With the process, I mention what may be the complications and that my attending and I will do everything that will make the process safe. I make sure I am confident enough with my technique with the hope that my patient is comfortable. Most patient show they are nervous some show they are calm nevertheless i assume they are all nervous I try my best to make them comfortable. I refrain from discussing about the procedure I believe this is the surgeon's domain.
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nanci
Junior Member
Posts: 57
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Post by nanci on May 18, 2018 16:48:01 GMT -5
1) Three main challenges: Ethical, Practical, and Relational challenges with obtaining informed consent- with the most common being ethical challenges.
2) Main challenge tends to be practical in that there are time constraints and a lot of information to communicate. When listening to the newer SRNA's who have not yet had enough repetition with the consent process I just encourage repetition and practice, listening to others obtain consent, and to modify as necessary to best communicate to the patient(s). It is, and will remain, challenging to effectively obtain thorough consents especially when there is a greater demand for lower room turnover time that is being tracked and higher demands on performance. The consent process might be the only time to form rapport with your patient and their family and when that is rushed or something is missed it can lead to huge complications and not form trust with them (of course all within 5 minutes of taking them back to the operating room). No one wants to make the consent process feel rushed yet being time tracked can inadvertently have some items be missed or not thoroughly discussed with the patient to a full understanding or to their satisfaction. Not an easy answer and hopefully the SRNA's obtain enough practice obtaining the consents through their clinical time to become proficient at it and with confidence as an independent provider.
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Post by belinda on May 22, 2018 10:33:07 GMT -5
1. 3 main challenges identified during informed consent: Ethical, Practical, Relational. Most common Ethical.
2. As other have noted practical with regards to time constraints especially in high turnover areas can add pressure to the anesthetists when obtaining consent. One thing not mentioned previously is that if the attending anesthesiologists has already obtained anesthesia consent for the case, you may not know what was said/covered. This can put you in an awkward position. I always briefly review the consent going over major risks but most importantly make sure all their questions are answered.
I agree that as a new practitioner, listening to many people obtain consent can help the SRNA tailor their own consent but also learning to tailor the consent process to each patients needs which is probably most important for good rapport and patient trust. The patient wants to know that we are listening, that we care and that we have their best interest in mind no matter what the situation.
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Post by Jessica Swtizman on May 25, 2018 8:39:19 GMT -5
The three main challenges during informed consent are Ethical, Practical and Rational; with Ethical being the most common
My main challenge of getting informed consent has to due with language barrier, even with an interpretor and especially in OB. I want to make sure the patient doesn't feel rushed and understands completely without overwhelming or increasing anxiety. In regard to SRNAs, I encourage they listen and gain experience while myself or the MD obtains consent.
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Post by darolyn on May 29, 2018 22:33:20 GMT -5
As previously stated the three main challenges during informed consent are Ethical, Practical and Rational.....Ethical challenges are the most common.
When an SRNA is obtaining consent I listen carefully to what is being asked and discussed with the patient. I will chime in to help elicit more information. For that I will say that Practical challenge of time is an issue. I am not sure where explaining the roles of a CRNA/SRNA and MDA fits in the challenge category, but that seems to come up when multiple anesthesia providers are introduced and repetition of questions and explanations occur.
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Post by chrisdiem on May 31, 2018 18:44:02 GMT -5
1. According to this article, what are the 3 main challenges identified during obtaining informed consent and what is most common among them?
— According to this study/article, there are three main categories of challenges in obtaining informed consent. They are divided into ethical, practical and relation. The most common challenge was identified as being ethical challenges which was further broken down into patient wishes not honored, patient and family wishes conflict with medical judgement, patient decision making capacity, upholding professional challenges.
2. If you may, would you describe your main challenge of getting informed consent, especially with a SRNA? How would you guide a SRNA to resolve the issue that arises during the consenting process?
—As others have stated I feel as though the most challenging aspect of obtaining informed consent is divulging the appropriate amount of information regarding the anesthetic in order for the patient to truly be informed. Each individual has a different level of education and understanding regarding the medical field so you must identify where on that spectrum they are. Additionally, there are those individuals who prefer not to be given all the specific risks and possible complications as it will only make them more anxious and they know that there may not be another option because the surgery they are having requires anesthesia. It is our responsibility to understand what it is the patient needs to be “informed” and feel comfortable signing consent. If it is a newer SRNA I let them watch me during obtaining consent and then talk with them afterwards about what they thought I did well, if they felt anything was missing, and what there understanding of informed consent is. Once this discussion has taken place I then ask them to go through the consent process and I watch them obtain consent. Once again after this we have the same discussion only know about how they felt there consent process went. I feel as though this allows them to get a good understanding of the consenting process.
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Post by Chuck Eder on May 31, 2018 22:17:02 GMT -5
1. The 3 main challenges during obtaining informed consent are ethical, rational, and practical. Ethical challenges are the most common.
2. An SRNA needs to develop their own style and delivery for their informed consent. It's a balance of not inundating the patient with too many extra details, but presenting enough information so that they are informed. I honestly think that most patients only hear/understand a few of our details. I believe they are more occupied with the details of their pending surgery and the anesthesia aspect is an added/mandatory portion of the procedure. I will work with SRNAs to help them find the "right" mix of details to include in their consent delivery. I often suggest that they write down on paper their consent discussion and memorize. It helps them to sound more professional instead of stuttering and fumbling thru it.
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Post by klinden on May 31, 2018 23:21:06 GMT -5
The main challenges are ethical, practical and relational. the main issue in obtaining informed consent with an srna is finding the comfortable balance in explaining the possible complications related to the anesthetic.
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