Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the BC College of Nurses and Midwives, and all legislation relevant to nursing practice.
Consent is the voluntary agreement to some act or purpose made by a capable individual. Clients and their substitute decision makers have the legal right to agree to, refuse or revoke permission for proposed care, service, treatment or research provided by a health care professional, at anytime.
Nurses1 have both legal and ethical obligations regarding consent for proposed care, service, treatment or research. The specific legislation that applies to a nurse’s practice depends on the work setting and the nature of the work. Some related legislation are listed in the Resources section at the end of this practice standard. The ethical obligations of nurses are to recognize, respect, and promote the client's right to be informed and make informed choices, including to refuse or revoke permission.
consent2 generally requires that:
Informed consent is the formal consent sought by the health professional responsible for directing care. Nurses are responsible for obtaining consent when initiating care, and reviewing consent before providing the care ordered by another health care professional.
Employers provide the organizational supports and systems necessary for nurses to meet consent requirements and the standards of practice.
It is not appropriate for nurses to take responsibility for obtaining consent for care, treatment, or services outside of their scope of practice (e.g., the provision of surgical services or anesthesia outside the nurse's scope of practice).
Be aware of the roles and responsibilities of substitute decision-makers, representatives, and advance directives.
Health care services are governed by different legislation*, depending on the circumstances, including some that create exceptions to consent. Organizations may establish policies to assist nurses in interpreting or applying the law regarding consent. Any issues or questions should be directed to your organization, or you should seek legal advice.*See "Resources" below, and the BCCNM publication,
Legislation Relevant to Nurses' Practice.
Consent may be given verbally, in writing, or through an alternative communication system (e.g., computer assisted). You should ensure the client or substitute decision maker has the information needed to make an informed decision.
Consent can be implied through the behaviour of a
client3 (i.e., cooperating with your actions); however, you should also have a reasonable belief that the client is
consenting4. Implied consent is not appropriate in all cases, and you should consider whether accepting implied consent is correct when you are providing care.
In circumstances when the client's right to consent has been taken away (e.g., when a client is certified under the
Mental Health Act and deemed incapable), clients have a right to know what care is being provided.
Health Care (Consent) and Care Facility (Admission) Act outlines the requirements for some of the limited circumstances when care may be provided without obtaining consent from the client or their substitute decision maker. See the BCCNM publication
Legislation Relevant to Nurses' Practice for more information.
The Infants Act deals with consent for clients under 19 years of age. This Act uses the term "infant" to describe all minors, and provides rules to determine when a minor qualifies as "mature" and is therefore entitled to give consent to their own health care.
Understand the legal requirements for determining if a minor can provide valid consent.
Know who may give consent if your minor client cannot. (This may be affected, for example, by an agreement or court order under the
Family Law Act.)
Understand your obligation to report under the
Child, Family and Community Service Act if a mature minor or the parent or guardian of an immature minor refuses to give consent to necessary health care.
In some specific circumstances, the usual requirements related to consent may not apply. In this case, identify legislation relevant to your practice setting. Legislation may include the
Human Tissue Gift Act, the
Mental Health Act, and the
Public Health Act.
Be aware of the power dynamic between health professionals and clients/substitute decision maker, and how it may influence their decisions regarding care.
Effective communication helps to ensure a client's or substitute decision maker's health care decisions are understood, expressed, and respected by everyone involved. Some ways nurses can assist clients in communicating and understanding consent include:
Giving verbal explanations
Using visual aids and handouts
Asking clients for feedback about what they understand
Asking clients if they have any questions
Engaging any family or friends who are supporting the client to help the client understand
Helping the client obtain information from the most appropriate health professional
Using plain language, consistent terms, and age-appropriate terminology
Using the services of a qualified interpreter if a language barrier exists
Providing information through an alternate mode (e.g., using sign language).
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Scope of Practice for Registered Nurses: Standards, Limits and Conditions
Giving Client-Specific Orders
Information about legislation relevant to consent are found in the
Legislation Relevant to Nurses' Practice document.
Some examples of relevant legislation include:
*The list above is not intended to be exhaustive of all legislation that may have a bearing on the issue of consent in a particular situation. Consult your employer or seek legal advice as needed. *