Informed Consent and the Incapable Adult

I am a brand-new manager in a long-term care facility. I have been approached by a visitor who informed me that they now hold a power of attorney for their friend who has recently been legally deemed incompetent to deal with their own affairs. What should I, as a manager, expect from the RNs who provide ongoing care?

• RNs are accountable and accept responsibility for their own actions and decisions (1).
• RNs practice in accordance with the current CNA Code of Ethics for Registered Nurses (2).
• RNs provide safe, ethical, competent, compassionate, client-centred and evidence-informed nursing care across the lifespan in response to client needs (3).
• RNs advocate for client’s rights and ensure informed consent, guided by legislation, practice standards and ethics (4).
• RNs assess client’s understanding of informed consent and implement actions when the client is unable to provide informed consent (5). Actions include involving substitute decision-makers in care planning and family meetings.
• RNs demonstrate knowledge of a substitute decision-maker’s role in providing informed consent and decision-making for client care (6).
• RNs listen respectfully to the expressed needs of clients, families and others (7).
• RNs communicate respectfully and effectively in collaboration with client, family, colleagues and others, and resolve conflict should it occur (8).
• RNs, along with other health care providers and substitute decision-makers, consider and respect the best interests of the person receiving care and any previously known wishes or advance care planning that applies in the situation (9).

Should there be additional documentation on the chart when a care decision has been made by a substitute decision-maker?

Yes. Decisions and consent for care made by a substitute decision-maker should be clearly documented on the chart according to organization policy.

CRNS Resources

Code of Ethics for Registered Nurses (2017)

Registered Nurse Practice Standards (2019)

Registered Nurse Entry-level Competencies (2019)

External Resources

Consent for the Incapable Adult, Canadian Nurses Protective Society (CNPS)

The Health Care Directives and Substitute Health Care Decision Makers Act, 2017