Patient Experience Lecture

‫وزارة الصحة‬
‫وكالة الوزارة للخدمات العالجية‬

‫االدارة العامة لشؤون التمريض‬
‫مشروع التزام العاملين بمنهجية ما قبل اإلجراء الطبي (أمانة واستنارة)‬

‫لعام ‪2020‬م‬
‫اإلدارة العامة لشؤون التمريض‬

Program Description
A Program designed for nurses in MOH. The implementation of this program will ensure the provi-
sion of safe, competent and efficient nursing care.
In alignment with national and international standards for patient centered care, this program aims
at involving, engaging and then empowering patients and family that will enhance patient satisfaction
and strengthen patient experience through the following three domains:
• Communication
• Ethics
• Quality
Enhancing communication between patient and nurses will involve and engage patient in the nursing
process. Prior to any nursing procedure, patient must be involved in the decisions related to his health
by seeking his verbal or written consent as it is ethical practice and required by standard of care. The
outcome of the communication and maintaining ethical practice through involvement and engagement
will lead to patient empowerment that will enhance nursing care quality and patient experience as an
ultimate outcome
Quality Care
Patient Experience
Ethics: Involve- En-

Communication
gage- Empower
Objectives of the program:
By the end of the course the participants will be able to:

1.Identify the importance of the IDC program.
2.Promote a culture that encourages effective communication within the health. professional team
that meets patients and family expectations.
3.Identify the correct way in explaining the nursing procedures and complications.
4.Understand the legal and ethical aspects of giving informed consent.
5.Assurance of quality in providing the mechanism to effectively communicate ,explain procedure
and taking the informed consent probably.
Target group:
- Qualified in Nursing Science in MOH hospitals and Primary health Care centers.
Requirements must be met before practicing the profession:
- A classification from the Saudi Commission for Health Specialties.

- A valid professional registration.
- A valid CPR license.
Place of residence:
In the health facility where the nurse works or geographical area according to the possibility of
training
Stages of program implementation
‫املرحلة الثالثة‬ ‫املرحلة الثانية‬ ‫املرحلة األولى‬
Third Stage Second stage First stage
‫التقييم النهائي‬ ‫حصر الفئة املستهدفة والتقييم‬

‫البدء بتنفيذ الدورة التدريبية‬
‫املبدئي‬
Post test Training Course
Target Group & Pre test
Operational plan :
1. Launch of the organizational plan (circular and its number).

2. Determine the number of nursing.
3. Announcing the start date of the program implementation, the approved training
plan and the advantages of IDC program.
4. Forming an internal committee in each health facility to implement the IDC pro-
gram training plan.
5. Start the implementation of the program stages
6. Evaluating the program by measuring indicators.
Training Plan
Time Line
Activities
Subject
1 2 3 4
Communication Pre test Lecture Training activity Post test
Code of Ethics Pre test Lecture Training activity Post test
Nursing of Quality Pre test Lecture Training activity Post test
Terminologies Definitions:
IDC Refer to :
Identification , Describe & Consent
Trainer:
Person who transmits the message (training content) through a communication channel (training methods)
to the recipients (trainees) and the trainer is core of training process.
Trainee:
Individuals who receive training content and understand, demonstrate and the application of what is being
trained.
Training method:
It is the training tool that are used by the instructor in delivering the training content or skill to the trainees,
taking into account the individual differences.
Training environment:
All the influences surrounding the place and the personnel associated with training are the equipment , hall,
the equipment and the facilities available, etc.
‫‪The Scientific Content‬‬

‫‪Effective Communication‬‬
The Framework of Learning objectives:

At the end of the course the participant will able to:
• Identify what is communication and why is it important.
• Understand the communication process.
• Describe types and methods of communications.
• Describe styles of communication.
• Understand effective communication skills.
• Explain common communication mistakes.
What is communication & Why is it important
WHAT IS COMMUNICATION?
The term communication refers not only to presenting factual information but to hearing and reflect-
ing what is said'. Another way of understanding it is to see it as the act of transferring information from
one person to another. While this looks and sounds simple, if we consider the many ways we com-
municate it becomes a lot more complex.
IMPORTANCE OF COMMUNICATION :
• To provide treatment while the patient is there to receive treatment.
• To learn how to manage aspects of their own treatment.
• To inquire, inform, persuade, entertain, request and investigate.
• To convey information/opinion, for example, “I have headache” or “I am
here to give you medication”.
• To request information/opinion/behavior, for example, “Are you allergic to
penicillin?” or “Tell me more about the injury”.
• To give social acknowledgement, for example, “Hello” or “Good morning”.
Why is good communication necessary?

Most people qualifying in nursing and the medically related professions do know of
the importance of clear and regular communication.
If communication between nurse and patient is clear, concise and spoken in a language
understandable to the patient, then the patient can feel less anxious and stressed and
there is less chance of confusion and misunderstanding. It also allows for a different
type of relationship in which the patient becomes more of a participant in their treat-
ment and not simply a passive recipient.
COMMUNICATION PROCESS
Linear model of communication entails a sender a message, a receiver and noise
Interactive model of communication gives a slightly more complex explanation of the
communication process
Methods of communications
• One-Way
Memo, fax, e-mail, voice mail, letter.
• Two-Way
Phone call, in-person
• Collaborative
Team meetings, consulting, consensus, decision making, group problem solving.
WHY IS GOOD COMMUNICATION IMPORTANT?

Good communication results in;
• BETTER - understanding.
• CLARITY - what is happening and why. What needs to happen.
• COMPLIANCE - where there is clarity and understanding in communi-
cation, patients are able to follow health care recommendations.
• CONTROL - patients who request information and receive it will feel
more in control of their treatment plan.
• ADDRESSED - when issues are addressed, fear and anxiety are reduced.
The two principal ways we communicate is

through the spoken word
(verbal) and through body language (non verbal)
Verbal Communication:
When we think of verbal communication it is difficult to separate it from the other means of commu-
nication also present and at work, for example, non verbal communication, capacity to listen, reflect
and clarify.
Before meeting the patient it may be useful to think through the following:
• WHAT - is it I want to learn about the patient or for the patient to under-
stand, for example, an aspect of their illness or treatment?
• THINK - what is the clearest and most concise way I can communicate with
this patient, for example, breaking down information into manageable chunks.
• NEED - what information or resources do I then need to give that will result
in this understanding?
• AWARE - are they likely to be stressed or anxious or have other issues that
mean they may not be able to take in the information.
• REPEAT - therefore I may have to repeat or rephrase what I said a number
of times.
• CHECK - how am I going to check that the patient has grasped clearly the
information given?
When verbally communicating with the patient be aware of:
• TONE - the way you say something, the tone you use will influence how
your message is received by the patient. If your tone is too aggressive the pa-
tient may feel intimidated and less inclined to ask questions or respond. If
your tone is too soft, then the patient may not take seriously what you are
saying.
• SPEAK - with confidence: if you speak with confidence then you speak
with a self-assurance which conveys knowledge and understanding of what
you are saying.
• BE CLEAR - you need to be clear about what you want to say. If you are vague or
uncertain this may cause confusion.
• PRIOR KNOWLEDGE - ask what they already know about the topic for dis-
cussion. 'what do you already understand about.......'.
• BE CONSCISE - ask yourself: 'is the patient looking confused and getting lost in
my words?'
• DONT TALK TOO MUCH - if you give the patient too much Information in
one go, they may not be able to take it all in. Always check that the patient is clear about
each aspect of what is being said before moving on.
• FOCUS - on your body language: when speaking face to face with a patient your body
language can play a more significant role than you imagine and can communicate far more than the words
you use.
• LISTEN - not only listen to what the patient says to you but also listen for
the message the patient may give either through the questions they ask or
through any comment they may make. Remember even if the patient says
nothing and asks no questions, this is a communication which may be signifi-
cant and therefore should be checked out. A possible question could be; can
you recall what it is I said to you?
Communicate Affectively with patient?

Showing Acceptance – When talking to patients show them that you are listening care-
fully.
Offering Yourself – Make it clear that you are there to serve their health care needed
Paraphrasing – Always paraphrase to enhance understanding and rapport.
Non Verbal Communication
Non verbal communication is mediated through the language of our body. Posture,
eye contact, facial expressions are examples of nonverbal communication.
Non verbal communication is mediated also through the fol-

lowing:
• PLACE - where the communication takes place, for example, a
dialysis unit, waiting room, hospital corridor or clinic room.
• PEOPLE - the people involved.
• CULTURE - the culture of the participants.
What are some of the different types of non verbal

communication?
BODY MOVEMENTS - nodding or shaking of the head, emphasizing what is be-

ing said using hand gestures.
• POSTURE - crossing arms can indicate a reluctance to ask or answer questions.
Standing over someone can be seen to be overbearing. Sitting at the same level allow
more 'equal conversation' and indicates you have time to talk and you may appear
more relaxed and confident.
• EYE CONTACT - maintaining eye contact (without staring) conveys trust and
engagement.
• LANGUAGE - not only what is said but also the tone and pitch of the voice. Also
the speed at which speech occurs.
CLOSENESS - it is important to respect personal space and how close you sit may
depend on what the communication is all about. Touch can be useful and reassuring or
can be taboo so consider carefully the value of touching the patient when communi-
cating with them.
• FACIAL EXPRESSIONS - being aware of both yours and their facial expres-
sion is really important when you speak or listen to a patient.
Effective Communication Skills
For any communication to be effective the nurse should be 'familiar with the
patient's needs, pick up the cues from the patient, give the right information at
the right kind of pace‘ .
Common Communication Mistakes:

Mistakes and poor communication can becaused by:
• ATTITUDE - of the nurse
• LANGUAGE - specialized
• LOCATION - where the communication takes
place is inappropriate
• INFORMATION - not clear
• LACK OF AWARENESS - how the nurse is communicating, e.g. non verbal, tone
of voice
What inhibits good communications?

• There are a number of factors that inhibit communication. You
many have seen or experienced some of these factors that inhibit
conversation:
ATTITUDE:
• Assuming you know what is best for the patient without consulting them.
• Feeling you have to be responsible for everything.
• Imposing your values, expectations and opinions on the patient.
• Not asking the patient what they know.
• Letting resentment or irritation dictate how you care for the patient.
LANGUAGE:
• Information is often given using specialized language the patient is unfa-
miliar with. This can evoke a passive response from the patient leading to a
type of parent/child relationship between nurse and patient .
• Some patients find it difficult to put into words what concerns them. You
may need to use gentle questioning to find a way to overcome this barrier.
PLACE:
• Information given within a hospital context can often inhibit good com-
munication. For many patients going to hospital makes them anxious mak-
ing them poor listeners and limiting their capacity to retain the information
given.
• The patient's diagnosis and treatment can affect their self-image. Frequent
hospital visits will impact both on their capacity to communicate and to take
in information given.
‫‪Barriers to Effective Communication‬‬

 Complex systems: excessive use of direct, yes or no and why ques-

tions.
 Continuity gaps and switching topics.
 Showing power: ordering, threatening, commanding or directing.
 Time constraints
 Volume of information
 Confidentiality
 Attacking: criticizing, blaming or shaming.
 Limitations of learning & training

 Staring at patient or avoiding eye contact.
 Very relaxed or very tense gestures.
 Quick or slow movement.
 Unfriendly atmosphere (e.g., the decoration of the clinic).
 Very low tone or loud voice.
Case Study-1
The patient is a twenty one year old female. Her symptoms are severe headaches and
vomiting with high blood pressure. Her GP refers her to hospital. Her Consultant wants
her to remain in hospital for further tests. As she has just started a new job she is
reluctant to take time off. The Consultant and she agree that further tests can be carried
out on an out-patient basis, provided all tests are completed within a week. At her
subsequent appointment her Consultant insists she be admitted to hospital for further
tests. Two days later while she is alone in her ward, her Consultant informs her she has
end stage renal failure, will need to commence dialysis and be assessed for a
transplant. Having given this information, the Consultant leaves.
Questions for reflection
• What do you think her priorities are right now?

• How do you imagine she reacted to this information?
Do you agree with the way the Consultant gave the diagnosis. If not, how could it have
been done differently
Case Study - 2
A year ago the patient was diagnosed with IGA Nephropathy. They attend on an out-
patient basis regularly. The patient is on blood pressure medication, and on a strict diet.
Dialysis has been
mentioned. While no date has been finalized, the patient is aware that dialysis is not
too far away.
The patient is sent to you for more education about dialysis options. However as soon
as you begin to talk, the patient bursts into tears.
Questions for reflection

• What is your immediate reaction and style of language?
• If this happened to you, what would you then do to help this pa-
tient?
• Having read this book, are there any pointers that would allow you
to
• respond in a positive and supportive way to this patient?
Legal & Ethical Nursing aspects
Objectives:
By the end of this presentation, nurses will be able to:

1. Define “Nursing Ethics” and “Informed Consent”.
2. Empower patient and family through Informed Consent
3. Understand the importance of Nursing Ethics while obtaining
consent form for nursing procedures
4. Enhance nurses role as patient advocate by understanding the
ethical and legal aspects related to Informed Consent
Definitions
Ethics: The moral principles that govern a person’s behavior or the con-
ducting of an activity.
Nursing Ethics: is a branch of applied ethics that concerns itself with activ-
ities in the field of nursing. Nursing ethics shares many principles with
medical ethics, such as beneficence, non-maleficence and respect for auton-
omy. It can be distinguished by its emphasis on relationships, human dig-
nity and collaborative care.
Nursing Code of Ethics: Is a guide for carrying out nursing responsibilities
in a manner consistent with quality in nursing care and the ethical obliga-
tions of the profession.
Informed consent: is the process by which a patient learns about and un-
derstands the purpose, benefits, and potential risks of any procedures, in-
cluding clinical research trials, and then agrees to receive the treatment or
participate in the trial
Introduction:
The patient has the freedom to decide what should or should not happen to
his or her body, as well as to gather information before undergoing any pro-
cedure or treatment. No doctor, Nurse, hospital, or clinical researcher can
certainly avoid legal liability with informed consent.
1. Ethical Aspects
Nurses may strive to ensure patient autonomy and rights through appropri-
ate participation in the informed consent process.
Nevertheless, compliance with legal and regulatory requirements as well as
ethical and patient family concerns can make the concept of informed con-
sent challenging.
As patient advocates and direct care providers, nurses have a unique oppor-
tunity to meaningfully advocate for mutual decision making, a process that
promotes:
(a)Patient Autonomy,
(b) Patient Education
(c)Patient Comprehension
(d) Self-Determination.
Patient Autonomy
Expressing respect for patients’ AUTONOMY means: ACKNOWLEDGING
THAT PATIENTS WHO HAVE DECISION-MAKING CAPACITY HAVE THE RIGHT TO
MAKE DECISIONS REGARDING THEIR CARE, EVEN WHEN THEIR DECISIONS
CONTRADICT THEIR CLINICIANS’ RECOMMENDATIONS
It is evident that some nursing care procedures have the potential to infringe
patient autonomy if undertaken without consent. Furthermore, these proce-
dures may not be easily identifiable
Self Determination
The ethical principle of self-determination is a subset of autonomy.
PATIENT EDUCATION
Consent forms are potential meaningful education tools that nurses may use
as springboards into important discussions about what to expect before and
after nursing procedure.
Nurses as health care professionals may, within the scope of the informed
consent process, move beyond simply informing a patient of risks to actu-
ally educating a patient.
Approaching the informed consent process for a nursing procedure using an

educational model may result in liability reduction by serving to develop an
alliance between the patient and the nurse
PATIENT COMPREHENSION
Comprehension of the information provided is a precondition for obtaining
a valid informed consent.
Ideally, a patient would demonstrate full comprehension, but the practical
application of that ideal can be problematic in implementation. Important
factors such as (a) the disease itself, (b) anxiety, (c) pain, and (d) various
therapeutic interventions can hinder a patient's ability to participate in
shared decision making.
To maximize comprehension, information should be carefully provided in a
manner that increases patient understanding of what is being explained.
Nurses could contribute toward maximizing comprehension by using a re-
peat-back process on comprehension after informed consent discussions by
asking patients to recount what they had learned in the informed consent
discussion.
The repeat-back methodology has been shown to have an effect on patient
comprehension of information disclosed during informed consent for nurs-
ing procedure.
2. Legal Aspects:
An “informed consent” signed by the patient, from a legal standpoint, is not

the actual consent but evidence that the patient is consenting to a particular
procedure at a given time.
Legally, no one has the right to touch, let alone treat another person without
permission. This would be classified as “battery” — physical assault — and
is punishable by law. From this, one might say obtaining consent is neces-
sary for anything other than a routine physical examination.
The only time a consent is not necessary is in the event of an emergency, in

which case a doctor may have to operate in the absence of consent to save
the life of the patient.
A patient has to be given the opportunity to ask questions and clarify all
doubts. There must not be any kind of pressure. Consent must be voluntary,
and a patient should have the freedom to revoke the consent. If consent is
given under fear of intimidation, or if it includes misconceptions or misrep-
resentation of facts, it can be considered invalid
Where there may be doubt that the consent is legal because of the capacity
of the patient (e.g. – a person under 18 years of age or with a significant
mental health condition), then the opinion of the treating practitioner (that
the patient is able to consent) should be documented
Nurses should keep the following principles in mind when in doubt

about how to interpret the legislation.
• Clients have a legal and ethical right to information about their
care and treatment, and a right to refuse that treatment.
• Regardless of whether consent has been obtained by the nurse,
nurses should always explain to the client the treatment or proce-
dure they are performing.
• Nurses should not provide a treatment if there is any doubt about
whether the client understands and is capable of consenting. This
applies whether or not there is an order, or even if the client has al-
ready consented.
• Consent can be withdrawn at any time.
• Nurses need to advocate for clients’ access to information about
care and treatment if it is not forthcoming from other care provid-
ers.
• Informed consent does not always need to be written, but can be
oral or implied
Conclusion:
Nurses are obligated to provide ethical and legal patient care that demon-
strates respect for others.
Informed Consent must be obtained prior to any nursing procedure or treat-
ment. This is unrestricted by considerations of age, color, creed, culture,
disability or illness, gender, nationality, politics, race or social status
Test;
Q1: Nursing Ethics could be defined as:
a. The process by which a patient learns about and understands the
purpose, benefits, and potential risks of any procedures
b. A branch of applied ethics that concerns itself with activities in
the field of nursing
c. Moral principles that govern a nursing behavior during conduct-
ing a nursing activity.
d. B & C only
Q2: All statements are true about Informed Consent except:

a. It defined as the process by which a patient learns about and un-
derstands the purpose, benefits, and potential risks of any proce-
dure
b. Informed Consent can be withdrawn at any time
c. In absence of “Informed Consent”, nurses could proceed with a
nursing procedure or treatment
d. Informed consent does not always need to be written, but can be
oral or implied
Q3 Nurses have a unique opportunity to meaningfully advocate for mu-

tual decision making, a process that promotes:
(a)Patient Autonomy,
(b) Patient Education and Patient Comprehension
(c)Self-Determination.
(d) All of the above
Q3 Nurses could contribute toward maximizing comprehension by us-

ing a repeat-back process on comprehension after informed consent
discussions by asking patients to recount what they had learned in the
informed consent discussion.
(a)True
(b) False
Q3 Nurses are not obligated to provide ethical and legal patient care
that demonstrates respect for others.
(a)True
(b) False
‫‪Quality Of Care‬‬
Introduction
 A program designed for the nursing candidates in MOH . Implemented
to ensure the efficiency of the nurse to provide safe nursing care.
 This program will focus on the following tree domains:
 Communication
 Ethics
 Quality
 In this lecture, our special interest lies in the connection between the
quality of nursing care and patient education regarding informed con-
sent.
 The evaluation of the quality of informed consent is a fundamental re-
sponsibility of all professionals in all areas which needs surgical inter-
vention.
 Focus on patient education is thus key when it comes to improving the
patient-centred quality of care.
 On the part of professionals, patient education requires a lot of time,
competence to use different types of material, programms and instru-
ments, and skills to evaluate the empowerment of patients.
Objectives:
1. To provide an interdisciplinary aproach to meeting the health care educa-
tional needs of our patients and their famlies.
2. To ensure that patients and families are provided with quality education
that increases their knowledge regaring the disease process and
treament plan.
3. To ensure staff compliance toward the guidelines of pt. & family docu-
mentation procedure.
Definition:
— Patient & Family Education:

Provision of individualized quality education that would increase
knowledge and skills of patients regarding the disease process, treatment
plans and treatment alternatives.
— Quality assurance (QA) is a way of preventing mistakes and de-
fects in manufactured products and avoiding problems when deliv-
ering products or services to customers
Health Care Professionals:
any individual who are involved in developing or implementing the
health care plan and may include but is not limited to nurses, physicians,
social workers, physical therapists, health educators, pharmacists, and
dieticians involved in the delivery of health care teaching.
Policy/Form:
— The policy and form that related to multidisciplinary patient and
family education and informed consents need to be prepared,
shared to the staff, and monitored.
In assessing patient's needs, abilities, and readiness for education, staff

members should take into account such variables as:
1- The patient's and/or family's beliefs and values, including cultural.
2- The literacy, education level, and primary language of the patient
and/or family.
3- Emotional barriers & motivation
4- Physical & cognitive limitations.
5- Learning preference.
Educational Methods
Educational methods may include, but not be limited to:
1. Individual / Group teaching
2. Printed materials
3. Audio and/or visual aids
4. Demonstrations
— The hospital takes efforts to ensure that adequate and appro-

priate resources are available for:
1. When appropriate & as available, education &/or educational
materials will be provided in patients primary language, other-
wise in Arabic or English.
2. The focus of the education program will include, but not .2
limited to, instruction in specific knowledge &/or skills
needed by the pt./family to meet the pt’s. ongoing health care
needs during the pt’s. hospital course of stay.
Family Education
— Instructions are provided to FAMILY MEMBERS when the patient
is unable to comprehend the instruction in situation such as:
1. Unconscious.
2. Learning disability.
3.Children.
Teaching Focus
ITEM PROVIDER
The disease process, Physician

condition, treatment op-
tions, prognosis and / or
health promotion
Nutrition Interventions
Physician / Dietitian /Nurse/Midwife
Medication Usage, ef- Pharmacist

fect, and interaction
Daily activities, safe and Physician/

effective use of equip- Physiotherapist
ment exercises and / or
rehabilitation technique
Available community re-

source and follow-up (to
be filled up by Social Social Worker
Worker)
Patient care education Nursing Staff
Additional Information All as needed

‫‪Nursing Role:‬‬
Nursing Role:
1. Self-Care Needs:
 The RN completes an initial comprehensive assessment at the time of ad-
mission. At this time, self-care needs are identified and addressed in the pa-
tient's plan of care. The staff nurses will provide education, with special
concerns referred to the appropriate discipline.
2- Safe and Effective Use of Medications.
The Nursing and Pharmacy staff provide education about specific medications admin-
istered as necessary Medication education should include as appropriate:
— The name and description of the medication.
— The dosage, route of administration, and duration of the medication therapy.
— Intended use and expected actions of the medication therapy.
— Special directions and precautions for preparing, self-administering or using
the medication by the patient.
— Significant side effects.
— Proper storage and expiration of medications.
— Prescription refills.
— Drug-food interactions.
— Proper disposal of unused or expired medications, especially controlled sub-
stances.
— Other information specific to the patient or medication therapy.
3. Diet and Nutrition:
— At the time of admission, nutritional educational needs are identified. The

staff nurses will provide diet education, and as appropriate, the dietitian will
educate patients regarding prescribed modified diets. Additionally, the dieti-
tian may provide education on potential food-drug interactions. All patients
receive medications instruction at the time of discharge and potential food-
drug interactions are included in this information.
‫‪Consents‬‬
‫‪The Difference Between General Consent and Informed‬‬

‫;‪Consent‬‬
— General consent: is required before the patient can be examined or

treated or before minor testing (such as lab work or routine imag-
ing studies) can be done.
— Informed consent is required (generally) before an invasive proce-
dure that carries a material risk of harm can be performed. Invasive
procedures can include anything from a root canal to major sur-
gery. If the patient’s informed consent is required, the provider
must discuss the risks and benefits of as well as the alternatives to
the proposed procedure.
—
Consents
 All items on the consent form must be completed, signed, and
dated according to the policy of the hospital.
 The consent form must be completed in English for non-Arabic
speaking patient / and in Arabic for Arabic speaking patient.
 Except for life saving;
 PROCEDURES can be performed without written consent
signed by the patient or authorized family member.
 It is required to have signatures of two (2) physicians in the con-
sent form and documented in the Medical Record.
Consent types
General Consent
1.
Informed consent for surgical/medical procedure
2.
Anesthesia/sedation consent
3.
Dialysis consent
4.
Chemotherapy consent
5.
Consent for blood/blood components transfusion
6.
Physician’s role in obtaining informed consent
— The physician provides the client with complete information about:
 The treatment or procedure
 The potential risks including pain and complications
 The benefits of the treatment or procedure,
 Who will perform the planned treatment or procedure

 Any possible alternatives to the treatment or procedure including
their benefits and risks.
Nurse’s role in obtaining informed consent

— The nurse is responsible and accountable for the verification of and
witnessing that the patient or the legal representative has signed
the consent document in their presence.
— The patient, or the legal representative, is of legal age and compe-
tent to provide consent.
— Confirm that the patient has sufficient knowledge to make a
knowledgeable decision.
Patient’s role in obtaining informed consent

— The patient or their legal representative must give consent voluntar-
ily and without any coercion by others.
They must ask questions and clarify things until they are certain about the
procedure, the benefits, the risks, and possible alternatives
— Questions?
— What is the nurse’s role in obtaining informed consent?
1. Provide information about the treatment or procedure.
2. The benefits of the treatment or procedure
3. The potential risks including pain and complications

4. verification and witnessing
— In assessing patient's needs, abilities, and readiness for education,

you should take into consideration:
1. The literacy, education level, and primary
2. language of the patient and/or family.
3. Emotional barriers & motivation
4. All of the above.
Instructions are provided to family members when the patient is:

1. Conscious
2. Unconscious
3. Oriented
4. Aware to sign the consent
Is this statement TRUE or FALSE?

— Informed consent is required before the patient can be examined or
treated or before minor testing e.g lab work or routine imaging stud-
ies. (FALSE)
—
References:
• Pagano, Michael( 2016) P., Dr., PhD, Communication for Healthcare Profession-
als : An Applied Approach ISBN:9780826124425,Springer Publishing Com-
pany
• Raphael-Grimm, Theresa, (2014)PhD, CNS The Art of Communication in Nurs-
ing and Health Care : An Interdisciplinary Approach ISBN:9780826110565
Springer Publishing Company
• AMA J Ethics. 2016;18(1):12-17. doi: 10.1001/journalofeth-
ics.2017.18.1.ecas2-1601.
• AVEYARD H. (2002), The requirement for informed consent prior to nurs-
ing care procedures, Journal of Advanced Nursing 37(3), 243-249
• Central Board for Accreditation of Healthcare Institution, National Hospital
Standards, 5th Edition, 2018
• College of Nurses of Ontario, 2017, Consent, Practice Guideline
• International Council of Nurses, The ICN Code of Ethics for Nurses, 2012
• Joint Commission International Accreditation standards for Hospital, 6th
Edition, 2017
• Menendez, J. B. (2013). Informed consent: essential legal and ethical princi-
ples for nurses. JONA'S healthcare law, ethics and regulation, 15(4), 140-
144.
• Victorian Government (2012) Medical Treatment Act 1988. http;//www.leg-
islation.vic.gov.au
• •Saudi Central Board for Accreditation of Healthcare Instituations. 2015. Na-
tional Hospital Standards. CBAHI. 3rd edition.2015. https://por-
tal.cbahi.gov.sa/english/accreditation-programs/hospital-accreditation-program
‫اللجنة الفنية إلعداد الحقيبة التدريبية ملشروع التزام العاملين بمنهجية ما قبل اإلجراء‬
‫الطبي (أمانة واستنارة) لعام ‪2020‬م‬
‫رئيس اللجنة‪ /‬اإلدارة العامة لشؤون التمريض‬ ‫د‪ .‬فهد بن سالم البلوي‬
‫تهاني علي الخليفة‬
‫اإلدارة العامة لشؤون التمريض‬ ‫سامية فارس الزهراني‬
‫تهاني سعد الغامدي‬
‫مدير التعليم التمريض ي بالتجمع الصحي باملنطقة الشرقية‬ ‫د ‪ /‬عادل حرب‬
‫إدارة التمريض بصحة الرياض‬ ‫مشاعل القويعي‬
‫مدينة امللك فهد الطبية‬ ‫خالد جمال األطرش‬
‫مستشفى امللك فهد بالهفوف‬ ‫أ‪ /‬محمد الخلف‬
‫مدير التعليم التمريض ي بمدينة امللك سعود الطبية‬ ‫أ‪ /‬حسن العبس ي‬

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‫وزارة الصحة‬

‫وكالة الوزارة للخدمات العالجية‬

‫مشروع التزام العاملين بمنهجية ما قبل اإلجراء الطبي (أمانة واستنارة)‬

‫اإلدارة العامة لشؤون التمريض‬

Ethics: Involve- En-

Objectives of the program:

By the end of the course the participants will be able to:

Requirements must be met before practicing the profession:

- A classification from the Saudi Commission for Health Specialties.

Stages of program implementation

‫املرحلة الثالثة‬ ‫املرحلة الثانية‬ ‫املرحلة األولى‬

Third Stage Second stage First stage

‫التقييم النهائي‬ ‫حصر الفئة املستهدفة والتقييم‬

1. Launch of the organizational plan (circular and its number).

Communication Pre test Lecture Training activity Post test

Code of Ethics Pre test Lecture Training activity Post test

Nursing of Quality Pre test Lecture Training activity Post test

‫‪The Scientific Content‬‬

The Framework of Learning objectives:

What is communication & Why is it important

Why is good communication necessary?

WHY IS GOOD COMMUNICATION IMPORTANT?

The two principal ways we communicate is

When verbally communicating with the patient be aware of:

Communicate Affectively with patient?

Non Verbal Communication

Non verbal communication is mediated also through the fol-

What are some of the different types of non verbal

BODY MOVEMENTS - nodding or shaking of the head, emphasizing what is be-

Effective Communication Skills

Common Communication Mistakes:

What inhibits good communications?

‫‪Barriers to Effective Communication‬‬

 Complex systems: excessive use of direct, yes or no and why ques-

 Limitations of learning & training

Questions for reflection

• What do you think her priorities are right now?

Questions for reflection

Legal & Ethical Nursing aspects

By the end of this presentation, nurses will be able to:

MAKE DECISIONS REGARDING THEIR CARE, EVEN WHEN THEIR DECISIONS

CONTRADICT THEIR CLINICIANS’ RECOMMENDATIONS

Approaching the informed consent process for a nursing procedure using an

An “informed consent” signed by the patient, from a legal standpoint, is not

The only time a consent is not necessary is in the event of an emergency, in

Nurses should keep the following principles in mind when in doubt

Q2: All statements are true about Informed Consent except:

Q3 Nurses have a unique opportunity to meaningfully advocate for mu-

Q3 Nurses could contribute toward maximizing comprehension by us-

— Patient & Family Education:

In assessing patient's needs, abilities, and readiness for education, staff

— The hospital takes efforts to ensure that adequate and appro-

The disease process, Physician

Medication Usage, ef- Pharmacist

Daily activities, safe and Physician/

Available community re-

Patient care education Nursing Staff

Additional Information All as needed