Aveyard Helen
School of Health Care, Oxford Brookes University, UK.
J Adv Nurs. 2002 Jul;39(2):201-7. doi: 10.1046/j.1365-2648.2002.02260.x.
THE AIM OF THE PAPER is to demonstrate the nurses should be wary of relying on the concept of implied consent prior to nursing care procedures.
The difference between a patient who implies consent and who merely complies with a procedure is almost undetectable.
An exploratory study, incorporating use of focus groups and critical incident technique to examine the way in which nurses obtain consent prior to nursing care procedures.
Many nurses administer care without seeking verbal or written consent, but claim that the patient's consent is implied. However, there is evidence that care is often administered in the absence of information-giving and that this perceived implied consent should more realistically be called compliance. Implied consent is consent for which information is a crucial component. There is evidence that the term implied consent signifies different things to different nurses. Furthermore, even if there is agreement about what constitutes implied consent, in practice, implied consent may be indistinguishable from compliance. Nurses who assume that they have the patient's implied consent, when in reality only have compliance, risk carrying out care procedures without the patient's consent.
Nurses should be familiar with the principles of implied consent. They should be wary of relying on the use of implied consent prior to nursing care procedures because of the difficulty in distinguishing implied consent and compliance. Nurses should approach all aspects of care-giving with the offer of information. In order to reduce the risk of misinterpretation of a patient's implied consent, they should seek the verbal affirmation of a patient prior to a nursing care procedure. Where nurses rely on the patient's implied consent, they should do so at their own discretion and with full understanding of the meaning of the term.
本文的目的是证明护士在护理操作前应警惕依赖默示同意的概念。
默示同意的患者与仅仅配合操作的患者之间的区别几乎难以察觉。
一项探索性研究，采用焦点小组和关键事件技术来考察护士在护理操作前获取同意的方式。
许多护士在未寻求口头或书面同意的情况下实施护理，但声称患者的同意是默示的。然而，有证据表明，护理通常是在未提供信息的情况下进行的，这种被视为默示同意的情况实际上更应被称为配合。默示同意是以信息为关键组成部分的同意。有证据表明，默示同意这个术语对不同的护士意味着不同的事情。此外，即使对于什么构成默示同意达成了一致，在实践中，默示同意可能与配合难以区分。那些认为自己得到了患者默示同意而实际上只有配合的护士，有可能在未经患者同意的情况下实施护理操作。
护士应熟悉默示同意的原则。由于难以区分默示同意和配合，他们在护理操作前应警惕依赖默示同意的使用。护士在提供护理的各个方面都应提供信息。为了降低对患者默示同意的误解风险，他们应在护理操作前寻求患者的口头确认。当护士依赖患者的默示同意时，应自行决定并充分理解该术语的含义。
