Competence and the nurse-patient relationship.

Patient competence is a prerequisite to fulfilling the primary ethical principle of patient autonomy or self-determination. This article defines the legal designation of incompetence and describes the components of the assessment of a patient's decision-making capacity. These assessments occur within the context of relationships, the most influential of which is that between the nurse and patient. Attention to the nurse-patient relationship promotes patient autonomy, patient advocacy, and decision making based upon the patient's values--which is, ultimately, ethical health care.