Informed consent, confidentiality, and patient rights

Consent questions are guaranteed on the NLE. The examiners test three things: what makes consent valid, who may give it, and what the nurse's exact role is. Confidentiality and patient rights items follow the same scenario style.

Elements of valid informed consent

Consent is valid only when all elements are present:

• Disclosure: the client receives adequate information about the nature of the procedure, its benefits, material risks, alternatives, and the consequences of refusal
• Comprehension: the client actually understands the information, in a language and manner suited to him
• Voluntariness: the decision is free from force, coercion, or undue influence
• Competence (capacity): the client is legally and mentally able to decide
• Consent itself: the authorization, usually written for invasive procedures

Missing any element invalidates the consent. A signature obtained from a sedated, coerced, or uninformed client is worthless.

Roles: who explains, who witnesses

The physician who will perform the procedure is responsible for explaining it and obtaining informed consent. The nurse's role is to witness the signature, verify that the client signed voluntarily and appears to understand, and reinforce or clarify information within nursing scope. If the client shows confusion or new questions about the procedure itself, the nurse stops the process and calls the physician back; the nurse does not supply the medical explanation.

Who may give consent

Client situation	Who consents
Competent adult, 18 and above	The client himself, always first in priority
Married minor or emancipated minor	The minor, for himself
Unemancipated minor	Parent or legal guardian
Unconscious adult, non-emergency	Legal spouse or next of kin per the legal order
Life-threatening emergency, no surrogate available	No consent needed; doctrine of implied or emergency consent applies
Mentally incompetent adult	Legal guardian or judicially authorized representative

Other consent facts the exam loves: consent may be withdrawn at any time, even after signing; a general admission consent does not cover invasive procedures; refusal by a competent adult must be respected and documented, often with a waiver or against-medical-advice form; and telephone consent generally requires two witnesses on the line.

Confidentiality and data privacy

Confidentiality obliges the nurse to protect all client information, sharing it only with team members directly involved in care. In the Philippines, the Data Privacy Act reinforces this by treating health information as sensitive personal information that requires consent for processing outside legitimate care purposes. Practical rules:

• Never discuss clients in elevators, canteens, jeepneys, or on social media
• Do not photograph clients or records without proper consent
• Verify the identity and legitimate need of anyone requesting information, including relatives and media
• Charts stay in the unit; access is limited to those caring for the client

Exceptions where disclosure is legally required or permitted: notifiable diseases reported to health authorities, suspected child abuse, gunshot and stab wounds reported to police, court orders, and threats of serious harm to identifiable persons.

Patient's bill of rights

Core rights that recur on the exam: the right to considerate, respectful care; to complete information about diagnosis and treatment; to informed consent and to refuse treatment to the extent permitted by law; to privacy and confidentiality; to know the identity of caregivers; to examine and question the bill; to continuity of care; and the right to leave against medical advice after being informed of the risks. Rights imply responsibilities as well: giving accurate information and following the agreed plan of care.

Key points

• All five elements: disclosure, comprehension, voluntariness, competence, and the authorization itself must be present for valid consent.
• The physician explains and obtains consent; the nurse witnesses the signature and verifies voluntariness and apparent understanding.
• A competent adult always consents for himself and may withdraw consent at any time.
• Emergencies with no available surrogate proceed under implied consent when delay threatens life or limb.
• Confidentiality has legal exceptions: notifiable diseases, abuse, court orders, and danger to others.
• When a stem shows a sedated, confused, or pressured client signing a form, the consent is invalid; the correct action is to stop and notify the physician.