Welcome to the final chapter p of the Health Care Consent Module. During this chapter you will have the opportunity to complete the questions and scenarios from chapters 1 to 3. Completing chapter 4 may be used for self-review, to help you assess your own understanding and to identify areas that may require additional review. review This chapter may be completed on its own own, but it does not replace the opportunities to learn from the previous three chapters. Additionally, the completion of the E-Learning module on consent does not replace the review of the Briefing Note to the Health Care Consent Act or the Health Care Consent Act itself. After the conclusion of this chapter please let us know what you thought about this chapter by completing a brief survey.

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Chapter p 4 of the Health Care Consent E-Learning g Module contains seven ‘Test Your Knowledge’ questions. Additionally, questions related to 11 case scenarios are also included in this chapter. y leave this chapter p at any y time to return to a p previous You may chapter for additional review Let’s begin…

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Match the type yp of consent with the most appropriate pp p law. To answer, click a law on the left, then drag and release it over the matching statement on the right. O Once you have h completed l t d your selections, l ti click li k submit. b it

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Read this statement and decide if the answer is true or false. Once you have made your selection, click submit to continue.

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After 2 sessions of ultrasound a p patient decides she does not want to continue the treatment. When obtaining her original informed consent, the physiotherapist explained that she might require 6-10 sessions to see positive results. The patient understood and agreed to this treatment. Can consent be withdrawn now that the treatment plan is being carried out? Choose the correct response and click submit to continue.

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The health care p practitioner p proposing p g the treatment is responsible p for determining if the patient is capable to provide consent. Choose the correct response, then click submit to continue.

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Edith,, 89,, lives independently p y in an apartment. p The physiotherapist that has assessed Edith in her home has determined that she does not have the capacity to provide consent for her physiotherapy treatment. The physiotherapist needs to advise Edith of her determination of incapacity and include Edith in the decision-making to the extent that this is reasonably possible.

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Because Edith is alone when the p physiotherapist y p p performs her assessment, the physiotherapist can initiate the treatment and find a substitute decision-maker later. Choose the correct response and click submit to continue.

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Edith asks her daughter, g , Jane,, to speak p with the p physiotherapist. y p Jane tells the physiotherapist that she is responsible for making her mother’s health care decisions.

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How should the p physiotherapist y p confirm that Jane is the substitute decision-maker? Select the most correct answer and click submit to continue.

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After a few sessions with Edith,, the physiotherapist p y p is concerned about her pain medication. Edith has mentioned that the ‘pills make no difference’ and she is spending greater periods of time in bed. The physiotherapist’s concern has prompted a call to the family doctor to discuss Edith’s symptoms.

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When the p physiotherapist y p shares Edith’s subjective j information,, observations, and clinical opinions with the doctor, what consent law should be considered? Select the most appropriate response and click submit to continue.

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Let’s look at an example… p Consider Joanne, a physiotherapist treating a child with cerebral palsy. Joanne has recently taken a course that offers an alternative way to address the increased tone in the child’s leg muscles. She has already y determined that the yyoung g child does not have the capacity to consent to this treatment so Joanne speaks with the parents who are the substitute decision-makers.

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Joanne is so convinced of the effectiveness of this treatment that she doesn’t think to tell the parents about some of the alternatives to this treatment. As well, Joanne describes the potential benefits in great detail but omits the potentially painful side effects.

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Based on this example, p , tryy to answer the following gq questions. Click on ‘submit’ once you have selected your answer. If the parents agree to the treatment, will consent be fully informed?

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Has the p physiotherapist y p misrepresented p the treatment in any y way? y

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Janet was asked to treat Dave’s p patients because he called in sick. She reviewed the charts and noted what treatments were being provided. In each chart Dave has documented that he obtained informed consent for a treatment plan.

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Read through g the following g statements and select the most correct answer. Click submit to continue.

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Let’s work through g an example. p Vivian just had a knee replacement yesterday. At the preadmission clinic, Vivian received information about the surgery and the treatment that would be required afterwards including the physiotherapy p y py care map. p She asked a few q questions and agreed g to the plan. Muhammad is the physiotherapist that visits Vivian the day after surgery to assess Vivian and begin the treatment protocol. patient reacted Muhammad reviews the chart and notes that the p poorly to the anaesthetic. When he arrives at Vivian’s room she is confused, aggressive and uncooperative. She is, in effect, refusing treatment.

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In this scenario Vivian is refusing g treatment that she consented to during the pre-admission clinic. Her capacity is reduced following surgery. Read the statements and select the most appropriate action, then click submit to continue.

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In this scenario Vivian is refusing g treatment that she consented to during the pre-admission clinic. Her capacity is reduced following surgery. Read the statements and select the most appropriate action, then click submit to continue.

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Zoe,, the physiotherapist p y p support pp p person is supervising p g Ajay, j y, a patient, while he is crutch walking. The physiotherapist has already obtained consent for treatment and for Zoe’s participation in treatment. j y are walking g together g Ajay j y has q questions about While Zoe and Ajay the treatment for his fractured femur.

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Read the three statements and select the most appropriate pp p response. After selecting your response, click on submit to continue.

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Read the statements and select the most correct answer and click submit to continue.

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An 80 y year old p patient,, Mrs. Tam has declined a treatment proposed by Jim, the physiotherapist. He has explained that this treatment is the most effective treatment available for the condition. Jim has explained the side effects, benefits and the associated risks of declining the treatment. He believes Mrs. Tam is making a bad decision. Select the most correct response and click submit to continue.

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An 80 y year old p patient,, Mrs. Tam has declined a treatment proposed by Jim, the physiotherapist. He has explained that this treatment is the most effective treatment available for the condition. Jim has explained the side effects, benefits and the associated risks of declining the treatment. He believes Mrs. Tam is making a bad decision. Select the most correct response and click submit to continue.

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A substitute decision-maker has the right g to access the information necessary to make an informed decision. Select a response and click on submit to continue.

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Take a moment to answer a q question about expressed p wishes. Once you have selected the correct answer, click on submit to continue.

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Select either ‘true’ or ‘false’ as y your response p and click on submit to continue.

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In scenario 8,, Peter obtains informed consent from Jacob,, a patient with early Alzheimer’s. Although Jacob is forgetful Peter deems him capable to provide consent for the following course of treatment: g g exercises for the lower extremities • Strengthening • Range of motion exercises for the upper and lower extremities • Balance exercises Peter’s discussion includes how treatment will progress, the equipment to be used (weights and resistance band) and the personnel that will be involved in treatment. During this session Jacob’s wife, Irene, is also present.

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After several treatments,, Peter believes that Jacob will benefit from walking on a treadmill. Does Peter need to obtain informed consent for this treatment? S l t your answer and Select d click li k on submit. b it

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In the second scenario we meet Mrs. Smith who arrives for her first visit at a clinic. She has never seen a physiotherapist before this day. The friendly receptionist hands her a clip board and politely asks her to fill out the forms while she waits for the physiotherapist. Mrs. Smith takes a look at the five detailed sheets and feeling a bit overwhelmed, sits down to start on the paperwork. Have you ever experienced this scenario as a patient or a p practitioner?

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One of the forms relates to consent for the assessment and treatment. Mrs. Smith signs a statement that she agrees to the care that the physiotherapist will provide, she will ask questions if necessary, and she can withdraw consent at anytime. p y p , escorts Mrs. Smith from the waiting g Reid,, her physiotherapist, room to an assessment room and starts taking Mrs. Smith’s history. Mrs. Smith does not want to interrupt Reid so she doesn’t bother g any yq questions about the forms she completed. p asking

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In the next two slides y you have been p provided with statements about scenario 2. After reading the statement, please select ‘true’ or ‘false’ then click submit to continue.

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The next scenario highlights g g the issues of obtaining g consent when assigning treatment to support personnel and the documentation of consent. Katie provided information about the treatment plan to Sue, the patient. She included the p p possible risks,, benefits,, side effects and alternatives to the proposed treatment. As well, Katie gave Sue information about the role of the support person that Katie planned to assign portions of care. g the use of support pp Sue consented to the treatment, including personnel. Following this process, Katie documented the following: “Consent was discussed and obtained”.

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Did Katie document enough g information in the chart to indicate that informed consent was obtained? While the Standard for Professional Practice – Record Keeping indicates that consent must be documented, the standard does not indicate how this should appear in the patient’s record. Physiotherapists should follow a consistent consent process and consider documenting that process in a policy and procedure manual. For treatments of higher risk, more details about the consent process may be warranted.

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Kate,, the physiotherapist, p y p , has received an order to see Mr. Lum,, an elderly gentleman who initially came unaccompanied to the emergency department with a productive cough and fever. Medical examination and tests confirm a diagnosis of right lower lobe pneumonia. Kate enters the room and observes an older, frail looking gentleman who is nodding pleasantly. It becomes quickly apparent that Mr. Lum does not understand or speak any English.

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Kate approaches pp the bedside and Mr. Lum takes his arms from his gown and leans forward in the bed implying that she can listen to his chest. Kate conducts a respiratory assessment, identifies abnormal physiotherapy’ y py is breath sounds and determines that ‘chest p indicated for Mr. Lum. Under the Health Care Consent Act, Kate is obligated to obtain informed consent for treatment from Mr. Lum prior to initiating treatment.

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Read the statement on the slide and decide if it is accurate by y selecting either True or False. Once you have made your selection, click submit.

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Click on the references to be linked to the corresponding p g documents.

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If yyou have anyy questions q related to this module,, p please contact the Practice Advisor.

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We are very y interested to hear your y feedback on this chapter p of the Consent E-Learning Module. Please use the link on the screen to complete a very short online survey. Thank you.

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