You are a staff nurse in a surgical unit.

Shortly after reporting for duty, you make rounds on all your patients. Mrs. Jones is a 36-year-old woman scheduled for a bilateral salpingo-oophorectomy and hysterectomy. In the course of conversation, Mrs. Jones comments that she is glad she will not be undergoing menopause as a result of this surgery. She elaborates by stating that one of her friends had surgery that resulted in ""surgical menopause"" and that it was devastating to her. You return to the chart and check the surgical permit and doctor's progress notes. The operating room permit reads ""bilateral salpingo-oophorectomy and hysterectomy,"" which does lead to menopause, and it is signed by Mrs. Jones. The physician has noted ""discussed surgery with patient"" in the progress notes. You return to Mrs. Jones's room and ask her what type of surgery she is having. She states, ""I'm having my uterus removed."" You phone the physician and relate your information to the surgeon who says, ""Mrs. Jones knows that I will take out her ovaries if necessary; I've discussed it with her. She signed the permit. Now, please get her ready for surgery�she is the next case.""

ASSIGNMENT:  Discuss what you should do  at this point. Why did you select this course of action? What issues are involved here? Be sure to discuss legal ramifications of this case."\

Course of Action:

 Clarify Patient Understanding:

 Immediate Action: Back to Mrs. Jones and check on her understanding of the surgery. Politely let her tell you all that she thinks will happen when she is being operated on, including have her ovaries removed and whether she expects to go through menopause.

 Why: This makes sure that the civil liberty of patient consent does mean that he or she has full understanding of the nature and ramifications of surgery.

 Re-Evaluate Informed Consent:

 Action: If Mrs. Jones does not understand fully that the surgery is a bilateral salpingo-oophorectomy that will cause the surgical menopause then she cannot be considered to have informed consent. This means the surgery should not go on until she has received all the information an is agreeing to the surgery again.

 Why: Both legal and ethical, informed consent is mandatory. The patient serving as a receptor of the procedure must understand the process, probability for risk factors, and implication of the action before agreeing.

 Contact the Surgeon:

 Action: It is suggested that Mrs. Jones remains rather naive as for the consequences of the operation, thus, it is crucial to inform the surgeon about it. Also, ask that the said surgeon explain the procedure details and the effects to her in person.

 Why: The burden of the duty lies on the side of the surgeon to make sure that the patient in question understands all that is being done to him or her. Consequently, as a nurse, your duty is also to stand for the patient autonomy right to be or not knowledgeable.

 Document the Interaction:

 Action: Jot down all discussions with Mrs. Jones and the surgeon and all the instructions that the surgeon has provided.

 Why: Documentation is vital especially for legal purposes and where the task involved is done to leave a trace on what was done.

 Delay Surgery if Necessary:

 Action: Depending on the surgeon’s explanation to Mrs. Jones or if Mrs. Jones is still not clear about the surgery, the patients’ best interest should be channeled to a stop on the surgery until informed consent is witnessed.

 Why: Surgical operation done without the patients’ consent could result in cases with the patient filing a case of negligence or battery.

 Issues Involved:

 Informed Consent:

 The main problem is whether or not Mrs. Jones has consented to have the surgery done willingly. Informed consent presupposes full disclosure of the information concerning the particular procedure, possible risks, and chances for the given patient. The omission of the fact that Mrs. Jones has no idea that her ovaries are to be removed and that this will lead to menopause speaks volume of informed consent.

 Patient Autonomy:

 Mrs. Jones has access to information about own health and thus has rights to make decisions regarding own health care. This autonomy is violated if she has limited understanding of the consequences of her surgery.

 Legal Ramifications:

 Negligence: Using informed consent in surgeons can be seen as negligence since it does not measure up to the standard of care to practice surgery without it.

 Battery: That is why operation without the patient’s consent could be regarded as battery, as it is an unlawful touching of the patient’s body.

 Documentation: Documentation must be done and proper so that it can be used in legal cases and to show that everything done was done right and for the benefit of the patient.

 Ethical Considerations:

 Non-maleficence: The core of the issue at stake is the medical codification of the principle of ‘do no harm’. Continuing without the candor that is expected in informed consent is likely to cause increase psychological harm to Mrs. Jones, if only she realizes that she underwent a procedure she did not fully understand.

 Beneficence: Explain to Mrs. Jones what her surgery entails is not only the right step to follow as a healthcare provider but also meets the legal right of the patient.

 Conclusion:

 The proper thing to do is to make certain that Mrs. Jones has made an ‘informed consent’ for her surgery. This consists of explain the situation to her, calling the surgeon, and maybe postposing the surgery. The questions of patient’s self-determination, the concept of informed consent, one’s legal and moral responsibilities are at the heart of this case.