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Inherent in nursing practice is recognition of the right of people to make informed decisions and to formally consent (or refuse to consent) to care and treatment related to their health needs. To this end the International Council of Nurses (2006) Code of ethics for nurses prescribes: 'The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.' Th e Code of ethics for nurses in Australia (ANMC 2008) similarly prescribes 'Nurses value the legal and moral right of people, including children, to participate whenever possible in decision making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision-making'.
In recent years the adoption of 'consumer engagement' and 'consumer-centred care' as fundamental standards of safety and quality in health care has seen significant improvements in consent processes and engaged decisionmaking by consumers. Nonetheless, problems remain. Of concern to nurses are the daily challenges they face when, due to contextual factors that are often beyond their control, they are stymied in their duties and sometimes are even unable to fulfil them when trying to provide the assistance that patients and their loved ones are entitled to receive when formally required to consent to treatment. Individuals who are vulnerable (eg. the frail elderly, people with cognitive impairment, health care consumers who do not speak or understand English) are particularly at risk of having their entitlements to make informed decisions being overlooked...