El documento de consentimiento informado en enfermería desde el marco legal del principio de autonomíala canalización venosa central de acceso periférico en neonatología

Abstract

The Principle of Autonomy was the basis for the legislative development of the right to patient information and became a legal tool through the appearance of the informed consent (IC). The national law Act. No. 41/2002, 14 November, and regional legistation Act. No. 3/2009, 11 May 11, of rights and duties of the users of the sanitary system of the Region of Murcia, regulate these aspects. This autonomic law incorporated the express and written consent for "techniques" and recognized the figure of the "responsible nurse" of the care plan. Nurses in Neonatology are the professionals who channel the peripherally inserted central catheters (PICC), an invasive technique that meets the legal conditions of the IC forms. The historical-philosophical background of the Principle of Autonomy, the description of nursing education in Ethics of Care, legislation, Nursing Deontology, scientific publications and the description of the channeling technique and its risks, justify the presence of nurses in the IC forms. Main objective: To propose an IC form for the PICC to the newborn admitted to the Neonatal Intensive Care Unit of the Hospital Maternal and Child Hospital of the Virgen de la Arrixaca University Clinic containing the identification of the nurses who inform and perform this technique. Specific objectives: To analyze the influence of the historical-philosophical development of the Principle of Autonomy in the context of care and its incorporation into sanitary practices. Study and interpret the legal norms and deontological codes that have developed the jurisprudence on IC in Spain from a nurse's perspective. Describe the distribution and use of IC forms for the PICCs in the Neonatal Intensive Care Units of Spanish hospitals. Methodology: Retrospective descriptive study from a qualitative perspective. A research on electronic databases and bibliographic collections was conducted, followed by a fieldwork that collected data from 225 medical records and 162 telephone interviews with Spanish hospitals offering neonatal care with public functional dependency. Conclusions: 1. The professionalization of Nursing was born influenced by religious morality, gender condition and subordinated to the traditional paternalistic ideas of Medicine, without including respect for the Autonomy of the patient. The care that guarantees the right to information, autonomy and informed consent arose in 2008 within the University Degree in Nursing. 2. The correct channeling of a PICC is not enough to offer quality care. 3. Legal texts, deontological codes and the Ethics of Care ratify that informed consent is part of the nurse's lex artis, although its contents have not facilitated the explicit recognition of nursing professionals as an integral part of this doctrine. 4. The use of different terms to define the same concept and the regional legislative development, convey a greater concern for the content of the medical IC form than for the protection of the patient's right to autonomy. 5. Nursing informed consent forms for the PICC channeling in Neonatology are not incorporated into Spanish health practices. 6. Nurses in the neonatal field must update their legal and bioethical knowledge and detach from the influence of Anglo-Saxon welfare practices of the early twentieth century. 7. The programmed channeling of a PICC in Neonatology must have the IC from the parents in form of a written document, that collects the data from doctors and nurses who inform, solve doubts and perform the channeling. Key words: autonomy personal, peripherally inserted central catheter, informed consent, nursing, consent forms, neonatology and newborn.