From informed to empowered consent.

Informed consent is ethically incomplete and should be redefined as empowered consent. This essay challenges theoretical assumptions of the value of informed consent in light of substantial evidence of its failure in clinical practice and questions the continued emphasis on autonomy as the primary ethical justification for the practice of consent in health care. Human dignity-rather than autonomy-is advanced from a nursing ethics perspective as a preferred justification for consent practices in health care. The adequacy of an ethic of obligation (namely, principlism) as the dominant theoretical lens for recognising and responding to persistent problems in consent practices is also reconsidered. A feminist empowerment framework is adopted as an alternative ethical theory to principlism and is advanced as a more practical and complete lens for examining the concept and context of consent in health care. To accomplish this, the three leading conceptions of informed consent are overviewed, followed by a feminist critique to reveal practical problems with each of them. The need for a language change from informed to empowered consent is strongly considered. Implications for consent activities in clinical practice are reviewed with focused discussion on the need for greater role clarity for all involved in consent-beyond and inclusive of the patient-physician dyad, as the practice and improvement of consent is necessarily a transdisciplinary endeavour. Specific concrete and practical recommendations for leveraging nursing expertise in this space are presented. Perhaps what is most needed in the discourse and practice of consent in health care is nursing.

State of DNP education: Lessons learned from a novel academic fellowship in teaching and education.

OBJECTIVE: We examine the gap between the current and desired state of Doctor of Nursing Practice (DNP) education from the perspective of postdoctoral (DNP) teaching and education fellows. OBSERVATIONS: In the assessment of the DNP Essentials framework, command of scholarly and scientific writing, ability to demonstrate critical thought, and significant variation in clinical experience among DNP graduates are top concerns. DISCUSSION: These inconsistencies are problematic to the professional and public value of this terminal degree in nursing.