A CNA observes a resident attempting to sign a document for care, but the resident seems confused. The appropriate action is to ...

• A. Assist the resident in understanding the document and obtain nurse assessment of capacity.
• B. Sign the document on the resident's behalf.
• C. Discard the document and proceed with care.
• D. Tell the resident to defer the decision to a family member.

Answer: (A)

Informed consent requires the resident to have the capacity to understand what they’re agreeing to and to make a voluntary decision. When you notice confusion as a resident tries to sign a care document, your first priority is to support understanding and involve a clinician to assess capacity. Calmly explain the document in plain terms, then ask the resident to restate what they understand and what choices they’re weighing. This helps determine whether they truly grasp the information and are making a voluntary decision. If the nurse—or the appropriate clinician—determines the resident has capacity, the signing can proceed with proper documentation and any required witnesses. If capacity is lacking, a legally authorized representative should be involved to make decisions in the resident’s best interests. Signing for the resident would bypass consent and could do more harm than good, and discarding the document without addressing consent would ignore the resident’s rights and safety. Simply telling the resident to defer to a family member isn’t appropriate until capacity is evaluated and a representative is identified if needed.