Challenges of Obtaining Informed Consent in Emergency Ward: A Qualitative Study in One Iranian Hospital

Nayyereh Davoudi1, Nahid Dehghan Nayeri2, *, Mohammad Saeed Zokaei3, Nematallah Fazeli4
1 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 Faculty of Social Sciences, Allameh Tabataba'i University, Tehran, Iran
4 Institute for Humanities and Cultural Studies, Tehran, Iran

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Creative Commons License
© 2017 Davoudi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran; Tel: +982166914368; Fax: +982161054170; E-mails:,


Background and Objective:

Regarding the fact that emergency ward has unique characteristics, whose uniqueness affects informed consent processes by creating specific challenges. Hence, it seems necessary to identify the process and challenges of informed consent in the emergency ward through a qualitative study to understand actual patients’ and health care providers’ experiences, beliefs, values, and feelings about the informed consent in the emergency ward. Through such studies, new insight can be gained on the process of informed consent and its challenges with the hope that the resulting knowledge will enable the promotion of ethical, legal as well as effective health services to the patients in the emergency ward.


In this qualitative study, research field was one of the emergency wards of educational and public hospitals in Iran. Field work and participant observation were carried out for 515 hours from June 2014 to March 2016. Also, conversations and semi-structured interviews based on the observations were conducted. The participants of the study were nurses and physicians working in the emergency ward, as well as patients and their attendants who were involved in the process of obtaining informed consent.


Three main categories were extracted from the data: a sense of frustration; reverse protection; and culture of paternalism in consent process.


Findings of this study can be utilized in correcting the structures and processes of obtaining informed consent together with promotion of patients' ethical and legal care in emergency ward. In this way, the approaches in consent process will be changed from paternalistic approach to patient-centered care which concomitantly protects patient’s autonomy.

Keywords: Informed consent, Emergency ward, Qualitative content analysis, Medical paternalism, Healthcare providers.