Can the client with chronic schizophrenia consent to nursing research?

As nurses enter the field of research and design nursing studies, an awareness of the standards of informed consent becomes imperative. Informed consent is commonly considered to include providing the subject with adequate and understandable information regarding therapeutic and experimental procedures and ensuring subjects' competent understanding of this information. Providing information about a procedure is relatively easy but evaluating competency is often difficult. It is especially difficult with the subject who may suffer cognitive impairment, e.g. schizophrenia. Clients with schizophrenia have traditionally been a disenfranchised group. It is important they do not become neglected in nursing research because of concerns about competency to provide informed consent. This paper provides a discussion of the historical development of informed consent. Additionally, the legal standards of informed consent and the legally accepted standards of competency are elucidated. Four issues are considered: (a) evidencing a choice, (b) factual understanding of the issues, (c) rational manipulation of information, and (d) appreciation of the nature of the situation. These issues are related to a nursing research study designed by the senior author to test the beliefs of subjects with chronic schizophrenia.