Legal and ethical considerations in emergency nursing Consent
Consent is the agreement of a patient to submit to proposed investigation or treatment. Although it is a fundamental requirement in all nursing settings, consent is a particularly important consideration in the emergency nursing context where the care provided is often fast-paced, and may progress with little direct patient involvement. Consent may be provided in written, verbal or non-verbal form. Once given, consent applies indefinitely; however, it may also be refused or withdrawn at any time, if a patient considers this in their best interest – even if this places their wellbeing at risk. In the emergency nursing context, seeking consent can be thought of as a ‘process’; nurses should continually seek the consent of patients to provide investigation and / or treatment, rather than during a single event. For consent to be valid, or legally sound, “it must be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question” (Department of Health, 2009: p. 9).
As an emergency nurse, you may frequently deal with patients who are unconscious. It is important, therefore, to make a note about consent in unconscious patients. If a patient is unconscious, it is assumed that – in most situations – as a mentally competent person they would wish for all appropriate measures to sustain life and promote wellbeing to be taken by the professionals involved in their care. However, in some cases (particularly in patients who are palliated), advance decisions may be made to refuse life-sustaining measures, such as resuscitation; in these situations, the decision to refuse consent will be formally documented.
Duty of care
Duty of care is owed by a nurse to any person – and particularly patients – who may be affected by their actions, advice or admissions. A breach of duty of care occurs when a nurse fails to do what a ‘reasonable’ person would do in a similar situation, or does what a ‘reasonable’ person would not do. The standard of care expected is that of a nurse with an average level of skills, knowledge and experience. To maintain your duty of care, you must practice within your scope. Essentially, this means you must provide care consistent with your own skills, knowledge and experience, and not beyond what you have learned in your training and become qualified to administer. It is important to highlight that nurses working in emergency care settings come from a variety of professional backgrounds and, therefore, have diverse skills, knowledge and experience. Furthermore, an emergency nurse’s scope of practice may be impacted by factors such as the type of emergency care setting in which they practice (including the degree of autonomy they are afforded), and the region in which they are located. A nurse may be found legally negligent if they work outside their scope of practice, breach their duty of care, and cause damage to the patient (e.g. injury or loss). To avoid breaching your duty of care and practicing negligently, you must be familiar with, and work within, your own scope of practice at all times.
Restraint
Restraint – that is, restricting a patient’s movement, with the intention of protecting their own and / or others’ safety – can be used in managing patients who are violent or aggressive, and particularly those who are mentally ill, intoxicated or otherwise incapacitated. There are two types of restraint: (1) physical restraint, or the restriction of movement by physical or mechanical means, and (2) chemical restraint, usually via the administration of sedative medication. Although there is a movement away from restraint in healthcare settings in the UK, it is essential that you are familiar with your organisation’s policies and procedures for the appropriate use of restraint.
Privacy and confidentiality
Maintaining the right of patients to privacy and confidentiality is a requirement in all general practice settings, but is particularly important for nurses working in busy and fast-paced emergency settings. It is crucial that nurses working in emergency care settings understand with whom, and under what circumstances, they are permitted to share a patient’s confidential information. Nurses must also ensure they are familiar with their organisation’s systems for the collection, recording and storage of a patient’s confidential information in the busy, fast-paced emergency care settings.
Conclusion
This chapter has provided a broad introduction to emergency nursing as a practice speciality in the UK. It has introduced emergency nursing as a diverse and complex practice specialty; one which requires nurses to work with a variety of patients, manage various clinical conditions, and practice in a range of different settings. It has also analysed some of the complex legal and ethical issues relevant to practice in an emergency care setting, and discussed the key challenges in the future of emergency care nursing in the UK.
Reference list
Department of Health. (2009). Reference Guide to Consent for Examination or Treatment: Second Edition. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf
