Emergency Nursing, Education, and Legal Issues

Emergency Nursing Discuss the role of the emergency nurse in

community and patient education

Education of the ED NurseKnowledgeable in every discipline:

PediatricsObstetricsMedicineCardiologyOrthopedicsTrauma

OncologyInfectious

diseasePsychiatry Others

Knowledgeable in caring for all age groups:Newborns InfantsToddlersChildhood

Education of the ED Nurse

AdolescenceAdultGeriatric

Education of the ED NurseFacilitators of Learning in the ED

Nurse EducatorOrganizes and implements orientation

programsNurse ManagerPreceptorTeam LeaderCharge Nurse

Approaches to ED Nurse Orientation Review of EDs standards of care Check skills with return demonstration Preceptor-sponsored orientation Competency-based orientation

Organized system of assessing new ED nurses ability to perform proficiencies, tasks and ED skills

Essential components includeSkill and knowledge assessmentCompetence standards and critical

behaviors

Continuing ED Education Needed to promote

competence in nursing Enhance nurse’s working knowledge and environment Advances skills in education, research, theory Improves healthcare to the client Fosters personal and professional delopment

Beneficiaries of Education Nurse Employer

Increased competence Decreased liability Advanced expertise to benefit patient care

Profession Increased adherence to standards of practice Strengthened image of the nurse

Public Improved patient care

Obtaining Continuing Education Self-learning – Self-study Home study or correspondence Institution-sponsored CE Workshops, seminars Organizational meetings (ENA, AACN) Degree advancement Computer based instruction

Education of the ED Patient

Patient education: an ongoing process during the ED visit- information from the ED should change the patient’s knowledge, attitudes and skills

Education encompasses all disciplines of medicine

Information had to be customized to age and developmental level

Teaching should be adapted to culture and ethnicity

Education of the ED Patient “One-moment, one-visit” opportunity

Must be concise Immediately understandable Nurse must have information committed to memory

Opportunities for education Teaching begins at triage Before, during and after treatments Before and after medication administration Event specific education at discharge

Nurse’s role and responsibility Patient right to be education about disease process

or injury Education before and after procedure or

medication Nurse is legally responsible for teaching

content and is, therefore, open to potential litigation

Education – A Patient’s Right

Potential Obstacles to ED Education Lack of privacy Time constraints Effective nurse-patient rapport Deficiency in involvement of family of impaired

patient Opportunity to establish continuity and to follow

up for reinforcement and evaluation

Barriers to ED EducationPhysiological barriers: pain, restlessness,

age, prognosis, critical illnessPsychological barriers: intelligence, anxiety,

denial, depression, psychosisEnvironmental barriers: separation from

family, noise level, lack of sleepSociocultural barriers: language

barrier, ethnic background, lack of education

Illiteracy

Objectives Legal Issues Describe types of laws and legal

concepts of the emergency nurse Discuss the role of the emergency nurse

in patient transfer and legal issues

Consents Express consent

The voluntary consent of an individual seeking medical treatment

Implied consent Consent is implied when an individual is in a life- or limb-

threatening situation and is unable to provide express consent

Involuntary consent When the individual refuses to consent to needed

treatment, yet another individual (police, judge, physician) can ensure that the individual receives the treatment

Consents continued Informed consent

Three essential components presented to the patient/family by the physician before the procedure1. Describe the procedure to be performed2. Explain alternatives available3. Detail the risks of the procedure

Physicians have the responsibility to provide the information required

Consent DilemmasMinors

Minor may be allowed to consent to medical treatment if:Minor is emancipated- economically independent, married

True Emergency

Consent Dilemmas continued Refusal to consent based on religious conviction

Jehovah’s Witness – refusal of blood products Most states allow competent adults to refuse If the death of the adult would leave minor children

without a parent, the social policy consideration may override the patient’s wishes

If the patient is a minor and the parents are refusing medical care, it is necessary to involve hospital administration or legal council

Consent Dilemmas continued

Refusal of treatment-leaving AMA If a patient refuses treatment- ? patient’s

competency If found competent, ED physician must

explain risks involved in refusing treatment. This MUST be thoroughly documented

If the refusal puts life at risk, competency must be questioned – and MUST be documented

Consent Dilemmas continued

Patients in custody of law enforcement Consent for treatment remains with the

individual, not law enforcement personnel State law governs whether the individual

can refuse consent for withdrawal of blood or specimens when in custody

Transfer

Emergency Medical Treatment and Active Labor Act (EMTALA)

Considerations for Choosing Type Considerations for Choosing Type of Transportof Transport

Patient care requirementsPatient care requirements Patient’s response or contraindicationsPatient’s response or contraindications Out-of-hospital transit timeOut-of-hospital transit time Work space required vs. space availableWork space required vs. space available Personnel qualificationsPersonnel qualifications Weather conditions Weather conditions Terrain and/or road conditionsTerrain and/or road conditions

Stabilization & Preparation before Transport

ABCs with C-spine precautions

Splinting of injured extremities

Wound care Psychosocial

responses of patient Baseline diagnostic

studies Documentation to

accompany patient

Communication Before Before

transport:transport: Referring physician Referring physician

to receiving to receiving physician physician

Primary nurse to Primary nurse to receiving charge receiving charge nurse nurse

Referring/receiving Referring/receiving physician to physician to transport transport personnelpersonnel

Communication Communication (cont.)(cont.)

During transport: aa. Contact from vehicle or aircraft to sending Contact from vehicle or aircraft to sending

and/orand/or receiving facilityreceiving facility b. 3b. 3rdrd party relay if direct contact not possible party relay if direct contact not possible

After transport: a.a. Follow-up reportsFollow-up reports b. Auditsb. Audits c. Education and conferencesc. Education and conferences

Family Members and Friends

Crisis interventionNeed explanation of

condition and reason for transfer

Obtain consent for transferRemain at initial facility until

patient leavesNeed time with patient before

departureMaps and written directions

helpful