KONSEP KEPERAWATAN GAWAT DARURAT

Dwi Prihatiningsih, M.Ng.

Dua before Studying

“I’ve accepted Allah as my Lord And Islam as my way of life

And Muhammad As Allah’s Prophet and Messenger. O Allah! Advance
me in Knowledge and true understanding”
Learning Outcome

At the end of this topik, students will be able to show understanding of:
1. Legal and Ethical Issues in Emergency Nursing
2. Patient safety in Emergency Department
Legal Issues for Emergency Nurses

Consent: Is the patient’s acknowledgement and acceptance of medical

treatment
Types of consent
• Implied consent
• Express consent
• Informed concent
• Involuntary consent
Types of Consent
Type Description
Implied Consent Allows any appropriate treatment in an emergency
situation when the patient is unable to give consent.
Based on the assumption that a patient, if able,
would provide consent for livesaving treatment
Express Consent Written or oral agreement to treatment. Example
include assessment, evaluation, medications,
radiographs, and laboratory studies.
Informed Consent The patient has full understanding of risks and
benefits of the proposed treatment. Example:
surgery, invasive procedure
Involuntary Consent When individual refuse to consent to needed medical
treatment. Example: suicidal, delusional or demented
patients
Patient Safety in the Emergency Department

• The prevention of health care errors and the elimination or

mitigation of patient injury caused by health care errors.
• Health care errors is unintended health care outcome caused by a
defect in the delivery of care to a patient
• These errors may be ones of commission (doing the wrong thing),
omission (not doing the right thing) or execution (doing the right
thing incorectly)
Triage

• Triage: During triage, the patient’s medical priority is evaluated, and

this evaluation is used to sort and prioritize the patient’s condition
and need for care
• Using team triage in these models, with a specialist physician in the
front line decreased the percentage of patients at the ED leaving
without being seen (LWBS)
• Shorter decision pathways between physicians and other team
members lead to increased patient safety.
Patient safety risks in the ED

• Communication failures: shift change is a critical moment, transfer

of patients from the ED
• To improve patient safety, it is important to develop communication
skills; e.g., Situation, Background, Assessment, Recommendation (or
SBAR)
• Overcrowding: longer waiting times, and increased suffering for the
patients who must wait. Lack of competence in the triage may lead
to further hospitalizations and more problems in output
• Team-work
Measures of patient safety in the ED

• Whether the patient spends more than 4 hours in the ED

• The percentage of patients who return within 24 or 72 hours from
the first visit for the same chief complaint
• The percentage of patients who leave without being seen (LWBS),
and mortality within 7 or 30 days after the first visit to the ED
Ethical Dilemmas in Emergency Nursing

• Autonomy: Self-determination or freedom of choice

• Beneficence: Promote good
• Nonmaleficence: do no harm
• Justice: fairness
• Utility: good of many outweights the wants and needs of the
individual
• Veracity: truth telling
• Fidelity: keeping promises, loyalty and accountability
Specific Situation

Do Not Resuscitate
Informed consent or refusal
Confidentiality
Triage