The absence of any one element renders the consent invalid. Consent may be given in several ways:
• Implied consent: Implied consent is the most straightforward. With implied consent, by virtue of the patient presenting at the triage area to be assessed does not necessarily imply consent, but consent is often implied by the patient’ s behaviour. This implied consent becomes less defined if the patient is confused or unable to communicate for any other reason.
• Verbal consent: This form of consent is more valid than implied consent. For example, if the Triage Nurse states that he or she is going to ask the patient a couple of questions, and the patient agrees to this, this implies verbal consent.
• Written consent: This form of consent is not something that is necessarily obtained by the Triage Nurse during his or her assessment, however there should be awareness of the local policies and procedures regarding obtaining of written consent.
Duty of care
By engaging with a patient as they present to the ED, the Triage Nurse enters into a health professional – patient relationship. The nurse shares the responsibility of the hospital to ensure that patients who present to the ED are offered an appropriate assessment of their treatment needs.
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A‘ duty’ is an obligation that is recognised by law, and the nurse’ s duty to a patient is to provide the same level or degree of care that would be employed by a nurse practising under similar or the same circumstances. The Triage Nurse then has an obligation to try to protect the patient from any foreseeable harm or injury ensuring a reasonable standard of care. This reasonable standard of care may be informed by policies such as the Minimum Standards for Triage and other documents such as the Australian Nursing and Midwifery Council( ANMC) competencies.
Scales such as the ATS are also utilised to guide decision-making, remembering that the ATS are guidelines for care.
There are certain circumstances when the Triage Nurse may be forced to rapidly detain a patient because if they leave they pose a risk of harming themselves or others in the community. Such action is covered by legislation( which is different in different jurisdictions) and may be initiated under the principle of necessity under common law. It is important that such circumstances are immediately referred to the senior clinician on duty.
The proportion of patients who do not wait for medical treatment in EDs may be up to 20 per cent of presentations. This is regarded as representing a failure to access the health system. Patients may choose to leave the hospital without being seen by the medical staff in the ED, and if the patient is competent the Triage Nurse cannot restrain them. However, the Triage Nurse has a responsibility to warn the patient of the consequences of such a decision, and appropriate documentation recording this decision should be completed by the patient and witnessed.
Department of Health and Ageing – Emergency Triage Education Kit