UNIT 1: LEGAL ISSUES IN NURSING (10 sessions)
Key Unit competence: To explain effectively the good and bad nursing practic.
1.0 Introductory activity
Read carefully the case study below and answer to the related questions.
A 25 years old female has been treated in the health centre after presenting the following signs: abdominal pain, fever and loss of appetite. These problems have evolved since two years and by auto medication, she has taken some drugs for relieving headache and but she is still feeling abdominal pain . On admission, the nurse well received the patient and positioned her on the bed before data collection. She started by taking vital signs and the client was shivering with high temperature of 390 Celsius. The nurse decided to withdraw a blood sample then give medication to reduce body temperature. However, a nurse committed an error of giving drug in the wrong route; while the drug should be given in subcutaneous route, she gave it in intramuscular route.
Consequently, the drug given to client resulted in allergic reactions and the client had difficulty in breathing and cyanosis. The nearest hospital was informed and the ambulance comes soon to conduct the client in the hospital. The client was admitted in emergency for better management of the case, a day after she was discharged but she complains against the nurse for being not well cared.
a) Identify the activities carried out by the nurse which may be qualified as good in nursing practice
1.1. Identification of good and bad nursing practice
Learning activity 1.1
After reading the previous scenario, answer to the related questions: During a procedure of drug administration, a nurse gave medication to reduce body temperature but, committed an error of giving drug in the wrong route; while the drug should be given in subcutaneous route, she gave it in intramuscular route.
a) Which acts must be qualified as nursing malpractice?
Definition of nursing practice: Nursing practice may be work experience that is direct and/or indirect patient care in clinical practice, nursing administration, education, research, or consultation in the specialty represented by the credential. The position must be one that may be filled by associate or Registered Nurse.
A good nursing practice is when the nurse provides care with kindness, empathy, compassion and good communication with the patient. The nurse, while caring inspires fairness and trust (Ezio Di Nucci, 2019). Is also when a nurse acts to benefit clients by relieving suffering, restoring and promoting health or preventing diseases (Bandman, 2004). Example: A good practice should respect the six rights of drug administration: right patient, right drug, right dose, right route, right time and right documentation.
Nurses play a vital role in in health care settings in order to meet the needs of their patients with exceptional care. Beyond getting expertise acquired through a nursing degree program, but they display higher qualities that contribute to their professional success. Those ones include:
Hardworking,Knowledgeable,Curious,Effective,Communicator,Optimistic,Compas sionate,Empathetic,Even-Tempered,Flexible,Detail-Oriented,Critical Thinker
a) Hardworking: good nurses have willingness to put in the hard work it takes to meet their goals. At times, lengthy shifts spent on one’s feet make this career physically demanding.
b) Knowledgeable: nurses must possess extensive knowledge to care effectively for their patients, an in-depth understanding of subjects such as human anatomy, microbiology and pathophysiology, added with the skills to apply healthcare theories in real-life situations.
c) Curious: nursing is a professional career that requires specific medical knowledge. It also requires practitioners to be life-long learners. Continuing education is crucial for all healthcare workers. Nurses can pursue additional degrees by entering an RN to BSN program, Master of Science in Nursing and can attend specialized certification programs to grow their knowledge in specific fields.
d) Effective Communicator: Another quality of a good nurse is strong communication skills. In the workplace, nurses must be able to communicate clearly with their co-workers and with patients and their families. They must be able to take instructions from co-workers and supervisors, especially in high-pressure situations.. They must be able to read charts and understand a treatment plan without in-depth instruction..
e) Optimistic: Successful nurses bring an optimistic attitude to their job. They can see the bright side of situations and encourage their patients. Nurses know how to remain positive and focus on serving others. Further, nurses who have a positive attitude can act as leaders in their practice, inspiring optimism in others as well.
f) Compassionate: One of the most important qualities of a good nurse is compassion. In their career, nurses will see patients suffer. Beyond simply offering a solution, they must be able to express compassion for patients and their families. This allows them to form meaningful relationships with their patients.
g) Empathetic: Nurses can listen to patient concerns without interrupting or questioning what patients think might be causing their illness. For some, empathy can be as simple as being told what to expect during a treatment process. The way most healthcare professionals develop empathy for patients is by imagining what they would want if the roles were reversed.
h) Event-Tempered: Healthcare is an emotionally demanding industry, and each day brings highs of joy and lows of sadness. Not getting visibly angry or upset with patients is important no matter how difficult the day has been. Nurses must be able to manage their responses to difficult situations in order to solve problems and concentrate on their patients’ health and safety.
i) Flexible: Remaining calm under pressure also helps nurses stay flexible in their work since shifts are typically long. Nurses may have to work nights, weekends and holidays. They may be called in on their days off to cover shifts. On the job, flexibility is a must for nurses. They cannot predict what the day will bring and what illnesses or injuries they will have to treat.
j) Detail-Oriented: A successful nurse pays close attention to detail. From keeping medical records to developing a care plan, a nurse must avoid making errors at all costs. In this field, mistakes can have severe consequences.
k) Critical Thinker: Nursing requires strong analytical and problem-solving skills. to put together pieces of information and draw rational conclusions. They have to think quickly under pressure to troubleshoot patient needs. A bad nursing practice is when nursing practice has a significant negative impact on client care and the outcome of nursing care provision (Zane Wolf, 2012). All acts involving negligence, abuse and incompetence are qualified poor nursing practice rather than error (Ion et al., 2016a; Ion et al., 2016b). It is also a nursing care provided with poor or low quality level including acts of neglect, abuse or incompetence which occur for any reason not always explicable.
A bad practice can make a significant negative impact on patient and can even lead to negative outcomes. E.g.: administration of a drug to a wrong patient, wrong drug, wrong dose, wrong route, and wrong time and without documenting can lead to fatal consequences to the patient.
Self-assessment 1.1
After understanding the meaning of negligence and malpractice
1. Explain 2 examples of malpractice in nursing care
2. Explain 2 possible consequences of malpractice on the client
1. 2. Concepts of malpractice and negligence
Learning activity 1.2
Each day, patients seek medical treatment from physicians, surgeons, and other health professionals including nurses in low levels of health institutions. Patients place their health, trust, beliefs and lives into the hands of their doctors and nurses. In return, doctors assure their patients that they will provide the best medical care and attention possible in order to promote health. Unfortunately, nurses mistakes have been often observed and left a patient with permanent damages.
a) Considering what you have seen in health institution about the work of nurses, how can you explain a malpractice?
b) Differentiate a mistake and negligence in the nursing practice.
Definition of Nursing malpractice & Nursing negligence
Nursing malpractice is the breach of the duty of care by a health provider (nurse) or medical doctor. Nursing negligence applies when a health provider makes a “mistake” in treating patient and that mistake results in harm to the patient.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines that negligence is a failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” JCAHO defines malpractice as “improper or unethical conduct or unreasonable lack of skill by a professional nurse
Specifically, nursing malpractice or negligence refers to a nurse failing to adequately complete his or her tasks, ultimately resulting in harm to the patient. Failing to properly monitor vital signs or administering the wrong medication can be life altering errors, and sometimes even fatal.
It is described as an act of omission or commission of duty. The components of professional negligence include:
1) Duty to use due care;
2) Failure to meet the standard of care or breach of duty;
3) Anticipation of harm and injury
4) Direct relationship between failure to meet the standard of care and injury.
Examples of nursing negligence: a nurse failing to follow a doctor’s orders for treatment, a nurse administering the wrong medication to a patient, a nurse may fail to: monitor a patient call a doctor for immediate help, perform a nursing procedure properly etc…
Nursing Negligence and its Impact in the Nursing Profession
The nursing profession is a very sensitive work motivated by altruism; it has an autonomy that governs its right and ability to make decisions; it has authority which makes nursing practice updated because of its evidence-based principles; it has accountability for its conducts and responsibilities; it has code of ethics, referring to its professional, social values and it has a distinct identity. As defined by Virginia Henderson, it is done with the heart, the head, and the hand.
Self-assessment 1.2
A male client has attended the district hospital for headache, loss of appetite and body general weakness and dizziness. While the client was standing with others, he starts vomiting, others clients call for help but the nurse who was around did not pay attention to the client. When he approaches for vital signs monitoring, he vomits again and the nurse decide to give a drug against the vomiting. However, she mistakenly gave a somniferous drug.
a) Identify mistakes committed by the nurse
b) Which act of negligence he has done?
c) Explain the impact of this nursing practice on the client health and trust
d) Read the following acts and in 2 columns separate nursing negligence and malpractice
– Failure to assist a client with ambulation
– Administration of a wrong medication
– Failure to call a doctor for immediate help
– Giving a drug in wrong route
– Improper insertion of urinary catheter
– Record vital signs while they are not taken
1.3. Legal issues in nursing practice
Learning activity 1.3
Mr M. was admitted in surgical unit after road accident with head injury and high blood pressure. When he was asleep and unaware, he has not been informed by the nurse and no verbal or written consent given to the nurse. The client has known the event by a friend. The nurse has not followed the code of professional conduct and may face consequences as the client and his family was very unhappy. During that situation, a nurse was taking photos of him and posted then on social media.
1) Enumerate the nursing values violated the nurse
2) The above action is it a malpractice or negligence?
Definition of concepts
The most common legal issues that impact on nursing and nursing practice are those relating to informed consent and refusing treatment, licensure, the safeguarding of clients’ personal possessions and valuables, malpractice, negligence are relating to fights. When the nurse fails to respect nursing values while practicing the profession, this create ethical, legal and professional issues for the nurse.
Legal Issues: are legal implications of nursing practice tied to licensure, scope of practice and a public expectation that nurses practice at a high professional standard. The nurse’s education, license and nursing standard provide the framework by which nurses are expected to practice. When a nurse’s practice falls below acceptable standards of care and competence, this exposes the nurse to litigation/lawsuit. Acts of omission and commission will also subject the nurse to litigation and professional license review. Both litigation and professional license review can result in reprimand of a nurse’s license or loss of a license.
In nursing profession common causes of nursing lawsuits include for example, a failure to advocate for a client by asking precision about a medical order can lead to medication and treatment error. The following errors can lead to lawsuits:
Medication and treatment error, failure to follow standards of care (examples: Institutional policies, medications orders), failure to assess and monitor.
Failure to communicate (example: failure to report in timely manner, failure to report significant changes in patient status, poor communication)
Failure to use equipment in responsible manner, use of defective equipment
Failure to act as a patient advocate (e.g to question incomplete medical orders) , Infection caused or made worse by poor nursing care and failure to document ( Basavanthappa, 2006).
Self-assessment 1.3
Inmate client calls the nurse for help as he has bleeding from the noise and headache. The nurse was doing many other inmates to examine and provide medication and she doesn’t go to see the person who was bleeding until he develops coma status
1) Which ethical problem may arise in that case?
2) Identify the legal issue that this nurse may face?
1.4. Legal Sanctions in nursing practice
Learning activity 1.4
Observe the above pictures, read the scenario below then answer to the questions:
A five years old child have been admitted in Pediatrics unit for general weakness, diarrhea and vomiting, inability to eat and fever. The mother explains the signs and symptoms that had lasted for 3 days. After assessment, the child was dehydrated, has fever and thirsty. The physician ordered fluid replacement, antipyretics drugs and close monitoring of the child. The nurse has given medical order to the mother to bring medication from pharmacy. The nurse has not considered the emergency of fluid replacement and he left the child alone on the bed. While the mother and the nurse were absent, the child has developed seizures, falls down and died. After two hours, the mother come back and found her child already died still lying on the ground
She decides to address a legal complain.
1. Considering this scenario, has the mother right to complain?
2. Enumerate what would be the nurse course of action for this child to avoid the death
3. Which malpractice committed by the nurse that can be legally punished for?
The basis for litigation (legal action or process) can be related to negligence or malpractice, failing to exercise the level of care that a reasonable, cautious nurse would under similar circumstances and professional nurse must avoid.
Acts of omission will also subject the nurse to litigation and professional license review. Both litigation and professional license review can result in loss of a license to practice.
The Board of Nursing in keeping with its mission to protect the public health, safety, and welfare, believes it is important to take a strong position regarding the licensure of individuals who have engaged in dishonest, that may place the public or patients at risk.
The law requires examining what lies behind the purpose of sanctions, which is not to be punitive but to protect the public interest and to promote the profession. The public interest includes protection of patients and clients, maintenance of public confidence in the profession. Therefore, the regulatory body declares and upholds proper standards of professional conduct and behavior.
Possible sanctions may include Suspension order and caution order. A suspension order results in the suspension of the nurse or midwife’s registration for a period of up to one year. They may not practice as a registered nurse or midwife during the period for which the order is in force. A caution order can be imposed for a period of between one and five years, and can be disclosed to anyone enquiring about the nurse or midwife’s fitness to practice history.
Self-assessment 1.4
Considering the role and types of sanction that can be applied to the nurse:
a) Explain 3 public benefits of imposing sanction to the nurse in case of litigation
b) Organize a role play in which we have the mother who has lost the child, the nurse explaining what was happened, the unit manager, 4 from nurses different units as observers and a member of the tribunal court who impose sanction of suspension order
c) What is the main cause of litigation in nursing practice?
1.5. Disclosure of clinical information
Learning activity 1.5
Mr. J. is a nurse working in the health center, he is talkative and a clients treated by him would not like to come to him again, and prefer to change their appointments to avoid him. According to the expected relationship between the nurse and the client, what are probably the problems met by client when cared by Mr. J.?
Nursing staff treat everyone in their care with dignity and humanity.They understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally. A health provider must not disclose patient’s information for any purpose other than providing health care services to the specific patient. It will be considered as violation of confidentiality once patient’s information is disclosed outside delivering care. It is prohibited to disclose patient’s information without their consent, for the client will encounter social outcome like lose confidence from family or society, and for the nurses will lose trust from patient and bad image of the profession.
Self-assessment 1.5
While caring a client in all clinical setting (Health center or Hospital)
a) Explain why a patient information should not be disclosed
1.6. End unit assessment / Summative assessment
End unit assessment
After covering this unit, understanding the legal issues in nursing profession and how to behave in order to promote client health and avoid any action against nursing practice, answer to the following questions:
A. Multiple choice questions (MCQs)
1. Law is defined as those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner. The following are functions of law in nursing except:
a. It provides a framework for establishing which nursing actions in the care of client are legal.
b. It differentiates the nurse’s responsibilities from those of other health professional.
c. It helps establish the boundaries of independent nursing action.
d. It recommends nurses to respect Doctors in medical services
2. While taking care of Mrs. Aurelia, the nurse knows that avoiding deliberate harm or risk of harm that occurs during the performance of nursing actions she is applying which principle among the following?
a. Autonomy
b. Beneficence
c. Justice
d. Non-maleficence
3. Currently, in clinical setting, the client has right to give consent before any medical or nursing intervention. The client consent is:
a. A patient’s right based on the ethical principles of autonomy, respect and decision making about the individual life
b. It is an obligation document that every client must sign if he/she wishes to be cared in health setting
c. It is a document used only before major medical intervention like caesarian section
d. It is a phantom document that explain in mass media but which is not used in practice
B. Read carefully the following statements then, give appropriate answer using True (T) or False (F):
1. The nurse documentation is a way of communication within the health care team
2. When the nurse violated standards of nursing practice, this may lead to litigation and loss of license to practice
3. During the exercise of nursing profession, the nurse has right to opportunities for career mobility and continued education
4. The purpose of law in nursing profession is only to decide sanction against nurses in case of negligence and malpractice
5. Disclosure of clinical information is prohibited in nursing practice
6. Malpractice and negligence can cause negative outcomes for the patient’s health
7. Legal sanctions in nursing include dismissal of the nursing licence
C. CASE STUDY
A 10 years old child is admitted in Paediatric unit for general weakness, diarrhoea, abdominal distension and fever. The mother explains that the signs and symptoms have lasted for 10 days.
After the assessment, the child was found dehydrated and anaemic. The physician orders to withdraw blood sample for laboratory investigations in preparation for to blood transfusion, fluid replacement with Ringer Lactate, antipyretics drugs , and monitoring of vital signs and hydration status every 2 hours. Then, a nurse forgot to take blood sample; the amount of fluid to be given in 4 hours was given in 2 hours. He recorded vital signs not taken and the blood transfusion was not given. The mother decided to address a legal complain.
1. Identify ethical principles not respected with this client
2. After reading the case study, explain the concepts of malpractice and negligence and illustrate your answer by 2 examples from the above scenario
3. If this client dies due to anaemia, do we have a litigation issue against the nurse? Explain your answer.