Ethical and Legal Objective #2

Most common intentional tort?

Battery

How does a nurse get accused of assault and battery?

there must be an absence of consent on the part of the client, (negligence does not have to be proved in this case)

4 elements required to make a claim of negligence and malpractice

1. a duty was owed to the client (patient) 2. the professional violated the duty and failed to conform to the standard of care (breach of duty) 3. the failure to act by the professional ws the proximate cause of the resulting injuries (causality) 4. Actual injuries resulted from the breach of duty (damages)

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. What mistakes were made by the nurses in this case?

-Someone missed the laceration of his liver -he had VS that were all out of whack and no one looked further into those numbers -refusal to give water because he smelled like alcohol? I don't understand the logic here -giving pain meds if you think client has been drinking? -didn't assess patients pain

Examples of nursing malpractice:

-failure to question a physicians order when you see evidence that conflicts with physicians decision -leaving foreign objects inside of a client during surgery -failing to listen to and respond to a client's complaints -not properly documenting a phone conversation and orders from physician -failing to question physician orders when indicated (too much medication, inappropriate diet) -failing to clarify poorly written or illegible physician orders -failing to assess and observe a client as directed -failing to obtain a proper informed consent -failing to report a change in a client's condition such as Vital Signs, circulatory status, and LOC -failing to report another health-care providers incompetency or negligence -failing to take actions to provide for a clients safety, (not cleaning up liquid spill on the floor that causes a client to fall) -failing to provide a client with sufficient, appropriate education before discharge

Case study of the 44 year old client who died of an inoperable brain tumor. Family sued claiming they failed to institute proper and appropriate preventive measures and failed to inform the client of the seriousness of her condition. What might the nurse have done to prevent the suit in the first place? page 180 (191)

-have patient sign a form stating that she understands her condition, and these are the steps she needs to take to get better -document that she was referred to a nutritionist or a dietician

Definition of the possible defense of "defense of the fact":

-the actions of the nurse followed standard of care -OR if the actions were in violation of the standards of care, the actions themselves were not the direct cause of the injury

3 ways that intentional torts can be distinguished from malpractice and acts of negligence:

-the nurse must intend to bring about the consequences of the act -the nurse's act must be intended to interfere with the client or the client's property -the act must be a substantial factor in bringing about the injury or consequences.

What are the Electronic Pitfalls?

-use of computerized documentation and telemedicine has led to several lawsuits based on breach of confidentiality and malpractice -records lost because of computer failure -correction of charting errors

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. What are your feelings toward inebriated clients? Did the nurses attitudes about inebriation affect their judgments?

As a nurse your job is to care for people, (all people, in all their forms, people are not perfect), and to not pass judgement and the man certainly didn't deserve to die because of judgemental health care providers

intentional tort- assault and battery:

Assault is the unjustifiable attempt to touch another person or the threat of doing so. Battery is actual harmful or unwarranted contact with another person without his or her consent

Some documentation guidelines on page 188 (page 200) What are the key elements in your experience for effective documentation?

Clear documentation, only state facts, avoid making statements that may admit fault

Examples of nursing negligence:

Duty owed or breach of duty: failure to monitor a patient (side rails down & patient just prescribed narcotics) Foreseeability : inappropriate work assignment (giving a CNA a job she/he shouldn't be doing), inadequate supervision (not checking in on your CNA's work)

Refer to the case study on page 172, Mr Fagan's cast was too tight, when the nurse called physician he was unconcerned. Leg had to be amputated. How should nurses deal with reluctant or hostile physicians?

Every situation is different but you have to trust what you are seeing and advocate for your patient.

Case study of the 44 year old client who died of an inoperable brain tumor. Family sued claiming they failed to institute proper and appropriate preventive measures and failed to inform the client of the seriousness of her condition. Did the nurse's actions contribute to the filing of this suit? page 180 (191)

I don't know anything about inoperable aneurysms other than they are a weak place in an artery. In what little facts we have on this case, it was most likely caused by her high BP, exacerbated by being overweight. The nurse did tell her she should lose weight and outlined a plan, on her follow visit the patient gained more weight, so she was uncompliant

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. Why are clients who are drunk at higher risk for injury and poor medical outcomes than other clients?

I'm hoping it isn't because of nursing judgements I think it adds a higher level of complexity because it is a drug that the client may be dependent on, and no one has any idea to what degree it will affect the medication or treatments provided

Definition of the possible defense of statute of limitations:

If too much time has gone by you can't be sued, pediatric's is until the patient turns 21

What impact does social media have for nurses? Think in terms of the quasi-intentional torts.

It's important not to post things about the work environment online, because you can inadvertently leak data

Review box 9.7 on page (188) (8.7 on page 201) What to look for in an insurance policy?

Look at the type of insurance policy types of injuries covered exclusions who is covered limitations and deductions the right to select counsel the right to consent to settlement

A common example of false imprisonment?

Mentally impaired client can be detained against their will ONLY if they are at risk for injuring themselves or others. the use of threats or meds that interfere with the clients ability to leave the facility can also be considered false imprisonment.

Differentiate between negligence and malpractice

Negligence is the omission of an act, malpractice adds the professional aspect to it, professionals are held to a higher standard, because you have training and skills to protect the rights of your patient.

types of tort law

Negligence, malpractice, standards of care

Do nurses have privileged communication?

No, however, they can be bound, by extension, under the seal of privileged communication if they are in a room with a physician when the client reveals personal information, or overhear the information are held to the same standards as the physician.

Provide example of defamation of character?

Nurse tells a friend that a caterer for whom she was caring for was being treated for syphilis, it was not true, but became public knowledge and ruined his business.

Malpractice

Professional negligence, (more serious than negligence) it indicates professional misconduct or unreasonable lack of skill in performing professional duties. Because of their professional status nurses are held to a a higher standard of conduct than the ordinary layperson

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. What actions could the nurses have taken with this client to prevent a lawsuit?

Provided care to the patient advocated for the patient to go to a floor where he could get a room Called the physician as soon as his VS dropped assessed his pain, brought him water listened to patient not been judgemental about his drinking

What risk is there in talking in public places? What does this include?

Risk of invasion of privacy, slander, breach of confidentiality,

effective communication

SBAR (situation, background, assessment, recommendation). The Joint Commission concluded that miscommunication among health care workers is the leading cause of health care created errors leading to injury, death and lawsuits

Refer to the case study on page 172, Mr Fagan's cast was too tight, when the nurse called physician he was unconcerned. Leg had to be amputated. What could have been done to prevent the incident?

The night charge nurse should have called the doctor immediately instead of waiting until the day shift nurse came on. If she didn't agree with the doctors response she could have called the ED doctor herself, so the patient could be seen earlier.

What are the nurses responsibilities when procedures for physical and chemical restraints are used?

The use of restraints are okay when they are used to maintain the safety of a confused, disoriented, or otherwise incompetent client. Generally mental impaired clients can be detained against their will only if they are at risk for injuring themselves or others

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. How can nurses best prepare for trial in this case?

They can't, They were wrong.

Why are nurses (and nursing students) at risk?

They may meet people in the community, and have friends that they also may encounter at the hospital or medical workplace

An example of client abandonment?

When a nurse accepts a patient assignment and then leaves the facility without handing over the patient's care to another qualified nurse or individual, patient abandonment can be alleged

Should you have your own liability / malpractice insurance?

Yes

Refer to the case study on page 172, Mr Fagan's cast was too tight, when the nurse called physician he was unconcerned. Leg had to be amputated. Are all the elements in this case for a bona fide lawsuit?

Yes, as a nurse we are required to advocate for our patient. The nurses knew that the doctors actions were inappropriate

Tort Law

a division of civil law: which is defined as a wrongful act committed against a person or his or her property independently of a contract.

Quasi-intentional torts

a mixture of unintentional and intentional torts. A voluntary act that directly caused injury or distress without intent (to injure or to cause distress.)

A common example of assault and battery?

a nurse physically restrains a client and gives an injection against patient wishes

tort feasor

a person who commits a tort and is liable for damages to those who are affected by the persons actions.

Give a general definition of tort law?

a wrongful act committed against a person or his or her property independently of a contract. Torts are classified as unintentional, intentional, or quasi-intentional

What are the limitation on The Good Samaritan Act?

as long as the care provided was given according to the established guidelines and was within the scope of the professionals education.

intentional tort-false imprisonment:

occurs when a competent client is confined or restrained with intent to prevent him or her from leaving the hospital

intentional tort-client abandonment:

occurs within there is a unilateral severance of the professional relationship with the client without adequate notice and while the requirement for care still exists.

Negligence

omission of an act the a reasonable and prudent person would or would NOT perform in a similar situation.

medical record

charting is the best way to display the care provided and the communication between health care workers. If it isn't written it didn't happen. It should not contain personal opinion, should be legible, should be in chronological order, written and signed by the nurse

Breach of confidentiality

confidentiality of information concerning the client must be honoured. A breach of confidentiality result when a client's trust and confidence are violated by public revelation of confidential or privileged communication.

Possible defense to a malpractice suit:

contributory negligence comparative negligence Assumption of risk The Good Samaritan Act unavoidable accident defense of the fact statute of limitations

Case study of the 44 year old client who died of an inoperable brain tumor. Family sued claiming they failed to institute proper and appropriate preventive measures and failed to inform the client of the seriousness of her condition. What is the nurses role in defending against this suit? page 180 (191)

contributory negligence- client contributed to the problem by not losing weight unavoidable accident- when someone weighs this weight, with high BP, and has this condition it is only a matter of time? defense of the fact-the nurse followed standards of care

Liability insurance

is a necessity, nurses who do not carry liability insurance place themselves at high risk. Personal assets, as well as wages may be subject to a judgment awarded in a malpractice action. Even if the client dose not win at the trial, the litigation process, including hiring a lawyer an pain the costs of experts can be financially devastating

Types of Quasi- intentional torts

defamation of character (slander, libel) invasion of privacy Breach of confidentiality

Preventing lawsuits

effective communication medical record rapport with clients knowledge of clients

What is privileged communication?

ensures that the professional who obtains any information from the client can't be forced to reveal that information even in a court of law under oath

rapport with clients

establishing a rapport with clients through honest, open communication goes a long way in avoiding lawsuits

Definition of defamation of character:

harm to a persons reputation (diminishing the esteem, respect, good will, or confidence that others have for the person.

Definition of the possible defense of comparative negligence:

if your state has a comparative negligence law, then the awards are based on the determination of the percentage of fault by both parties

Definition of the possible defense of contributory negligence:

if your state has a contributory negligence law, then clients are not allowed to receive money for an injury if they participated in the injury in anyway.

statute of limitations

is a specified time in which a malpractice suit must be filed, generally begins at the time of the injury or when the injury is discovered and lets until some specified future time. In most states its 1-6 years. However involving children, the limitation extends until the person reaches 21 years of age

Invasion of privacy

is a violation of a person's right to protection against unreasonable and unwarranted interference with one's personal life

Definition of the possible defense of The Good Samaritan Act:

is designed to legally protect health care provider who provide care at the scene of an accident or disaster, as long as the care provided was given according to the established guidelines and was within the scope of the professionals education.

Maine State Board of Nursing (MSBON) definition of of Abandonment of a patient

is the termination of the nurse/patient relationship without the patient's consent or without first making arrangements for continuation of required nursing care by others. Reasonable notification or request for alternative care of a patient to an attending physician or to a staff supervisor prior to termination of the relationship is sufficient to permit such termination. Further, refusal to accept an employment assignment or refusal to accept a nurse/patient relationship is not considered abandonment. The nurse/patient relationship begins when responsibility for nursing care of a patient is accepted by the nurse.

unintentional tort

negligence is the primary form, often called omission of an act that a reasonable and prudent person would or would NOT perform in a similar situation.

Critical thinking exercise on pg 192 (pg 203) ED nurse sent a man to be admitted to the med surg floor, with low BP, he ultimately died of shock. What legal liability did the nurses incur by their actions?

negligence, malpractice (abandonment) because they didn't advocate and look more closely at the probable causes for this mans issue,

knowledge of clients

recognizing the client who is lawsuit prone can help reduce the risk for litigation: some common characteristics include: constant dissatisfaction with the care given constant compliants about all aspects of care negative comments about other nurses on another shift or has a history of lawsuits against nurses

What happens if a nurse is found liable?

several actions: -the nurse may be required to provide monetary compensation to the client for general damages that were a direct result of the injury, including pain, suffering, disability, and disfigurement. -the nurse is often required to pay for special damages that resulted from the injury such as all involved medical expenses, out of pocket expenses and wages lost by the client -optional damages include those for emotional distress, mental suffering, and counselling expenses that were an outgrowth of the initial injury may be added to the total settlement. -if the client is able to prove that the nurse acted with conscious disregard for the client's safety or acted in a malicious, wilful, or wanton manner that produced injury, an additional assessment of punitive or exemplary damages may be added to the award.

Definition of the possible defense of assumption of risk:

since a consent form was signed, if one of the listed complications occurred the client has no grounds to sue.

Defamation of character includes:

slander, libel, abuse of the principle of privileged communication

Definition of the possible defense of unavoidable accident:

sometimes accidents happen without any contributing causes from the nurse, hospital, or physician.

Slander

spoken communication in which one person discusses another in terms that harm that person's reputation

intentional tort

wilful act that violates another person's right or property. Most encountered are: assault, battery, false imprisonment, abandonment, and intentional infliction of emotional distress.

libel

written communication in which a person makes statements or uses language that harms another persons reputation

Case study of the 44 year old client who died of an inoperable brain tumor. Family sued claiming they failed to institute proper and appropriate preventive measures and failed to inform the client of the seriousness of her condition. Is there any contributory negligence? page 180 (191)

yes because the client contributed to the condition since she was uncompliant with doctors orders