(1/8)Legal Exam #2: CH 5 Standards of Care

error in judgement rule

*When deciding which standards of care apply, courts consider error in judgement rule and the two schools of thoughts doctrine The honest error in judgment rule allows the court to evaluate the standards of care given a patient even if there was an honest error in judgement, including an error in the diagnosis. What the court evaluates is the care given and whether that care met the prevailing standards, not whether the judgment was correct. Fraijo v. Hartland Hospital (1979) Court states that a nurse is not bound to do exactly what another nurse would do, only to select one approach among several that exists at the time and is reasonable

National standards

Based on reasonableness and are the average degree of skill, care and diligence exercised by members of the same profession. Such a national standard means nurses in rural settings must meet the same standard means that members of the profession practicing in large urban areas

Internal standards

Set by the role and education of the nurse, or by the individual institution. These include the professional nurse's job description, level of education, and expertise as well as an institution's policies and procedures. EX. Miller v. Jacoby (2001) pt. had penrose drain placed to promote postop drainage following renal surgery- DR ordered drain to be removed on the 3rd postop day. RN who removed the Penrose drain had more than 30 years experience in post op care, and removed in excess of 100 penrose drains during career. resistance was met when drain was removed- the removeed piece had a jagged edge, and it was discovered during imaging studied 3 months later that a 5.5 cm portion of the drain had been retained int he patient

External standards

Set by the state boards of nursing, professional organizations, specialty nursing organizations, current nursing literature, federal organizations, and federal guidelines. These standards are seen as external b/c they transcend individual practitioners and single institutions. In many instances, external standards are synonymous with national standards. Ex. State boards of nursing publish acceptable standards in the nurse practice act

Two schools of thought doctrine

Supports the nurse who chooses among alternative means of delivering quality health care. in this instance, the court evaluates the standards of care given when the nurse chooses among the alternative modes of treatment. Were standards of care met in the chosen mode of treatment? If the answer is yes, courts support the quality of care as delivered, even though other nurses would choose a different course of action.

Standards of care

The level or degree of quality considered adequate by a given profession. Standards of care are the skills and knowledge commonly possessed by members of a profession. *Created by thre duty undertaken, standards of care describe the minimal requirements that define an acceptable level or care, which is to exercise ordinary and reasonable care to see that no unnecessary harm comes to a patient. King v. State of Louisiana (1999) ..."Legal duty of care or standards of care means a nurse must have and use the knowledge and skill ordinarilty possessed and used by nurses actively practicing in the nurses specialty area" Wulbrecht v. Jehle (2010)... standards are the minimal care required but that health care providers can and do exceed standards