NUR 450 4th Lecture PDF

Legal Considerations: Common Areas of Negligence and Liability Legal Aspects and Ethical Issues in Profession (NUR450) 1st semester 1446H Objectives At the end of the session, the students will be able to: 1. Differentiate between negligence and malpractice. 2. List examples of negligence. 3. Ide...

Legal Considerations: Common Areas of Negligence and Liability Legal Aspects and Ethical Issues in Profession (NUR450) 1st semester 1446H Objectives At the end of the session, the students will be able to: 1. Differentiate between negligence and malpractice. 2. List examples of negligence. 3. Identify the elements of nursing malpractice. 4. Differentiate between intentional and nonintentional torts. 5. Discuss the issue of discharge against medical advice. 6. Discuss the workplace violence. What is tort?  Tort legal term referring to a civil wrong that causes harm or loss to another person, for which the law provides a remedy. It is distinct from a criminal offense and typically involves disputes between private parties. In tort law, the person who has suffered harm (the plaintiff) can seek compensation or damages from the person or entity responsible for the harm (the defendant). Most seen classification of law in the health care setting  Purpose or tort law To provide relief to individuals who have been harmed by the unreasonable actions of others To impose liability on those responsible To deter others from committing similar wrongs. Elements of tort  Types of Tort Law 1. Unintentional Tort (Negligence/Malpractice): Failure to exercise reasonable care, resulting in harm to another person (e.g., medical malpractice, slip and fall accidents). 2. Intentional Torts: Actions taken with the intent to cause harm or that are recklessly disregarding the likelihood of harm (e.g., assault, battery, false imprisonment). Unintentional Torts Acts that are committed with no intent to cause harm but are done with a disregard for the consequences. The term negligence is used to describe such actions when health care practitioners fail to exercise ordinary care resulting in patient injury. Malpractice is the negligent delivery of professional services.  Intentional Torts Assault ‫اﻟﮭﺟوم‬ Battery ‫اﻟﺿرب‬ To cause another person to feel An action that causes bodily harm to threatened. another. Even touching without permission. Invasion of privacy Fraud ‫ﺧداع‬ Interference with a person’s Depriving or attempting to deprive a right to be left alone. person of his or her rights. Defamation of Character‫اﻟﺗﺷﮭﯾر‬ False Imprisonment‫اﻟﺳﺟن‬ Damaging a person’s reputation Intentional, unlawful restraint or by making a public statement. confinement of a person. 9 Negligence and Liability Negligence: is a general term that denotes conduct lacking in due care/is a legal failure to behave with a reasonable level of care. Liability: is a standard that reflects a person’s responsibility for the injury of another person. The difference between negligence and liability lies in the element of control. Negligence Negligence can be either an act of “commission” or an act of “omission” Act of Omission: something one should have done but did not do Act of Commission: something they did but should not have Malpractice Malpractice, sometimes referred to as professional negligence, is a more specific term that addresses a professional standard of care as well as the professional status of the caregiver. To be liable for malpractice, the tortfeasor (person committing the civil wrong) must be a professional, such as a physician, nurse, accountant, or lawyer. Negligence Example Abandonment Improper patient monitoring – for example, not correctly recording observations or vital signs Failure to call for a doctor where assistance is required Not properly checking equipment Failure to follow procedures or errors in procedures like inserting IV lines Administering the wrong medication or a wrong dosage Failure to communicate clearly and care for the patient Elements of Nursing Malpractice All of the following elements must be established in a court of law to prove malpractice: Duty: A nurse-client relationship exists. Breach: the standard of care was not met and harm was a foreseeable consequence of the action or inaction. Causation: injury was caused by the nurse’s breach. Harm: Injury resulted in damages. Duty Owed the Patient In law, duty of care is defined as a duty to provide care at a level reasonably expected of any competent doctor, nurse, midwife, surgeon, etc. Example: Failing to monitor the patient Breach of the Duty Owed the Patient Breaching duty means that a healthcare provider failed to react or act accordingly to a patient's illness or injury, or that an act he or she took was indeed negligent, and the outcome resulted in additional harm to the patient. Example: Failing to report a change in patient status, Giving prescriptions for the incorrect medicines, Wrong site surgery. Causation Somewhat more difficult to prove is causation , which means that the injury must have been incurred directly as a result of the breach of duty owed the patient. Causation is frequently subdivided into the concepts of (1) cause-in-fact and (2) proximate cause. Cause-in-fact denotes that the breach of duty owed caused the injury. As example restraining a patient improperly Proximate cause is the events or acts closely related to injury. As example improper medication administration. Injury The plaintiff must demonstrate that some type of physical, financial, or emotional injury resulted from the breach of duty owed the patient. Example: Allowing a patient to be burned. Harm/Damage The basic purpose of awarding damages is compensatory, with the law attempting to restore the injured party to his or her original position so far as is financially possible. Essentially four types of damages may be compensated 1. General : Using equipment incorrectly 2. Special: Failing to follow ordered treatments 3. Emotional: Failing to provide patient education and discharge instructions. 4. Punitive: Acting in a manner that wholly disregards the patient’s safety Discharge Against Medical Advice Discharge against medical advice (DAMA) occurs when a hospitalised patient chooses to leave the hospital before the medical care team recommends discharge. Against medical advice (AMA) occurs when a patient refuses to undergo diagnostic or therapeutic procedures or refuses to follow treatment plan as recommended by healthcare providers. DAMA/AMA form must be signed. Workplace Violence Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. The Effects of Violence Minor physical injuries Serious physical injuries Temporary and permanent physical disability Psychological trauma Death Healthcare workers experiencing workplace violence may experience suicidal ideation, posttraumatic stress disorder, depression, anxiety, burnout, and continue to feel anger and fear and other emotions (Nigam et al, 2023; Lanctot & Guay, 2014). Risk Factors for Workplace Violence in Healthcare Settings Clinical Risk Factors 1. Substance use or misuse 2. Patients who are in pain 3. History of violence by the patient 4. Cognitive impairment Risk Factors for Workplace Violence in Healthcare Settings Environment Risk Factors 1. Accessibility to healthcare workers 2. Increased stress (such as confusing signage or disturbing noise levels in the facility) 3. Security measures that limit staff’s ability to respond appropriately to violent incidents Risk Factors for Workplace Violence in Healthcare Settings Individual Risk Factors 1. Stressful and emotional work 2. Fatigue 3. Inadequate interpersonal, coping or conflict management skills  Prevention Strategies Environmental design Administrative controls Behavior modification 26  Environmental Designs Emergency signaling, alarms, and monitoring systems Security devices Cameras Provide security escorts Design waiting areas Design public areas 27  Administrative Controls Designing staffing patterns Restricting the movement of the public by card- controlled access Developing a system for alerting security personnel when violence is threatened 28  Behavior Modifications Recognizing and managing assaults Resolving conflicts Maintaining hazard awareness 29  Outcome Measures Providing an environment that promotes open communication Develop written procedures for reporting and responding to violence Employers should offer and encourage counseling 30  Warning signs of the Manifestation of Violent Behavior Verbal Cues Non-Verbal Cues Raised voice/yelling Physical appearance (neglected hygiene and clothing) Arms folded tight against chest Swearing Clenched fists Threating tone of voice Heavy breathing Pacing or agitation A terrified look (signifying fear or high anxiety) A fixed stare Aggressive or threatening posture Thrown objects Sudden changes in behavior Indications of drunkenness or substance31 abuse Scenario Sarah, a registered nurse working on a busy medical-surgical floor, is assigned to care for Mr. Ahmed, a 65-year-old patient admitted for pneumonia. During her shift, Sarah is responsible for administering medications, monitoring vital signs, and providing general care. At 10:00 AM, Sarah is scheduled to give Mr. Ahmed his antibiotic, a dose of vancomycin, which is ordered to be given intravenously over 60 minutes. However, Sarah gets distracted by a colleague and forgets to administer the medication. At 1:00 PM, three hours later, Sarah realizes she has missed the scheduled dose. Without informing the doctor or checking the patient’s condition, she administers the full dose of vancomycin over 20 minutes, thinking this will "catch up" with the schedule. Shortly after the rapid infusion, Mr. Ahmed develops signs of "Red Man Syndrome," including severe flushing, hypotension, and difficulty breathing. Sarah panics and contacts the physician only after the patient’s condition deteriorates. Mr. Ahmed is transferred to the ICU for emergency care due to the complications arising from the incorrect administration of the medication. Points of Negligence in the Scenario: Failure to Administer Medication on Time Failure to Follow Protocol for Late Medication Improper Medication Administration Failure to Monitor the Patient After Medication Delay in Reporting the Incident Negligence in Communication and Documentation Teaching Points on Negligence Duty of Care: Nurses have a legal and professional responsibility to provide safe and timely care to their patients. In this scenario, Sarah breached her duty by not administering the medication on time and not following proper procedures when she realized the error. Teaching Points on Negligence Breach of Standard of Care: By administering vancomycin too quickly and without proper monitoring, Sarah violated the standard of care expected of her. This breach directly led to Mr. Ahmed’s complications. Teaching Points on Negligence Causation: The nurse’s actions directly caused harm to the patient. The improper administration of vancomycin resulted in Mr. Ahmed’s adverse reaction and subsequent ICU admission. Teaching Points on Negligence Harm: The patient experienced actual harm due to Sarah’s negligence, including a severe reaction (Red Man Syndrome) and the need for critical care in the ICU. Prevention: This scenario highlights the importance of proper time management, adherence to medication protocols, and communication in preventing errors. Nurses should never hesitate to ask for help or report an error immediately, as early intervention can save lives. References Arbury, S., Collins, N. R., Magtahas, J., Holmes, M., & Hodgson, M. J. (2022). OSHA Workplace Violence Enforcement. Journal of occupational and environmental medicine, 64(4), e211–e216. https://doi.org/10.1097/JOM.0000000000002482 Guido, G. W. (2020). Legal and ethical issues in nursing (Seventh edition). Pearson Education, Inc. Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 5 – Legal Implications. Available from: https://www.ncbi.nlm.nih.gov/books/NBK598383/