Learning Exercise 4.9
To See or Not to See
For the last few days, you have been taking care of Mr.Cole, a 28-year-old patient with end-stage cystic fibrosis. You have developed a caring relationship with Mr. Cole and his wife. They are both aware of the prognosis of his disease and realize that he has only a short time left to live.
When Dr. Jones made rounds this morning, she told the Coles that Mr. Cole could be discharged home today if his condition remains stable. They were both excited about the news because they had been urging the doctor to let him go home to enjoy his remaining time surrounded by the people he loves.(Bioethical Presentation Essay Sample)
When you bring in Mr. Cole’s discharge orders to his room to review his medications and other treatments, you find Mrs. Cole assisting Mr. Cole as he coughs up bright red blood. When you confront them, they both beg you not to tell the doctor or chart the incident because they do not want their discharge to be delayed. They believe that it is their right to go home and let Mr. Cole die surrounded by his family. They said that they know that they can leave against their physician’s wishes and go home against medical advice, but if they do, their insurance will not pay for home care.(Bioethical Presentation Essay Sample)
Bioethical Presentation Essay Sample
(Bioethical Presentation)The nursing profession has legal aspects that influence how care is offered to patients by trained nurses. These legal issues determine the surroundings where nursing care is administered in addition to establishing how patient health documents are kept as well as stored. As such, the American Nurses Association (ANA) defines the Standards of Professional Nursing Practice as commanding pronouncements outlining the obligations which all registered nurses have to competently perform their role, population or even area of specialty notwithstanding(Bioethical Presentation Essay Sample). ANA takes an extra step of acknowledging that the nursing standards can alter depending on the evolving dynamics of professional nursing, which particular clinical scenarios might impact on the way the standards of care are applied at any one given point in time. Contemporary nurses have to be conscious and aware of the nursing standards as the fundamentals that steer their excellence in practice while simultaneously recognizing the legal implications of these standards. As such, nurses and the nursing care that they deliver to their patients’ are evaluated based on these legal definitions that embody the combined understanding the requirements of the ordinary nurse by setting the baseline parameters for proficiency. Consequently, this essay purposes to discover the effect the law has on nursing in designated practice settings.(Bioethical Presentation Essay Sample)
Case 1: Chapter 17 (Guido, p. 362)
The scenario involved Judy, a 20-year-old admitted in a psychiatric acute care facility suffering from serious depression and having morbid ideations. Within the facility, the patient was put on protocol that required her to check every 15 minutes but the next day, Judy was unobserved for more than 45 minutes upon which the nurse checking found her choking on the belt of her robe from the shower rod. Though she survived the suicide attempt, Judy suffered an anoxic brain injury that was not only severe but also severe permanent – a fact that made her parents sue, claiming that nursing care standards had been broken.(Bioethical Presentation Essay Sample)
To begin with, it is clear from the condition of the patient and her being on a 15-minute observation protocol that the nurse was negligent by unlocking the bathroom door and allowing Judy to be in the shower all by herself without a nurse keeping watch. Unlike in traditional times, when nurses were not considered as professionals delivering professional care, the contemporary scope of nursing practice has extended together with expertise and nurses acquiring advanced education. As such, the legal principle of the nurses’ standards of care as a living concept makes the nurse guilty of ordinary negligence. It is a broad concept which, when stretched to the extreme, makes the nurse liable for nursing malpractice considering that malpractice is taken to describe either breach of duty, negligence or even misconduct by a professional, which ends up in the harm or injury to a patient.(Bioethical Presentation Essay Sample)
Even though nursing standards of care are broad statements whose legal definition that is not contained in state legislation or public codes of health, and even nurse practice act, the present case was beneath the care standards. The nurse should have ensured the bathroom door was not locked when the therapist paid Judy a visit. Judy. Suffice to say that nurses are deemed to possess a general nursing knowledge as opposed to the specialist physician with an understanding that the standard of care is to be considered as that of the reasonable, typical nurse with the said standard of care applying at the time of the incident. Furthermore, testimony against the nurse is assessed based on the nurse’s experience in the area of nursing in context. For example, in this case, being a psychiatric ward, the psychiatric nurse would be evaluated on the parameters of judicious psychiatric care practicing within the same or similar circumstances of the suicidal patients.(Bioethical Presentation Essay Sample)
The psychiatric facility policies and procedures in Judy’s case are significant in that while they do not explicitly define the standards of nursing care, they act as the guidelines that are more specific about the care and treatment plans offered to the patient within that particular facility which in his case was 15-minute observation protocol(Bioethical Presentation Essay Sample). A breach that means three consecutive observations was skipped with dire consequences on the suicidal patient. If I were to be the judge, in the present case, I would determine the case in favor of the plaintiff if all the four elements of malpractice are proved on a balance of probability by the complaint or plaintiff. These are that the nurse had a duty of care to the client, there was a negation of responsibility by the nurse by having skipped three observations that a patient injury occurred with the patient’s attempted suicide. The fourth component of malpractice is that there exists a causal connection between the breach of duty (Skipping the 15-minute observation branch) and resulting patient injury (suffering severe brain injury ) the severity of which could have been reduced had the 15 minute been observed. All of the components would respond with a, yes, yet the statute of limitations would not cover the nurse since the complaints filed their case immediately ad, not after two years after which the limitation statute would apply in her case so my verdict would be guilty as charged ad therefore liable.(Bioethical Presentation Essay Sample)
Case 2: Chapter 18 (Guido, p. 393)
The facts of the case were that Mr. Gonzalez had undergone a routine colonoscopy was performed, and three polyps removed after a period of one ad a half hours. After a day, abdominal pains on the patient commenced making him call the attending physician to no avail and reached the physician’s nurse three hours later. The staff had gone home in which case the nurse advised Gonzalez to self- medicate through aspirin and in the morning that followed was put on antibiotics at the facility without resolution. Five days later, counting from the day of the original colonoscopy, he had another surgery, which determined that Gonzalez’s intestines were perforated during the removal of polyps and now had to have a permanent colonoscopy.(Bioethical Presentation Essay Sample)
The nurse should not have recommended aspirin in this patient’s case since Aspirin (ASA) is a medication that may cause gastrointestinal lesions (Bujanda et al., 2018). Therefore based on, the Revised Judicature Act of 1961 of the State of Michigan states that a civil action for malpractice can ensue on any individual acknowledging or regarding themselves to be a member of a profession licensed by the state. Current clinical practice does not allow the physician to attest on nurses standards of care as only a nurse is regarded to possess the unique body of knowledge, training as well as experience to provide testimony touching on what ordinary nurse would do if faced with similar or same conditions for a patient bestowing in the equal or comparable way.(Bioethical Presentation Essay Sample)
On the pertinent issue of whether the nurse exceeded her scope of practice through the advice that she offered to the client in this case, it is essential to consider that according to the affordable care act (ACA) nurses have a significant role in delivering patient-focused care that is of high quality, accessible and affordable. Furthermore, Ortiz et al. (2018) note that Nurse Practitioners are actively helping to address the shortage of primary caregivers by having the scope of practice that ranges from independent practice to instances where direct physical oversight is required although this varies from one state to another within the US(Bioethical Presentation Essay Sample). Subsequently, unless the state in context decreed; otherwise, the nurse I this case had not exceeded her scope of practice in advising Mr. Gonzalez. Considering that the severity of the pain was relatively low, the nurse need not have instructed the patient in context to seek emergency care at the local health facility.(Bioethical Presentation Essay Sample)
As a judge, in this case, I would decree that neither the nurse nor the attending physician was legally responsible for professional malpractice. However, I would recommend the professionals and the facility to follow the recommendations of Health Care Quality Improvement Act of 1986 which calls for hospitals, state licensing boards as well as professional societies to identify and resolve through corrective action health care professionals who are found by their peer reviews to have engaged in unprofessional or negligent misconduct.(Bioethical Presentation Essay Sample)
Case 3: Chapter 20 (Guido, P. 439)
An overview of the case at hand indicates that the 81-year-old Aburu had prior history of analytical vascular accidents whose hospitalization as an outpatient patient emanated from an operation that was meant to drain a membrane lesion on his trunk. Afterwards, the patient went back to his long term nursing care home because complications from this type are considered below. Within five hours, the elderly patient had to be rushed back to the acute care infirmary after the nursing home staff observed some blood on the site of the incision, where the patient died within 24 hours. At the trial, the evidence adduced showed that many registered and unlicensed staff availed nursing care services to Aburu. None of the staff did examine his bandage till an aide on his bed sheets observed bleeding.(Bioethical Presentation Essay Sample)
Olotu et al. (2019) posit that advancing age presents with risks that can adversely affect the postoperative outcome of patients aged 65 and above. Mr. Aburu fell within the old elderly at 81 years. For an excellent postoperative outcome, there is a need for preservation of performance, autonomy, functionality as well as the patient’s quality of life through avoidance of post-operative delirium amongst other measures(Bioethical Presentation Essay Sample). The post-operative checklist should include a daily evaluation of delirium or cognitive impairment whose management strategy should include pain control, optimized physical environment and removal of catheters. Second is, acute perioperative pain requiring the care gives to initiate multimodal and customized pain control followed by checking for pulmonary complication where prevention strategies entail aspiration precautions, early mobilization (Mohanty et al., 2016). Other standards of care in postoperative care are fall risk evaluation, ability to maintain sufficient nutrition, prevention of urinary tract infections, daily evaluation of functional decline and pressure ulcer development.(Bioethical Presentation Essay Sample)
Although the nursing care plan had not stipulated that surgical wound be checked after every 60 minutes, the prudent nurse ought to have checked the patient on an hourly basis and used prophylaxis and perioperative bleeding therapy like tranexamic acid and fibrinogen amongst others. Additionally, point of care testing of hemostatic function would probably have effectively managed the patient’s bleeding. In my view, the surgeon should not be at the center of this lawsuit since the risk assessment of developing complications after colonoscopy is relatively low, and therefore it was a reasonable clinical decision to release the patient. As the Presiding judge, in this case, my verdict would be that none of the professionals is guilty of professional malpractice. However, I would remind the nurses to be familiar with the legal jeopardies involved in offering care and, therefore, should undertake some measures that decrease the risk of facing a lawsuit for malpractice. These measures include being aware and following the nurse practice act specific to a state and the healthcare facility’s guidelines and processes, remaining updated on one’s field of practice and follow-up on assessment or care that is delegated to others.(Bioethical Presentation Essay Sample)
In conclusion, this essay has established a general overview of some of the legal aspects of nursing, as presented in the selected practice settings. The rubric is the legal description of the nurses care standard as describing that which a prudent and reasonable nurse would ensure when offering care for a similar for matching patient under the equivalent or comparable conditions. Be that as it may, nurses should seek guidance from their organization’s risk management or legal department for specific legal questions or issues since they are the ones more conversant with local laws as well as regulatory necessities.(Bioethical Presentation Essay Sample)
Bujanda, L., Sarasqueta, C., Vega, P., Salve, M., Quintero, E., Alvarez-Sánchez, V., & Ferrandez, A. (2018). Effect of aspirin on the diagnostic accuracy of the faucal immunochemical test for advanced colorectal neoplasia. United European Gastroenterology Journal, 6(1), 123-130.
Ghadimi, K., Levy, J. H., & Welsby, I. J. (2016). Perioperative management of the bleeding patient. BJA: British Journal of Anesthesia, 117(suppl_3), iii18-iii30.(Bioethical Presentation Essay Sample)
Guido, G. W. (2014). Legal and ethical issues in nursing (6th Ed.). Upper Saddle River, NJ: Prentice-Hall.
Kim, F. J., da Silva, R. D., Gustafson, D., Nogueira, L., Harlin, T., & Paul, D. L. (2015). Current issues in patient safety in surgery: a review. Patient safety in surgery, 9(1), 26.(Bioethical Presentation Essay Sample)
Mohanty, S., Rosenthal, R. A., Russell, M. M., Neuman, M. D., Ko, C. Y., & Esnaola, N. F. (2016). Optimal perioperative management of the geriatric patient: a best practice guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. Journal of the American College of Surgeons, 222(5), 930-947.
Olotu, C., Weimann, A., Bahrs, C., Schwenk, W., Scherer, M., & Kiefmann, R. (2019). The Perioperative Care of Older Patients: Time for a New, Interdisciplinary Approach. Deutsches Ärzteblatt International, 116(5), 63.(Bioethical Presentation Essay Sample)
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute.(Bioethical Presentation Essay Sample)