4840+Legal+and+Ethical+Issues+Module

West Legal & Ethical Issues Module 4840

Chapter 11 Nurses are obligated to provide care to the best of their abilities within their scope of practice for their patients as would be expected. This is duty of care. A written or implied contract must be in effect to establish duty (P. McMullen, A. R. McMullen and Creasia, 2007, p. 266). Duty of care in medical malpractice cases falls under the area of tort law (Shestokas, 2009). A tort occurs when the actions of one person cause harm to another (P. McMullen, et. al., p. 258). When a nurse is assigned a patient and the patient has agreed to treatment in exchange for payment, the patient has the right to expect to be provided care which is normal for a patient in his or her medical situation. It is the nurse’s responsibility to meet the standard of care and his or her obligation toward the patient. References: McMullen, P., McMullen, A. R., & Creasia, J. L. (2007). //Legal aspects of nursing practice//. In Creasia, J. L. & Parker, B. J., Conceptual foundations: The bridge to professional nursing practice (p. 258 & 266). St. Louis: Saunders Elsevier.
 * #1. ** Duty of Care:

Shestokas, D. J. (2009, March 25). The Law of Negligence: Duty, breach of duty, injury & causation. Suite 101.com. Retrieved from http://law.suite101.com/article.cfm/the_law_of_negligence

Breach of Duty: In order to have a breach of duty it must first be recognized that the duty was there. The nurse must have failed to meet the expectations of the written or implied contract. There may or may not be actual harm to the patient. The case against a nurse can be determined even if there is a potential for harm discovered and proven. According to Shestokas (2009), breach of duty occurs when the nurse “knowingly exposes another to potential damage”. Shestokas continues to qualify by saying that breach of duty still exists if the nurse did not recognize the possible harm but should have. In a case of law, breach of duty is usually determined by the testimony of another health care provider (P. McMullen, A. R. McMullen and Creasia, 2007, p. 266). Under the law, breach of duty is a matter of negligence. The nurse neglects to meet an obligation to the patient which places the patient in potential danger.

References: McMullen, P., McMullen, A. R., & Creasia, J. L. (2007). //Legal aspects of nursing practice//. In Creasia, J. L. & Parker, B. J., Conceptual foundations: The bridge to professional nursing practice (p. 266). St. Louis: Saunders Elsevier.

Shestokas, D. J. (2009, March 25). The Law of negligence: Duty, breach of duty, injury & causation. Suite 101.com. Retrieved from []

Three examples of breach of duty:
 * 1) A nurse promises to return to a patient after assisting the patient on a bedpan. The nurse does not return for several hours and the patient subsequently develops a decubitus ulcer at areas of pressure from the bedpan.


 * 1) A nurse leaves her patient who is disoriented and confused in bed without placing the siderail up. She has a duty to keep the patient safe with the least restrictive measures however; this patient is not able to make competent decisions and subsequently falls out of the bed incurring a broken hip.


 * 1) A patient has a blood sugar check due at 0700. His nurse becomes involved in a code and does not delegate the glucometer check to a qualified co-worker. The patient’s blood sugar is not checked until two hours later at which time the patient’s sugar is found to be 30.

Reference: (2009). Post-anesthesia nursing care: physician not informed promptly, nurses negligent. //Legal Eagle Eye Newsletter for the Nursing Profession//, 17(8), 6. Retrieved from CINAHL Plus with Full Text database. In this case two nurses were found negligent by not reporting crucial patient information to the surgeon in a timely manner. The patient underwent an aortofemoral bypass graft during which the blood flow to the patient’s legs was clamped off for an extraordinary length of time due to unusual calcification in the patient’s renal arteries. The patient arrived at the post-anesthesia care unit (PACU) with low blood pressure at 6:42 p.m.. The nurse at that time assessed the patient finding post-tibial pulses bilaterally (with the Doppler) and the patient able to move both legs without problem. Not long after, the patient began complaining of severe pain, a sensation of pressure in his legs and pelvis and a loss of feeling in his legs. The nurse noted the patients legs were cool to touch and becoming pale. She did not notify the surgeon at this time. The patient’s blood pressure continued to drop. It wasn’t until the next nurse on duty noted mottling of the patient’s right leg that the surgeon was notified. That was at 8:40 p.m.. The second nurse had come on duty at 7:45 p.m.. When she first assessed the patient she charted the patient was already losing the ability to move his legs. This case was noted in the //Legal Eye Newsletter for the Nursing Profession// (2009). Both nurses had a duty to report the patient’s abnormal conditions to the surgeon at the time of discovery. The patient’s medical expert determined the surgeon was without fault. Respondent superior applies because the nurses’ inaction occurred during their employment at the hospital. The hospital incurs some responsibility for the acts of its employees. There are several implications of this case to nursing practice. First, the nurse must be aware of the importance of clinical findings. Second, he or she must realize the repercussions of not reporting significant adverse changes to the physician in a timely manner. The nurse must ask “How will it affect the patient?”
 * #2. ** Medical Malpractice Case:

Chapter 12 Morals are the values or guidelines inherent in the individuals. The person’s nature is determined by his or her morals. Moral decisions are made more by the “rightness” or “wrongness” of such decisions. Morals do not normally change throughout the person’s life. Ethics are more of a group term, meaning ethics is normally determined by a faction of people instead of the individual. Ethics guide how we ought to act in a given scenario. Ethical decisions may vary upon the circumstances, in other words, the outcome can be dependent upon the variables. This writer believes it is morally important to treat others as writer would like to be treated. Writer would not ethically be able to assist another person with his or her death even though it may be considered an act of compassion. Even though this writer would like to think she would not ask this of another given her belief in Christianity, it is difficult to say without actually being in said situation.
 * #1. ** The difference between morals and ethics

The professional practice of the bedside nurse can only be enhanced by the use of the nursing Code of Ethics. When a nurse follows the Code, the patient is treated with compassion and respect on an individual basis. The nurse will be guided by an obligation to his or her patient however the patient may be defined. These practices will help to develop a trusting relationship between patient and nurse. The nurse will perform within his or her scope to provide the best care he or she is capable of with reasonable regards to the needs of other patients. This will aid in ensuring the best possible outcome for the patient. The nurse will be a diligent advocate to guarantee the patient’s rights. He or she will be in tune to the patient’s need for further education. The nurse should embrace personal and professional growth and be a champion for needed change in the environment and in nursing as a practice. To do so will not only benefit the patients currently under the nurse’s care but future patients at the facility. This nurse should also be able to collaborate with others in the field and the public to strive for improvements in local, national and worldwide health care (Fry and Grace, 2007, p. 285). These staid guidelines impart ethical parameters by which the nurse should govern his or herself. Reference: Fry, S. T., & Grace, P. J. (2007). //Ethical dimensions of nursing and health care.// In Creasia, J. L. & Parker, B. J., Conceptual foundations: The bridge to professional nursing practice (p. 285). St. Louis: Saunders Elsevier. In an ethical environment the patient would receive the best reasonable care possible resulting in a greater degree of patient satisfaction. Managed care would not equate to test and treatment denial or understaffing. Nursing staff would be skilled, professional, motivated and have knowledge of ethics through education. In this environment the nurse would relay and exhibit a high degree of job satisfaction. The nurse would experience less stress from being caught in the middle of ethical disputes and would have moral support when these instances occur. Nurse burnout and staffing turnover would be significantly decreased. The greater satisfaction of patient and nurse would multiply more favorable patient outcomes. The facility would be able to consistently accomplish its mission statement without constant worry of closing its doors. In order to establish an ethical environment all staff must be educated on what ethics entails. We would need to have an ethics committee of knowledgeable staff who are approachable for other staff to receive assistance in resolving moral dilemmas which occur. Our quality control supervisor in collaboration with the personnel director can use patient and staff satisfaction surveys and interviews to access knowledge of the most pertinent and immediate solutions needed. This information must be used once obtained. Otherwise the process was only an exercise in futility and another waste of resources. It is imperative that the leaders and managers not only learn staff’s most motivating factors, but that steps are made to try to accommodate at least some of these, within reason, to act in good faith. This will be one move in the right direction toward retaining staff which is already trained. In turn, costs of replacing staff would decrease. Teamwork should be stressed with the idea that everyone on the particular team is an integral member. The personnel director in agreement with other managerial staff may want to look at some creative staffing ideas. For example if there are two nurses who want to work only part time, combine their efforts in one full time position. With increase in staff satisfaction attitudes should improve. We need to implement measures to expound on acknowledging when a staff member goes above and beyond the usual or comes up with solutions to the many care issues that arise daily. The facility needs to embrace the idea of employee ownership where employees will want to take responsibility for their actions and their patients care. All of these interventions should have a snowball effect if successful. Employees with better attitudes due to higher job satisfaction are prone to produce a higher quality of work. Patients will benefit from this which in turn should lead to at least some better patient outcomes and an increase in patient satisfaction. The facility administrator could research the successful implementation of ethical environments in other comparable organizations and learn from their example. While this writer realizes some of these interventions may be highly optimistic in long term care, no doubt some of the ideas could help us work toward a more ethical work environment. To measure the results of these changes one need first notice the atmosphere of the facility. Is there an air of enlightenment or is there a cloud of doom about the place? Other ways to measure an ethical atmosphere would be to, once again, implement patient satisfaction surveys and direct interviews of patients and staff. In long term care this writer always pays attention to the patients. Do they look happy? Are they involved in activities? Do they interact easily with staff members? These are only a few indicators that care is, on average, what it should be.
 * #2. ** ANA Code of Ethics for Nurses
 * #3. ** An Ethical Environment

The writer as Mrs. Jones’ nurse should contact the doctor and request either an increase in pain medication or use of an alternate pain medication to try and alleviate her pain. We all deal with and tolerate pain differently. The principles used to come to this decision are that of beneficence, the obligation to do good (Fry and Grace, 2007, p. 283) and fidelity, keeping one’s promise and caring (p. 289). The theory of formalism is most in line with the writer’s approach to this particular dilemma. In this theory the nurse honors his or her duty to care for the patient. Mrs. Nelson has a right to know what can happen if there is a DNR in place and what to expect if there is no DNR, should further complications arise with Mr. Nelson. This nurse used the principles of autonomy which allows Mrs. Nelson to make her own informed decision and veracity which obliges the nurse to give accurate information without deception (pp. 284-86). The theory which best applies is that of naturalism which propagates honesty. This nurse would feel obligated to give Mr. and Mrs. Smith truthful information regarding the possibility of the new baby developing AIDS. The nurse would also provide support group and resource information to the couple. The writer used the sanctity of human life principle and that of veracity to come to this conclusion (pp. 286-87). Once again the writer was guided by the theory of formalism by giving the parents accurate information. Reference: Fry, S. T., & Grace, P. J. (2007). //Ethical dimensions of nursing and health care.// In Creasia, J. L. & Parker, B. J., Conceptual foundations: The bridge to professional nursing practice (pp. 283-87 & 289). St. Louis: Saunders Elsevier.
 * #4. ** Scenarios