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2 Unit I Nursing Within the Context of Contemporary Health Care

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2 Unit I Nursing Within the Context of Contemporary Health Care

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  • March 13, 2024
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  • 2023/2024
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  • 2 Unit I Nursing Within the Context of Contemporar
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results in injury to another. The differentiating factor is
that malpractice is considered “professional negligence.”
A.Negligence and Malpractice
1.Negligence.
a. Occurs when a nurse fails to implement reason-
able care as dictated by standards of care by
omission or commission of an act and/or fails
to act how a reasonable and prudent layperson
would in similar circumstances.
b. Must result in physical, emotional, or finan-
cial harm.
2.Malpractice.
a. Professional form of negligence.
b. Occurs when a nurse fails to provide an expected
level of care consistent with professional stan-
dards of practice and/or fails to act how another
nurse would in similar circumstances.
c. Must result in physical, emotional, or finan-
cial harm.
d. Litigation occurs when a patient (the plaintiff)
initiates a civil suit in court against a provider of
health care (the defendant). To prove malprac-
tice, the plaintiff must establish by a preponder-
ance of the evidence four elements of liability.
(1)Duty: The nurse-patient relationship establishes that the nurse has a legal obli-
gation to the patient when the patient
seeks nursing care.
(2)Breach of duty: The nurse’s actions by
omission or commission of an act failed to
meet standards of care established by a job
description, agency policy or procedures,
the state nurse practice act, standards estab-
lished by professional organizations, and/or
a text deemed to be authoritative.
(3)Causation: Involves two elements that must
be proven by the plaintiff.
(a) A nurse’s action or inaction was the immediate cause of the plaintiff’s injury
(proximate cause).
(b) A nurse should have known that the
breach of the nursing standard could result in harm or injury (foreseeability).
(4)Damages: A plaintiff must prove that physi-
cal, emotional, or financial harm or injury
was the result of the breach of duty, such as
pain, suffering, disfigurement, disability,
medical expenses, or lost wages.
B.Common Malpractice Claims Related to Nursing
Practice
1.Failure to assess the patient and make appropriate
nursing diagnoses.
a. Includes:
(1) Failure to complete an admission assess-
ment or assignment.(2) Failure to make ongoing assessments.
(3) Failure to recognize a cluster of data that indicates a problem.
(4) Failure to identify safety needs, such as a
risk of falls or pressure ulcers.
(5) Failure to listen to patient concerns or requests.
b. To minimize the risk of litigation, the nurse must:
(1) Make a complete assessment.
(2) Have a strong knowledge base of the science
of nursing, anatomy and physiology, sociol-
ogy, psychology, chemistry, and so forth; col-
lect, analyze, and recognize the significance
of data; and have the ability to identify a patient’s needs.
(3) Make ongoing assessments until a patient is
stable.
(4) Listen to a patient’s concerns or requests
and respond appropriately.
2.Failure to plan appropriate nursing care.
a. Includes:
(1) Failure to design a plan of care according to
facility policy and procedures.
(2) Failure to include appropriate nursing interventions in the plan of care, such as
failure to plan for assistance when a debili-
tated patient moves from a bed to a chair
and subsequently falls or failure to plan to
assist a patient with meals who is at risk for
aspiration and who subsequently aspirates.
b. To minimize the risk of litigation, the nurse must:
(1) Formulate a plan of care for every patient,
including problems/needs, goals/outcomes,
and planned interventions.
(2) Document the plan of care according to
agency policy and procedures.
(3) Include all appropriate nursing interven-
tions in the plan of care to achieve the patient’s goals/outcomes based on profes-
sional standards of care.
3.Failure to implement a plan of care appropriately.
a. Includes:
(1) Failure to follow standards of practice and
agency policy and procedures, such as unsafe
use of equipment, improper application of restraints, medication error, or disregard for
do-not-attempt-resuscitation (DNAR) orders.
(2) Failure to follow state laws or regulations
concerning the prescription of medications
and performance of medical/surgical interventions.
(3) Failure to function as an advocate, such as
failure to protect a patient’s physical safety,
report an impaired nurse, or report suspected
abuse or neglect.22 Unit I Nursing Within the Context of Contemporary Health Care3706_Ch02_019-044 08/10/13 4:17 PM Page 22

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