Do you agree with the jury's decision against the nurse? Why?
The jury made a just decision. The nurse acted negligibly and deserved the sentence given. Since the patient had a leg amputation and still partially sedated after surgery, the client was at a high risk of fall for he lacked proper balance and ability to comprehend instructions. His caregiver, therefore, was solely responsible for his safety and putting up measures to prevent him from falling. The nurse should have assessed the condition of the patient and realized that he was at a high risk of falling. Therefore, it was not wise to allow him to move about freely immediately after surgery while he was still under the influence of anesthesia even if the physician gave the orders.
Leaving a sedated amputee unattended on a bed without raised rails shows negligence. The nurse had the professional obligation to question the doctor's orders and restrain the client's movements until he was at least fully conscious. If not, she should have avoided leaving him unattended as provided in the policies and procedures manual of the hospital. Nurses have a legal and moral obligation to put patients' safety first, even if it means disregarding standing orders. The nurse, in this case, deserved what she gets since chose to obey physician's instructions instead of following policies and procedures laid out by the hospital
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Is there ever a situation when the nurse can ignore an order?
The principle of fidelity requires nurses to obey physician's orders inpatient care. However, some situations may force them to disregard a doctor's request if it puts the life of a patient at risk. Nurses have a moral and ethical obligation to act in the best interest of their clients always. Sometimes, this may involve disregarding standing orders given by a healthcare provider to protect their patients from foreseeable risks. In the health profession, nurses are the last line of defense against harm to a patient, which makes them the most frequently sued caregivers in America. It is, therefore, paramount that they be vigilant enough to determine which orders to follow or ignore.
One of the main reasons nurses can ignore physician's orders is safety concerns surrounding medication or some procedures. The administration of drugs should not just be about following a prescription given by another healthcare provider. Instead, nurses have an individual responsibility first to assess the state of the patient, perform a safety check, and determine if the medication is indicated in quantities prescribed. As an example, it is not acceptable to administer dextrose to someone whose blood glucose is well above acceptable levels, even if a physician prescribes it as it may cause death. In such a case, the nurse has the right to question the order by contacting the requesting physician. If the later insists, the nurse should hold the medication and notify the supervisor.
Under what legal principle was the hospital held liable for the nurse's actions?
The jury held the hospital vicariously liable for the nurse's actions under the legal principle of "respondeat superior." This doctrine, translated as "let the master answer," states that employers are legally responsible for their employees' negligent actions under certain circumstances. For the "respondeat superior" to apply, the employees act negligibly within the scope of their employment. In essence, this includes when an injury occurs due to activity the staff was hired to perform or while the employee was on the clock. In the case study, the nurse is an employee of the hospital hired to take care of the plaintiff and protect him from harm while he recovers. However, she acted negligibly by leaving the patent unattended without raised bed rails, which caused him to fall and injure himself; this means that the injury occurred while the nurse acted within the scope of her employment. Therefore, the "respondeat superior" principle applies. The jury used it to hold the hospital liable for the nurse's negligence.
What other actions might the nurse have taken to prevent the patient from falling?
Being at a high risk of falls, the patient, in this case, should not have gotten off the bed without assistance. The nurse should have made him aware of fall risk and caution him against attempting to get off the bed without help. To avoid unnecessary movement, the caregiver should have ensured the patient is comfortable and has all his possessions within safe reach. She ought to have anticipated why the client would need to get off the bed and met those needs before leaving him unattended. Some of the actions include scheduling ample toileting, offering food and fluids, and providing pain relief and calming interventions. Besides, getting the patient in a comfortable position and helping them stretch would have reduced their need to get out of bed.
Keeping the patient busy could have reduced the risk of falls. The nurse should have given him a task such as reading, drawing, or doing puzzles to keep him occupied while she was away. The patient would have been less likely to get out of bed if he was busy. Besides, the nurse should have ensured there was an alarm on the bed that went off whenever the patient tried to get off. Maintaining a call light or bell within reach for the client to use to summon the caregiver would have also helped in averting the fall. The nurse could have also assigned the patient a safety companion who would observe him continuously and assist him whenever he needed to move.
References
Carroll, D. L., Dykes, P. C., & Hurley, A. C. (2010). Patients' perspectives of falling while in an acute care hospital and suggestions for prevention. Applied Nursing Research , 23 (4), 238-241.
Catalano, J. T. (2019). Nursing Now: Today's Issues, Tomorrows Trends . FA Davis.
Tan, S. Y. (2012). Medical Malpractice: A Cardiovascular Perspective. Cardiovascular Therapeutics , 30 (3).
