Research shows several errors leading to nursing negligence. For instance, a nurse fails to follow standards of care, fails to use equipment in a responsible manner, fails to communicate, fails to document, fails to assess and monitor and fails to act as a patients advocate (Croke, 2003). In 1998, Hurwitz states in order to prove medical negligence, the patient plaintiff must prove: The defendant nurse owned the plaintiff a duty of care and breached in this duty of care by failing to provide the required reasonable standard of care.
Thus this breach of duty of care caused the plaintiff damage. I would like to discuss a case encounter in my practice for example to reflect my knowledge. A 55 year old patient admitted for chest pain and on telemetry monitoring. This patient requested for shower, a nurse removed his telemetry and was ask to assist the patient during shower, but the patient insisted to shower on his own. Then the nurse left the patient alone without instructing him to call for help if he felt any discomfort. After a while, the nurse went back to check, patient was found collapsed on the toilet floor. The issue that came across my mind is If I am that nurse, am I negligent?
Learning point 1: Duty of care
A patient went to the hospital and hospital is agreeable for patients treatment, there will be a contract between the hospital and patient. The hospital has the duty to provide quality treatment to the patient. Nurse as the employee, if he acts badly, it can be reasonably foreseen that the patient may be injured. Therefore the nurse owes a duty of care in treating the patient (Staunton & Whyburn, 1996). In this scenario, I have a bond with my patient; therefore I owe a duty to provide reasonable and competent care to my patient (Hurwitz, 1998).
Learning point 2: Standard of care
The nursing standard of care is what the reasonably prudent nurse did in the same circumstances (Staunton & Whyburn, 1996). In Singapore, we have the standard of care and code of ethics for nurses and midwifes as our guideline for practice, it is our responsibility to follow the standard ( Singapore nursing board, 2011). In this case, the patients determination to shower without assistance, is his autonomy (Tay, 2001). According to value statement of code of ethics, I respected the patients individual needs and privacy, and also respected and promoted patients autonomy by allowing patient to do so (Singapore Nursing Board, 2011). In this case, there is a conflict between respecting patients autonomy and providing care in a responsible and accountable manner. I need to make a choice between two alternatives. There is no absolutely right or wrong decision (Keilman & Dontje, 2002).
The decision made by me is to respect the patients autonomy, but this may violate the principle of non-maleficence as this decision of allowing patient to shower alone may delay the time to find out patient has collapsed, then it unintentionally caused harm, so I failed to provide in a responsible and accountable care (Chitty & Black, 2011). If I choose to provide care in a responsible and accountable manner, I should have insisted to accompany patient, but by doing so I may violate patients autonomy. According to standard of care of nurses and midwives, I should communicate with client effectively and provide appropriate information to the patient (Singapore nursing board, 2011). I should inform patient that he is on high risk of developing heart attack and shall be monitored closely. Failure to communicate effectively leads a breach of duty.
Learning point 3: Avoid medical negligence
To avoid medical negligence, I think the most important is to prevent the breach of duty of care. According to Bolam test, I will not breach the duty of care if I followed the standard of care (Hurwitz, 1998). In order to meet the standard of care, I need to be a knowledgeable and a safe practitioner, be technically competent, and keep up-to-date with current practice (Chitty & Black, 2011). We must be familiarized with the standard in nursing practice. When we use them to guide our daily practice, we are acting in the best interest of the patient (Singapore Nursing Board, 2011). When you do decision making, ask yourself, have you followed the standard of care? Nowadays, the nurses are also being encouraged to act as advocates for their patients, to safeguard standards of care and to speak out where those standards may be at risk. (McHale & Tingle, 2001, p36). I think, our role as an advocate needs to improve, as nurses do not have the courage to interrogate the doctors order.
If this scenario happens again, what do you think will help the patient? I feel there are some good strategies to adhere: Set hospital policy and educate the staff to provide comprehensive information (Chitty & Black, 2011), for example, they must understand that for clients on telemetry monitoring, patient should not be left alone. The patient must be warned that he is at risk of heart attack. To persuade patient for his desired action, and for his own safety, he should allow assistance. If patient is stubborn and insists to shower without supervision, delegate a staff to standby at the shower door, the hospital need to ensure adequate staff patient ratio (Chitty & Black, 2011).
Chitty, K. K., & Black, B. P. (2011). Professional nursing: concepts & challenges (6th ed.). Maryland Heights, Mo.: Saunders/Elsevier. Croke, E. M., (2003). Nurses, Negligence, and Malpractice. American Journal of Nursing, 103(9). 54-63. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?article_id=423284 Hurwitz, B. (1998). Clinical guidelines and the law: negligence, discretion, and judgement. UK: Radcliffe Medical Press. McHale, J. V., & Tingle, J. (2001). Law and nursing (2nd ed.). Oxford: Butterworth/Heinemann. Singapore Nursing Board. (2011). Codes of Ethics & Professional Conduct. Retrieved from http://www.healthprofessionals.gov.sg/content/dam/hprof/snb/docs/publications/Code%20of%20Ethics%20and%20Professional%20Conduct%20%2815%20Mar%201999%29.pdf