Nursing malpractice poses a risk to patient’s health and life. Moreover, it gives rise to a range of ethical and legal issues, which impact the reputation of the nurse, the physician, and the medical facility. The purpose of this paper is to analyze the ethical and legal problems provided in the Case Study 2 and to identify what can actually prove nursing malpractice. Since the lawsuit of the patient was filed against the Purple Valley hospital, there is a need to conduct an investigation based on the actual evidence and determine whether the Vistaril injection was the cause of sciatic nerve damage, as the plaintiff asserts. Then, it is necessary to refer to the Nurse Practice Act to ensure that Laura, the nurse of the Intensive Care Unit in the clinic, cannot be accused of the accident. The research demonstrates that the nurse is not guilty of the patient’s injury, and the supporting evidence is offered. Anyhow, the hospital is to conduct an additional examination and treatment of the patient. Therefore, the paper has revealed the ethical and legal dilemmas including informed consent, incompetence of the medical personnel members, the need to prove nurse’s expertize, and satisfaction of the patient’s claim. The problems mentioned above should be taken into consideration in similar situations.

Keywords: nursing malpractice, injection, standards of care, malpractice liability, ethical dilemma, justice

Learning Assessment System

Laura, the nurse of the Intensive Care Unit in the Purple Valley hospital has faced an accident related to the patient of her colleague, the physician. After the Vistaril injection had been given by Laura to the patient, a year passed. At present, the medical center receives the lawsuit where the patient claims that the injection caused sciatic nerve damage, so his leg is numb. After one year, it appears unclear whether the injection was actually the reason for patient’s injury. Undoubtedly, there is a need to respond to the lawsuit. With consideration for the facts and evidence, it was found that Laura did not commit the actions, which resulted in the sciatic nerve damage and numb leg of the patient. The general solution of the issue lies in proving the incorrectness of accusation against the nurse of the Intensive Care Unit and providing the additional treatment to the suffered patient. Nevertheless, despite the emerging ethical and legal issues of the described occurrence, Laura cannot have malpractice liability because she has acted according to the standards of nursing care and a range of defenses are available to her.

Identification of the Case Study 2

Ethical Dilemma of Caring

Nursing practice poses a risk to patients because it may lead to harm and injuries. The case 2 tells about several ethical dilemmas, which Laura, the nurse of Purple Valley hospital, experienced. Firstly, it is the dilemma of informed consent. Irrespective of the fact that the nurse checked all the necessary records and medication, which was ordered to the patient, it was not pointed that she informed the patient about the injection of Vistaril (Sarani, Balouchi, Masinaeinezhad, & Ebrahimitabas, 2015). On the one hand, the patient could have asked about the medication, its side effects, etc. (Din? & Gastmans, 2013). However, the nurse could explain the necessary information to the patient. In particular, the latter had to know about the side effects and the possible time when they could appear. Besides, it is difficult to solve the problem because the patient already has the damage.

Another ethical dilemma may emerge from incompetence among colleagues. In the context of the given case study, it can be noted that one of the medical workers is not competent enough to work without control or assistance. The circumstances of the accident can represent the presumption that the nurse was incompetent while performing her duties. Even though the lawsuit was filed due to the fact of injury, the nurse can hardly be considered guilty because her actions were in compliance with the Nurse Practice Act (Sarani et al., 2015). On the other hand, the question about the physician’s incompetence is raised. The physician could not take into consideration the presupposition that Laura could appear to be inexperienced. Nonetheless, there is a need to conduct the monitoring of skills and knowledge as well as launch the training programs aimed at the communication competence in nurse-patient relationships. Therefore, these actions should be introduced to ensure that all members are experienced enough to deliver healthcare services.

Having studied all the pros and cons of the accident, one may deduce that another ethical dilemma can occur. The fact of the lawsuit gives rise to unjust and unfounded accusations of Laura in her incompetence. The nurse adhered to the protocol and requirements provided by her professional code (Sarani et al., 2015). Generally, she did not breach the duty because she performed all actions in compliance with the standard of care delivery (Sarani et al., 2015). Hence, there are no grounds to hold the nurse accountable. However, the analysis of the medical record, Vistaril instructions and evidence given by the nurse, the physician and the patient would be helpful to find the ultimate solution to the problem.

Ethical Dilemma of Justice

In this case, the major ethical dilemma of justice can be the question of satisfying the claim of the patient. On the one hand, the sciatic nerve damage of the leg serves as an unquestionable fact of Laura’s nursing malpractice (Kumar, Gokhale, Jain, & Mathur, 2013). Notwithstanding, the plaintiff applied to the authorities late enough to pose challenge to inappropriate health care delivery. Moreover, there can be other causes for the current damage of the patient. Nevertheless, the hospital must not leave the patient without support. Therefore, the medical setting has to conduct the additional treatment of the suffered individual, even if his lawsuit is not satisfied.

Identification and Analysis of the Environment

Identification and Analysis of the Regulatory, Criminal, or Civil Environment

To analyze the case completely, one should emphasize what nursing malpractice actually means. It was found that malpractice represents misconduct, negligence, or breach of duty, which inevitably results in the damage or injury to a patient (Kumar et al., 2013). On the one hand, the accident with Laura and the patient reflects the malpractice example because the latter claims for the sciatic nerve damage. However, malpractice includes several obligatory requirements that must be followed by a nurse (Din? & Gastmans, 2013). Hence, these are assessment and monitoring, following the standards of care, usage of equipment in an appropriate manner, communication, recording, and acting as a patient’s advocate.

Besides, to prove the nursing malpractice the plaintiff has to refer to four elements such as the fact of a duty of the nurse to the patient, breach of duty, damage caused to the patient as well as cause-and-effect relationship of the violated duty and the injury (Sarani et al., 2015). Thus, firstly, one can find that Laura, the nurse, had a duty to the patient. In other words, she was actively involved in providing nursing care. Furthermore, the physician ordered Laura to give an injection, and it can point to the fact that the nurse is experienced enough to work with patients without the physician’s control.

Secondly, the presence of the breach of the duty is questionable because the nurse did not commit the actions, which resulted in the sciatic nerve damage and numb leg. On the contrary, Laura followed all the appropriate steps of giving the injection (Sarani et al., 2015). At the beginning, she checked the medication, found it correct, made the patient identification, and gave the injection in the right upper outer quadrant of the buttock, as stated in the instructions to Vistaril (Bouqui? et al., 2014). Then, the nurse documented this in the patient’s medical record (Bouqui? et al., 2014). Apparently, the medical record presents a valuable evidence for the investigation. Moreover, the defense for Laura can be the fact that the injection was performed a year later and only after this time, the claim from the patient was filed. Another defense may incorporate the nurse checking the medication, the patient’s identification, as well as medical records independently on the physician’s order and validating the data. Then, the medication instruction may point to Laura’s guiltlessness because there is no information about side effects in the form of sciatic nerve damage. Thus, one can see that the charges are unsubstantiated.

The third element is related to the second one and refers to the causal relationship between the action of the nurse and the harm caused to the patient. In fact, the injection did not lead to an immediate damage. Moreover, there was no prohibition on the usage of the medication because it was prescribed by the physician (Kumar et al., 2013). In addition, the patient did not apply to the hospital because of worsening of his health condition and did not ask for additional examination. Besides, the side effects of Vistaril include burning, coldness, feeling of pressure, discoloration of the skin or redness, along with the pain of skin at the injection site (Bouqui? et al., 2014). Shakiness or trembling of the legs, feet, arms, or hands occurs rarely (Bouqui? et al., 2014). The medication instruction does not mention the sciatic nerve damage as the side effect as well (Bouqui? et al., 2014). Furthermore, the patient did not mention any of these side effects after the injection. Therefore, it is difficult to speak about malpractice of Laura. The fourth element concerns the damage. The fact of the patient’s injury is present; however, it is hard to prove that it was caused by the Vistaril injection.

The lawsuit for medical or nursing malpractice can be initiated in different ways regarding the specific regulations of a particular state. The complaints may be brought to the nurse or the physician, as well as to the whole hospital thereby worsening the reputation, as it was presented in the case study (Kumar et al., 2013). In this respect, the physician may have malpractice liability, and there are a few reasons for this. Firstly, this doctor is an attending physician of the suffered patient, so it determines him or her as responsible for the patient’s health and life. Secondly, the physician might appear to prescribe wrong medication or inappropriate dose of it. Finally, he or she might understand the medical records incorrectly, which could serve as the mistake based on the human element. Anyhow, although the evidence does not witness the incompetence of Laura and the physician, the hospital should take care of the suffered patient and provide all the necessary healthcare services. The benefit of this solution lies in the opportunity of the medical facility to rehabilitate the patient and prove that he can be treated comprehensively and attentively. However, the disadvantages of such an outcome may result in the patient’s refusal to be attended to in the Purple Valley hospital. Moreover, he can demand the compensation from the healthcare institution again, instead of the additional treatment.

Identification and Analysis of the Ethical Concerns

Although the evidence has established that Laura, the nurse of the Purple Valley hospital, cannot be accused of medical malpractice, the ethical concerns related to the nurse and the patient remain unaddressed. The first ethical concern, namely informed consent, is relatively common in the nursing practice (Din? & Gastmans, 2013). The case study has shown that Laura acted according to the Nurse Practice Act and followed all the regulations provided (Din? & Gastmans, 2013). Thus, she had the order of the physician about the necessity to give the injection of Vistaril to the particular patient. Then, the nurse only used the administered medication (Sarani et al., 2015). Additionally, she documented and reported everything she did to the patient (Sarani et al., 2015). Moreover, there is no evidence of the patient’s complaints in the medical record. Therefore, all standards of care have been fulfilled.

However, one can notice that the nurse did not explain the possible side effects of the Vistaril injection to the patient. Hence, it has led to the lawsuit against the hospital. On the one hand, the patient has a full right to be aware of the medication he or she takes (Din? & Gastmans, 2013; Kumar et al., 2013). In addition, the patient is allowed to ask the nurse for explanations. Here, the ethical issue is related to the extent of knowledge of the health care consumer. Sometimes, there is the information that the medical attendant is not ready to tell (Sarani et al., 2015). However, in case of the Purple Valley hospital, Laura should have described the side effects of the medication. In turn, this would have helped to avoid the lawsuit and suspicions in malpractice. Nevertheless, during the investigation, the patient can be convinced that it is not the Vistaril injection that caused sciatic nerve damage. Furthermore, the patient should be re-examined in order to find the true causes of his injury.

The second ethical concern is linked to the professional incompetence of the medical staff. Apparently, suspicion in malpractice impeaches Laura, as well as the physician, who prescribed the Vistaril injection. It may pose a risk of conflicts based on the mistrust to the expert’s experience (Kumar et al., 2013). Notwithstanding, a crucial role is devoted to one of the most important principles of the medical practice – to protect health, well-being and life of a patient (Kumar et al., 2013; Din? & Gastmans, 2013). Violation of this principle would include inappropriate delivery of the healthcare services, thus resulting in the inability to occupy the position in the medical setting. Again, the competence and experience can be proven by the investigation of the existent evidence.

The third ethical issue concerns the ungrounded accusation of professional incompetence and malpractice from the patient’s side. Besides, this problem can be connected to the first one because the patient did not get comprehensive explanations about the side effects of the medication. Nevertheless, the unjust blame can negatively affect the reputation of the nurse (Sarani et al., 2015). It is hard to assert that Laura can solve the present issue alone. However, in this case, the hospital administration have to implement the plan of the improvement of healthcare services and mitigate the risk of possible malpractice.

Firstly, it would be useful to ensure that the nurses have to be aware of legal risks in their practice. Thus, the medical staff should follow the Nurse Practice Act of the state along with policies and procedures provided by the healthcare facility (Sarani et al., 2015). Then, the nurses should constantly increase their knowledge and skills as well as develop in their field of practice. Additionally, it would be important to conduct the assessment of patients in compliance with the policy and regulations of the hospital or physician’s orders (Sarani et al., 2015). Moreover, the assessments can be performed more frequently, if there is the necessity. The nurse should also document and promptly report on any abnormal assessment. Another action requires constant training and practice, in particular communication competence (Din? & Gastmans, 2013). The nurse should communicate openly with patients (Din? & Gastmans, 2013). Furthermore, he or she should learn how to give the relevant information to the patient since this skill is highly essential for the nurses because it influences the ethical behavior and reputation of the medical professionals (Din? & Gastmans, 2013). Further, the communication skill and appropriate behavior are critical in the daily activities and interaction with other healthcare providers. Then, the nurse has to record all nursing care thoroughly to ensure that the nursing process is documented accurately (Sarani et al., 2015). Finally, there is a need to promptly report on the incidents or deviations in the care plan. Consequently, all these actions can be helpful for caregiving and risk minimization.

Conclusion

The Case Study 2 represents the accident of lawsuit filed against the Purple Valley hospital, which is based on the fact of sciatic nerve damage of the leg that was supposedly caused by the injection of Vistaril given to the patient by Laura, the nurse, a year earlier. The present scenario gives rise to ethical and juridical dilemmas of the nursing practice. The ethical dilemmas include informed consent, revealing the incompetence of the medical staff and confirming the nurse’s expertize related to the patient. The ethical dilemma of justice is reflected in the need of satisfying the patient’s complaint. From a particular point of view, the accident can be indicative of Laura’s malpractice. However, there are some statements that defend the nurse. Firstly, she completely followed the protocol for medication administration. Secondly, the period of one year can be regarded as the exceedingly long one for the appearance of side effects. Nevertheless, even if the patient is proved to be wrong, the hospital has to take care of the latter and provide additional treatment.

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