Have you committed malpractice?

Patient situation: Jimmy Smith is a 19-year-old male who had a severe compound fracture of his tibia yesterday in football practice. Last evening about 4 pm he had surgery to set and cast the leg. The evening shift reported that he was having a bit of swelling from the severe trauma that accompanied the fracture, but that the toes on the effected leg were warm and he had good pedal pulses. By the time you received report and went to check on Jimmy, you felt that his pedal pulses were slightly diminished and his foot was slightly cool to the touch. By 2 am you felt swelling had increased and his toes were quite cool although they were not blue. You phoned his physician and he was upset to be awakened in the middle of the night. He instructed you to put ice on the cast and to elevate Jimmy’s leg higher to reduce the swelling and promised you that he would see Jimmy first thing in the morning. As the night wears on, you become increasingly alarmed. By the time the night supervisor arrived at 4 am you were so concerned that you asked her to check the casted leg. The supervisor rushed out of the room and said, “The circulation in this boy’s leg is severely compromised, why you haven’t gotten the doctor here to cut the cast?”

1. Theoretical Knowledge
   a) Have you committed malpractice? Has the doctor? What is the nurse’s responsibility in reporting a patient conditions to their physician? Examine the elements of malpractice. If there is permanent damage to Jimmy’s leg, who will be liable for the failure to take action soon enough to prevent injury?
   b) What standards, guidelines, and laws apply to determine whether the nurse’s actions were in accordance with standards of practice?

Patient Situation: Mrs. Smith is a 23-year old woman who has had frequent episodes of nose bleeds, easy bruising, and one infection after another. After a bone marrow biopsy, Mrs. Smith, who is caring for her mother and ill father at home along with an 18-month infant, is visited by an oncologist and several residents. She is informed by the oncologist about her diagnosis of acute lymphocytic leukemia. She has a dazed look about her as the physician describes the next step of treatment, which will be aggressive chemotherapy. The physician leaves with the consent form signed, but when you question her, you realize that she did not hear a word of what transpired.

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1. Critical Thinking
   a) As the Registered Nurse, would you consider this an informed consent?
   b) From an ethical perspective, what are the items in her history that you would like to have more information about?
   c) How would you proceed as the client advocate in this case?

Sample Solution

Theoretical Knowledge:

a) The nurse did not commit malpractice as she identified a potential problem with Jimmy’s leg and reported it to the physician. The physician, however, may have committed malpractice by failing to respond promptly to the nurse’s concerns and by giving inadequate advice over the phone. The nurse’s responsibility is to report any changes in the patient’s condition to the physician promptly. The elements of malpractice are duty, breach of duty, causation, and damages. If there is permanent damage to Jimmy’s leg, both the nurse and the physician may be liable for the failure to take action soon enough to prevent injury.

b) The standards, guidelines, and laws that apply to determine whether the nurse’s actions were in accordance with the standards of practice include the Nurse Practice Act, the facility’s policies and procedures, and the professional standards of nursing practice. The nurse must ensure that she follows the standard of care for her patients and that she provides competent and safe care.

Critical Thinking:

a) No, the consent is not informed since Mrs. Smith did not understand what the physician explained to her about her diagnosis and treatment. Informed…ORDER A COMPREHENSIVE ANSWER

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