Damanhour University

Faculty of nursing
Nursing Education Department
Master Autumn 2023 -2024

Responsibility , liability and scare

resources (legal perspective)

Under
supervision

Assist
.Prof.
Dr\
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Outline:
 Introduction.
 Definitions
 Responsibility ,liability
 Scare resources
 Models of Curriculum development
 Ralph Tyler’s Model
 Introduction.
 Major components
 Four tyler`s model steps
 Strengths of Tyler’s mode
 Weakness points
 Taba`s model
 Introduction
 Characteristics of taba`s model
 taba`s model steps for curriculum devolpment
 Strengths of taba’s mode
 Weakness points
 Comparison between taba and tyler model

Objectives:
 General objective:

At the end of this seminar the learner will be able to:

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  Know about the tyler and taba model for curriculum development..

 Specific objectives:

Introduction :
The availability of resources for health care is a hot topic of debate. It is
clear that the provision of medical services occurs in an environment of
resource limitation, notwithstanding government assertions about
increased funding and decreasing wait times within the NHS. This
seminar's goal is to look at the legal issues that could come up for nurses
trying to care for patients and uphold standards of practice in the face of
such financial strains. Among the concerns examined are the options
available to nurses in the event that they are required to perform tasks

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beyond their scope of practice or education, as well as potential judicial
accommodations.

Definitions :
 Responsibility : is explained as the obligation to perform duties, tasks
or roles using sound professional judgement and being answerable for
the decisions made in doing this . For example, nurses are responsible
for administration of medication and providing comprehensive pt care.

 Liability : Asserts that every person is responsible for the wrong or

injury done to another resulting from carelessness . For example,
nurses are liable when they fail to carry out doctor's orders.

 The scarcity of resources : is a multifaceted challenge. Whether it's a

shortage of skilled staff, medical equipment, or bed availability,
resource limitations can impede the efficiency and effectiveness of
healthcare facilities. The patient load, on the other hand, can ebb and
flow, often exceeding the capacity of healthcare institutions.

Forms of the resources scarcity :

1. Human Resources: Human capital is a vital resource that is

frequently lacking, particularly in specialized sectors like primary
care and nursing. Hiring and keeping qualified workers is a constant
struggle.

2. Medical Supplies and Equipment: Due to financial limitations,

healthcare organizations frequently find it difficult to stay up to date

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with the newest supplies and equipment despite the rapid
improvements in medical technology.

3. Facilities and Beds: Overcrowding is a typical problem that puts a

strain on personnel and increases patient wait times.

Impacts of inadequate resources:

 Malpractice
 non-nursing tasks (e.g., cleaning)
 unfinished nursing care which expresses the nursing care planned
but not delivered or delivered late
 Imbalanced workload was the most important cause of stress,
dissatisfaction and burnout in the work environment. Inappropriate
nurse-patient ratios, high workloads, overtime, rapid turnover of
patients, and conducting non-nursing tasks were the major
constituents of imbalanced workloads.
 Inadequate staffing and heavy workloads threatened patient safety
and care quality.
 Heavy workloads, boring environments, and the lack of possibility
to ask for days off lead to emotional exhaustion and a tendency to
absenteeism

 Newly employed nurses do not have sufficient theoretical and

practical knowledge. We need to start from the basics and teach
them. This is time and energy consuming. It takes longer for her to
make decisions, and her efficiency will drop.

 Inadequate equipment leads to disruption, missed care or delay in

delivery of care, and emotional tensions.

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  Crowded wards with high levels of turnover and poor physical
environments lead to serious physical harm to the patients and
nurses.

Malpractice in Nursing

Malpractice in nursing is defined as providing standard care below the

quality of care a similarly-trained professional would have offered under
the same circumstances. They may have acted improperly or unsafely,
failed to anticipate problems that a reasonably competent person would
have, or not taken actions they should have taken under the
circumstances. Both acts or omissions can be considered malpractice in
nursing.

 Negligence occurs when a nurse does not fulfill the standard of

care unintentionally, not realizing their omission or negligent act
could harm the patient.
 Malpractice involves a situation where a nurse consciously fails to
adhere to the accepted standards, knowing that it could be harmful
to the patient.

For example, if a nurse forgets to wash her hands before touching a

patient, and that patient gets an infection, this is regarded as negligence.
On contrary, if a nurse knowingly deploys an improper method during a
procedure, leading to an injury, it would be considered as malpractice.

Examples of malpractice in nursing

There are many different examples of situations that are nursing

malpractice including the following.

Botched Treatment

Nurses sometimes provide treatments to patients. This is especially true

for nurse practitioners, certified nurse midwives or other specialized
professionals whose role is to offer hands-on help. If a nurse fails to
perform the treatment adequately, this can result in a claim of malpractice
in nursing.

Failure to Monitor

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Nurses are often in charge of monitoring a patient’s condition to identify
and report signs of worrisome changes. A nurse with a monitoring
obligation who fails to adequately observe and respond to potential
problems could be held accountable for the consequences of this failure.

Failure to Provide Care

Nurses may need to take action, especially in an emergency situation, to

get help for a patient or to provide medical interventions. If nurses do not
offer assistance appropriate to the situation and their training and level of
knowledge, this can result in a malpractice claim.

Medication Errors
It is common for nurses to administer medication to patients. If they make
a mistake, such as providing the wrong medication or the wrong dose,
this medication error is a clear cut example of malpractice in nursing.

Improper Documentation
When nurses are tasked with updating patient medical records or
documenting treatment and they fail to do so correctly (or to do so at all),
this can have consequences for future treatment. It can also be an
actionable form of nursing malpractice if the nurse’s omissions or errors
are the direct cause of harm.

Legal implication resulting from malpractice related to scarcity of

resources

The nurses as healthcare providers owe a duty of care to their patients.

This duty of care includes providing competent and appropriate medical
treatment, given the patient’s unique medical condition and needs.
Meeting those needs may be challenging when there isn’t sufficient
equipment and staffing in a healthcare setting, whether that setting is a
hospital or nursing home. There are times when understaffing and
scarcity of resources may serve as a partial basis for a medical
malpractice lawsuit.

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elements needed to prove nursing malpractice

Although malpractice lawsuits against nurses and nursing students are

uncommon, it's crucial to know what needs to be proven in order to
successfully defend against such claims. To prove malpractice, a court of
law must establish each of the following components.
 Duty: A nurse-client relationship exists.
 Standard of care : These policies and procedures are guidelines
that all nurses must follow.
 Breach: The standard of care was not met and harm was a
foreseeable consequence of the action or inaction.
 Cause: Injury was caused by the nurse’s breach.
 Harm: Injury resulted in damages.

Parties bringing a lawsuit must be able to demonstrate their interests were

harmed, providing a reason to stand before the court. The person bringing
the lawsuit is called the plaintiff. The parties named in the lawsuit are
called defendants. Most malpractice lawsuits name physicians or
hospitals, although nurses can be individually named. Employers can be
held liable for the actions of their employees

Duty :
In the work environment, a duty is created when the nurse accepts
responsibility for a patient and establishes a nurse-patient relationship.
This generally occurs during inpatient care upon acceptance of a handoff
report from another nurse. Outside the work environment, a nurse-patient
relationship is created when the nurse volunteers services. Some states
have statutes requiring notification of authorities (also referred to as
mandatory reporting) or summoning assistance.

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 Good Samaritan

The Good Samaritan Law provides protections against negligence

claims to individuals who render aid to people experiencing medical
emergencies outside of clinical environments. Differences exist in
state laws regarding protection of bystanders who provide aid. For
example, in Wisconsin, the law states, “Any person who renders
emergency care at the scene of any emergency or accident in good
faith is immune from civil liability for the person’s acts or omissions
in rendering such emergency care.” There are a few states that require
some emergency bystander action, so nurses should review the law in
states they are visiting. It is also important to keep in mind that
although anyone can file a lawsuit against someone who provides
bystander aid, the Good Samaritan laws typically negate any penalty
to the person rendering aid.

Implications for nurses

Duty can be established in many ways. Nurses have a duty of reasonable
care for a patient they have been assigned. They may also have a duty in
other circumstances. Therefore, nurses should understand the following
 Recognize that a nurse-patient relationship is established upon
acceptance of responsibility for a patient, whether after a handoff
report in the workplace or during volunteered services.
 Assume that on-call or supervisory responsibilities create a duty to
patients, even in the absence of an expressed nurse-patient
relationship.

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 Standards of care

Standards of care in nursing are guidelines that provide a foundation

as to how a nurse should act, and what they should and should not do
in their professional capacity. These policies and procedures are
guidelines that all nurses must follow.

Having these protocols in place helps to establish a baseline of quality

patient care and provides an objective standard of accountability
within the profession. The goal of having established standards of
practice is to provide consistency throughout the profession. If a nurse
has special knowledge or skill, the standard is to evaluate that nurse by
the same standard of a nurse with similar skill and knowledge in
similar circumstances.

Two questions are brought up by this possibility: first, to what degree

will nurses be held legally responsible for the results of cost-cutting
measures over which they have little or no control, and second, is there
anything that nurses can do to lessen the possibility that they will be the
focus of lawsuits stemming from resource reduction? Employers have the
ultimate legal duty for patient safety, even if nurses have a professional,
ethical, and legal obligation to ensure patients' safety. As business
organizations, institutions run the possibility of being held directly liable
for their own wrongdoing. Healthcare facilities have a responsibility to
ensure the safety of the patients in their care, which includes personnel
selection, training, supervision, and monitoring. In cases where patient
harm could

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For example:
A mental health patient in Jinks v. Cardwell drowned in the bathtub due
to a hypotensive reaction to his medication. The hospital violated its duty
of care to protect a patient in multiple ways, including by having
insufficient staff, and the trial judge determined that this constituted
direct negligence. "Thirty-three mentally ill patients were being cared for
by just two nurses—one RNA and one RN. One of these nurses was
obliged to be in an inner office doing reports during shift change, which
was from 7:00 to 07:30. She was unable to assist with patient care or
supervision during this period.

Who is responsible
A nurse can be held legally liable for malpractice in nursing.
Supervising physicians and the clinic or hospital where the nurse
works can also be held liable for the negligent actions of a nurse.
The doctor or hospital could be held responsible based on their
own negligence for inadequate supervision or other improper
policies or based on a legal doctrine called vicarious liability that
makes employers responsible for negligent acts of their staff
members. Can nurses realistically do anything to reduce the risk of
harm? The answer is yes. Implementation of risk-management
strategies depends almost entirely on RNs. These strategies include:
patient assessment, communication of patient assessment,
identification of risk, notifying management of resource-related risks,
notifying physicians of treatment-related risks, planning and co-
ordinating care including delegation of tasks to other workers,
determining appropriate orientation and education for new staff and
support workers, and providing appropriate supervision in conformity
with professional standards and institutional policies.

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References :
 Affarella, R. S. (2020). Planning programs for adult learners: A
practical guide for educators, trainers, and staff developers (2 ed.). San
Francisco: Jossey-Bass, Inc.
 Kern, D., Thomas, P., Howard, D., & Bass, E. (2022). Curriculum
development for medical education: a six-step approach. Baltimore
and London: The Johns Hopkins University Press. PDF available
through
www.medicine.osu.edu/education/document/curriculum_design
 Moore DE, Green J and Gallis A (2019). Achieving Desired Results
and Improved Outcomes: Integrating Planning and Assessment
Throughout Learning Activates.
 Baker, J., Lynch, K., Cantillon, S and Walsh, J., 2021. Equality: from
theory to action. Basingstoke: Palgrave Macmillan.
 Borders, T., 2023. Curriculum Theories Connexions, March 13th 2006
http//cnx.org/content/m13293/1.9
 Coleman, U., 2022. Curriculum Matters. Dublin: City of Dublin VEC
Coleman, U., 2006. Reflection on Draft Curriculum Report
(unpublished paper) for National Adult Literacy Agency

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