Nurses’ Legal Status NSC 402.

1
 Litigation – is a process of making or
defending a claim in court.
 There are laws and strategies put in place
to protect the nurse against litigation.
 The Good Samaritan’s acts are laws
designed to help protect nurses and
healthcare providers, when assisting at the
scene of an accident.
 There are guidelines for nurses who render
emergency care at the scene of accident.
Guidelines for Nurses
 Limit actions to those normally considered
as first aid.
 Do not perform actions that you do not know
how to do.
 Offer assistance but do not insist.
 Have someone call the doctor, or go for
additional help.
 Do not leave the scene wait until the injured
person leaves or another qualified person
takes over.
 Do no accept any compensation.
Nurses’ Legal Status cont’
 Provision of safe, competent practice is
by following the nurse practice act and
standards of practice which is a major
legal safeguard for nurses.
 Also maintenance of accurate and
complete documentation is a critical
component of legal protection for the
nurse.
 Signing of informed consent form by
the patient is another way of legal
safeguard for the nurse.
Nurses’ Legal Status cont’
 In all healthcare facilities and agencies,
informed or voluntary consent is needed for
specialized diagnostic procedures, medical or
surgical treatment.
 As well as for experimental research
procedures.
 Except in emergency situations where a
person’s life is threatened and no legal or
relation is available to sign the consent form.
 The consent must be written and designed for
the procedure to be performed.
 This has to be signed by the patient or person
legally responsible for the patient.
Nurses’ Legal Status cont’
 Informed consent protects, the
nurse, the physician or surgeon and
the anaesthetist in case of surgery
and the hospital or the institution.
 The patient is protected from
procedures not signed for, promotes
his/her well-being as well as respect
the patient’s self determination.
Nurses’ Legal Status cont’
 Informed consent has four (4) elements
which include;
1. Disclosure has the patient been informed
of the;
 Nature of the procedure
 Risks (the magnitude, probability of the
risk) and benefits.
 Alternatives (including the option of non-
treatment).
 Facts that no outcomes can be
guaranteed.
Nurses’ Legal Status cont’
2. Comprehensive- that the patient should
be able to repeat what he was told for
him to sign the consent.
3. Competence- that the patient
understands the information needed to
make this decision. He/she is alert
mentality and not disoriented.
4. Voluntary- the patient signed the
consent voluntarily or refused to sign,
that there is no manipulative and
coercive influences.
Liabilities For Nurses
 Potential areas of liability for nurses
could be viewed using the components
of the nursing process.
1. Assessment
 The nurse collects patient health data.
 Incomplete data obtained-- occurs
especially when the patient is too ill at
admission to respond to questions.
 Significant omission or errors in
recording the data obtained.
Assessment cont’
 Failure to note in the patients’ care
plan (even failure to execute)
 and need for more frequent nursing
assessment.
 Failure to recognize and report
significant changes in the patient’s
condition.
 These could be seen in the following
example.
.
Assessment cont
 A child too weak to be weighed on
admission;
 chart contains no record of patient’s
weight; dosage of post operative
antibiotic therapy should be
calculated on child’s weight which
was not done; so too small antibiotic
was given to prevent infection. Thus
wound develops sepsis
Assessment cont’
 Mother’s labour is failing to
progress,
 Nurses are unaware of signs of
foetal distress,
 Obstetrician was not informed,
thus there occurred cerebral
damage to foetus.
Assessment cont’

 Healthy patients making slower than

usual post-anaesthesia recovery,
 showing signs of developing
cerebrovascular accident (slurred
speech, difficulty in moving
extremities and falling to one side)
 and these were not noticed.
2. Diagnosis
 The nurse analyses the assessment
data in determining diagnoses.
 Failure to identify priority nursing
diagnosis critical to the patient’s
care.
 Nursing diagnosis incorrectly
developed and labels the patient
negatively. Examples include;
Diagnosis
 Nowhere in patient’s care plan
that the patient has a history of
choking while eating (impaired
swallowing)
 Therefore, needs close
supervision
 this was not done and patient
aspirated and died.
Diagnosis cont’
 A homosexual male patient without
HIV/AIDS infection was admitted for
gallbladder surgery,
 Based on few question asked by the
nurse during the interaction with the
client,
 Made a nursing diagnosis of high risk
for violence; directed at others(AIDS)
related to homosexuality.
3. Outcome Identification and
Planning
 The nurse identifies expected outcomes
individualized to the patient but;
 No indication in nursing care plan for
nurses to be aware and sensitive to the
patient’s healthcare priorities. E.g.
 An obese patient with a history of
impaired circulation continually refuses
to ambulate after major abdominal
surgery.
3.Outcome Identification and
Planning
 Patient dies after a massive
pulmonary embolism,
 plan of care showed no concern or
attempt to compensate for patient’s
lack of mobility.
 Family states no nurse consulted
them to encourage mobility.
4. Implementation
 The nurse implements the
intervention in the plan of care,
then;
 Patient’s record contains no
documentation of attempts
 to teach appropriate self-care
measures to patient and family.
E.g.
Implementation

 A male patient discharged home

with crutches,
 He falls first day at home,
 Re-fracturing the leg.
 He alleged that he did not
receive any instruction on crutch
walking that caused the fall.
Implementation cont’
 Patient’s record contains no
documentation of client education.
 A frail older homebound patient’s
skin breaks down and worsens with
eventual muscle deterioration.
 Leading to sepsis, nurses seem to be
confused about treatment regimen
 For pressure ulcer treatment that
was inconsistent.
5. Evaluation
 The nurse evaluates the patient’s
progress toward attainment of
outcomes but;
 No evidence in plan of care and
nursing notes that nurses evaluated
whether the patient achieved target
goals.
 Patient discharged home before key
goals are met without follow-up
instructions. e.g.
Evaluation cont’
 A male patient, newly started on
insulin therapy discharged
 After giving himself the insulin
injection only once
 Without understanding the
relationship between food,
exercise and insulin.
Evaluation cont’

 No referral was made to visiting

nurse or to the healthcare centre
nearby.
 Patient was readmitted after 2
weeks
 with dangerously low blood sugar
after overdosed with insulin.