Introduction to Nursing Law
Nursing law in Australia is governed and regulated by Australian Health Practitioner Regulation Agency (AHPRA). They have provided standard guidelines and codes for the nurses and midwives through Professional Practice Framework (PPF). This framework defines the statutory requirements and board expectations to provide proper guidance. Nurse practitioners are obliged to act according to the provisions of section 38 of the National Law (Anderson, 2000). Primary objective of this norm is to define the required qualification for nursing endorsement along with their responsibilities. Present project report will focus on the provisions of nursing care for the safety of patient. For this purpose, various regulations will be explained along with the suitable case studies.
Section 1: Patient Safety
Nursing care plays vital role in cure of patient. It is because nursing staff is responsible to take care of patients in appropriate manner. If nurses of midwives fails to comply their duties then they will be responsible for the injury of the patient. Charge on nursing staff will vary as per criminal or civil negligence. For this purpose case of Wisconsin can be referred. In this case situation, criminal complaint was filed against Wisconsin due to act negligence which causes great bodily harm to the pregnant patient (Atkins, Britton, & De Lacey, 2011). By reference to this case, it has been held by the Court of Law of Australia that nurses or midwives should act accordance with the statutory standard guidelines in order to prevent risk of injury for patients. Similar to this case, provisions of section 38 of the National Law were not complied in the case of death of Christopher Hammett.
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Analysis of nursing care that is outlined by the coroner in the Findings of the Inquest in to the death of Christopher Hammett is as follows-
In the case of death of Christopher Hammett, patient was died due to compounded human errors. According to findings of the Corner, care and treatment received by the patient was the reason of death. Christopher Hammett was 41 year old. He died in April 2005 after elective operation. According to the medical documents, operation was done for the replacement of L5-S1 disc in his back at the Pacific Private Hospital (DʼARCY, 2005). In the legal investigation of case, Coroner found that there was poor nursing management regarding oxygen level in the evening shifts. Due to this fact, error escalated from inadequate pain relief in operation theatre.
Operation of Christopher Hammett had not contained any unusual events. In the operation, his oxygen level maintained at 99% but suddenly it dropped to 64% while transferring from operation theatre to Post Anaesthetic Care Unit. As per his medical records, he was provided with the two doses of morphine at 2mg each prior to the transfer to another ward. However, he was not examined by the doctor in transferred ward. Registered nurse Dean Manton in Post Anaesthetic Care Unit (accommodation ward) said in one of her statements that “he was not aware about the Hammett desaturation event prior to the transfer”.
During Dean Manton's shift, it was found by the Corner that inappropriate diagnosis and low oxygen saturations lead to the combination of sleep apnoea along with the use of morphine. In addition to this, it was noticed by the Mr Hammett's chart that he pressed painkiller button 125 times in two and half hours i.e. repeatedly in each 15 seconds but nurse didn't notice that he is in pain. Another issue in this case was registered that nurse left the ward by trusting an enrolled nurse (Jennifer Valentine) who should have been working under her supervisor (Mr. Gibbon).
Miss Valentine fails to link the mask to oxygen supply while she was changing Mr Hammett's nasal prongs with an oxygen mask. After few minutes, she noticed that oxygen saturation levels of Mr Hammett began to drop. However, this mistake was corrected by his supervisor. In the absence of supervisor, she repeatedly wrongly filled his observation chart regarding saturation level. Finally, she requested her supervisor for the visit due to dropping oxygen level (OFFICE OF THE STATE CORONER FINDINGS OF INQUEST, 2015). On the response, Mr Gibbons attended Christopher Hammett in between 1am and 2am. Gibbons analyse the entire situation at the ward. He increased the oxygen level. After that, he takes break for his sleep. However, RN Gibbons failed to analyse situation in appropriate manner. He thought patient is asleep but in actual he was unconscious. At 2 Pm where nurse checked Mr Hammett, she found his eyes were partial opened, his skin was “dusty” in colour and she could not rouse him. She called an Ambulance and patient was taken to the Gold Coast Hospital. However, by resurgence efforts, patient was declared dead (Guido, 2006).
Sequential mistake in nursing care of Pacific Private Hospital can be noticed. Initial mistake in the scenario was limited pain relief administered in operation theatre. Due to which proper cure was not provided to the patient regarding his disease. After the operation theatre, patient was transferred in PACU (GROVE, 2006). In PACU nursing staff was not skilled due to which several issues were occurred in evening and night shift in ward. Low SaO2 was managed by increasing O2 therapy by nursing staff in ward. In addition to this, high pain scores were noticed due to the poor initial pain relied in OT. With the all these mistakes medical condition was severe which cannot be cured by the nursing staff of Gold Coast Hospital (OFFICE OF THE STATE CORONER FINDINGS OF INQUEST, 2015).
In this situation, main reason of death of patient was inappropriate care and negligence of nurses. At the several points, there were so many severe mistakes that were made by the nursing staff due to which situation became to be worse. Death of Christopher Hammett could be easily avoided as nursing staff was skilled and qualified for their work. Due to the compounded human error, death occurred. Thus, warrant was issued against the medical and nursing staff by the medical disciplinary body (the Australian Health Practitioner Regulation Agency).
Section 2: The Tort Of Negligence
Applicability of tort of negligence to nurses involved in this case
Tort can be defined as a wrongful act which causes harm to the innocent party. Generally torturous act is based on the act of negligence of individual. In order to make successful claim for the act of negligence following principles are required to be satisfied-
Duty of care- Initially performing party should owe duty of care to the aggrieved to prevent possibility of injury. Duty of care is general responsibilities which is expected from the prudent person while conduct of act.
Breach of duty- Performing party should failed to take standard care in their actions for the claim of negligence. General reason for the breach of duty is act of negligence (Forrester & Griffiths, 2005).
Actual damage or harm sustained- There should be real or actual injury to the aggrieved party from the act of negligence.
Causation- According to this element, act of performing party or failure of performing party in taking standard care should be primary reason for the injury. In addition to this, aggrieved must not have any contribution in the act of negligence else they will be not be able to be able to claim damages for injury (Guido, 2006). Malpractice is synonym of professional negligence. Provision of malpractice is applied when a health care professional fails to take standard care of their actions. In the present era, nursing practitioners are becoming likely targets of plaintiff and their attorneys in case scenario of medical malpractice.
In the present case scenario negligence at all the transfer can be noticed. Description of this negligence is as follows-
Transfer from PACU to the Accommodation Ward- With this transfer RN Manton took over the care of Mr Hammett from RN Turrell. According to the statement of Manton, Turrell did not inform him of the desaturation event in PACU during the transfer. This act will be considered as professional negligence. It is because, it is generally expected from the medical professionals to provide all necessary information while handover of patient. However, in this case scenario Turrell failed to do so (NURSING LIABILITY AND NURSING MALPRACTICE, 2015).
Accommodation Ward- In the accommodation ward, Miss Valentine fails to link the mask to oxygen supply while she was changing Mr Hammett's nasal prongs with an oxygen mask. In addition to this, she repeatedly wrongly filled his observation chart regarding saturation level. This will also be considered as act of negligence of the nurse. Due to her negligence, patient suffered from the pain (Guido, 2006).
Accommodation ward- At the ward, RN Gibbons failed to analyse situation in appropriate manner (Keatings, Smith & Keatings, 2010). He thought patient is asleep but in actual he was unconscious. Act of misinterpretation by Gibbons will be considered as negligent act because it causes delay in treatment of patient at Gold coast hospital.
Both the nurses owes duty of care to the Christopher Hammett. It is general responsibility of nursing practitioners to comply standard guidelines and to avoid act of omissions. In both the described situations, nurses fail to take care of their general responsibilities. Due to their negligence and omission injury (death) was occurred to the Christopher Hammett. In addition to this, primary reason of injury of the patient was negligence conducted by nurses. Thus, in this case scenario all the elements of negligence were satisfied in the investigation of Coroner and claim of the defendant was held successful.
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Section 3: Ethical Issues
In the described case scenario of Christopher Hammett several ethical issues can be noticed. Due to these issues, nursing practitioners in the case had faced ethical dilemma while taking care of the patients. Initially RN Turrell had faced issue of disclosure of information. It is general dilemma of nursing practitioners that how much information should be disclosed while handover to another practitioner. In the present case scenario, RN Turrell was required to provide all the essential information to the transferee nurse. It is because, other doctor will be able to provide better treatment to the patient by considering all the essential facts. Another ethical issue was faced by the EN Valentine regarding interpretation of situation while observing the patient. At that night, Christopher Hammett had removed his oxygen mask various times and each time mask was replaced by the Valentine (Nursing and Midwifery Board of Australia - Guidelines on endorsement as a nurse practitioner, 2015). At the time of surveillance she thought replacement of mask is primary reason of low oxygen saturation levels. Such kind of ethical issues are faced by so many practitioners because there are so many possibilities of single situation. In addition to this, her supervisor Gibson does not assist her in appropriate manner. Due to this fact, she had to apply her interpretation while filling observance form of patient. However, she called RN Gibbons to attend the patient due to continuous reduction saturation level of oxygen. Action taken by Valentine was appropriate in against of the ethical issue however she is still responsible for the act of negligence. Due to the above described ethical issues nursing practitioners were not able to take care of the patient in reasonable manner (Nightingale & McDonald, 2009). However, these ethical issues cannot be used as defence by the nursing practitioners as it can be resolved by making wise decisions. Due to this issue, nursing practitioners are trained to face emergency situations to reduce the risk of injury. In the present case death of patient was due to mistake of several practitioners. If they had acted in standard manner, then death of patient can easily be avoided.
From the present project report conclusion can be drawn that nursing practitioners are obliged to take care of duties and responsibilities to prevent possibility of injury. They should emerged in act which is contradictory to the ethical and legal norms. If they failed to do so they will be held liable for their wrongdoings. Misconduct of the nursing practitioners will be judged by considering provisions of civil and criminal law. In the present case of death of Christopher Hammett, provision of civil law were applied. It is because primary reason of death of patient was negligence of nursing practitioners. Adverse consequences can be easily prevented if practitioners had acted in standard manner. Thus, to create an example for other nursing practitioners severe charges were drawn against the tortfeasor.
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- Atkins, K., Britton, B., & De Lacey, S. (2011).Ethics and law for Australian nurses. Cambridge: Cambridge University Press.
- DʼARCY, Y. (2005). Pain management standards, the law, and you.Nursing.
- Forrester, K., & Griffiths, D. (2005).Essentials of law for health professionals. Marrickville, NSW: Elsevier Mosby.
- GROVE, T. (2006). Oregonʼs law reaps extra benefits.Nursing.
- Guido, G. (2006).Legal and ethical issues in nursing. Upper Saddle River, N.J.: Pearson/Prentice Hall.
- Keatings, M., Smith, O., & Keatings, M. (2010).Ethical & legal issues in Canadian nursing. Toronto, ON, Canada: Moseby Elsevier.
- Nightingale, F., & McDonald, L. (2009).Florence Nightingale. Waterloo, ON: Wilfrid Laurier University Press.