Ethical-legal Issues in Health Care
MN506M2-2: Analyze ethical-legal principles and dilemmas related to health care.
Using the information from the case study (below), discuss the following issues from the perspective of an APN role:
Standards of care — Which standards of care were violated and who was responsible?
In your role as an educator, administrator, or practitioner, what risk management steps should be taken before or after the incident to alleviate the issue?
Case Study: Malpractice Action Brought by Yolanda Pinellas
Yolanda Pinellas is a 21-year-old female student studying to be a music conductor. She was admitted for chemotherapy. The medication Mitomycin was administered by intravenous infusion through an infusion pump.
During the evening shift, the infusion pump began to beep. The RN found that the IV was dislodged, discontinued the infusion, notified the physician, and provided care to the infusion site. The patient testified that a nurse came in and pressed some buttons, and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done. The documentation in the medical record indicates that there was an IV infiltration.
Two weeks after the event, the patient developed necrosis of the hand, required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The patient alleges that she is no longer able to perform as a musical conductor because of this.
While reviewing charts, the risk manager noted that there were short-staffing issues during the 3 months prior to this incident, and many nurses were working double shifts (evenings and nights) then coming back to work the evening shift again. The risk manager also noted a pattern of using float nurses among several units.
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Ethical-legal issues in health care
Advanced Practice nurses (APNs) have received additional training to work in the clinical setting with a high degree of independence and responsibility within the healthcare system. The dynamism being experienced in the healthcare system has necessitated the need for increased involvement of APNs in providing universal care. APNs can work in diverse clinical settings, including hospitals, nursing homes, research institutes, nursing offices, and education. This paper explores the role of APNs and analyzes a case study by identifying the standards of care violated and the necessary risk management steps before and after the occurrence of an adverse event.
Nurse Administrators play a critical role in managing the facility’s nursing staff. They are at the forefront of coordinating clinical schedules, drawing budgets, and implementing policies (Woo et al., 2019). They are tasked to ensure that staff members are working effectively while growing professionally and personally. Nurse Administrators hold different positions such as clinic managers, health information managers, office managers, human resource managers, and information technology managers. Also, Nurse Administrators have an integral role in providing education opportunities, using ethics to inform decision-making, collaborating with other nursing departments, and ensuring that care is based on evidence. Their background and advanced training allow them to handle the intricacies prevalent in the nursing profession and healthcare industry. Nurse Administrators are also involved in recruitment, counseling, training, and evaluating nursing staff competence. They verify licensure, credentials, and certifications for the nursing staff (Woo et al., 2019). In addition, these professionals are involved in evaluating purchasing decisions and determining the services that nursing staff can offer to patients.
Nurse Practitioners are actively involved in providing timely care by negating unnecessary delays in treatment. Nurse Practitioners are autonomous in making clinical decisions by assessing, diagnosing, and interpreting test results. These professionals can independently prescribe appropriate medications, evaluate patients and refer them to specialists if necessary. As a result, they provide safe, cost-effective, and high-quality patient-centered care (Woo et al., 2017). Nurse Practitioners are also involved in health promotion, counseling to communities, groups, families and individuals, disease prevention, and managing acute, chronic, and complex health conditions. They also serve as interdisciplinary consultants, patient advocates, and health researchers. Nurse Practitioners play a vital role in professional development and advancement by attending professional organizations’ meetings and workshops and actively participating in health policy activities at the local, state, federal, and international levels.
Nurse Educators prepare aspiring nurse students in their transition to competent nurse professionals. They inspire, mentor, and teach the next generation of nurses ensuring continuity in care provision (Daw et al., 2018). Nurse Educators have developed competencies in the profession to use educational theory and evidence-based practice to instill new ideas to nursing students. They evaluate educational programs, develop lesson plans, oversee students’ clinical practice and serve as role models to junior nurses. These professionals keep nurses updated on the latest needs and policies governing patient care (Daw et al., 2018). Nurse Educators also develop, implement, evaluate and revise nursing education programs. In addition, these professionals are involved in providing care in the clinical setting.
Standards of care
Different standards of care were violated in this case. Infection prevention and control, management of care environment, and human resources are some of the standards violated in this scenario (Wadhwa & Huynh, 2021). These standards are set by the Joint Commission (TJC). Infection prevention and control were violated by not setting appropriate measures to ensure that the patient was safe. The IV was dislodged and discontinued, and the patient ended up developing other infections such as necrosis of the hand. The standard was violated by the Registered Nurse providing care to this patient. Management of the environment of care standard was violated by leaving the patient susceptible to harm. Preventable mistakes were thus committed, such as the disconnection of the infusion pump. This standard was violated by the entire caring team, including the physician, registered nurse, and the nurse who disconnected the infusion pump since the continuum of care was disrupted during the evening shift. The human resource standard was also violated in this scenario. The organization had been having a staffing shortage three months before this incident, as the risk manager had noted. This standard of care was violated by the nurse administrators tasked to ensure that the organization has enough staff to facilitate care.
The American Association of Nurse Practitioners (AANP) has set different standards to guide nursing care. AANP standards of care which were violated in this case include care priorities and interdisciplinary collaboration. Care priority standard requires the nurse practitioner to promote optimal health by creating a safe environment and promoting optimal health (AANP, 2019. This was violated since the patient did not receive necessary nursing attention and was left unmonitored, which aggravated the patient’s health condition. Interdisciplinary collaboration standard of care requires the healthcare professionals to work collaboratively in providing medical care (AANP, 2019. This was not the case in the presented scenario, as noted during the evening shift where a nurse practitioner disconnected the infusion pump without making any consultation. The standard was violated by the nurse practitioner and physician who were part of the caring team.
Risk Management Steps Before
It is essential to establish an ongoing risk management plan to help in identifying, managing, and mitigating risk. It is critical to facilitate education and training, including new employees’ orientation and in-service training (McGowan et al., 2021). This will ensure that professionals are conversant with the safety requirement, thus reducing the occurrence of preventable mistakes. Training will also improve employees’ keenness and commitment to the caring process. The nurse educator will do this risk management step. It is also essential to create a communication plan and document follow-up activities (McGowan et al., 2021). This will ensure that all processes are monitored and that the nurse practitioners are informed on the care requirements.
Establishing contingency plans is also vital to remedy system failure and dysfunctions. These are emergency preparedness due to errors or ineffectiveness of the adopted care plan and will be facilitated by the nurse practitioner and nurse administrators. Reporting protocols should also be defined before the caring process starts and include documentation systems, tracking possible risks and adverse events, and clarifying the caring decisions.
Risk Management Steps After
Root-cause analysis (RCA) will help analyze the current health condition for this patient and determine what might have caused the problem before appropriate remedies are undertaken. RCA will identify the failures that occurred at the initial stages leading to adverse events (McGowan et al., 2021). Upon identifying the provocation events that led to this adverse event, an active correction plan will be established to eliminate or control system hazards directly linked with the causal and contributory factors. Nurse administrators and nurse practitioners will facilitate this step.
The nurse practitioner should document and report the incident to the nurse administrators. This will help avoid further complications in patient care by ensuring that appropriate interventions are undertaken earlier. Any immediate danger associated with the committed mistakes should be eliminated to increase the patient’s safety. The Nurse Administrators should develop new policies and amendments to minimize the chances of such events reoccurring. Nurse Administrators should ensure that the organization has an adequate number of licensed Nurse Practitioners who will work collaboratively in this busy working environment to meet each patient’s unique needs.
Using evidence to gather the preceding events before the adverse event is also an essential risk management step. This will entail seeking clarification from the nurse who disconnected the infusion pump on the prevailing condition before and after the discussion, consulting the nurse practitioner on any caring steps that may have been skipped or administered wrongly, and also identifying any other challenges that might have led to the occurrence of these mistakes. These may include burnout or an unfavorable nurse-patient ratio due to staffing shortage. This will provide helpful information on the decisions that should be undertaken to alleviate the patient’s recovery and how these can be initiated.
Advanced practice nursing has expanded the scope and diversity of the nursing profession. APNs have played a substantial role in improving the quality by providing care that meets each patient’s unique needs. APNs are expected to maintain the developed standards of care by ensuring that the nursing practice protects patient safety. They are tasked with improving patient health outcomes and reducing the occurrence of preventable mistakes. In addition, their education and background allow them to enhance the clinical unit’s performance and quality of nursing practice.
AANP. (2019). Standards of practice for nurse practitioners. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners
Daw, P., Mills, M. E., & Ibarra, O. (2018). Investing in the future of nurse faculty: A state-level program evaluation. Nursing Economics, 36(2), 59-82. https://nursesupport.org/assets/files/1/files/nspii/nursing-economicsinvesting-in-the-future-of-nfa-statelevel-program-evaluation.pdf
McGowan, J., Wojahn, A., & Nicolini, J. R. (2021). Risk Management Event Evaluation and Responsibilities. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559326/
Wadhwa, R., & Huynh, A. P. (2021). The Joint Commission. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557846/
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 1-22. https://doi.org/10.1186/s12960-017-0237-9
Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. W. S. (2019). Practice patterns and role perception of advanced practice nurses: A nationwide cross‐sectional study. Journal of Nursing Management, 27(5), 992-1004. https://doi.org/10.1111/jonm.12759