Nursing Leadership

Discussion Question:

Read this article:  Austin, S. (2011). Stay out of court with proper documentation. Nursing, 41(4), 24-30. Of the four elements that must be proven to determine negligence, do you think that any of them is harder to prove than others?

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If you have ever come close to committing nursing negligence, what would your advice be for others? If not, have you ever seen someone commit negligence, and if so, what is the lesson in it? If no for each, make up a scenario to share your professional advice.

Choose scenario 1, 2, or 3 in the article. Summarize the lesson to be learned, and what you would have done to avoid the error.

Response 1:

(A)According to Weiss and Tappen (2015) the definition of negligence is “the unintentional tort of acting or failing to act as an ordinary, reasonable, prudent person, resulting in harm to the person to who the duty of care is owed”. There are four legal elements in negligence: duty, breach of duty, causation, and harm or injury (Weiss& Tappen, 2015). To be proven guilty of negligence, all four elements must be shown and proven. In nursing, negligence is how we perform or not perform our duties within the scope of practice and standards of patient care. Standards of care policies and procedures are set by the healthcare facility to protect patients from sub-standard care. According to Westrick and Jacob (2016) one of the leading causes of nursing negligence is medication errors. A report showed close to 98,000 patients die in the United States each year due to preventable medication errors (Westrick & Jacob, 2016).

           In regards to the four elements of negligence, the hardest to prove might be causation. Causation may be direct or indirect and may be challenging to form a judgment based solely on one clinician’s action causing injury or death to a patient. Other significant factors may often contribute to the patient’s injury or death, with one cause not being specifically determined or pinpointed. 

           In working on a medical-surgical floor, there were many times nursing negligence unintentionally occurred with the limited number of nurses scheduled. For a nurse to have ten patients on a night shift with one nursing assistant, the probability of negligence was high. It is vital that every patient be provided with the highest quality of care. To ensure you are providing quality care, go to the charge nurse or house supervisor to verbalize your concerns of potential negligence.

           Regarding the stay out of court with proper documentation article, the first scenario may be the most commonly type of negligence committed. Patients who do not receive treatments, medication as ordered by physicians are at risk. In this scenario, if the nurse had taken the time to suction the patient, and put in a call to the physician, this fatal outcome may have been avoided. Although, many nurses may not like to suction traches, it must be done. The nurse needed to place a call to the provider to inform him or her of their patients breathing difficulties. This nurse needed to document both to protect her license and the facility. Documentation is essential, as we all learned in nursing school, if is not documented, it was not done. 

                                                     Reference

 Austin S. (2011). Stay out of court with proper documentation. Retrieved from Nursing2020, April 2011 Vol41(4), pg. 24-29. Retrieved from 

            doi: 10.1097/01.NURSE.0000395202.86451d4

Weiss, S. & Tappen, R. (2015). Essentials of nursing leadership and management (6th ed.). F.A. Davis Company.

Westrick, S., & Jacob, N. (2016). Disclosure of errors and apology: Law and ethics. The Journal for Nurse Practitioners, 12(2), 120-126. http://dx.doi.org/10.1016/j.nurpra.2015.10.007

Respond 2

Of the four elements that must be proven to determine negligence, I think that the hardest to prove is “a duty to the patient existed” Unlike a patient being injured or a breach of duty occurred, a duty to the patient existed would only be proven if the nurse’s moral compass is intact or the nurse is ethical enough to admit. 

I was working in a nursing home as an LPN, one weekend, the second nurse called out, subsequently I had to work the entire floor by myself. This was a rehabilitation unit with a census of forty patients, I had numerous wound care, vital sign, and endless narcotic due to post surgical wound. That day I did my best to accomplish all my duties, however, there was one patient that had hip surgery and needed a dressing change, I checked the dressing which looks clean and decided omit it. At the end of my shift I gave hand off report and endorse to the oncoming nurse, who stated, “It doesn’t have to be done every day anyway.” I went to my car and could not leave, knowing that the dressing would not be done for more than twenty four hours. I went back to the unit and did the dressing and felt a sense of relief. My advice would be, if there is a breach in ethics never try to cover it, the consequences of that is always greater. Nurses are human and we are expected to make mistakes, we are also expected to do right by that mistake by reporting it. that mistake could be a teaching or an inservice to all. Negligence occurs sometimes when we refuse to asked for help. If you feel overwhelmed, and know that there is no way you can accomplish the goals set forth, reach out to someone for help, if there is no help document properly, but never leave anything undone without proper documentation.

The Joint Commission on Accreditation of Healthcare Organization defines negligence as a failure to use such care as a reasonably prudent and careful person would use under similar circumstances. They also defines malpractice as improper or unethical conduct or unreasonable lack of skills by a holder of a professional or official position (lippincott NursingCenter

Health Assessment Question

Discussion Question:1

The CDC and Healthy People 2020 continue to educate on the importance, the improved ease of access and insurance coverage for screenings and vaccinations. It is the responsibility of nurses to engage our ageing adults in self-advocating for services that benefit the individual and community health. How can you, as a registered nurse, impact older adults to encourage routine vaccination? What impact does this have on the

RESPONSE 1

(A)Vaccines do not apply only to children. Older adults and those with chronic health conditions are particularly at risk for vaccine-preventable diseases. Every year thousands of adults in the U.S. become seriously ill and are hospitalized because of diseases that vaccines can help prevent.  By getting vaccinated, older adults can lower the chances of getting certain diseases (Sampathkumar, 2012). Vaccines that are recommended for older adults include, Shingles Vaccine, Pneumococcal Vaccine, and the Flu Vaccine (Sampathkumar, 2012). Unfortunately, rates among U.S. adults have remained below the U.S. Department of Health and Human Services Healthy People 2020 goals (Healthy People, 2020). Approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventable diseases (Healthy People, 2020).

The community also improves financially. Vaccination is among the most cost‐effective interventions for healthy aging strategies (Ozawa et al., 2016). For example, a recent study estimated that under-vaccination of adults costs the US 7.1 billion USD in healthcare expenditure per year (Ozawa et al., 2016).

Nurses are leaders for a multidisciplinary team that focuses on disease prevention, including immunization. In general, nurses have the most contact with patients, proving that they have a vital role in addressing the vaccination recommendations. Communication with patients is essential in delivering the education necessary for appropriate health choices regarding vaccinations. Nurses must advocate the cause of adult immunization and organize activities to ensure that opportunities for vaccination are readily available. By taking advantage of the electronic health record (EHR), nurses can be reminded when vaccines are needed. Once alerted to the need for a vaccine, nurses must seize the appropriate opportunity to begin a discussion with the patient regarding their beliefs and concerns about vaccinations. In addition to strong communication, the use of standing orders enables nurses to assess the patient’s immunization recommendations and administer vaccines without obtaining a physician order (Doherty et al., 2018).

Infectious diseases are a critical public health concern, and nurses must continue to advocate for vaccinations. Vaccination can serve as an additional strategy to support healthy aging, alongside healthy diet, and exercise.

References

Doherty, T. M., Connolly, M. P., Giudice, G. D., Flamaing, J., Goronzy, J. J., Grubeck-Loebenstein, B., . . . Pasquale, A. D. (2018). Vaccination programs for older adults in an era of demographic change. European Geriatric Medicine, 9(3), 289-300. doi:10.1007/s41999-018-0040-8

Healthy People. (2020). Immunization and Infectious Diseases. Retrieved November 17, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases

Ozawa, S., Portnoy, A., Getaneh, H., Clark, S., Knoll, M., Bishai, D., . . . Patwardhan, P. D. (2016). Modeling The Economic Burden Of Adult Vaccine-Preventable Diseases In The United States. Health Affairs, 35(11), 2124-2132. doi:10.1377/hlthaff.2016.046

Sampathkumar, P. (2012). Adult Immunizations. Mayo Clinic Infectious Diseases Board Review, 516-524. doi:10.1093/med/9780199827626.003.0044

RESPONSE 2

(B) https://www.youtube.com/watch?v=hodb65EkorM

Do you believe or oppose to the use of vaccinations?  Should vaccinations be mandatory? Please reply.

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