1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 08: Legal Issues in Critical Care Nursing

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Five Legal Responsibilities of the Registered Nurse

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins What Is “Reasonable Care”? Expert testimony Professional organization’s standards of care Agency policy and procedure manuals Nursing textbooks and literature Job description of the nurse Manufacturer’s instructions for equipment, if involved

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Avoiding the Legal Pitfalls of Floating See Box 8-2.

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 1 A client arrives in the emergency department in full arrest and resuscitation is started. The family arrives and produces the client’s living will. The family informs the health care team to stop resuscitation efforts. Apply your knowledge of advance directives to this situation. What steps should the health care team take?

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 2 A 88-year-old man living in a nursing home has a documented DNR order. Colon cancer and a stroke have left the client wheelchair bound. He is totally blind and has amnesia, short-term memory loss, and difficulty swallowing. The man is brought to the hospital with a new-onset stroke. The son states that he has the health care power of attorney. He wants all medications stopped and hospice called. Apply your knowledge of advanced directives to this situation. What steps should the health care team take?

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 3 A 22-year-old man has met the criteria for brain death. The family informs the nurse that they want their son to continue on life support and to remain a full code. Apply your knowledge of advanced directives to this situation. What steps should the health care team take?

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The critical care nurse performs neurological checks every hour on a patient at high risk for a stroke and finds new-onset right-sided paralysis, aphasia, and pupil changes. She does not report the findings to the neurologist. The nurse is taking meperidine prn for back pain. This is called which of the following? A. Ordinary negligence B. Gross negligence C. Criminal assault D. Criminal battery

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Gross negligence. Rationale: Ordinary negligence is professional carelessness and not willful neglect. In this case the nurse is taking medications that can impair judgment and willfully ignored the risks of harm to the patient by not reporting the evolving neurological changes. This constitutes gross negligence. This is not criminal assault because the nurse did not willfully threaten to physically harm the patient. This is not criminal battery because the nurse did not willfully inflict physical harm on the patient.

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about making the injured patient whole is correct? A. Pain and suffering would be determined by an actuary. B. The spouse or children of the patient are never entitled to a settlement for economic losses. C. Many states place monetary limits on how much a patient can receive for loss of consortium services. D. Lost wages are awarded at the current rate when the court case is settled.

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Many states place monetary limits on how much a patient can receive for loss of consortium services. Rationale: Many states place monetary limits on pain and suffering, which includes loss of consortium services (loss of marital relations or the ability to perform tasks around the home). An actuary is an accountant who determines monetary compensation for lost wages, medical costs, and other economic damages for the past, present, and future based on economic formulas. The spouse or children of the patient may be entitled to compensation for any economic damages they incurred.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The ICU is chronically understaffed. There is one critical care nurse in the ICU and two nurses on the adjacent step-down unit. A patient arrests in the ICU. The code button signal does not reach the step-down unit. The patient dies because of the delay to get help. This is: A. A case of respondeat superior B. A case of corporate liability C. A rule of personal liability D. A case of negligent supervision

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. A case of corporate liability Rationale: Corporate liability is the unreasonable behavior of the hospital in staffing the unit with one nurse, expecting that the nurse can adequately care for patients by getting the step-down nurses to help. Respondeat superior states that a hospital is responsible for the negligence of its employees, and the nurse is not at fault because the code was called. Negligent supervision occurs if the supervisor fails to supervise the staff properly, resulting in injury of the patient. Personal liability is a result of not exercising proper judgment on a questionable order.