Page 7 Complete Your CE Test Online - Click Here admitted client’s vital signs. The nursing assistant does so and finds that the client’s pulse is rapid, weak, and irregular. The female client, who was admitted for evaluation of intermittent upper abdominal pain, is diaphoretic and complains of nausea, but denies pain at this time. The client does state, however, that her jaw “aches” and she “just feels as though something is really wrong.” The nursing assistant informs the nurse about the vital signs, nausea, and the client’s feeling that “something is really wrong.” The nurse is very busy and assumes that the findings are due to the intermittent abdominal pain. An hour later, the nurse goes to the client’s room to perform the admission assessment only to find that the client is unresponsive. Ultimately, the client is diagnosed as having had a myocardial infarction. The client experiences significant cardiac damage and will no longer be able to return to her previously active life style. The nurse is sued for malpractice. Elements of malpractice were met. The nurse assumed a duty to the client upon admission, but breached that duty by failing to assess the client in a timely manner, despite initial information from the nursing assistant that indicated the need for such assessment. The client suffered harm due to the nurse’s failure to adhere to appropriate standards of care. Damages The term damages refers to the monetary value of the alleged harm. After malpractice has been proven, damages are intended to compensate the client/plaintiff for the harm suffered as a result of the breach of duty (Mathes & Reifsnyder, 2014). Damages usually include out-of-pocket medical and related expenses resulting from the occurrence of malpractice. Examples of expenses include lost wages, costs of medical treatment, and pain and suffering experienced by the client as the result of the harm caused by malpractice (Mathes & Reifsnyder, 2014). For the client/plaintiff to win a malpractice lawsuit, all elements of malpractice must be proven. The burden or responsibility for proving malpractice remains with the client/plaintiff. The nurse (defendant) does not have to prove that his/her actions were not negligent. The client/ plaintiff’s attorney must prove that malpractice occurred. The defendant’s attorney will attempt to convince the judge or jury that each element of malpractice has not been proven (Mathes & Reifsnyder, 2014). Unfortunately, some clients and/or families may file lawsuits for reasons that actually have nothing to do with the healthcare they received. Clients/families may be unhappy with the outcome of a procedure or the impact of a serious diagnosis. Families/clients may sue out of grief over the outcome of an illness or may sue because a loved one died even though the care was appropriate. Still others may sue because they see the healthcare setting as an opportunity to gain financially, even though the care was safe and competent (Mathes & Reifsnyder, 2014). Remember that to win a lawsuit, the client/plaintiff must prove all elements of malpractice. Malpractice coverage Although the healthcare organization for which the nurse works may cover him/her under the organization’s malpractice insurance policy, it is important that all nurses understand the kinds of events and financial limitations covered by that policy. Nurses should regularly check their employer’s coverage of its nurses to be ensure that coverage has not changed or even discontinued (Mathes & Reifsnyder, 2014). Should nurses have their own malpractice insurance? Nurses who are self-employed or who work as consultants or independent practitioners should consider purchasing their own malpractice insurance (Mathes & Reifsnyder, 2014). If the nurse and her/his employer are both named as defendants in a lawsuit, and even if the nurse is covered by the employer’s malpractice insurance, the interests of the nurse and the employer may be contradictory. It is possible that the employer could claim that the nurse failed to act within the scope of her/his employment and is consequently not covered by the employer’s malpractice policy (Mathes & Reifsnyder, 2014). In any event, it is reasonable for nurses to consult with a professional malpractice company about her/his employment duties, nursing standards, scope of practice, and potential benefits of having personal malpractice coverage independent of that of the employer (Mathes & Reifsnyder, 2014). What are some steps nurses can take to reduce their risk of being named in a lawsuit? Here are some tips for limiting risk of potential liability (Mathes & Reifsnyder, 2014). Nurses must: ● ● Have a thorough knowledge of the NPA and standards of nursing practice as well as rules, position statements, legal and ethical principles, and responsibilities of job fulfillment as they apply to the nurse’s practice. Incorporate all of these factors into everyday practice. ● ● Maintain competence in their specialty area of practice. ● ● Practice within the bounds of their professional license. ● ● Know their strengths and weaknesses. ● ● Establish and maintain open, objective, honest, respectful, professional relationships with clients and family members. Ethical principles Ethics generally involve deeply held beliefs about right and wrong or good and bad. These beliefs guide, to a significant extent, behavior in both professional and private settings. It can, at times, be difficult to differentiate legal requirements from ethical standards. Both establish standards of behavior; however, legal norms originate from, and are enforced by, law. Ethical norms, often referred to as morals, reflect personal values and values as established by specific professions, such as nursing (Mathes & Reifsnyder, 2014). Legal and ethical principles often, but not always, concur. When there is lack of concurrence, ethical dilemmas result that can significantly impact nursing practice. As previously noted, professional ethical behavior is characterized by the assumption that nurses are performing nursing responsibilities legally, acting with integrity, and adhering to the professional standards for legal and ethical behavior (Mathes & Reifsnyder, 2014). Confidentiality One of the most prominent legal and ethical issues that nurses must deal with is the issue of confidentiality. Nurses have an ethical obligation not to disclose information about clients. They must maintain the client’s confidentiality, which refers to the duty of nurses not to disclose or share information without the express consent of the client. They must also respect the client’s right to privacy, which means that clients have the right to keep information about their lives from being made public, even to one other person, if they so choose. Confidentiality is an ethical and professional obligation, but privacy may be protected by law (Mathes & Reifsnyder, 2014). Example: While the dangers of cigarette smoking were apparent as early as 1953, it was not until the mid-to-late 1960s that the United States (U.S.) federal government mandated warnings in an attempt to inform the public of health dangers associated with smoking. What ethical obligations did healthcare professionals have to act on research findings regardless of legislative mandates? What options do healthcare professionals have now when they are made aware of a practice that may compromise wellness, but would mean disclosure of confidential client information? Consider this ethical dilemma: Mrs. Davidson is a 60-year-old investment banker who has recently been diagnosed with Stage II breast cancer. Her mother and grandmother were also breast cancer survivors. Mrs. Davison has a 35-year-old daughter, from whom she is estranged. After undergoing genetic testing, it is determined that Mrs. Davidson has a genetic mutation that significantly increases the risk of breast cancer. Mrs. Davison has made it clear to her physician and the nursing staff that she will not be sharing the results of the genetic testing with her daughter, Victoria. One of Mrs. Davidson’s nurses knows Victoria, since