For this week assignment, write a 1500-word essay addressing each of the following points/questions.
Read the case study presented at the end of Chapter 10, which begins “The elderly patient resided at the nursing home for almost a year before she died at the hospital.”
• Did the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case?
• Was there negligence on the part of the nursing staff in the care of this patient?
• What could the nurse have done differently to facilitate a different outcome in this case?
• How would you decide this case?
Using the sample professional liability insurance policy (Chapter 11 p. 191-192 Figure 11-1) locate the various provisions:
• Limits of liability
• Reservation of rights
• Covered injuries
• Defense costs
• Coverage conditions and supplementary payments
• Did you have difficulty finding some of the sections? Would this be a policy that you would consider purchasing for your own liability coverage? Why or why not?
Read the case study presented at the end of Chapter 11, You Be the Judge, which begins, “During an unexpected heat wave,…” (Guido, p. 195):
• What provisions of an insurance policy would you consult to determine if an insurance company should pay such a claim, and what would the limits of the liability be?
• Is the nursing home insurance company correct in saying that this is a professional judgment issue?
• Which insurance company (the nursing home’s or that of the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment?
• How would you decide the case?
Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.
Evidence-based, quality, and safe nursing practice is termed accurate, clear, and accessible discrimination of a patient’s diagnosis history, treatment, and progress. All phases of the nursing practice are responsible and accountable for documentation. Documenting the nurses’ tasks is crucial as it helps attain effective communication. Nursing documentation is also used in legal issues, payment practices, and insurance policies. Lastly, documenting shows the contribution of nurses to a patients’ care results and proves contribution to the viability and effectiveness of the healthcare organization that encourages the provision of quality care. The essay will look into two major case studies related to legal proceedings resulting from inadequate patient documentation and examination and poor healthcare professionals’ decisions.
Case Study, Chapter 10
- Failure to document in admitting nurse’s assessment notes and effect on the outcome
My main concern is whether the nursing home laid out guidelines on managing bedridden patients and whether there are strategies to provide special mattresses for non-ambulatory clients to curb and care for pressure ulcers. I think that lack of documentation of the patient’s necrotic grade III pressure ulcer on the coccyx and particular care like the need for a special mattress could or could not have affected the patient outcome. Firstly, it can be termed a missed diagnosis that the nurse overlooked while attending to the patient. In this case, the unnoticed diagnosis could not have been documented. The professionalism of the nurses in the nursing home should also be questioned. There is a likelihood lack of experience results in the inability to detect the pressure ulcer during the examination and the importance of having a mattress. There was a need to detect the task for the pressure ulcers hence indicating the urgency of having a particular mattress to avoid worsening the condition. I would also highlight that if the diagnosis was developed but no documenting was done, this would affect the failed outcome of the patient. If a recording was done, then it could aid in ensuring positive patients outcomes.
- Evidence of presence or absence of negligence
My opinion is that there was evident negligence among the nurses in the way they cared for the patient, which led to death. The nurses failed to adhere to the clinical nursing practice standards, which is evident by failing to examine and monitor the patient (Guido, 2001). A nurse should help the patients by examining them and frequently documenting the changes in their health condition. Nurses should also interact with patients in a friendly way to ensure that they grasp all-important details on how they are progressing. This would aid in detecting any signs of health deterioration, and once such is noted, close exanimation should be done, including a physical examination (Guido, 2001).
In this scenario, a thorough physical examination would have helped detect the ulcers in the patient, and negligence would not be associated with the nurse or the facility. In this case, the nursing staff did not thoroughly access hence failing to diagnose pressure ulcers, which impacted the patient outcome (Arganata, 2021). There is also evident negligence as the nursing staff did not copy to suitable standards of documentation and care. Bedridden patients need to be aided in ambulation and rippled mattresses to curb and manage the pressure ulcers, which was not documented in the patient records. In this case, I assume that if it was not documented, it was not done, and the staff looking after the patient failed to adhere to the requirements.
- What could have been done differently by the nurses to change the outcome?
I believe that the patient’s outcome could have been changed if the nurses had shown more vigilance regarding the effects of pressure ulcers on the patient (Guido, 2001). Pressure ulcers are common among non-ambulatory and bedridden patients. In this case, the nursing staff could have detected the risk of pressure ulcers in the patient and suffered the use of rippled mattresses to curb the progression of the pressure ulcers. Also, the nurse could have done a thorough examination on the patient during admission and during the patient’s stay in the facility to detect the pressure ulcers early, which would have curbed progression. Doing this would have enabled the nurse to document and alert the management and physician to take action. This would have inhibited developing sepsis and gram negative septicemia in a patient with low immunity aggravated by acute myeloid leukemia.
- How I would rule the case
I would rule in favor of the patient’s family and argue that the facility portrayed negligence in the type of acre they offered the patient. My verdict would be based on the fact that the nurse failed to examine the patient fully and notice the pressure ulcers. I would also favor the patient’s family because the facility did not establish guidelines for caring for bedridden elderly patients. There was no clear record that the patient had been provided with the unique mattress to cope with the condition (Arganata, 2021).
Various provisions (Chapter 11, pages 191-192)
The limit of liability in this particular context is the personal, professional liability of $3,000,000 comprehensive/ $1,000,000 in each claim.
Declarations: In the event of a lawsuit, the insured agreed to inform the insurer in writing, detailing the addresses of the injured party, as well as witnesses, as well as the time and location of the event. She also stated that she would explicitly reference the insurer’s claim delegate about the incident and would provide complete support.
Exclusions: The insurance policy does not cater for the liability of the insured party as a superintended proprietor, execute officer of a facility, clinic with boarding amenities, laboratory, or sanitarium except those outlined in the declarations.
Deductibles: There is no specific amount stated regarding what policyholders should compensate from their pockets in case of a claim.
Reservation of rights: The insurer will not cater for a person’s professional liability as a participant of a partnership engaged in the practitioner of the person insured’s a profession as defined in the declarations, which include service by the participant certified on a formal certification or similar career board, hospital review panel, or society of experts.
Covered injuries: The policy caters for all damages due to the provision of or lack of offering professional services during the coverage by the insured or by any person whose oversights and acts when the insured is lawfully responsible.
Coverage conditions and the additional expenses: The coverage terms indicate the compulsions of the insured when a suit or claim occurs, that the insured should do a written and formal notification. The insured should also ensure they quickly submit all demands summons to the company in the occurrence of a claim or suit. The additional expenses the company will incur entail all costs taxed against the person insured in the case defended, expenses incurred by the company, and practical costs incurred by the insured during a request by the company to aid in investigating or defending a legal suit or claim.
Defense costs: The insurance company will cater for costs incurred by the company and other expenses taxed by the insured party in any suit against the company and all the interest on the overall judgment.
Challenges in finding some sections
Some of the sections are not well-illustrated; hence I encountered vast challenges in finding them. I would not opt to use this policy for my professional policy as it has missing segments and is difficult to understand.
Case Study, Chapter 11, page 195
- Provisions of the insurance to consult to analyze if the claim can also be covered the limits of liability
These provisions include the policy declarations, reservation of rights, liability limits, coverage conditions, defense costs, supplemental payments, exclusions, and deductibles (Hughes, 2021).
- The exactness of the nursing home insurance in indicating the issue as a professional decision
In this case, the insurance company offers professional liability policy to the facility’s administrator who was sued rather than the nursing home’s insurance. My opinion is that the issue indicated in the case study is a clear professional judgment related to the administrator opting not to switch on the air conditioner. This is a professional judgment as the decision by the administrator was based on experience and understanding hence not turning on the air conditioner, which caused the death of four patients.
- The insurance company is supposed to pay for the court-ordered judgment.
The administrator used her proficient comprehension to decide what led to deaths (Guido, 2001). The nursing homes insurance company has the right to claim that the decision made was professional. The nursing home’s insurance company should not pay. Rather, her insurance company should do so if she possesses a professional liability policy.
- My decision
I was to decide on this case and review the situation leading to the deaths of the patients. My take would be that this is a professional judgment concern. I would argue that the administrator utilized experience and made a decision that unfortunately led to the death of the patients. In this case, I would order the court-ordered judgment to be agreed upon by her insurance company, offering her a professional liability insurance policy, which would help manage the issue at hand.
In a nutshell, it is evident that documenting/recording in nursing care is vital to help attain safe and quality care. All steps and communications with the patients and procedures/medications and interventions used should be recorded. This allows nurses to stay free from lawsuits caused by misconducts like patient negligence, as illustrated in the case study in chapter 10. It is also significant to have a professional liability policy to help health providers protect their careers and themselves if misfortune does not intend to occur.
Arganata, R. (2021). The Nurses’ Negligence on Patients. Journal of Computational and Theoretical Nanoscience, 18(1-2), 100-104.
Guido, G. W. (2001). Legal and ethical issues in nursing.
Hughes, T. (2021). Ethical Conflicts and Legal Liability in Professional Nursing. In The Medical-Legal Aspects of Acute Care Medicine (pp. 393-415). Springer, Cham.