Chapter 17 case

Judy was depressed and thus suicidal. The fact that the bathroom door was locked means that the facility was taking precautions to prevent her from committing suicide (Jacobs et al., 2010). She had already tried to commit suicide by making a rope from her robe. At this point, it is clear that she was in a bad state of mind and the facility ought to have proceeded with care in handling her. The nurse decided to open the bathroom door (Guido, 2014). The psychiatrist came to speak to Judy, and the nurse left leaving the bathroom open. The nurse was negligent for unlocking the door and then leaving without closing it. It is clear that it was not the facility’s policy for the psychiatrist to inform the attending nurse once done with the patient. The nurse should thus have closed the door before leaving.

Given that, the psychiatrist left Judy’s room and went to the charting area just next to the nurse’s room and never informed the nurse that Judy was alone shows that there is no such policy in the facility. The primary care of Judy thus lied with the attending nurse. The psychiatrist stayed with Judy for 45 minutes, and the nurse did not come in to check on Judy. The nurse should have known that the psychiatrist had no responsibility of informing her when finished with Judy. Thus, the nurse should have kept checking up on Judy to determine whether the psychiatrist was through with her. However, the nurse did nothing of this sort and instead checked on Judy 15 minutes after the psychiatrist was gone. She should have closed the door when the psychiatrist came to see Judy.

In this instance, hospital procedures and policies are very significant. Had the psychiatrist informed the nurse that Judy was alone; the nurse would have been there to supervise Judy as she bathed. It is intriguing to note that the psychiatrist after leaving Judy’s room went to the charting area just next to the nurses’ station and never bothered to inform the nurse that Judy was alone (Guido, 2014). The nurse, on the other hand, was not keen enough to notice the psychiatrist leaving Judy’s room. It is significant to have procedures in hospitals. The nurse had left Judy with the psychiatrist, and at the immediate period, the psychiatrist had the standard of care. However, the hospital procedures and policy did not dictate that a psychiatrist informs the nurse once a suicidal patient was alone. This instance presents a failure of the management for not drafting and implementing effective procedures and policies. The situation shows just how procedures and policies can guide the provision of quality health care.

The primary standard of care for Judy was with the attending nurse. However, when the psychiatrist came to see Judy, the nurse only checked on Judy after one hour. The psychiatrist 0on the other hand stayed with Judy for 45 minutes. The nurse was negligent in leaving the bathroom door open. Judy was her primary responsibility, and the psychiatrist was just an interested party (Furrow et al., 2014). However, the lack of effective procedures in the facility participated in this case. In determining this case, I would hold the nurse and the management liable.

Chapter 18 case

The nurse acted negligently by advising Mr. Gonzales to take aspirin and call in the morning. As the physician’s nurse, she should have informed the physician of the situation and act according to the instructions of the physician. However, the nurse opted to advise the patient to take some painkillers and call again in the morning. The primary standard of care lies with the physician, and if necessary, the physician can transfer some components of the care. In this case, no transfer of care happened but the nurse took it upon herself to prescribe medication to the patient (Guido, 2014).

The nurse exceeded the scope of practice by advising Mr. Gonzales to take some medicine. A patient’s primary caretaker has the standard of care for the patient (American Nurses Association, 2010). The attending physician was responsible for the patient. The nurse ought to have contacted the physician and convey the information concerning the patient. The physician could then directly attend to the patient or advice the nurse on the appropriate action to take. The nurse made the decision to advise the patient to take some aspirin and then call again in the morning without the consent of the physician.

When Mr. Gonzales called the physicians nurse, the nurse informed him that everybody had gone home. She prescribed aspirin and advised him to call again in the morning. On the previous day, the patient had a routine colonoscopy conducted and three polyps removed. Under the circumstances, anything that happened to the patient was a concern. Considering that, a colonoscopy involves inserting flexible tubes to the large intestines, any indications that the patient was suffering from stomach would be a concern (Sanchez, Harewood & Petersen, 2004). Since everybody had gone home and the patient could not get the attending physician on the phone, the nurse ought to have advised Mr. Gonzales to visit the local emergency centers. The emergency centers exist specifically to cater for emergency cases. The fact that everybody in the surgical center had gone home did not mean that none could be available to take care of Mr. Gonzales.

The fact that the colonoscopy was a routine shows that it was not the first time the patient was undergoing the procedure. However, the following day, he experienced abdominal pain and could not get hold of the attending physician on the phone. Mr. Gonzales called the physician’s nurse who informed him everybody had gone home. The nurse advised him to take aspirin. In deciding this case, I would hold the nurse liable. The nurse exceeded her scope and advised the patient to take aspirin. Since everybody at the surgical center had gone home, the nurse ought to have advised the patient to visit the nearest emergency center (Furrow et al., 2014). In any case, the nurse was in a better position to contact the physician for the way forward. It was negligent for the nurse to assume the role of the physician and prescribe medication to the patient.

Chapter 20 Case

Aburu has a history of cerebral vascular accidents. He was hospitalized for a surgical procedure. However, after the surgery, he was transferred to a nursing home. According to the judgment of the nursing home administrator and the attending surgeon, there was no reason why Aburu could not receive adequate care at the nursing home. According to the American College of Surgeons, the responsibility of the patients lies with the surgeon even after the surgery. The operating surgeon has to maintain a critical role in directing the patients care (American College of Surgeons, n.d.). If necessary, the surgeon can transfer the primary responsibility to another physician, but the surgeon remains involved in the care of the patient. For Aburu, the surgeon should not have transferred the care of the patient to the nursing home. In the nursing home, both licensed and unlicensed people handled Aburu, and none of them was prudent to check his dressing.

Even if the care plan of the nurses in the nursing did not specify that a patient’s wound should be checked hourly, a prudent nurse should have done so. The primary responsibility of nurses in a nursing home is to take care of the patients. Given that Aburu had just undergone an operation, a prudent nurse should have taken special care of the incision site. In addition, Aburu was 81 years old and thus susceptible to uncontrolled bleeding. A prudent nurse would have checked the wound constantly as part of quality nursing are to the patient.

The lawsuit should not focus primarily on the surgeon for allowing the transfer of the patient to the nursing home instead of checking on him for 24 hours. This should be one of the primary concerns of the case. The surgeon ought to have provided postoperative care to the patient. He should have waited for at least 24 hours before transferring the patient.  Another primary concern of the lawsuit should be the fact that the surgeon transferred the care of the patient to people with no capability to offer the care the patient needed. A surgeon can transfer the primary care of the patient to another surgeon or qualified physician when necessary. However, the surgeon, in this case, transferred the care of the patient to the nursing home attendants some of whom had no license. This amounts to a breach of the standard of care.

The surgeon owed a duty of care to the patient. The patient has a history of cerebral vascular accidents (Guido, 2014). Surgery can result in complications in this kind of a situation. Besides, the patient is 81 years and thus susceptible to continuous bleeding. There was a need for regular assessment on his wound. The surgeon ought to have provided postoperative care until the patient was stable. However, the surgeon allowed the transfer of the patient to a nursing with licensed and unlicensed attendants. In addition, there was no surgeon on the nursing home to assess the patient. The surgeon did not instruct the attending nurse to check on the wound regularly. In deciding this case, I would hold the surgeon liable for the immediate death of Aburu.

References

American Nurses Association. (2010). Nursing: Scope and standards of practice. Nursesbooks. org.

American College of Surgeons (n.d.),. Statements on Principles. American College of Surgeons. Retrieved 2 November 2016, from https://www.facs.org/about-acs/statements/stonprin

Furrow, B., Greaney, T., Johnson, S., Jost, T., & Schwartz, R. (2014). Health law (3rd ed.). Minnesota: West Academic.

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.

Jacobs, D. G., Baldessarini, R. J., Conwell, Y., Fawcett, J. A., Horton, L., Meltzer, H., … & Simon, R. I. (2010). Assessment and treatment of patients with suicidal behaviors. APA Pract Guidel.

Sanchez, W., Harewood, G. C., & Petersen, B. T. (2004). Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. The American journal of gastroenterology, 99(10), 1941-1945.

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