Standards of care – nursing care plan

You be the Judge Judy, age 20, was admitted to an inpatient psychiatric facility for acute depression and suicidal ideation. She had gone to the local police station the previous afternoon, stating that she was suicidal. The police transported her to the emergency center, and Judy was admitted on a 24-hour emergency mental health hold. On admission, Judy was obviously depressed and stated that she was still tormented with thoughts about killing herself. Later that evening, the nurses heard a crash from Judy’s room and, upon investigation, found her sitting on the bed with an overturned chair next to the bed. She had torn her robe, tied the pieces together as a rope, and fell from the chair as she was attempting to tie the homemade rope to the ceiling. Judy was immediately placed on a 15-minute observation protocol. The following morning, the patient was still on observation every 15 minutes. The nurse at that point determined that Judy was more coherent and noted that Judy was disturbed by her appearance as she had not bathed in some days. The nurse unlocked the bathroom door so that Judy could shower. Soon after the bathroom door was unlocked, Judy’s psychiatrist came to speak with her. She remained with Judy for about 45 minutes, left the room, and entered a charting area next to the nurses’ station. The nurse caring for Judy did not see the psychiatrist leave Judy’s room, nor did the psychiatrist inform the nurse that Judy was now alone in her room. The nurse checked on Judy approximately 15 minutes later. She found Judy hanging by the belt of her bathrobe from the shower rod. Judy was in full cardiac and respiratory arrest, a code was called, and Judy now has severe and permanent anoxic brain injury. Her parents have brought this lawsuit alleging breach of the standard of nursing care. Questions Was the nurse negligent for unlocking the bathroom door and allowing Judy to shower by herself? Was it below the standard of care for the nurse to leave the bathroom door unlocked when the psychiatrist came to see Judy? How significant are the hospital policy and procedures in this instance? How would you decide this case? You be the Judge Mr. Gonzales was admitted to a surgical center for a routine colonoscopy during which three polyps were removed. The procedure began at 11:00 a.m. and he was released at 12:30 p.m. The patient began experiencing abdominal pain the following day. He tried to phone the attending physician at 2:00 p.m. and later called the physician’s nurse at 5:00 p.m. Mr. Gonzales told the nurse he was experiencing severe abdominal pain and that he was flushed and felt he had a fever. The nurse told Mr. Gonzales that everyone had gone home for the day, and she advised him to take aspirin for the fever and call back in the morning. Mrs. Gonzales drove her husband to the hospital the following morning at 10:00 a.m. He was placed on antibiotics, which did not resolve the problem, and he had surgery on the fifth day following the original colonoscopy. At that time, it was determined that the patient’s intestine was perforated at the time of the polyp removal, and Mr. Gonzales now has a permanent colostomy. The patient has now filed a lawsuit against the nurse and physician for malpractice.

Questions

Was the nurse negligent in the advice she gave Mr. Gonzales concerning his condition? Did the nurse exceed her scope of practice in the advice she gave the patient? Should the nurse have instructed Mr. Gonzales to go immediately to the local emergency center? How would you decide this case? Who, if anyone, is liable in this case? You be the Judge Mr. Aburu, 81, with a history of cerebral vascular accidents, was hospitalized as an outpatient for a surgical procedure to incise and drain a skin lesion on his chest. After the procedure, he returned to the long-term care facility with sterile packing in the partially sutured incision site. The packing was to remain for 3 days, then be removed, and the wound covered with a dry dressing. The risk of complications for this type of surgery was considered quite low, and both the nursing home administrator and the attending surgeon saw no reason why the patient could not be adequately cared for in the nursing home immediately after surgery. Approximately 5 hours after Mr. Aburu returned to the nursing home, blood was observed at the incision site. He was transferred back to the acute care hospital, where he died the following day. Evidence at trial showed that for the 5 hours that Mr. Aburu was at the nursing home, several licensed and unlicensed personnel attended to him. At lunchtime, two aides escorted Mr. Aburu to the dining room; lunch was about 3 hours after his return to the nursing home. None of the personnel examined his dressing until an aide noticed that he was bleeding though his bed sheets. Shortly after discovering the bleeding, the patient was transferred by ambulance to the hospital. His family has filed a lawsuit for the wrongful death of their father, alleging that the care given to the patient after surgery fell below the acceptable standards of care.

Questions

What should the standards of care be for such a patient? Even though the nursing care plan did not specify that the wound should be checked hourly, how should the prudent nurse have acted? Should the lawsuit center primarily on the surgeon for allowing this patient to be sent back to the nursing home for postoperative care rather than insisting that he be kept for 24 hours in an acute care facility postoperatively? How would you decide this case?

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