Health Policy, Ethical and Legal Perspectives of the HCS

Standards of care – which standards of care were violated and who was responsible?

In your role as practitioner, what risk management steps should be taken before or after the incident to alleviate the issue?

Case Study: Malpractice Action Brought by Yolanda Pinellas

Yolanda Pinellas is a 21-year-old female studying to be a music conductor. She was admitted for chemotherapy. The medication mitomycin was administered by intravenous infusion through an infusion pump.

During the evening shift, the infusion pump began to beep. The RN found that the IV was dislodged, discontinued the infusion, notified the physician, and provided care to the infusion site. The patient testified that a nurse came in, pressed some buttons, and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done. The documentation in the medical record indicates that there was an IV infiltration.

Two weeks after the event, the patient developed necrosis of the hand, required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The patient alleges that, because of this, she is no longer able to perform as a musical conductor.

While reviewing charts, the risk manager had noted that during the 3 months prior to this incident, there were short-staffing issues with many nurses working double shifts (evenings plus nights) then coming back to work the evening shift again. The risk manager also noted a pattern of using float nurses among several units.

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Application of Standards of Care

Discuss the standard(s) of care to which the parties will be held in this case scenario. How will the standards of care and your state’s Nurse Practice Act be applied in the courts if the case is sued?

Case Scenario

SK, age 61, went to the hospital with what she thought was a bad cold, and was admitted with a diagnosis of pneumonia. Following admission, she became increasingly feverish and short of breath, but her family’s calls for help went unanswered. In fact, her daughter was unable to find anyone when she went to the nurses’ station looking for help. The patient eventually stopped breathing, and someone finally responded to the family’s desperate and frantic calls for help. SK was successfully resuscitated, but sustained brain damage due to oxygen deprivation. She was left unable to walk, talk, or care for herself.

Because of nurse understaffing in the hospital, her assigned RN had not assessed her often enough and did not monitor her oxygen level. There were 41 other patients on this unit. Although the hospital’s own staffing standards called for five registered nurses and two licensed practical nurses to staff this unit, only three registered nurses were on duty. Records for the unit in question indicated that the hospital failed to meet its own staffing standards for 51 out of 59 days before this incident.

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Assignment Guidelines:

Using the option below based on your specialization;
Mental health Nurse Practitioner
Create an ethical and legal decision-making dilemma involving an advanced practice nurse in the field of a nurse practitioner:

Practice Dilemma – Honesty versus Withholding Information

Describe one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts.

Construct a decision that demonstrates integrity and that would prevent violation of the ethical principle and prevent the law from being violated.

List three recommendations that will resolve advanced practice nurses’ moral distress in the dilemma you have presented. Support your paper with a minimum of three scholarly references.

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Ethical dilemma : "Do Not Resuscitate" . Present your dilemma to the ethics committee of your institution. Outline an ethical theory or model you wish the committee to consider when reviewing this case. What arguments do you have to support the use of this model? Discuss the role of the ethics committee in this particular ethical dilemma.

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In the course, you will research ethical decision-making and legal issues that influence your role as a nursing leader, explain how you see your role as a nursing leader making ethical-legal and moral decisions. Include what actions you plan to take to minimize or alleviate moral distress caused by ethical dilemmas and the values that support your actions.

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