SUBJECT: NCM 69 (NURSING LEADERSHIP AND MANAGEMENT LECTURE)

TOPIC: LEGAL ASPECTS IN NURSING

Name of student: SANCHEZ, CAMILLE T.

CASE ANALYSIS

Case 1

 A patient came in walking to the out-patient clinic for injection of vaccine. Nurse X,
injected the vaccine to the patient’s buttocks. Upon administering the injection, the
patient experienced extreme pain. His leg felt weak and he was subsequently
paralyzed. His sciatic nerve was injured.

LEGAL ANALYSIS: 

What doctrine of law is applicable to the case? And discuss.

The term negligence refers to the commission or omission of an act, pursuant to a

duty, that are reasonably prudent person in the same or similar circumstance would
or would not do, and acting or the non-acting of which is the proximate cause of
injury to another person or his property. The concept of negligence states that if a
person charged with negligence shows that she meets or even surpasses this
standard then there is no negligence or carelessness. But if the defendant's actions
fail to meet the standard, then there has been negligence.

In addition, negligence occurs if the nurse fails to follow established procedures and
standards of care in the same manner that another reasonable nurse would do in the
same situation. (Berman and Synder, 2012).
Because Nurse X makes a “mistake” in treating a patient and that mistake results in
harm to the patient then she is liable for negligence.

The plaintiff must prove the elements of Negligence in giving a lawsuits to the
defendant and these are the following:

1. Duty - The defendant owed a legal duty to the plaintiff under the
circumstances;
- When assessing a negligence claim, the first step is to look to see whether
or not the defendant owed the plaintiff a legal duty of care. In some
circumstances, the relationship between the plaintiff and defendant might
create a legal duty -- for instance, a nurse owes a patient a legal duty to
provide him or her with competent medical care. Which in the scenario the
nurse fails to provide competent medical care to the patient.

2. Breach  - The defendant breached that legal duty by acting or failing to act in
a certain way;
 -There must be a standard of care that is expected in the specific situation
but the nurse did not observe.
3. Causation  - It was the defendant's actions (or inaction) that actually caused
the plaintiff's injury; and
- The third element requires that the plaintiff show that the defendant's
negligence actually caused his or her injury. Which in the scenario the nurse
is found liable because the patient was dead after the procedure.
4. Damages - The plaintiff was harmed or injured as a result of the defendant's
actions.

NURSES RESPONSIBILITY AND ACCOUNTABLITY FOR THE ACTIONS RENDERED.

Nurse X is liable for negligence because of the following:

 Failing to avoid injury to the sciatic nerve

 Failing to identify the proper injection site
 Failing to use acceptable injection practices
 Failing to consider proper landmarks prior to injection

In this case, Nurse X is liable for medical malpractice, the patient can receive
compensation for the damage including the medical bills and damages such as pain
and suffering. In worst cases, the court, can further punish the responsible party by
giving them punitive damages such as revocation of license or depending on the
severity of the malpractice and injuries resulted.

 C. ALTERNATE COURSES OF ACTION

The nurse alternate course of action should be following the 10 rights of medication
administration right patient, right medication, right time, right dose, right route,
right education/advice, right to refuse, right assessment, right evaluation/response
and documentation. Specifically, the right route because the scenario states that the
sciatic nerve was injured and in doing intramuscular injection in the buttocks is very
critical. First, start by dividing the buttock into 4 quarters. Then divide the buttock in
half from top to bottom and then in half from side to side. The injection will be given
in the upper outer quarter. You should be able to feel a curved bone in this quarter.
The injection will go in this quarter below the curved bone. Lastly, Stretch the skin
tight and hold the syringe like a dart. Insert the needle at a right (90°) angle to your
skin.(Staywell 2019).
Case 2. 

Nurse P injected Penstrep to a boy who had a swollen foot. The nurse informed the
parents that she was not a doctor. Upon insistence of the parents to have their child
treated, she informed them that the doctor usually gave penstrep injections in such
cases. She injected the medicine with a doctor ‘s prescription. The boy died of
cardiorespiratory failure secondary to anaphylactic shock due to the injection of the
drug.

A. What is the criminal act is applicable to the case? And discuss.

The criminal act applicable to the case of Nurse P is Negligence Homicide. According
to Royle (2020) negligent homicide, sometimes referred to as criminally negligent
homicide or involuntary manslaughter, is a form of murder under Arizona law.
Negligent homicide is the lowest level of all murder charges. The concept of
negligence homicide states that you had no intention to kill when you commit the
crime. Acting with criminal negligence means that you failed to recognize a
substantial and unjustifiable risk of causing the death of another person. The type of
risk the law is talking about is one that a reasonable person would not have taken.

B. NURSES RESPONSIBILITY AND ACCOUNTABLITY FOR THE ACTIONS RENDERED.

The nurse should document the action rendered in the nurse’s notes fully,
accurately, legibly, and promptly their observations from admission to the time of
the event. The nurse should also report the event to the nurse supervisor to aware
the hospital personnel that there an investigation will happened. Medical records
are usually used to give importance evidence in legal proceedings. In addition, the
court will order subpoena duces tecum that requires a witness to bring documents
and testifies that the patient's records are kept and protected from unauthorized
handling and change.
When an incident with patient care occurs, the first step in the criminal process is an
investigation. So in this case if investigation takes place the nurse has the right to
remain silent when being questioned by a police.

C.  ALTERNATE COURSES OF ACTION

Given the scenario that the patient is suffering from a swollen foot the nurse should
choose other alternatives like increasing the circulation of the patient’s body through
frequently raising the affected area of the body so that it is above the level of your
heart. Furthermore, it to massage the area or use compression socks to keep
pressure on the edema. Prior to giving medication, the nurse should first ask the
parents if the patient have any allergies and the nurse should do skin test first before
administering any medication. Lastly, the nurse should get a consent form since the
doctor has given him a permission to do the procedure and the parent’s of the
patient also agree to do the procedure.
Case 3.

Nurse Eden is on 3-11 shift duty on medical ward. The medical ward is located on the
second floor building. Nurse Eden has 40 patients to attend to. At 11pm while all the
patient are sleeping an earthquake happened with a magnitude of 7. The ceiling fan
fell upon a patient causing severe injury.

A. What is the doctrine of law is applicable to the case? And discuss.

The doctrine of law in Force majeure is applicable to this case. This states that events
are usually defined as certain acts, events or circumstances beyond the control of
the parties, which is unforeseen or unavoidable. Unexpected or unanticipated
conditions might be triggered by natural disasters such as fire, flood or earthquake
or by certain situations specified and included in this doctrine. Under the Civil Code
of the Philippines stated that, “no person shall be responsible for those events which
could not be foreseen, or which, though foreseen, were inevitable, except in cases
expressly specified by law.”

In that case, Nurse Eden is not held liable or accountable in the scenario because
disasters in hospital like a magnitude 7 earthquake are unavoidable events.

B. NURSES RESPONSIBILITY AND ACCOUNTABLITY FOR THE SITUATION.

As I have discuss earlier, Nurse Eden is not liable or does not have any accountability
because it is not her fault that the patient got injured due to the unfortunate falling
of the ceiling fan since an earthquake happened during her duty and she cannot
avoid the unexpected event. Nonetheless, it is still her duty to take care of all the
patients in the medical ward, especially the injured patient after the earthquake.

C. ALTERNATE COURSES OF ACTION

The alternate courses of action in the case scenario are that the management of the
hospital should not put the ceiling fan near the patient’s bed. Since the scenario
states that the patient was injured because of the falling ceiling fan. During
earthquake drill or inspection in an institution, it is relevant that ceiling should not
place in near the patient and the ceiling fan should have a brace so that it will not fall
easily.
References
Legal rights and responsibilities: NCLEX-RN. (2016).RN Programs - Registered Nurse
|| RegisteredNursing.org. https://www.registerednursing.org/nclex/legal-rights-
responsibilities/

Royle, F. (2020). Negligent homicide. Feldman Royle.

https://www.feldmanroyle.com/homicide/negligent-homicide/
Proving fault: What is negligence? - FindLaw. (2019. Findlaw.
https://www.findlaw.com/injury/accident-injury-law/proving-fault-what-is-
negligence.html