Introduction
Nurses are guided by a code of ethics, which requires them to ensure that they offer quality care to their patients by adhering to a given standard of care. In case of failure to adhere to the standard of care, nurses and health institutions face the risk of being legally liable for any harm that patients may suffer due to caregivers’ negligence. Of particular interest is providing quality care to high-risk patients. Nurses have to ensure that such patients do not incur any injuries that may arise due to falls. Nurses often face a dilemma when dealing with cases where high-risk patients need ambulation, especially when the chances of any movement resulting in the fall of the patient are high. Where such conflicts arise, nurses are advised to opt for the decision that will best benefit the patient’s wellbeing. The following is a judgment of a case study where a patient sues the nurse for negligence after he (the nurse) allows him (the patient) to go to the restroom such that the subsequent events lead him to experience a fracture in his ankle.
High-Risk Patients
High-risk patients refer to individuals whose health status is prone to other serious happenings, irrespective of the standard of care that they get from health practitioners. Such individuals may demonstrate comorbidities that relate to their respective livers, hearts, or even kidney issues (Guido, 2010). Some of the influencing factors include old age due to the loss of muscle power, susceptibility to ailments and medication, and neuropathy among other medical conditions. In the current case study, the patient can be considered high-risk based on his old age of close to 80 years. He has been taking a variety of medications while at the same time demonstrating atrial fibrillation and renal problems. Atrial fibrillation has been recorded as an autonomous risk factor for deliberate falls in aged patients. Furthermore, according to the physician, the patient understudy has a moderate to high fall risk. Considering the health condition and age of the ailing individual who has been getting medication for a renal breakdown, it suffices to declare him a high-risk patient.
The Patient’s Environment
Tofthagen, Visovsky, and Berry (2010) reveal how environmental factors have a huge impact on the occurrence or prevention of falls. Predisposing environmental factors include perils such as rutted or creepy floors and inappropriate placing of materials that are often used by the patients, for instance, positioning them too high or too low, such that one has to apply some extra force to access them. Poor lighting is also an extrinsic factor that exposes the patient to falls. Conversely, other factors include the presence of surveillance options, chair, and bed alarms, and the availability of sitters and flagging for high-risk patients. Thus, the environment design can prevent or increase the patient’s risk of falling. The fact from the current case reveals that the restroom is fixed with safety rails and alarms. The patient is also informed on how to alert the nurse in case of any issue. Before going to the restroom, the facts indicate that a bedpan has been availed to the patient for use instead of going to the restroom. Going by these facts, extrinsic factors help in the prevention of falls. Fall risk assessment is of great importance when it comes to determining whether the hospital takes every step that is necessary for ensuring that falls do not occur. Nurses should inform the patients not only about their medical condition but also how it exposes them to falls. According to Sole, Klein, and Moseley (2012), nurses should also demonstrate how to use the available prevention mechanisms so that patients can stand a chance of reducing the risks that can worsen their health status.
What I can do differently
As a nurse, I can choose to adhere to the code of ethics that guides the nursing profession. Patients have a right to receive quality care. Nurses have to adhere to a standard of care that is set by health institutions and organizations such as the American Nursing Association (ANA). The ANA code of ethics requires nurses to respect patients’ right to self-determination since they (patients) have the privilege to decide what should be done to them. Furthermore, in case of a conflict of interest, for instance, a dispute concerning what the patient wants and what the health practitioner wants, nurses should opt for the decision that safeguards the patient’s safety. In this case, if the patient insists on using the restroom, instead of the bedpan, I would consent to his request by offering him the proper device for ambulation purposes whenever any movement is required (Sole et al., 2012).
Moreover, I would inform him about the available measures that he should take to escape any fall risks. Where a sign or record is available to show that the patient might trigger personal injury or interfere with other patients’ peace, I may decide to apply restraint. However, through empirical evidence, medical experts have encouraged mobility and immobility of patients as restraints that prevent other medical problems. In the current case, physicians have indicated that the patient has a moderate-to-high risk. As a nurse, the implication is that I should offer the needed assistance in case of ambulation (Tofthagen et al., 2010).
Negligence on the Part of the Nurse
As indicated earlier, nurses must offer quality care to their patients, contrary to which they breach the standards of care. The legal standard of care requires patients who have a moderate-to-high fall risk to have more than one nurse to avail the needed assistance. From the case study, when the patient insists on going to the lavatory, the nurse has the option of applying restraint or allowing the patient to go to the washroom under adequate care. In this case, the nurse opts for the latter strategy. Thus, the caregiver has to provide safe and high-standard attention. Furthermore, the nurse needs to know the potential perils and execute the relevant measures to evade the risks. In this case, the nurse should have conducted a risk assessment to determine the patient’s level of alertness (Guido, 2010).
From the facts, one might quickly infer that the nurse did not conduct a post-risk assessment to determine whether the patient can sustain the given assistance. Despite handling the patient gently, he seems too heavy for the nurse to handle. This situation causes the patient to fall. Eventually, he experiences a fracture in his ankle. Nursing negligence involves failing to adhere to the proper standard of care. The slackness exposes the patients to more tribulations. In this case, the caregiver has failed to adhere to the necessary obligations. Thus, he is liable for negligence.
Conclusion
The above case shows the sensitivity of handling high-risk patients. This category of patients requires extra attention because any slight ignorance by the nurses may bring huge damage to the patients’ already ailing bodies. Hence, nurses must be extra careful when making decisions that touch on high-risk patients to ensure that they do not deny such patients their right to self-determination. The patient-nurse interaction should be characterized by cooperation such that the stipulated decisions are in line with the patient’s health requirements. Hospitals should be designed in a way that limits cases of falls by promoting easy ambulation. Moreover, nurses should be adequately trained on how to offer the needed assistance. Patients should also be informed of their condition concerning their risk of falls. Indeed, having adequate information from both parties will enhance cooperation between caregivers and patients. This strategy eventually reduces any instances of the patient falling. Any falling case might worsen the patient’s health. In other cases, a fall usually results in the death of the patient.
Reference List
Guido, G. (2010). Legal and Ethical Issues in Nursing. New York, NY: Pearson.
Sole, M., Klein, D., & Moseley, M. (2012). Introduction to Critical Care Nursing. Missouri: Elsevier Health Sciences.
Tofthagen, C., Visovsky, C., & Berry, D. (2010). Strength and Balance Training for Adults with Peripheral Neuropathy and High Risk of fall: Current Evidence and Implications for Future Research. Oncology Nursing Forum, 39(5), 416-424.