Nurses and Legal Difficulties
Nurses and other health professionals confront a range of legal difficulties, particularly as a result of medical misconduct. Medical malpractice, according to Abbott and Cohen (2013), is defined as a caregiver's failure to act or omit some significant medical practices that violate established standards of practice. The actions of the healthcare professional may cause injury to the patient, either directly or indirectly. Failure by a medical practitioner to diagnose is listed as a significant medical misconduct by Fisher and Schneider (2014). Medical practitioners may fail to identify and, in rare cases, misdiagnose a medical sickness, condition, or injury, resulting in a patient's condition worsening. One such condition is stroke which when given the correct treatment and diagnosis on time can be reversed. A high number of stroke cases are caused by blockage of an artery to the brain which when not properly treated in time can have debilitating side effects. Over the decade, medical professional have administered tissue plasminogen activator (tPA) as a brain-saving treatment to avoid life-long complications for stroke patients. However, only a small number of patients with stroke receive this treatment as a result of the high number of risks that are associated with this medication (Fisher & Schneider, 2014). Medical practitioners fear legal outcomes that are linked to tPA. This paper focuses on a case involving a plaintiff with stroke and reviews the legal issues that are present in the case.
The Legal Issues Present in the Case
Abbott and Cohen (2013) state that there exist medico-legal concerns that have hindered treatment of stroke patients with tPA. The case study presented involves failure of the medical practitioners to correctly diagnose the patient and their failure to treat the patient's condition with tPA. The legal issues that are present in a case involving medical negligence are a duty of the medical practitioners to treat the patient, a breach of that duty, injury caused by the breach, and damages correlative to the injury (Abbott & Cohen, 2013). In the case presented there was owing of a duty by the doctor and the nurses, the medical practitioners breached their duty as they failed to conform to their standard of care, the failure of the medical professionals to follow their standard of care caused an injury to the plaintiff, and finally there are legal issues since the injury caused by the malpractice led to damages on the patient.
Specialist Consultation and Documentation
In the case study, a specialist was consulted but there was no tPA that was administered to the patient. Therefore, the roles and responsibilities in the medical scenario of the plaintiff can be regarded as one of the legal issues that can be contested in the medico-legal case presented. There was also no evidence of any documentation referring to the medical decision making that was undertaken in the case study. Another legal issue is causation and breach of duty. The physician in the emergency medical stroke management case presented failed to treat the patient with tPA. In the presentation of the case, the first legal issue to be examined is whether the patient was a legible candidate for a tPA therapy. The patient must be undertaken through a series of inclusion and exclusion criteria to determine if he/she qualifies. In cases involving a stroke patient, the patient’s actual eligibility is judged based on the retrospective review of the record, deposition testimony, and the opinions of experts. The patient can easily allege that he/she was a good candidate of tPA since there is no documentation to refute the claim. Causation is another legal issue which surrounds the concept that the patient would have received a benefit if treated with tPA and therefore would have the same results that they suffered from the stroke. According to Hickey (2014), expert opinions and testimony are important in regard to this issue. The expert opinions are used as the primary basis for defense and prosecution in a case involving a stroke patient.
Risk-mitigation Techniques
The hospital presented as the defendant in the medico-legal case could have employed a number of techniques such as having a proper documentation strategy of discussion with the family of the patient in place. The hospital should also encourage its staff to ensure there is a timely transfer of patients to other facilities in the case where they do not have a tPA protocol in place. The hospital can also set a tPA protocol in place to ensure patients who qualify for this procedure are undertaken through it successfully before the symptoms advance. Other risk mitigations that would help favor the hospital are informed consent and documentation of onset of symptoms in the patient. According to Hickey (2014), the patient should be taken through the benefits and the risks that are associated with the treatment of stroke through tPA. The decision that the patient makes after being informed of the use of tPA should be properly documented. The hospital should also ensure they have enough personnel to facilitate thrombolytic therapy by investing in human resource and facilities and if they lack the manpower and facilities then they could have ensured they transfer the patient on time for treatment in another hospital.
Improving Stroke Knowledge
Fisher and Schneider (2014) argue that the available medical services have revealed that stroke-specific knowledge has been deficient. Therefore, the hospital could help improve the overall knowledge and identification of stroke symptoms by its medical professionals through additional stroke-specific education programs. The hospital could have involved its care providers in a course curriculum that includes more information on stroke management and diagnosis. Hickey (2014) states that care providers in a medical facility need to ensure they remain current on stroke cases and the warning signs. Therefore, the hospital could have ensured that the physician and the nursing staff that take part in the care of stroke patients in the hospital and the emergency department participate in scheduled stroke education programs. These programs are important as they help them to acquire and maintain skills important for treatment and management of all stroke types.
Actions of the Nurse To Improve the Outcome
Nurses hold a critical role in ensuring patient safety and quality care is provided. The nurse could have ensured frequent monitoring of the patient's vital signs. According to Hickey (2014), health care providers including nurses need to ensure control of the vital signs and prevent medical complications. The nurse could have performed all important diagnostic and evaluation tests once the patient had arrived at the hospital. The nurses should also strictly follow the set hospital and health protocols in regard to the detection, treatment, and handling of stroke patients. There are higher chances of mortality and morbidity in cases where the nurse deviates from the hospital and national treatment guidelines for tPA. The nurse should not be persuaded by either the patient or the patient's family to offer treatment that violates the protocols that have been established. The nurse could also ensure documentation of all treatment decisions as this is important to avoid such legal liability. The documentation could also have focused on why tPA was not offered to the patient even after the doctor had diagnosed the patient with transient ischemic attack.
References
Abbott, R., & Cohen, M. (January 01, 2013). Medico-legal issues in cardiology. Cardiology in Review, 21, 5, 222-8.
Fisher, M., & Schneider, P. (January 01, 2014). Stroke and the law: principles and practice. Stroke, 45, 10, 3141 -6.
Hickey, J. V. (2014). The clinical practice of neurological and neurosurgical nursing. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
