Analyzing a Nursing Negligence Case: Practice Standards, Preventive Measures, and Disciplinary Action

QUESTION

The discussion board assignment requires the exploration and analysis of a case study adapted from the CNO disciplinary hearing. According to the student‘s last name, you will be assigned a case study to review and post your answer to the pertaining questions (Case study A or B). Students will respond to the alternate case studies in response to their peer’s original post. Therefore, you are required to read both case studies—the case study you were assigned to analyze and the 2^nd case study in response to one of your peer’s postings.

Discussion board post (x2) must follow the criteria below:

1. ● Minimum of 300 to a maximum of 500 words per post
2. ● One original post
3. ● One response to a peer’s post
4. Posted within the time limits provided
5. ● Review the Rubric
6. Include two scholarly references from the Lewis (2019) med-surg textbook or PND course textbooks
7. Follow APA Guidelines
8. Show evidence of knowledge and application of evidence-based/informed practice and course content.
9. It is important to include CNO Practice Standards and Guidelines to support your analysis and demonstrate your understanding.

At the time of the incident, the Nurse K. charge nurse was working a night shift in a geriatric psychiatry unit (the “Unit”). It was a busy night and they had 2 sick calls that were not covered. Patient M. was 83 years old with moderate to advanced dementia. Occasionally at night she could be challenging, call out for her husband and getting out of bed wandering the unit upsetting other patients, and often challenging and aggressive during the evening and night.

Nurse K. and three nursing colleagues transferred Patient M. who appeared calm, from a wheelchair to a Broda chair in the Unit’s dining room. Nurse K. and her colleagues applied a pelvic restraint to the patient without a physician’s order. Neither the nurse nor her colleagues documented the application of the restraint or the rationale for applying the restraint. The patient was left restrained in the Unit’s dining room for approximately 5.5 hours. During this time, the Nurse K. and her colleagues failed to appropriately observe and monitor the patient, or continually assess the ongoing need for restraints.

Between approximately 12:30 am and 5:30 am, Patient M. was sitting in a Broda chair in the Unit’s dining room. Despite expressing distress, including removing her gown and exposing herself, the nurses did not observe or provide care to the patient. Nurse K. falsely documented that the patient had fallen sleep and was transferred to her bedroom despite remaining in the Broda chair in various states of distress in the dining room.

Upon observing the patient in the early morning, Nurse K. believed that Patient. M. was deceased. The nurses did not call a Code Blue, take the patient’s vital signs, or ensure that her colleagues follow the organization’s policy. Instead, the nurse delegated a colleague to wheel the patient to her room. They placed the patient in her bed with the collective intention to make it appear as though the patient had died in bed or more recently than suspected. They falsely documented that the patient was in bed during the time that she remained restrained in the Broda chair. They later provided inaccurate information during the facility’s investigation into the patient’s death.

Adapted from the College of Nurses of Ontario. (2022). CNO Disciplinary Hearing. https://www.cno.org/en/protect-public/hearing-schedule/

1. List and describe practice standards that were not followed. What are the examples of negligence in the case study?
2. Describe the correct and professional course action and care that should be provided.
3. What can nurses do to prevent negligence in nursing practice?
4. What disciplinary action should be implemented for the nurses involved?

ANSWER

Analyzing a Nursing Negligence Case: Practice Standards, Preventive Measures, and Disciplinary Action

Introduction

The case study presented involves a disturbing incident of nursing negligence that took place in a geriatric psychiatry unit. Nurse K. and her colleagues failed to adhere to practice standards, leading to dire consequences for the patient, Patient M. In this essay, we will explore the practice standards that were not followed, examples of negligence, discuss the correct course of action, preventive measures to avoid negligence, and suggest appropriate disciplinary action for the nurses involved.

Practice Standards Not Followed

Several practice standards were not followed in this case:

1. Restraint Use: The nurses applied a pelvic restraint to Patient M. without a physician’s order, which violates the practice standard for the use of restraints. Restraints should only be used as a last resort, with a physician’s order, and should be monitored closely.

2. Documentation: The failure to document the application of the restraint and the rationale for it is a violation of documentation standards. Proper documentation is essential to ensure the continuity of care and legal protection.

3. Patient Assessment: Neglecting to observe, monitor, and assess the patient while she was restrained demonstrates a clear breach of patient assessment standards. Continuous assessment is necessary to ensure patient safety and well-being.

Examples of Negligence

The examples of negligence in this case are:

1. Inappropriate Restraint Use: Applying a restraint without a physician’s order is a grave violation of patient rights and safety.

2. Failure to Monitor: The nurses neglected to monitor the patient’s distress and needs for over 5.5 hours, even when the patient expressed distress by removing her gown. This is a critical failure in patient care.

3. Falsifying Records: Falsifying documentation and providing inaccurate information during the facility’s investigation further compounds the negligence.

Correct Course of Action and Care

In this case, the correct and professional course of action would have been:

1. Physician’s Order: Obtain a physician’s order before applying any restraints, ensuring it is the last resort after alternative interventions have been explored.

2. Proper Monitoring: Continuously observe and monitor the restrained patient, addressing any distress or needs promptly. Follow organizational policies and procedures for restraint use and monitoring.

3. Accurate Documentation: Document the application of restraints, the rationale, and the ongoing assessment of the patient accurately. Ensure that records reflect the patient’s actual condition and care provided.

Preventive Measures to Avoid Negligence

To prevent negligence in nursing practice, nurses can:

1. Education and Training: Stay updated on practice standards, guidelines, and regulations. Regular training on restraint use, documentation, and patient assessment is crucial.

2. Effective Communication: Promote open communication within the healthcare team. If concerns arise, discuss them with colleagues and superiors to ensure patient safety.

3. Ethical Decision-Making: Uphold ethical principles and patient rights. Always prioritize the well-being and dignity of the patient.

Disciplinary Action

Appropriate disciplinary action should be taken for the nurses involved. This may include:

1. Suspension: Temporary suspension from clinical duties pending an investigation.

2. Reeducation: Mandatory training and education on practice standards, patient safety, and ethics.

3. Probation: A probationary period with close supervision to ensure adherence to standards.

4. Termination: In cases of extreme negligence or repeated violations, termination may be necessary to protect patient safety.

Conclusion

The case study illustrates a disturbing example of nursing negligence, highlighting the importance of adhering to practice standards, continuous patient monitoring, accurate documentation, and ethical care. Preventing negligence requires ongoing education, effective communication, and a commitment to patient safety. Disciplinary action should be implemented to ensure accountability and to maintain the integrity of the nursing profession and patient care.