Case Study

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Identify the errors in nursing judgment and systems problems, which contributed to the error(s) made.

            One of the errors in nursing judgment and system problems that contributed to the errors made was the failure of the bedside nurse to take advantage of the system to detect the puncture at Holston's heart caused by the central venous pressure (CVP) catheter. The puncturing of Holston’s heart was the major problem as it caused the nine-inch long catheter to get embedded in a section of Holston's heart muscle. Besides, it ran down her internal jugular vein into her heart, and through the wall of the heart with its tip just beyond the wall of the heart into the pericardial sac. Such an error made the fluid from the IV to pass through the pericardial sac as opposed to the intended blood vessel, a situation which caused continuous accumulation of fluid in the pericardial sac (cardiac tamponade), thereby creating high pressure on Holston’s heart, and eventually causing her to suffer cardiac arrest.

            Another error in nursing judgment and system problems that contributed to the errors made was the failure of St. Anthony, through its nursing staff, to detect Holston's deteriorating condition. If the nursing staff had detected the patient's worsening condition, they would have notified the relevant doctors of Holston's condition at an earlier stage, and they would have saved her life since cardiac tamponade, if detected and corrected early enough, is a reversible condition.

Describe in detail the appropriate action(s) the staff nurse should have taken.

            One of the actions Christine Carlson, the staff nurse, should have taken was to examine the patient herself after observing a rise in Holston’s pulse to 120 beats per minute. Besides, Carlson appeared not to be satisfied with the response from the nurse who had been attending to the patient before 4 p.m. that the rise in pulse rate was as a result of the patient’s agitation. Therefore, instead of asking her supervisor to examine the patient, she would have examined Holston herself, and she would have detected the problem in time. By asking Pam Markin, the charge nurse, to examine Holston without immediate response, Carlson would have examined Holston herself or sought the assistance of a different nurse instead of waiting for 20 minutes for the charge nurse to respond to her request.

            Since Carson believed that Holston’s cardiac tamponade condition might have been in the early stages, based on her testified observations of various indicators such as the increased pulse, CVP reading, and the patient’s marginal urinary output, Carlson would have contacted the treating physician, Dr. Sharp. Besides, Markin was reluctant to examine the patient, and it would have been wise if the staff nurse notified the treating nurse about the patient’s worsening condition.

            After seeking Markin’s attention several times to examine the nurse, Carlson must have realized Markin’s reluctance to examine the patient appropriately. Additionally, despite the worsening condition of the patient, Markin was so reluctant to contact the treating physician. Therefore, having been convinced that Holston was tamponading, Carlson ought to have contacted the Dr. Sharp immediately instead of bothering Markin who, through her reactions, expressed a lack of dedication and unwillingness to attend to the patient. After observing the patient's low urinary output, her climbing pulse rate, as well as significantly high CVP, Carlson was convinced that Holston's condition was deteriorating. Therefore, she would have insisted on contacting the Dr. Sharp despite the resistance from Markin.



How do you feel about nurses being charged with negligent homicide?

            Negligent homicide is more than ordinary carelessness, and it has a direct impact on the patient's life. Nurses charged with negligent homicide are accused of criminal neglect, an omission or course of conduct that their failure to provide adequate medical care results in the loss of patient's life. By being charged with negligent homicide, the nurses must have knowingly, purposely, negligently, or recklessly caused the death of a patient. Such nurses, therefore, should have their licenses revoked by the relevant nursing board. Additionally, if convicted of negligent homicide, such nurses should face penalties of life imprisonment for deliberately causing the death of a patient.

Does the nurse have a “duty” to the victim?  If so, please explain.

            The nurse has a duty to the victim. That is because it is the role of the nurse to monitor the condition of the victim (patient) and report the changes in the patient's condition to the treating physician. The health of the patient therefore significantly relies on the actions of the nurse since it is the nurse that plays the patient's monitoring role. Additionally, it is the role of the nurse to decide when to contact the treating physician for further examination of the patient’s condition, failure to which the condition of the patient may get complicated.

Explain the legal protections provided to nurses?

            The legal protection for nurses is provided by the statutes in every state. In the United States, for example, individual states take part in determining and interpreting the laws (Bennett, 2008). Besides, the state courts assist in interpreting statutes and producing written opinions that explain the interpretation of the law (Bennett, 2008). In the United States, nurses have protection under the laws that govern the "statute of limitation. The statute of limitation defines the period following a purported injury during which a plaintiff may present his or her claim (Rosenbaum, 2003). In cases where a nurse is only subject to ordinary negligence, there may be a significant lengthening of the statute of limitation. In overall, the statute of limitation for various medical actions by nurses is two years from the time of the act alleged to have caused an injury to the patient. However, the statute of limitation may vary in cases of pediatric or wrongful deaths (Rosenbaum, 2003). Additionally, nurses have protection under the laws that only allow them to testify concerning what a nurse would do in the same situation with the same patient.

Does the law provide exceptions to these protections?

            The law provides exceptions to the legal protections given to nurses. One of the exceptions to the nurses' legal protection is in the case where the health professional councils are required by the law provide the complainant with a written copy of the reasons for the nurse's decision (Bennett, 2008). Additionally, the law limits the protection given to the nurses when there is a clear evidence of the omission or negligence by the nurse that led to the patient's injury or loss of life (Rosenbaum, 2003).

Clarify the negligent acts of the nurse?

             One of the negligent acts of the nurse was the failure to take concerns raised by the staff nurse seriously. Shortly after reporting on duty, Carlson observed the patient's risen pulse rate to 120 beats per minute and asked the patient who had been attending to the patient about the pulse rise. Without a proper examination, the nurse claimed the pulse rise was due to the patient's agitation, which was contrary to the real cause of the increase in the patient's pulse rate. Another act of negligent act of the nurse was the action by Markin to ignore Carlson’s first request to examine the patient after Carlson had observed the worsening of the patient’s condition.

            Markin also displayed an act of negligence when she refused to contact Dr. Sharp when requested to do so by Carlson, who had observed the patient’s pulse rate rising to 140. Even after Carlson was convinced that the patient was tamponading, Markin still did not find it necessary to contact the treating doctor. Instead, she instructed Carlson to continue monitoring the patient for signs of a dropping blood pressure. That was an evident act of negligence by the charge nurse, Pam Markin. Additionally, when Carlson attempted to call Dr. Sharp herself after realizing that Holston’s CVP was significantly high and her pulse rate was continuing to rise, Markin stopped her from calling Dr. Sharp and, instead, instructed her to return to her station. That was another clear act of negligence committed by the charge nurse.

Drs. Sharp and Maxwell were not charged. Do you agree or disagree with these findings?

             I do agree with the findings that Drs. Sharp and Maxwell were not charged. That is because they did not, in any way, neglect their responsibilities. Both Dr. Sharp and Dr. Maxwell responded immediately when contacted to attend to the patient. However, by the time they got called, it was already late since the patient's pulse rate, and CVP readings were at dangerously high levels. Both Drs. Sharp and Maxwell should have been informed of Holston's condition earlier than 5 p.m. since that would have given them enough time diagnose the patient correctly and offer appropriate treatment for tamponade before the patient's condition became irreversible.

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