Some implications for nurses and managers of recent changes to the processing and hearing of medical negligence claims

Aim This paper considers some possible implications for individual nurses and their managers of moves to delegate tasks formerly undertaken by medical practitioners to nurses, in the light of recent changes in the legal process, relating to the funding and the hearing of cases of medical negligence.
Background It is suggested that the introduction of a system of conditional fees, under which lawyers will only recover their costs if they win cases, may lead to a more specialist approach to negligence claims and to greater scrutiny of medical evidence. The implications of the recent 'Bolitho' judgement, when judges for the first time subjected expert medical testimony to their own independent analysis, are also explored.
Findings It is suggested that in the light of the disparities in the training of medical and nursing personnel and in their disciplinary processes, and in view of the lack of consensus about what training is necessary for those who will substitute for junior doctors, or represent themselves as 'practitioners', 'specialists', or 'consultants', that nurses may in the future find themselves more directly involved in civil proceedings.     

Some remarks on the mentally disabled patients right to receive and to refuse treatment

I wish to offer several comments on the paper presented by Elsie Band-man. She argues that the nurse's commitment to advocating the interests of mentally disabled patients can promote nurses’ rights.¹ Dr. Band-man cites the Darling case [an 18-year-old boy who suffered a leg fracture and had to have his leg amputated as a result of physician and nurse negligence] to support her contention that nurses require rights in order to carry out their responsibilities. According to Elsie Band-man's account, “nurses were found negligent in their failure to use channels of authority to report negligence of the physician and to remedy the condition.” “Nursing negligence in the Darling case,” Elsie Bandman contends, “clearly places responsibility on the shoulders of nurses for supporting the right to treatment.“     

Thinking about certification.

Earning certification in your area of expertise is a logical step in professional growth. Certification implies excellence, which is something that all critical care nurses strive for in their daily care of patients and families. This brief article will discuss why certification is important and how to prepare for a certification examination and will provide steps to make recertification easier.     

护理缺陷产生的相关因素及对策

目的调查和分析护理缺陷产生的相关因素，探讨有效控制和降低护理缺陷发生率的措施。方法对2002年9月至2004年9月期间40起护理缺陷进行回顾性调查和分析。结果40起护理缺陷普遍存在年资较低的护士不规范操作、高危时段、涉及高龄患者等，与护理管理机制、人员结构层次、法律意识等因素有关。结论加强降低护理缺陷的有效措施：(1)完善有效的管理机制；(2)增强护理人员的风险意识；(3)规范护理操作和行为；(4)加强护理人员的岗位培训；(5)注重环节及即时质量。     

Saying sorry: the legal implications

Anecdotal evidence suggests that nurses believe they should not say sorry when an adverse event or act of negligence has occurred in case they are sued or reported to the Nursing and Midwifery Council. However, this article argues that saying sorry in such circumstances is not an admission of liability but rather a standard to which all nurses should aspire.     

Defamation actions.

Registered nurses working in today's fast paced, high-tech health care environments are aware of their professional accountability and that, at some point, they may be involved in legal proceedings related to their practice. A civil lawsuit alleging negligence is the predominant concern nurses have when they turn their minds to this issue.     

The neuroscience nurse as an expert witness.

Serving as an expert witness in cases alleging nursing negligence is an interesting, rewarding and stressful role. Having knowledge about qualifications of an expert, what is expected of the expert, how to assess adequacy of nursing care, and how to bill for services may lower the stress. If after careful consideration you choose to serve as an expert witness, you should experience satisfaction knowing you are fulfilling a professional responsibility to maintain standards of care and to protect nurses accused unjustly of negligence.     

Compensation for psychiatric injury: evolution of a law of nervous shock

District nurses will be well aware that if a person receives an injury because of someone else's negligence they are entitled to compensation for the harm that has been caused. However, where the injury is in the form of psychiatric harm the law has traditionally imposed rules that set out the conditions to be met before a successful claim for damages can be made. Even in today's enlightened society the law still does not always treat a psychiatric injury in the same way as a physical injury. In this article Richard Griffith outlines the development of the law in relation to psychiatric injury--historically called "nervous shock"--and considers the current approach to claims for damages where a person suffers psychiatric harm because of another's negligent act.     

Documentation, part 1: Principles for self-protection. Preserve the medical record--and defend yourself

This article discusses principles that inform all good methods of charting and examines an actual court case to illustrate how adequate documentation can protect nurses against allegations of negligence and malpractice. Also discussed are the importance of preserving the medical record and mistakes commonly made in charting that leave nurses vulnerable to lawsuits.     

Changing liability of the nurse over the past decade

Many changes have occurred over the past decade in legal responsibilities of nurses. These reforms have led to attitude changes toward nurses by the legal, medical, and public realms. To avoid legal charges of negligence, nurses must keep abreast of the rapidly changing areas of instrumentation, documentation, and patient care.     

Veterinary nursing: from practice to teaching

Abstract

Considering a move into teaching is something that many veterinary nurses contemplate. However, a lack of understanding regarding what exactly the role entails may prevent them from taking it any further. This article will detail the journey of an RVN from practice to teaching and a subsequent managerial role within a large veterinary nursing teaching institution.     

新的《医疗事故处理条例》对护士心理行为影响的调查

目的 :为了解《医疗事故处理条例》实施后护士认知、心理、行为的变化情况。方法 :采用随机抽样的方法对 93名护士进行问卷调查。结果 :不同学历、工龄、职称的护士对《医疗事故处理条例》掌握情况具有统计学意义(P <0 .0 5 )。护士心理压力主要是担心发生医疗事故、护理记录不完善造成纠纷等。行为表现 :主动学习法律及业务知识的积极性增高 ,工作中更加注重病人的各项权利。结论 :护士学法、懂法有利于维护病人及自身的合法权益 ,有利于提高护理质量 ,保证护理安全     

From Mendel to the Human Genome Project: the implications for nurse education

The Human Genome Project has heralded a whole new era in our understanding of the molecular basis of disease. New opportunities now arise to predict disease by genetic testing, and in some cases to prevent disease through surveillance or other specific interventions. Increasingly it will be possible to test for predisposition to disease, to develop new treatments or to tailor available treatments more specifically to an individual's genetic make-up. Midwives and paediatric nurses are at the forefront of these developments with new national antenatal and neonatal genetic screening programmes due to be implemented by 2004. However, in the near future it is likely that nurses in most clinical areas will encounter genetic aspects of their practice. If they are to capitalise on opportunities offered by the new genetics, health professionals will need to become knowledgeable and skilled in genetics. They will need to understand something of the basic science and also develop an awareness of many ethical, legal and social aspects. In the light of a recent review of education in genetics for health professionals, the Department of Health and The Wellcome Trust have commissioned a process to develop a programme of education for the United Kingdom.     

Introduction to the law

OBJECTIVES: To provide an introduction to the legal concepts that are involved in negligence suits involving oncology nurses. DATA SOURCES: Medline, Lexis, Westlaw, legal literature and texts. CONCLUSIONS: To avoid liability and guard against negligence or malpractice suits, the oncology nurse must be aware of the legal responsibilities of each aspect of the nursing role. IMPLICATIONS FOR NURSING PRACTICE: Protecting yourself against medical malpractice begins by understanding terms and concepts that are essential in instituting legal action against the nurse and incorporating the appropriate risk reduction practices into daily practice.     

Death education in baccalaureate nursing programs

These findings reveal that an emphasis on death and dying in baccalaureate nursing schools has definitely increased over the past 20 years. Ninety-five percent of the schools reported here have some emphasis on death and dying. The majority of nursing students take the death and dying offerings. Overwhelmingly, the professional background of the instructor is nursing. While only 5 percent of the schools do not offer anything in death and dying, nearly half of these plan to offer something "within the next five years." If death and dying offerings influence students' attitudes, as is suggested in research cited above, baccalaureate nursing programs in the United States apparently have taken positive steps toward helping nurses cope with dying over the past 20 years. If nurses themselves cannot deal with death, caring for a dying patient may be difficult. With continued increased emphasis on death and dying in nursing curricula, both nurses, patients, and patients' families will hopefully benefit.     

Caring and competency

The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals. The author defines caring and competency by providing examples of what they are not in examining 200 actual cases of hospital nursing acts of incompetence by nursing discipline. None of these examples of imputed negligence was reported to the National Practitioner Data Bank because the "corporate shield" protected the nurses by not being named in the complaint nor named as part of the settlement against the hospital.A new model of the hospitalist, the nurse hospitalist, is presented to act as a daily teacher and facilitator for hospital nurses based on a curriculum of day-to-day examples of substandard patient care. This nurse specialist is an inpatient generalist advanced practice nurse who is employed by the hospital and reports to the chief nurse executive. The author proposes that this new model of the nurse hospitalist be devoted entirely to collaborating with nurse leaders, educators, charge nurses, and floor nurses throughout disciplines in advancing the competency of nursing. This daily proactive and prospective model of improving nursing performance in a facultative manner offers strategies to mitigate the limitations of the retrospective model of quality control. Total quality improvement practiced retroactively is ineffective. The author recommends no structural change in the institution but an educational agenda by the nurse hospitalist, with hospital administration to assist nurses in a new learning environment.     

Patient dignity in psychiatric nursing practice

Professional nurses have an ethical responsibility to protect and preserve the patients' dignity. The aim of this study was to describe how nurses experienced incidents relating to patients' dignity in a psychiatric nursing practice. A hermeneutic approach was used and data were collected using the critical incident technique. Data included 77 written critical incidents, which were interpreted by using a hermeneutic text interpretation. The findings show preserved dignity--caregivers have the courage to be present, and offended dignity - caregivers create powerlessness taken away by the patient. These findings show that patients' dignity in a psychiatric nursing practice can be preserved when caregivers act on their ethical responsibility. When patients' dignity is offended, the caregiver has become an inner value conflict, something they have been a part of against their own will.     

Creating trust in an acute psychiatric ward

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as ;fragile' phenomena that can easily ;tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.     

手术室护士的心理压力源分析与对策

目的了解手术室护士心理压力源，采取针对性的心理护理．预防及减轻各种压力，增强手术室护士的心理防护能力和应急能力，不断提高手术室护理质量。方法采用问卷调查法了解29名手术室护士的工作压力源。结果手术室护士心理压力源依次为：处理危急情况时、针刺伤等职业危害、面对患者突然死亡、急救技能与急救知识的缺乏、害怕发生差错和事故等。心理压力与年龄、护龄成正相关，年龄越大、护龄越长所承受的压力越大。结论手术室护士的心理压力源与手术室护理工作的环境和性质有关。