Mr George is a 65‐year‐old widowed father of Giovanni and Maria. He was admitted to your ward for elective lumbar surgery after several years of back pain resulting from a workplace injury. His ability to mobilise has been significantly reduced and he uses a walking aid. Mr George does not speak English and relies on his son to translate for him. Mr George’s admission paperwork was completed with Giovanni’s assistance. Mr George is allergic to morphine. Giovanni thinks it caused an itchy rash, but Mr George cannot recall. RN Sriya has written this in the paperwork but forgot to put on a red allergy wrist band. His neurological limb assessment shows a left foot drop with full feet numbness and his vital signs are unremarkable. Mr George has a past history of atrial fibrillation. He is on digoxin (0.25 mg/day) and aspirin (100 mg/day). He is noted to be on the organ donor register and Giovanni is the documented medical treatment decision maker. Giovanni has advised that his father does not wish to be resuscitated in an emergency, but Giovanni is not supportive of this and would like all measures taken. Giovanni has also advised that Mr George is quite anxious about his brother, Steven who is also in the hospital, having been admitted for surgery after falling in the garden. Professor Charcot, the surgeon, visited Mr George and Giovanni on the ward to see that Mr George is settling in well and reminded Mr George and Giovanni that he would perform an L2/3 laminectomy the following morning. RN Kate looked after Mr George on night shift but had difficulty communicating with him. As she thought he might have had a stroke, she placed an electronic order for an emergency CT Brain. In her hand over to the AM nurse (RN Chan), she advised that the CT results were not back but did not documented this. When RN Chan took Mr George to theatre, they noted that a consent form signed by the patient and the surgeon was not in the file and inserted a blank form into the file for completion. RN Chan alerted Professor Charcot to this. Professor Charcot responded by yelling at RN Chan in front of other nurses and surgeons “You’re so incompetent. Who do you think you are? If you dare speak to me like that again I will have you fired! Of course, I have already consented the patient! He wouldn’t be here if he didn’t know what was happening. Are you the idiot who ordered a CT Brain on my patient?”. RN Chan returned to the ward, upset. They told their manager what had occurred and that they felt bullied and harassed by Professor Charcot. After surgery when Mr George returned to the ward, RN Chan noticed that the hospital consent form had still not been signed and when listening to the Registrars talking to each other about the case, overheard one say, “Prof didn’t use x‐ray and did the L4/5 by mistake”. RN Chan did not say anything to their manager as they thought that the doctors would advise the patient and his son. They were also too scared to say anything because they didn’t want to be yelled at further and lose their job. RN Chan went home very upset at the day’s events and wrote on their Facebook status update that “some surgeons are so arrogant! At least I am not the incompetent surgeon who operated on the wrong spinal level!” During the next shift and about 8 hours after surgery, it was noted by the PM nurse, RN Sriya, that Mr George had not passed urine. The protocol of the hospital requires a urinary catheter be inserted if the patient has not passed urine 8 hours after spinal surgery. RN Sriya contacted the Registrar who advised she could not arrive to insert the catheter for 2 hours as she was in surgery with another surgeon and that RN Sriya would have to do it herself. RN Sriya had not inserted a catheter into a male patient before and, assuming it couldn’t be much different to inserting female catheters, undertook the procedure. As a result, frank haematuria occurred with a large amount of blood loss. A MET (Medical Emergency Team) was called, and the patient assessed. Mr George was in a lot of pain and the attending MET doctor, Dr. Pratt orders 5mg of morphine intravenously stat. Mr George was rushed to emergency theatre and a Urologist, Miss O’Donnell, called to surgically repair the damaged urethra. During the operation Mr George went into cardiac arrest and died. When Giovanni and Maria arrived at the hospital to see their father, RN Sriya asked “Didn’t they call you? He died in the operation”. Maria was understandably angry and upset and stated “No one called me! I am going to sue the hospital and Professor Charcot for negligence, and I am going to the coroner, media, and escalating this as far as I can take it!”.
Assessment title: Legal Case Analysis
Alignment with unit learning outcome(s):
| 2 | Describe the Australian healthcare system and how nurses practice in these settings |
| 3 | Discuss common and statute laws relevant to professional practice |
| 4 | Evaluate the legal concepts and mechanisms that underpin the practice of nursing |
| 5 | Utilise legal and professional standards in the various practice related scenarios |
| 6 | Analyse the legal implications of actions taken in nursing practice |
| 9 | Explore ethical and legal aspects of end of life decision making |
Preamble: As citizens, we are obligated to uphold the law. As nurses, we are also obligated to follow and adhere to the Nursing Standards of Practice. This assessment will allow you to understand Standard 1: Thinks critically and analyses nursing practice; Standard 2: Engages in therapeutic and professional relationships and Standard 6: Provides safe, appropriate and responsive quality nursing practice
SOLUTION – Mr George 65‐year‐old widowed father of Giovanni and Maria
Based on the scenario provided, let’s analyze the legal and professional implications of the actions taken by the healthcare team:
- Informed Consent: It’s concerning that the consent form for Mr. George’s surgery was not signed by him or the surgeon. Informed consent is a fundamental ethical and legal principle, and procedures should not proceed without it. Professor Charcot’s reaction to RN Chan’s concern was inappropriate and unprofessional.
- Patient Advocacy: Nurses have a duty to advocate for their patients’ rights and preferences. RN Chan should have escalated concerns about the incomplete consent form and the overheard conversation regarding the wrong spinal level to appropriate authorities, regardless of fear of retribution.
- Medical Errors: Operating on the wrong spinal level is a serious medical error that can have significant consequences for the patient. This should be disclosed to the patient and their family promptly and transparently, and appropriate actions should be taken to address the error and prevent recurrence.
- Bullying and Harassment: Professor Charcot’s behavior towards RN Chan constitutes workplace bullying and harassment, which is unacceptable and unlawful. RN Chan should report this behavior to their manager or HR department for investigation and intervention.
- Urethral Catheterization: RN Sriya’s decision to proceed with urethral catheterization without proper training and experience led to a serious adverse event for the patient. Nurses must only perform procedures within their scope of practice and competence to ensure patient safety.
- Communication and Notification: Failure to communicate effectively with the patient’s family about his deteriorating condition and eventual death is a breach of professional and ethical standards. Open and honest communication is essential in healthcare, especially during difficult situations like end-of-life care.
- Documentation: Proper documentation of patient care, including assessments, interventions, and communication with other healthcare providers, is essential for continuity of care, legal accountability, and quality improvement.
In summary, the healthcare team in this scenario failed to uphold ethical and legal standards in various aspects of patient care, including informed consent, patient advocacy, medical error management, workplace behavior, procedural competence, communication, and documentation. These failures led to adverse outcomes for the patient and his family and could result in legal and professional consequences for the individuals involved and the healthcare institution.
