Contemporary Nursing Essay Discussing Legal Issues & Laws Involved In The Case

Question

Task:
Mr. Colin Lapse is a 54-year-oldmale admitted to ICU after surgery following a workplace accident on a construction site where he was a labourer. He was struck by in the abdomen by a spike from loaded wire that was being maneuvered by a crane. The wire broke off, knocked him off balance and perforated his abdomen. The site foreman, Ms. Joanne Charge ordered the crane to lift the load out of the way and as the worksite qualified first aider, she applied pressure to Mr Lapse’s abdomen and called an ambulance. Due to the injuries sustained Mr. Lapse became hypovolaemic and went into cardiac arrest. Ms Charge directed his co-workersto support delivery of CPR. With the arrival of the paramedics, ROSC was achieved, he was stabilised and transferred to the emergency department (ED).

On arrival, Mr. Lapse’s vital signs were documented as: respiratory rate – 25/ min, use of accessory muscles noted, ECG heart rate was 120/min (sinus tachycardia), Temperature 36.5 degrees Celsius, blood glucose level was 7.5mmol/L, his GCS (Glascow coma scale) was 12/15 (Eyes 3 / Verbal 4 / Movement 5). Pupils were equal and reactive (size 2). His blood pressure was 105/80 mmHg. The triage doctor (Dr. Goode) ordered an urgent head, spine and abdominal CT. And a “full workup of blood tests”. He tried to discuss the situation with Mr. Lapse, however, the paramedics had given Mr. Lapse methoxyfluraneand a total of 15mg IV morphine. He was very drowsy and seemed confused. Dr. Goode asked the patient “Who is your next of kin?” Mr. Lapse stated it was “Queen Ree”. Without further information Dr. Goode decided to proceed with the medical management plan and Mr. Lapse underwent the diagnostic tests and was returned to the resus bay in ED while waiting for the results of the scan.

A short time later, while Dr Goode was reviewing the scan report which showed a small bleed in the liver, he heard shouting in the emergency waiting room and in the company of security, went to investigate. He saw a middle aged woman and an olderman in a verbal altercation and asked what the problem was. The lady stated, “I am Ree Lapse, Col’s wife” she was quickly interrupted by the elderly man who stated, “She means ex-wife, I am Mr. Tymme Lapse, Col’s father and his medical treatment decision maker”. Mrs. Ree Lapse interjected and said, “I am still married to him” and Mr. Tymme Lapse stated, “not for long”. Dr. Goode asked both to respect the hospital environment and be mindful of other unwell patients. On turning to Charge Nurse Indira, Dr. Goode said, “Be sure to make a referral to social work, these people are crazy”. Charge Nurse Indira laughed and agreed. Both Ree and Tymme yelled at the Charge Nurse Indira, who told the security guard to “watch them” and walked off.

As Dr Goode walked back to the resus bay, the nurse allocated to look after Mr. Lapse, Nurse Helmut, approached him and told him that the patient was becoming tachycardic and his blood pressure was dropping. Fearing the worst, Dr. Goode contacted the general surgeon and his best friend, Dr. Bill Duct for a surgical consult. Dr. Duct told Dr. Goode he was just coming back from lunch at the pub and would be a couple of minutes. On assessing Mr. Lapse, Dr Duct stated that if the patient was not operated on in the next 60 minutes, then he would die. Dr. Duct approached both Ree and Tymme for consent for surgery. Ree did not want the surgery but Tymme did. Reminded by Tymme that he was the medical treatment decision maker and given the patient’s situation, Dr. Duct proceeded with the operation. Ree screamed at him that she would “Get the lawyers to prevent him” and threatened Dr Duct. She was escorted from the hospital premises by security.

Dr Duct took the patient to the theatre for surgery. Mr. Lapse was anaesthetised, and an endotracheal tube inserted, an IV canula was inserted by the surgeon and Nurse Maisy inserted an indwelling catheter. The insertion of the urinary catheter caused some bleeding and this was noted in the patient file. Nurse Maisy also told the scrub nurse, Abioye. During the surgery,the patient’s blood pressure kept dropping and the anaesthetist had difficulty maintaining a good output. Dr. Duct noted more extensive bleeding from Mr. Lapse’s liver than thought but could not explain why as there did not appear to be any bleeding from the liver post-surgical repair. The patient’s abdomen was closed with minimal bleeding was noted on the abdominal dressing. The patient was stable but in critical condition and transferred to the ICU to Nurse Chan. On ICU arrival, Mr. Lapse’s vital signs were documented as: respiratory rate – 18/ min, no use of accessory muscles noted, ECG heart rate was 100/min (sinus), Temperature 36.7 degrees Celsius, blood glucose level was 5.5mmol/L, his GCS was not recorded, pupils were sluggish equal and reactive (size 4). His blood pressure was 100/80 mmHg. Nurse Chan noticed the urine colour from the catheter bag to be claret in colour and 500 ml in the bag. There had been no mention of this from the ISBAR handover from theatre staff. Approximately 30 minutes after arrival into ICU, Mr. Lapse went into cardiac arrest and could not be resuscitated.

The ICU registrar advised the coroner’s office of the death and arrangements were made to have police attend as is required. By this time, Ree had returned to the hospital with her solicitor and found out that Mr. Lapse was deceased. She declared that she was suing the hospital and Dr Duct for negligence and stated that all of the staff involved in the surgery assaulted her husband and demanded that the police arrest everyone for assault and battery and that they all are guilty of murder. That evening Nurse Chan sent an update on their Instagram page with a photo image of the catheter bag and a caption that said “Inserted by incompetent nurses in theatre and not handedover. How dumb can you be?” Nurse Indira, a friend of Nurse Chan replied comment with “Is that the patient with the crazy wife?”.

The purpose of the contemporary nursing essay is to present a coherent argument for the legal considerations that are relevant to the case study. This essay provides an opportunity for you to demonstrate in-depth understanding and sound, logical and academic argument to support your thoughtful position on the legal considerations present in the scenario.

Answer

Introduction
According to the research on contemporary nursing essay, it is stated that in Australia, nurses and midwives are subject to two kinds of regulatory oversight: legislative oversight and self-regulation. In Australia, the Nursing and Midwifery Board of Australia (NMBA) is required by law to oversee the practice of nurses and midwives on the country's islands (Thornton, 2015). All professional practice components, including title protection, registration criteria (such as the required degree of education and competence for admission to practise) and ongoing fitness to practise requirements are subject to legislative oversight. According to the National Law of 2009, all registered nurses, enlisted nurses, registered midwives, and nurse practitioners must fulfil national minimum competency standards (Australian Nursing & Midwifery Federation, 2013). The National Nursing and Midwifery Board of Australia (NMBA) use these criteria to determine who is eligible to practise as an Australian nurse or midwife. On the other hand, self-regulation is a defining characteristic of a professional organisation since the profession itself establishes the standards for conduct. Nurses and midwives in Australia have achieved the professional standing that they have now due to years of dedication on the part of many people. This means that after one has completed the first training in our respective areas of nursing and midwifery, one will be able to choose the criteria for our professional practice and practise them. Nursing Due to the absence of legislation creating self-regulatory norms, these standards are not legally binding (Australian Nursing & Midwifery Federation, 2013). When used in conjunction with statutory regulatory requirements, they may be utilised in legal settings to assess the behaviour of nurses and midwives in particular circumstances, which is referred to as soft law in this context.

Mr Colin Lapse's case, in which he was wounded and subsequently died as a consequence of his negligence, lack of authorisation, and violation of social media regulations, serves as an example of a wide range of legal issues and concerns. The main aim of this investigation is to get a better knowledge of these legal issues and the laws that regulate them in this particular case study.

Legal issue 1: Giving anesthetic (methoxyflurane) to the patient before discussing the treatment and taking consent
Understanding the consent related to anesthetic drugs to patients
It is only with the patient's permission that anaesthesia may be given. There have been discussions regarding various anaesthetic organisations releasing guidelines for use by practitioners for quite some time now, and these have taken place all around the world. Specifically, the study examines some of the most recent advances in this area, including research and discussions, and determines if any legal standards have been established. Anesthesiologists have an ethical and legal obligation to get the consent of patients before conducting any anaesthetic treatments on such patients. Following legal guidelines, informed consent must be obtained, which means that the proposed procedure, as well as any alternatives, must be thoroughly explained, along with the potential benefits and risks of each option, and all questions must be answered in plain language to assist patients in determining whether or not to accept or reject the proposed plan. The Australian Nursing and Midwifery Federation published a report in 2013 stating that Comprehension of the patient's condition and understanding of the treatment plan are required for voluntary acceptance of the treatment plan. The Joint Commission on Accreditation for Healthcare Organizations says that information should be recorded in a form, progress notes, or elsewhere in the record.

Because the patient agrees to surgery, they implicitly consent to anaesthesia, with the surgical agreement specifically stating that anaesthesia is needed and that there are dangers associated with it (Martinez-Pujalte, 2019). The signature of an anesthesiologist will be required on this document since it was signed in a surgical office without the presence of the patient. A surgeon is not competent to develop an anaesthetic care plan or to discuss the benefits, drawbacks, and treatment choices connected with it. He is also not trained to offer anaesthesia services in any capacity (Kim et al., 2013). It is also inappropriate to get surgical permission in situations when individuals need anaesthetics for nonsurgical treatments due to young age, claustrophobia or developmental delays. And on top of all of that, some surgeons are hesitant to include anaesthesia or its risks in their consent form for fear of exposing themselves to legal liability.

It has taken a long time for anesthesiologists to be recognised as highly trained experts with a separate practise area from surgeons, and the battle continues today (Broaddus & Chandrasekhar, 2012). When it comes to providing safe anaesthetic care, it is essential that nurses include the patients as active partners in their own care. The informed consent of a patient provides them more influence over medical decisions, and as a consequence, the patient or family member is happier. A member of the surgical team will not be able to acquire consent for anaesthesia on their own. These steps must be taken by anesthesiologists in order to ensure that the patient is fully educated about the procedure, including risks, advantages, and alternatives, and that they are well informed about the process.

Another challenge is obtaining informed permission documentation since there are three options: a customised handwritten letter, a separate anaesthesia consent paperwork, or documentation in the patient's medical file (Broaddus & Chandrasekhar, 2012). The ability of patients to comprehend the nature and purpose of the planned anaesthetic treatments increased as a result of receiving a separate authorisation for anaesthesia from their physicians. As a consequence, more individuals expressed satisfaction with the level of information they received regarding common side effects and issues.

Although having a signed document seems to be beneficial in a lawsuit, this is not always the case. Patients may express dissatisfaction with their ability to understand all that was stated, and there may be disputes about whether or not they were able to comprehend everything that was said. Patients may need a higher capacity to understand abstract concepts and risks associated with anaesthesia than they will require appreciating the options and risks associated with surgery (Martinez-Pujalte, 2019). The signing of a document may provide jurors with evidence that the patient was informed and that they agreed to the plan once that information was made available to them. This information assists jurors in concentrating on assessing the overall quality of treatment provided. In contrast, issues of informed consent have not played a significant part in the majority of cases. The consent process must be followed in spirit, not just on paper, in order to be valid.

Relation of the case study with the law of consent
To relieve the pain and additional suffering that Mr Colin Lapse was experiencing as a result of the accident, an anaesthetic (methoxyflurane) was given. Important to mention in this respect is that the patient was already in cardiac arrest and his state was not in good shape at the time of his admission because of negligence where the Duty of care was breached, and the casual attitude was marked as the hospital administration was not prepared to get the permission of the patient's family members or the patient himself before to giving such medicines in this situation (Kim et al., 2013). Because of this, the patient's condition worsened. In this case, the patient's health and severity were not adequately taken into account, and the act of consent was given much less significance than it should have been. As a result, this is the most severe legal problem that has arisen in connection with the case study.

Wrongs Act 1958
Under the Wrongs Act, anyone who suffers physical harm or death as a result of someone else's carelessness or fault in Victoria may file a claim for economic and non-economic damages. If one has been hurt as a result of a slip-and-fall accident or medical negligence, one may be entitled to compensation under the Wrongs Act of Australia. As long as the victim can demonstrate that they were negligent, they may be awarded monetary damages to compensate them for their losses (Singh, 2017). The fact that Mr Colins' injury resulted in his death means that there is no such thing as a permanent handicap in his case. The required threshold values are 10 percent or more (for mental harm) and 5 percent or more (for spinal damage) in order to be taken into account, respectively (injuries other than psychiatric or spinal injuries). In this particular case, the stakes are very high, and a special bench is required to investigate the situation fully. Hence a hefty amount of compensation may be charged from the hospital authority to the family members for injecting such medicines without the prior consent of the patient party.

Legal issue 2: Inserted an indwelling catheter by the nurse, which caused bleeding and is not mentioned in ISBAR handover
Understanding ISBAR handover
Patients may suffer as a consequence of poor communication, or the situation may make work more challenging. Poor communication has been identified as a significant cause of unfavourable events and consumer complaints, according to data gathered from various sources. Organisations in Australia and across the globe recognise the need of taking action to improve the quality of healthcare communication. Adopting a consistent structure is advantageous for transmitting information under time constraints, according to the findings of the study. ISBAR (Introduction, Situation, Background Assessment, and Recommendation) is an example of this kind of procedure. A debate on the essential elements of information transmission is being organised by the Isba (Slater and Gordon, 2019). Several studies have shown that it is helpful in both clinical and non-clinical communication transfer situations.

The Importance of ISBAR
Clear and efficient communication is essential for providing safe patient care. The failure of individuals to communicate clearly and effectively may have serious consequences. A framework makes it difficult to lose sight of important clinical facts. The ISBAR technique (Identify – Situation – Background – Assessment – Recommendation) may be used to organise and arrange communication in a variety of situations. In addition, it offers workers a straightforward and focused way of establishing expectations for what will be conveyed and ensuring that they get a prompt and appropriate response to their questions (Slater and Gordon, 2019). The fact that it provides a framework within which to arrange one's ideas and articulate their intended outcome helps to ensure that crucial elements are not overlooked or overlooked entirely.

Violation of ISBAR
However, there was no mention of the patient's urine colour or the numerous devices that were implanted in his body. Both the existence of a catheter and the colour of the urine were two of the most important variables in identifying the kind of internal damage that had occurred in the patient's body. This is an example of extreme negligence on the part of the nurses and others who were caring for the patient, who completely overlooked the fact that it should have been added to the ISBAR list. So when they were moved, and the doctors came, they were completely ignorant of the issue and incident that had occurred earlier. Because of the poor communication, the hospital administration was completely negligent in keeping acceptable standards data records and patient information on the patient's condition (Martinez-Pujalte, 2019). This is one of the most important elements that contribute to the patient's death, and it must be addressed immediately. Because of a lack of efficient communication between the patient-nurse and the hospital administration, much of what was going on was not known to the doctors. The nurses were reluctant to complete the ISBAR record sheet with all of the necessary information because they were worried about being sued (White & Willmott, 2019). This is one of the most significant legal issues that must be addressed, and the hospital authorities may be charged with some serious crimes as well as a lack of proper management and power in the facility.

Duty of care and a case of complete and utter neglect
Whenever someone is harmed because of another person's conduct (or, in some cases, inaction), it is a violation of a duty of care. This is true even if the action was reasonably foreseeable that it would cause damage, and a reasonable person in the same situation would not have reacted in the same manner as the injured party. It is possible that breaching a duty of care promise may have severe financial and reputational repercussions for a business or an individual (Educare, 2018). Personal agreements may be used to settle financial issues, but legal procedures are more often employed to resolve these conflicts. Whenever an expert offers services to a customer, such as when a doctor treats a patient, the criteria listed above must be followed. When confronted with circumstances that are similar to these, other competent professionals will exercise the same degree of caution that one would be obliged to use (Fehring et al., 2019).

The case study involves a lack of Duty of care and negligence as Colins is admitted to the hospital for accident and treatment of the wound. The nurse inserted an indwelling catheter by the nurse who caused bleeding; hence the nurses were inexperienced. The nurse who took care of him is not the same as the one who first diagnosed the patient's condition, and the communication between them was not strong as the ISBAR had no updates on the catheter (EFFECTIVE CLINICAL COMMUNICATION ISBAR, 2021). The practitioner makes the mistake of not examining the catheter, urine colour and other details. Because other surgeons in a comparable circumstance would have interpreted the patient record correctly, there was very definitely a breach of Duty on the part of the orthopaedist. Hence hefty fines, compensation can be claimed.

Legal issue 3: Posting patient’s information and pictures on social media without consent
The Privacy Act of 1988
According to the Australian Medical Association, a proactive privacy compliance strategy is now needed in every medical practice (AMA). According to the Australian Medical Association, health care has registered the highest number of privacy breaches since new privacy laws went into effect in 2018, with penalties of up to $2.1 million possible (Ernst & Maschi, 2018). The Australian Medical Association (AMA) requires a comprehensive privacy compliance policy in order to guarantee compliance with privacy laws. The legal duties include the need to disclose data breaches, the implementation of laws governing data processing throughout its life cycle, and the protection of patient confidentiality (Berman et al., 2018). The Privacy Act of 1988 in Australia is essentially the same as THE PRIVACY ACT OF 1988 in terms of content. Additionally, as a healthcare practitioner, one is obligated by the standards and norms of conduct established by the Australian Health Practitioner Regulation Agency (AHPRA).

Professionals in the healthcare field should never post personal information about their patients on social media. It is possible to publish some information in limited circumstances as long as the appropriate patient consent has been obtained beforehand, but this is not always the case (Ireland et al., 2017). The patient must be fully informed about how their data is released, despite the fact that this consent must explain how the Australian Medical Association's recommendations will be utilised and disseminated. If an AMA is posted on social media without the permission of the patient, the PRIVACY ACT 1988 may be breached. This includes any text, image, video, or other material that identifies the individual as a patient of the practice, as well as any medium in which patients of a practice or the Australian Medical Association are identifiable.

Patient identification does not need the use of a specific name in order to identify a patient. Even if a posting does not directly identify a patient, it may include enough information to allow the patient to be identified as a result of the posting (Cheng et al., 2020). Additionally, they should refrain from acknowledging a patient's use of social media to convey health information to other patients. Whenever a patient posts a bad review of the clinic or discusses a disagreement with the practice on social media, the clinic and its employees should refrain from contacting that individual. Considering that discussions about a patient's treatment often result in more details about the patient's care being revealed and subsequently improper disclosures of AMA, receiving the patient's health information may result in a violation of THE PRIVACY ACT 1988. This assertion is supported by a substantial amount of evidence.

Violating the law and failing to safeguard patients' personal information
One should notify the Australian Medical Association if one sees someone misusing social media or other electronic media platforms (AMA). Each country has its own set of rules that define the reasons on which the (board of nursing) BON may initiate disciplinary action against a BON. Unprofessional conduct, unethical conduct, moral turpitude (defined as conduct that is considered contrary to community standards of justice, honesty, or good morals), mismanagement of patient records, the revelation of privileged communication, and breach of confidentiality are all grounds for an investigation by the Australian Medical Association (AMA) into inappropriate social media disclosures by a nurse (Chew et al., 2016). Depending on the circumstances, the AMA may decide to take disciplinary action against the nurse, which may include a reprimand or punishment, the imposition of a monetary fine, or the revocation of the nurse's licence.

Inappropriate use of social media by nurses may constitute a breach of patient privacy and confidentiality laws at the state and federal levels, according to certain authorities. If one commits one of these kinds of offences, one may face civil and criminal penalties, including fines and jail time. It is possible for a nurse to be held personally liable for defamation, invasion of privacy, and harassment in the workplace. When it comes to patient abuse and exploitation, particularly severe misbehaviour on social networking sites may have legal consequences under federal and state laws designed to prevent such abuse and exploitation (Buchan & Andersson Burnett, 2019). If the nurse's conduct violates the company's policies, she may be subjected to disciplinary action, which may include termination. The behaviour of a nurse may also damage the reputation of a healthcare organisation, putting the organisation at risk of a lawsuit or regulatory consequences.

Relating the case to the case study
Following the death of Mr Collins, the nurses were preoccupied with making fun of his wife and family, rather than recognising that something had gone wrong with the patient's care. This kind of scenario is characterised by a lack of communication and appropriate treatment, as well as carelessness, and the patient finally died as a result (Epstein & Quinn, 2020). In this specific case study, not only was there a violation of the Duty of good faith and fair dealing but there were also numerous acts of carelessness that were totally ignored. Because of a lack of communication and a failure to maintain appropriate documentation, the nurses and physicians were not fully aware of the situation. However, after the patient's death, one of the nurses took to social media to demonstrate the level of negligence shown by a specific nurse who had improperly inserted an indwelling catheter, which resulted in bleeding (Trepte, 2020). There were a number of other remarks, some of which were linked to the mental condition of the patient family.

Throughout the case, the nurses found themselves in a position of ridiculing and amusing themselves. In this particular instance, it is essential to highlight that the nurse has broken the patient's privacy rules by publishing a picture of the patient on Instagram. According to the Australian Privacy Legislation of 1988, this is a violation of the act that protects patient information and data privacy policies. It is essential to highlight that the hospital authorities will be subjected to a significant financial penalty, and the nurses may be permanently dismissed from their employment at that specific hospital in this situation. Nurses were not only prohibited from publishing any information on the patient but they were also prohibited from taking photographs of the patient (NCSBN, 2018). In this particular instance, the nurses were not properly educated, and as a result, they committed this kind of violation and failed to protect the patient's personal information, which may be regarded to be one of the most significant legal concerns that this case study raises.

Conclusion
When it comes to health practitioners, NMBA is responsible for enforcing the requirements of each state and territory's Health Practitioner Regulation National Law (the National Law). In Australia, the NMBA regulates the nursing and midwifery profession, with one of its main duties being to protect the public. The NMBA is responsible for developing national registration standards, rules of professional conduct, practise guidelines, and standards of care for nurses and midwives across Australia. As a conclusion, it should be noted that this specific case study raises a number of significant legal problems, which are discussed further below. Negligence, a failure to fulfil a duty of care, and the employment of inefficient caregivers are only a few of the severe reasons that violate the Privacy Act of 2020, the Wrong Act, the Misuse of ISBAR guidelines, and other applicable laws. In addition to substantial penalties and restitution, the legislation and authorities may consider additional severe punishments, such as the revocation of the hospital's operating licence. The hospital administration may thus be sued in order to get harsher penalties from the court system.

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