Page 39 - Essentials of Nursing Leadership and Management, 5th Edition

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26 unit 1 | Professional Considerations CikguOnline
client and possibly a lawsuit for the staff. Consider institutions are also protected against false imprison-
the following: ment. Nurses need to find out the policies of their
state and employing institution.
Mr. Harrison, who is 87 years old, was admitted
through the emergency department with severe Assault and Battery
lower abdominal pain of 3 days’ duration. Physical
Assault is threatening to do harm. Battery is touch-
assessment revealed severe dehydration and acute
ing another person without his or her consent.The
distress. A surgeon was called, and an abdominal
significance of an assault is in the threat: “If you
laparotomy was performed, revealing a ruptured
don’t stop pushing that call bell, I’ll give you this
appendix. Surgery was successful, and the client was
injection with the biggest needle I can find”is con-
sent to the intensive care unit for 24 hours. On
sidered an assaultive statement. Battery would
transfer to the surgical floor the next day,
occur if the injection were given when it was
Mr. Harrison was in stable condition. Later that
refused, even if medical personnel deemed it was
night, he became confused, irritable, and anxious.
for the “client’s good.”With few exceptions, clients
He attempted to climb out of bed and pulled out his
have a right to refuse treatment. Holding down a
indwelling urinary catheter. The nurse restrained
violent client against his or her will and injecting a
him. The next day, his irritability and confusion
sedative is battery. Most medical treatments, par-
continued. Mr. Harrison’s nurse placed him in a
ticularly surgery, would be battery if it were not for
chair, tying him in and restraining his hands.Three
informed consent from the client.
hours later he was found in cardiopulmonary arrest.
A lawsuit of wrongful death and false imprison-
ment was brought against the nurse manager, the Standards of Practice
nurses caring for Mr. Harrison, and the institution.
Concern for the quality of care is a major part of
During discovery, it was determined that the
nursing’s responsibility to the public. Therefore,
primary cause of Mr. Harrison’s behavior was
the nursing profession is accountable to the con-
hypoxemia. A violation of law occurred with the
sumer for the quality of its services. One of the
failure of the nursing staff to notify the physician of
defining characteristics of a profession is the abil-
the client’s condition and to follow the institution’s
ity to set its own standards. Nursing standards
standard of practice on the use of restraints.
were established as guidelines for the profession
To protect themselves against charges of negli- to ensure acceptable quality of care (Beckman,
gence or false imprisonment in such cases, nurses 1995). Standards of practice are also used as crite-
should discuss safety needs with clients, their fam- ria to determine whether appropriate care has been
ilies, or other members of the health-care team. delivered. In practice, they represent the minimum
Careful assessment and documentation of client acceptable level of care. Nurses are judged on gen-
status are also imperative; confusion, irritability, erally accepted standards of practice for their level
and anxiety often have metabolic causes that need of education, experience, position, and specialty
correction, not restraint. area. Standards take many forms. Some are
There are statutes and case laws specific to the written and appear as criteria of professional
admission of clients to psychiatric institutions. Most organizations, job descriptions, agency policies
states have guidelines for emergency involuntary and procedures, and textbooks. Others, which may
hospitalization for a specific period. Involuntary be intrinsic to the custom of practice, are not
admission is considered necessary when clients are a found in writing (Beckman, 1995).
danger to themselves or others. Specific procedures State boards of nursing and professional orga-
must be followed. A determination by a judge or nizations vary by role and responsibility in relation
administrative agency or certification by a specified to standards of development and implementation
number of physicians that a person’s mental health (ANA, 1998; 2004). Statutes, professional organi-
justifies the person’s detention and treatment may be zations, and health-care institutions establish stan-
required. Once admitted, these clients may not be dards of practice. The nurse practice acts of indi-
restrained unless the guidelines established by state vidual states define the boundaries of nursing prac-
law and the institution’s policies provide. Clients tice within the state. In Canada, the provincial and
who voluntarily admit themselves to psychiatric territorial associations define practice.