Part 1: You are a surgical nurse at Memorial Hospital

At 4:00 PM, you receive a patient from the recovery room who has had a total hip replacement. You note that the hip dressings are saturated with blood but are aware that total hip replacements frequently have some postoperative oozing from the wound. There is an order on the chart to reinforce the dressing as needed, and you do so. When you next check the dressing at 6:00 PM, you find the reinforcements saturated and drainage on the bed linen. You call the physician and tell her that you believe the patient is bleeding too heavily. The physician reassures you that the amount of bleeding you have described is not excessive but encourages you to continue to monitor the patient closely. You recheck the patient's dressings at 7:00 and 8:00 PM. You again call the physician and tell her that the bleeding still looks too heavy. She again reassures you and tells you to continue to watch the patient closely. At 10:00 PM, the patient's blood pressure becomes non-palpable, and she goes into shock. You summon the doctor, and she comes immediately.

Question  1:

 What are the legal ramifications of this case?

Question  2:

Using the components of professional negligence outlined in Table 5.3 of your book, determine who in this case is guilty of malpractice. Justify your answer.

Question  3:

At what point in the scenario should each character have altered his or her actions to reduce the probability of a negative outcome?"

1. Legal Ramifications

 Legal Ramifications:

 Potential for Malpractice Claim: In view of this development, the defendant and other concerned practitioners might have committed malpractice by failing to adequately treat the patient’s condition, leading to the manifestation of shock and subsequently, fear owing to excessive bleeding. The claim could be made on what may have been done to stop the bleeding that was uncontrollable in a timely manner.

 Duty of Care: Since the surgical nurse and the physician are jointly responsible for the client, they have the client’s best interest at heart with regards to the postoperative complications. Any failure or delay in relation to such matters as excessive bleeding is likely to be deemed a breach of this duty.

 Documentation and Communication: The specific documentation of the observations made by the nurse and the communication with the physician shall be very vital in legal cases. Documentation is vital since it shows if there was an assessment failure or if the patient’s state was not effectively managed.

 Informed Consent: If the surgery was associated with the high risk of heavy blood loss then it is supposed to be stated in the consent form together with measures that can be taken in order to minimize this risk and manage it.

 2. Professional Negligence and Malpractice

 Components of Professional Negligence:

 Duty of Care: Both the nurse and the physician had a responsibility of performing their duties with professionalism when handling the patient.

 Breach of Duty:

 Nurse: The nurse could have been in violations of the duty of care if one failed to report or go further to ensure that bleeding was well controlled once he or she observed that the patient was bleeding profusely or after the dressings were just re-emphasized.

 Physician: The physician may have been negligent if the nurse’s complaints of heavy bleeding were not believed or if the nurse was not offered or given other options to have heavy bleeding looked at despite reporting it severally.

 Causation: The hemorrhage which occurred fascinated the patient to shock, thereby strongly suggesting that had there been no inadequate intervention, then definitely the poor outcome would not have prevailed.

 Damages: Patients lost a lot of blood and shocked hence being consider and treated as a harm patient.

 Guilty of Malpractice:

 Physician: Probably even more to blame in this case, as the physician was in a position of being able to and of responsibility to manage the bleeding. Even though, the nurse conveyed her concerns on several occasions, the physician did not implement additional actions or conduct systematic review of the patient’s status comprehensively.

 Nurse: Perhaps less legally responsible if they performed their jobs as instructed and auditory and otherwise properly reported violations to the extent feasible. Nonetheless, the failure to go further up the ladder or to take other steps might well be a breach of duty.

 3. Suggestions for the Change of Behaviors

 Nurse's Actions:

 4:00 PM: I recalled that the dressings were soaked, then obeyed the order to restock. This was appropriate initially.

 6:00 PM & 7:00 PM: The nurse should have recorded the level of bleeding more accurately and perhaps, the nurse could have sought a more aggressive action/ or another assessment instead of re–emphasizing the dressings.

 8:00 PM: When bleeding persisted the nurse should have thought of taking this problem to another level, may be consult another doctor the patient or seek for an urgent surgical intervention.

 Physician's Actions:

 Initial Response (4:00 PM): Simply said, provided a level of support to the nurse, without gathering more information or executing extra actions. The physician should have obtained additional elaborated information and/or considered additional diagnostic or clinical action.

 6:00 PM & 8:00 PM: The physician should have re-examined the situation of the patient or requested other diagnostic imagines to determine the cause of bleeding. It is at this time that a consultation with a surgeon or further diagnostic procedures should have been done.

 General Recommendations:

 Increased Monitoring and Documentation: The nurse and the physician should take extra precautions and record often of the state of the patient.

 Intervention and Escalation: Thus, when bleeding was abnormal more vigorous treatment and increase in functioning level should have been practiced.

 Effective Communication: Reoccurrence of concern should lead to effective communication between the nurse and the physician since they belong to different functional roles.