This article provides a solution essay to Impact of the Law on Patient Care Issues.
Professional Development Exercises :
Read the case study presented at the end of Chapter 8 (Guido, p. 150)
Is the patient correct in asserting that he has a right to know the names and status of individuals who will be performing this procedure?
Does the manner in which the student introduced herself and the two other team members have relevance in this case?
Was the informed consent deficient to the degree that there was a lack of informed consent by the patient?
How would you decide this case?
A patient is admitted to your surgical center for a breast biopsy under local anesthesia. The surgeon has previously informed the patient of the procedure, risks, alternatives, desired outcomes, and possible complications. You give the surgery permit form to the patient for her signature. She readily states that she knows about the procedure and has no additional questions; she signs the form with no hesitation. Her husband, who is visiting with her, says he is worried that something may be said during the procedure to alarm his wife. What do you do at this point? Do you alert the surgeon that informed consent has not been obtained? Do you request that the surgeon revisit the patient and reinstruct her about the surgery? Since the patient has already signed the form, is there anything more you should do?
Impact of the Law on Patient Care Issues
The legal components of nursing significantly impact the way nurses deliver care to their patients. Legal concerns similarly impact not only on the environment in which nursing is practiced but also determine how health documents are stored as well as shared. In the final analysis, nursing professionals, together with the nursing care that they offer, are evaluated from a legal definition reinforced by ethical considerations for the standards of care expected of nurses. While the written guidelines and standards of care come in handy when determining the how nursing care is delivered combined with the quality of care, it is essential to note that the standards of care legal definition are neither a guideline nor a policy. Instead, it is essential to acknowledge that this legal definition is an embodiment of collective knowledge on what is demanded of the average nursing professional, which also sets the minimum parameters for proficiency.
In the US, just like in most of the other countries of the world, healthcare happens to be one of the most regulated sectors of trade with much of these regulations stemming from federal and state laws. Other regulation requirements are introduced and enforced by government-sponsored programs like Medicare or even self-sanctioned in order to conform to both private and government initiatives. These legal-ethical and professional guidelines imply that nursing staff are faced with potential civil and criminal liabilities in addition to sanctions concerning healthcare necessitating these nursing professionals to familiarize themselves with fundamental statutes and regulations in the course of delivering healthcare (Kadivar et al., 2017). Consequently, this essay purposes of examining the impact the law has on issues concerning patient care.
To achieve the goal, three case studies are discussed with the first one revolving around a patient whose fundoplication surgery to repair an esophageal hernia resulted in a medical error where the patient sued, and the court returned a verdict in the patient’s favor. Case study two involved a breast biopsy patient who despite her signing the informed consent forms, the husband still felt that caution should be taken so that the professional does not do anything that might alarm the patient. Lastly, case study three explored the issue of two parents (both being father and mother) of Jung, leukemia where the mother is determined to sign the consent form for the boy to undergo further chemotherapy sessions. At the same time, the husband is equally determined in opposing the granting of such a procedure arguing that the boy has already suffered enough.
Section I: A Student tore the Fundoplication Surgery Patient Who’s Esophagus Lining
After going through the facts of the case study presented at the tail end either chapter of Guido, 2014, p.150), it is clear that the patient had a right to know the full name and status of each person involved in their healthcare process. According to Mohamed, Seedhom & Ghazawy (2018), every patient has a right as envisaged in the patients’ bill of rights. Synonymously known as the Consumer Bill of Rights and Responsibilities and adopted the US Advisory Commission on Consumer Protection and Quality in the Healthcare Industry of 1998, every patient has a right to choose healthcare professionals who can give one high-quality healthcare when one needs it. Had the patient known that the healthcare provider who was to insert the esophageal dilator was a student the patient would have expressed their reservation and probably demanded more vigilance or even rejected to be treated by the student nurse as the lead healthcare giver. As Masic & Izetbegovic (2014) note the healthcare professional introducing themselves to their patients is a patient safety issue which besides fostering effective communication bolsters the patient’s confidence in the professional so that just in case something went wrong the patient does not attribute it to the caregiver as having had something to hide like their insufficiency of professional skills.
The professional should identify themselves in their full names, the professional title and role that will play in the patient’s treatment. In the present case, informed consent at the express and implied level were not met since under the law the following components have got to be disclosed include the provider’s fiduciary duty to obtain the patient’s informed consent where the professional ameliorates the patient’s unequal information status by supplying this information evidenced by lack of the patient’s material information concerning their medical condition. This is because the patient reserves the right to chart their destiny premised on the material information supplied by the doctor so that they can make intelligent decisions that will chart the destiny of their health and well-being with dignity. From the outset, this patient was not accorded adequate information on the proposed care, treatment as well as services the patient was to get.
There was also the absence of information regarding the potential gains, risks and side effects of the proposed care, treatment, services in addition to the reasonable alternatives that were at the disposal of the patient. Even though some could argue that entering the physician’s office for treatment implies consent and that that express consent has been granted by the patient who is competent or the patient’s authorized representative, I would like the return a guilty verdict on the side of the student nurse and the supervising anesthesiologist because both overlooked the institution’s policy on who should conduct the fundoplication surgery (Li et al., 2019).
Section II: The Case of the Breast Biopsy Surgery under Local Anesthesia
The case summarizes that the patient underwent a breast biopsy surgery under local anesthesia where we are informed the surgeon had before this visit educated the patient on the procedure, risks, alternatives, the outcomes desired and possible complications that may arise which made the patient sign the consent forms immediately. However, the husband who has accompanied his wife on this visit opines that something could be said that alarms the wife during the procedure. Under the Washington statute and case law, the disclosure elements needed for informed concerned are spelt out. Shickich, Joyce & Fox (2016) aver that while a signed written document of informed consent may shift the burden of proof to the patient, the mere presence of the signed document is only evidential and not absolute proof of consent.
Under ideal conditions, the rationale is that the signed document attests to the presumption under the law that consent was informed yet case law demonstrates that the patient could still claim uninformed consent because they did not understand the terminologies used to describe the treatment entirely. Were either the patient or the husband to prove this to be the case later and argue that this would have led the woman to withhold consent, then the best course of action to follow the moment the husband voiced the sentiment of alarm, would be to postpone the biopsy until all these elements were adequately covered. While every measure one is taken to ensure the patient fully understood all the aspects of the treatment proposed, I would inform the surgeon that full consent had not been fully granted and despite their signing, the patient could be accorded the alternative to informed consent where the consent known as an acknowledgement of shared decision making. The shared decision-making process entails the doctor discussing with the patient or their chosen representative addressing information on the services, use of a patient decision aid as well as patient shares with the professional, relevant personal information that might make the patient’s treatment or side effects more or less tolerable in comparison to others. The scenario mentioned above raises several issues about ethical principles touching on enduring challenges that continue to bedevil informed consent as raised by the woman’s husband.
As an almost universally accepted legal, ethical and regulatory necessity for a majority of transactions in the healthcare, informed consent varies depending on the context while the resulting reality more often than not falls short of the propagated theoretical ideals. One of the ethical principles the husband raises is the moral force of consent. This is because the moral force of consent is not just confined in the halls of healthcare or research but are also part and parcel of many interactions at an interpersonal level that across ages has been inculcated in both jurisprudence and societal values. As such, consent has the potential to render actions to be morally permissible, which, in its absence, would become morally wrong (Grady, 2015).
Consent in non-healthcare concept can be illustrated using the fact that with consent, it is acceptable to borrow another individual’s car or draw their blood without which the two become crimes of theft and battery, respectively. The healthcare professional should at all times, safeguard the patient’s right to self-determination by understanding the normative underpinnings of informed consent with regard to their autonomy. The husbands in voicing his sentiments attempt to bridge the gap between theory and practice by ensuring all the loopholes concerning consent are sealed. The nurse, in this case, should be guided by the ethical principle of having an integrated consent, shared decision making consent guided by evidence on what the individual giving consent wants to know and the available alternatives including that of non-treatment.
Section III: Case of Jimmy Chang
In this third and last of the case studies exploring the impact of the law on patient care, the general facts are that Jimmy Chang is a 20-year-old college student who was diagnosed with leukemia at the age of 15. Before the presenting acute active phase of leukemia, Jimmy had enjoyed a 14-month remission preceded by several courses of chemotherapy. The present dilemma emerges from his parents’ opposed stand on the benefits of additional chemotherapy where the mother is for it while the father is equally opposed to it claiming the son has suffered long enough. As the nurse present in this case, it is imperative for both parents to be aware that the best decision making not just for treatment but also on the informed consent signing is one that embraces the highest quality of research evidence on the gains and risks of available treatments, the clinical expertise of the physicians and the views, opinions and preference of not just the family members but also the views of the patient who in this case happens is not just a son but is above 18 so he can sign the form himself (Valdez-Martinez, Noyes & Bedolla, 2014). The reason why jimmy gets to sign the consent form is that besides being above 18 years, his disease does not have an impact on his mental capacities.
Additionally research has shown that children from as early as the age of 12 can give informed consent instead of assent. Hein et al. (2015) have in their research found that several advantages abound as children above 12 years get justice on their capacities as they resolve challenges they face when they have to decide on treatment and research choices touching on their health and well-being. Should the nurse fail to reconcile the two parents on whether to sign or not, the nurse has to at all-time act as the patient’s advocate and therefore call upon the differing parents to respect the informed decision of their son. While deciding on who should Jimmy’s informed consent form is straightforward from a legal point of view considering that he is above 18 and of sound mind and therefore competently make a decision on whether he should or should not have additional chemotherapy, the same cannot be said of using the ethical angle. This is because contemporary medical practice is faced with several factors that do impinge on the doctor-patient relationship.
The ethical lens focuses on the ethical principle of patient autonomy and fundamental human rights which decree that a patient has all the freedoms and latitude in deciding on what should or should not happen to their body in addition to having unrestricted access to collection information before undergoing any healthcare procedure be kit a test, procedure or even surgery (Rao, 2008). Going by this, it is clear to all from the nurse, to the mother to the father that the ultimate decision on whether Jimmy should undergo additional therapy rests with Jimmy himself and that nobody has the prerogative of coercing him to follow a particular course. Even the role of the healthcare professional is only to facilitate but not to decide on behalf of the patient. As such this is one of those instances where using the ethical model or the legal model leads one to derive the same answer on who has the ultimate responsibility of deciding the best course of medical treatment to be administered on the patient.
In conclusion, this analysis has established that indeed the impacts on patient care issues on determining what is legally and ethically permissible. The case studies have also demonstrated that getting informed consent is not just an ethical duty but also a legal responsibility where the level of disclosure should be case-specific. All healthcare professionals should also live with the full knowledge that a signed informed consent cannot entirely absolve one from legal liability. This implies that at all times, the healthcare professional must take sufficient precaution and act with care and diligence. The overriding note is that cultivating and maintaining a positive relationship with the patient yields better results than even the best structured informed consent.
Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, 372(9), 855-862.
Guido, G. W. (2014).Legal and ethical issues in nursing (6th Ed.). Upper Saddle River, NJ: Prentice Hall
Hein, I. M., De Vries, M. C., Troost, P. W., Meynen, G., Van Goudoever, J. B., & Lindauer, R. J. (2015). Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children’s competence to consent to clinical research. BMC medical ethics, 16(1), 76.
Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of medical ethics and history of medicine, 10.
Li, Z. T., Ji, F., Han, X. W., Yuan, L. L., Wu, Z. Y., Xu, M., … & Wang, Z. G. (2019). Role of fundoplication in treatment of patients with symptoms of hiatal hernia. Scientific reports, 9(1), 1-8.
Masic, I., & Izetbegovic, S. (2014). The role of medical staff in providing patients’ rights. Medical Archives, 68(1), 61.
Pozgar, G. D. (2013).Legal and ethical issues for health professionals (3rd ed.).Boston: Jones and Bartlett.
Rao, K. S. (2008). Informed consent: an ethical obligation or legal compulsion?. Journal of cutaneous and aesthetic surgery, 1(1), 33.
Valdez-Martinez, E., Noyes, J., & Bedolla, M. (2014). When to stop? Decision-making when children’s cancer treatment is no longer curative: a mixed-method systematic review. BMC pediatrics, 14(1), 124.
Question – Impact of the Law on Patient Care Issues
Professional Development Exercises :
- Read the case study presented at the end of Chapter 8 (Guido, p. 150)
- Is the patient correct in asserting that he has a right to know the names and status of individuals who will be performing this procedure?
- Does the manner in which the student introduced herself and the two other team members have relevance in this case?
- Was the informed consent deficient to the degree that there was a lack of informed consent by the patient?
- How would you decide this case?
- A patient is admitted to your surgical center for a breast biopsy under local anesthesia. The surgeon has previously informed the patient of the procedure, risks, alternatives, desired outcomes, and possible complications. You give the surgery permit form to the patient for her signature. She readily states that she knows about the procedure and has no additional questions; she signs the form with no hesitation. Her husband, who is visiting with her, says he is worried that something may be said during the procedure to alarm his wife. What do you do at this point? Do you alert the surgeon that informed consent has not been obtained? Do you request that the surgeon revisit the patient and reinstruct her about the surgery? Since the patient has already signed the form, is there anything more you should do?
Now consider the ethical issues that such a scenario raises. Which ethical principles is the husband in this example most portraying? Which ethical principles should guide the nurse in working with this patient and family member?
- Jimmy Chang, a 20- year- old college student, is admitted to your institution for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission. His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because \”Jimmy has suffered enough.\”
You are his primary nurse and must assist in somehow resolving this impasse. What do you do about the informed consent form? Who signs and why? Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective. Did you come to the same conclusion using both an ethical and a legal approach?
Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling. Include introduction and conclusion.
Please combine all of these responses into a single Microsoft Word document for submission
- Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall. (Chapter 8)
- Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett. (Chapters 12, 13, and 14)