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Health Assessment · Chapter 1

The Case Bench

When a case is reviewed, the question is never whether you meant well — it is whether you met the standard of care: what a reasonably prudent nurse with similar preparation would have done in similar circumstances. Take each case, decide how a review would classify it, prove or break the elements, and read what the nurse should have done instead.

1 · Pick a case

2 · Rule on it

Step one — how would a review classify this?

Ruling

Classify the case, complete step two, then rule on it.

Bench reference

Four elements of negligence — a plaintiff must prove all four

  • Duty — a nurse–patient relationship existed
  • Breach — you departed from the standard of care
  • Causation — that breach caused the harm
  • Damages — real injury occurred

Missing one element ends the case — and a case that would fail in court is still a reportable safety event.

Intentional torts

  • Assault — threatening unwanted contact
  • Battery — the contact itself, including a procedure the patient refused
  • False imprisonment — restraining or confining without an order or emergency justification
  • Defamation — libel in writing, slander in speech
  • Invasion of privacy — accessing or disclosing information without need to know

Informed consent — who does what

The provider explains the diagnosis, the nature and purpose of the procedure, the risks and benefits, the alternatives and the consequences of refusing. The nurse verifies the form is signed, that the signature is voluntary, and that the patient can describe in their own words what is about to happen — then witnesses the signature. Consent obtained after a sedating premedication is not valid consent.

Restraints

Last resort only, never for short staffing, convenience or punishment, and only after less restrictive alternatives are tried and documented. A provider order is required, is never PRN, and is time-limited: for violent or self-destructive behavior up to 4 hours for an adult, 2 hours for ages 9–17, 1 hour for children under 9, with a face-to-face evaluation by a physician or trained licensed independent practitioner within 1 hour of initiation. Use the least restrictive effective type and monitor frequently with release, repositioning, range of motion, fluids, toileting, circulation and skin checks.

Six Standards of Practice · six ethical principles

Assessment, diagnosis, outcomes identification, planning, implementation, evaluation. — Autonomy, beneficence, nonmaleficence, justice, fidelity, veracity.