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L W F D R T H E N U R S E M N G E R

Nursing M alprac ticeCause for ConsiderationB Y J A N I N E F I E S T A R N J D

BSTR CTBecause so manyfactors influence aimtients heaith, it sdifficult to know

with certainty that a nurse s erroractually caused the negative out-come.In nursingmalpracticecases,causation can be a successful de-fensestrateg} .[Nurs Manage 19S9:3D[2):12-13]

lthoughtheplaintiff in am alprac-tice lawsuit must establish thefour elements of malpracticeduty,breach of duty, damages, andcausa-tionto receive compensation, prov-ing causation often presentsthemostdifficult challenge.TTiese four elementszredefinedasfollows:Dutyprevailing professional stan-dardofnursing care.Breach of rf/zj^'departure fromstandard of care that s owed to a pa-tient.Damagesactual injui-yorharm.Causationcause of injury bynurse's departure from ihe standardof care. Nurses involved in malprac-tice cases often focusoncausationasa successful defense strategy.A cause in feet establishes thattheinjury was causedbybreachofduty.A proximate cause,in legal causalre-lationships, establishes that there'sagreater than 5 0 chance an injury w ascausedby abreachofduty.'

Notifying physiciansof complicationsIn Rampe v. Community GeneralHospital the plaintiff began experi-encing labor contractionsandher ob-stetrician's office directed her to thehospital. Upon arrival, the labo r nu rse

performed avaginal examinationandattached an external fetal monitor.Ashort while later,thenurse observeda deceleration in the fetal heart ratethat sheperceived to be a late de-celeration.The hospital contacted thephysi-cian, who directed nurses to placethe patienton herside andadminis-ter oxygen. The physician arrivedatthe hospital about an hour later,

checkedthemo nitor strips and foundnothing troublingorsuggestiveof fe-tal distress.

I s s u e s of causa t ioncan become

ext remelycomplicated when

more than onefactor or ca reg ive rmay have

caused harm.He ruptured the patient 'smem-branes, observed meconium in theamniotic fluid, andattached an inter-nal fetal monitor. The first readingsfrom thedevice showedaprolongeddeceleration.Thephysician decided,basedonthis deceleration, themeco-nium-stained fluid, and the relativelyslow rate at which labor had pro-gressed, thathe should performa ce-sarean section. The baby sufferedfrom meconium aspiration syndrome.The plaintiffs alleged that the nursefailed tonotify the physician thatthedecelerations continued to occur. Thecourt found thatan additional phone

call to the physician wouldn't haveprom pted him to order a cesarean sec-

tionat anearlier time. Therefore,thverdict against the hospital couldnstand.Noevidence showed that thbreachofapplicable standardsofresonable care caused the infants injuries.'^When a Florida patient sufferecomplications following a routinedagnostic cardiac test, the plaintiffaleged that nurses caused the injuriw^hen they failed to promptly noti

physiciansof problems that aroseate rthetest. The patienthad acardicatheterization and thephysician alperformed a balloon angioplasty witout authorization. Unfortunately, thphysician inserted the catheters inthe wrong ar tery , which compromised blood flow.The errorwascompounded whenurses failed to reach the primaphysician for 6 hours after thepro

lem developed and never attempteto reach the backup physician.Thfollowing day another physicianatempted an arteriogram to treat thright leg.However, he accessed thwrong artery in the left leg.Shortafter, the patient began to lose puland sensation in the left leg. Thnurses didn't report this conditiontthe physician and the patient lost bolegs.-^Failingt followphysician ordersIn an Indiana case, a patient enterethe hospital for open-heart surgerHer surgeon ordered a preoperatiHibielens shower, which her nurdidn't perform. The surgeon alsoodered postoperative antibioticsnindoses, 6 hours apart.Thenurseaministered the fir.st three doses ascheduled,butgave the remainings sporadically.The patient was readmitted with

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