Examining ASPAN Standards. Lori DeWitt MSN RN NEA-BC CAPA CPAN September 6, 2014

Transcription

1 Examining ASPAN Standards Lori DeWitt MSN RN NEA-BC CAPA CPAN September 6, 2014

2 Objectives 1. Describe the purpose for standards of care 2. Describe the Perianesthesia Practice Standards, Practice recommendations, and Position Statements 3. Define the four elements of negligence

3 Why Standards of Care? All professions have standards of care Each profession is responsible to define their practice to protect consumers and assure quality service Minimal level of expertise that must be delivered to the patient Starting point for acceptable nursing care

4 Standards of Care Set internally or externally Internal pertain to individual practitioner or institution External pertain to nurses in all states and territories

5 Found in Standards of Care State Nurse Practice Act State Board of Nursing Federal agency guidelines and regulations Published standards of professional organizations and specialty practice groups (ASPAN, AORN, ANA) Accrediting bodies like TJC Hospital policy and procedure manuals Individual nurse s job description Manufacturers published materials

6 Standards of Care Nurses are accountable for all standards of care as they pertain to their profession To maintain competence and skill Read professional journals Attend pertinent continuing nursing education programs

7 Standards of Care Determined for the judicial system by expert witnesses Experts testify to the prevailing standards in the community These are standards that all nurses are accountable for matching or exceeding Adherence to such standards ensures that patients receive quality, competent nursing care

8 Standards of Care In specialty practice areas Courts are almost universally holding health care providers to a national standard of care Reasons All have access to same information/educational opportunities Most important: all patients have the right to quality health care regardless of where that care is delivered - small or large, rural or urban

9 Perianesthesia Practice Standards, Practice Recommendations, Position Statements, and Resources

10 Scope of Perianesthesia Nursing Practice ANA defines scope of practice for nursing profession as a whole ASPAN defines the scope of perianesthesia nursing as a specialty

11 ASPAN Standards of Perianesthesia Nursing Practice Framework for the expanding scope of care across all perianesthesia settings. Regularly monitored and updated - republished biennially. Each revised edition incorporates current evidence-based practice, emerging regulatory requirements and reflects changing technology and nursing practice.

12 Scope of Perianesthesia Nursing Practice Preanesthesia Level of care Preadmission Day of Surgery Postanesthesia Level of care Phase I Phase II Extended care

13 Principles of Perianesthesia Practice Standard for Ethical practice ASPAN endorses the ANA code of ethics Moral commitment to uphold values and ethical obligations of nurses Unique situations in care of patients undergoing surgery and anesthesia

14 Perianesthesia Standards for ANA Code of Ethics Ethical Practice Uphold values and ethical obligation of all nurses ASPAN Competency Responsibility to patients Professional responsibility Collegiality Research Advocacy

15 Standard for Safe Perianesthesia Practice Culture of safety Communication Advocacy Competency Efficiency/timeliness Teamwork

16 Perianesthesia Practice Standards Standards of Perianesthesia Nursing Practice: Provides framework for care of diverse population in all perianesthesia settings Practice Recommendations: describe the desirable level of performance of perianesthesia RNs and the perianesthesia environment of care

17 Perianesthesia Practice Standard Position Statements: represent an organization s viewpoint on a particular issue Resources: recommendations for practice based primarily on expert consensus, expertise and opinion

18 Standards of Perianesthesia Nursing Practice

19 Standards of Perianesthesia Nursing Practice I. Patient Rights i. Maintain autonomy, confidentiality, privacy, dignity, and worth of individuals ii. Each individual deserves respect /recognition and the right to quality healthcare

20 II. Environment of Care II. Environment of Care safe, comfortable, therapeutic environment (safety) i. Preanesthesia, Phase I, Phase II, extended care are distinct levels of care ii. All maintain privacy to ensure confidentiality iii. Adhere to institution-specific practices for access, security, safety iv. Phase I is close to where anesthesia given v. Preanesthesia pts. separate from pts. undergoing procedures and/or recovering from anesthesia/sedation

21 II. Environment of Care Policy to ensure safe transportation of patients Personnel and visitor dress codes based on proximity to OR Routine/emergency supplies available Adhere to institution/regulatory practices on infection control and safe sharp practices Mode of transportation/# and type of personnel RN verifies arrangements for safe transportation home Transport from freestanding to hospital

22 III. Staffing and Personnel Management Appropriate # of RNs with demonstrated competence to provide safe, quality care Expertise of perianesthesia nurse is necessary Staffing patterns Receive regularly scheduled performance reviews Written plan for orientation and ongoing continuing education Annual competencies Phase I nurse will maintain current ACLS and/or PALS

23 III. Staffing and Personnel Management Phase II nurse recommended to maintain ACLS and/or PALS Staffing will reflect ASPANs Patient Classification/Recommended Staffing Guidelines Staffing is based on patient acuity, census, patient flow process and physical facility A competent perianesthesia RN is providing direct care and/or supervision at all times in all perianesthesia levels of care

24 III. Staffing and Personnel Management Preadmission staffing based on volume, health status Phase I 2 RNs in the same room/unit as the patient receiving care at all times, one being competent in Phase I postanesthesia care Phase II 2 competent personnel, 1 RN competent in Phase II postanesthesia nursing in the same room/unit as patient receiving care

25 III. Staffing and Personnel Management Extended care 2 competent personnel, one who is RN with competence for the patient population in the same room/unit as patient receiving extended care

26 IV. Quality Improvement Evaluation of the quality of patient care through the monitoring of process and outcomes ensures excellence in perianesthesia care Data collected and analyzed Includes the identification of critical processes, nurse-sensitive and patient satisfaction quality indicators Multi-disciplinary problem-solving approach

27 V. Research and Clinical Inquiry Perianesthesia nurses participate in clinical inquiry Important for validating perianesthesia nursing practice Research and evidence-based findings guide decision making in the nurse s role

28 VI. Nursing Process The perianesthesia nurse applies the nursing process to each patient Perianesthesia patient is systematically assessed Comprehensive plan of care is developed, individualized, and implemented to achieve optimal patient outcomes Evaluates the effectiveness of outcomes

29 Clinical Practice Guidelines ASPANs Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia ASPANs Clinical Guideline for Pain & Comfort ASPANs Evidence-Based Clinical Practice Guideline for the Prevention and/or Management of PONV/PDNV

30 Practice Recommendations

31 PR 1: Patient Classification/Staffing Recommendations 1. Staffing based on patient acuity, census, patient flow process, physical facility 2. RN uses critical judgment/thinking to determine nurse to patient ratios, patient mix, staffing mix

32 PR 1: Patient Classification/Staffing Recommendations Preadmission Focus on assessing patient Plan of care for psychological, spiritual, educational, sociocultural needs Preparing for the experience Depends on volume, patient health status

33 PR 1: Patient Classification/Staffing Recommendations Day of surgery Validation of existing information Continue to assess and develop plan of care Varied complexity across the nation Staffing determined by institution based on: Patient safety # and acuity Complexity and required interventions Moderate sedation Procedures, such as blocks

34 PR 1: Patient Classification/Staffing Recommendations Phase I Level of Care Focus: Providing postanesthesia care to the patient in the immediate postanesthesia period and transitioning the patient to Phase II level of care, inpatient bed, or ICU for continued care 2 RNs; 1 who is competent in Phase I care are in the same room/unit where the patient is receiving Phase I level of care

35 PR 1: Patient Classification/Staffing Phase I Level of care Recommendations Staffing should reflect acuity In general, 1:2 nurse patient ratio allows for flexibility in assignments as patient acuity changes New admissions assigned so nurse can devote attention to care of admission until *critical elements are met Phase I nurse is not left alone with the patient. 2 nd nurse should hear a call for assistance and be immediately available to assist

36 PR 1: Patient Classification/Staffing Recommendations * Critical elements defined as: Report has been received from the anesthesia provider - Questions have been answered - Transfer of care has taken place Patient has a stable/secure airway Initial assessment complete Patient is hemodynamically stable Patient is free from agitation, restlessness, combative behaviors

37 PR 1: Patient Classification/Staffing Recommendations Phase I Level of Care Class 1:2 One nurse to two patients 2 conscious patients, stable, without complications, but don t meet D/C criteria 2 conscious patients, stable, 8 y.o. and under, with family or competent support staff, but don t meet D/C criteria 1 unconscious patient, hemodynamically stable, with a stable airway, over 8 y.o. and 1 conscious patient, stable, and free of complications

38 PR 1: Patient Classification/Staffing Recommendations Phase I Level of Care CLASS 1:1 ONE NURSE TO ONE PATIENT At the time of admission, until the critical elements are met Airway and/or hemodynamic instability Any unconscious child 8 y.o and under A 2nd nurse must be available to assist as necessary

39 PR 1: Patient Classification/Staffing Recommendations Class 1:1 One nurse to one patient Unstable airway Requires active intervention (jaw lift/chin lift or oral airway) Evidence of obstruction, active or probable Symptoms of respiratory distress includes dyspnea, tachypnea, panic, agitation, cyanosis Class 2:1 Two nurses to one patient One critically ill, unstable patient

40 PR 1: Patient Classification/Staffing Recommendations Phase II Level of Care Focus: preparing the patient/family/significant other for care in the home or Extended Care level of care 2 competent personnel, 1 who is RN competent in Phase II postanesthesia nursing, are in same unit/room as patient receiving Phase II care

41 PR 1: Patient Classification/Staffing Recommendations Phase II Level of Care An RN must be in Phase II PACU at all times Generally 1:3 nurse patient ratio New admissions should be assigned so nurse can devote attention to discharge assessment and teaching

42 PR 1: Patient Classification/Staffing Recommendations Phase II Level of Care Class 1:3 ONE NURSE TO THREE PATIENTS Examples include but not limited to: Over 8 years of age 8 years of age and under with family present Class 1:2 ONE NURSE TO TWO PATIENTS Examples include but not limited to: 8 y.o and under without family or support staff Initial admission of patient post procedure

43 PR 1: Patient Classification/Staffing Recommendations Phase II Level of Care Class 1:1 ONE NURSE TO ONE PATIENT Examples include but not limited to: Unstable patient of any age requiring transfer to a higher level of care

44 PR 1: Patient Classification/Staffing Recommendations Extended Care Focus: Providing ongoing care for those patients requiring extended observation/intervention after transfer from Phase I and Phase II level of care 2 competent personnel, one who is RN with competence in patient population are in the same room/unit where the patient is receiving extended level of care

45 PR 1: Patient Classification/Staffing Recommendations Extended Care Class 1:3/5 ONE NURSE TO THREE-FIVE PATIENTS Patients waiting transport home Patients with no caregiver Patients being held for an inpatient bed Patients who had a procedure requiring extended observation/intervention (e.x. potential risk of bleeding, pain management, PONV)

46 PR 1: Patient Classification/Staffing Recommendations Blended Levels of care Perianesthesia units may provide Phase I, Phase II, and/or Extended care levels within the same environment. This may require the blending of patients and staffing patterns The perianesthesia RN uses clinical judgment and critical thinking based on patient acuity, nursing observations and required interventions to determine staffing needs

47 PR 1A: Staffing Recommendation and Management of Patient on Precautions Standard precautions are the 1 st tier of defense Transmission-based precautions Communication regarding requirement for transmission precautions should occur Nurse to patient ratio should be 1:1 upon arrival of patient Ratios may advance providing the care needs of the patients allows sufficient time for donning and removing respiratory protection and other protective barriers and washing hands in-between patients

48 PR 2: Assessment for the Perianesthesia Patient Preadmission Health history Physical assessment Testing/referrals Patient preferences Psychological family status Discharge planning Preop teaching Advance directive review Plan of care

49 PR 2: Assessment for the Perianesthesia Patient Day of Surgery/Procedure Review preadmission assessment Relevant preop status Normothermia Pain Comfort Patient safety needs Emotional, psychological needs Previous anesthetic history Pt. identification Verify surgical prep Accompanying responsible adult Safe transport home Peds birth hx, dev. Stages, gestational age, parental interactions

50 PR 2: Assessment for the Perianesthesia Patient Phase I Vital signs Frequency is institution-specific Varies from 5 15 minutes Recommendation is the frequency of vital signs occur a minimum of every 15 during phase I Peds 74% of those surveyed said an initial BP is always obtained on arrival to Phase I Postanesthesia scoring system if used Initial, ongoing, discharge

51 PR 2: Assessment for the Perianesthesia Patient Phase II Vital signs Frequency is institution-specific Practice varies across country from Expert opinion recommends minimum of arrival and discharge and as clinical condition requires Postanesthesia scoring system if used Discharge criteria should be developed and approved by anesthesia dept. and medical staff

52 PR 2: Assessment for the Perianesthesia Patient Extended Care Vital signs as indicated Respiratory/ventilation status Circulatory status Surgical site Pain Ability to ambulate nourishment D/C criteria should be provided by the surgeon

53 PR 3: Equipment Should be size-appropriate for population served Preadmission Latex-free supplies Means to call for help Means to ensure privacy Ht, wt, BP, pulse ox Fax/scanner/copier

54 PR 3: Equipment Day of Surgery/Procedure Prep Each patient bedside will have: Means to deliver oxygen Means to provide constant/intermittent suction Means to monitor BP Means to ensure privacy Equipment available as needed Emergency airway equipment, VTE prophylaxis, surgical prep supplies

55 P3: Equipment Day of Surgery/Procedure Prep Equipment Method to call for assistance in emergencies Emergency cart Defibrillator adult/peds and cardiac pacing Latex free supplies/equipment Means to secure patient belongings Means to safely transport patient to the OR or procedure

56 PR 3: Equipment Phase I Each patient bedside will be equipped with: Various types/sizes of artificial airways Various means of oxygen delivery Constant/intermittent suction Means to monitor BP Adjustable lighting Means to ensure privacy ECG monitor

57 PR 3: Equipment Phase I Means to warm hypothermic patient Supplies as recommended by MHAUS At least 1 ventilator readily accessible Bag-valve-masks Adult and pediatric Emergency carts Defibrillator Method to call for assistance in emergency situations Various supplies

58 PR 3: Equipment Phase II Means to deliver oxygen Means to deliver intermittent and constant suction Bag-valve-mask MH supplies Emergency cart/defibrillator Warming devices Means to call for assistance in emergency situations Means to safely transport patients

59 PR 4: Competencies BLS, ACLS, PALS, PEARS based on unit functions Airway management Anesthetic agents MH 12 lead ECG interpretation Age-specific care PONV/PDNV Cultural sensitivity Pain management

60 PR 5: Competencies of Perianesthesia Support Staff Communication skills Protection of patient rights and confidentiality Infection prevention Care of the patient basic life support, basic airway support, preop testing Recognition of alarming IV, etc. Measurement & reporting of v.s.

61 PR 6: Safe Transfer of Care Handoff & Transportation The perianesthesia nurse is responsible for the safe transfer of care of patients between care providers The perianesthesia nurse will determine the mode of transport to ensure safe transfer of care The perianesthesia nurse uses appropriate process for communication handoff

62 PR 6: Safe Transfer of Care Handoff Handoff & Transportation A structured handoff has been shown to reduce the rate of errors & omission of information Guidelines: Receiving caregiver will be notified of impending transfer Receiving care provider will be given a complete report before or at the time of transfer Opportunity is provided for questioning between the giver and receiver

63 PR 6: Safe Transfer of Care Handoff Safe transportation & Transportation A policy exists to ensure safe transport of patients Perianesthesia RN determines mode, #, and competency level of accompanying personnel Perianesthesia RN ensures availability of appropriate transport of patient from facility The patient will be discharged with a responsible adult Peds recommended there are 2 adults, one seated with the child A plan exists for those patients who don t have accompanying responsible adult or reliable transportation

64 PR 6: Safe Transfer of Care Handoff & Transportation Transport personnel will remain with the patient until receiving unit personnel are at bedside to assume responsibility Perianesthesia RN accompanies Those who require continuous cardiac monitoring Require evaluation and/or treatment during transport (vasopressors or pulse ox)

65 PR 7: Role of RN in Management of Patients Undergoing Sedation ACLS/PALS is recommended Pre-sedation evaluation must be completed prior to sedation and IC obtained Guidelines developed by Dept. of Anesthesia for oversight of sedation/analgesia The RN managing the care of the patient receiving sedation shall have no other responsibilities that would leave patient unattended or compromise continuous monitoring The institution has educational competency validation mechanism

66 PR 7: Role of RN in Management of Patients Undergoing Sedation RN managing care of patients receiving and recovering from sedation Knowledge of: pharmacology, cardiac dysrhythmias, complications of sedation, O2 delivery, respiratory physiology, oxygen delivery devices Airway management and resuscitation Emergency Equipment must be available Supplemental O2 Airway adjuncts/bag-valve-mask device Suction Emergency cart/defibrillator

67 PR 7: Role of RN in Management of Patients Undergoing Sedation Know the definitions of the 4 levels of sedation 1. Minimal sedation (anxiolysis) 2. Moderate sedation/analgesia ( Conscious sedation ) 3. Deep sedation/analgesia 4. Anesthesia

68 PR 7: Role of RN in Management of Patients Undergoing Sedation Minimal sedation (anxiolysis) Patient responds normally to verbal commands Ventilatory & cardiovascular functions unaffected Cognitive function and coordination may be impaired Examples: Pre-procedure and Pre-op medications

69 PR 7: Role of RN in Management of Patients Undergoing Sedation Moderate sedation ( Conscious sedation ) Depressed level of consciousness Patient responds purposefully to verbal commands alone or by light tactile stimulation No interventions needed to maintain patent airway or protective reflexes; spontaneous ventilation is adequate CV function is maintained Example: Used for short procedures & diagnostic exams

70 PR 7: Role of RN in Management of Patients Undergoing Sedation Deep sedation/analgesia Patient cannot be easily aroused, but responds purposefully to repeated or painful stimulation Ability to maintain independent ventilatory function & patent airway may be impaired Patient may need assistance to maintain patent airway CV function is usually maintained

71 PR 7: Role of RN in Management of Patients Undergoing Sedation Anesthesia Drug-induced loss of consciousness Patients are not arousable, even by painful stimulation Ability to independently maintain ventilatory function is often impaired Patients often require assistance in maintaining a patent airway Ventilation may be required due to depressed spontaneous ventilation or depression of NM function CV function may be impaired

72 PR 8: Fast Tracking the Ambulatory Surgery Patient Fast tracking: bypassing Phase I level of care having met Phase I discharge criteria prior to leaving the OR Patient selection and education Requires team collaboration Use of appropriate anesthetic agents Appropriate patient assessments Phase II is a level of care, not a physical place

73 PR 8: Fast Tracking the Ambulatory Surgery Patient Discharge criteria from the operating room should include the following: Awake or easily arousable Hemodynamic stability Patient on room air and maintaining appropriate oxygen saturations Minimal pain Minimal nausea Stability of surgical site, e.g., no active bleeding

74 PR 9: Visitation in the PACU Preoperative Education During Induction Widely accepted and expected by many parents Conflicting evidence Postoperative Phase Appropriateness based on patient status, patient wishes, activity in the unit, and nurse ability to spend time with the patient & family

75 PR 10: Obstructive Sleep Apnea in the Adult Patient Reduced muscle tone in the airway leading to frequent airway obstruction during sleep Incidence is 3-7% in men; 2-5% in women 41% in obese and 78% in morbidly obese 80% of men and 93% of women who present for elective surgery are at risk for OSA and are undiagnosed Affects 2-26% of the population

76 PR 10: Obstructive Sleep Apnea in the Recommendations: Adult Patient 1. Assess and screen patients for risk factors (BMI>30, increased abd fat, CV disease, male gender, Type II diabetes, enlargement of upper airway, stroke, Black > Caucasian) Male peak prevalence age Female peak prevalence age Assess and screen undiagnosed patients for S&S Daytime sleepiness, snoring, fatigue 3. Incorporate use of standardized screening tool to identify patients at risk (STOP-BANG)

77 PR 10: Obstructive Sleep Apnea in the Adult Patient STOP-Bang Scoring Tool 1. Do you Snore loudly 2. Do you often feel Tired, fatigued during the day 3. Has anyone Observed you stop breathing while sleeping 4. Do you have (or being treated for) High Blood Pressure 5. BMI more than Age over 50 years old 7. Neck circumference greater than 17 male; 16 female 8. Gender male Three yes responses puts pt. in suspected hi risk of having OSA

78 PR 10: Obstructive Sleep Apnea in the Adult Patient 4. Initiate postanesthesia management of patient diagnosed or suspected OSA 5. Plan for patient discharge Phase I Capnography Multimodal approach OSA patients are sensitive to opioids and sedatives May require extended monitoring in immediate postop period

79 PR 10: Obstructive Sleep Apnea in the Adult Patient 6. Plan for patient discharge Phase II Minimum observation of 2-6 hours OP should be observed on average 3 hours longer than non-osa With hypoxemic event, monitoring should occur for 7 hours Oxygen saturation should be >94% or at baseline for at least 2 hours before discharge 7. Provide discharge education to patients Need to have a responsible adult with them overnight after discharge

80 ASPAN Resources Standards for Postanesthesia Care Standard I All patients who have received general anesthesia, regional anesthesia or monitored anesthesia care shall receive appropriate postanesthesia management Standard II A patient transported to the PACU shall be accompanied by a member of the anesthesia care team who is knowledgeable about the patient s condition. The patient shall be continuously evaluated and treated during transport with monitoring and support appropriate to the patient condition

81 Standard for Postanesthesia Care Standard III Upon arrival in the PACU, the patient shall be reevaluated and a verbal report provided to the responsible PACU nurse by the member of the anesthesia care team who accompanies the patient Patient status on arrival in the PACU shall be documented Member of anesthesia care team will remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient

82 Standard for Postanesthesia Care Standard IV The patient s condition shall be evaluated continually in the PACU Medical supervision by anesthesiologist Policy to assure availability of MD capable of handling emergencies Accurate written record of PACU period Use of scoring system encouraged Patient to be observed/monitored. Particular attention to LOC, oxygenation, ventilation, circulation, temperature Measurement of oxygenation, such as pulse oximetry Not recovery of OB patient where regional used for L&D vaginal delivery

83 Standard for Postanesthesia Care Standard V A physician is responsible for the discharge of the patient from the PACU If D/C criteria used, they must be approved by Dept. of Anesthesia In the absence of the physician responsible for the discharge, the PACU nurse will determine the patient meets D/C criteria. The name of the physician accepting responsibility for discharge shall be noted on the record

84 Position Statements Do Not Resuscitate Advance Directive Reclarify wishes, institution should have P&P detailing management during perianesthesia period RN utilization of unlicensed assistive personnel Education, training, and utilization RN responsible for provision of nursing care and appropriate delegation RN supervises UAP

85 Position Statements On call/work schedule Plan to augment on call staff based on census/acuity or provide relief if safe care compromised ICU overflow patients Medical management Competencies Primary responsibility to recover patients Appropriate staffing requirements

86 Position Statements Med-Surg overflow Competencies Medical management of patient established If unable to get into PACU from OR, the patient should receive the same standard of care for Phase I Overflow patients should receive the same standard of care as RNF

87 Position Statements Safe medication administration RNs accountable to know their state nurse practice act Knowledge on any med given Know P&P on securing medications Waste unused narcotics/sedatives Older adult Knowledge of considerations for aging adult

88 Position Statements Pediatric patient Commitment to family-centered care Competencies in age-specific pathophysiology Substance abuse Recognition/reporting the problem Treatment options

89 Position Statements Workplace Violence Nurses are responsible for reporting any disruptive behavior in the workplace to the management team Leaders and educators must educate and mentor nurses empowering them to manage perceived workplace violence Leaders must develop guidelines within their own setting to incorporate this position statement

90 Legal Concepts Civil law based on rules and regulations Administered through courts as damages or $ compensation Most important area is tort law, which involves compensation to those wrongfully injured Criminal Law conduct that is offensive or harmful to society as a whole

91 Legal Concepts Tort Law a civil wrong that allows the injured party to seek reparation; concerns any action or omission that harms someone Negligence Malpractice Assault and battery Invasion of privacy False imprisonment defamation

92 Intentional Torts Intent is necessary and there is a willful action Assault An attempt or threat that causes a person to fear physical touch or injury Action causes apprehension or unwarranted touching Ex. threatening a patient Battery Unauthorized touching of an individuals body, any extension of it or anything attached to it in an offensive or injurious manner Ex. Lack of consent for treatment

93 Legal Terminology Plaintiff the person or party who brings the lawsuit Defendant person or entity against whom plaintiff s allegations are made Negligence - Deviation from the standard of care that a reasonable person would use in a certain set of circumstances Standard of care the care and judgment exercised by a reasonable, prudent nurse under the same circumstances Malpractice (Professional negligence) a negligence that involves a standard of care that can be reasonable expected from professionals (nurses); failure to act as a reasonable prudent nurse would act under similar circumstances

94 Essential Elements of Professional Negligence (Malpractice) 1. Duty once you accept responsibility for the care of the patient, you are under duty to act in accordance with the standard of care 2. Breach of duty failure to act in accordance with the standard of care (omission or commission) 3. Causation (*most difficult to prove) - Plaintiff must prove the breach of duty was the cause of damages 4. Damages - actual loss or damages must be established (ex. nerve damage)

95 Legal Concepts Res ipsa loguitur the thing speaks for itself rule of evidence that allows supposition of negligence of defendant (ex. Permanent loss of neuromuscular control of arm after hysterectomy Respondent superior let the master speak Employer is liable for negligent acts of employee if it occurred during employment and is part of job responsibilities

96 Legal Concepts Quasi-intentional torts Invasion of privacy Public disclosure of private facts about a person Placing person in a false light in the public s eye Defamation Libel (written form) Slander (spoken form)