C.

Written Asignment ( 30% )

i) Negligence is the “failure of individual not to perform an act ( omission ) or

to perform an act ( commission ) that a reasonable, prudent person would or
would not perform in similar set of circumstances” ( Sullivan & Decker - 2001 )

Discuss ONE case of negligence in your clinical practice. Why do you say it is
negligence?.

ii) Outline of the Assignment:

 Introduction – Definition and brief account on Negligence

The basic and legal definition of negligence means breach of duty or injury. Standards
of care in nursing generally mean those practices that "a reasonably prudent nurses
would use." So a good nurse knows and understands ethics in the medical field and
strives to provide excellent quality of care in order to avoid negligence. However,
mistakes, which will happen, do not necessarily mean negligence has occurred.

The legal review of a nursing negligence case requires proof that injury was done. And
that was the result of the nurse’s care or lack thereof. There are five main elements in a
nursing negligence case, and all elements must be proven in order for a case to be
valid. If one or more of the elements is not present, the case may be difficult to pursue.
The nurse had a duty to perform, the appropriate care was apparent in the situation,
there was a breach or violation of care ,there was an injury proven to result from the
nurse’s negligence and there is proof that damages occurred as a direct result of the
situation
  Description – the scenario of the Negligence ( what , why and how it
happened)

The scenario of the Negligence happen in labour room when the midwife did not follow
standard of procedure while doing stitches to episiotomy wound. There two (U29 ) staff
mid wife senior and junior on shift duty that day.

Staff midwife( senior ) using gauze to dap wound in the vagina while looking for the ‘
apec’ . the wound oozing so the midwife kept the gauze to apply as pressure to the
wound and stop bleeding temporary .This will help the midwife stitch easily without
messy from the oozing wound. The mid wife continue doing the stitches’ , it is about
75% of finishing stitching the episiotomy wound, the other pregnant women in active
labour and need to delivered her baby by assisted vaccum as instruct by specialist
oncall. The specialist want senior midwife to assist her doing the procedure. So the
senior midwife left the procedure stitching the episiotomy wound to the junior staff
midwife to continue without informing the junior regarding the gauze inside the vagina.

The patient was sent to ward after the vital sign post delivery taken. Anyway the junior
staff midwife did expel the blood from vaginal and post vagina examination done after
the episiotomy stitches completed.

May be in lacking of experience she did not feel the gauze in posterior fornix. The
patient was sent home the next day.

During day six of postnatal period the patient had high temperature due to infected
foreign body ( gauze). She also had severe lowered abdominal pain and can afford to
hold the baby to breast fed.

Patient husband took his wife for further investigation and treatment to our clinic O&G.
The couple was informed there is foreign body( gauze ) in the vagina, The head of
department was informed regarding the scenario and emergency conference done .

With a sincerely apology by the head of department the couple excepted.

Disscussion your view from legal and / or ethical perpective (address this
principle / code of ethics – the Malaysian perspective )

All nurses should bear in mind that the patients are there because they have special
needs and that they are the ones responsible in giving the patients those needs. Nurses
show love and respect as if the patients are a close relative of theirs. Once the nurses
start developing positive feelings towards their patients, the tendency is that they would
treat them the way they deserve to be, and they will not be able to commit any
misconduct.

In this scenario there is a negligence because there is no appropriate care by the nurse
and there was a breach or violation of care . Proven by , when the patient had high
temperature by infected foreign body ( gauge). The lochia was smelly.

she should followed the SOP ( standard of procedure ) . The mistake she made using
gauze during episiotomy repaired . According to standard of procedure when doing the
stitches to episiotomy the staff midwife should not used any gauze to dap or inserted to
the vargina The staff midwife must used tampon while doing the stitches to dap or to
apply pressure to any cut to varginal wall .

A good nurse is well- informed regarding health and safety laws, as well as board
regulation and customs of nursing. Knowing her duties and is familiar with procedure . A
good nurse will avoids negligence when she practices good Standard of procedure with
patients and works within legal guidelines.
Recommendation

The staff midwife should follow the SOP and check list provided .The episiotomy set
should have list of item contain in the set for check list. Staff doing the procedure
stitches the episiotomy must count the gauze before and after the procedure with one
staff witness. Before sending patient to ward , post vagina examination have to be done
and documentation in the system in PC . Shift in charged should make sure signature
by examiner of post Vaginal done, and written document in the patient ticket. In the
post natal ward while taking the observation continue the practice by asking the patient
situation and lochia flow /any abnormal colour and smell. It can prevent further damage.

Nursing staff working in Labour Room must have midwifery course with division 1.
Minimize the Jururawat Masyarakat working in Labour Room because they carry less
responsibility compare to staff with midwifery course.

Address the nursing shortage during union meeting .Allowed expending the nurses
faculty with midwifery ,will in turn increase the number of qualified midwifery nursing
student. By increased number of staff with midwifery in labour will help staff burn out
and less malpractice occur. They will performance well and relax , their mind will
concentrate well on the job / assignment given.

The health system planner and consumer must come together in a meaningful way to
create a health care strategic in set long term goal.
Conclusion

Nurses provide a comforting human interface between patients and the hospital, and
between communities and the health care system thus forming the "heart" of medical
and health care service provision in Malaysia. The rapidly changing Malaysian health
environment has required nurses to provide care through extended roles in order to
complement the services rendered by other health professionals. These extended roles
have forced Malaysian nurses to become more involved in practices that may have
profound individual legal consequences. Consequently, Malaysian nurses have become
increasingly aware of legal and ethical issues that have impacted on their practices and
have also recognized the importance of a solid foundation in legal and ethical principles
thus promoting competency in independent complex decision making.
References – APA style

1.Copyright 2008-2009 NursingAvenue .com.”Nursing in on act of critical Thinking and

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2.copyright 2004 by the American association of critical - care nurses