Nursing Assessment: Nurse's Exercise Of Best Nursing Judgment Upheld By Court
Legal Eagle Eye Newsletter for the Nursing Profession
January 1996
Quick Summary: Based on her charting that day, including a note regarding routine p.m. care, the nurse was allowed to state to the court it had been her nursing assessment that the patient appeared and acted as she did because it had been a busy day for her in rehab therapy, and because she was getting substantial doses of pain medication.
A family member stated she went to the nursing station to report that the patient’s condition had changed suddenly, that "she could not talk right," her speech being garbled and unintelligible, and that her level of consciousness had changed so that she was "woozy."
The nurse admitted she had no recollection of the family member reporting this to her. However, the court was willing to accept it as a fact that this nurse had a habit or routine practice always to respond immediately to such reports from family members.
The patient had had a stroke. However, the court upheld the nurse’s assessment of this patient. The standard of care calls for nurses to use their best nursing judgment in the assessment and care of patients, under the circumstances, even if it proves erroneous after the fact.
APPELLATE COURT OF ILLINOIS, 1995.
A patient was being cared for in the hospital following a serious auto accident. Two weeks following her admission, damage to the carotid artery sustained in the accident had not yet been detected, which was compromising blood flow to her brain.
A family member testified she reported signs to the nurse which could have been consistent with a transient ischemic attack, evidence the patient was experiencing or about to experience a stroke. The signs reported by the family member, according to the court, could, alternatively, have been consistent with the nurse’s assessment of fatigue and the influence of narcotic pain medication.
The nurse testified she had no recollection of the family member’s complaint, and it was not charted. The Appellate Court of Illinois had to resolve this obvious conflict in the testimony over what had really happened on the evening in question. It ruled in favor of the nurse. The court accepted it as a fact that it was this nurse’s habit and routine practice always to respond promptly to such complaints from family members, to assess the patient’s condition, to take appropriate measures and to chart the incident.
The nurse had charted "routine p.m. care" for this patient, one and one half hours after the family member’s alleged complaint about the patient’s condition. Routine p.m. care would have included observation of the patient, an assessment of whether the patient was capable of verbalizing and assessment of whether the patient appeared to be in pain. The patient had complained of pain and got Demerol.
Although the patient had a stroke sometime that evening, the nurse’s judgment was not faulted. Hajian vs. Hospital, 652 N.E. 2d 1132 (Ill. App., 1995).