Safe Nursing Practice in
cludes an understanding
of the legal boundaries in
which nurses must function.
An understanding of the implication
of the law supports
critical thinking on the
Nurses part. Laws are changing
constantly to reflect
changes in society, changes in
the delivery of health care
and advancement in medical
technology.
The role of the Nurses and
the ethical dilemmas associated
with client care have increased
and often becomes legal issues.
The community is now better
aware than in the past about
their rights in health care. The
Consumer Protection Act
(CPA) was passed by the Government
of India in 1986 to protect
the interests of the consumer.
Consumer means any
person who buys any goods
against consideration is a consumer.
Similarly any person
who hires services against consideration
is also a consumer. In
health care delivery, patient is
a consumer. Government institutions
do not come under the
perview of CPA because the consumers
pay only nominal
amount of registration charges,
so cannot fall within the ambit
“Consumer”
Organisation of Consumer
Protection Council
This is a central protection
The authors are Principal, Reader and
Lecturer respectively, at Mohan Dai
Oswal Cancer Treatment & Research
Foundation, Ludhiana
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council and consists of the
following members :
1. The minister incharge of
the consumer affairs in
the central government
who shall be its chairman.
2. Officials and non-official
members representing
such interests as may be
prescribed.
The Central government
is legal authority in three
ways: (a) Through the Government
Service Conduct
Rules, (b) through the Indian
Nursing Council Act, and (c)
through British laws which
continue to remain in effect
even after independence.
The Central Council
meets once a year.
Objectives of the Council
1. The right to be protected
against the marketing of
goods and services,
which are hazardous to
life and property.
2. The right to be informed
about the quality, quantity,
potency, purity, standard
and price of goods
(or consumer against, as
the case may be) so as to
protect the consumer
against unfair trade practices.
3. The right to be assured,
wherever possible, access
to a variety of goods
(and services) at competitive
prices.
4. The right to be heard and
to be assured that
consumer’s interests will
receive due consideration
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at appropriate fora.
5. The right to seek redress
against unfair trade practices
(for restrictive trade
practices) or unscrupulous
exploitation of consumers.
Negligence
Negligence is the conduct
that falls below the standard
of care. The standard of care
is established by the law for
the protection of consumers
against and unreasonable
practices which create risk or
harm. Professionals such as
Nurses, doctors having special
skills and knowledge.
Nursing Practice act describe
and define the legal
boundaries of nursing practice
within each state. The
responsibilities of the Indian
Nursing Council, State Council
and University to regulate
the standard of the Nursing.
Common Sources of Negligence
Nurses should be aware of the
common negligent acts that
have resulted in lawsuits
against hospital and nurses.
The commonly occurring
examples are outlined below:
1. Medication errors that result
in injury to client.
2. Intravenous therapy errors
resulting is infiltration
or phlebitis.
3. Burn to clients caused by
equipment, bathing, or
spill of hot liquids and
food.
4. Falls resulting in injury
to client.
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5. Failure to use aseptic
technique where required.
6. Errors in sponge, instruments,
or needle count in
surgical cases.
7. Failure to give a report,
or giving an incomplete
report, to an oncoming
shift.
8. Failure to adequately
monitor a client’s condition.
9. Failure to notify a physician
of a significant
change in a client’s status.
With advancement in
nursing profession, nurses
are in a position to take independent
decision, this increases
their responsibility
and commitment. In previous
years, the consumers
were hardly moving court
cases against nurses, but
now, due to commercialisation
of the nursing profession,
there has been mushrooming
of nursing schools /
colleges. The product coming
out is far below the standards.
Graduates from these
institutions are not up to the
mark; nurses from these institutions
have not developed
the right attitude towards
their profession. Carelessness
or negligence on the part
of nurses is not uncommon.
This is very unfortunate as
professional nurses used to
have more responsibility and
commitment. The time is not
far when cases of negligence
or carelessness will be filed
against nurses and heavy
damages could be awarded
against the nurse.
Nurses have to abide by
the laws related to : informed
consent for operation / invasive
procedure; correct identity
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should be placed on print
media as well as on electronic
media, so that the
name of the health care
practitioners and hospital
on whom allegations are
made regarding Nursing
and Medical negligence
should not be exposed till
he /she is found guilty and
is convicted by the court
of law.
Prevention of Error
Several suggestions are
made for reducing error.
Leape suggests that many
health care delivery systems,
especially in hospital
could be redesigned to significantly
reduce the likelihood
of error.
1. Reduced reliance on
memory by using checklists
protocols and computerised
decision aids
for prescription writing.
2. Improved information access
with availability of
computerised medical
record at bedside.
3. Error proofing - use of
forcing function in computer
programmes so
that a physician cannot
enter an overdose or prescribe
a medication to
which the patient is allergic.
4. Standardisation of drug
doses and time of administration,
of information
displays, equipment and
supplies location in hospital.
5. Training of doctors, nursing
and other staff in safe
practice.
For the individual nurses following
strategies appear prudent.
1. Read prescription care-
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fully. Physician’s prescriptions
are at times illegible
and lead to litigation
and medication errors.
2. Medication errors occur
due to mistakes (knowledge-
based or rule-based)
and slips of action and
lapses of memory. Focus
on the task at hand.
Knowledgeable and experienced
nurses can easily
identify the mistakes.
3. Be careful while administering
drugs / doses.
Doctor should avoid trailing
zeros e.g. 10.0 mg
which may be read 100
mg.
4. Beware of high-risk
situtaitons e.g. elderly patients
on multiple drugs.
5. Review basic drug-re
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lated information from approved standard textbook.
6. Avoid use of a drug for unproved unlabelled indications
especially where risk of drug use is higher than expected
benefits.
7. Communicate effectively when patients,
families, pharmacists question prescriptions.
Conclusion
Rules and regulations
framed by statutory bodies
must be strictly followed at
all levels. Nursing students,
during their training period,
should be made aware of the
Consumer Protection Act.
Continuing nursing education
programme through
workshops, conferences and
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in-service education courses
to refresh their knowledge
and also to create awareness
among nurses regarding new
technologies in medical sciences,
which will be beneficial
for self-development, to
patient and society at large.
References
1. Joglekar S Kamal. Hospital Ward
Management : Professional Adjustments
and Trends in Nursing,
“The Nurses and law” Vohra
Medical Publication, Bombay-
400031, pp 120, 131
2. Kaur Satvinder (2005). Professional
Adjustment Ward Management
and Trends in Nursing,
“Legalisation in Nursing”, 1st edn,
Lotus Publishers, Jalandhar City,
pp 24-30
3. Kaushal Anoop (2004). Universal
Medical Negligence and
Legal Remedies, 3rd edn, Universal
Law Publishing Co,
Delhi, pp 216
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Health education and
awareness programme
for people should be conducted
through media so
that common man should
be educated regarding intricacies
of human body,
disease and treatment.
This will help in reducing
the litigation cases
against medical practitioners.