Ethical and Legal Issues in Perioperative Nursing

30.1 INTRODUCTION

Perioperative nurses care of surgical patients throughout the continuous perioperative nursing practice,
the professional nurses render direct care through nursing process activities, ensure implementing
specialized activities such as educating staff and peer, support, reassure the patient emotionally, serve
as patient’s advocate, control the theatre environment, provide resources, maintain asepsis, monitor
physiological and psychological status, manage all patient needs, supervise the auxiliary workers in the
theatre, validate and explore current and prospective practice, integrate and co-ordinate the nursing
care across all disciplines, with full collaboration and consultation with perioperative health team
members, where the operation theatre nurse assumes different roles such as theatre manager, nurse
educators, theatre nurse practitioner and theatre nurse researcher and practitioner in hospitals, clinics,
nursing educational institutes, providing competent patient care is the best way to avoid malpractice
and negligence claim, unfortunately even under best possible perioperative nursing care, the patient
may be injured, therefore, legal issues arises, understanding issues interfering in pre, intra and post-
operative nursing will help the perioperative nurse to avoid malpractice and maintain ethics and
standards of perioperative nursing care in the theatre nursing.

30.2 CONCEPT OF PERIOPERATIVE NURSING

30.2.1 Concept of Perioperative Professional Nurse

Any registered nurses who underwent training in operation theatre nursing are eligible to be a professional perioperative
nurse who workouts in the following three phases of perioperative nursing:

Pre-operative Phase:  This phase begins when the decision is

made to do surgical intervention in the patient, where nurse starts
the assessment of patient to identify actual, potential physiological,
psychological, psychosocial and spiritual needs and problems,
determines expected outcome of perioperative experience, the nurse
plans, prioritizes, and initiates the plans to carry out designed
outcomes.

Intra-operative Phase:  This phase begins with placement of the

patient on the operation theatre and continues until the patient is
admitted in the post-operative ward, where implementation and
evaluation continues, nurse plans the nursing care with skill, safety,
efficiency, and effectiveness, assists the doctor, and monitors the
patient survey and handover to post-operative nurse.

Post-operative Phase:  This phase begins with admission of the

patient to post-operative ward, where the patients is observed for
anaesthetic effect, care is taken to monitor the patient’s airway,
ensure and maintain breathing and circulation. This is the phase
where evaluation of nursing care is done.
30.3 ETHICAL AND LEGAL ISSUES

30.3.1 Legal and Ethical Issues Intervening the Perioperative Nursing Care
Any care givers can be filed under law suit, regardless of change of the team, any member of perioperative health team who
are prone for legal and ethical issues, will be sued by law if they violate the legal and ethical principles. There are increased
developments in consumerism, movement focusing on the consumer rights. The public has more awareness about expected
nursing care, quality care, and about the outcome of care given by the perioperative team members. If the patient feels that
there is no good outcome from the perioperative team then the patient can file a case in the court based on the severity of the
injury and the compensation will be given as per the report given by the judge.

There are many issues that affect the perioperative nursing care. They are as follows:

1. Liability issues

2. Borrowed servant rule issues

3. Independent contractor issues

4. Doctrine of reasonable man issues

5. Doctrine of res ipsa loquitur (Latin for ‘the thing speaks for itself’) issues

6. Doctrine of corporate negligence issues

7. Extension doctrine issues

8. Assault and battery issues

9. Invasion and violating privacy issues

10. Abandonment issues

11. Informed consent issues

12. Advance directive issues

13. Documentation issues

14. Drug and medication issues in their use on patients

15. Issues of standards of professional ethics

16. Bioethical issues

30.4 LIABILITY IN PERIOPERATIVE NURSING

All health care providers are liable for their health care actions towards the patients. Throughout the perioperative phase, all
the health care providers should carry out their work according to standards of high quality care, as per laws established by
state practice act, nursing professional organization and also federal law. Every health provider has to follow code of ethics,
legal law, and the rules and regulation framed by federal and state laws.

Any kind of deviation from the standard of care throughout perioperative phase once result in injury or harm to the patient
and therefore, health care providers are liable to be under law suits, will be punished by law as per negligence in the practice
of care. For example, nurse needs to count the sponges used in the surgery, if she/he missed any sponge or any instrument,
the patient’s body is sutured without removing the sponge then the scrub nurse in the intra-operative phase will be held
liable since it is her responsibility. The person who initiates law suit is called a “plaintiff ”.

Factors that lead to the arrival of or causes of plaintiff are as follows:

1. Deliver low standard of care

2. Deviation from duty by omitting any important nursing action

3. Causing any direct injury by deviating from doing normal duty4. Complication faced by the patient due to injury caused by the nurse
Figure 30.2 depicts liability process in perioperative phase that includes the entire illegal practice causing the nurse to be
held in legal suit.

Figure 30.2 Liability process in perioperative phase

 Tort in nursing—Mistakes committed by the nurse for patient.

 Criminal offence—Any crime or act of negligence or malpractice that directly injuries the patient’s life, for example, misinterpreting

the results, giving wrong reports to the doctors carelessness in checking blood pressure of a patient, if the nurse gives result as normal

then believing the nurse if the doctor gives hypotensive drug which further deteriorates the patient’s life then it is a crime.

 Negligence in perioperative phase can lead to deviation of patient’s health, adding to that with malpractice doing substandard care, for

example, not performing proper surgical hand washing that leads to nosocomial infection in the patient.

 Slander—giving a false statement orally about other nurse or any co-workers in the perioperative team.

 Libel—giving a false written statement about other nurses or co-workers to hinder their reputation.

 Outcome of the liability—nurse is held in the law suit if any tort, crime, malpractice, negligence, slander or libel is found, therefore,

held as a defendant.

 Defendant—a person or nurse (here) who has been held as accused in breaking the law, nurses will be summoned in the court, granted

punishment, with penalty, nurse has to pay for the damage which means to pay money as compensation awarded to make restitution for

injury or tort.

 Deposition—will be given by the patient as a formal written statement made by the nurse. If the patient is a witness to any criminal

act, this can be used as a witness statement. Since the patient cannot be presented in the court because of the illness, the written

statement is enough to act as a witness to prove the negligence act in absentia.

The nurse practitioner with more experience who leads the perioperative nursing team will be libel in the court if any nurse
from the team has done negligence or malpractice or criminal or tort actions that have injured the patient seriously. If
patient gives a case in the court to get compensation from the hospital nurse, then he/she will be imprisoned and should pay
the penalty as per the damages made.