8/3/2019 PHC (Nursing Negligence Case)

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Case # 2: Patient Left Unrestrained, Patient Injured. Nurses Judgment Call.(SOURCE: http://www.nursefriendly.com)

Summary: The decision to use or not use restraints must be made with caution and goodjudgment. Their intended purpose must be to protect either the patient or others who may

be injured by the patient including the staff caring for the client. The ultimatedetermination of necessity is left with the physician. Often, the moment to moment

necessity is determined by the nurse. In this case a nurse did not feel restraining thepatient was necessary. When an injury occurred, the patient sued.

The patient was involved in a motor vehicle accident. A head injury was suffered leaving

him in a state of confusion and prone to agitation.

Following the head injury, the patient was visibly confused and frequently becameagitated. During the course of his admission, an order for "soft" wrist restraints was

obtained and implemented to protect the patient from injury related to mental status

(personality) changes.

On the day of the incident, the nurse on duty had assessed the patient. In her professionalopinion restraints were not needed.

She based this decision on her observation of the patient's mental, physical state and level

of consciousness. It is common procedure and protocol in facilities for patients to be

released from restraints when the danger of violence is felt to have passed.

Later in the shift, the same nurse was helping the patient get up. In the course of this

maneuver, the patient fell and claimed that an injury was sustained.

A lawsuit would be filed against the facility alleging negligence on the part of the nurse.

The patient contended that the removal of the restraints breached standards of care.

In the initial trial, the jury was instructed to view the nurse's role as an "error injudgment." Based on this and on testimony on the proper use of restraints, standards of

care, the court found for the facility.

The patient appealed.

Questions to be answered:

1. Was the nurse in error to remove the restraints from a patient when she felt they wereno longer needed?

2. Did the removal of the restraints directly contribute to the "injury" that the patient

claimed to sustain?

3. Were the standards of care governing restraint use adequately maintained?

8/3/2019 PHC (Nursing Negligence Case)

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