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Mrs C was a resident at a nursing home for 10 weeks until five days before she died.  As a result of the  care she received at the nursing home she developed bed sores on her sacrum and heel and bilateral pneumonia from aspiration.  Her daily activities were neither monitored nor recorded properly including what she was eating and drinking as well as her general wellbeing. As the nursing home failed to identify and care for pressure areas, which resulted in pressure sores developing, there was a delay in Mrs C receiving medical treatment.  Although it was unlikely that the poor care had led directly to Mrs C’s death, it certainly made the last three months of her life extremely uncomfortable.  Her daughter, who was alerted to the poor treatment her mother had been subjected to, brought a claim on behalf of her mother’s estate for the poor care she had received at the nursing home.
Think about duty of care and negligence

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What is meant by the term ‘duty of care’ and when does a nurse owe such a duty and to whom ?

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What is meant by the term ‘duty of care’ and when does a nurse owe such a duty and to whom ?

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What is the appropriate standard of care and what criteria determine whether the nurse is in breach of that duty?

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What is the appropriate standard of care and what criteria determine whether the nurse is in breach of that duty?

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A nurse on the way home from work passes a road accident. Do they have an obligation to stop and render first aid ? If they  do stop and help and something goes wrong, would they be liable?

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A nurse on the way home from work passes a road accident. Do they have an obligation to stop and render first aid ? If they  do stop and help and something goes wrong, would they be liable?

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Discuss acting as a "good samaritan"  (Think about duty of care and negligence)

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Nurses know they must have their patients’ informed consent before giving any form of care or treatment but they may not be fully aware of the legal basis behind this and the implications of not doing so. What is informed consent? Why is it important? What does it mean for practice? Think about duty of care and negligence

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In Airedale NHS Trust v Bland [1993] AC 789, Lord Keith of Kinkel stated that “it is unlawful, so as to constitute both a tort and the crime of battery, to administer medical treatment to an adult, who is conscious and of sound mind, without his consent”.

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In Airedale NHS Trust v Bland [1993] AC 789, Lord Keith of Kinkel stated that “it is unlawful, so as to constitute both a tort and the crime of battery, to administer medical treatment to an adult, who is conscious and of sound mind, without his consent”.

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What does this mean? Explain the consequences of giving nursing care without consent. Think about duty of care and negligence.

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Airedale N.H.S. Trust v Bland[1993] A.C. 789House of Lords

Tony Bland was a young supporter of Liverpool F.C. who was caught in the Hillsborough crush which reduced him to a persistent vegetative state. He had been in this state for three years and was being kept alive on life support machines. His brain stem was still functioning, which controlled his heartbeat, breathing and digestion, so technically he was still alive. However, he was not conscious and had no hope of recovery. The hospital with the consent of his parents applied for a declaration that it might lawfully discontinue all life-sustaining treatment and medical support measures designed to keep him alive in that state, including the termination of ventilation, nutrition and hydration by artificial means.

Held:

The declaration was granted.

The court recognised there was the intention was to cause death. Lord goff stated to actively to bring a patient's life to an end is:-
"to cross the Rubicon which runs between on the one hand the care of the living patient and on the other hand euthanasia - actively causing his death to avoid or to end his suffering. Euthanasia is not lawful at common law": per Lord Goff at p. 865 F.

Withdrawal of treatment was, however, properly to be characterised as an omission. An omission to act would nonetheless be culpable if there was a duty to act. There was no duty to treat if treatment was not in the best interests of the patient. Since there was no prospect of the treatment improving his condition the treatment was futile and there was no interest for Tony Bland in continuing the process of artificially feeding him upon which the prolongation of his life depends.

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a duty of care is a legal obligation which any individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be established to proceed with an action in negligence. Nurses owe a duty of care to every patient they look after as everyone should be treated the same as they require to give person centred care. No one should be harmed or treated differently in a bad way everyone patient a nurse is with should be treated by a nurse with a duty of care. They should give a duty of care when they are doing personal care, giving out medications, anything that has anything to do with the patient should be done with a duty of care.

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As a nurse or someone that knows first aid or the basics of first aid it would be their duty of care to stop for the road accident - this would be if there was not anyone else at the scene at the time such as an ambulance. I remember when I done the clinical skills day with Claire and another lecturer and we touched on this - if someone seen you leave the scene of the knowing that you were a nurse they could possibly report you and then this would be taken to the NMC. In addition to this if you had drove past the accident knowing full well that you could have helped and if anything had happened to that individual then you would feel responsible for not stepping in and helping. Me myself as a student nurse would intervene and help as best I could and knowing that I may have had an impact and preserved worsening of their conditions until the ambulance got there

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The term duty of care is about individual wellbeing, welfare, compliance and good practice. A duty of care is a legal obligation which is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. Nurses/ health care professionals must owe this duty of care to their employer, patients, NMC and themselves and everyone deserves to be treated equally allowing them to feel dignified and respected.

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A Duty of Care is defined simply as a legal obligation to always act in the best interests of individuals and others. To not act or fail to act in a way that results in harm. To act within your competence and not take on anything you do not believe you can safely do.
Nurses owe a duty of care to every single patient, health care professionals and the NMC code. It is their responsibility to ensure everyone is treat equally and in their best interests.

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Duty of care is an obligation which is placed upon people to act towards others in a particular way, this should be in keeping with certain standards such as the  NMC standards. The NMC's main aim is to protect the public, they do this by setting out standards for education, conduct, training and performance. If a healthcare professional fails to perform their professional duty of care such as by breaching the code they may be referred to the NMC under the NMC's fitness to practice procedures.
Nurses owe a duty of care to everyone they provide care for as well as every professional they work with, to provide safe, quality and competent nursing care.

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duty of care was absent in this nursing home as the nurses and care assistants have a duty of care towards Mrs C to ensure she is receiving the bast care possible. This was not the case as Mrs C ended up with bed sores as a result Mrs C will have been extremely uncomfortable for a long time. The staff have been negligent towards Mrs C as they seem to have pushed her to a side and not cared for her the way she should have been. They should have noticed to pressure sores and immediately reported it to get medical treatment.They also had a duty of care to record correctly such as her food and drink intake chart, which they never done, some days Mrs C may have gone a day without eating or drinking. Mrs C was badly treated from this nursing home   

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duty of care was absent in this nursing home as the nurses and care assistants have a duty of care towards Mrs C to ensure she is receiving the bast care possible. This was not the case as Mrs C ended up with bed sores as a result Mrs C will have been extremely uncomfortable for a long time. The staff have been negligent towards Mrs C as they seem to have pushed her to a side and not cared for her the way she should have been. They should have noticed to pressure sores and immediately reported it to get medical treatment.They also had a duty of care to record correctly such as her food and drink intake chart, which they never done, some days Mrs C may have gone a day without eating or drinking. Mrs C was badly treated from this nursing home   

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Emylia MH - As a registered or student nurse, you have a duty of care and negligence in accordance with the NMC code to assist people in need of help and first aid.  If you were the first at the scene that was qualified to do so, before emergency services arrived it would be your duty as a nurse to administer first aid to any injured people. If you did not stop and help, you would not only feel responsible for any further worsened conditions but you could be held liable if someone seen you there and not do anything. Nurses registered with the NMC have an obligation to practice effective care. Even if something was to go wrong whilst you were administering care you could be held liable but at least you attempted to help. 

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Emylia MH - As a registered or student nurse, you have a duty of care and negligence in accordance with the NMC code to assist people in need of help and first aid.  If you were the first at the scene that was qualified to do so, before emergency services arrived it would be your duty as a nurse to administer first aid to any injured people. If you did not stop and help, you would not only feel responsible for any further worsened conditions but you could be held liable if someone seen you there and not do anything. Nurses registered with the NMC have an obligation to practice effective care. Even if something was to go wrong whilst you were administering care you could be held liable but at least you attempted to help. 

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Heather Mackay,                  When Mrs C came to this nursing home, the Nurses and health care assistants had a duty of care, which should have involved regular skin checks and if any part of Mrs C's skin had changed this should have been documented and looked at, so if treatment was needed, it could have been given.This could be seen as neglecting the care of Mrs C, as she was a new patient she should have been monitored with food and drink, as not noticing the lack of food and drink Mrs C was having is again neglect of care and not following a duty of care. This may have made Mrs C feel as she was not treated properly and probably lead her to be in pain that could have been treated. 

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Heather Mackay,                  When Mrs C came to this nursing home, the Nurses and health care assistants had a duty of care, which should have involved regular skin checks and if any part of Mrs C's skin had changed this should have been documented and looked at, so if treatment was needed, it could have been given.This could be seen as neglecting the care of Mrs C, as she was a new patient she should have been monitored with food and drink, as not noticing the lack of food and drink Mrs C was having is again neglect of care and not following a duty of care. This may have made Mrs C feel as she was not treated properly and probably lead her to be in pain that could have been treated. 

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Duty of Care: A health care professional for example a nurse is said to have duty of care to a service user, if the nurse is responsible for that service user. That is, the nurse is providing a service to the service user. This means that a health care professional does not automatically have duty of care to a service user or any service user unless the health care provider is delivering or providing a service to that specific service user.

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Duty of Care: A health care professional for example a nurse is said to have duty of care to a service user, if the nurse is responsible for that service user. That is, the nurse is providing a service to the service user. This means that a health care professional does not automatically have duty of care to a service user or any service user unless the health care provider is delivering or providing a service to that specific service user.

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The appropriate standard of care are general guidelines that provide a foundation as to how a nurse should act and what they should and should not do in their professional capacity. Deviating from this standard can result in certain legal implications. Criteria that determines whether a nurse is in breach of the duty is if they breach the code or any of the relating standards as they may be referred to the NMC under the NMC’s Fitness to Practise procedures. Failure to provide patients treatment that meets a standard of care can incur legal liability for any injury or death that results.

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Negligence: Mrs C suffered negligence. To prove this fact of negligence, a duty of care has to be proven. The nursing home had duty of care owed to Mrs C as she had been a resident at the care home for the last 10 weeks. During her time at the nursing home, she would have been registered as being mobile or immobile and in need of extra care. For her to have suffered pressure sores, the staff present at the care home would have left her bed bound for longer periods than expected. A look at the nursing home policy around management of pressure sores would ascertain if the staff were in breach and negligence declared or negligence would be around the management of the nursing home lacking policy around pressure sore management. For they (Staff or nursing home) would not be guilty of negligence if they acted under a practice accepted as proper by a responsible body medically skilled in that area for example NMC. 

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Negligence: Mrs C suffered negligence. To prove this fact of negligence, a duty of care has to be proven. The nursing home had duty of care owed to Mrs C as she had been a resident at the care home for the last 10 weeks. During her time at the nursing home, she would have been registered as being mobile or immobile and in need of extra care. For her to have suffered pressure sores, the staff present at the care home would have left her bed bound for longer periods than expected. A look at the nursing home policy around management of pressure sores would ascertain if the staff were in breach and negligence declared or negligence would be around the management of the nursing home lacking policy around pressure sore management. For they (Staff or nursing home) would not be guilty of negligence if they acted under a practice accepted as proper by a responsible body medically skilled in that area for example NMC. 

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Mrs C's daughter would require a duty of candour from the nursing home if it proved negligence on either the nursing home side or the staff

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Duty of care is a legal obligation to care for others in a certain way that meets the standards of the NMC. Duty of care should be given to everyone, patients, colleagues, employers and yourself. A safe  and competent work practice should be always top priority in health and social care. 

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Duty of care is a legal obligation to care for others in a certain way that meets the standards of the NMC. Duty of care should be given to everyone, patients, colleagues, employers and yourself. A safe  and competent work practice should be always top priority in health and social care. 

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The term duty of care means a moral or legal obligation to protect the safety and well-being of an individual. As a nurse you should act in the best interest of your patients, be respectful towards other people’s views and beliefs and act within your own competence in order to protect your patients and prevent harm. A nurse always owes a duty of care regardless being at work or not, when at work the nurse owes a duty of care to their patients and the families or carers they work with.

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The duty of care is a moral or legal obligation in order to ensure individuals are always safe. Duty of care is to prevent causing harm to other individuals therefore nurses constantly have a duty of care no matter the place, time, individual or situation. The NMC ensures nurses have a duty of care as it sets out regulations in which nurses have to follow in order to treat individuals with respect and dignity as well as causing them no harm. However if a nurse is not physically fit to undertake a particular activity they should be aware that if they do take part in this activity it could have an impact on the safety of the individual's care.

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An article on the Nursing Times reads that legally nurses are not obliged to help out, in the eyes of the law they have no more responsibility than any other member of the public. However, until recently the NMC code stated that nurses had a duty to intervene where ever the crisis happened. Only this year was this removed and now states that as a nurse you are expected to 'provide a high standard of practice and care at all times, making the care of people your first concern'. It also states as a nurse you must be able to demonstrate that you have acted in someone's best interests if you have provided care in an emergency. Nurses feel a moral duty to intervene, however they do so without their employers backing. The NHS indemnity for example covers nurses in the workplace but not out of the workplace.

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Battery occurs in healthcare when a service user's refusal of treatment is over ridden or if the service user does not know what they have consented to.

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Battery occurs in healthcare when a service user's refusal of treatment is over ridden or if the service user does not know what they have consented to.

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In order to get consent from a service user, their autonomy must be upheld. The reasons for obtaining consent from a service user is not to be used as a defence mechanism by the nurse, but to form a therapeutic relationship that will ensure the service user freely agrees to all treatments intended to be carried out, after an explanation about all the treatment and touching will occur to the service user has been relayed by the nurse. Failure for the nurse to do this will result in trespass to the person and actionable in law as in William v East London and City.

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Duty of care requires healthcare professionals to respect the patient’s wishes first and foremost. A patient needs to give consent to any treatment or medical procedure presented to them as an option. If the patient is deemed capable to make decisions for themselves then their decision regarding accepting or rejecting treatment needs to be respected, even if the decision seems controversial or unwise. If the decision is taken on behalf of the patient, under the Mental Capacity Act 2015, it needs to be in patient’s best interest. In Mr Bland’s case, his family and doctors decided that continuing artificial nutrition and hydration was not in Mr Bland’s best interest as there was nothing that could be done to improve his condition (persistent vegetative state). Therefore, removing the life-sustaining treatment is seen the same as not initiating the life support in the first place and classed as omission and not as breach of duty of care. 

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Duty of care was absent in the case of Mrs C’s Care, due to the lack of regular observation and monitoring of tissue viability and recording of her food and fluid intake. An obvious lack of proper documentation omitted, and any concerns had not been escalated leading to a series of failings by staff.

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Duty of Care is about individual wellbeing, welfare, compliance and good practice. For nurses the NMC Code is something that can be followed to ensure the best practice for everyone involved, patients, family of the patients and even colleagues. As a nurse we owe every individual around us a duty of care in order to provide the best practice for everyone.

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Informed consent means that the Patient has understood the procedure they're about to undergo and have been given all the relevant information about the procedure with possible side effects and outcomes and are fully aware of what the procedure entails and is happy for it to go ahead. Informed consent is always very important because each individual always has the right to withdraw from any part of their care and they always have the right to do what they wish with their care, Informed consent means that the specific individual has been given all of this and is still happy to go along with the procedure and they understand the pros and cons in doing so. In terms of practice, if a patient doesn't give you a form of consent whether that be written or verbal you must not undertake any procedure or change/interfere with their care, as they haven't given you any form of permission to do so. All you can do as a professional is give your professional opinion if in the best interest of the patient and give them all the relevant information they need to know involving their care/ treatment and the outcomes of receiving or not receiving that you're wanting them to consent to. We as professionals have a duty of care to that patient and everything we do must be at the best interest of the patient.

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Informed consent is the principle that requires clinicians to provide sufficient information to patients in order to render their consent. Patients should receive enough information to make an educated decision about their treatment They should be informed of any risks, alternatives and possible benefits of any treatments. Since no one can guarantee positive outcomes in healthcare settings, informed consent at least ensures patients understand the risk they undertake with treatment. Informed consent in practice creates trust between the healthcare professional and patient by ensuring good understanding. Information should be given to patients well before any procedures or treatments start, so patients don’t feel pressured and that they decide the best option for themselves. As healthcare professionals in practice, they have a duty of care to provide patients with sufficient information before gaining any consent. Patients should only consent to procedures and treatments solely on their own beliefs, others shouldn’t have any influence on this decision. If patients don’t give any form of consent, any treatments or procedures shouldn’t be performed. As a professional, you must accept this and continue to think about the next steps, with the patient’s best interests in mind.

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For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. There are a few exceptions when treatment may be able to go ahead without the person's consent, even if they're capable of giving their permission. A person may be being kept alive with supportive treatments, such as lung ventilation, without having made an advance decision, which outlines the care they'd refuse to receive.
In these cases, a decision about continuing or stopping treatment needs to be made based on what that person's best interests are believed to be.
It is important to gain consent in case you become liable for something going wrong, from having consent it means the patient understood any of the possible risks that may occur.
Alicia Skowronek

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Duty of care is a legal obligation to act in the best interests of others and not act in a way that causes harm. It is imposed on a nurse when it is reasonably foreseeable that something might cause harm through their actions.

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A duty of care is a legal obligation in which professionals must be able to provide to all individuals, it's a standard of reasonable care which should be followed whilst carrying out acts which could potentially harm others. Nurses should ensure a duty of care to patients, the public, work colleagues, the Nursing and Midwifery Council and themselves.

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Duty of care is defined as an obligation to act in a specific way towards other individuals to an expected standard. For example, a nurse or healthcare professional is expected to treat every patient with the upmost respect and provide the best care according to their ability, whilst adhering to the NMC Code of Conduct.
Charlotte F

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There are different types of obligation in this scenario: legal, moral and professional. In the UK, nurses are not legally obliged to stop and render first aid in the event of a road traffic accident. However, from a moral and professional perspective, they are expected to offer assistance in an emergency, and this is reflected in paragraph 15 of the NMC code.

If the nurse stops to help and something goes wrong, they may be liable, but this is dependant on the circumstances and also how the “wrong” specified in the question has been defined. The duty of care starts when first aid is begun, and the nurse is potentially liable from this point onwards. If the nurse acts within the limits of their knowledge and competence and can justify their clinical decisions, it would be difficult to prove that there has been a breach in the standard of the duty of care owed.

Nursing unions including the Royal College of Nursing offer an indemnity scheme as part of their membership. This covers volunteers, those who are self-employed, bank/agency staff and those acting as a “good Samaritan”.

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Informed consent is when the patient is fully aware of the procedure they need, including the possible risks and side effects, and have given their full consent for the procedure to go forward. Informed consent is important as it ensures the patient has full knowledge of what is going to happen to them during their procedure which can help them feel happier and more comfortable for the procedure to go ahead. In practice, without consent from the patient no care can take place even if the care is life saving, duty of care is important here because as a professional all you can do in a situation where consent has not been given is provide the patient with what you think is in their best interest and provide them with all relevant information to help them feel more comfortable with what is going on and may help them feel more at ease with giving consent for their care to go ahead.
Louise W

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The term ‘Standard of care’ has been and is debated among health professionals for many years. There are many legal cases and history as well as definitions of ‘standard of care’.

Personally, an appropriate standard of care is when all health professionals are open and honest with patients, even when something goes wrong with treatment or has potential to cause to harm. Part if the NCM Code of Conduct, ‘Preseve Safety and Pracise Effectively’ explains what this means for health professionals (NMC, 2018).

Being in breach of this duty of candour can be split down into four sections;

·         Communicate with the patient and/or family when something has gone wrong

Apologise for what has happened

Offer an appropriate support, or remedy (if that is possible)

Explain the short and long term effects to the patient and/or family

All health professionals must support and encourage each other to be open and honest, and not stop someone from raising concerns. This is also another way where a breach of duty could be recognised.

Reference - NMC Code of Conduct, 2018, Pages 9-17, London

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Duty of care has not been provided to Mrs C in this nursing home as the nurses and health care assistants have made her quality of life poor as they have no looked after her in the way that they should of. They have not checked her skin regularly as she has had many pressure sores therefor they have not given her the correct pressure care. Mrs C had been aspirating which shows that she was not on the correct diet and should have been assessed also none of the this information had been documented such as the pressure sores or when Mrs c had been given pressure care, if this had been  done some of the sores could have been prevented making the last few weeks of her life more comfortable. No concerns had been raised by any staff and no correct documentation or recordings had been made therefor resulting in the duty of care being absent. 

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Duty of care has not been provided to Mrs C in this nursing home as the nurses and health care assistants have made her quality of life poor as they have no looked after her in the way that they should of. They have not checked her skin regularly as she has had many pressure sores therefor they have not given her the correct pressure care. Mrs C had been aspirating which shows that she was not on the correct diet and should have been assessed also none of the this information had been documented such as the pressure sores or when Mrs c had been given pressure care, if this had been  done some of the sores could have been prevented making the last few weeks of her life more comfortable. No concerns had been raised by any staff and no correct documentation or recordings had been made therefor resulting in the duty of care being absent. 

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A duty of care is the obligation a nurse has to her patient or client to act towards them in accordance with the standards of the NMC Code of Practice. The nurse should take care to act in a way, or not to omit anything, that she could reasonable forsee would cause them harm

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As a student nurse we have the skills and knowledge to help an individual if they were in need of first aid. I believe along with a duty of care to help in any way possible, we would also feel morally bound to help. This runs in line with the NMC code of conduct and values we should posses. As long as we follow our training we will not be legally liable if something goes wrong because, we have tried to help the individual.

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As a student nurse we have the skills and knowledge to help an individual if they were in need of first aid. I believe along with a duty of care to help in any way possible, we would also feel morally bound to help. This runs in line with the NMC code of conduct and values we should posses. As long as we follow our training we will not be legally liable if something goes wrong because, we have tried to help the individual.