The educational role of home health and wound care nurses

Most everyone realizes that healthcare is now multidisciplinary. The lines are sometimes blurry between roles and tasks of physicians versus registered nurses, nurse practitioners, and physician assistants.

In some settings, such as home health nursing, responsibilities may even be shared between a nurse and the patient or an unlicensed caregiver. We are currently working on a case where this is an issue.

Our client received home health nursing to assist with a surgical wound following an open cholecystectomy, which is a surgery to remove an inflamed and infected gallbladder. The home health nurse is the only provider who documented using a specialized form of wound packing material called iodoform gauze, which is designed to be removed a day or two after use.

Around two years after the gallbladder procedure and the wound was felt to have healed, our client experienced pain at the prior surgical site and noticed that the area was red and inflamed. She returned to the hospital and was taken to surgery after imaging showed something suspicious in that area. Lo and behold, the surgeon removed a very long piece of iodoform gauze.

When things like iodoform gauze are accidentally left behind, they act as magnets for infection. That’s what happened our client. An infection slowly developed over time until it smoldered and led to sepsis. She nearly lost her life.

We filed a medical malpractice lawsuit against the home health nursing agency on our client’s behalf. Their defense is to blame the patient and her family. (Incidentally, early in my career I defended hospitals and physicians, and learned that it’s a very risky proposition to blame the patient and family plaintiffs in a medical malpractice trial).

The basis for defense argument is that part of the plan of care called for the nurse to provide patient and caregiver education on the use of iodoform gauze. The first problem with this theory is that there is no documentation that it ever occurred.

The wound care nursing expert whom we retained to review the case identified another issue with the argument that it was the fault of the patient and family. You see, the standard of care requires nurses performing patient and family education to use the “see one, do one, teach one” approach. I love the way this educational technique is described, because it’s so self-explanatory.

It’s not enough for a nurse to explain or teach an element of care verbally, when there’s an expectation that the patient or an unlicensed caregiver will perform the task independently. Instead, the standard of care requires the nurse educator to demonstrate the care (see one), then have the patient or unlicensed caregiver repeat the care independently (do one), and finally have the patient or unlicensed caregiver explain the care again as if teaching it (teach one).

When followed, this excellent nursing technique distinguishes between a lecture and communication. A lecture may not be comprehended, but with true communication the message gets across. This is also useful tool for patients and family members to know about. When being educated by healthcare provider, asked to use it to make sure that you understand what’s expected of you.

When home health nurses ignore this educational requirement, they needlessly place their patients at risk. Plus, while nurses are allowed to delegate certain tasks to unlicensed individuals, they remain responsible for supervising what they've delegated.

If you’ve been seriously injured because of poor hospital, physician, or nursing care in Texas, then contact a top-rated experienced Houston, Texas medical malpractice lawyer about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.