# Situation: A nurse works in a private lying-in clinic that offers prenatal care, normal births, postpartum care, and family planning services. The nurse assigned to a mother in the first hours after birth missed two of the ordered hourly blood pressure checks; all later readings were normal. After discharge, the mother developed a perineal wound infection that her physician found was unrelated to blood pressure monitoring. The family plans to sue the nurse for negligence. Which element would the family be unable to prove?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in a private lying-in clinic that offers prenatal care, normal births, postpartum care, and family planning services.

The nurse assigned to a mother in the first hours after birth missed two of the ordered hourly blood pressure checks; all later readings were normal. After discharge, the mother developed a perineal wound infection that her physician found was unrelated to blood pressure monitoring. The family plans to sue the nurse for negligence. Which element would the family be unable to prove?

## 보기

1. Duty
2. Damage
3. Causation **✔ 정답**
4. Breach of duty

**정답: 3**

## 해설

Negligence requires duty, breach, causation, and damage, all proven by the injured party. The assigned nurse had a duty and breached the standard of care by missing ordered checks, and the mother did suffer harm (the infection). But the harm did not result from the missed checks, so the breach was not the proximate cause of the injury and the claim fails on causation.

## 심화 해설

Legal framework of negligence in nursing

For a negligence claim to succeed, the injured party must prove four separate elements: duty, breach of duty, causation, and damage [2][4]. Each element is a distinct legal requirement, and failure to establish even one means the claim cannot proceed. In this scenario, the family would be able to prove three of the four elements but would fail on causation.

Why duty and breach are provable

Duty arises from the existence of a professional relationship between the patient and the healthcare provider [2]. The nurse was assigned to care for the mother in the first hours after birth, which clearly established a nurse–patient relationship. Once that relationship exists, the nurse owes the patient the legal obligation to act as a reasonable nurse would under the same or similar circumstances [4].

Breach of duty occurs when the nurse’s conduct falls below the applicable standard of care. The physician ordered hourly blood pressure checks, and the nurse missed two of them. A reasonable nurse in a postpartum setting would follow ordered monitoring schedules. Missing ordered assessments is a deviation from the expected standard, so breach is established [3].

Why damage is provable

Damage refers to actual harm or injury suffered by the patient [2][4]. The mother developed a perineal wound infection after discharge. An infection is a recognized form of harm that can support a negligence claim, so the damage element is satisfied. The fact that the harm exists is not in dispute.

Why causation fails

Causation requires a causal link between the claimant’s loss and the negligent behavior of the defendant [1]. This link has two components: factual causation and legal causation. Factual causation asks whether the harm would have occurred “but for” the breach. Legal causation asks whether the breach was a proximate or sufficiently direct cause of the harm [1].

In this scenario, the physician determined that the perineal wound infection was unrelated to blood pressure monitoring. The missed blood pressure checks did not cause the infection, nor did they contribute to its development. Even though the nurse breached the standard of care and the mother suffered harm, the breach was not the proximate cause of the injury [1]. The causal chain is broken because the type of harm that occurred has no connection to the type of duty that was breached.

Key point! Negligence requires all four elements to be proven together. A breach without a causal link to the harm is not actionable negligence.

Watch out! Do not confuse breach with causation. Missing vital sign checks is a breach, but if the patient’s injury arises from an entirely different mechanism, causation is absent and the claim fails.

Clinical and legal reasoning for the licensure exam

| Element | Definition | Application to this case | Provable? |
| --- | --- | --- | --- |
| Duty | Professional relationship creating a legal obligation to act reasonably | Nurse assigned to postpartum mother | Yes |
| Breach of duty | Conduct falling below the standard of care | Missed two ordered hourly BP checks | Yes |
| Damage | Actual harm or injury | Perineal wound infection after discharge | Yes |
| Causation | Causal link between breach and harm | Infection unrelated to BP monitoring | No |

The family would be unable to prove causation. The missed blood pressure checks were a breach, but they did not cause the perineal wound infection. Because the harm arose from a source independent of the negligent act, the legal requirement of a causal connection is not met, and the negligence claim cannot succeed on this element [1][2][4].References (research sources)

- [1]Factual and legal causation - their relation to negligence in nursing.Research articleTurton G (2009) · DOI: 10.12968/bjon.2009.18.13.43219

- [2]Legal update--1996, Part 3.Research articleFiesta J (1997)

- [3]Defeating malpractice risk, Part 2.Research articleSheehan JP (2000)

- [4]Negligence in the operating room: understanding the law.Research articleSchild SM (1991)

## 임상 시나리오

Negligence in Postpartum NursingWhy causation is the missing element
A negligence claim requires duty, breach, causation, and damage—all proven by the injured party. Missing even one element means the claim fails.

The nurse had a duty through the assigned nurse-patient relationship, and missing 2 ordered hourly BP checks was a breach. The infection is provable damage.

However, the physician confirmed the infection was unrelated to BP monitoring. The breach was not the proximate cause of the harm, so causation cannot be proven.

CautionNever assume that any breach automatically proves negligence. The harm must be directly linked to the specific act or omission, not merely occur in the same timeframe.

## 핵심 개념

- **Negligence** — Failure to act as a reasonable nurse would under similar circumstances, requiring proof of duty, breach, causation, and damage
- **Duty** — Legal obligation arising from a professional nurse-patient relationship to provide care meeting the standard of a reasonable nurse
- **Breach of duty** — Conduct falling below the applicable standard of care, such as missing ordered assessments
- **Causation** — A direct link between the breach of duty and the harm suffered; the breach must be the proximate cause of injury
- **Damage** — Actual harm or injury suffered by the patient, such as infection or other recognized injury

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