Clinical Notes

involved. This group of patients occupied a four-beddedbay, the fourth bed space being empty.

After obtaining the necessary information for assess-ment the patients were made comfortable. A supportivetherapy group session was conducted which consisted ofsimple controlled breathing techniques, progressivemuscle relaxation and therapeutic/holistic foot massage.This was accompanied by the sound of a 'New World'tnusic tape. - j f lMio* blsjuw

As Irene had no previous experiences in this form ofsupport I was surprised to observe how well she managedwith the progressive rnuscle relaxation. Linda was doingwell and needed little instruction; however, this was herfifth session. Sarah, however, scetned to be finding it quitedifficult even with further guidance. Irene's feet were veryrelaxed during her massage. During Sarah's massage herfeet held little tension; however, her body appeared to bevery tense. Afterwards Litida commented that she likedthe session very much and contitiucd by sayitig that shewas very tired, was going to have a sleep. She then slept foran hour.

Sarah cotntnented that she had never been aware of sotnuch tension in her body, she laughed and said that herfeet were relaxed but the rest of her was tense. Sarahexplained to me that although she knew the theory andvalue of progressive tnuscle relaxation she foutid it verydifficult to put in to practice. She commented in heropinion 'nurses are alike, they find it very difficult toreceive care'. Sarah asked tne in-depth questions aboutstipportive therapies includitig cfiects and responses. Igave her instruction on some sitiiple breathing exercises forher to practice.

I had known Iretie for over a year and at almost everyadmission had been her associate nurse. I was totallyunprepared and touched by Irene's spontaneous reactionfollowitTg this simple session. She spoke to tiic on acompletely different level than she had done before. Shetalked about how she felt about many issues including herfamily, friends, religion and death. In previous situationswhilst nursing I recall observing certain views frompattents ready to talk about their fears and personal life.With the use of intuition, together with some insight andskill, I've usually been gradually able to facilitate suchopenness. In Irene's case her respotise was one of spon-taneity and without the cues I had once been familiar with.Whilst at ease and comfortable with this conversation I didwonder at the time, however, how a less experienced nurseWould deal and cope with Irene's itnmediate response.Although Irene didn't actually cry or come close to tearsshe was very emotional and continued to make reference tothe session over the following days to staff and other

patients. Irene told me she felt 'as if a huge weight hadbeen lifted off my shoulders' and her manner was that ofelation.

Irene went on to develop her new found skills inrelaxation and stated confidently 2 weeks later, that ithelped her to cope in every way. She continued to talkopenly and although confident she viewed her prognosisrealistically. Voicing her doubts about the future Ireneexplained to me that this time she didn't think she wouldget better. One afternoon 3 weeks following her firstsupportive-therapy session, she told me at length about thedecisions she had made concerning her family.

Although I feel there is much to be learnt from thisparticular experience I will concentrate on the assumptionsand preconceived ideas I had automatically made prior tothe session concerning Irene. Initially I assumed thatalthough Irene would probably enjoy the massage it wouldhave no great therapeutic effect. Two years later I now findthis very hard to believe. Although I included Irene in thesession I have to admit that inwardly I was half-hearted inthe attempt. Outwardly I believed I was professional withthe approach and I felt I appeared to give as much supportto Irene as Linda and Sarah. On reflection I realize I hadprejudged Irene and made an assumption about her whichproved to be quite incorrect. This experience led to furtherscrutiny of my practice and I became more aware of myperceptions of patients in many situations. I found that Icontinued to make assumptions and I am repeatedlyenlightened by most patients responses although now I ammore prepared for the enlightenment.

Gone the 'Good Samaritan'!: resusci-tation and litigationSIMON COOPER BA, RGNDistrict Resuscitation Training Officer, Plymouth Health Authority,Derriford Hospital, Derriford Road. Plymouth, Devon Pl.b HDH

Frotii a variety of publications over recent years it appearsthat tiiedical professionals are becoming increasingly para-noid over litigation, especially in the area of bystanderintervention. One recent article even implied that allnurses, in whatever speciality they are trained or whereverthey work, should be competent and efficient at a resus-citation attempt, while it is common to hear that manypeople would be loath to stop to help a casualty 'in casethey were sued'.

One has to be t ealistic. This fear of the law is totallyunjustified especially as recovery of damages cannot be

Clinical Notes

based on an undesirable outcome alone. There must beproof that the 'aider' acted negligently and that thenegligence was the cause of the injury, with immunity forthose acts carried out in good faith and not involving grossnegligence or wilful, wanton or reckless misconduct.

British law relies on the definition of 'reasonable be-haviour'. Of course the definition of 'reasonableness' canbe highly subjective, but in general it is interpreted as'doing ones best'. If an individual is highly trained inresuscitation skills it is 'reasonable' that they should notmake too many mistakes. Conversely, nurses who havebeen working as hospital managers for 10 years would notbe expected to perform to a very high standard, eventhough they are 'a nurse'. Medical personnel all have theirareas of expertise and cannot be expected to have expertknowledge in all aspects of medical treatment and care.

In the case of negligence, tortious liability is thereforeentirely dependent on whether the defendant has done oromitted to do what would be expected of 'a reasonableman/women in the circumstances' (Martin, 1973). Anyonecan make a mistake, however, remember that mistake mustbe 'reasonable' under the circumstances.

The real issue lies with those who talk away and neglecttheir moral duty to assist. In the UK there is no commonlaw duty to render assistance, unlike in many other legalsystems. In the USA, for example, it is a serious offenceunder the penal code not to render a.ssistance —'The GoodSamaritan Act'. However, General Practitioners, for ex-ample, coming across an unconscious person within theirown practice boundaries, may be in breach of their NHS

terms and conditions if they do not render assistance(BMA, 1992). >(l) ,!jy

There may not be a legal duty to act positively for thebenefit of others, however, 'an adult who stands by andwatches a child (to whom he stands in no special relation-ship) drown in a foot of water may have to answer to somehigher tribunal somewhere, sometime, but he is notaccountable to an English court, though he has omitted todo what most other men would for others' (Rogers, 1984).

By far the majority of health-care professionals have hadextremely limited training in resu.scitation, therefore ofcourse it is 'reasonable' for a few mistakes to be made. Thefear of litigation should not be allowed to dissuade peoplefrom their moral duty to render assistance. It is clear thatmany doctors and nurses are out of touch with setresuscitation standards, training is not always available andin the present climate there are few resources to enableupdates to be carried out at regular intervals.

A nurse working in a department where there is rarely acardiac arrest and where there is limited resuscitationtraining available, cannot be expected to perform to a highstandard, despite their professional title, yet should notneglect their moral duty to render assistance to the best oftheir ability.

References

BMA (1992) Rights and Responsibilities of Doctors. BMA, London.Martin C. (1973) Law relating to Medical Practice. Pitman Medical,

London.Rogers W. (ed.) (1984) Tort, 12th edn. Sweet and Maxwell, London.