Evan is a psychiatric nurse working on an inpatient floor in a general community hospital. Mr. Girardi has been in a car accident, which has landed both him and his daughter in critical care. Because of Mr. Girardi’s extensive injuries, his physicians prescribe that he be put on light sedatives that do not induce coma but keep him sleepy and calm. They simultaneously decide to not immediately inform him of his daughter’s critical condition. The rationale for both decisions is their concern that he not cry, which would cause extended damage to his perforated lung. Mr. Girardi is kept drowsy and motionless and as pain-free as possible. He has asked about his daughter, but when told that the staff will check on her, he is satisfied with that and drifts back to sleep.
 

Mr. Girardi’s wife arrives to stay with him. It is 3:18 a.m., and Evan has just administered Mr. Girardi a sedative through his IV set. Mrs. Girardi tells Evan that her husband took his last “kidney stone pill” at 6 p.m. with his dinner before he and his daughter left the house. “He’s overdue for that kidney stone pill,” Mrs. Girardi says. “He’s not supposed to skip that.”
 

Evan says, “He shouldn’t take anything else right now, but I’ll check that out.” She assures Mrs. Girardi that she’ll ask the doctor about that and leaves the room.
 

Fifteen minutes later, Evan returns, explaining that she consulted with the hospital surgeon, who checked with Mr. Girardi’s urologist. The urologist confirmed that the “kidney stone pill” was a painkiller, which, under the circumstances, should be discontinued as long as Mr. Girardi is on the more powerful IV sedatives.
 

“Oh, that’s okay,” Mrs. Girardi tells Evan. “He woke up a bit while you were gone, and I was able to give him his pills.”
 

Mr. Girardi suffers moderate complications from the IV sedative and oral analgesic combination, which extends his hospital stay by 2 days. The Girardis feel the hospital should have been in better control of the overdose, saying that if the staff had been on top of things and supervising more closely, this would not have happened.

1. In the case of Mr. Girardi, do you think this case is most concerned with a cause, in fact, proximate cause, or foreseeability of harm? 

2. Explain your rationale for your answer to Question     

  Include scholarly evidence to support your answer.