Avoiding Litigation: Legal-Based Mediation Education for Nurses

Sunday, 27 July 2014

Takako HIramatsu, RN, MSN
Department of nursing, Kawasaki Medical School Hospital, Kurashiki, Japan
Michiko Senda, RN
Department of Nursing, Kawasaki Medical School Hospital, Kurashiki, Japan


In response to an increasing number of litigations relating to medical errors and growing awareness of patients’ rights, training for a medical mediator, who engages in a mediating role in a hospital, is in progress. Mediation is a dialogue based negotiation, and is one of conflict management models, which aims to resolve confrontations resulting from different values and interests held between individuals or nations. Mediation also aims to manage individuals’ psychological and emotional conflicts.

Following the establishment of a medical safety administration department at our institution in 2003, multidisciplinary teams including nurse medical safety officers have taken the lead in tackling prevention of in-house medical errors. The activities included mediation education for nurses, in which the legal aspects of various problem cases were discussed with the guidance from the hospital’s legal advisors. By enabling nurses to act as first responders to a problem using mediation skills based on direct conversation, it was expected that nurses could promote good communication between patient and medical staff prior to escalation of a situation to something serious like medical litigation.

This poster describes our mediation education program. We hope that sharing our experience would facilitate discussion of how to design an effective training program for medical mediators.


Nursing administrators presented problem cases they were personally dealing with and then discussed these cases in groups. The hospital’s legal advisors commented on legal aspects and participants learned how to build good legal and ethical relationships as a nurse.


The first session

In the first session, 20 nursing administrators and 6 legal advisors examined two cases regarding “dealing with family”. Key words included “family registration law”, “legal heirs” and “livelihood protection law”, and the definition of family was thoroughly debated.

The second session

In the second session, a topic of “dealing with a patient’s verbal abuse and violence” was discussed by 22 nursing administrators and 6 legal advisors. Key words of this session were “patient’s competence in decision-making”, “a charge relating to infliction of bodily injury”, and “criminal intimidation”. The nursing administrators received legal advice on how to deal with situations where nurses are exposed to immediate danger. In particular, nursing administrators realized the importance in discussing these issues in nursing and multidisciplinary conferences, if the issue can be solved by medical teams or if patients’ violence and verbal abuse result from their illnesses.

The third and fourth sessions

A further two sessions were held based on different themes. One of the topics was “the right to self-determination”, and nursing administrators discussed the pros and cons of a related advance directive system and a method of writing nursing records during problematic situations were shared. Another topic was medical procedures defined in the Medical Practitioners Acts and Act on Public Health Nurses, Midwives and Nurses. Managerial topics relating to patients’ violence was also discussed. The example included how to document patients’ behaviors, which break the hospital regulations and obstruct nursing practice.


In addition to providing an opportunity for thinking from an ethical perspective, which is integral to nursing, consideration of problem cases from a legal standpoint during discussion with legal advisors enables nurses to acquire the skills to not only build relationships with patients but also protect themselves as nurses. The outcomes of this educational program have not yet been evaluated. However, it is expected the continuance of this educational program would lead to desirable changes in the behaviors of nursing administrators.