Date: February 6-8, 2014

Clinical Area: ER 7
3
I was assigned to ER for the first time in this rotation. I expected it to be tiresome
because of course we were to handle emergent cases that require us to work efficiently.
Out of these days, I have experienced nursing procedures that Ive never done before
such as Pre-operative skin care (AP), Urine Catheterization of Male and most
importantly Cardio Pulmonary Resuscitation (Chest Compression).
A1.
I felt great and pleased after accomplishing the tasks that Ive had to do. As to be
expected, I felt nervous at first when I was about to start shaving the site of the patient. I
did not also do well because I embarked cuts on my patient and I knew it pained him
despite the denial he gave me. Doing CPR proved to be exhausting and concerning
because as I was doing chest compression, I had to remember that if I do it intensely
then I might end up inflicting rib fracture on the patient.
A2.
If I were to evaluate myself, I could say that I have done quite a good job. The
bad thing was that as Ive said earlier I embarked cuts on the skin of my patient while
shaving and also despite the efforts that we had put in reviving the patient by means of
doing chest compression, the output was still not good. But despite these, there were
also a couple of things Ive done quite well like working in the triage in collaboration with
the staffs assigned in there during the first and second days of the rotation and
monitoring closely the situation of my assigned patient in the CIU during the last day of
the rotation.
A3.
Out of the exposure I had in the ER, I have come to realize that if one desires to
be an emergency nurse, then he/she must be fully equipped not just with the knowledge
acquisition but more importantly with psychomotor skills. I have also learned that a
delay in nursing/medical intervention will result to a faulty nursing care that leads to the
detriment of the patient just like what happened back then. As what I have observed,
the condition of the patient seemed to be deteriorating (weak pulses, active bleeding as
evidenced by having hematochezia etc). These findings were reported by my classmate
assigned to that patient to the NOD. The NOD then asked the watcher if she would want
to consent the intubation of the patient. And I heard her say YES. But it took quite few
hours for the patient to be intubated. I dont really know the reason behind the delay but
regardless of the reason, it was still obvious that the fault lies in the hand of the health
team. Though he was intubated, it was still too late.
A4.
To better cope up with the situation, I think it would have been better if the priority
actions have been intervened quickly. It would not have turned that way. I mean the
death of a patient just shows in one way or another, that an ineffective or poor nursing
care was given to the patient.
A5.
With the actions Ive rendered in the clinical area, the best action that I think Ive
done was doing chest compression to the patient because as we all know, it is an
attempt to save someones life. I know it was devastating that despite the efforts put in
reviving the patient the patient still died. But the thought of doing something to help
counted the most over doing nothing.
B.
Key Areas of Responsibilities with Core Competencies (Head Nursing)
Competency Standards Gained Competency Standards to be Developed
1. Safe & Quality Nursing Care
CC 2: Provides sound decision making in the
care of individuals
CC 4: Sets priorities in nursing care based on
clients needs
CC 5: Ensures continuity of care

1. Safe & Quality Nursing Care
CC 1: Demonstartes knowledge base on the
health/illness status of individuals

2. Management of Resources & Environment
CC 1: Organizes workload to facilitate client
care
CC 4: Maintains a safe environmet
3.Health Education
CC 1: Assesses the learning needs of the client
CC 2: Develops health education plan based
on assessed and anticipated needs.
4.Legal Responsibility
CC 2: Adheres to organizational policies &
procedures
CC 3: Documents care rendered to clients
6. Personal & Professional Development
CC 1:Identifies own learning needs
CC 4: Projects a professional image of the nurse
CC 6: Performs function according to
professional standards
5. Ethico-moral Responsibility
CC 1: Respects the rights of individual
CC 2: Accepts responsibility
2.Management of Resources &
Environment
CC 2: Utilizes financial resources to support client
care
6. Personal & Professional Development
CC 5: Possesses positive attitude towards
change & criticism

7. Quality Improvement
CC 1: Gathers data for quality improvement
CC 2: Participates in nursing audits & rounds
CC 3: Identifies and reports variances

9. Records Management
CC 1: Maintains accurate & updated
documentation of client care
CC 2: Records outcome of client care

10. Communication
CC 1: Establishes rapport with client, significant
others and members of the health team
CC 4: Responds to needs of individuals, family

11. Collaboration & Teamwork
CC 1: Establishes collaborative relationship
with colleagues & other members of the health
team
CC 2: Identifies verbal and non-verbal cues



C.
So who then is really responsible and accountable for the death of the patient?
Role responsibility, according to Hart (1968, p.212), arises whenever people occupy a
distinctive place or office in a society to which specific duties are attached. In such
cases they can be said to be responsible for doing what is necessary to fulfil them. It is
important to note that a nurses role is not just about performing particular tasks but also
about issues such as competence and maintaining appropriate standards of care. This
is confirmed in the Code, which states that nurses must maintain and improve (their)
professional knowledge and competence. Similarly, the UKCC document The Scope of
Professional Practice states that nurses must endeavor always to achieve, maintain
and develop knowledge, skill and competence and respond to the needs and interests
(of patients and clients).
Before looking at accountabilitys various meanings, it is important to distinguish
it from the concept of responsibility, with which it is often mistakenly confused. Thus,
one can be responsible for something in the sense that he caused it to happen
without being accountable. Put it simply, accountability is about justifying actions,
explaining why something was (or was not) done. By this, I could say that the NOD has
a legal responsibility to attend to the said patient. But then is she legally accountable for
what just happened? Or is she simply morally accountable for it?
D1.
I did well in the triage unit. I owe it to the staff who was there with me and my
classmate. He explained to us in detail the things that we needed to know and to do just
before the unit was filled with patients for admission. I did not do so well in my pre-
operative skin care in which I have cut the skin of my patient while shaving.
D2.
Id like to keep my attitude of being open-minded which is an integral part in
learning. I know that in my present state, I still have to lots of things to learn before Ill
become a full pledged RN. And to achieve that, I need to eliminate my hesitance and
fear in doing nursing procedures just because I dont have enough confidence and
reliance in my psychomotor skills.
D3.
I learned various things in ER department, things that are surely of significance in
my path of becoming an RN someday. I have experienced doing chest compression
that I was longing to do prior to my exposure to this clinical area. Also, I have learned
the activities of the staff assigned at triage.

Hendrick, J. (2010). Law and Ethics in Nursing and Health Care. Nelson-Thornes Ltd,
6 64-66.

That nurses should study ethics is widely accepted and its inclusion in nurse
education is now commonplace. The burgeoning literature on healthcare law for nurses
is a more recent development but not surprising given that the subject area is now firmly
established as a distinct and important discipline within law itself. In fact the subject has
developed so rapidly in the last decade that legal texts need to be constantly updated to
keep pace with the huge rise in medical case law and the increasing complexity of the
subject. Much less common, but now also beginning to proliferate, are nursing texts that
combine law and ethics.