A review and response to questions.

https://www.qsen.org/post/the-lewis-blackman-story

1. What does professional accountability mean to you?
   1. To me Professionally accountability coincides with a responsibility that we have and that we owe to our patients and the people that we treat.  Nursing is held in high regards as the most trusted profession.  In choosing nursing as my profession, I know that I am expected to be proficient, knowledgeable, and capable to provide care.  This is a life-long process of learning and growing to become better and to advance the field of medicine as we advance with it.  We hold ourselves to high standards as that is we vow to provide the best care to the all the people.
2. How do health professionals demonstrate:
   1. A feeling of accountability for the reliability of the system in which they work?
      1. Peer review would be a large aspect of accountability and reliability.  I have found that I am driven by the people who I work with and surrounded by daily.  There is a sense of pride as the field of nursing is nurturing and inspiring.  We all have different skill sets and a common one is that we can empathize and inspire.  By being held accountable we are not judged, but we are encouraged to grow individually and ultimately grow the system which we are all a part of.  The growth of the system comes from within, the expectations are for all of us to grow together and become stronger as a collective team of healthcare professions.
   1. Lack of accountability for the reliability of the system in which they work?
      1. A lack of accountability is a dangerous thing.  While accountability should be used as a tool and should nurture growth and development of skills, the lack of it could create regression.  A healthcare system with a lack of accountability would allow people to hide mistakes and allow for people who do not truly care of their quality of work.  People rely on healthcare in a heavy way, the situations that are presented to healthcare employees are dire and very likely fatal.  With such high expectations there must be accountability in order for people to rely on the system.  Just like as a nurse we do not know who is on the other side of the curtain and what scenario will be presented, the converse is true, and the patient does not know the nurse or provider.  The patient has faith as well as expectations that the healthcare system and the providers are capable, able, and willing.
3. Helen Haskell describes nurses focused on task completion (including documentation of a plan of care) rather than on accurate assessment, application of knowledge, listening to patient and family, and action on the patient’s behalf. How accurate is her depiction of nursing care you have observed? In instances where you have made similar observations, what contributes to this “misplaced” work focus?
   1. In the case of Lewis Blackman Helen Haskell emphasizes the lack of advocacy.  The nursing staff went to lengths to not listen to and not act upon the patients’ requests.  The nursing staff had their own agenda and view of how the situation was and how they were going to treat it.  The nurses overlooked the family’s insight and their needs.  There was a lack of acknowledgment and response which created patient provider divide.  The nursing staff had been going through the motions.  I have been fortunate enough in my limited clinical experience to have not experienced this.  In all my clinical scenarios when the family or patient has a request it has been followed up on.  I think this is a nursing fundamental.  As the patient and family knows themselves the best and they need care.  Although they do not have the medical expertise that nurses and providers have, their needs should be met as they are requested.  By using evidence-based judgment we can explore their needs and fully assess the situation that is being presented.
4. Describe what happens in your current health care setting if someone is involved in an error?
   1. Accountability in my experience has been met with openness as opposed to what I have seen in my past career.  Typically, the word accountability has meant punishment for actions.  What I am experiencing now in nursing is that accountability means that there is an issue that needs to be learned from and everyone can grow from it.  Of course, in scenarios of nursing torts there are repercussions.  From my experience the situation is examined to see how this error can be prevented and how to move onward and upward from it.
5. What errors happened in Lewis’s story?
   1. In the case of Lewis Blackman, he was provided too much ketorolac and too little IV fluid.  This medication error was followed by a larger error of the nursing staff not listening to the concerns of the family.  The nurses involved were carrying out their actions with little attention to details.  They overlooked what the parents had to say and seem to have imparted ego.  This resulted in them ignoring warning signs that the patient was not tolerating the medications.  Patients and their families are the most knowledgeable about their own bodies and their baseline of comfort vs discomfort.  It is important for a nurse to work with the family to provide the best care.