Chapter 1 The Accident and Imergency

Chapter 1
The Accident And Emergency
1.1 Reporting, Record, Documenting
An emergency department (ED), also known as an accident &

emergency department (A&E), emergency room(ER), emergency
ward (EW) or casualty department, is a medical treatment facility
specializing in emergency medicine, the acute care of patients who
present without prior appointment; either by their own means or by that
of an ambulance. The emergency department is usually found in
a hospital or other primary care center.
Due to the unplanned nature of patient attendance, the department

must provide initial treatment for a broad spectrum of illnesses and
injuries, some of which may be life-threatening and require immediate
attention. In some countries, emergency departments have become
important entry points for those without other means of access to
medical care.
The emergency departments of most hospitals operate 24 hours a day,

although staffing levels may be varied in an attempt to reflect patient
volume.
A. Report
The purpose of the report is to be transmitted valuable

information to a person or a group of persons. A report, either oral or
written, ought to be brief and to include all the relevant information,
without further details. Moreover, the report during the change of
shift and the report through the telephone, can also include the
exchange of information or ideas with other colleagues and other
professionals of the health system relatively to the care provided to
the patient.
 Report of the shift change
1 | THE ACCIDENT AND EMERGENCY

The report of the shift change is the report that is given to all the
nurses of the next shift. Its purpose is to provide constant care to the
patients, giving to the employees of the new shift a brief summary of
the needs of the patients and instructions for their care. The reports
during the shift change can be given written or orally, either by
personal communication between the nurses or by a recording
cassette. The report person by person allows the listener to make
questions during the report. The written and recorded reports are
usually shorter and less time is wasted
 Nursing visits
The nursing visits are processes in which two or more nurses visit
selected patients.
During the visits the nurse determines records a brief summary of
the nursing needs of the patient and the interventions which have
been applied. The nursing visits offer advantages to the patients as
well as to the nurses. The patients can participate in the conversation
and the nurses can observe again the patient’s health situation and
the equipment that is required.

B. Record
Recording Systems of the Nursing Care

There is an important number of recording systems, which is used
today:
1. The recording focused on the source
2. The recording focused on the problem
3. The recording model problem-interventionevaluation (ΡΙΕ)
4. The focused recording
5. Charting by exception
6. Recording to the computer
7. Case Management
1. The recording focused on the source
The most widely used data recording method is the one that
takes place based on the source of information. Each person or
professional branch manufactures symbol systems for a specific
area or pieces of the patient’s diagram. For example, the entry
department has an entry leaf, the doctor has a medical background
leaf, instruction leaves and progress notes. Nurses use the nursing

notes and the other professional branches, which are occupied with
the patient, have their own files .
In this type of recording, information over a specific problem
is distributed all over the file. The descriptive diagram constitutes a
common department of recording based on the source. This consists
of written notes which include the routine care, the usual results of
it and the patient’s problems. The registrations based on the source
are useful because those who provide care can easily locate the
forms in which they are going to record the data and it’s easy to
discover some specifically registrated information. The
disadvantage is that the information related to a problem is scattered
all over the diagram, and as a result of that it’s difficult to find
chronological information over the problems and the patient’s
progress.
2. The recording focused on the problem
At the registration focused on the problem, the data is
recorded according to the problems of the patient and not the source
of information. All the members of the therapy group complete the
problem list, the care plan and the progress notes.
The plans on each active or possible problem are stereotyped
and the progress notes are recorded for each problem. The
advantage of this recording method is that: a) it encourages the
collaboration and b) the list of problems at the first part of the
diagram sets on guard those who provide care to the patient’s needs
and that way it’s easier to observe the situation of each problem.
The disadvantages are that (a) people who provide care vary on the
ability to use this type of registration, (b) plenty of time is
demanded to complete daily the list of problems and (c) it is sort of
inadequate because evaluations and interventions, which are made
for more than one problems, must be repeated.
The registration focused on the problem has four (4) basic
components:

• Data base
• List of problems
• Care plan
• Progress notes
Furthermore, the forms of surveillance (flow) and the notes are
added in the file as required
 Data base
The data base consists of all the available information on the
patient, when he is entering the hospital or visiting a sanitary
service for the first time. It includes nursing evaluation, medical
history, social and family elements, and the results of the clinical
examination and the basic diagnostic control. The data is always
informed according to the changes of the patient’s health situation.
 List of Problems
The list of problems emanates from the data base. It is
usually used in front of the diagram and it is used as an indicator, so
that the entries are numbered in the progress notes. The problems
are recorded in the list, so that they are recognized, and the list is
always informed as far as new problems are concerned and as far as
the solved ones as well.
 Care Plan
In the care plan the active problems are recorded. The care
plans are created by the people who locate the problems. The
doctors record medical instructions or medical care plans and the
nurses record nursing instructions or nursing care plans.
 Progress Notes
During the recording where the problem is focused, the
progress notes are written by all the professionals of the health
system who are involved in the patient’s care.
3 . The recording model problem – intervention – evaluation PIE
In the registration model PIE the information is divided into three
categories. The ΡΙΕ is decisive for the problems, the interventions

and the evaluation of the nursing care. This model consists of an
evaluation diagram on the patient’s care and the progress notes. The
diagram uses certain evaluation criteria with a particular structure,
such as human needs or functional health patterns.
4. The Focusing Diagram
In the focusing diagram the patient, his worries and his faculties
constitute the centre of care.The focusing diagram provides a total
depiction of the patient and his needs. The three components of the
PIE don’t need to be recorded in a certain order and each note
doesn’t need to have all three categories. The diagrams and the
control lists are often used in the focusing diagram, so that the
duties of the nursing routine and the evaluation data are recorded .
5. Charting by Exception ( CBE)

In the documentation by exception are reported only unnatural or
important discoveries or exceptions. In this registration model there
are three basic elements:
1. Diagrams. Such examples are the thermometrical diagram, the

recording of the liquid balance, the recording of daily care, the
recording of the medical-nursing instructions that concern the
patient, the recording of the patient’s exit and the recording of
the skin situation.
2. Criteria of the nursing care. The registration which is based on the
standards of the nursing care averts the repeated registration of
the daily care .
3. Access to the diagrams next to the nursing bed.
The advantage of this registration model is the avoidance of

long and repeated notes and the fact that the changes in the
patient’s situation are more apparent and more directly
observed.
6. Recording to the Computer

The recording systems through the PC are developed as a method
of settlement and management of the enormous piece of
information which is required in the modern care health. Nurses
use the computer in order to store the patient’s data, to add new
data, to create and repeat care plans and to record the progress of
the patient. Some contemporary nursing institutes have a small
manually-operated terminal next to the patient’s bed, which helps
at the immediate recording of the nurse’s care, which has just been
provided to the patient.
PC’s render the planning of nursing care a rather easy
process. In order to register the nursing interventions and the
reactions of the patients, the nurse selects either certain lists with
knowledgeable terms out of the stored programs of the PC or types
of descriptive information stored in the PC. Today, the technology
of automated voice recognition allows nurses to enter data using
their voice in order to change the written information. The online
connection of the nursing institutions and departments render
possible the transmission of registered information from one care
unit to another. At the same time, an effort is being made today to
create standards for the collection and registration of specific,
necessary nursing data, so that these are included in the PC’s data
base.
Preservation of confidential and private files in computers
Because of the increased use of the patients’ computerized files ,
the sanitary organizations have developed policies and procedures
for the preservation of the patient’s confidential and private
information, which is found stored in the computers. All of the
bellow constitute suggestions on the confidential preservation of
the computerized files:
1. A personal code, is necessary to enter and complete the work in
the computer files. Don’t share this code with anyone else,
included the rest of the family members.

2. After you have completed the procedure, don’t ever leave the
computer on without your presence there.
3. Don’t leave the patient’s information exposed on the computer’s

screen, because other people might see it.
4. It is not necessary for all the elements to appear on the

computer’s work surface.
5. Be aware of the manners and the procedures for the correction

of a mistake.
Follow the institution’s procedures for the documentation of

sensitive information, such as AIDS’ diagnosis.
7. Case Management
This documentation model emphasizes on the quality and the
cost of care effectiveness, which is provided throughout the
patient’s stay at the nursing institute. This model uses a
multidisciplinary approach in the designing and recording of the
patient’s care, using also critical thought. At the same time, this is
useful for the determination of the daily results of care, which are
expected out of certain groups of patients, after specific
interventions which take place every day.
 Conclusions
The documentation of the provided nursing care composes a

piece of the nursing activity of vital importance. A great percentage
of the nursing time is dedicated in the registration of the executed
nursing work. The documentation in the health system takes place
in order to fulfill administrative and clinical purposes, while in the
bibliography various nursing documentation types are reported:
notes of narrative type, the files which are directed to the problem,
the files which are directed to the source, the recording by
exception, the Kardex, the recording of each case and the electronic

files. Even though the rules for a successful nursing documentation
are many, qualitative nursing documentation should remain the
focus point so that sufficient and individualized care of the patients
is ensured.
It is doubtful, the fact that the role of the nurse is determined

by the output and the documentation of the nursing work in the
health system. The strengthening of Nursing should be focused on
the need of revision and readjustment of the subordinate models and
patterns of care benefit, while it is quite important the fact that the
resolution of the problems of the patients requires the collaboration
between the members of the sanitary team. For these reasons, the
written speech remains at the center of communication as the safer,
more complete and legally secured way of communication in all of
the health departments.
Deductively, nursing documentation is an extremely essential

process of nursing practice and an integral piece of each nursing
intervention. Its contribution to the course of the patient’s health is
undeniable for the reason that it organizes his care, and facilitates
the communication among the members of the therapy group. The
nursing files, no matter how they are created and reserved, they
have the ability to be modified dew to new data, and that renders
nursing documentation a dynamic process.
C. Documitation
Documentation is the written and legal recording of the

interventions that concern the patient and it includes a sequence of
processes. Documentation is established with the personal record of the
patient, which constitutes a base of information on the situation of his
health. The importance of nursing documentation is neuralgic, provided
that without it, there cannot be a complete qualitative nursing
intervention and not even an effective care for the patient. In the
purposes of nursing documentation are included the research on a more

effective care of the already detected problems, the programming of care
through the organization and modification of the plan on patient’s care
and the more direct communication between the professionals of the
health system, who collaborate on the patient’s care. The methods of
documentation are multiple and among the most basic ones are the
method directed towards the source or the problem, the system problem-
intervention-evaluation, the focused registration, the focusing diagram,
the registration by exception, the electronic files and the home
documentation.
 Purpose of the Nursing Documentation

A basic purpose of the nursing documentation is the creation
of a data base in which the patients’ files are included. The patient’s
file is kept for many reasons, from which the most important ones
are :
• Communication among the professionals of the health system,
through the exchange of information that concerns the patient.
• Creation of the Patient Care Plan
Each scientist uses documents from the patient’s file to prepare

the care plan of
the particular patient.
• Control of the health organizations.

The control is a review of the patient’s file with the view to
confirm the provided quality.
• Research
The information, that is contained in a file can form a valuable
source of elements for research. The care plan can bring up useful
information on the care of many patients.
• Education
Students in various schools of the health science often use
patients’ files as educational tools.

• Compensation
The documentation also assists in obtaining easily a compensation
from the public and private insurances. In order to obtain a
compensation, the file of the patient’s clinical situation should
have the right diagnosis, which should be included in the group of
illnesses that are being compensated and also report that the
appropriate care has been provided.
• Legal documentation
The information of the files can assist the professionals of the
health system to point out the needs of the particular nursing
institution, as well as the hospital’s services.
 Documentation of the nursing activities.

The patient’s file should describe his current situation and reflect the
entire nursing process. Regardless of the documentation system that
is used by an institution, nurses register constantly various evidence
of the nursing activity, throughout the duration of the care benefit.
 Nursing evaluation during the entry
The initial estimation of the situation of the patient is taking place
during his entry to the nursing unit and is called initial data base,
nursing background or nursing evaluation. The initial evaluation of
the situation is being carried out with the systematically clinical
examination and with the examination of the functional capabilities
of the patient, the investigation of the health problems and the
possible dangers. The nurse generally records the oncoming
evaluations or reevaluations on leaves of flow or in nursing progress
notes.
 Nursing care plan
The certification committees of the health care organizations require,
the clinical documentation to include elements from the evaluations
of the patients, the nursing diagnosis and / or the patients’ needs, the
nursing interventions, the results that the patients showed and the

elements of a current nursing care plan. Depended from the
documentation system that is used, the nursing care plan can be
different from the patient’s background, can be included in the
nursing notes or be incorporated in a multidimensional care plan.
There are two types of nursing care plan: the traditional and the
standardized one. The traditional care plan is written for each patient.
The type varies from organization to organization according to the
needs of the patient and the department. Most types have three
columns: one for the nursing diagnosis, a second for the expected
results and a third one for the nursing interventions. The standardized
care plans are developed in order to save time during the registration.
These plans can rely on the steady practices of the organization,
contributing thus in the benefit of high quality in the care. The
standardized care plans should be individualized by the nurse, in
order to satisfy the individual needs of each patient.
Documentation: encompasses all written and/or electronic entries

reflecting all aspects of patient care communicated, planned
recommended or given to that patient.
‘End of shift’ progress notes: nursing documentation written as a
summary at the end or towards the end of shift.
‘Real time’ progress notes: nursing documentation written in a timely
manner during the shift.
ISBAR: (Identify, Situation, Background, Assessment,
Recommendation) framework for clinical communication
Admission assessment: Comprehensive nursing assessment including
patient history, general appearance, physical examination and vital
signs completed at the time of admission.
Shift assessment: Concise nursing assessment completed at the
commencement of each shift or if patient condition changes at any
other time during your shift.
 Process

Nursing documentation will support the process;
1. Patient assessment,
2. Plan of care
3. Real time progress notes
 Patient assessment
An admission assessment is completed and documented on the

Nursing Admission (MR850/A) as per Nursing assessment
guideline.
Exceptions: See Special Considerations
 Plan of Care
Taking into consideration the patient assessment, clinical handover,

previous patient documentation and verbal communication with the
patient and family the plan of care for the shift is made and
documented on the Patient Care Plan (MR 856/A). The plan should
be negotiated with patients’ and their carers to ensure clear
expectations of care, procedures, investigations and discharge, are set
early in the shift. The plan of care should align with information on
the patient journey board.
 Real time Progress Notes
Documentation is captured in the patient’s progress notes in ‘real

time’ throughout the shift instead of a single entry at the end of shift.
Any relevant clinical information is entered in a timely manner such

as;
 Abnormal assessment, eg. Uncontrolled pain, tachycardic, increased

WOB, poor perfusion, hypotensive, febrile etc.
 Change in condition, eg. Patient deterioration, improvements,
neurological status, desaturation, etc.

 Adverse findings or events, eg. IV painful, inflamed or leaking
requiring removal, vomiting, rash, incontinence, fall, pressure
injury; wound infection, drain losses, electrolyte imbalance, +/-fluid
balance etc.
 Change in plan (Any alterations or omissions from plan of care on

patient care plan) eg. Rest in bed, increase fluids, fasting, any
clinical investigations (bloods, xray), mobilisation status,
medication changes, infusions etc.
 Patient outcomes after interventions eg. Dressing changes, pain
management, mobilisation, hygiene, overall improvements,
responses to care etc.
 Family centred care eg. Parent level of understanding, education
outcomes, participation in care, child-family interactions, welfare
issues, visiting arrangements etc.
 Social issues eg. Accommodation, travel, financial, legal etc.
Progress note entries should include nursing content and

evidence of critical thinking. That is, they should not simply list
tasks or events but provide information about what occurred,
consider why and include details of the impact and outcome for the
particular patient and family involved.
 Structure
The structure of each progress note entry should follow

the ISBAR philosophy with a focus on the four points of
Assessment, Action, Response and Recommendation.
Identify. Positive patient identification and ensure details are
correct on documents. Write the current date, time and “Nursing”
heading. The first entry you make each shift must include your full
signature, printed name and designation. Subsequent entries on the
same shift must be identified with date/time and ‘Nursing’ but may
be signed only.

Situation & Background. not often required for ‘real-time’ entries.
Maybe relevant for admission notes or transfer from one dept to
another.
Assessment. What does the patient look like? What has happened?
2. The Triage Assessment Tool, although not meant to replace

clinical judgement and experience, is designed to augment to
the decision making skills of the triage nurse. This is attained by
focusing the user on the importance of sequence, and
examination of pertinent data, thus ensuring a precise triage
decision. Triage is a critical assessment process performed by a
registered nurse or nurse practitioner with a minimum of
oneyear of emergency nursing experience, as well as
appropriate additional credentials and education that may
include certification in emergency nursing and continuing
education in trauma, pediatrics, and cardiac care, with
verification or certification in those subspecialties as
appropriate. Emergency nurses complete a comprehensive,
evidence-based triage education course and a clinical
orientation with an experienced preceptor to enhance triage
knowledge and skills. Triage nurses are engaged in an ongoing
triage competency validation process that includes observation
and chart review, with remediation and further education as
appropriate. Emergency department leadership ensures that
registered nurses receive appropriate education and demonstrate
the knowledge application and situational awareness required to
successfully function in the role of triage nurse according to
professional and accreditation standards. Emergency nurses
support and participate in research involving the triage process
and patient outcomes in the emergency care setting.
Triage and the colour Codes: the health traffic light When
arriving at the Accident and Emergency department, the

patient’s level of urgency will be evaluated by trained nurses. A
"colour code" will be given to establish the priority of access to
treatment on the basis of the seriousness of the case. This does
not depend on the arrival time at the hospital. This approach is
called “Triage” and it is aimed at avoiding delays for truly
urgent cases. Triage does not guarantee any reduction in
waiting times, as its goal is to ensure that patients in extremely
serious condition do not have to waste precious time.
1. Code Red: very critical, danger of death, maximum

priority, immediate access to treatment;
2. Code Yellow: fairly critical, high level of risk,

potential danger of death; treatment cannot be
delayed;
3. Code Green: not very critical, no risk of condition

worsening, treatment can be delayed;
4. Code Blue: not critical, acute but not serious,

treatment can be deferred;
5. Code White: not critical, not serious and/or not acute.
If more than one person has the same colour code, priority is
given to the following: children, pregnant women, people with
disabilities, people who have suffered violence, the elderly over
80 and other special categories of patients. When a co-payment
(ticket) is due. Patients who are assigned red, yellow and green
codes are not required to make co-payments. Patients who are
assigned white or blue code are required to make a co-payment
of 25 Euros (inclusive of medical assessment and clinical tests)
and a further 25 euros should instrumental diagnostic exams be
required. Access to Accident and Emergency Department is

free for: Children under the age of 14 , Patients with legally
recognised medical exemptions , Pregnant women Patients who
have suffered an accident in the workplace ,Situations classified
under white and blue codes involving acute poisoning, wounds
needing stitches or immobilization , Patients requiring short
periods of observation in Accident and Emergency Department
or hospital ward
3. Focused Assessment
The focused assessment is the stage in which the problem is

exposed and treated. Due to the importance of vital signs and
their ever-changing nature, they are continuously monitored
during all parts of the assessment. Depending on the malady,
initial treatment for pain and long-term treatment for the root
cause of the malady is administered and monitored. Part of the
goal of the focused assessment is to diagnose and treat the
patient in order to stabilize her condition. Focused assessments
may also include X-rays or other types of tests.
4. Time-Lapsed Assessment
Once treatment has been implemented, a time-lapsed

assessment must be conducted to ensure that the patient is
recovering from his malady and his condition has stabilized.
Depending on the nature of the malady, the time-lapsed
assessment may span the length of one or two hours or a couple
of months. During the time-lapsed assessment, the current status
of the patient is compared to the previous baseline during and
prior to treatment. Similar to the focused assessment, the time-
lapsed assessment may also include lab work, X-rays or other
diagnostic medical testing.

5. Emergency Assessments
During emergency procedures, a nurse is focused on rapidly

identifying the root causes of concern for the patient and
assessing the airway, breathing and circulation (ABCs) of the
patient. Once the ABCs are stabilized, the emergency
assessment may turn into an initial or focused assessment,
depending on the situation. If the nurse is not in a health care
setting, emergency assessments must also include an assessment
for scene safety so that no other individuals, including the nurse
himself, are hurt during the rescue and emergency response
process.
Action. What have you done about it? Interventions,
investigations, change in care or treatment required?
Response. How has the patient responded? What has changed?
Improvement or deterioration?
Recommendation. What is your recommendation or plan for
further interventions or care?
1.2 EXPRESSING PROHIBITION
Prohibition is an expression to warn other people not to do something

Or to forbide.
To express prohibition you can use:
a. It is prohibited to ...

b. You aren’t allowed to ...
c. You mustn’t ...
d. You aren’t permitted to ...
e. It is forbidden to ...
Examples:
1. Parking is strictly prohibited between these gates.

2. Students aren't allowed to come too late to school.

3. Drivers mustn't park their cars here.
4. It is forbidden to walk on grass.
5. Smoking isn't permitted in hospitals.
6. People aren't permitted to throw rubbish here.
Prohibition also has two patterns, they are Verbal Prohibition and
Nominal Prohibition.
1. Verbal Prohibition
This Verbal Prohibition uses verbs (verb) in the sentence,

prohibition always uses verb 1. Remember the sentence must start
with don't or do not. Then there will be a prohibition of verbal
formulas like this: Don't + Verb 1
Example :
 Don’t do it! (jangan lakukan itu!)

 Don’t enter the room! (jangan masuk ke ruangan itu!)
 Do not follow me! (jangan ikuti saya!)
 Don’t go away from me! (jangan pergi dariku!)
 Don’t leave me alone! (jangan tinggalkan aku sendiri!)
 Don’t forget! (jangan lupa!)
 Don’t move! (jangan bergerak!)
 Don’t disturb him! (jangan ganggu dia!)
To make a polite prohibition, use “please” at the beginning or at the
end of the sentence!
1. Please don’t cry! (janganlah menangis!)
2. Don’t cry, please! (janganlah menangis!)
2. Nominal Prohibition.
Nominal Prohibition is a prohibited sentence containing the

words Adverb (Adverb), Noun (Noun), and Adjective (Adjective).
Then the formula is Don't + be + Adverb / Noun / Adjective. Here
are examples of nominal prohibition sentences:
 Don’t be lazy! (jangan malas!)

 Don’t be stupid! (jangan bodoh!)
 Don’t be careless! (jangan ceroboh!)
 Don’t be stingy! (janganlah pelit!)
 Don’t be late! (jangan terlambat!)
 Don’t be confused! (jangan bingung!)
 Don’t be angry at me! (jangan marah padaku!)
Beside the pattern above, we can also use this follows pattern!
For Examples;
1. No smoking! (dilarang merokok!)
2. No parking! (dilarang parkir!)
Dialogue :
Nurse :”Exuse me, sir. What are you doing here. You are not
allowed to enter this room?
Man :”Sorry nurse, I want to see doctor”
Nurse :”before seeing doctor you should make appoinment first.

Show your ID card please”
Man :”Here you are, nurse”
Nurse :”Okay sir, I will be process, you can come again at 02.00 PM.
Please Don’t be late and Don’t forget to bring your ID card”
Man :”Thank you nurse”
1.3 FIRST AID EQUIPMENTS
1. Definition of first aid

Helper who first arrives at the scene and provides help based on the
condition of the victim, basic medical trained.
2. First Aid Actors Basic Equipment

In carrying out the task as a first aid actor, of course we need
some basic equipment. This basic equipment can be divided into two

categories, the first is self-protection equipment or better known as
Personal Protection Equipment (PPE) and the second is first aid
equipment to do the task.
A. Personal Protective Equipment (PPE)

As a first aid agent, a person is very vulnerable or will easily
be exposed to microorganisms or body fluids from a victim that
might cause the first aid agent to be infected by the disease. For
example some diseases that can be transmitted include Hepatitis, TB,
HIV and AIDS. In addition, PPE also serves to prevent rescuers
from being injured or injured in carrying out their duties.
Some PPE, namely:

1. Latex gloves
2. Protective Glasses
3. Protective clothing

4. Helper Masks
5. Resuscitation Masks
6. Helmet

Note: The minimum personal protective equipment (PPE) for a first aid
person is a resuscitation glove and mask.
The use of PPE cannot fully protect the helper. There are several other
actions that must be taken as a precautionary measure, namely:
1. Handwashing
2. Cleaning Equipment
B. First Aid Equipment The other First Aid Equipment are:
1. Cover of the wound

a) Sterile gauze
b) Gauze pads
2. Bandages
For example:
a. Roll / Pipe Bandages
b. Triangle / Mitela bandages
c. Tubular / Tube bandages
d. Adhesive Tape / Plaster
3. Antiseptic Liquid
for example:
a. Alcohol 70%
b. Povidone iodine 10%
c. Eyewash Liquid

d. Boorwater
4. Stabilization equipment
for example:
a. Bidai
b. Long Spinal Board
c. Short Spinal Board
5. Scissors Bandages
6. Tweezers
7. Flashlight
8. Cotton
9. Blanket
10. Card of Victim
11. Stationery
12. Oxygen
13. Tensimeter and Stethoscop
14. Stretcher
1.4 GRAMMAR CORRECTIONS
1. Simple Past Tense

Use ː
 Action took place in the past, mostly connected with an
expression of time (no connection to the present)
Form and example ː

S + V2 + O
They went to emergency room
S + did not + V1 + O
They did not go to emergency room
Did + S + V1 + O?
Did they go to emergency room?
7W1H + did + S + V1 + O?
How did they go to emergency room?
2. Past Continuous Tense

Use ː
 An action happened in the middle of another action
 Someone was doing something at a certain time in the past –
you don’t know whether it was finished or not
Form and example ː

S + was/were + Ving + O
She was taking a bandage
S + (was/were) not + Ving + O
She was not taking a bandage
Was/were + S + Ving + O?
Was she taking a bandage?
7W1H + was/were + S + Ving + O?
Where was she taking a bandage?
3. Simple Past Perfect Tense

Use ː
 Mostly when two actions in story are related to each other ː
the action which had already happened is put into past
perfect, the other action into simple past
Form and example ː
S + had + V3 + O
He had injected the patient before he went to laboratory
S + had not + V3 + O
He had not injected the patient before he went to laboratory
Had + S + V3 + O?
Had he injected the patient before he went to laboratory?
7W1H + had + S + V3 + O?
Where had he injected the patient before he went to laboratory?
4. Past Perfect Continuous Tense

Use ː
 How long something had been happening before something
else happened
Form and example ː
S + had + been + Ving + O + since/for + adv. of time
She had been working in Emergency room for 2 hours this morning
before he came
S + had not + been + Ving + O + since/for + adv. of time
She had not been working in Emergency room for 2 hours this
morning before he came
Had + S + been + Ving + O + since/for + adv. of time?
Had been she working in Emergency room for 2 hours this morning
before he came?
7W1H + had + S + been + Ving + O + since/for + adv. of time?
Where had been she working for 2 hours this morning before he
came?
5. Simple Present Tense
Use ː
 Something happens repeatedly
 How often something happens
 One action follows another
 Things in general
 With verbs like to love, to hate, to think, etc
Form and example ː

S + V1 + O
I work in Emergency room
S + (do/does) not + V1 + O
I do not work in Emergency room
Do/does + S + V1 + O?
Do I work in Emergency room?
7W1H + Do/does + S + V1 + O?
Why do I work in Emergency room?

6. Present Continuous Tense
Use ː
 Something is happening at the same time of speaking or
around it
 Future meaning ː when you have already decided and
arranged to do it
Form and example ː
S + to be + V-ing + O
She is bandaging the wound now
S + (to be) not + V-ing + O
She is not bandaging the wound now?
To be + S + V-ing + O?
Is she bandaging the wound now?
7W1H + to be + S + V-ing + O?
What is she bandaging now?
7. Present Perfect Tense
Use ː
 You say that something has happened or is finished in the
past and it has a connection to the present
 Action started in the past and continues up to the present
Form and example ː
S + have/has + V3 + O + since/for + adv. of time
He has already worked in the Emergency room since 3 years
S + (have/has) not + V3 + O + since/for + adv. of time
He has not worked in the Emergency room since 3 years
Have/has + S + V3 + O + since/for + adv. of time?
Has he worked in the Emergency room since 3 years?
7W1H + have/has + S + V3 + O + since/for + adv. of time?
How long Has he worked in the Emergency room?
8. Present Perfect Continuous Tense

Use ː
 Action began in the past and has just stopped
 How long the action has been happening
Form and example ː
S + have/has + been + Ving + O + since/for + adv. of time

You have been working in this hospital since 5 years
S + (have/has) not + been + Ving + O + since/for + adv. of time
You have not been working in this hospital since 5 years
Have/has + S + been+ Ving + O + since/for + adv. of time?
Have you been working in this hospital since 5 years?
7W1H + have/has + S + been + Ving + O + since/for + adv. of
time?
Where have you working since 5 years?
9. Simple Future Tense
Use ː
 Predictions about the future (you think that something will
happen)
 You decide to do something spontaneously at the time of
speaking
Form and example ː
S + will + V1 + O
She will come tonight
S + will not + V1 + O
She will not come tonight
Will + S + V1 + O?
Will she come tonight?
7W1H + will + S + V1 + O?
How will she come tonight?
10. Future Continuous Tense

Use ː
 An action will be in progress at a certain time in the future.
This action has begun before the certain time
 Something happens because it normally happens
Form and example ː
S + will be + Ving + O
She will be working in Emergency room at 7 a.m. tomorrow
S + will not be + Ving + O
She will not be working in Emergency room at 7 a.m. tomorrow
Will + S + be + Ving + O?
Will she be working in Emergency room at 7 a.m. tomorrow?
7W1H + will + S + be + Ving + O?
Where will she be working tomorrow at 7 a.m.?
11. Future Perfect Tense
Use ː
 Something will already have happened before a certain time
in the future
Form and example ː
S + will + heve + V3 + O
You will have retired in Emergency room by next five years
S + will not + have + V3 + O
You will not have retired in Emergency room by next five years
Will + S + have + V3 + O?
Will you have retired in Emergency room?
7W1H + will + S + have + V3 + O?
When will you have retired in Emergency room?
12. Future Perfect Continuous Tense

Use ː

 Something will already happened before a certain time in the
future
Form and example ː
S + will + have + been + Ving + O
Noi will have been working in Emergency room for five years by
next year
S + will not + have + been + Ving + O
Noi will not have been working in Emergency room for five years
by next year
Will + S + have + been + Ving + O?
Will Noi have been working in Emergency room for five years by
next year?
7W1H + will + S + have + been + Ving + O?
When will Noi have been working in Emergency room for five
years?
13. Simple Past Future Tense (Conditionally Type II)
Use :
 Something that might happen
 Main clause in type II of the conditional sentences
S + would + V1
I would work
She would go if she could
14. Past Future Continuous Tense
Use :
 Something that might happen, length of time of an action
S + would + be + V-ing
She would be working in this hospital at this time the following day
15. Past Future Perfect Tense (Conditionally Type III)
Use :
 Something that might have happened in the past
 Main clause in type III in the conditional sentences
S + would + have + V3

I would have stayed there if he had asked me
16. Past Future Perfect Continuous Tense
Use :
 Something that might have happened in the past, length of
time of an action
S + would + have + been + V-ing
I would have been working by this time last night
1.5 PRONUNCIATION CORRECTION
Emergency is a serious, unexpected and often dangerous situation

requiring immediate action.
When you are in an emergency situation call the emergency number
at your area. Try to keep calm and speak clearly. The operator will need to
know which emergency service you require, what is wrong and where you
are. Remember, if you are out in a new place, always try to be aware of
where you are. Pay attention to the road names and any distinguishing
landmarks nearby in case you need to describe your location
Some phrases that usually used in accident and emergency situation.
a. Discribing an accident
- An accident occurred / happened between two cars travelling in
the same / opposite direction. One car was travelling at speed (at
X miles per hour)
- As the driver was rounding the corner, he drove straight into
another car which was on the wrong side of the road. The driver
lost control of the car and ploughed into the other lane /
overturned / drove into an oncoming vehicle / into a tree.
- As the driver was overtaking another / went through a red light /
he drove straight into oncoming traffic
- A lorry jackknifed, spilling its load over the road.
- The brakes failed / the car driver misjudged the distance.
- The car was speeding / doing 80mph in a 30mph area.

- The driver was under the influence of alcohol / drugs / on his
mobile phone at the time.
b. Phrases in an emergency situation
- I need an ambulance
- Please hurry
- I need the police
- The building is on fire
- I can smell burning
- Where is the fire escape
- Call the fire brigade
- There’s been an accident
- I need a doctor
- She’s not breathing
- Does anyone know how to do CPR
Some words related in accident and emergency situation.
- Alert - Coastguard
- Ambulance - Mayday
- Force - Life-saver
- Lifeguard - Rescue
- Paramedic - Panic Button
- Collapsed - Passed out
- Bleeding - Unconscious
Example dialogue
A: Hello, help! We need a doctor! We need a doctor!
B: Calm down sir, tell me what is the problem
A: There’s car accident here! A car skidded on a wet surface because its
raining hard here and I think the driver lost control! I can see there’s so
much blood from the victim now!
B: Could you tell me where it is, sir?

A: I’m near Polythecnic of Health of Denpasar at Jalan Pulau Moyo No. 33,
hurry up!
B: Okay sir, we will send fire brigade and ambulance right now
A: Okay please, thankyou
A: I need a doctor! Get a doctor here, immediately!
B: What's the problem, sir?
A: My wife is on the floor, she's unconscious!
B: Sir, could you calm down a little bit, please?
A: Calm down?! My wife is unconscious, and you're telling me to calm
down?!
B: Hold on just a second, sir. I'm dialing 911.
A: Hurry up, please.
B: I'm connecting you now, sir.
Some tips to help with your pronunciation.
1. Get a 'pronunciation tool box'
This should include:
 a notebook specifically for pronunciation

 a recording device such as an mp3 recorder (or mobile phone)
 a dictionary with phonetic transcription (showing the sounds in
words).
2. Find someone to give you feedback
Let's call this person a 'pronunciation buddy', someone who

speaks English clearly and fluently, perhaps a friend, work colleague or
fellow student. Your 'pronunciation buddy' can be your 'sounding board',
that is, someone who can give you regular support and feedback about
how you sound in academic or work situations.

Your buddy can help with many aspects of your speech and
pronunciation. You can also do some analysis yourself. Ask yourself:
 What aspects of my pronunciation are affecting my communication?

What would help me to communicate more effectively?
 What words or expressions are people asking me to repeat?
 Are there some sounds which re-occur in these words, expressions
etc.?
 Is it hard to say longer words and word groups clearly and fluently?
 Am I getting feedback that I 'speak too fast'?
It's hard to do everything correctly, especially if you have a

number of things to work on. So just practice one thing at a time, for
example, words which contain a problem sound, word stress or the key
words in a speech chunk. You can slowly build up to controlling more
features at the same time:
 Make a note of the words or terminology you use commonly

 Mark the syllable stress and note any problem sounds
 Check your dictionary to get the correct pronunciation
 Practice the items aloud, individually and in sentences.
When you practice, limit what you say. For example, say the
main key word and its tone, or link one or two words together, or only
say the key words. Add more words to make phrases. Repeat several
times till you feel more confident. Then build on the speed and number
of words you say.
You could also ask for feedback on your speech in general conversation.
3. Listen to yourself
One of the most useful and powerful forms of feedback on your

pronunciation, is to listen to a recording of your voice. It's often a shock

- even for native speakers - to hear themselves speaking. The best way
to do this is to record yourself speaking so you can listen to your voice
and pronunciation and reflect on how you sound. Very often we actually
have a pretty accurate idea of what's making us difficult to understand
when we listen carefully to how we are speaking. To be on the safe side
however, check your impressions by getting feedback from your '
pronunciation buddy'. Otherwise, you could be 'too hard' or 'too soft' on
yourself.

Chapter 1 The Accident and Imergency

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Chapter 1 The Accident and Imergency

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Chapter 1

The Accident And Emergency

1.1 Reporting, Record, Documenting

An emergency department (ED), also known as an accident &

Due to the unplanned nature of patient attendance, the department

The emergency departments of most hospitals operate 24 hours a day,

The purpose of the report is to be transmitted valuable

1 | THE ACCIDENT AND EMERGENCY

2 | THE ACCIDENT AND EMERGENCY

Recording Systems of the Nursing Care

3 | THE ACCIDENT AND EMERGENCY

4 | THE ACCIDENT AND EMERGENCY

5 | THE ACCIDENT AND EMERGENCY

5. Charting by Exception ( CBE)

1. Diagrams. Such examples are the thermometrical diagram, the

The advantage of this registration model is the avoidance of

6. Recording to the Computer

6 | THE ACCIDENT AND EMERGENCY

7 | THE ACCIDENT AND EMERGENCY

3. Don’t leave the patient’s information exposed on the computer’s

4. It is not necessary for all the elements to appear on the

5. Be aware of the manners and the procedures for the correction

Follow the institution’s procedures for the documentation of

The documentation of the provided nursing care composes a

8 | THE ACCIDENT AND EMERGENCY

It is doubtful, the fact that the role of the nurse is determined

Deductively, nursing documentation is an extremely essential

Documentation is the written and legal recording of the

9 | THE ACCIDENT AND EMERGENCY

 Purpose of the Nursing Documentation

Each scientist uses documents from the patient’s file to prepare

the particular patient.

• Control of the health organizations.

10 | THE ACCIDENT AND EMERGENCY

 Documentation of the nursing activities.

11 | THE ACCIDENT AND EMERGENCY

Documentation: encompasses all written and/or electronic entries

12 | THE ACCIDENT AND EMERGENCY

An admission assessment is completed and documented on the

Taking into consideration the patient assessment, clinical handover,

 Real time Progress Notes

Documentation is captured in the patient’s progress notes in ‘real

Any relevant clinical information is entered in a timely manner such

 Abnormal assessment, eg. Uncontrolled pain, tachycardic, increased

13 | THE ACCIDENT AND EMERGENCY

 Change in plan (Any alterations or omissions from plan of care on

Progress note entries should include nursing content and

The structure of each progress note entry should follow

14 | THE ACCIDENT AND EMERGENCY

2. The Triage Assessment Tool, although not meant to replace

15 | THE ACCIDENT AND EMERGENCY

1. Code Red: very critical, danger of death, maximum

2. Code Yellow: fairly critical, high level of risk,

3. Code Green: not very critical, no risk of condition

4. Code Blue: not critical, acute but not serious,

5. Code White: not critical, not serious and/or not acute.

16 | THE ACCIDENT AND EMERGENCY

The focused assessment is the stage in which the problem is

Once treatment has been implemented, a time-lapsed

17 | THE ACCIDENT AND EMERGENCY

During emergency procedures, a nurse is focused on rapidly

1.2 EXPRESSING PROHIBITION

Prohibition is an expression to warn other people not to do something