Nursing Reflection Paper | Road Accidents: Causes and Solutions

Road accident fatalities are one of the major causes of death and injuries in Malaysia. Believed it or not, every years more people died because of road accident compare to diseases. Human factors, including their attitudes, carelessness and health contributed to almost all road accidents in this country and number keep on increasing every year and last year alone it shown increases of 397,194 cases in which fatal death accident note down 6,218 cases sources from Road Safety Department Malaysia (RSDM). In Asia, it estimated 400,000 people are killed because of road accident and about 4 million suffered injuries. Apart from that, about 15 million more suffered disability for life sources from Transport & Research Laboratory, United Kingdom. The increasing number of road accident fatalities is contributed from the fast growing of economic, population, motorisation and the improvement development of the industrial sector in this country on wide scale. Each year, Malaysian has a new car on the road due to most of Malaysian, affords to buy a new car each year. Last year alone, car sales peak up 2 percent nearly 536,905 vehicles said Aishah Ahmad (2010).

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The aim of this paper is to provide critical knowledge and understanding the causes and nature of accidents, statistical data regarding road accidents, social-economical context and impact towards my practise environment especially nursing profession. Hopefully, I critically enable too highlight the reflected issue.

Nurse is a noble career. This career suit appropriate for a particular person with warm hearted, caring, concern and patience in accept challenges. A nurse has a great deal of responsibility in saving people lives like a doctor who are skillful medical expert and healer. Nurse as a healthcare provider, working shoulder to shoulder with doctors. In fact, the nurse’s presence indeed can make a difference between life and death. I’m a nurse, working in Emergency and Trauma Department (ED), ED provides twenty four hours emergency care for the population of Putrajaya and Cyberjaya district and its surrounding area and responsible for the immediate recognition, evaluation, treatment, stabilisation and disposition of medical and surgical emergencies. Other emergency care services provided include Definitive Care Management, Pre Hospital Care, Call Centre and Disaster Management.

As an ED nurse working at twenty four hours emergency care unit facing up with the increasing fatalities of road accident injury had burden up the workload towards nurses job itself. Delivering effective, accurate and carried out appropriate triaging system can be at stack. Why? Because of the stress amount had to carried out due to interpersonal attitudes, physical ability, shortage of working personal like doctor, nurses or assistant medical assistant (AMO), lack of appropriate equipment, working staff poor of knowledge and skill in dealing with patient with unstable conditions, that need to be treated quickly. Because time is such an essential factor in emergency treatment and proper triaging of patient in ED allows life-saving and first aid measures. In fact, triaging reducing patient waiting times that are in need of urgent attention and assessment on arrival. This will determine their priority of care, this was adapted from military medical practice as describe by Crouch R (1992).

The goals and the potential benefits of triage especially at ED is in assessing patient priority of care upon arrival, provision of life-saving and first aid interventions, reducing the anxiety frustration by quick assessment, provide information to patients and relatives, more efficient use of resources by early and appropriate directing of patient, it is according to the my department Patient’s Charter. The benefit of this assessment, able to direct patient to the most appropriate care area. Bailey. A (1997).

Because of patient care increasingly needed on treating the sickest, the need for advanced practice nurse to provide and coordinate care in emergency rooms or trauma care has never been greater. In response to the increasing demand and changes within the scope of professional practice as a qualified nurse. There are few essential responsibilities carried out by nurses at ED. For instance, identifies

Substantial psycho-emotion need by evaluate and assessing patient before distribute them for appropriate care area, age-specific plans for patient accordance to the standard nursing guidelines for proper care and treatment, perform constant observation of vital sign. Perform duties as a mentor and key player particularily in advanced area for other nurses and health care professional. In providing good quality nursing care as outlined by Nurses Act 1950 (Revised-1969). Currently and in future ahead nurse’s role will increase along side with the rising health consciousness and in need of good quality health care worldwide. In reality, nurses are one of a crucial component in patient’s recovery stated by Richardson LD (2001).

As defined by, nurse in ED is who has a nursing practice with formal post-basic education in holistic assessment, physical diagnosis, treatment and promotion of health. Similarly, Tritsch (1998), has observed that the transition into excited environments has highlighted the need for theory-based practice to new level. Nurse in ED performs all responsibilities or duties meets Nursing and Midwifery Board, Malaysia standard of service. There are still some debate about nursing roles in the ED, suggesting that there have been some erosion of conventional nursing value such as care, compassion and loyalty. The responsibility of nurses in ED needs to be clarified; as we know, nurses not practically care for non-critical patients as review by Watkinson S, (2006).

The nurses role in ED is high recognisable and which is also allow the development of the nursing knowledge and skill. This includes triage, trauma care for patient in the entire areas of the ED as required. Jones (1990); found that normal practice in these departments was impossible to establish, such was the variety of skills of a medical practitioner being undertaken. In making these potential roles in patient care are to be realised, the ED nurse should not be viewed as a replacement to the junior doctor or AMO, but view as a professional with high qualities and skills said Hooker R (2006). In addition, there should be determine some appropriate scope of practice for ED nurse to established a position within the multidisciplinary team in enhance ED care.

There’s should be inter-professional discussion to clarify the manpower, educational and professional/political implication of the ED nurse role. The implication of the ED nurse role system can provides towards the development of nursing practice in each trust on a multidisciplinary basis, providing of vicarious liability by the employing right for each ED nurse, providing appropriate education programmes i.e. ED nurse should retain a generic education programme such as Post-Basic in Advanced Emergency Medical Trauma Care (AEMTC) or separate module of high tertiary level of education in Degree or Master and also provide with short time programme development like MTLS(Malaysia Trauma Life Support), ACLS(Advanced Cardiac Life Support), BLS(Basic Life Support) and in PALS(Paediatric Advanced Life Support), but this unique opportunity not an effective resource whereby, possible de-skilling of the emergency nurse practice in other aspects of nursing care.

There are many causes of accident on the road. Driving recklessly examples awful personal habits, speeding, lack of awareness, in proper or unacceptable behaviour and not wearing proper safety gear or attire especially for motorcyclist and other road user are some of the problems that contribute factor for accidents. According to a study by Universiti Sains Malaysia (USM, 2009), it shown nearly 500 drivers involved in road accident, it found out that some of car driver driving when sleepy, driving late night and driving for six to eight hours non-stop or lack of sleep, this linked up with a significant raise and risk of a car crash and would resulting in severe injury or death.

Human error is a central element in accidents. Peter (1998) defined an error is a set of human series of action that exceeds level of tolerability. Usually, the normal judgment in behavior and human error is a departure from a normal human being. Reason (1990), reflect unsafe acts is an errors, mistake and violation. Errors can happen with or without conscious thought. It like an action that result from misinterpretation of the actual situation. In other words, mistakes are accidental behaviors that involve incorrect choice of inappropriate action for that particular situation. Routine violations come from the rules which involve behaviors, such as driving faster than the speed limit i.e.120 km/h. According to the Royal Malaysia Police (RMP) Malaysia, the road accident fatality in Malaysia for year 2008 are 373,407 compared with years 2009 which is estimated 397,330 road accident. The difference is about 24,283 or 6.5 percent cases of road accident throughout the whole state of Malaysia. In the meantime, if comparing with other developed countries like Switzerland, Germany and the United States they have managed to reduce the percentage of road accident percentage from 1.9 percent to 1.4 percent said Road Safety Department, Malaysia. See appendix. The number of casualties due to motor vehicle accident (MVA) in the year 2009 for my ED alone stated up to 854 cases.

Accident was the first main cause of hospitalization and cause of death for my hospitals. From recent analysis shown that, accidents are more commonly involved motor vehicles and non-motorized vehicles. For 2009, the majority of emergency call for ambulance service which is my ED had this specialized mobilised team in attend patient involved in MVA for early stabilisation and treatment, followed by attending patient who had injuries at workplace and domestic accidents. The increasing of trauma cases were related to the coverage area involving the opening of Maju expressway and the increased of population of office area, commercial centre and housing area. See Appendix.

Statistical analysis shown most of the admitted or received patient at my ED for 2005-2009 reported the significant case of head injury was due to MVA. It can be sub-divide into different type of category range from severe to minor head injury. See appendix.

The most common cases involved in road accident fatalities caused by severe head injury with 86 patients out of 269 of total head injury suffered from MVA. About 90 percent of the total patient was in coma or with low GCS (Glasgow Coma Scale), the level of consciousness in most of the patient were 3/15 in scale.

Enlighten with the government policies and needs on extended the roles of nurses at ED, provided with the underline guidelines and together with the ethical framework of professional practice. As highlighted the requirement for a safe standard of care, nurses have a responsibility to act accordance with rules and guidance which adopted the ethical theories of Deontology; where it is a special duty and obligation to specific people or community. Ethically it is a good practice for examples a healthcare worker have an obligation to protect and safe people who had an injury or in need of help. Here, I have identified six principles for professional practice can be widen; recognition that the nursing practice carried out meet the needs of patient, continually striving for skills and knowledge that provide safe and competent care delivery, recognize the personal limitation of skill and knowledge and effort to ensure meet of patients needs, identify the expansion role must maintain continuously for safety of the patient care, recognition of the effort of other healthcare workers involved in patient care and provide treatment and lastly the ability to delegate task appropriately.

These projections are affected to some and this in fact extent to our context where; in our modern society road accident constitute a major problem thus imposing a significant burden on the workload and financial resources to the government. Malaysia is one of the countries, who have the highest road accident fatality in comparing with among other Southeast Asia country. Road accident fatality causes this country losses man power or working power professional or non professional workers, causes property and infrastructure damage, medical billing burst up sky high, create poor productivity due to disability suffered from injury and lack of professional workers and other revenue maintenance management costly increased and this effect the country economic growth edited by Radin Umar (1998). An average compensation of insurance in the event of damage to or loss of property, life or a person has peak up tremendously. The increasing number of road accident fatalities could push the insurer to press on the insurance premium and the money paid up in the event of damage was a terrible lost of economic profit to the country.

According to from Transport & Research Laboratory, United Kingdom reported, during 2005-2009 between 750.000 and 880.000 people died in road accidents worldwide. Most of them from the developing and mid-develop countries. Globally, most of the productive age group was involved in the road accident fatalities and loss of disability. The General Insurance Association of Malaysia (PIAM) is concerned over the recent rise in accidents involving commercial vehicles definitely will definitely increased insurance compensation because generally, the whole nation not just Malaysia suffered the effect and economic burden of road accident fatality and it’s estimated about 500 billion dollar. This event causing the held back of social and economic development at large. It involved million of money compensation due to raise of death toll and injuries, costly medical bill, rigorous demand on resources in providing welfare service and contribution, economic growth below per-average, the state become poorer due to loss of productivity.


I found out the current situation of healthcare in ED, nurses need to adapt to the constantly changing healthcare procedure, skilled and technique in treating a patient and find new ways to deliver good care-specifically in terms of make it more practical and effective nursing practice to a utmost level ED standard. Having seeing the increasing number of patients involved in road fatality and in-accomplished the goal for urgent-care centers and integrated standard of care of a patient in ED. Nurse are excellent in communicating with patients and in collaborate with other colleague of the para-professional team. Nurses can deliver an exceptional role in terms of reorganizing the ED standard of practice with the current emergency crisis.

While road safety has long been consider one of the social responsibilities to the government of Malaysia. I believe this responsibility should not solely rest on the government because there are many ways that the private sector can support government road safety campaigns and initiatives. I hoped members of the private sector would participate and contribute to the effort of increasing road awareness. The government will carry on investing seriously on road safety campaigns in bringing down the fatality rate to below two for every 10,000 registered vehicles by 2020, on par with other developed countries. With the government’s spending on multimedia awareness campaigns for road users and upgrading accident-prone roads for safer use is hopefully will further reduce road deaths.

Of all road accidents in Malaysia, fatal accident justified a higher degree of concern. However, road authorities feel contend with the figures of 6,218 cases death for last year alone. Although studies shown that causes to most of the accident is because of the drivers themselves. The need for providing a safe and efficient road system has been a main concern to the Malaysian government. Extra measures have to be taken up such as aggressive road safety campaign awareness in civilizing and educate road user to abide by the law and road regulation. Other relevant agencies such as Ministry of Works, Malaysia (MOW) in providing a better and safer road and Ministry of Transport, Malaysia (MOT) constantly make an positive effort in order to improve traffic accident in Malaysia, alongside with the Ministry of Health, Malaysia (MOH) in providing better emergency aid management in attending and treating MVA cases and other government authority efforts to reduce traffic accident and to achieve its targets, because prevention is better than cure as point up by Furthermore, positive steps have taken into respond by encourage people especially road user to shared care when go for work, encourage to use and support public transport, promote walking as part of health exercise and use of bicycle as an option to traffic congestion and for better and cleaner air for environment and to people to breath.

As whole year, most Malaysian will witnessing and exposed with sizzling catchphrase advertisement throughout the radio, television, internet, poster, newspaper and giant electronic screen placed in most major city throughout Malaysia. Some of the phrase held like Stop on Red Light, Ware your seat belt, Celebration, Drive safely, Driving in patient and other sought kind of positive catchphrase. The campaign brought by Road Safety Council Malaysia (2010) and they will highlight on four main issue such as; road safety is a together and community effort and not a sole effort of a government, road regulation and rules is a mandatory ruling to be follow by all road user or bear-up will the summon and severe penalty, follow the law will reducing and avoid fatality and lastly if every citizen support this campaign with uncompromisingly. Hopefully, in future; collaboration between intra and inter government agency will improve more on road safety and nevertheless, the government could achieve road accident death toll to below par level. As it will also could, save million of Ringgit in term of property damage, working force and productivity loss and also medical cost.