Introduction

Professional nurses are sworn to perform their duties with

confidence, knowledge and responsibility(CRNBC 2015). From the
Nightingale pledge, I will do all in my power to maintain and elevate
the standard of my profession, and will hold in confidence all personal
matters committed to my keeping and all family affairs coming to my
knowledge in the practice of my calling(ANA 2015); the professional
nurse holds a role that is very fragile and very complex, to preserve
human life. But nevertheless, an account for error is inevitable. For an
instance, a surgeon left a gauze inside the stomach cavity following
abdominal surgery. A mother suffered a cardiorespiratory arrest during
a normal delivery. A set of X-ray films with a diagnosis of cancer was
given to the wrong patient, and those situations are just the tip of the
iceberg(Kohn L., et al. 1999). Enlightenment then enters the scenario.
Enlightenment is taken commonly as an emergence from self-incurred
immaturity(Kant 1784). It is understood in context regarding more on
the

religious

and

philosophical

perspective;

illumination,

understanding and many other terms. As a concept of enlightenment

in ones error, the person, specifically a competent nurse responsible,
is held in an extreme scenario of reaction. For an ideal nurse to
respond to such incident of malpractice, one usually takes the virtue to
learn from the mistake and move on or otherwise. There are two
parallel strategies to respond to the situation; in an enlightened

manner, where one accepts and learns from the mistake, which is also
labelled as the systems approach; or the negative reaction, individual
blame. On systems approach, the institution affected does not relieve
the individual nurse of responsibility. Wherein as a part of the nurse
committing the error, he or she has a responsibility to report the error,
participate in investigating the causal systems failures, undergo
constructive criticism and reveal the error to the primary physician and
the patient. Thus the systems approach allows a nurse to be
enlightened, mentally and ethically, although that does not eliminate
accountability(Leape, 2005). In contrast to this method one can also
engage in Individual blame where enlightenment is disregarded
through destructive criticism, sanctioning the nurse to be censured of
such act, and be held responsible for his or her actions. Both strategies
confer differently, but are capable of achieving the enlightenment in
error.

Definitions
Analyzing the concept of enlightenment, it is understood as the
state of having knowledge or understanding or the act of giving
someone

knowledge

or

understanding(Merriam-Webster,

2015).

Enlightenment is then defined as the action or states of attaining or

having attained spiritual knowledge or insight, in particular to
awareness which frees a person from the cycle of rebirth according to
the Oxford dictionary(2015). In an ancient perspective dating back to
the Grecian times, enlightenment plays a major role in philosophy.
According to Socrates, enlightenment is something that is already
within a person, only with the necessity to experience and to be
capable of discovering it(McBride, 2009). It has influenced their
practices towards discovering that potential and with it began other
causes and beliefs to increase that capability to attain enlightenment.
And according to Buddhism, enlightenment is said to be familiarizing
with oneself, bringing one persons head to heart, until they are ones
own experience and no longer merely intellectual, ideally focusing on
(Robina, 2007). Enlightenment then was thought to be achieved by
means of being mindful(Pamojjo, 2013). Thus, enlightenment was first
understood as a matter of an abstract idea or potential that is believed
to be innate in a person. This can be referred to as knowledge, skill,
behaviour, and the like. Furthermore, enlightenment in the later refined
parts was viewed as a process that releases us from the status of

'immaturity.' And by 'immaturity,' it means a certain state of our will

that makes us accept someone else's authority to lead us in areas
where the use of reason is called for. This was explained by Immanuel
Kant, a german philosopher from the article: Was ist Aufklrung?
meaning, What is enlightenment?(Foucult 1984). And along with it In
the nursing perspective, enlightenment is defined as a person to be in
position to promote positive change within him/her, as well as other
members of the health care team, thereby improving both quality of
care

and

patient

satisfaction

and

to

avoid

negative

consequences(Siccardi, 2008).
Error then is defined as simply something that is not correct, a
wrong action or statement. It is an act or condition of ignorant or
imprudent deviation from a code of behaviour, an act involving an
unintentional deviation from truth or accuracy. The word error
originates from the word errour which is of anglo-french descent. It is
synonymous with words such as mistake, blunder, slip, lapse wherein
they all imply a departure from what is true, right or proper(MerriamWebster, 2015). According to the Oxford dictionary(2015), error is the
state or condition of being wrong in conduct or judgment. Errors range
along a spectrum from those relatively local to the phenomenon
(usually easily remedied in the laboratory) to those more conceptually
derived

(involving

longterm).

One

theory

may

or

classify

cultural
error

factors,

types

sometimes

broadly

as

quite

material,

observational, conceptual or discoursive(Allchin, 2002). The Institute of

Medicine (IOM) defined error as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim
(Kohn et al., 2000, p. 28).

Literature Review
The title of this report encapsulates its purpose. Human beings,
in all lines of work, make errors. Errors can be prevented by designing
systems that make it hard for people to do the wrong thing and easy
for people to do the right thing. Cars are designed so that drivers
cannot start them while in reverse because that prevents accidents.
Work schedules for pilots are designed so they don't fly too many
consecutive hours without rest because alertness and performance are
compromised.

Therefore,

through

these

given

examples

of

countermeasures learned from mistakes, the researchers introduce a

persons enlightenment through their error.
In health care, building a safer system means designing
processes of care to ensure that patients are safe from accidental
injury. When agreement has been reached to pursue a course of
medical treatment, patients should have the assurance that it will
proceed correctly and safely so they have the best chance possible of
achieving the desired outcome(Kohn., et al, 1999). Understanding the
causes of errors may provide the basis for lower error rates. Lucien
Leape(2005), in his review of errors in medicine, pointed out that
Florence Nightingale gave the nursing profession a valuable motto
when she wrote in her manuscript Notes on Hospitals in 1863 Primum
non nocere meaning most importantly, cause no harm. All of the

time, the patient is at the utmost care of the nurse, working to give all
the patients needs- physically, physiologically, socially, emotionally,
and spiritually(Cawi., et al, 2005). There are several areas that nurses
report as difficulties. These include managing patient caseload and
making clinical decisions in patients with complex medical diagnoses
(Hickey, 2009). An example to reducing the chances of committing
these reach the extent of knowledge and observance of the nurses
code of ethics among nurses and student nurses intuitive knowledge
as well is the foundation upon which the future of nursing is secured. A
high extent predicts a bright future; a low extent forecasts a dark
tomorrow; enlightenment then applies(Domes., et al, 2005). The stakes
are high for nurses who have great responsibilities for the safety and
well-being of their patients. In particular, novice nurses may have
greater

risk

for

errors

than

the

experienced

RN

(Berkow

&

Virkstis2008). As the nurse moves from classroom to practice, an

enlightenment of the challenges and potential for mistakes must be
identified. It is imperative that novice nurses are aware of potential
mistakes and move towards reducing the number of errors made. The
extent of performance in nurses take into account variables to identify
their competency through enlightened skill(Acupan et al, 2005). These
scenarios where potential mistakes are made and acted upon on,
positively or negatively, is an actionable improvement opportunity, an
opportunity for enlightenment(Tucker, 2003). Although, there are also a

few factors that limit one or a hospitals capability of acknowledging

enlightenment. In a practical situation, it is difficult for managers to
assess full costs of failures because they were rarely present when
failures occurred, did not receive much information from nurses about
these situations, and did not experience the impact firsthand.
Unfortunately, research suggests that managers perceptions about
failures can also be inaccurate(Tucker, 2003). Therefore, some failures
that are worthy of attention are likely to be ignored while other more
trivial

situations

may

receive

attention.

Fiindings

suggest

an

explanation for common lament of healthcare workers that their calls

for management assistance in rectifying known trouble spots fall on
deaf ears until a crisis emerges(Chassin and Becher, 2002). In sum,
higher level support was often insufficient, perhaps because managers
were unaware of the failures. Nonetheless, the lack of managerial
support was a serious setback as most failures to attain enlightenment
originated in non- nursing units and therefore needed more clout than
rank-and-file workers possessed to get other departments to examine
and modify their work practices. Despite difficulty in drawing attention
to failures as well as being enlightened from it, failures are worthy of
solution efforts. Thus, the enforcement of enlightenment among the
nurses is likely. Much can be learned from the enlightenment in errors.
All adverse events resulting in serious injury or death should be
evaluated to assess whether improvements in the delivery system can

be made to reduce the likelihood of similar events occurring in the

future which promotes enlightenment and acceptance of the mistake.
Errors that do not result in harm also represent an important
opportunity to identify system improvements having the potential to
prevent adverse events. Enlightening ones self from errors committed
means designing the health care system at all levels to make it
safer(Kohn., et al, 1999).

Antecedents
Antecedents are the events that need to take place prior to the
occurrence of the concept (Walker & Avant, 1999). In attaining
enlightenment in error, one must experience or have the necessary
criteria. The nurse who is enlightened in error must of course
experience committing an error in any form, which has been either
resolved or ignored. From any action taken, that nurse must have
acknowledged or identified his or her action in stances like, the nurse
decided to learn from it, to set measures to prevent it from happening
again, or to either let it pass as anything of no significance. The nurse
should also at least experience collaborative assessment of the error
such as the inclusion of fellow nurses, staff nurses or the chief in
resolving such scenarios.

Defining Attributes
Defining attributes are a list of characteristics of a concept that
appear over and over again when reviewing the literature. They help
you name the occurrence of the concept as differentiated from a
similar concept (Walker & Avant, 1999). Enlightenment in error stands
as a responsive behavior towards a negative extreme situation,
wherein they acknowledge their own doing and establish steps, given if
they encounter it again. A nurse who is enlightened in error learns to
create measures that increase chances of performing the right action,
and lessen the chances of committing mistakes. Adaptive to situations
as such, they respond to error as something that should be avoided,
but also something to learn from. A nurse enlightened in error
identifies mistakes as opportunities for enlightenment.
Consequences
According to Walker and Avant (1999), consequences are the
events or incidents that occur as a result of the occurrence of the
concept. As a consequence of enlightenment in error, the individual
involved gains a transformative response to negative situations, which
then increases positive attitude, constructive understanding and a
competent knowledge. Intuitively, performance increases due to
responses and actions that are developed upon experiencing. Other
possible consequences include increased anticipatory and problem

solving skills. Self-image also develops due to the derived acceptance

of negative enforcements situationally and environmentally.

Model Case
This is the case of Athena, a professional nurse who worked
at Notre Dame de Lourdes Hospital, Baguio City in the early years of
her career, who later on continued to work overseas at the Royal New
Castle Hospital for a re-entry course. Today, she presently works at
Mater Brisbane Hospital as a staff nurse at the OPD. Through her years
of experience as a professional nurse, she does not deny her
successful career as attained through the mistakes she learned from.
As she had narrated, she experienced mistakes, both the grave and
benign but identified them all as an opportunity for learning. Through
her previous experiences in the hospitals, an account for error greatly
helps her in knowing more than the average knowledge. But hence the
advantages, it should still be avoided since it affects your performance
and your dignity as a nurse, she claimed. As a staff nurse in the
present, she even set guidelines for other nurses under her supervision
to follow standards and measures when an error is encountered, she
formulated procedures to refer incidents of the unlikely, to identify and
resolve errors and acknowledge them as a learning experience for
other nurses. And so far, she has developed recognition in their

hospital for her resilience and skill as an enlightened health care

provider.

Contrary Case
This is the case of Juno, an ongoing student nurse who has
average experiences in Baguio General Hospital and Medical Center,
Benguet General Hospital and Roseville Rehabilitation Complex Baguio.
He is currently a fourth year student, and under the years of his
experience, he views error as something inevitable and thus, believes
that one does not have to experience the error to learn from it.
Although he does not claim to have a perfect clinical performance, he
usually keeps his errors to himself and as much as possible evades
blame by ignoring the situation. He doesnt think it is an effective idea
to collaborate with significant others and upper classes in resolving
errors since he believes that they will not remember the good things
that you did, but they will not forget your mistakes. Thus he finds it
unnecessary to dwell in the error committed and instead view it as an
experience of natural cause.

Borderline Case

This is the case of Aphrodite, a professional nurse of broad

experiences in the field of medicine. He started his career as a nurse
fellow in Baguio General Hospital and Medical Center for a year, moved
to the Ilocos region to work as a community nurse, then worked as a
community facilitator for a private mining company, and he presently
works at Libya in St. Benghazi hospital as a MICU nurse. He views error
as an opportunity for realization of the unknown. He believes so that
learning is a continuous process, and errors are among them.
Although in the nursing setting, an account for error is something
serious, he regards more of enlightening himself of the errors he
committed outside of nursing practice. He believes that errors are
more of behavioral guidelines that shape us nurses. He believes more
that errors outside the nursing profession should be more of focus than
the nursing aspect since errors committed within the hospital are ones
liability and one should be able to resolve it deductively as it was
taught in the courses. He believes that one can definitely be
enlightened through ones error since error is what also balances our
reasoning and beliefs.

Invented case

There once was a boy named Egdir Hassan, who was a

petty and unadventurous lad. He prefers to stay at home than play
with other children. He was skinny and short for his age. He thought
that he was better off alone and satisfied than to go outside, out to the
unknown. One day, while playing all by himself in the living room, he
heard a knock on their door. Egdirs mother opened the door and out
there knocking was a woman who introduced herself as their new
neighbor. All he saw was the amused fumbling of their conversation,
same adult things he knows he is too young to understand. As his
mother invited the new neighbors to come in, he noticed something
else. The woman did not enter alone. With her was a girl, same as him,
only a little bit taller. She looked petite but also uncanny. The girl was
energetic and even shook hands with his mother. Egdirs mother
introduced him to her, but he was very shy. Then surprisingly, she
asked his mom if she can play with him outside. The idea stunned
Egdir. He was frozen like a statue that he did not even notice he was
already pulled by the girl out of the door. She finally let go of him on
the pathway, and skipped along while asking Egdir a dozen of
questions. Still puzzled, he did nothing but just nod. She then told him
to follow her to the tall grasses. But he hated the idea. He was afraid of
the idea of outdoors, but he was helpless, he had to follow. As they got
further, she started running around and he followed. She tumbled, and
hopped, and he followed; until he realized how fun it was after all. He

enjoyed this day, and he was happy. They both got tired and decided to
lie down on the dry, warm pastures and gaze up at the orange horizon
of a beautiful sunset. Before it was dusk, they decided to go home. And
they both waved each other goodbye, with smiles on both of their
faces. That night, Egdir gazed up from his bed and realized how
happier it was to gaze up and see the skies than to see a blank white
ceiling. The next day, he opened the door.
Implications to Nursing
As student nurses, they are still considered to be classified as
beginners. And as such, the chances for committing an error are
greater. Since that is the case, they all tend to respond in rather
stressful situations as to what they are taught or intuitively. Student
nurses learn later on that these errors they commit imprint on them
and therefore, they learn from it. Case sensitively, the more mistakes
you encounter, the more you learn from them, at the same time, the
more you avoid them from happening again. In a collaborative sense, a
nurse can also learn and achieve enlightenment not only on their
errors, but also from others. The very point that one has been able to
adapt or to resolve the error grants the nurse an opportunity to learn
further practically. Enlightenment in error defines the simple concept of
developing, to be competent from incompetence.
References

College of Registered Nurses of British Columbia(2015) Professional

standards for registered nurses and nurse practitioners(July.,2015),
pp.7 CRNBC
American

Nurses

Association(2015)

Florence

nightingale

pledge

2015(March.,2015)ANA
Kohn, K.T., Corrigan, J.M., & Donaldson, M.S. (Eds.). (2000). To err is
human: Building a safer health system. Washington, DC:National
Academy Press.
Kant

E.

(Nov.,

2005)

An

answer

to

the

question:

"what

is

enlightenment?" Konigsberg, Prussia

Leape, L.L. (2005). Ethical issues in patient safety. Thoracic Surgery
Clinics, 15(4), pp. 493-502.
Kelley, G.A. (2002). Living at the sharp end: Moral obligations of nurses
in reporting and disclosing errors in health care. Critical Care Nursing
Clinics of North America, 14(4), pp. 401-405.
American Nurses Association (ANA). (2001). Code of ethics for nurses
with interpretative statements. Silver Spring, MD: American Nurses
Publishing.
Sharpe, V.A. (2003). Promoting patient safety: An ethical basis for
policy deliberation. Hastings Center Report, 33(5), S3-18.

Rosenstein, A.H., & ODaniel, M. (2005). Disruptive behavior and

clinical outcomes: Perceptions of nurses and physicians. American
Journal of Nursing, 105(1), pp. 54-64.
Robina,

V.

(2007)

Notes

on

the

bhuddist

path

to

enlightenment.Kadampa Center.org pp. 7-8

Pammojjo, P. L., & Santidham W. S. (2013). The Path to Enlightenment I
PRIMA Publishing Co., LTD
Foucault, M. (1984) The Foucault reader. New York, Pantheon books
1984, pp. 32-50
McBride, K. (2009) Heres a breakdown of platos allegory of the
cave Seminole State College pp.1-3
Siccardi, A., & Iseminger, K. (2008) Philosophical exploration through
the mind, heart and soul of nurses. Author House 2008 pp. 37
Allchin, D., (2002) Error types. Minnesota Center for the Philosophy of
Science pp.1
Hickey M.T. (2009) Preceptor perceptions of new graduate nurse
readiness for practice.Journal for Nurses in Staff Development pp.25,
3541.
Berkow

J.D.

&

Virkstis

K.

(2008)

Assessing

new

graduate

nurseperformance. Journal of Nursing Administration pp.38, 468474.

Kohn L.T., Corrigan J.M., & Donaldson M.S. (1999) To err is human
building a safer health system Committee on Quality of Health Care in
America, NATIONAL ACADEMY PRESS, Washington, D.C. 1999 pp.8
Cawi, J.G., Ramos, B.G., & Toyoken, J.B. (2005) Barriers encountered by
student nurses in rendering nursing care. Benguet State University
College of Nursing Library.
Domes, D.F., Gay-as, M., & Salcedo, D.A. (2005) Extent of knowledge
and observance of nurses code of ethics among student nurses at
benguet state university. Benguet State University College of Nursing
Library.
Acupan, M., Kidkid, V., & Yawan, C. (2005) Extent of performance of
nursing students in data gathering procedure for nursing care plan.I
Benguet State University College of Nursing Library.
Hatch, D. (2001) Incidence and acceptance of errors in medicine.
Editores

Medicorum

Helveticorum

Schweizerische

rztezeitung

Bulletin des mdecins suisses / Bollettino dei medici svizzeri. pp 1339

Tucker, A.L. (2003) The impact of operational failures on hospital
nurses and their patients Harvard University: Soldiers Field pp.26-27
Chassin, M.R., & Becher E.C. (2002) The wrong patient Ann. Intern Med