# Situation: A 36-year-old man with schizophrenia is on a psychiatric ward that uses an electronic health record (EHR). Nurses write focus charting notes, and the treatment team writes SOAPIE progress notes (Subjective, Objective, Assessment, Plan, Intervention, Evaluation). This morning he threw chairs in the dayroom and was placed in seclusion on the order of the attending psychiatrist. At 15:00 a colleague whose computer has frozen asks to type her observation notes under the nurse's open session on the electronic health record. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630254  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 36-year-old man with schizophrenia is on a psychiatric ward that uses an electronic health record (EHR). Nurses write focus charting notes, and the treatment team writes SOAPIE progress notes (Subjective, Objective, Assessment, Plan, Intervention, Evaluation). This morning he threw chairs in the dayroom and was placed in seclusion on the order of the attending psychiatrist.

At 15:00 a colleague whose computer has frozen asks to type her observation notes under the nurse's open session on the electronic health record. What should the nurse do?

## 보기

1. Log out so she can sign in here with her own account **✔ 정답**
2. Let her type, as long as she writes her name in the note
3. Type her notes for her and name her as the observer
4. Let her type, then review and countersign her entries

**정답: 1**

## 해설

Every entry must be authenticated by its author, and nurses chart only their own care. Sharing a login breaks authentication and the audit trail and defeats the security safeguards required for health data, which the Data Privacy Act of 2012 (Republic Act 10173) treats as sensitive personal information; the colleague should log in with her own credentials.

## 심화 해설

Core principle: authentication and the audit trail

The correct action is to log out so the colleague can sign in under her own account. In an electronic health record, every entry must be traceable to the person who actually made it. When a nurse lets someone else type under an open session, the system records that entry as if the original nurse authored it. This breaks two linked safeguards: authentication, which verifies that the person entering data is who the system says they are, and the audit trail, which is the chronological record of who accessed, created, or modified information and when . Without both, the record can no longer reliably answer the question, “Who documented this observation, and were they authorized to do so?”

Why sharing a login is never acceptable

EHR systems are built on the assumption that each user has unique credentials tied to a specific role and scope of practice. Nurses chart only the care they themselves provided or directly observed. If a colleague types her notes under another nurse’s login, the system attributes that documentation to the wrong person. Even if the colleague writes her name inside the note text, the metadata—the system-level record of who created the entry—still points to the original nurse. The same problem occurs if the nurse types the notes “for” the colleague or reviews and countersigns afterward: the entry’s origin is misrepresented, and the audit trail is corrupted from the start.

Watch out! Writing a name in the body of a note does not fix the authentication problem. The EHR’s audit log, not the typed name, is what courts, regulators, and quality reviewers examine.

Legal and data-protection context

Health information is classified as sensitive personal information under the Data Privacy Act of 2012 (Republic Act 10173). This classification imposes stricter safeguards on access, use, and disclosure. Shared logins defeat those safeguards because they make it impossible to determine who actually accessed a patient’s record. In the Philippine setting, organizational factors such as staffing, infrastructure, and training affect how consistently EHR safeguards are applied . However, even when a computer freezes or time is short, the security requirement does not change: each user must authenticate individually.

Applying this to the psychiatric ward scenario

The patient has schizophrenia and was placed in seclusion after an aggressive episode. This is a high-risk clinical situation where documentation must be precise, timely, and clearly attributable. Seclusion is a restrictive intervention with legal and ethical implications, so every observation note—behavior before seclusion, response during seclusion, vital signs, mental status—must be linked to the nurse who actually observed and recorded it. A shared login would make the seclusion documentation legally indefensible if the patient’s care or the seclusion order were later reviewed.

| Option | What happens in the EHR | Why it fails or succeeds |
| --- | --- | --- |
| 1. Log out; colleague signs in | Each entry is attributed to the correct author | Preserves authentication and audit trail; correct action |
| 2. Let her type; she writes her name | Metadata still names the original nurse as author | Name in text does not override system attribution |
| 3. Type her notes; name her as observer | Original nurse is recorded as the data enterer | Misrepresents who performed the documentation |
| 4. Let her type; review and countersign | Original nurse appears as author; countersignature adds confusion | Does not restore accurate attribution of the original entry |

Practical workflow point

The colleague’s frozen computer is an equipment problem, not a reason to bypass access controls. The correct response is to have the colleague use another workstation, wait for the computer to be restored, or contact IT support. Key point! Authentication is a per-user requirement; it cannot be delegated, shared, or temporarily suspended for convenience. The nurse should log out of the open session immediately so the colleague can authenticate with her own credentials and document her own observations.

The systematic review on EHR adoption in Philippine public hospitals highlights that inconsistent implementation and resource constraints can create pressure to take shortcuts . However, documentation integrity is a non-negotiable component of safe psychiatric nursing care, particularly when restrictive measures such as seclusion are involved. The audit trail is the mechanism that makes the record trustworthy, and it only works when each entry is genuinely tied to the person who created it .

## 임상 시나리오

EHR Login SecurityNever share an open session
Every EHR entry must be traceable to the person who actually made it through authentication and a reliable audit trail. Nurses chart only care they provided or directly observed.

If a colleague needs to document, the nurse should log out so she can sign in with her own credentials. The Data Privacy Act of 2012 treats health data as sensitive personal information requiring these safeguards.

CautionWriting a name in the note text, typing for someone else, or countersigning afterward does not fix the corrupted metadata. The system still records the entry as authored by the original login holder.

## 핵심 개념

- **Authentication** — The process of verifying that the person entering data is who the system says they are.
- **Audit trail** — A chronological record of who accessed, created, or modified information and when.
- **Data Privacy Act of 2012** — Republic Act 10173, which treats health data as sensitive personal information requiring security safeguards.
- **Focus charting** — A nursing documentation method that organizes notes by patient-focused concerns.
- **SOAPIE** — Progress note format: Subjective, Objective, Assessment, Plan, Intervention, Evaluation.

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