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NRSG140 Integrated Practice

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NRSG140 Integrated Practice

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Course Code: NRSG140
University: Australian Catholic University

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Country: Australia

Question:
Develop a beginning professional portfolio using Mahara which will include the following:
 
Certificate of completion National Standard Medication Chart (NSMC) Course (https://learn.nps.org.au/mod/page/view.php?id=4278) 
Reflection using Gibb’s Reflection Cycle: –
 
Select one of the new skills accomplished.
 
Using Gibb’s Cycle of Reflection as a structural framework, reflect on the relationship of the clinical skill and your preparedness for clinical practicum.
Answer:

From the newly acquired skills of clinical practise, the one that I have found to be quite significant during our clinical practicum is the maintenance of proper hand hygiene and ensuring the proper standards of hand hygiene while carrying out our clinical practise. This paper therefore aims to discuss the importance of hand hygiene by relating with the experience of my clinical practicum
Description
While I was placed in the surgical ward of the hospital, during the second year of my placement, I had to care for an old gentleman of seventy two years. He had immediately undergone an abdominal surgery. I was asked by the RN to remove the wound dressing of the patient in order to allow the doctor to access the wound while the doctor wound come for his rounds in the ward.
As instructed I removed the dressing, during which I used the non-touch procedure and had to clean as the doctor. While I was doing this, the RN was immediately called by another patient of the ward, for whom the RN was examining the wound. After this I noticed that she directly came to the previous patient to examine his wound, without washing her hands or using alcohol to clean her hands. She had been wearing a long sleeved uniform therefore there was a chance for the sleeves to be contaminated. Although I thought of saying something but it was too late as she had already examined the patient.
Feelings
During this incident I was quite alarmed as I thought the doctor would wash her hands or use alcohol before examining the patient. I felt a little intimated and did not want to embarrass her. During our studies we had learnt the importance of hand hygiene and we always made sure that we washed our hands before examining every patient.
Evaluation
This situation that had risen was quite challenging for me therefore I regret not acting properly according to the skills that we had learnt about. However, I was quite pleased that the doctor had responded in a positive way to the feedback of my mentor. I had also observed that the doctor had changed her practice in future as a result of this incident. From this incident I also have learned that, there is a lot of importance of the process of acting in an assertive way with the colleagues along with acting in a sensitive manner so that the patients’ well-being is safeguarded.  
Analysis
As the Royal College of Nursing has stated that hand hygiene is one of the single most essential activities for the reduction of cross-infection from taking place, and it also points out that most of the health care professionals are not responsible enough to decontaminate their hands which they are expected to do before attending to the patients, as often as they should (Shahriari et al., 2013). As reported by a recent guidance that was published by the Department of Health, it was highlighted that there was a possibility that the staff are responsible for transmitting infections through their uniforms and there is a need to review the policies on the dressing of the staff (Shinde & Mohite, 2014). According to the Nursing and Midwifery Council Code of Professional Conduct, it states that being a nurse we need to act in order to identify along with the minimisation of the risk to patients and clients’ (Loveday et al., 2014). Being the student nurse responsible for caring for the concerned patient under the supervision, the terms of hand wash also applies to my own practice as a student nurse.  
Conclusion
When I look back on this incident, I have perceived that I should have acted sooner. Additionally it should also be mentioned that I needed to ensure that the doctor should have washed her hands before she examined the concerned patient. Therefore now I can understand that my inaction during this situation had put the well-being of the patient at risk. After I had discussed this issue with my mentor, I had been able to recognise that I need to develop the confidence in order to challenge the practices conducted by my colleagues, therefore by putting the client’s well-being at the forefront of my mind. Even I had realised that there was a need to be supportive in nature to my colleagues, therefore by understanding the prevailing pressures that they might be under. However by ensuring that the practice carried out by them does not put the well being of the patient at risk.
Action plan
As deduced from the whole situation, I have understood that in future I will be professional enough in my practise. In order to do so I will aim to develop my assertive skills while I am engaged in working with colleagues, so that I am able to ensure the well-being of the patient and this is maintained. Therefore during my next placement, I will take an effort to make this a goal for my learning, and will take necessary steps to discuss this issue of hand hygiene with my mentor in order to work out strategies for how I can achieve this.
References
Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., … & Wilcox, M. (2014). epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.
Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013). Nursing ethical values and definitions: A literature review. Iranian journal of nursing and midwifery research, 18(1), 1.
Shinde, M. B., & Mohite, V. R. (2014). A study to assess knowledge, attitude and practices of five moments of hand hygiene among nursing staff and students at a tertiary care hospital at Karad. International Journal of Science and Research (IJSR), 3(2), 311-321.

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