Example Reflective Account on Hand Hygiene in Nursing Care

During the time of placement in the respiratory ward, I once had to care for an old patient with multi-morbid disorders. He was primarily admitted to the ward because he faced shortness of breath the previous night and was immediately admitted to the respiratory ward. He was diagnosed with chronic obstructive pulmonary disorders and his excessive levels of smoking were stated to be the main contributor for the disorder. Besides, he was suffering from diabetes and had many wounds all over the skin due to poor skin integrity. He had unmanaged diabetes with high levels of blood glucose. The wounds were not dressed properly and therefore, nursing professionals needed to dress his wounds properly. During one of the busy days, I was given the responsibility of dressing the wounds by the senior facilitator. It was a very busy shift and I had to handle many patients within a short span of time. Therefore, I was rushing from one patient to another completing their assessments of health, meeting their needs, documenting important information and many others. I was supposed to administer a medication to one patient and dress the wounds of the quoted patient at the same time. Therefore,  I could not set the priorities right and chose the dressing intervention as the first task to proceed with it. As I was in a hurry, I could not get time for washing my hands and using sanitizers. I also did not wear gloves out of hurry and immediately started dressing the wounds. After completing the task, I went to the next patient for administration of the medication. Later, my mentor called me in the ward, where she stated that the quoted patient had developed infections of MRSA and his sufferings had increased. She was upset about my carelessness and asked me to be careful from the next time. I visited the patient seeing that the infected areas on the skin had become red and swollen and the person was suffering from intense pain.

Immediately after witnessing the entire incident, I felt embarrassed, as I could not fulfill the responsibility and oath of a nursing professional to provide safe and quality care to a patient.  I felt terribly upset with my own performance, as I could not do justice to the expectation of the nation from a responsible nursing professional. I felt quite sad that I could not step up the expectation of my facilitator who had so much trust and confidence on my knowledge. I was quite disheartened by seeing the suffering of the patient which had increased due to my improper hand hygiene. I realized that it was because of my improper following of hand hygiene protocols that had made the patient infected with MRSA (methylene-resistant staphylococcus aureus). However, I also felt that this failure in effective treatment helped me realize that I do not have proper skills for effective maintenance of hand hygiene and therefore. Therefore, I promised myself to become more knowledgeable and develop expert skills that would help me to maintain hand hygiene effectively and reduce chances of spread of infection successfully.

The Importance of Hand Hygiene in Nursing Care

The bad part of the experience was that it resulted in huge suffering for the patient. Nursing philosophies as well as bioethical principles advice nurses to follow the two important ethics of beneficence and non-maleficence (Shinde and Mohite 2014)).  Beneficence dictates nurses to provide care to patients which are not only safest but also evidence based and would bring out the best outcomes in the patient helping in their comprehensive and holistic recovery (Smidy et al. 2015)). Non-maleficence on the other hand dictates healthcare professionals to apply interventions in ways that should not cause any form of suffering or negative impacts on the health of the patients. However, I had failed to follow both the bioethical principles as my care had not only caused suffering of the patient but had also proved that I have also not followed the hand hygiene protocols successfully. The good part of the incident was that it taught me that I do not have proper time management skills to manage more patients successfully within a limited amount of time. I often tend to get nervous and take wrong decisions out of nervousness. Moreover, this incident also helped me to realize that I do not have proper knowledge about hand hygiene and therefore could not follow the protocols. Helping me to identify my knowledge gaps is the only food part of the incident.

After analyzing through the different segments of the incident that day and later discussing the entire incident with my mentor, I had developed huge amount of knowledge. I also had conducted evidence-based research after the incident to develop good ideas about how the entire incident had resulted and what caused the increase in severity of the patient’s condition. Bacteria alone are the contributors of 90% of the cases of the hospital-acquired infection while fungus and viruses result in the rest of the 10% of the cases (Luangasanatip et al. 2015). Some of the common types of bacteria that can be responsible for the development of such form of infections are staphylococcus aureus, Escherichia coli, Enterococci as well as Pseudomonas Aeruginosa (Castle et al. 2016). This form of microbes might spread predominantly through different person-to-person contact and this can include unclean hands as well as handling of contaminated medical instruments and other hospital equipments. Studies are of the opinion that MRSA might spread through contaminated equipments as well as through contacts of contaminated objects (Hou et al. 2017). Researchers are of the opinion that nurses always do not need to touch directly a patient for the spreading of the infection. Even touching, hospital beds, rails, doorknobs and many others, which were contaminated, can spread such infections. Cross contamination occurs through particular steps. Firstly, organisms remain present either in skin or on inanimate objects. Organisms are then transferred to the hands of the healthcare workers. The organisms are then seen to survive on the skin for several minutes. Inadequate or that of absent hand hygiene might cause the organism to spread. Direct contact with a patient might enable successful transmission of the microbes (Gould et al. 2017).

Bioethical Principles in Nursing Care

It has been seen in the articles that simply washing the hands or that of rubbing the alcohol immediately after coming in contact with the organisms can prevent their ability in surviving on the skin (Foote et al. 2016). It is important for the healthcare professionals to know how to maintain hand hygiene and wash our hands prior to manage wound dressing interventions or contacts with patients. Hand Hygiene WHO has successfully identified 5 crucial timings when hand hygiene protocols need to be followed (Cruz et al. 2016). These are before touching a patient, before a procedure, after a procedure or body fluid exposure, after touching a patient as well as after touching the surrounding of a patient. The WHO guidelines for hand washing mainly advise healthcare professionals to follow certain basic steps for maintaining hand hygiene. At first, the healthcare professionals should wet hands with water and thereby apply enough soap for covering all the hand surfaces. Then they should rub palm to palm, then right palm over left dorsum with the fingers in interlaced position (Kingston et al. 2017). Then the washing motion should follow the palm-to-palm movement with fingers interlaced followed by back of fingers to opposing of the palms with fingers interlocked. Rotational rubbing of the palms followed by rinsing of hands, drying thoroughly are some of the steps that are needed to be followed (Doronina et al. 2017). Using gloves, sanitizing the hands, sterilizing equipments and similar other actions are important to prevent spread of disorders.

Conclusion:

From the above discussion, it has been clearly seen that maintenance of hand hygiene protocols is extremely important for spreading of different types of healthcare associated infections. Failure of this can result the patient to be infected with harmful microorganisms that can not only affect the conditions of their wounds but also add to the sufferings of the already present disorders (Karadag et al. 2016). Such incidents might increase the length of hospital stays of the patients, readmissions, excessive preventable sufferings, huge expenditure of healthcare resources, financial drainage of patients and many others (Chassin et al. 2015). Therefore, I need to be extremely cautious while handling patients and ensure following of hand hygiene protocols strictly.

The first skill and knowledge that I need to develop is the hand hygiene maintenance skills and protocols. I would mainly do these by searching various nursing and healthcare databases and thereby find out peer-reviewed articles that give me more insight into the topic. Moreover, I would also join workshop sessions that would mainly help in developing the practical skills of maintaining hand hygiene and would make me expert in this aspect. Moreover, I also have self-awareness and self-regulation issues and cannot control my nervousness and emotions successfully. Therefore, I would try to engage in mindfulness-based therapies as well as yoga and meditation. All these initiatives would help me in regulating myself successfully and help me in managing myself in strenuous situations successfully. These would help me become an experts nursing professional and provide best care to my patients ensuring patient satisfaction.

References:

Castle, N., Handler, S. and Wagner, L., 2016. Hand hygiene practices reported by nurse aides in nursing homes. Journal of Applied Gerontology, 35(3), pp.267-285.

Chassin, M.R., Nether, K., Mayer, C. and Dickerson, M.F., 2015. Beyond the collaborative: spreading effective improvement in hand hygiene compliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), pp.13-AP3.

Cruz, J.P. and Bashtawi, M.A., 2016. Predictors of hand hygiene practice among Saudi nursing students: A cross-sectional self-reported study. Journal of infection and public health, 9(4), pp.485-493.

Doronina, O., Jones, D., Martello, M., Biron, A. and Lavoie?Tremblay, M., 2017. A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship, 49(2), pp.143-152.

Foote, A. and El-Masri, M., 2016. Self-perceived hand hygiene practices among undergraduate nursing students. Journal of Research in Nursing, 21(1), pp.8-19.

Gould, D.J., Moralejo, D., Drey, N., Chudleigh, J.H. and Taljaard, M., 2017. Interventions to improve hand hygiene compliance in patient care. Cochrane database of systematic reviews, (9).

Hou, C., Rosenberg, M., Steer, R., Miller, M., Cricco, C. and Campos, K., 2017. How to Increase Hand Hygiene Adherence for Nurses with an Electronic Warning System. American Journal of Infection Control, 45(6), p.S59.

Karadag, M., Pekin Iseri, O., Yildirim, N. and Etikan, I., 2016. Knowledge, beliefs and practices of nurses and nursing students for hand hygiene. Jundishapur Journal of Health Sciences, 8(4).

Kingston, L.M., O’Connell, N.H. and Dunne, C.P., 2017. Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub. Nurse education today, 52, pp.57-62.

Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A.S., Harbarth, S., Day, N.P., Graves, N. and Cooper, B.S., 2015. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. bmj, 351, p.h3728.

Shinde, M.B. and 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), pp.311-321.

Smiddy, M.P., O’Connell, R. and Creedon, S.A., 2015. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. American journal of infection control, 43(3), pp.269-274.