The Handwashing Techniques - Essay Example

Scenario A is being assessed formatively on their hand washing technique and on their ability to apply the principles of asepsis. The started by washing their hands according to the recommended criteria, explaining how important correct hand washing is to reduce the risk of cross infection. The student dried their hands thoroughly before lifting the lid of the pedal bin with one of their clean hands to discard the soiled paper towel. The student then went on to prepare for the clinical activity. The following essay will deal with, what prima facie is, a failing student. Using the literature I will look at and explore the factors that may have influenced the learner and their performance in Scenario One (hand washing). I will then, with reference to the literature, identify one of these contributory factors and critically discuss and analyse the mentor's role in addressing the identified factor. I will then identify recommendations for best practice. Confidentiality will be maintained. Any names used will have been changed to maintain confidentiality. I will begin by looking at the process of assessment. Assessment is a vital part of the education process (Ewan and White 1996, Rowntree 1987). There are many definitions of assessment in the literature. According to Rowntree (1987) "assessment occurs whenever one person in some kind of interaction, direct or in direct, with another is conscious of obtaining and interpreting information about the knowledge and understanding of the abilities and attitudes of this person". Curzon (1990) defines assessment as the process of: "collection, measuring and interpreting information relating to students' responses to the process of instruction". Ewan and White (1996) define assessment as "the process by which teachers attempt to gauge student' progress and learning". Quinn (2000), states that through assessment in practice judgement is made on the quality of the learners' work, as a way of supporting the learner and of appraising their achievement of their set of outcomes. The common theme of the above mentioned definitions is measurement and progression or competence and outcome Flanagan et al (1999). From the scenario we see that the student is being assessed formatively. It is important that the mentor is aware of the difference between formative and summative assessments. Price (2005) discusses the two purposes of assessment: Formative assessment in which the mentor is the advisor. The formative assessment is to advise the student of progress towards the goal. Summative assessment is in order to judge the learning. The purpose of the assessment in the given scenario is to observe the maintenance of asepsis. Medical Asepsis is defined as, "the procedures used to reduce the number of microorganisms and prevent their spread." [Mosby 2009]. One of the basic principles of health care that is drilled into the minds of all health care professionals from a very early stage in their training is the importance of maintaining strict asepsis in their handling of patients. The lesson is repeated so often as to become second nature for health care professionals. The reason that maintenance of asepsis is stressed upon so often in medical practice is that significant benefits can accrue from following a few simple rules. The rate of transmission of infection from on patient to another in wards and OPDs can be reduced significantly. Asepsis can also be productive towards decreasing the incidence of illness among health care workers themselves by reducing transmission of pathogenic bacteria from patients to carers. A number of rules are in practice for the maintenance of asepsis. These include specific techniques for handwashing and use of sterilization procedures for the sheets, instruments and apparatus used in relation with patients. In the chosen scenario, the student follows the instructions taught to the letter, but forgets to apply simple sense to the situation and soils her hand without even realizing what she has done. There can be a number of reasons to which her negligence can be attributed. Foremost amongst them would be the stress of the testing environment, which would promote mistakes that might never be made in clinical practice. Under the watchful eyes of the examiner the student performed all the steps that she had memorized in sequence but stumbled on the last, perhaps simplest yet most essential step mainly because it hadn't been a part of her exhaustive repetition of the procedure during her exam prep. Another reason that could be applicable in this case is that teaching is very often still by rote. We are taught what to do and how to do it, but the question of why is very often neglected. Procedure becomes more important than the end result to be attained from the procedure. Stress is repeatedly laid on the steps that are to be followed and how it is important that each step be completed, but emphasis on the point being achieved through those steps is often sadly lacking. For example, a student performing a physical examination is taught to focus on making sure that every step of the examination is covered, whether the clinical finding is appreciated or not. While this manner of teaching may be advantangeous in some instances, in others like the case under discussion, it is counterproductive. The student is so single mindedly focused on demonstrating each and every step that they overlook the actual purpose of the exercise. Another reason which cannot be overlooked is simply ineptitude of the student. When a student is found making the same types of errors again and again or when he or she is making multiple errors, [Emerson 2007] this reason becomes more likely. In my opinion however, the single major factor that plays the most important role in determining the competence of students is the quality of mentorship available to them. A poor performance by a student reflects, at one level or another, the failure of the mentor in guiding the student. A mentor is defined as "an experienced nurse who shares knowledge with less experienced nurses to help advance their careers." [Chitty 2001] In healthcare, there are some things that need to become second nature to the students, the reason being that any fumbles in those procedures could mean the difference between life and death not just for the patient but for the nurse as well. Learning proper disposal of sharps, learning the use of protective gear when coming in contact with patient secretions, etc. are examples of such procedures. So is maintenance of asepsis. The mentor should ensure that the importance of these concepts and procedures is drilled into the minds of the students. The mentor can do this in a number of ways, most prominently by setting an example for the students to follow. Also strict punishments should be enforced for any lapses in attention like the one evinced by the student in the case under study. It is only by taking such stringent measures at the student stage that it can be assured that such mistakes will not be made in clinical practice when no one will be available to monitor and correct them. Such conditioning will serve the student in good stead in their professional life. Also the mentors need to be aware of their responsibility to the medical profession and should be conscientious in filtering out the students whose clinical performance is consistently not up to par. Failing a student is not an easy decision for any mentor. In many cases, the mentors recognize that "weak students often had a history of problems with clinical practice but were given the benefit of doubt and so progressed through the system." [Duffy 2004]. A mentor needs to identify weak students early in the course of his interaction with them and should also be able to pinpoint the nature of the weakness, whether it is a lack of interest, lack of practical skills or poor communication. By recognizing the students needs early in the course of his training, formal procedures can be initiated to either bring about definite improvements in performance or weeding out students whose persistently display poor performance. [Duffy 2004]. Certain features can alert the mentor that the student is likely to fail. These include: -" Inconsistency in meeting the required level of competence for the stage of training; - Inconsistent clinical performance; - Lack of insight into weaknesses so unable to change following constructive feedback; - Unsafe practice; - Not responding appropriately to feedback; - Lack of interest or motivation; - Limited practical, interpersonal and communication skills; - Absence of professional boundaries and/or poor professional behaviour; - Experiencing continual poor health, feeling depressed, uncommitted, withdrawn, sad, tired or listless; - Unreliability, persistent lateness/absence; - Preoccupation with personal issues; - Lack of theoretical knowledge." Mentors should keep in mind the difference between formative and summative assessments and should not hesitate from making constructive criticism at crucial junctures when they think the student is lagging behind his peers. [Duffy and Hardicre 2007] Another important step that needs to be taken is to ensure the professional competency of the mentors themselves. The quality of the students produced is very obviously dependent on the competence of the mentors. The performance of the mentors in the mentor preparation programs should be monitored. Periodic refresher courses for the mentors should also be arranged. [NMC 2008] Nursing is a very broad field with the nurses working in a large number of sub-specializations. Tailoring the training in accordance with the post graduate field of choice of the nurse can also yield beneficial results. However this has most significance for nurses doing post graduate degrees. The mentor assigned to a nurse should be accomplished in the field the nurse herself is pursuing. "There is asynergisticrelationship between education and practical experience that exists in clinical practice areas which must be explored when considering what, when and how format educational programmes should be used to support clinical practice. How nurses use education and learning to develop their practice is an important factor in effective education but is virtually overlooked in current literature. Consequently, education is rarely evaluatedaccording towhat learning actually means to individuals, or how they use it to enhance practice at an individual or collective level." [Santy 2000] Using the assessment made solely in an exam environment may give a skewed opinion of the competence of the students. The weightage given to the clinical skills exhibited in the exam should be reduced in favor of the acumen demonstrated by the student in the clinical milieu. This can be assessed continuously by mentors at regular intervals during the training period and can count towards the final result. To this end, the concept of work based learning may prove to be beneficial in providing a platform where nursing students can learn and be assessed in the environment in which they will need to demonstrate their skills after graduation. [Flanaghan 2001] The relationship between the mentor and the student also plays a vital role in the competence of students. The mentor has to act as the adviser, role model, problem solver, counselor, guide and supporter of the student. [Ali & Panther 2008] To perform all these roles, the mentor has to overcome numerous challenges like limitations on time, dual responsibility of student teaching and patient care and high workload. [ Bennet 2003] He has to place himself infront of his students as the perfect role model for them to idealize and follow. He should be "a perfect exemplar of excellence. That is, someone whose practice standards, attitudes and beliefs the observer can emulate." [Kinnel & Hughes 2009]. The mentor has to exercise subjectivity in his assessment of the students. This subjectivity is a demand of the contract of trust and commitment between the mentor and his student. [Cassidy 2009]. Factors that can have a negative influence on mentoring include poor communication, differing expectations between mentor and mentee, lack of trust and lack of appreciation of everyday life circumstances that affects each person. The use of learning contracts, formulation of ground rules, use of information in student handbooks and discussion of the expectations of the mentor and mentee can help prevent or counteract problems in the relationship. [Hodges 2009] In conclusion, in order to improve student performance, mentor selection should be made carefully. The mentors should be patient, enthusiastic, knowledgeable and respectful [Fawcett 2002]. They should get to know the students [Shaffer et al 2000] and establish a bond with them to facilitate mentoring but, at the same time should not be afraid of failing the student or drawing attention to him if his performance is consistently below par. The mentor should make frequent formative assessments the results of which are accessible by the students so that they can also see where their short-comings lie. By maintaining a high standard in the choice of mentors, the quality of the students trained under them can be certified. SOURCES Ali, Parveen Azam; Panther, Wendy 2008. Professional development and the role of mentorship Nursing Standard. 22(42):35-39, June 25 Bennett CL (2003) How to be a good mentor. Nursing Standard. 17, 36. B Shaffer, B Tallarica, J Walsh, "Win-win mentoring," Nursing Management 31 (January 200O) 32-34. Chitty, K. (2001) Professional Nursing: Concepts and Challenges, third ed (Philadelphia: W B Saunders Co, 2001). Cassidy, S (2009) Subjectively and the valid assessment of pre-registration student nurse clinical learning outcome: implications for mentors. Nurse Education Today. Jan 29(1). pp33-9 Duffy, K (2004) Failing to fail. Two year study funded by United Kingdom Central Council for Nursing, Midwifery and Health Visiting. London: Nursing and Midwifery Council. Duffy, K: Hardicre, J. (2007) Supporting failing students in practice, part 1: assessment. Nursing Times 20 Nov 103(47). pp. 28-9 Emerson, Roberta. (2007) Nursing Education in the Clinical Setting. Mosby Elsevier. Flanagan, J., Baldwin, S. and Clarke, D. (2000), Work-Based Learning as a means of developing and assessing nursing competence. Journal of Clinical Nursing, 9: 360-368. doi: 10.1046/j.1365 Fawcett, Debra. 2002. What is mentoring and how to make it work AORN journal. Hodges, B (2009) Factors that can influence mentorship relationship. Paediatric Nursing. 2009 Jul 21(6). pp32-5 Kinnell, D and Hughes, P (2009) Mentoring Nursing and healthcare students London: Sage Publications LTD. Nursing and Midwifery Council (2008) Standards to support learning and assessment in Practice NMC Standards for Mentors, practice educators and teachers 2nd edition London Nursing and Midwifery Council. Mosbys Medical dictionary. 8 edition. 2009. Santy, J. 2000. "Assessment and learning in post-registration nurse education." Nursing Standards 14, no. 18: 38-41. Read More