Hand Hygiene in the Practice of Nursing - Essay Example

INTRODUCTION The main indicator of quality health care in accordance to the agenda of clinical governance is prevention of further infections among patients within healthcare units. According to the department of health (2000), each situation resulting to health care infection costs an estimate of £3,000. Thus, as much as there is a need to reduce patients’ distress, the policies and strategies developed to prevent Healthcare Associated Infection (HCAI) should also consider the financial implications (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg, 2007). To curb healthcare associated infections, health care practitioners ought to apply affect hand hygiene (Infection Control Nurses Association, 2003). This applies especial to me as a nursing student. In the long run, I intend to be a mentor and an influential individual in managing infection control. During my initial days in the school of nursing, I thought nursing was merely a routine procedure: Taking blood pressure or blood samples, dressing wounds and prescribing medication. During these few weeks from my enrolment in 27th march 2013, my knowledge of nursing has expounded. I have leant that nurses ought to abide by the nursing code of conduct when handling patients. This covers the manner in which they communicate to patients and hand hygiene when taking care of patients. Health professional mostly apply Gibb’s model of reflection. The model has six stages: description; feeling; evaluation; analysis; conclusion, and action plan. This model helps in assessment of experience and in examining my practice as a nurse. I this case I plan to focus on the stages of evaluation and analysis. However, health practitioners ought to understand that to reflecting alone is not adequate. They need to implement these practices into action. This enables the practitioner to assess their performance and identify areas that they have fully understood and those that they ought to improve or develop. Preference to this model lies since it is precise and easy to follow. The nursing code of conduct stipulates that effective communication entails: Respect to patients’ confidentiality (Nursing, midwife and council, 2008b). Some cultures do not allow sharing of certain information the practitioner should know the patients’ culture, religion and essential background in advance. Nurses should practice keen listening skills, use of non-verbal communication and to apply a professional language when dealing with patients (Nursing Council of New Zealand 2012). In addition, they should also have good writing skill in the case of record keeping. According to McCabe and Timmins (2006), effective communication in the practice of nursing results in Improvement in, patients' conditions; increase in rates of recovery and patients’ satisfaction with nursing services. In this study I will discuss my learning from a novice to an advanced beginner in the practice of hand hygiene in nursing. I will outline how Gibb’s cycle of reflection helped in my learning process. The importance of hand hygiene; the latest policies in hand washing and how Blooms taxonomy of learning helped in gaining; new knowledge, new skills, and new attitude. DESCRIPTION: FROM NOVICE TO ADVANCED BEGINNER At the time, I commenced my undergraduate degree in nursing on 27th march 2013; my knowledge in this field was quit vague. I thought of nursing as a routine practice to patients’ recovery as I had previously witnessed in hospitals. Health practitioners I encounter in health facilities do not take the issue of hand hygiene as serious as it should be. It had never crossed my mind that hand hygiene was such an integral part of nursing. In the initial days of my learning, I did not consider decontaminating my hands before I attend to a patient. According to Benner (2001), there are five levels in a nurse’s career experience, this include; novice, advance beginner, competent, proficient, and expert. Novice refers to a beginner without prior experience (Benner, 2001), at this stage I learnt of the general guidelines that would help me carry out my task as a health practitioner, this rules are applied universally, and they inflexible and limited. I was also introduced to the nursing code of conduct that stipulates behavior around patients. As a novice, I’d simply do what I was instructed to since I had not gathered adequate knowledge in the field (Benner, 2001). For instance, if the instructions stated that I should disinfect my hands before attending to patients, then I’d do exactly that. 1. Advanced beginner According to Benner (2001), an advanced beginner demonstrates levels of acceptable performance. This category of learners has gained prior experience in relation to actual circumstances and has recognized the relevance of these components (Benner, 2001). At this stage, actions are guided by gained principles from prior experience. The first few weeks of my study mainly focused on infection prevention through hand hygiene. During this period, I learnt that, mere negligence of failing to disinfect hands before attending to a patient can lead to negative consequences. Hands are the main causes of health care associated infections. Healthcare associated infections (HCAI) can result in advanced illness, slow recovery rate, increase in patients’ level of stress, low morale and extension of admission in hospital (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg 2007). Moreover, HCAI increases hospital bills; the patient does not only suffer physically but, there is an additional financial burden. Thorough hand washing takes an estimate of a minute, yet research conducted indicates that conformity to hand hygiene by practitioners is less than 40% (Widmer, 2000). It is very important for healthcare professionals to know and practice their responsibilities or else they will be held accountable any negligence that endangers lives (Nursing, midwife and council, 2008b). This entails failure in compliance to hand hygiene guidelines as outlined in the nursing code of conduct Due to this development in knowledge and the extent of this mere negligence (Gould, 2010). I ensure that before I attend to a patient in any way, my hands must be disinfected to avoid further infections to the patient, due to this development in knowledge and the extent of this mere negligence. Gaining this knowledge made me an involved participant, ready to make a difference as opposed to the initial days of my study when I would observe or act based on abstract principles. HCAI’s are costly not only to the patient but, to the hospital and community at large; the hospital could suffer a shut down and the community could lose the health facility (Flores, 2008). Through the gained knowledge, I can clearly outline the importance of hand hygiene. 2. Policy on Hand Washing According to the national institute for clinical excellence (NICE) (2003), to ensure effective hand hygiene: i.) Health facilities should be adequately supplied with; paper towels, liquid soaps and hand rub disinfectants, whenever health practitioners attend to patients. ii.) Practitioners ought to disinfect their hands before any direct contact when taking care patients and after any encounter that could potentially lead to hand contamination. iii.) Hands that are grossly infected or extremely dirty ought to be decontaminated with liquid soap and water. iv.) It is also recommended that health practitioners can apply alcohol based liquid or gel, unless their hands are extremely gross with dirt. v.) Practitioners must ensure they remove any form of hand jewelry before decontamination. They should also ensure they cover any form of bruises and cuts with a waterproof dressing. They should also keep their nails clean, short, and nail polish free. Importance of hand hygiene Hand hygiene the most effective means of reducing or preventing infection within healthcare facilities (Gould, 2010). The practice of hand hygiene saves lives; if all health practitioners complied to hand hygiene guidelines, healthcare associated infections could decrease by an estimate of 20% (The National Audit Office, 2000). It estimated that around 5000 deaths in UK results from HCAI’s this further contributes to an estimate of 15,000 deaths annually (Nursing, midwife and council, 2008b). Therefore, if compliance to hand hygiene is adhered to by health practitioners, the rates of death could be reduced, and around 6,500 lives could be saved annually (Flores, 2008). FEELING: THE PROCESS OF KNOWLEDGE ASSESSMENT According to Bloom (1956) the taxonomy of learning involves three domains; cognitive domain which involves six major categories, from the simplest behavior that is knowledge; to the most complex, that is evaluation. The next domain is the affective domain; the effective domain entails feeling, value, appreciation, enthusiasms, motivation, and attitude (Bloom, Krathwohl, & Masia, 1956). The third domain is psychomotor domain; this domain entails physical and manual skills. The three categories are often referred by instructors as KSA (knowledge, skills and affective or attitude). This model will facilitate my explanation of the new knowledge, new skills and a new attitude I have gained throughout this module (Bloom, Krathwohl, & Masia, 1956). New knowledge As a novice, I had no prior knowledge of the in depth importance of hand washing before I attended the undergraduate nursing degree in 27th march 2013. The past few weeks of studying this module have enhanced my knowledge in understanding the Nursing Code of Conduct. I can recall on how to effectively communicate to patients in a professional manner and the process of ensuring that my hands are hygienic before I attend to patients. The activities entailed in effective hand hygiene are broken down into four categories: First, wash and rinse hands; second, dry hands thoroughly; third, apply alcohol on hands, and finally, care for the hands (Gould, 2010). According to Damani (2003) transient micro-organisms on hands can be eliminated by the use of liquid soap and water. Health practitioners can apply antimicrobial cleanser after attending to infected patients or immune-compromised patients (Infection Control Nurses Association, 1997). These cleaners contain a residual effect that prevents continuous bacterial activities on the hands for a given period (Holyoak, 2010). It is recommended that good quality papers should be used when drying hand; cloth towels are not recommended due to potential contamination (Damani, 2003). Hand rubbing with alcohol based liquid or gel for an estimate of 30 seconds is a reliable supplement to hand washing (Heeg, 2001). New skill The knowledge I gained facilitated my attention to details. During my initial days in nursing school I view hand hygiene with high value for it. Am very cautious about my hand hygiene; before eating, after visiting the toilet and after an action as simple as handshakes I ensure I clean my hands. This practice is essential since I intend to be a mentor to fellow upcoming health professionals (Bloom, Krathwohl, & Masia, 1956). This has become a routine practice; I personally advise my fellow students to clean their hand under circumstances that they walk out of the wash room without doing so. The perception I hold towards hand hygiene has enhanced to the level that I can describe and distinguish hygienic hands from contaminated hands by the first glance. Initial I would only imitate my instructor or act on a trial and error basis; am ready to act as an advanced learner, basing my judgment on concrete principles. I can clearly follow instructions on hand hygiene and outline the essentials of effective communication as stipulated in the nursing code of conduct. New attitude This level of learning entails, perception, readiness to act, and guided response. Perception and readiness to act reflect the attitude of a novice learner. Guided responses relate to the attitude of an advanced beginner (Bloom, 2001). Before I attended the undergraduate nursing program, I did not regard hand hygiene with high value. Through this module, I developed an interest after understanding how essential the hand washing process is. At this stage, I was ready and willing to practice it (Benner, 2001). After a detailed elaboration in hand hygiene my thoughts and beliefs towards hand washing have changed. I constantly practice hand hygiene, on regular bases; before meals, after visiting the toilet and in other activities. EVALUATION The simplest and the most effective way of preventing healthcare associated infections are through hand hygiene (Holyoak, 2010). In UK, several initiates have been launched in the promotion of hand hygiene. For instance, ‘winning ways’ promised to ensure reduction in healthcare associated infections by ensuring that practitioners comply with the preset guidelines in hand hygiene. There are several barriers to hand hygiene in health facilities; some are as a result of lack of appropriate education or poor knowledge in relation to the health practitioner (Lippncott, Williams & Wilkins, 2009). Other relevant factors include, inadequate resources in health facilities, and work over load to that in turn, results in lack of time for effective hand washing (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg 2007). . In 2003, the National Patient Safety Agency NPSA (2003) carried out a hand hygiene campaign. This initiative was the first to involve patients in actively improving healthcare practitioners’ hand hygiene. The campaign employed the use of badgers by nursing, stating; ‘clean your hands. It is okay to ask’. This encouraged patients to ask nurses if their hands were disinfected before they attended to them, (Gould, 2010). The campaign was facilitated by distribution of leaflets to ward patients. Information relating to health care associated infections was outlined in the leaflets. This information encouraged patients to ask the practitioners whether they had complied with the hand hygiene guidelines. Healthcare settings can provide a complicated environment in managing risks associated with the transfer of infections from a health practitioner to the patient, or between equipments, health staff and patients. Patients are extremely vulnerable to infections. Therefore, vigilance is required around the clock to curb such incidents (Rowley, & Simon, 2011). It is my duty as a potential health staff to develop an understanding of how infections are transferred and how different pathogens spread Due to this development in knowledge and the extent of this mere negligence (Nursing Council of New Zealand 2012). This knowledge is very crucial in infection prevention. ANALYSIS Infection control and prevention are at the core of the Principals in the practice of nursing (Nursing Council of New Zealand 2012). As outlined in the nursing code of conduct, healthcare practitioners are responsible for risk management in patients, and they should be extremely vigilant in handling the risk factor. In addition, health staffs are responsible for patients’ safety within the health facilities (Nursing, midwife and council, 2008b). This nursing principle outlines an overarching framework in attaining quality from healthcare staff. It emphasizes the significant contributions of nursing care in improving patients’ recovery (Cowen, and Moorhead, 2011) As earlier stated, health practitioners can ensure hand hygiene by the use of soap and water or hand rubs; alcohol hand gels (Nursing Council of New Zealand, 2012). Alcohol based hand liquid or gels provide an effective and efficient to clean hands (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg, 2007). In my case, I constantly clean my hands with water around public places the use of soap is yet to be effective. CONCLUSION This paper has outlined my process of learning from a novice to an advance beginner. Novice refers to beginner with no prior experience. All I knew were the general guidelines in relation to healthcare. As an advance beginner my actions are guided by prior experience and concrete evidence from the health practice (Bloom, Krathwohl, & Masia, 1956). It can therefore, be concluded that hand hygiene is the most effective practice in preventing healthcare associated infections (HCAI’s) (Ward, 2013). It is also evident that when there is a concerted effort to create awareness among health staff about hand hygiene and affirmative policies, there is a significant decrease in infection rates (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg, 2007). Healthcare Practitioners ought of the significance of their responsibilities to patient recovery (Nursing Council of New Zealand, 2012). Failure to comply with hands washing guidelines before and after contact with patients’ has the potential of causing cross-infection, prolonged recovery period, and death of a patient (Wilding, 2008). Nurses should be vigilant to avoid any act of negligence that could potentially result to injury or harm. Given the level of the consequences that result from negligence it is no longer appropriate to blame busy work schedule, equipment or materials for healthcare associated infections. It is the duty of every health practitioner to ensure the safety of patients’ within the health facilities (Nursing, midwife and council, 2008b). This level of understanding can only be practiced y an advanced learner since they are surer of their actions than novice learners. Finally, it is important for health practitioners to be aware of the local policies and guidelines should always be complied with. Health employers should ensure that the Standard infection control precautions, formulated for the purpose of protecting both patients and clients from infections (Nursing, midwife and council, 2008b). By implementing these standard precautions on a routine basis and to all patients, this act becomes second nature. Therefore, the risks of infection are reduced (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg 2007). ACTION PLAN This category focuses on the activities that ought to be carried out in order to curb healthcare associated infections. All health care facilities (including hospitals, care homes, and GP surgeries) ought to have policies and guidelines relating to hand hygiene. All health staff must be familiarized to this guidelines and health facility should ensure they comply with them (Nursing, midwife and council, 2008b). As a potential health practitioner; I should disinfect my hands before; contact with patients, after contact with susceptible patients, after performing an aseptic task. Moreover, I should disinfect my hands; after removing gloves, after contact with body fluids and contact with the patient and after contact with patients’ immediate environment (Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, and Weinberg 2007). All healthcare practitioners ought to follow this procedure in order to ensure patients safety as stipulated in the nursing code of conduct. Another act than can ensure hand hygiene and reduce healthcare associated infection, is creating awareness among patients. Patients should be authorized to enquire whether the practicing nurse has disinfected their hands before they attend to them. The nurses should also carry budgets that encourage patients to remind them to disinfect their hands. . References BENNER, P. E. (2001). 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