Introduction In this essay
In this essay, I aim to reflect on an incident which I observed during my first clinical placement. Reflection is about learning from experience and I think is a crucial part of my learning experience as it helps to recall how I felt and acted and allows me to gain a deeper insight and knowledge into my experience on placement. Although reflection is more centralised around skilled practice, it is important in all aspects of a person’s life (Lishman 2015). I will be using Gibbs’ Reflective Cycle (1988), it is one of the most well-known reflective cycles and it helps the person reflecting as it has six distinct stages: description, feelings, evaluation, analysis, conclusion and action plan (Howatson-Jones 2016).
I was in my first clinical placement on Medical 2 and was looking after a sixty-year old gentleman, Mr. Murphy (pseudonym) who was after having replacement knee surgery a couple weeks beforehand. My preceptor was out on this day, so I was working with a different registered nurse on the ward. The doctor had given the clear to remove the clips from the wound, and the nurse I was working with was going to remove them. I decided I would observe as I thought it would benefit me. I was talking to the patient while the nurse went to gather everything she needed. Before she came into the room she went into one of the other bays to help another patient. I noticed when she came into the room she put on PPE, but she never washed her hands or used alcohol gel. I thought about what to do or say, but by the time I had built up enough courage to say anything to her, she had already started removing the clips from Mr. Murphy’s wound. She didn’t use an aseptic technique while removing the clips or dressing the wound, and I recalled about being taught the five moments of hand hygiene in my Skills lab in college.
I was in total shock by this. At the time of the incident, I had many thoughts going through my mind and I didn’t know how to react. I had thought that the nurse would have washed her hands before doing the procedure, especially since she had been with another patient beforehand. I knew it was wrong, but I felt too intimidated to say anything because she was a nurse who had years of experience and I was only a first year student nurse. As expressed by (Pittet and Allegranzi 2009) hand hygiene is the biggest act to prevent the spread of healthcare associated infections such as MRSA and Clostridium difficile. I couldn’t understand how a skilled and experienced nurse could compromise a patient’s health and safety. The following day I spoke to my preceptor and she decided that we should speak to the nurse together. I felt at ease knowing my preceptor was with me, when she questioned the nurse she admitted to not having washed her hands as she completely forgot to. My preceptor stated to her the importance of hand hygiene and an aseptic technique while dressing a wound, she then assured us that it would never happen again, and it was mistake on her behalf.
This incident was very difficult and challenging for me. The bad thing about this situation is that the patient was put at risk, which is unacceptable. I’m disappointed that I didn’t stop the nurse before she started the procedure on Mr. Murphy, I should have stood up to her and been more assertive. Although the unfortunate event, I am pleased that the nurse has now changed her habits and performs adequate hand hygiene which is a good thing. This experience was very useful as I have learned from the nurse’s mistake and from my own poor quality of communication.
(Mathur 2011) states that in most clinical areas, obedience to the suggested hand-washing routine remains excessively low. I think that I should have been more assertive with the nurse and made sure she washed her hands, even as a student nurse it was my responsibility to ensure the patients health was priority. Good hand hygiene is the most significant, easiest and cheapest way to prevent healthcare associated infections (Tschudin-Sutter et al. 2010), so in future, I think to prevent these infections nurses should always perform good hand hygiene. As part of the five moments for hand hygiene nurses must perform hand hygiene before clean/aseptic techniques (World Health Organization 2009). If the nurse was in a hurry to get to the patient she should have made sure that she had performed appropriate hand hygiene first and then apologised to Mr. Murphy when she got to him, his health should not have been endangered.
It’s clear to me that I should have acted sooner and stopped the nurse to make sure she washed her hands before carrying out the procedure. I know that my lack of action during the incident put Mr. Murphy’s health at risk. I can see that I must develop my confidence in the clinical area, especially communicating with my colleagues. I needed to keep the patients’ wellbeing at the front of my mind as it was the priority, and when I saw bad practice being done I should have intervened before it was too late. Although I know that nurses may be under intense pressure, they do need to be reminded when doing something wrong to prevent patients’ health and safety being put at risk.
In the future I will be more assertive and ensure the wellbeing of patients is priority. I think I need to work on my assertive skills and be able to stand up to other nurses when they’re in the wrong, whether I’m a student nurse or once I become a registered nurse. Nurses in the clinical area need to be aware of the risks of bad hand hygiene and how important aseptic technique is when dealing with wounds and I will make sure I practice these skills when needed in the clinical area.
I think this experience has had been both good and bad, undoubtedly, I have learned the importance of hand hygiene and aseptic techniques in the clinical area. It has helped me recognise the importance of practicing the skills I learn in college in the clinical area. After finishing this essay, the Gibbs Reflective Cycle has helped me to analyse my feelings and the overall experience which will certainly help me in the future.