Healthcare Practice and Policy Considerations-Samples for Students

Question: Demonstrates how the Gibb's reflective cycle helped an understanding of self and alternative view. Answer: Introduction The critical analysis of any issue or event through reflection cycle is helpful in increasing knowledge and understanding of the professional practice in aspects of behaviour and values in the healthcare and determines how behaviour will change in the future. It provide an insight into a particular incident that contribute to personality development and aids in ensuring continuous learning and role improvement. In the similar way, the analysis of the healthcare issue through reflective cycle helped to gain an insight into the importance of issue and uncertainties around healthcare practice and policy considerations. The incident took place during the second year of the placement while working at the surgical ward. During the wound examination, the doctor examined the wound without washing the hands with soap or alcohol. It was astonishing and surprising for healthcare professionals to exhibit such a malpractice in this profession, as hand hygiene is the simplest activity for cross-infection reduction. The five moments of hand hygiene also reduces the infection rates by cleaning hands in the right way and time. Therefore, in the next section, analysis of this incident through Gibbs reflection cycle will be done followed by uncertainty of health practice or policy and actions required to enhance hand hygiene in professional health practice. Gibbs reflection cycle Incident The incident occurred during the second year of my nursing placement. I was assigned to work in the surgical ward and under the supervision of my senior. My mentor instructed me to take care of a seventy-year old man. The patient had undergone abdominal surgery and was instructed for wound dressing removal for the doctor to examine during the round off. I removed the wound dressing under his guidance through a non-touch procedure. I cleaned the wound as instructed. At that moment, my mentor was called for visiting another patient and was advised to stay with the patient until the doctor come for the visit. The doctor was busy examining another patient and to my surprise, I noticed that doctor came straight to my patient and started examining his wound. Before examining my patients wound, the doctor without using alcohol or soap wash. I also noticed that doctors sleeves were long and concerned cuff contamination with the wound. At that time, I thought of what to do or say to the doctor by summoning courage, I realized that it was too late as the doctor was already examining my patient. Feelings This incident alarmed me. It is expected that being a healthcare professional, he would wash his hands with soap or alcohol before examining the patient. However, it did not happen and was astonished by the incident. I felt intimidated that as he is a doctor, he would be more experienced as compared to a nursing student. I did not want to embarrass him and kept quiet. I did not confront the doctor in front of the patient, as it would concern the patient. However, I gathered some courage and later spoke to my senior about this incident. He suggested that he would talk to the doctor about the whole incident. My mentor took and spoke to the doctor aside. My mentor asked the doctor that whether he had washed his hands before examining the patient. He looked shocked and was alarmed. He said that he had a busy schedule and missed it. Finally, my mentor discussed the five moments of hand hygiene and he assured my mentor that he will wash his hands before touching any patient in the future Evaluation This incident was shocking for me. It was also surprising for me. I regret that I would have acted before the doctor examined the patient. However, by the time, I had summoned courage; the doctor already examined the patient. However, I was pleased that the doctor responded in a positive manner when my mentor confronted him. He was empathetic when my mentor provided feedback and I have observed that he had changed his practice after the incident happened. I have also learned the importance of assertiveness with my colleagues and most importantly the five moments of hand hygiene for best health practice. Analysis Hand hygiene is the most important factor to prevent hospital related infection rates and cross-contamination. According to World Health Organization (WHO), one in 25 patients who are admitted in hospital suffer from hospital borne infections. Even the healthcare professionals are at risk for infection as they are in continuous contact with the patients. This prevention of infections is important in medical setting. It safeguards the patients and ensures highest quality of care in the healthcare. The improvement of hand hygiene is important to prevent and reduce the spread of hospital-associated infections. Recent guidelines provided by the Department of Australian Commission on Quality and Safety in Health Care (ACSQHC) states the maximization of implementation of hand hygiene practices. The Nursing and Midwifery Council Code of Professional Conduct, (Section 8), states that nurses have the responsibility to identify the risk and try to minimize to safeguard patient safety and deliv er highest quality of care. This statement greatly implies in this incident as the patient was under the supervision of my mentor. Moreover, for a student nurse, it is important to apply this hand hygiene practice in daily practice and has the responsibility to make others aware of it (Sickbert-Bennett et al. 2016). Apart from hand hygiene, assertiveness is also important for the nursing profession. Nurses should work schematically for problem solving by unveiling constraints for effective nursing and in improving quality of care. For effective communication, one has to behave assertively and prevent barriers to assertiveness among the nurses. As the doctor was experienced than me, I was unable to challenge his practice and as a result, endangered the patient safety. This is the reason, assertive skills are important in nursing for effective communication and risk in healthcare settings. Action Plan In the future, I will try to develop my assertiveness working with my colleagues that would ensure the patient safety and highest quality of care. It is my goal to make my colleagues aware of the importance of five moments of hand hygiene to provide the best quality of care and in ensuring patient safety. In my next nursing placement, I will make a goal to enhance my learning to achieve assertive skills and work in collaboration in ensuring patient safety (Howatson-Jones 2016). Hand Hygiene Policy and health practice After the incident, I wanted to gain an insight into the evidence-based practices and policy considerations regarding five moments of hand hygiene. For this, I have gone through various peer-reviewed journals for literature review to understand the uncertainties in hand hygiene practices and policies related to hand hygiene. According to Centres for Disease Control and Prevention (CDC), practicing of hand hygiene is the simplest and effective way to prevent germs and infections by eradicating resistant antibiotics that are difficult to mitigate (Shinde and Mohite 2014). According to Salmon et al. (2015) the healthcare professionals should perform five moments of hand hygiene to prevent hospital associated infections spread and chances of cross-contamination. According to World Health Organization (WHO), patient-care activities transmit bacteria to the healthcare professionals during wound-care, respiratory tract, intravascular catheter care (White et al. 2015). During these activities, there are possibilities of healthcare professionals to get infected with patient body fluids and secretions or during clean contact like patients temperature, pulse or blood pressure. Various microorganisms come in contact after patient visit are Clostridium difficile, MRSA, Klebsiellaspp., Staphylococcus aureus,or gram-ne gative bacteria. Contact with contaminated surfaces can also cause spread of infection. Hospitals also have hand hygiene policies that are important to guide the employees for hand hygiene (Mumford et al. 2014). However, I personally feel that it is not possible to imply these policies in a healthcare organization. At the professional level, this issue of hand hygiene requires high degree of compliance to make changes in the organization to reduce infection rates. According to a recent report by CDC, one in 25 patients get infected with healthcare-associated infection during the hospital stay that add up to 722,000 total infection cases in a year. Out of this number, around 75,000 patients die due to infections as clinicians neglect the basic practice of hand hygiene to prevent infection spread (White et al. 2015). The five moments of hand hygiene is an effective hand hygiene way as outlined by WHO. These are performing hand hygiene before contacting a patient, before any aseptic task, after exposure to bodily fluids and after patient contact and after being in contact with the patient and contaminated surroundings. At the personal level, I think that these hand hygiene policies can only work when people show adherence to hand hygiene practices on a daily basis. According to WHO guidelines, an estimated 50% to 60% of people show adherence to these five moments of hand hygiene. However, this non-compliance to hand hygiene is unintentional (Kwok, Callard and McLaws 2015). In a study conducted by New South Wales (NSW) and Australian Institute of Health and Welfare (AIHW) the clinicians and nursing staffs work under extreme demanding and stressful conditions and as a result, miss it (Kwok, Harris and McLaws 2017). In another study conducted by White et al. (2015) it highlighted the fact that one potential reason for hand hygiene non-compliance is that the target (pathogen) is visible. At the professional level, I feel that healthcare professionals do not realize the spread of infections by the carrying pathogens in their hands and pass to others. They are unable to understand how the pathogens are transmitted from contaminated hands to other patients when it may result in few days or months. Cost of time is another reason for their non-compliance to hand hygiene. A practice that is altruistic in nature makes them feel burdened to perform the task and nothing is there to reap the benefit (Srigley et al. 2015). In NSW Health, the Hand Hygiene Policy outlines the policies that minimize the risk of infection and prevent healthcare associated infections (Allegranzi et al. 2013). The policy sets out that medical staffs should perform hand hygiene by using soap and use of alcohol-based wash. In healthcare organizations, hand-washing facilities and Alcohol-based hand rubs (ABHR) should be available for all clinicians, medical staffs and visitors. There should be strict surveillance over the practice of good hand hygiene (Ellingson 2017). At the personal and professional level, I think this is possible through clinical audit in healthcare organizations on a monthly basis to reduce the rates of HAIs. Action plan to enhance the professional health practice Clinical auditing is the most effective action plan that can help to increase compliance to hand hygiene and in improving the quality of healthcare (Sickbert-Bennett et al. 2016). It is a clinical process that is well established and set out principles for the evidence-based practices. This clinical auditing will measure the compliance of hand hygiene by the clinicians and medical staffs. Clinical auditing is a measure of clinical governance where it provides opportunities for organizational change and hand hygiene adherence. It is an improvement process in the safety and quality of healthcare that outlines recommendations for compliance and behaviour change in reducing HAIs (Macinga et al. 2013). This can be performed through processing of outcome data after clinical audit measuring the hand hygiene compliance. The focused interviews and questionnaire obtained from the medical staffs and clinicians would help to evaluate the awareness among them regarding the infection control and adherence to hand hygiene. The evaluation of the interviews and questionnaires would help to determine the targeted group for behaviour change, its management and the potential barriers that hinder compliances. At the personal level, medical staffs and clinicians should understand the issue of hand hygiene that ensure patient safety and quality of healthcare. While working with patients, they should perform the five moments of hand hygiene at specific moments wither by alcohol wash or hand washing with soap. According to WHO, alcohol hand rub is the most easiest and effective method to perform hand hygiene on a daily basis in the healthcare delivery (Rawles 2014). However, it is also stated that hand rubs are not affordable and not available in many countries as said by WHO. Therefore, it is important to improve the affordability and accessibility of the hand rubs in saving lives while working in public and private collaboration. These issues are important to address to inculcate the practice of hand hygiene among the healthcare staffs. At the personal level, I think, creating awareness is the best way to help to increase compliance to hand hygiene. Hand hygiene programs can help to create awareness and act as a common platform to share the knowledge in promoting compliance and enhancing healthcare staffs to use hand hygiene products in their daily routine (McInnes et al. 2014). There is also need to assess the availability and accessibility of hand hygiene products in all parts of healthcare organization. Direct observation can also be done as it is regarded as a gold standard process that provide information about staff compliance to thoroug hness of cleaning and their behaviour towards the hand hygiene issue. Conclusion This incident made me realize that I should have acted at the right time. After looking back, I realized that I should have acted sooner and warned the doctor to wash his hands before examining the patient. I realize that I have put the patient safety at risk by not acting at the tight time. After a brief conversation with my mentor, I realize that I have to develop assertive skills and confidence to stand for the rightful thing. I have to challenge the wrong practice even if they are my seniors keeping in mind the safety and well-being of the patients at the forefront. I realize that I need to be understanding and supportive towards my colleagues keeping in mind the pressure and demand of the nursing profession. At the same time, it is my responsibility to ensure patient safety and in minimizing the client risk. 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