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Description In a placement during my second year when I was working on a surgical ward, I was working under the supervision of my mentor, caring for a seventy-two year old gentleman, Mr Khan (pseudonym), who had undergone abdominal surgery. I had been asked to remove his wound dressing so that the doctor could assess it on the ward round.
I removed the dressing under my mentor's supervision, using a non-touch procedure, and cleaned the wound, as requested by the doctor. My mentor was called to another patient at this point, so at her request I stayed with Mr Khan while we waited for the doctor to come to see him. The doctor had been with another patient, examining their wound, and I noticed that she came straight to Mr Khan to examine his wound, without either washing her hands or using alcohol gel first. I also noticed that she was wearing a long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I thought for a moment about what to do or say, but by the time I had summoned enough courage to say something, I thought it was too late as she was already examining Mr Khan. Feelings I was alarmed by this, as I had expected the doctor to wash her hands or use alcohol gel before examining Mr Khan. However, I felt intimidated because I felt that the doctor was more experienced than me as a second year nursing student; and I didn't want to embarrass her. Also, I didn't want to make Mr Khan concerned by confronting the doctor in front of him. Later, I spoke to my mentor about the incident. She suggested that we speak to the doctor together about it. My mentor took the doctor aside, and asked her whether she had washed her hands before examining Mr Khan. She looked quite shocked. She said that she had been very busy and hadn't thought about it. My mentor discussed the importance of hand hygiene with her, and the doctor assured her that she would wash her hands before examining every patient in the future. Evaluation The incident was extremely challenging for me. I regret that I did not act to challenge the doctor's practice before she examined Mr Khan. However, I am pleased that the doctor responded so positively to the feedback of my mentor, and I have observed that she has now changed her practice as a result of this incident. I too have learned from the incident, as it has taught me the importance of acting assertively with colleagues, in a sensitive manner, in order to safeguard patients' well-being. Analysis The Royal College of Nursing (2005) states that hand hygiene is the single most important activity for reducing cross-infection, and points out that many health care professionals do not decontaminate their hands as often as they should. Recent guidance published by the Department of Health (2007) highlights the possibility of staff transmitting infections via uniforms, and the need to review policies on staff dress. The Nursing and Midwifery Council Code of Professional Conduct (2004, section 8) states that as a nurse 'you must act to identify and minimise the risk to patients and clients'. As the student nurse caring for Mr Khan under my mentor's supervision, this also applies to my own practice as a student nurse. Conclusion Looking back on this incident, I can see that I should have acted sooner, and that I should have ensured that the doctor washed her hands before examining Mr Khan. I can now see that my inaction in this incident put Mr Khan's well-being at risk. After discussion with my mentor, I recognise that I need to develop the confidence to challenge the practice of colleagues, putting the well-being of clients at the forefront of my mind. I realise that I need to be supportive to colleagues, understanding the pressures that they may be under, but ensuring that their practice does not put clients at risk. Action Plan In future, I will aim to develop my assertive skills when working with colleagues, in order to ensure that the well-being of clients is maintained. In my next placement, I will make this a goal for my learning, and will discuss this with my mentor to work out strategies for how I can achieve this.
THE END ... or is it? This may be the conclusion of a single learning experience, but it is the beginning of your development as a professional, in which your confidence and assertiveness could have a direct impact on a patient’s wellbeing. Next time... you start with your action plan. How does it work out? What happens next time you are in a similar situation? You can continue to use Gibbs’ reflective cycle to chart your ongoing learning and development.
Department of Health (2007) Uniforms and Workwear: An evidence base for developing local policy (accessed 24 June 2019)
Nursing and Midwifery Council (2004) The NMC Code for Professional Conduct: Standards for conduct, Performance and Ethics London: Nursing and Midwifery Council
Royal College of Nursing (2005) Good practice in infection prevention and control: Guidance for nursing staff London: Royal College of Nursing