My First Day Of Clinical Placement

My second clinical day took place on September 24th, 2015 at Saint Barnabas Hospital in Livingston, New Jersey. My preceptor Maria Brilhante, MSN, RN, allowed me to observe the morning huddle that took place with all the nurse managers that are in the hospital. The purpose of this huddle was to keep the director of nursing informed about the census on each unit. I found this processed to be very uniformed and professional because the DON was engaged. The day went on with me attending meetings on how managers could implement plans to contain cost for the hospital. Maria did her daily rounds on her patients and her nursing staff. She has a folder that contains papers on how each nurse is progressing from the time they get off orientation. Her motto to the nurses is, “You are good at what you do, so when I coach don’t take offense. I am only trying to get you to be great”. This boost their confidence which I thought to be important.

Poor hand hygiene - spread of germs from one patient to another or spread for hands to surfaces.

My first clinical experience for this nursing program was completed at New England Rehab Hospital. I walked in with some clinical experience but no experience in the realm of nursing or certified nursing assistants (CNA). During that first semester we followed CNAs to understand their job and gain basic nursing skills like bathing patients, bed making and other daily tasks. It was useful and I’m still happy we were able to have that experience. A situation that made me uncomfortable during that semester that one particular CNA never sanitized his hands when entering and exiting a patient’s room. In most hospitals and nursing facilities there is a “pump in, pump out” rule to abide by when entering and exiting a patients room rule to ensure health care workers are not spreading bacteria to themselves and other patients. This particular CNA admitted to me that he pretends to push the hand sanitizer and rub his hands together without actually getting any sanitizer in his hands. His reasoning was that he found it overly drying to use the sanitizer so frequently despite the hospital providing lotion as well.

During my first day of clinical, I encountered an issue that I believe is very significant. As a student nurse, our duty for this day was to follow our health care aide around the ward and assist in completing resident care. The resident required assistance in many of her daily tasks. The health care aide asked if I would perform one of those and do perineal care for her. I turned down her offer because I did not feel comfortable with my skill level. The resident had a bowel movement during the night. There was a significant odour in the room that overwhelmed me. I really wanted to leave the room because it was so unpleasant, but I stayed in the room so that the resident would not be embarrassed. This feeling of embarrassment, I assume,

Personal hygiene is essential for good health and well being, having a clean and respectable appearance and pleasant environment is key to maintaining the self-esteem of the people you care for. The better they feel, the more they can enjoy life, making life more pleasurable for both them and for the staff. For most adults, hygiene is a personal and private concern. When you are helping someone with personal hygiene it's important to be sensitive and tactful, and to respect their dignity.

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters flittered around in my stomach, I had no idea what to expect. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

Many individuals understand the importance of personal hygiene but are unable to complete all the tasks required by themselves, paraplegics and amputees may have great difficulty in keeping personal hygiene to a high standard and may require assistance. Individuals with learning disabilities or mental health problems may not fully understand the importance of personal hygiene, and support workers would need to prompt the individuals to carry out personal care, informing them of the importance of maintaining high levels of Personal Hygiene. Individuals may experience temporary physical immobility such as suffering from broken bones, or recovering from an operation. In this case, family, friends or support workers can give support to them.

Keeping our hands clean is one of the most effcient and important steps we can do as humans to avoid getting sick or spreading germs to other people. Unwashed hands spread many diseases such as the flue, E. coli, and salmonella. Unfortunately, hand hygiene is still one of today’s most leading causes of infection in health care facilities. The risk of clinicians, patients, and visitors not complying with hand hygiene protocols creates a practice problem for nurses and their patient care. The cause of health care infections, also known as, health care-associated infections (HAIs) are increasing along with the rise of the inability to control or treat infections that are multi-drug resistant. Lack of proper hand hygiene is a major problem in clinical settings sourcing from critical care divisions where the most contaminations are prevalent. This paper will discuss how hand hygiene affects the nursing process and solutions of how to better prevent HAIs within the nursing scope of practice.

During my clinical competency placement, I was working on a surgical ward when a registered nurse on duty asked me to assist Mr. A with his shower. This incident happened on the fifth day of my clinical practice. He was a dementia patient and had undergone right knee total joint replacement. She also informed me that the patient did not like too many people in his room because of his dementia. When I went into his room, his wife was there with him. I talked to the patient about having a shower and getting dressed to look smart and he agreed to have a shower. The patient got out of the bed and walked to the bathroom and sat on the shower chair to have his shower. Then I asked his wife if I needs to stay with him to assist with shower, she said she can help him as she was taking care for him at home since he has been diagnosed with dementia. Therefore, I left the patient with his wife to help with his shower and told her to ring the bell if she needs any help. After some time I left the room, the wife rang the bell. As soon as I entered the room, I heard him shouting at his wife and she started crying and left the hospital. So I had to stay with him. He was very capable of washing himself and I just had to help him wash his back as he requested. After he had washed, I asked him if he was ready to get out of the bath, he started shouting at me.

Whilst on duty on a general ward I was asked by my senior nurse, if I could go down to the pharmacy to pick up some new medication for a new client, who would be needing them at lunch time. On my way to get them, I was approached by another health care assistant who requested my help with a client, who was lying in their own faeces. I therefore felt that the medication could wait, and that my main

Patients, family members, and visitors will be encouraged to follow these guidelines. Educational material will be provided in an attempt to improve understanding of the importance of good hand and nail hygiene for the prevention of healthcare-associated infection.

Among reviewing CNAs at a long-term care facility, it was seen that some CNA’s did not take off their gloves between giving perineal care of a patient after the patient used the bathroom and the CNA reached for the patient’s attire to put on the patient for that day. The CNA put every patient at risk of contracting the infection and the patients clothes could have became a source of C-diff. There are many cases similar to the one above where health workers are in a rush and do not perform their job/skills that they have been taught correctly. Health workers being in a rush also is due to shortage of staff. The CNAs at the long term facility discussed in this paragraph work a 9:1 ratio, which causes challenges for the health workers to give quality care to the patients.

Lack of personal hygiene, unchanged linens, trash can odors, and unclean cafeterias have been reported as well. Verbal abuse and neglecting the patient are also common (McNamee 2006).

Highlighted in the Keogh Review, and the Francis Report - Avoidable harm was inflicted by HCAI - Hand hygiene not routine amoung staff (REF). - Patients were not encouraged or assisted with hand hygiene, leading to risk of infection, staff lack awareness. - Further training needed - Staff and visitors need to comply with guidelines.

Hand hygiene is everybody’s job, including the patients. Linda Pearson (2006) refers to AL Damouk et al (2004) who suggests that inviting patients to become partners in their care maybe an appropriate response to reports of the rising incidence of healthcare associated infections and difficulties with