Reflection of a Critical Incident
I chose to write about this incident because I feel it emphasizes the risks to which the patients can be exposed while receiving care in a health care facility. It shows how policies and procedures can be neglected by the healthcare professionals, placing the patients at increased risk of getting hospital acquired infection. According to Statistics Canada one in nine patients admitted to Canadian hospitals acquire an infection as a result of their hospital stay. It has been identified that the transmission of microorganisms from the hands of health care providers is the main source of cross infection in hospitals and can be prevented by hand hygiene practices that are in keeping with recommended standards. The critical incident took place at 9:00 am in the orthopaedics unit, which is located on the 8th floor of the west wing of the Jewish general hospital, during the second week of my clinical setting. All names have been changed for reasons of confidentiality. I could not help but notice that the attending MD had just entered Mrs. X room requiring contact isolation precautions without wearing personal protective equipment or performing hand hygiene. In addition, after having completed the morning round, the MD exited Mrs. X room on to his next destination again without performing the hand hygiene. In this paragraph, I would elaborate on my feelings and thinking that took place in the event described above. I was astonished by the fact that the MD did not wash his hands or use alcohol prior to examining Mrs. X when all the infection control guidelines and protocols were in place. In spite of this fact I did not have confidence and felt intimidated due to the fact that the MD was much more experienced and more knowledgeable than I was as a second year McGill Nursing student. In addition, I had no intention in making him feel uncomfortable and unprofessional in front of the residents. Moreover, I did not want Mrs. X feel anxious and worried by standing up against the MD, since I knew he did not touch anything in the room.
On the other hand, I was thinking what would the MD had done if the patient reached out to shake his hand as a token of gratitude for the excellent care he was providing for her or how would have he responded to whatever the situation might have required. There is no denying that this situation was challenging and rather difficult for me as I felt disappointment for my lack of confidence in not confronting the MD prior him examining Mrs. X. Consequently, I observed that the resident had not said anything to the MD on that matter. I had learnt from this incident the importance of acting assertively with staff members in a sensitive approach in order to safeguard the patient’s health. Nurses have the responsibility to safeguard and promote the interests of individual patients and clients ( The Canadian Nurses association Code of Ethics for Registered Nurses (2008)). This responsibility include ensuring that his or her knowledge and competencies commensurate with the task being undertaken. Infection is responsible for increased morbidity and mortality, thus a comprehensive knowledge of infection control precautions and basic microbiology should a fundamental requirement of all healthcare professionals. Hands must be decontaminated before every episode of care that involves direct contact with patient’s skin or food, invasive devices or dressings.
Hand hygiene is a crucial factor in the control of hospital-acquired infection (HAI) because hands can easily transfer micro-organisms from one area or patient to another. The Infection Control Network’s study found that hospital-acquired infections like C. difficile kill 8,000 to 12,000 Canadians a year (Michael V’Inkin Lee, 2012). Although it has been suggested that uniforms act as are servoir or vector for transmission of infection in hospitals, no evidence is currently available linking the transmission of bacteria to patients (Wilson et al., 2007). It is also important to note that all clothing worn by all staff (doctors, therapists, cleaners) has the potential to become contaminated via the environmental micro-organisms, or those originating from patients or the wearer, and that nurses uniforms are not unique in that respect. This reinforces the need to ensure all clothing worn by staff in all clinical areas is fit for purpose and able to withstand laundering.
Advocacy ranges from activities on behalf of patients, such as hand washing and proper identification before treatments, to arguing that an early discharge will harm her patient’s recovery. According to Arnold and Boggs (2003) assertive nurse is able to stand up for the rights of others as well as for his or her own rights. If the complaint is justified then equally the nurse has duty to inform the MD of what has transpired because he or she has a duty to promote high standards of patient care and this includes confronting co-workers when the nurse believes their standards to be less adequate (Rumbad, G 1999). I strongly believe that it applies to my own practice as a McGill student nurse. In the future I feel I should have confronted the MD at that moment. In addition, I should have made sure the MD washed his hands prior examining the patient. I also realize that I put Mrs. X at higher risk of getting hospital acquired infection. I realize that I need to develop the confidence to challenge the practice of colleagues, understanding pressures that may be under but ensuring that their practice does not put patients at risk. If I observe a practice or procedure I believe to be wrong, advocating for my patient demands I speak out even if that practice was carried out by someone more experienced than I am.
I will continue to apply the collaborative approach as a McGill student nurse, to work as part of a team, learn more about how best to communicate in order to contribute to good nursing care. I will also continue to develop my assertive skills when working with staff members to ensure health and safety of patients is maintained. I would also like to point out that I will discuss the problems concerning the interpersonal relationships with my clinical instructor in the future.
•Budimir-Hussey M ( 2013). Exploring physician hygiene practices and perceptions in 2 community-based Canadian hospitals. Schulich School of Medicine and Dentistry, University of Western Ontario; and †University of Windsor, Faculty of Nursing, Windsor, Ontario, Canada.
•Pittet D, Boyce JM (2001). Hand hygiene and patient care: Pursuing the Semmelweis legacy. 1(9), 20.
•Pépin J, Valiquette L, Cossette B. (2005) Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec.?173:1037–1042.
•Leischner J, Johnson S, Sambol S, Parada J, Gerding D. (2005). Effect of alcohol hand gels and chlorhexidine hand wash in removing spores of Clostridium difficile (CD) from hands. In: Proceedings of the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society of Microbiology;. Abstract LB?29.
•Riggs MM, Sethi AK, Zabarsky TF, Eckstein EC, Jump RLP, Donskey CJ. (2007) Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long?term care facility residents. Clin Infect Dis;?45:992–998.
•Eltringham I. (1997) Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect (35) 1-8.7.