For this reflection, I am using the Gibbs Reflective Learning Cycle for reflecting my learning from one of my postings. I was been taught about taking blood culture venipuncture samples. I was under the supervision of a nurse in-charge and she has told me about the whole process verbally as well as by demonstrating me once. Later on, there was a patient who was suffering from an infection whose source was not known, and for its identification blood culture was needed to be isolated and the in-charge asked me to take the blood culture by myself. Within this, I was supposed to maintain a sterile field, and for that, the things must be introduced from a height to avoid any contamination neither in the blood culture nor in the site from where the blood culture was taken out.
Prior to the practically taking of the blood culture, I didn’t know that I would be doing the same after half-an-hour by just learning and taking one demonstration regarding the whole procedure. As soon as I got to know about this, I was quite nervous because I knew the severity of blood cultures and the importance of surgical asepsis and how even a little contamination can change the whole outcome and later on, somehow I stopped panicking and calmed myself and was ready to do the whole procedure. The very moment I was going to start the procedure, my supervisor yelled at me to keep the instruments above the waist level as below the waist level they are considered to be non-sterile. She was not wrong and it was my first posting, so, I was unaware of these technicalities but she could have told me this at the time of demonstration instead of yelling in front of the patient. I was shattered and got even more nervous than I was before.
I somehow gathered my self-confidence and started the procedure by keeping everything in mind, following every principle that was needed to maintain the asepsis field to avoid the contamination. Checking his chlorhexidine allergy history and following all safety & hygiene measures, I followed the sterile field principle of keeping all the equipments above the waist level to maintain the sterility of them and protecting it from being contaminated. It is a very important principle to be followed because in case of infections, contamination of equipments, blood culture, or the site from where the blood was collected comes with a lot of drawbacks either it is the change of the results identified after the tests or exposing the patient to another infection by contaminating the site. There is a great need for maintaining aseptic environment as according to Clare & Rowley (2018), aseptic technique is one of the most crucial competent techniques for preventing infection prevention and protecting patients from infections that are healthcare-associated. Moreover, healthcare professionals who have implemented the aseptic non-touch technique have verified the abridged variability as well as enhanced acquiescence with aseptic technique. It has reportedly seen that the implementation of an aseptic non-touch technique has enhanced compliance with the prerequisite steps for the provision of safe and efficient aseptic techniques. From cleaning to the discarding and then labeling the bottle with the patient’s name, the site used, date, and time all the steps were done carefully to avoid the chances of contamination and again after the careful disposal, hand hygiene and other safety measures were carefully performed to avoid infection. Venipuncture is a painful process but the implementation of the aseptic non-touch technique is a painless process that did not cause any type of problem to the patients and later on, providing appropriate healthcare services lead to patient-centered care. Patient-centered care is the fore-most goal of healthcare providers. To achieve this patient’s exact health requirements and his desired health outcomes are taking into considerations and have been focused the most. This type of care management system supports the vigorous alliance and shared decision-making between patients, their family members, and healthcare providers to plan and administer a personalized and comprehensive nursing care management plan. The main objective and the advantages of patient-centered care are to enhance the patient’s health outcomes. It improves the satisfaction scores of the patients as well as their family members and when the patient feels satisfied with the care, it will automatically gives the better health outcomes (Fix et al, 2018).
The main area of focus of my reflection is the maintenance of asepsis field for preventing contamination. Whenever undertaking any insidious procedure it is necessarily important to prevent the spread of microbes between the patients and the health provider (Loveday et al, 2014); and to achieve this asepsis field should be maintained. Asepsis refers to the absence of pathogenic microbes. However, the Aseptic technique is a technique or procedure that is used for achieving asepsis so that the transmission of potentially pathogenic microbes can be prevented that are potential in the development of microbial infection (Wilson, 2019). This technique of asepsis is needed for various clinical interventions this includes, insertion of insidious devices or wound dressing along with maintaining these devices (Loveday et al, 2014). Healthcare professionals that are about to perform aseptic techniques must receive adequate training regarding the correct approach to perform the procedure; this should also include a proficiency assessment to prevent any error in the future. Though, I was not assessed before applying this technique directly but, there is a need for an aseptic non-touch technique framework to be learned and excel before directly jumping into the practice. The framework of this technique is developed especially to provide reliable and consistent step-by-step direction that can be applied to various invasive procedures, these procedures could be the insertion of urinary catheters or peripheral cannulas, venipuncture, administration of intravenous drugs, and so on (Loveday et al, 2014). Moreover, it is important to bring theory and experience together in clinical practice because theory will help us in learning the principles and all the other aspects that are important during practice and experiences are what from which we learn and that makes our practice turn into evidence-based practice.
In my course of learning, I was able to gather the knowledge about various aspects, challenges, and benefits of maintaining asepsis field. Through this, I got to learn and develop critical skills and have enhanced my capabilities of providing patient-centered care. Though, in the beginning, there were some evident gaps in my knowledge such as not knowing about keeping instruments above the waist level and its significance in preventing contamination. Patient-centered care is the ultimate goal of every nurse and I am certain that the learning and the experience I got will be highly beneficial for me in my future course of practice, provision of patient-centered care, and help me grow as a registered nurse.
In the future, I will be more proactive while dealing with blood draw; this will include proper hand hygiene for the removal of ephemeral microbes present over hands, safe storage of the instruments so that there is no harm to the sterile instruments and to preserve their sterility so that microbial contamination can be prevented as well preparation of equipment, and use of personal protective equipments. Through the reflection of this experience of mine, I have been aware now that I need some more development while dealing with the infected patients, where there is a need for the blood draw and for achieving this I make sure to follow each step of the framework carefully and will train myself in an aseptic technique by including competent assessment. I will focus more on the approaches that lead to the standardized aseptic ways for the removal of ambiguity as well as variance that will allow the procedure for assurance and audit. I will also work by keeping the principles of asepsis in my mind and the aseptic non-touch technique framework.
Clare, S., & Rowley, S. (2018). Implementing the aseptic non touch technique (ANTT®) clinical practice framework for aseptic technique: A pragmatic evaluation using a mixed methods approach in two London hospitals. Journal of Infection Prevention, 19(1), 6–15. https://doi.org/10.1177/1757177417720996
Fix, G. M., VanDeusen Lukas, C., Bolton, R. E., Hill, J. N., Mueller, N., LaVela, S. L., & Bokhour, B. G. (2018). Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 21(1), 300–307. https://doi.org/10.1111/hex.12615
Loveday, H., P. et al (2014). Epic3: National evidence-based guidelines for preventing healthcare associated infections in NHS hospitals. Journal of Hospital Infection; 86, S1-S70.
Wilson, J. (2019). Infection Control in Clinical Practice. Elsevier.
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