Quality improvement activity is an activity performed to improve the nursing practice skills in order to be able to provide a good care to the patients. There are various challenges faced by the nurses like the time management when there is a work load, in providing effective and safe care to the patients, learning effective communication and decision making skills and so on. In effort to provide safe care to the patients and infection control, the area of priority is the improvement of hand hygiene among the nurses that work in healthcare. The quality program conducted at Sturt Health Service is on hand hygiene which is done to be able to prevent and control infections. This is a simple quality improvement activity program that will identify the challenges faced by the nurses during the course of action and finding various ways to mitigate the problems faced. This is a learning session for all the nurses so that they will be able to avoid the mistakes and will be successful in delivering safe care to the patient by preventing and controlling the spread of infection.
For infection control and transmission, hand hygiene is considered to be one of the most important elements (Centers for disease control and prevention, 2017). Being a leader, it is the duty of nurse to guide the performers about its importance, why is it done and how is it done. According to Nursing and Midwifery Board of Australia, national competency standards for RN 1.1 and 1.2 states that RN utilizes the best evidences available for safe and effective quality practice that includes research findings to access and analyze the situation (AHPRA, 2019). To identify the best practice and development, RN practice through reflection on knowledge, feelings, experiences and beliefs (Nursing and Midwifery Board of Australia, 2019). Following this, RN will identify all the performers of the team to analyze the situation and share their own experience. The first step will be to educate the nurses on telling them the importance of hand hygiene and how effective it can be in infection prevention and control. The nurses scope of practice includes the verbal teaching, hands on practice and finally the self-experience. The nurses were made to perform after their verbal session. In this, nurses were seen to use either gloves or gel. To use the best available evidence, as a leader I talked about my own experience where I made a mistake while performing on three patients consecutively. After cleaning the wound of the patient that returned from abdominal surgery, I shifted to another patient without washing my hands. The other patient was an old lady and elderly people are more prone to infections. Infections are more frequent in elderly people when compared to younger generation leading to be one of the main causes of morbidity and mortality in old people (Yahav et al., 2016). Hand hygiene is not only important in taking care of elderly people but patients of all gender and age. The following challenges were faced and suitable measures were taken to mitigate them
The first challenge witnessed as a leader was to make a right decision on using gloves, washing hands or hand rub using alcohol. The nurses were recorded on their preference for hand hygiene methods. It was observed that very few nurses made risk assessments based on the characteristics of individual patient as they had been taught. Many nurses were found proving the use of gloves as a nice idea because gel does not feel clean. According to Lee, 2013, the choice of hand decontamination should be given to the nurses based on their personal choice of clean and dirty and the use of gloves proved to be the first preference among nurses (Lee, 2013)
The second challenge faced as a leader was that the nurses were missing the hand hygiene when they were told to perform on various patients. The work load and time management skills of the nurses need to be improved. In order to take care of multiple patients in a day, they were skipping the hand decontamination process. It is the basic duty of a nurse to take care of the patients and provide them with safe care. The process of the nurses and practitioners in forgetting under the work load is an act of not providing the safe care to the patients. This way they are at high risk of infection transmission and the patient may acquire one. Nurses are always in a unique position and have the power to implement a change to improve the standards of patient care. The cornerstone of safe environment is the infection free environment. According to Center for Disease Control and Prevention when providing health care, there are universal precautions for prevention of the blood borne pathogens transmission. One of the most potent nurses arsenals in fighting infection is a hand washing procedure. Hand washing is the single most mandatory nursing intervention that is used to prevent and control infection (AMN Healthcare, 2018). CDC provides effective hand washing techniques such as washing with antimicrobial soap and water and the alcohol based hand rubs that can be used as substitutes (Wisconsin department of health services, 2018).
The third challenge witnessed by the nurse was after performing hand hygiene, the patient complaint of her using an alcohol to wash her hands which she said was against her belief. According to Nursing and Midwifery Board of Australia, standard 2.2 the RN should communicate effectively and should respect the persons beliefs, values, culture and rights. So I told the practitioners to respect the patients beliefs and culture and act accordingly. If the patient does not prefer the use of alcohol rubbed hands on her body then the nurse should instead use gloves. This way we will be able to mitigate this challenge and would be able to respect the persons dignity and believes. The nurses should respect and be knowledgeable about the diverse backgrounds along with being vigilant in giving quality care because patients may have their specific preferences in accordance to their religion or gender (Arkansas State University, 2017).
The fourth challenge faced by me was when I observed few nurses using the same gloves for multiple patients. They did not change gloves after doing the work of a particular patient. According to Nursing for Midwifery Board of Australia, standard 6.4 the RN should provide direction and supervision that is both effective and on time so that the practice is correct and safe. As a team leader, I addressed the problem on the spot and warned the nurse over the use of contaminated gloves on multiple patients. Evidence shows the over-use of non-sterile clinical gloves by the healthcare workers that includes nurses and they are believed to be associated with cross contamination (Wilson et al., 2017). According to glove use information leaflet, the hands should be washed either with soap or alcohol before wearing gloves, after removing gloves and once the work is over the gloves should be removed to wash the hands. The use of contaminated gloves results in germ transmission (World Health Organization, 2019).
Quality improvement activity on hand hygiene was conducted and the practitioners and nurses were told and taught about the various standards covered by the Nursing of Midwifery Board of Australia. It is concluded that health hygiene plays a very important role in infection prevention and control. Each challenge was very well addressed and measures were taken to mitigate them. Being a leader of a small team, all the incidents should be critically analyzed that involves patient safety and appropriate recommendations should be made for change in healthcare practice to address the quality issues. This quality improvement activity enhanced the knowledge and practice of the nurses and practitioners present in the small team.
AMN Healthcare. (2018). The nurses role in preventing hospital-acquired infections. Retrieved from https//www.rn.com/nursing-news/nurses-role-in-preventing-hospital-acquired-infections/Arkansas state university. (2017). The role of a professional nurse today. Retrieved from https//degree.astate.edu/articles/nursing/role-of-professional-nurse-today.aspxAustralian Health Practitioner Regulation Agency. (2019). Registered nurses standards for practice. Retrieved from https//www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspxCenters for Disease Control and Prevention. (2017). Clean hands count for safe healthcare. Retrieved from https//www.cdc.gov/features/handhygiene/index.htmlLee, K. (2013). Student and infection prevention and control nurses hand hygiene decision making in simulated clinical scenarios a qualitative research study of hand washing, gel and glove use choices.Journal of Infection Prevention,14(3), 96-103.
Nursing and Midwifery Board of Australia. (2019). Registered nurse standards for practice. Retrieved from https//www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspxWorld Health Organization. (2019). Glove use information leaflet. Retrieved from HYPERLINK https//www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
Wisconsin Department of Health Services. (2018). Infection control and prevention standard precautions. Retrieved from https//www.dhs.wisconsin.gov/ic/precautions.htmWilson, J., Bak, A., Whitfield, A., Dunnett, A., amp Loveday, H. (2017). Public perceptions of the use of gloves by healthcare workers and comparison with perceptions of student nurses.Journal of infection prevention,18(3), 123-132.
Yahav, D., Eliakim-Raz, N., Leibovici, L., amp Paul, M. (2016). Bloodstream infections in older patients.Virulence,7(3), 341-352.
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