Recorded assessment
I will critique my performance during the procedure of taking vital signs identifying the areas which were perfectly executed as well as those that need to be improved on. In this procedure, I measured the patient’s temperature, pulse and respirations.
Body
In preparation for the procedure, I gathered all the equipment that I needed except for a hanging watch. I was thus forced to keep turning to look at the wall clock which was to my back which was a bit distracting. I therefore failed to capitalize on the advantages of adequate preparations. Preparation of the equipment needed prior to initiating a procedure creates an enabling environment for the successful execution of the procedure. Environmental preparation additionally offers the nurse a chance to mentally rehearse the procedure in addition to enhancing the nurse’s level of confidence. It also boosts the patient’s trust and confidence in the nurse and expedites the successful completion of the procedure (Tollefson 2012, p.66). The lack of a hanging watch made me uncomfortable during the procedure and conveyed a sense of unpreparedness to my patients which must have negatively impacted on the confidence she had in my skills.
I washed my hands before and after taking the patient’s vital signs. The hands of health practitioners are the most common vehicles for the transmission of pathogenic microbes such as Staphylococcus aureus and pseudomonas from staff to staff and from one patient to patient another (Allegranzi, 2009). Maintenance of hand hygiene has been found effective in the prevention of cross-transmission of pathogenic micro-organisms and healthcare associated (HIAs) infections (Whitby et al., 2007). In particular, hand washing with soap and water has been shown to reduce microbial contamination by up to 70%. Wiping of hands with alcohol swabs has on the other hand been found to reduce microbial carriage rates by 16.1%. Therefore, by washing my hands with soap prior to and after attending to the patient I was complying with best practice guidelines on infection prevention particularly with the WHO recommendations on patient safety (Whitby et al., 2007).
However, despite the fact that I had washed my hands, I failed to wipe the table and I rested the arm of the patient on a pillow whose cleanliness I was not sure of because I found it the room and it probably had already been used by others. Accumulating evidence from recent studies indicates that environmental surfaces, previously thought to play a negligible role in the transmission of HIAs, are contaminated by nosocomial pathogens shed by patients at concentrations adequate for transmission of these infections. Microbes shed by patients onto hospital surfaces are capable of surviving for long periods despite attempts at decontaminating these surfaces. Commonly implicated pathogenic organisms include Staphlococcus Aureaus, Pseudomonas Aeruginosa, norovirus, vancomycin-resistant enterococci, Klebsiella amongst others (Otter, Yezli and French, 2011). These organisms are transferred to patients either through direct contact with the surfaces or through the hands of health carers (Nerandzic, Cadnum, Pultz and Donskey, 2010). Even simple procedures such as returning a patient’s chart to the bedside or touching the shoulders of patients have been found to result in the contamination of the hands of nurses (Rudrajit et al., 2011). Therefore, despite washing my hands, they could have easily been contaminated again by the surface of the table or by the pillow. My infection prevention procedures were thus inadequate because I should have used a clean pillow and decontaminated the surface of the table using phenol or hypochlorite. In the end, I put my patient at risk of acquiring a HAI.
Additionally, my failure to adhere to recommended disinfection procedures reflects a common practice amongst health care workers that needs to be improved on. An array of studies has concluded that in spite of the benefits they portend, compliance with guidelines environmental decontamination and disinfection procedures still remains suboptimal amongst heath care workers. This is despite the publication of evidence-based procedures on infection prevention. This calls for me to be more conscious and to display more callousness and vigor in the future in observing environmental hygiene (Lutala and Weber, 2008 as cited in Sessa, Giuseppe, Albano and Angelillo, 2011).
When measuring the patient’s pulse and respirations, I calculated the two concurrently and ended up forgetting the respirations which I had to measure again. I measured the radial pulse for a full minute. After obtaining the pulse I first recorded it then pretended I was calculating the pulse again by holding the patient’s hand at the wrist while in the real sense I was calculating the respirations. In measuring the pulse and the respirations, it is recommended that you obtain the pulse after which you should calculate the respirations while still holding the patient’s wrist and without informing them that you are obtaining their respirations. The latter recommendation is meant to prevent the patient from exercising voluntary control over their respirations once they become aware it is being assessed and hence give wrong data. As such, I was right not to inform the patient that I was assessing his respirations. However, I should not have recorded the pulse rate before obtaining the respiration rate because repetition of the procedure can cause undue anxiety to patients who might think that something is clearly amiss with their vitals.
Besides the rate, other characteristics such as the rhythm and volume of pulse as well as the condition of the arterial walls should also be assessed. These latter aspects of the pulse enable the detection of conditions such as arrhythmias and decreased cardiac output. For respirations, it is vital to also assess the depth, rhythm and sounds of the respirations (Tollefson et al., 2012). In my case, I failed to assess these characteristics of the respirations and pulse having only obtained the rates for both. As such, it is possible I missed important indicators of the condition of the patient. Considering that it was the first time the patient’s vitals were being assessed in our hospital, I calculated both the pulse and the respiratory rates for a full minute so as to establish a baseline. Finally, before the procedure, I failed to enquire on factors that could have potentially influenced the rates of the respiration and the pulse. These factors include the age of the patient, anxiety level, general fitness, medications, exposure to environmental heat, smoking habits and exercise.
I explained the procedure to the patient beforehand and communicated the findings after I had completed the procedure. Communication is the backbone of any interaction regardless of whether it is therapeutic, professional, personal or social (Hamilton and Martin, 2007). Provision of explanations to patients on what will be done and what will be expected of them fosters cooperation from the patient (Tollefson, 2012). Communication also helps to allay the patient’s anxiety caused by the disease and hospitalization. There was little communication during the procedure because I did not want to distract myself. Even when I had to repeat the respirations a second time, I did not explain to the patient why I had to repeat it. Nurses facilitate patient expression by displaying the willingness to engage and communicate. When I was assessing the patient’s pulse and respirations, I demonstrated little willingness to communicate because I felt that it would interfere with my concentration. Communication has been proposed as the tool for humanizing nursing care through dialogue with patients with an aim of clarifying their doubts relating to clinical procedures, diagnostic examinations and treatments (Morais, Costa, Fonte and Carneiro 2009, p.324). in this light, I may have unintentionally caused my patient undue anxiety when I started measuring the pulse rate again without explaining to her why I was doing it. As such, I need to develop more active listening skills so as to be able to discern the patient’s verbal and non-verbal cues. Provision of information relating to their diagnosis, management and prognosis to patients during nursing care potentially reduces pain and increases the recovery rates of patients (Hamilton and Martin, 2007).
Prior to the procedure, I obtained informed consent from the patient after carefully explaining what I was to do, why I was doing it and what was expected of the patient. Various nursing policies stipulate the requirement for nurses to obtain informed consent prior to providing any nursing care. The NMC (2008) in particular explicitly states that informed consent must be obtained prior to the provision of any treatment or care. Informed consent implies that the patient has to be clearly appraised of what the procedure will entail, what will be expected of them, the sensations or experiences they will go through, and the benefits and risks of such procedures (Aveyard, 2005). The ethical concept of informed consent is purposed to protect the patient’s autonomy particularly in light of the fact that nursing procedures have the potential to infringe on the patient’s autonomy. From a legal perspective, the touching of persons without their permission is considered battery (Aveyard, 2002). By obtaining an informed consent, I adhered to the ethical and legal requirements on the issue.
The definitions of privacy and dignity are inextricably interlinked (Woogara, 2005). Dignity is defined in the essence of care (2010) document as the quality of being respect worthy with privacy being defined as the freedom from unauthorized intrusion. Various documents by the National Health Service (NHS) and the 1998 Human Rights Act stipulate that privacy is a basic human right. Similarly, various regulatory bodies such as the Nursing and Midwifery Council have incorporated the concepts of privacy, humanism and holism into their codes of professional conduct. The patient I was attending to was in a private room thus her physical privacy was provided for as per the 2010 Department of Health essence of care document. I however failed to respect this privacy because I forgot to knock on the door before coming in to measure the vital signs of the patient. The unauthorized entry constituted a breach of privacy. Additionally, I failed to respect the dignity of the patient because I did not ask by which name she would have preferred to be addressed with. Factor 4 of the essence of care document stipulates that addressing people by their preferred names shows respect to their dignity (Department of Health, 2010).
Before starting the procedure, I positioned the patient in a comfortable position with her hand resting on a pillow. When I was taking the pulse and respiratory rates, the lack of a hanging watch left me feeling tense and uneasy as I had to keep turning to check the time. Considering that competency in the delivery of nursing care is thought to be correlated with the patient’s level of comfort (Wysong and Driver, 2009), it is explicit that my actions reflected a poor mastery of skills and hence the patient may have been uncomfortable with the care I was providing. The fact that I did not communicate with the patient during the procedure may also have been a source of discomfort to the patient. Findings from studies have shown that therapeutic communication enhances patients comfort because it makes the patient feel valued and enhances their sense of control (Baillie, 2007).
Finally, I forgot to wipe the table before and after the procedure and I used a pillow whose cleanliness I was not guaranteed of. As such, i failed to guarantee the safety of my patient from hospital acquired infections. As previously noted, hospital environmental surfaces are vehicles for the transmission of HIAs. More so considering that some of the pathogenic organisms shed on these surfaces can withstand disinfection procedures.
Conclusion
In conclusion thus, there were areas that well executed and others that I need to polish up on. Although I maintained hand hygiene before and after the procedure, I did not strictly adhere to infection prevention procedures. As such, I failed to provide for the safety of my patient against HAIs. Infection prevention is clearly an area I need to improve on. Communication with the patient is also an area I need to work on. Communication helps to improve the comfort of the patient by allaying their fears and fosters cooperation from the patient. Furthermore, once the patient understands what is to be done, the risks and benefits of the procedure, they are likely to consent to the procedure. My preparations also turned out to be inadequate and this interfered with the accuracy of the findings as well as my professional demeanor. Lastly, although the patient was in a private room, I failed to provide privacy as per the benchmarks contained in the essence of care document by the Department of Health (2010).
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