Professional Thesis Writing Service

1.0-       Terms of Reference

NTRODUCTION

Critical reflection acts as the precursor for transformative learning, which takes place by altering the level of personal understandings and the behavior (Mezirow, 1990). Critical refection leads to improved learning, assessment and thinking with respect to the system and the society (Smith, 2011). Critical reflection enables an individual to look beyond the horizon and visualize the bigger picture and develop reasonable views about the situation so that the assessment can become easier. Critical reflection is taught in various professional fields, including the health care system. This concept is not just theoretical but requires practical applicability also. Theoretically there are three models for reflecting critically. The first is the Dewey’s model of reflective learning which advocates that knowledge can be obtained by relating the past and present experiences. This approach is referred to as the pragmatic approach. The second model is that of Habermas’, which advocates the critical theory behind this approach and demonstrates three areas of knowledge, namely, practical, technical and emancipator. The third and the last model is the Kolb’s model of reflexive learning (Patricia Lucas, 2012). The Australian Nursing Federation’s standards of competency for a nurse have identified r put forward three domains of better level competencies: adaptation of practice, conceptualization of practice and leading on with the practice (Australian Nursing Foundation, 2005).

AIM AND OBJECTIVE

The objective of this paper is to critically examine and reflect on my professional skills and performance as a registered nurse, in the domain of adaptation of practice. The paper discusses about the main concept of critical reflection and also the competencies in the aforesaid domain. This essay is written in first person, as it will help in better understanding of the critical competencies possessed by an individual.

DESCRIPTION

The initial period of working in any professional field is very difficult and tiring. When I started to work as a nurse, in the emergency, I used to work for 6 days a week. The timings were also very stringent, from 8.00 AM till 3.00 PM. The work load was much higher as compared to the task force available. The number of nurses was reduced considerably and the health staff was under continuous stress as they had to cater to so many patients. Another problem faced by the health staff was the duration of stay of the patients and the workload on the emergency section. In my country, general statistics show that patients stayed for minimum two days. With each nurse catering to 6-7 patients at one time, it is nearly impossible to pay adequate attention to each on simultaneously. Plus this increases the work load to a greater extent. Most of the nurses, who worked, just had a diploma in nursing, while I and two others had the bachelor’s degree. This is what distinguished us. We had better theoretical as well as practical skills as compared to them. This plus point kind of added to the workload I had. I was made responsible for all the emergency situations and for looking after the patients who were brought in emergency conditions. One of the main procedures of emergency is suturing. Since suturing requires both practical as well as theoretical skills, I was the one who was given the task of suturing, assessing the wounds of the injured, examining any other damage like that to arteries or tendons or nerve fibers. The morning task was to review all the patients along with the doctors and then for the latter half of the day each nurse was assigned 6 to 7 patients to take care of.

OVERVIEW OF CRITICAL REFLECTION

Nursing literature frequently mentions about critical reflection but nowhere has this term been defined precisely (McBrien, 2007). Vaguely it has been mentioned as the process of analyzing practice through regulated self reflection (Crowe & O’Malley, 2006). Although everybody has the ability to think with a different perspective, the aim of critical reflection is to enhance knowledge and redefine our understanding about self, by increasing self awareness and self consciousness, thereby focusing on the outcomes of our actions (Forrest, 2008). There are too many scenarios in the health care system, where the nurses are exposed to unexplained judgments, interpretations and decisions. To relieve the stress burden from our shoulders, it is important to inculcate critical thinking in our lives. Yes, it is true, critical reflection will give fire to anxiety, conflict and also cause self doubting issues but it will, eventually, alter the professional practice in an affirmative way (O’Connor, 2008). The new energy within will help in challenging the beliefs and assumption, that already exist and lead to better understanding of the things and thereby bringing about a change for benefit of all. Because of the increase in expectation from the nurses, they face complex demands, change and higher accountability. To comply with such situations, they need to develop skills of thinking on a higher level and improvement in the reasoning abilities (Crowe & O’Malley, 2006). SchÓ§n (1983) has put forward two major reflections: reflection in action (which occurs when the action is being performed and is a result of thinking critically) and reflection on action (which is reflected after the action has been performed). Reflection in action involves many skills like being a good observer in every situation and trying to learn something out of every situation, interpreting, recording and understanding your feelings and responses to a certain situation and then inter relating your previous experiences, always make yourself counted in the experience via taking a ‘ witness’ stance. On the other hand reflection on action is the most common form of reflection as what you have learnt or understood from your past encounters, all reflects in your future actions (David Somerville, 2004). Critical reflection is important for nurses because they need to incorporate change in their daily interaction, apply and update their professional skills, should develop self awareness and self directedness. They can successfully utilize the opportunities only if they ponder upon the feedback of their interactions and their impact on the patient, their families, colleagues and the health care unit as a whole. Therefore, critical reflection forms the most important ingredient for cooking the recipe of good conduct.

DOMAIN OF INTEREST

Day by day the complexities of the health care system are increasing. Thus, to meet the requirements various competency standards have been set up for registered nurses for advanced nursing. These competency standards aim to distinguish between the general and advanced nursing practices (Australian Nursing Federation, 2005; International Council of Nurses, 2010). The domain of interest here is the domain of ‘adapting practice’. It contains the competency abilities of advanced registered nurses to comply with and adjust or adapt to the challenging and more complex situations and still yield in better outcomes in terms of services offered (Australian Nursing Federation, 2005). The standards that are set, help in encouraging post graduate education for development in the field of advanced nursing practices and also enable each individual to individually critically analyze their competency in different domains (McGee, 2009). Like every other domain, the domain of adapting practice also stresses on understanding and meeting the needs and requirements of the patients who are suffering from complex and critical conditions (competency standard 4). This domain also states that improvement in the predicted outcomes should be made by referring to the past experiences and gathering information from other sources as well (competency standard 6) (Australian Nursing Federation, 2005). This essay also reflects upon the competencies of a registered nurse and the abilities that were utilized during complex and stressful situations.

FEELINGS AND THOUGHTS

Adaptation to a new environment is extremely difficult and it takes lots of patience and practice to adapt comfortably. I face many challenges in my workplace and earlier found it difficult to adapt. I also felt embarrassed when I needed help and could not ask anybody, fearing that my reputation would go down and that my fellow colleagues would make fun of me. Being equipped with the interpersonal skills, theoretical as well as practical knowledge about taking care of the patients and delivering the best quality of service, enabled me to climb up the ladder of success. Even though earlier it was difficult for me to interact with my fellow colleagues, now I can converse comfortably with anyone including my colleagues, patient, families and other staff members. Most of this was the result of feedback which I received from the patients, who generally praised my ability to empathize with the patients and then cater to their needs. As quoted above, feedback is an essential component for critical reflection, the positive feedback that I received from the consumers and my fellow staff members helped me visualize things with a different approach. I started enjoying my work. There were situations when I feared the outcome of some medical action. In my country, there are no rules and regulations pertaining to the safety of the health care professionals. This causes safety issues with the carers. Even I found myself in such situation when the medical practices could not save the life of the patient and his family members were outrageous, blaming the hospital for their loss, intending to burn down the entire building and take revenge. But then one should not be afraid of shadows, as shadows mean there is light somewhere near. There is an instance that reminds me of my good work and better performance as a nurse. I once cared for a boy who had been stabbed in the abdomen. There was profuse bleeding and I had taken every possible measure to stop the blood flow and restore the consciousness of the boy. Three weeks later, that same boy came with his parents and thanked me for saving his life. Such precious compliments and gratitude’s count a lot in the long run.

EVALUATION

I realized that during my performance in the hospital, as a registered nurse, I had some positive as well as negative traits. Good command over English language was counted among my positive traits. This enabled me to quickly read and understand the nursing articles written in English. Also since I could understand and associate what was mentioned, I was able to deliver effective care to the patients. Also my expertise in the fields of pathophysiology and emergency skills made me an important person in the hospital. Whenever there was a case of any emergency, I was made responsible to monitor the patient and do the needful. On the contrary, the nurses who lacked the knowledge about emergency skills or were not fluent in English language missed the opportunity.

Ching Ying Lee (1998) has reported that nursing practice requires knowledge of proficient English as the nurses should be capable of using medical terms in fluent English. English is the most common language spoken worldwide and therefore, such a language should be known by all in order to address the cross cultural barriers in health care. Not only English is a common language but it has been named as the scientific language worldwide. Therefore, it is essential that all the communications pertaining to the medical condition of the patient, the health care outcomes and the treatment be explained in English to the patient as well as the concerned members (Mylaeus Renggli MI 1998).

Another positive point that added to my portfolio was the good interpersonal and communication skills. With these skills I was able to interact efficiently with the staff and the patients as well. In order to deliver better services I followed the rule of empathy. Whenever any new patient was put under my care, I listened to him/ her and tried to picture myself in her/ his situation, so that I can understand better about the current situation of the patient and accordingly provide the guidelines to the family and the other medical staff. Most frequently we were faced with situations in which the burden on the health care unit was so much that all the patients were not being given equal attention, due to lack of task force and increased number of patients. In such cases one or the other patient or the family member would stand and start shouting in anger. I helped in controlling many such situations by calmly making the individual understand our plight and thereby promising him that I will take care of his/ her family member as soon as I get free. I utilized my good communication skills to deal with such patients.

It is very important to have good communication skills in order to build trust between the patient and the doctor. It will consequently allow or enable the patient to disclose the information which might prove fruitful. Good communication also motivates the patient to get involved in the decisions related to health care, minimizes the risk of mishaps and errors and eventually enhances the satisfaction level of the patient (NHMRC, 2004). Literature has also shown the importance of understanding the cultural beliefs of the patients and making more accurate and meaningful decisions that are appreciated by the patient and the family both (Lawrence Dyche, 2007).

Another important learning from my experience was that knowledge is never enough. Even after being a Bachelor’s degree holder, I found myself lagging behind in the field of pharmacology. Thus, it became the need of the hour for me to undergo a special three months training in this field and then I was all set and comfortable in explaining the patients about different drugs and their prescriptions. Although it is not advisable for the nurses to get into doctor’s role and prescribe drugs t the patients but they should know what different drugs are meant for, so that if the patient has a query related to which drug is administered to him or why it is administered, they should be able to answer them with confidence (Clare Lomas, 2010).

One of the negative traits that I discovered within myself was not being able to extract the medical history of the patient. Emergency nurses should possess the skills of physical assessment as well as health history. This lag can be attributed to the overburden and work overload during the emergency situations. Another reason can be the demand for nurses as there had been shortage of nurses since of long time in my hospital.

Joann Griff Alspach (2011) has laid forward the importance of knowing the medical history of the patient as well as of his family. This is important because a track record of all the details about the illness that have been occurring in the family can help in predicting the prognosis of the current state of the patient. Also prior information can help the doctors determine the allergies the patient possesses when subjected to certain chemicals or drugs.

Another negative quality that I possessed was lack of team spirit. Whenever I had many patients and was overloaded with work, even though I wanted someone to help me, yet I never asked for help. I am now able to realize that team work is essential for efficient working of the team as it enables us to learn something new and benefit from each of the members involved.

ANALYSIS

My experience, expectations, feedback and results have majorly influenced the knowledge I have gained so far. My skills like being able to communicate proficiently in English and being able to understand the text presented in medical journals, which are generally written in English, has helped me gain recognition and my work has been appreciated by the authorities as well. Communication is an important aspect of health care as it promotes commonality of understanding and meaning (Sonia Allen, 2007). Also my skills like the knowledge of pathophysiology and dealing with patients during emergency situations helped me get positive response from the patients and their family members.

Though there are certain negative aspects also, like lack of team spirit and lack of ability to get medical history out from the patient, yet I am happy that I am now able to analyze my performance as a whole and can work in the field of teamwork and improve my traits further.

SYNTHESIS & RECOMMENDATION FOR FUTURE PRACTICE

I feel that I have precisely highlighted all my strengths, weaknesses, opportunities and threats pertaining to the nursing practices. According to the standards for practice specified by the Nursing Council, the very first principle to e followed if to respect the individuality and dignity of all the health consumers. Treating with respect means interacting with the consumers in a polite and considerate manner, thereby helping them cope with their deteriorated condition and enable quick recovery. It is important to understand the cultural needs as well and decide upon the course of treatment accordingly. All the registered nurses are expected to work in partnerships as this enhances the working capability and also builds trust among the members of the staff, leaving no scope of discrimination. Another perception of working in partnerships can be with respect to the health consumers. It is important to listen to them, respond to their concerns and acknowledge their preferences as well. It is not necessary to give affirmation to all their preferences but only to those which are practicable. Also, it the responsibility of the nurse to encourage and motivate the consumers by providing them relevant and complete information about their condition, so that they can make decisions independently. Another point to be kept in mind is to respect and allow patient’s privacy and confidentiality. The code of conduct should comprise of integrity so that the consumer’s trust can be justified. Integrity means consistency in the principles and ethics that you follow and not abusing the position held by you or the trust of the authorities. Lastly, all the registered nurses must maintain public confidence and trust in their profession and also maintain the ethics involved (Nursing Counsil, 2011).

CONCLUSION

The aim of this essay was to provide a detailed outline of the analysis of the performance of a registered nurse, when working in the domain of adapting practice. The basic concept of critical reflection and how it modifies the outlook or the perception has been well explained with the help of live examples.

• The aim of this report is to debate the effectiveness of interprofessional standards of infection control precaution for patients following surgical procedures.
• Factors influencing poor infection control and hygiene in relation to patient safety, including noted themes such as, hand hygiene, communication and interprofessional collaboration.
• To improve if possible, the efficiency of infection control, hand hygiene and use of personal protective equipment between the multidisciplinary team, introduce recommendations.
• Identify relevant themes in regard to hospital acquired infections and more specifically surgical site infections.
• It will acknowledge the relevant stakeholders and examine the perspectives and implications for each stakeholder in a national setting.

2.0-       Executive Summary

Hospital acquired infections (HAIs) can lead to longer stays, increased healthcare costs, and higher death rates (Haverstick, et al, 2017, p. e1). According to a study of HAIs conducted by Magill, et al, (2014) approximately 1 of every 25 patients in acute care hospital has at least one health care associated infection (Magill, et al, 2014, p. 1207).

This report highlights the importance of appropriate hand hygiene, efficient communication and the importance of interprofessional working in relation to patient safety in practice. Preparation of the surgical team and maintenance of a clean operating environment are crucial as there are a number of intraoperative risk factors that could contribute to the development of infections (International Society for Infectious Diseases (2018). It highlights that there is evidence to suggest that there is a high number of HAIs in the acute setting. The aim of this report is to discuss the prevalence and risks of HAIs and highlight some preventive measures that could possibly be recommended and implemented, specifically concerning SSIs.

Four stakeholders have been identified and their perspectives have been explored as well as how each stakeholder can work collaboratively to decrease the risks of hospital acquired infections.

3.0-       Introduction

A chain of infection is when a series of events have taken place for an individual to acquire an infection, to cause an infection, microorganisms need a host, a portal of entry and a portal of exit, where they become a source infection (Peto,2009, p. 93). The prevention of infection requires the understanding of relevant policies and protocols and the knowledge and skills to adapt them to the preoperative environment (Gilmour, 2010, p. 24).

HAIs according to the WHO add to functional disability and can increase emotional stress of the patient, in some cases it may lead to disabling conditions that reduce the patient’s quality of life (World Health Organisation, 2002, p. 1). Concern for increasing rates of infection has brought about the need for improved national surveillance and reporting of infection rates, as well as control of antibiotics and review of standard control of infection procedures (DoH, 2005, 2006, cited in Whittam, 2008, p. 64). In the healthcare setting the timely identification of HAIs are crucial steps for preventions, however the detection of transmission events is based on limited evidence (Faires, M, et al, 2014, p. 2).

A surgical intervention requires a break in skin integrity and the insertion of instruments and other foreign material into body tissue, therefore increasing the patient’s risk of infection (Gilmour, 2005, cited in Gilmour 2010, p. 24).Infection prevention includes various components, which aim at reducing the risk of infection for patients (Gilmour, 2010, p. 24). Surgical site infections (SSIs) complexifies 5% of all surgical procedures in the UK and is known to be a major cause of postoperative morbidity and a drain on healthcare resources (O’Donnell, et al, 2019, p. 1). This is mirrored in the guide to infection control in the hospital and operating room by the International Society for Infectious Diseases (2018). SSIs are the second most common type of adverse event among hospitalized patients, only surpassed by medication errors, and are known to be the most frequent cause of readmissions (Stevens, 2018, p. 1). Because SSIs are mainly acquired during the surgical procedure while the wound is open, several infection control practices merit scrutiny in the operating theatre (Stevens, 2018, p. 1).

4.0-       Main Body

4.1-       Themes

4.1.1  – Hand hygiene

LLapa-Rodríguez, et al (2018) states that hand hygiene is a simple action in the prevention of HAIs, being considered an excellent indicator of quality for patient safety (LLapa-Rodríguez, et al, 2018, p, 1579). The royal Australasian college of surgeons (2008, p. 29) also agree on the importance of hand hygiene, stating that it is the single most important facto in reducing HAIs. Bouwer, et al, (2017) suggest that one of the main causes of the spread of infections in the healthcare environment is by poor hand hygiene (Bouwer, 2017, p. 75). According to the WHO (2009, p. 28) a cause of poor compliance may be the lack of user-friendly hand hygiene equipment as well as lack of knowledge of good hand hygiene practice. Best practice in hand hygiene as highlighted by the NICE Guidelines (2013) suggest that the operating team should remove all hand jewellery, artificial nails and polish before operations to achieve best practice.

Widmer (2013) suggests that many causes of infection outbreaks have been traced to the contaminated hands of the surgical team, despite wearing sterile gloves, possibly facilitated by not routinely using double gloves (Widmer, 2013, p. s36). This suggests that although protocols and policies exist, some staff are choosing not to follow them. A survey study by Ogle (2003) suggests that the cause of surgeons to not double glove was because they felt two pairs of gloves compromised their surgical skills (Ogle, 2003, p. 2). However, Edlich, et al (2005) suggests that it takes time to gest use to double gloving (Eldich et al, 2005, cited in Phillips, 2011, p. 13). Thomas-Copeland (2009) goes on to suggest that anybody whom finds their dexterity reduced should allow time to adjust (Thomas-Copeland, 2009, cited in Phillips, 2011, p. 13).

4.1.2- Antibiotic prophylaxis

As mentioned previously the infection of a surgical wound is relatively common, however the risk can be reduced with the use of antibiotic prophylaxis as suggested by Stonebridge, et al (2006). The goals of antibiotic prophylaxis are to reduce the incidents of SSIs and to minimise adverse events. Prophylactic administration of antibiotics has been proven effective in reducing the rate of postoperative infections for surgical procedures, in a meta-analysis of randomised controlled trials of spine fusion surgery, Barker, et al (2002) noted a significant reduction on SSI (Barker, et al, 2002, cited in Tsai and Caterson, 2014, p. 4). Similarly, other studies have observed the effectiveness of prophylaxis antibiotics in general orthopaedics, total joint replacements and spinal surgery (Henley et al, 1986 and Lindwell, et al, 1987, cited in Tsai and Caterson, 2014, p. 4). However, a study by Vohra, et al (2017) concluded that although antibiotic prophylaxis appears to reduce superficial SSI at 30 days, there was no evidence antibiotic prophylaxis significantly reduced the rates of SSIs (Vohra, et al, 2017, p. 2238). The results from this study suggests that more studies are needed looking at the potential benefit of prophylaxis antibiotics.

Stonebridge, et al (2006) states that the value of antibiotic prophylaxis is related to the impact of local SSI, for example, in colorectal surgery, it reduces mortality, while in orthopaedic surgeries it reduced long-term morbidity Stonebridge, et al, (2006, p. 130). Broom, Broom (2018) highlight the issues of inappropriate prolonged prescription of antibiotic prophylaxis and compliance issues with timing, choice and dose. Inappropriate antibiotic prophylaxis poses a short-term risk to patients by their unnecessary usage, and mid to long-term risks of contributing to antibiotic resistance (Broom, Broom, 2018, p. 124).

        4.1.3- Interprofessional collaboration

Interprofessionalism and interprofessional health care, defined by Stern (2006) are terms used primarily to describe the delivery of care by different health care professionals (Stern, 2006, cited in Matthew, et al, 2011, p. 383). Gorman (1998) describes the operating theatre as being the ultimate example of multi-professional teamworking in health care (Gorman, 1998, cited in Coe and Gould, 2008, p. 609). Col, et al, (2011) states that understanding the roles of the individual profession is imperative in developing an atmosphere of collaboration, however understanding professional values and contributions of other participants are also important in creating an effective care team (Col, et al, 2011, p. 412).

Interprofessional working underpins a large majority of modern healthcare, which is critical in the operating theatre were different health professionals such as nurses, surgeons, ODP’s and anaesthetists work independently in complex arrangements where patient centred care is the focus (Healey, et al, 2006, p. 487). This suggests that the level of teamwork in the operating department is critical for patient centred care, inter-group relations.  However, Coe and Gould (2008) suggest concerns over the level of interprofessional conflict and aggression reported in the operating departments (Coe and Gould, 2008, p. 609). Ways of overcoming conflict within the operating department as suggested by Jones and Prescott (2010, p. 21) is to implement action learning into practice. Engagement with action learning helps to develop a range of valuable transferable skills, in addition to learning other ways of working and perspectives, as well as developing problem-solving skills and critical thinking (Jones and Prescott, 2010, p. 26).

4.1.4- Communication

A study conducted by Nestel and Kidd (2005) state that communication in the operating theatre is often diverse and complex, the results suggest that active listening is important as well as basic interpersonal skills such as clarity of speech, being polite and courteous. The most notable themes in Nestel and Kidd’s study appear to be factors that indirectly influence communication, especially confused and conflicting role perceptions.  Answers to questions in this study focused on the nurses’ roles but it is possible that perceptions of surgeons’ and anaesthetists’ roles also lacked clarity (Nestel and Kidd, 2005, p. 6).

Espin and Lingard (2001) state that effective communication is critical to the smooth functioning of an interprofessional surgical team of complex representatives from nursing, surgery and anaesthesiology; all disciplines with different health care models (Espin and Lingard, 2001, p. 672). Language can impact significantly on the ways in which health care professionals relate and collaboratively work together (Marshall, et al, 2011, p. 452). Jargon from different interprofessional teams could affect communication between different health care professionals. A study by Marshall, et al (2011) found that there is a variety of challenges when in comes to interprofessional jargon, stating that healthcare professionals need to avoid the use of exclusionary jargon so that all members of the healthcare team, including patients and families can adopt a more collaborative practice (Marshal, et al, 2011, p. 453).

4.2-       Stakeholders

This section will cover the perspectives of four chosen stakeholders, identified below in relation to infection control.

4.2.1- Theatre Nurse

The perioperative nurse is responsible for implementing aseptic practice and monitoring the aseptic technique of the entire surgical team, Goodman and Spry (2017, p. 95). Theatre nurses are often seen as an important component within the theatre team and is crucial in assisting the surgeon during surgical procedures.

Goodman and Spry (2017, p. 95) describe the responsibilities of the perioperative nurse as one whom continuously monitors the operating room environment to ensure adherence to aseptic principles and compliance with their aseptic practice. There has been issues regarding operating staff defining the role of a theatre nurse which has lead theatre nurses managing work outside their role. McGarvey, Chambers and Boore (2001) state that if nurses working in the operating department are to secure a future in providing care for surgical patients then it is important to clarify and articulate their role (McGarvey, Chambers and Boore, 2001, p. 2).

The Royal Australasian College of Surgeons (2008, p. 4) state the importance of teamwork in surgical practice with an emphasis on close working with not only surgical staff but non-surgical staff such as nurses. Good and appropriate communication, respect and courtesy should be the focus for all interactions with staff and patients. However, a focus group interview, exploring the perception and experiences of communication in the operating theatre by Nestel and Kidd (2006) highlighted issues on how nurses perceived to be treated in the operating theatre by surgeons. Participants found that they experienced poor communication with surgeons and expressed that they felt respect, common courtesies and manners were often absent. Nurses also reported inadequate communication between surgeons, which led to frustration and friction within the interprofessional team (Nestel and Kidd, 2006, p. 4). This issue has been highlighted in other studies with authors arguing that the nurse-doctor communication in the operating theatre show heavy signs of hierarchical tendencies, Nestel and Kidd’s (2006) study further highlights the nurses expressions of frustration on the issues of power and hierarchy in the operating theatres (Nestel and Kidd, 2006, p.5).

4.2.2- Service Users

As mentioned previously, the prevalence of SSIs are common in the hospital setting, there is also research on the risk, cause and prevention, however there is little research on the effect SSIs have on patients who experience them. Surgical infections can be considered as patient or procedure related, patient related factors that increase the risk of infection include, malnutrition or obesity, Smoking and steroid use (Bowley, 2006, p. 46).

A qualitative interview study by Tanner, et al (2012) highlights how SSIs affect the lives of patients. Patients reported experiencing pain and weakness as a result of the SSIs in addition to their physical symptoms, participants also reported feelings of mental distress and depression (Tanner, et al, 2012, p.166). Other studies exploring the experiences of patients after surgery found that communication was imperative, with the fear of the unknown leading to added anxiety (Lie et al, 2010; Chan et al, 2011, cited in Tanner, et al, 2012).

A study by Tartari, et al, (2017) suggests more educational opportunities need to be implemented to improve patient engagement. Educational interventions are likely to be more effective multifaceted and broadly applicable to meet various health needs across the general population (Tartari, et al, 2017, p. 4). Tartari, et al (2017) also highlights how nurses, surgeons and other health professionals could a meet different learning needs and achieve patient engagement by considering broader ways of sharing information through illustrations, computer technology, smartphone apps or audio videos on prevention of SSIs (Tartari, et al, 2017, p. 4).

4.2.3- Operation Department Practitioner

Traditionally, surgeons and anaesthetists have been primarily assisted by theatre nurses, this role has changed over the years and a relatively new profession is the Operation Department Practitioner (ODP) (Timmons and Tanner, 2004, p. 645). The complexity of working within the surgical environment requires the ODP, who work alongside a variety of different professionals, which require high developed communication and teamwork skills, Abbott and Booth (2014, p. 1). Timmons and Tanner (2004) describe ODP’s as members of the surgical teams working in operating theatres alongside a multi-professional team during operations, they provide care to patients before, during, and after surgery (Timmons and Tanner, 2004, p. 650). ODPs because regulated within the Health and Care Professions Council in 2017, and was taken under the allied health professions, during this the interprofessional working of theatre nurses and OPDs increased, with both professions working side by side (Rich, 2019, p. 488). However, this side by side working has not always been cohesive. Timmons and Tanner (2004) state that tensions and conflict between ODPs and theatre nurses may arise due to ODPs being a relatively new profession and being sufficiently similar to nurses (Timmons and Tanner, 2004, p. 663).

4.2.4- Surgeons

After marriage many surgeons remove their wedding ring during surgical procedures to reduce the risk of infections and to follow protocol. Stein, and Pankovich-Wargula (2009) suggest that this can be disheartening for some surgeons that always feel compelled to wear a band (Stein, and Pankovich-Wargula, 2009, p. 86). Theatre staff are sometimes reluctant to remove their wedding bands when scrubbing up. Higher microbial counts after washing found in health workers who prefer not to remove rings (Salooiee and Steenhoff, 2001, p.17), which in turn could increase the risks of HAIs. In a study by Bernthal (1997) and Salisbury, et al (1997) it revealed an increased bacterium count under rings and watches, where staff had not completed proper scrubbing under or around jewellery (Bernthal, 1997 and Salisbury, 1997, cited in Stein and Pankovich-Wargula, 2009, p. 86). However, it needs to be noted that neither of these studies recorded if these conditions leaded to a higher rate of HAIs. Most crucial factors in the prevention of HAIs, although difficult to measure, are the judgement and proper technique of the surgeon and surgical team, as well as the overall health of the patient (Nichols, 2001, p. 221). Everyone working in perioperative environment shares the responsibility for reducing the number of microorganisms in the operating room to the lowest level possible Goodman and Spry (2017, p. 95).

5.0-       Conclusion

This report has identified barriers to infection control in the surgical setting, as well as discussed, the identified themes and relevant stakeholders’ perspectives. The identified themes of hand hygiene highlighted possible issued with staffs understanding of policies and protocols as well as appropriate PPE, such as wearing wedding bands. Communication and interprofessional working has been highlighted and the barriers identified within has been discussed and analysed. The perspectives of the identified stakeholders have been discussed and evaluated in regard to infection control and interprofessional working.

6.0-       Recommendations     

Recommendations have been designed using the SMART tool (MacLeod, 2012, p. 70).

Recommendation 1:

Specific: Understanding each health professional’s role within the operating theatre to reduce lack of understanding on staff responsibilities. Measurable: Opportunities for staff to discuss roles and responsibilities with each other, with added feedback. Achievable: Yes, if time could be allocated for separate groups from the surgical team to meet. Realistic: No, different groups of staff with different roles would need to meet and it is unlikely many could allocate their time, however if it was allocated as training and efficient staff coverage was made it could be realistic. Staff may not want to attend face to face, and some may feel uncomfortable discussing their role or may feel it unnecessary. Timeframe: This could be achieved at any point of time in the healthcare professionals’ career; however, it would be more beneficial and achievable to complete this while training in a surgical environment.

Recommendation 2

Specific: Hospital staff should receive training in regard to understanding their local policies and procedures to reduce the risks of HAIs, receiving additional training when policies have been updated. Measurable: Relevant staff should receive practice skill sessions to assess their competencies in regards to the local policies. Achievable: Yes, if staff are willing and they are able to receive time for training. Realistic: Yes, however staff scheduling may cause issues with relevant staff being able to have time off work, as well as cost to provide training. Timeframe: Staff availability and recommendations on if this should be repeated annually.

References

• Abbott, H. and Booth, H. (2014) Foundations for operating department practice: Essential theory for practice. Berkshire: Open University Press
• Bowely, D. (2006) ‘Postoperative management’, in Kingsnorth, A. and Aljafri, M. (eds) Fundamentals of surgical practice. 2^nd edn. Cambridge: Cambridge Community Press.
• Broom, J. and Broom, A. (2018) ‘Fear and hierarchy: critical influences on antibiotic decision-making in the operating theatre’, Journal of Hospital Infection, 99 (2), pp. 124-126.
• Coe, R and Gould, D. (2008) ‘Disagreement and aggression in the operating theatre’ Journal of Advanced Nursing, 61 (6), 609-618.
• Col, N. et al, (2011) ‘Interprofessional education about shared decision making for patients in primary care settings’, Journal of Interprofessional Care, 25 (6), pp.409-415.
• Phillips, S. (2011) ‘The comparison of double gloving to single gloving in the theatre environment’, The journal of Perioprerative Practice, 21 (1), pp.10-15.
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7.0-       Glossary of Terms

• Aseptic practice/ technique: The practice by which contamination from microorganisms is prevented. (Goodman and Spry, 2017, p. 356)
• Infection: Infection occurs when harmful pathogenic microorganisms invade the human body and cause disease or even lead to death. Not all microorganisms are harmful, under the right condition’s infections can occur, highlighting the importance of preventing and controlling infection has its relation to maintain a safe environment (Whittam, 2014, p. 64).
• Microorganism: Any organism of microscopic size, such as a virus, bacterium, or protozoon. It may or may not be a pathogen, i.e. capable of causing disease, Mallik, Hall and Howard (2009, p. 462).

8.0-       Abbreviations

• DoH               Department of Health
• HAIs              Hospital Acquired Infections
• ODP              Operation Department Practitioner
• PPE               Personal Protective Equipment
• WHO             World Health Organisation
• SSIs              Surgical Site Infections