Description and cleaned the wound, as requested by the

Description 

In a placement during my first month when I was working on a postnatal
ward, I was working under the supervision of my mentor, caring for a fourty-two
year old postnatal mother, Mrs Kalsum (pseudonym), who had undergone caesarean
section. I had been asked to remove her wound dressing so that the doctor could
assess it on the ward round. I removed the dressing under my mentor’s
supervision, using a non-touch procedure, and cleaned the wound, as requested
by the doctor. My mentor was called to another patient at this point, so at her
request I stayed with the patient while we waited for the doctor to come to see
her. The doctor had been with another patient, examining their wound, and
I noticed that she came straight to Mrs Kalsum to examine her wound, without
either washing her hands or using alcohol gel first. I also noticed that she
was wearing a long-sleeved shirt, and I was concerned that the cuffs could be
contaminated. I thought for a moment about what to do or say, but by the time I
had summoned enough courage to say something, I thought it was too late as she
was already examining Mrs Kalsum.  

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Feelings

I was alarmed by this, as I had expected the doctor to wash her hands or
use alcohol gel before examining Mrs Kalsum. However, I felt intimidated
because I felt that the doctor was more experienced than me as a junior midwife
staff; and I didn’t want to embarrass her. Also, I didn’t want to make Mrs
Kalsum concerned by confronting the doctor in front of her. Later, I spoke
to my mentor about the incident. She suggested that we speak to the doctor
together about it. My mentor took the doctor aside, and asked her whether she
had washed her hands before examining Mrs Kalsum. She looked quite shocked. She
said that she had been very busy and hadn’t thought about it. My mentor
discussed the importance of hand hygiene with her, and the doctor assured her
that she would wash her hands before examining every patient in the
future.  

Evaluation  

The incident was extremely challenging for me. I regret that I did not
act to challenge the doctor’s practice before she examined Mrs Kalsum. However,
I am pleased that the doctor responded so positively to the feedback of my
mentor, and I have observed that she has now changed her practice as a result
of this incident. I too have learned from the incident, as it has taught me the
importance of acting assertively with colleagues, in a sensitive manner, in
order to safeguard patients’ well-being.  

Analysis  

The Ministry of Health Malaysia states that hand hygiene is the single
most important activity for reducing cross-infection, and points out that many
health care professionals do not decontaminate their hands as often as
they should. Recent guidance published by the Department
of Health (2007) highlights the possibility of staff transmitting
infections via uniforms, and the need to review policies on staff dress. The Kedah
state Infection Control team states that as a nurse ‘you must act to identify
and minimise the risk to patients and clients’. As the nurse caring for Mrs
Kalsum under my mentor’s supervision, this also applies to my own practice as a
junior midwife nurse.  

Conclusion

Looking back on this incident, I can see that I should have acted sooner,
and that I should have ensured that the doctor washed her hands before
examining Mrs Kalsum. I can now see that my inaction in this incident put Mrs
Kalsum’s well-being at risk. After discussion with my mentor, I recognise that
I need to develop the confidence to challenge the practice of colleagues,
putting the well-being of clients at the forefront of my mind. I realise that I
need to be supportive to colleagues, understanding the pressures that they may
be under, but ensuring that their practice does not put clients at
risk.  

Action Plan 

In future, I will aim to develop my assertive skills when working with
colleagues, in order to ensure that the well-being of clients is maintained. In
my next placement, I will make this a goal for my learning, and will discuss
this with my mentor to work out strategies for how I can achieve this.