Description In a placement during my first month when I was working on a postnatalward, I was working under the supervision of my mentor, caring for a fourty-twoyear old postnatal mother, Mrs Kalsum (pseudonym), who had undergone caesareansection. I had been asked to remove her wound dressing so that the doctor couldassess it on the ward round. I removed the dressing under my mentor’ssupervision, using a non-touch procedure, and cleaned the wound, as requestedby the doctor. My mentor was called to another patient at this point, so at herrequest I stayed with the patient while we waited for the doctor to come to seeher. The doctor had been with another patient, examining their wound, andI noticed that she came straight to Mrs Kalsum to examine her wound, withouteither washing her hands or using alcohol gel first. I also noticed that shewas wearing a long-sleeved shirt, and I was concerned that the cuffs could becontaminated.
I thought for a moment about what to do or say, but by the time Ihad summoned enough courage to say something, I thought it was too late as shewas already examining Mrs Kalsum. FeelingsI was alarmed by this, as I had expected the doctor to wash her hands oruse alcohol gel before examining Mrs Kalsum. However, I felt intimidatedbecause I felt that the doctor was more experienced than me as a junior midwifestaff; and I didn’t want to embarrass her. Also, I didn’t want to make MrsKalsum concerned by confronting the doctor in front of her. Later, I spoketo my mentor about the incident.
She suggested that we speak to the doctortogether about it. My mentor took the doctor aside, and asked her whether shehad washed her hands before examining Mrs Kalsum. She looked quite shocked. Shesaid that she had been very busy and hadn’t thought about it. My mentordiscussed the importance of hand hygiene with her, and the doctor assured herthat she would wash her hands before examining every patient in thefuture. Evaluation The incident was extremely challenging for me.
I regret that I did notact 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 mymentor, and I have observed that she has now changed her practice as a resultof this incident. I too have learned from the incident, as it has taught me theimportance of acting assertively with colleagues, in a sensitive manner, inorder to safeguard patients’ well-being. Analysis The Ministry of Health Malaysia states that hand hygiene is the singlemost important activity for reducing cross-infection, and points out that manyhealth care professionals do not decontaminate their hands as often asthey should. Recent guidance published by the Departmentof Health (2007) highlights the possibility of staff transmittinginfections via uniforms, and the need to review policies on staff dress. The Kedahstate Infection Control team states that as a nurse ‘you must act to identifyand minimise the risk to patients and clients’.
As the nurse caring for MrsKalsum under my mentor’s supervision, this also applies to my own practice as ajunior midwife nurse. ConclusionLooking 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 beforeexamining Mrs Kalsum. I can now see that my inaction in this incident put MrsKalsum’s well-being at risk. After discussion with my mentor, I recognise thatI 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 Ineed to be supportive to colleagues, understanding the pressures that they maybe under, but ensuring that their practice does not put clients atrisk. Action Plan In future, I will aim to develop my assertive skills when working withcolleagues, in order to ensure that the well-being of clients is maintained. Inmy next placement, I will make this a goal for my learning, and will discussthis with my mentor to work out strategies for how I can achieve this.