Handwashing Essay Example
Handwashing Essay Example

Handwashing Essay Example

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  • Pages: 6 (1490 words)
  • Published: December 20, 2017
  • Type: Case Study
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According to ICN (1998), hand hygiene is crucial in preventing cross-infection in healthcare settings. Hospital-acquired infections pose a significant risk to patients and place a heavy burden on national health services. As noted by Lusardi (2007), each occurrence of healthcare-associated infection in the UK costs approximately £3,000 (Department of Health 2000). Moreover, as nursing accounts for approximately 80% of direct patient care, it often involves personal and intimate care activities (Wade 1995).

Healthcare associated infections (HCAI) are a common and potentially life-threatening outcome of care, affecting approximately 10% of patients. These infections can be caused by microbes spread through the hands of caregivers, including student nurses. Therefore, evaluating the hand hygiene practices of nursing students is crucial, as they represent the future healthcare workforce, and pre-registration training is an excellent opportunity to address any factors leading


to non-compliance with hand hygiene practices. Lymer et al. (2004) suggest that nursing students have a unique position to promote effective hand hygiene by sharing good knowledge and practices with qualified staff, acting as agents of change in practice.

From my background, I aim to investigate whether student nurses comply with hand hygiene practices in clinical areas. To gather information, I will analyze academic research studies on hand hygiene among nursing students in clinical areas. The literature review will identify main themes, summarize key issues, and highlight gaps in current academic knowledge. I will develop a clear research question and determine an appropriate methodology to answer it.

Literature search was conducted through electronic, academic, and professional journal databases. The following databases were accessed: CINAHL, the British Nursing Index, Embase, Ovid Journals, and Medline. Key terms "hand hygiene," "barriers," and "compliance" were use

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initially, and results were analyzed individually and in combination. In order to obtain a broader understanding of the topic, key terms such as "hand washing," "alcohol gel," and "infection control precautions" were also utilized. The study focused on a specific group.

nursing students were searched for using the terms 'students' and 'nursing students', with limitations set for the dates between 2007-2009 to ensure up-to-date sources were gathered. Supplementary literature was found through manual searches of recent journals and texts, while online and library resources were utilized to access international and national guidelines.

As part of the search strategy, only articles published in English were included. From this search, four qualitative research articles were selected: Erasmus et al (2009), Barrett & Randle (2008), Cole (2008), and Lusardi (2007), which can be found in the appendix of this literature review. Through the analysis of these articles, commonalities, discrepancies, and debates surrounding hand hygiene among nursing students were identified. One significant finding across all four articles was the lack of positive role models for proper hand washing practices. Lusardi's (2007) article noted that students were more aware of bad practice than good practice when observing other staff's practices.

According to Lusardi (2007), one student reported a doctor who failed to practice hand hygiene by not washing their hands or using alcohol gel before moving from one ward to another. Another student described a doctor who entered and exited a ward where an outbreak of diarrhoea and vomiting had occurred, passing by all warning signs without washing their hands before tending to patients. Erasmus et al (2009) conducted research that supported Lusardi's findings concerning negative role models, such as

non-compliant experienced nurses and doctors, as reasons for students' non-compliance. The study also suggested that new students often mimic the hand hygiene behavior of the physicians they observe, leading to poor hygiene habits. Barrett and Randle's (2008) research indicated that students comply with hand hygiene practices observed in clinical areas to blend in with the nursing team and avoid disrupting their routines.

Students in this study stated that they followed their mentors' hand hygiene practices to be accepted as part of the nursing team. As a result, they sometimes neglected proper hand hygiene to appear busy and efficient. Cole (2008) found that students' compliance with hygiene is influenced by cues to action in clinical practice and the behavior of role models. In Lusardi's (2007) study, student participants recognized their responsibility for their own practice, demonstrating their understanding of their duty of care to patients. These results suggest that students' personal responsibility is the primary influence on their hand hygiene practices.

According to Lusardi (2007), taking responsibility for oneself and practicing good hand hygiene is crucial in preventing the spread of infection to patients. One interviewee emphasized the importance of using their conscience to avoid passing on infections and protecting themselves and their families from getting sick. Cole (2008) found similar results, stating that students' personal responsibility plays a significant role in their hand hygiene practices.

According to Cole's (2008) research, one student emphasized that hand washing is a fundamental aspect of one's identity, stating that neglecting this important practice not only puts patients at risk, but also oneself. The student also stressed the significance of doing the right thing before going home. However, analyzing the studies conducted

by Erasmus et al (2009) and Barrett & Randle (2008), no explicit mention was made about the responsibility of students in complying with hand hygiene protocols. Nevertheless, Erasmus et al (2009) discovered that individuals were more likely to perform hand hygiene in order to safeguard themselves from cross-infection. The existence of barriers that hinder proper hand hygiene compliance was also discussed.

According to various articles, performing regular hand hygiene poses difficulties including dryness and soreness, shortage of time and heavy workloads, and fewer opportunities during busy shifts. Erasmus et al (2009) discovered that participants experienced dryness and soreness as disadvantages from hand hygiene. Barrett and Randle (2008) suggest that frequent hand hygiene worsened pre-existing skin conditions such as eczema which made participants hesitant to cleanse their hands. However, Cole's (2008) study revealed a student who continued to wash their hands despite experiencing cracking and soreness.

As healthcare providers, our ultimate goal is to prioritize the welfare of our patients, even if it entails making sacrifices. According to Barret and Randle (2008), hand hygiene compliance faces challenges due to time constraints and a heavy workload. When there are numerous duties such as patient care and assisting with their hygiene during the busy morning shifts, there is less time available to focus on hand hygiene routines. Similarly, Erasmus et al (2009) reveal that participants in their study cite emergent situations, unavailability and inaccessibility of hand hygiene materials, as well as forgetfulness and shortage of time as hindrances to complying with hand hygiene protocols. A previous research done by Lusardi (2007) reported that six students identified poor hand hygiene due to time constraints and workload pressure - "I think

sometimes when you're rushing round, if someone needs something urgent doing, it's easy to forget."

According to Lusardi (2007), the main reason students fail to practice hand hygiene is due to lack of time, although two students admitted it was also due to laziness. Three students admitted time constraints but believed that staff should still maintain hand decontamination. Only one student mentioned a lack of staff as a reason for inadequate practice. Additionally, Barrett and Randle (2008) found that the type of clinical procedure being performed was a hindrance to complying with hand hygiene protocols.

Three articles shared a common theme of social control. According to Erasmus et al's (2009) study, all participants identified a lack of social control when it came to following hand hygiene guidelines. All groups faced difficulties in addressing other individuals about their hand hygiene behaviour. The students mentioned that they adhered to the hand hygiene practices observed in the clinical area to blend in with the nursing team and avoid causing any trouble. However, this also meant that students did not challenge staff members for fear of damaging their relationship and being rejected by the team (Barret and Randle 2008).

According to Lusardi (2007), the impact of socialization on students was evident during interviews. Students reported maintaining good hand hygiene despite poor practices around them, but were reluctant to confront other staff. Lusardi's study revealed that some students found it challenging to speak out when they were only there for a short time and did not want to get into trouble, particularly with auxiliary nurses. Multiple students also mentioned the pressure to "fit in" and connected other skills, such as manual handling, with

hand hygiene. Overall, improving healthcare workers' compliance with hand hygiene remains a multifaceted issue influenced by various factors. The aforementioned qualitative studies suggest that a lack of positive role models and social norms established by senior healthcare workers may hinder compliance.

Hand hygiene compliance in healthcare settings can be hindered by factors such as dryness and soreness caused by frequent hand washing, as well as the responsibility of healthcare workers. To promote effective and sustainable hand hygiene practices, nursing educators and registered staff should encourage students to take responsibility for their own practice. Lusardi (2007) suggests that these findings should inform methods for promoting hand hygiene compliance. To further improve nursing students' hand hygiene practice, additional research on their past and present experiences is needed, which could inform future research proposals.

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