Portfolio My evidence to meet the NMC's revalidation requirements

Fiona Maclean

Portfolio duration Tuesday, February 24, 2015 to Saturday, February 24, 2018

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RCNi Portfolio (RCNi.com)

Fiona Maclean: RCNi Portfolio for Feb 2015 – Feb 2018

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RCNi Portfolio (RCNi.com)

Fiona Maclean: RCNi Portfolio for Feb 2015 – Feb 2018

Personal CPD

Title: another personal CPD 8h 00mins

Date: Friday, February 27, 2015

Notes: this was a bit tricky

Title: Lecture given by Important person 2h 30mins

Date: Monday, March 2, 2015

Notes: Discussion afterwards was thought provoking.

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60 march 18 :: vol 29 no 29 :: 2015 NURSING STANDARD

CPD assessment

Child maltreatmentTEST YOUR KNOWLEDGE BY COMPLETING SELF-ASSESSMENT QUESTIONNAIRE 785

1. What proportion of adults report being maltreated as children?a) One in eight ❏

b) One in six ❏

c) One in four ❏

d) One in two ❏

2. Infants under one year of age experience how much more abuse than older children?a) Two times ❏

b) Four times ❏

c) Six times ❏

d) Eight times ❏

3. Maltreated children tend to display what sort of behaviour in childhood?a) Mental health problems ❏

b) Problems with self-regulation ❏

c) Addictions ❏

d) Lack of self-esteem ❏

4. Adults who have been abused as children:a) May abuse their children ❏

b) Always abuse their children ❏

c) Never abuse their children ❏

d) None of the above ❏

5. Neglected children:a) May not kn w any different ❏

b) Fail to recognise they are being maltreated ❏

c) Both a and b ❏

d) Neither a nor b ❏

6. What percentage of children who had been abused had disclosed abuse to an adult?a) 10 ❏

b) 20 ❏

c) 40 ❏

d) 80 ❏

7. What is never acceptable in the case of suspected child maltreatment?a) Informing your manager ❏

b) Doing nothing ❏

c) Calling social workers ❏

d) Confronting the parents ❏

8. How old was Daniel Pelka when he died?a) Three years ❏

b) Three and a half years ❏

c) Four years ❏

d) Four and a half years ❏

9. A sign that a child may be experiencing maltreatment is:a) Frequent injuries or unexplained

bruising ❏

b) Fear of going home ❏

c) Non-attachment to caregiver ❏

d) All of the above ❏

10. Which group is esponsible for recognising and r sponding to ch ld maltreatment?a) All nurse ❏

b) School nurses ❏

c) H lth visitors ❏

d) Paediatric nurses ❏

This self-assessm nt questionnaire was compiled by Ed Rowe

The answers to this questi nnaire will be pub ished on April 1

The answers to SAQ 783 on gastroenteritis in children, which appeared in he March 4 issue, are:1. d 2. b 3. d 4. b 5. a 6. c 7 c 8. c 9. d 10. b

This self-assessment questionnaire (SAQ) will help you to test your knowledge. Each week you will find ten multiple-choice questions that are broadly linked to the CPD article. Note: There is only one correct answer for each question.

4You could test your subject knowledge by attempting the questions before reading th arti le, and then go back o er th m to see if you would answer any ifferently.

4Yo might like to read the article to update yourself before attempting the questions.

When you have completed your self-assessment, cut out this page and add it to your professional portfolio. You can ecord the amount of time it has taken.

Space has been provided for comments.

Y u might like to consider writing a reflective account, see page 62.

How to use this assessment

This activity has taken me _ ____ hours to complete.Other comments:

Now that I have read this article and completed this assessment, I think my knowledge is:Excellent ❏

Good ❏

Satisfactory ❏

Unsatisfactory ❏

Poor ❏

As a result of this I intend to:

Report back

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38 march 18 :: vol 29 no 29 :: 2015 NURSING STANDARD

Art & science essential skills clusters: 3

recipient of care (Royal College of Nursing (RCN) 2012). Therefore, infection prevention is a key role for healthcare professionals, which must be underpinned by a thorough understanding of the practitioner’s role in preventing infection and compliance with strategies to promote infection control. These requirements form the basis of the infection prevention and control essential skills cluster (NMC 2010).

Local and national policies and guidelinesLocal and national policies relating to the prevention and control of infection in acute and community settings (Department of Health (DH) 2001, 2003, 2005, 2006, National Institute for Health and Care Excellence (NICE) 2012, RCN 2012) provide nurses with a framework within which to work (Baillie 2009). Therefore, it is important that all nurses and nursing students have an understanding of these policies and ho they apply to practice.

At a local level, these policies are u ed to inform direct patient care and to provide g ida ce on decontamination of equipment, disposal of waste, acquisition of urine or blood specimens, care of indwelling devices, isolation f infected patients and maintenance of a cl an and safe clinical environment (RCN 2012). Local polic es als set out guidelines fo dress codes and standards of personal hygiene that must be adher d to by healthcare staff

At a atio al le el, policies and guidelines relev nt t infection contr l also make

commendations reg rding the standard prin iples for controlling nd preventing healthcare-assoc ted infections (DH 2001, 2003, 2005, 2006, NICE 2012, RCN 201 ) Policies related to inf ction control are evidence based and aim to inform best practice, th reby optimising patient c re and safety

The infection control te m is instrumental to implementing local and n tional policies. It typically comp ises specialist infection control nurses, cons ltant doctors and medical microbiologists. It acts as a source of advice and is responsible for implementing local guidelines to reduce or prevent the spread of infection. The team is also responsible for developing local infection control policies in accordance with national policy, managing outbreaks, performing infection control audits and educating staff and patients in infection control.

Effective multidisciplinary team working is important for infection control and prevention. Nurses’ prompt recognition and reporting of common clinical signs of infection, such as

pyrexia, redness, localised inflammation and tenderness, will help to ensure the timely implementation of appropriate treatments, such as antibiotic therapy. Nurses should also be vigilant for other less common signs and symptoms that may be indicative of infection in patients they are caring for. These may include proteinuria, purulent sputum, subtle changes in vital signs, or confusion in older patients (Swanson and Jeanes 2011). Such clinical signs and symptoms should be reported to the medical team and documented, leading to prompt and appropriate investigation and assessment, such as blood tests, urinalysis or chest X-rays.

A plan of nursing care that incorporates interventions to prevent the spread of infection should be developed, wher appropriate. It is crucial to communicate this care plan to the patient and to other m mbers of the multidisciplinary team, to ensure th t all team members understand the rationale fo any interventions and that they w k together in the best interests of the p tient.

Risk assessmentManaging risk is an important aspect of a nurse’s role and is a important theme in the essential skills clu ter on the prevention and control of i fec ion. Undertaking a risk assessment is an important step in protecting the wellbeing of he lthcare staff and patients. This involves considering factors that could cause harm, as well as identifying appropriate precautions that should be taken to prevent harm. It is also necessary to comply with legal and safety standards. Nurses should undertake risk assessment before carrying out any aspect of direct patient care. Healthcare-associated infections in patients can be minimised by reducing the risks associated with handling waste, disposing of sharps, handling contaminated linen, and cleaning up spillages of blood and body fluids (NMC 2010). This requires compliance with standard precautions, which are central to effective infection control and prevention.

Standard precautions: essential elements of infection controlStandard precautions, sometimes called universal precautions, are fundamental infection control measures that aim to reduce the risk of transmission of blood-borne pathogens and other pathogens, through exposure to blood or body fluids among patients and healthcare workers (World Health Organization (WHO) 2006).

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NURSING STANDARD march 18 :: vol 29 no 29 :: 2015 39

Standard precautions incorporate nine elements of practice aimed at preventing or minimising the risk of cross-infection (Infection Control Nurses Association 2003). These are (Prieto and Kilpatrick 2011): 4Hand hygiene.4Personal protective equipment.4Prevention of occupational exposure

to infection.4Management of blood and body fluid spillages.4Management of equipment used during care.4Environmental control.4Safe disposal of waste, including sharps.4Linen.4Appropriate patient placement.It is essential that nurses and healthcare workers are vigilant in adhering to standard precaution guidelines because of the risk of exposure to blood, body fluids and pathogens. The essential skills cluster specifies that the standard precaution guidelines are relevant to all fields of nursing (NMC 2010). Thus, nurses and nursing students must understand and practise in accordance with standard precautions.

Hand hygieneThe hands of healthcare staff are thought to be the most common route by whi h microorganisms are spread to patients in hospitals Wilson 2006). This is because many microorganisms are found on the hands, some of which have the ability to spread, multiply and ause infection. Various factors influence the sit ations in which and should be deco aminated and the f quency at which hand decon amination should b undertak n including (DH 20 1): 4Level of anticipated contac with patients,

equipment or objects.4Type of patient care ac ivities being

performed.4Extent of contamination that may oc ur.4Condition of the patient and his or her

susceptibility to infection.It is important that hand hygiene should be performed before any procedure that places the patient at risk of infection; if an activity carried out has, or could have, contaminated the hands; or if the hands are visibly contaminated. The ‘five moments for hand hygiene’ model (WHO 2009) defines five moments when healthcare workers should perform hand hygiene. This evidence-based, user-centred approach was developed to be easy to learn, logical and applicable to multiple healthcare settings. It recommends that healthcare workers clean their hands (WHO 2009):

4Before touching a patient.4Before clean or aseptic procedures.4After body fluid exposure risk.4After touching a patient.4After touching patient surroundings.Alcohol handrubs have become more widely used in the healthcare environment because of their convenience and speed of use, and have been promoted for routine hand hygiene (Gould and Drey 2008). However, it is important to remember that handwashing with soap and water is required when hands are visibly soiled, or when caring for patients with, or suspected to have, spore-forming infections such as Clostridium difficile (Gould 2012).

Personal prote tive equipment and prevention of exposure to infectionPersonal protective equipment r fers to items that ar ed to protect healthcare workers and pati ts from exposu to blood, body fluids and pathogen Gloves and aprons are the most ommon types of personal protective equipment,

although gowns, eye shields, visors, face masks, caps and rote tive footwear may also be worn in some clini al areas. Risk assessments should be undertaken to determi e when personal pro ctive equipment is requ red. The most appropriate equipm nt should be determined for the activity that is to be undertaken, according to the anticipated e el of exposure to blood, body fluid or pathogens.

It is important that the healthcare worker covers any breaks in his or her skin to avoid entry of pathogens and potential exposure to infection. He or she should avoid actions that present a high risk of infection, such as re-sheathing needles, over-filling sharps containers and not wearing personal protective equipment.

Management of blood and body �uid spillagesIn the healthcare environment, it may be necessary to deal with spills of blood or urine. These may contain pathogens, which may be harmful to patients, visitors and healthcare staff. It is essential that such spills be cleaned up as safely and efficiently as possible. This can be achieved by cleaning the area with disinfectant. The equipment required for dealing with spills is often provided in a spill kit. Nurses and nursing students should be familiar with the contents of the spill kit and its location. Protective clothing must be put on before cleaning up spillages. The recommended procedures should be followed,

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40 march 18 :: vol 29 no 29 :: 2015 NURSING STANDARD

Art & science essential skills clusters: 3

in accordance with local policy guidelines and the manufacturer’s specific product information. If a spill were to occur in the home setting on a carpet or soft furnishings, the area should be washed with detergent and water using disposable cloths (Lawrence and May 2003).

Safe disposal of waste including sharpsHospitals and other healthcare environments, including the home or community setting, generate vast amounts of waste every day that must be disposed of appropriately to prevent contamination and infection. Safe disposal is important both for health and safety reasons and to ensure compliance with environmental protection regulations.

Clinical waste includes waste that has been in contact with blood or other body fluids (Nicol et al 2012). Clinical waste should be placed in appropriately coloured plastic bags or sha ps containers (DH 2006). Typically, these are y llow in colour. Clinical waste must be inci era d to prevent harm. It includes: 4Blood or human tissue.4Used incontinence pads.4Soiled dressings.4Swabs.4Used syringes, eed es or disposable urgi al

instruments4Urinary cathet rs.4Sputum pot4Used aprons and gloves, and o her items of

di posable personal pro ective equipment tha have been contamin ted with body fluids.

Used sharps such as needles, scalpels, suture cutters, intraven us cannulae and broken glass pose a consider ble infection risk. Therefore, it is essentia that the correct procedures are followed r garding their safe andling and disposal Sharps must be dispos d of in sharps containers. Local policy guidelines and relevant Control of Substances Hazardous to Health guidelines should be f llowed at all times (Health and Safety Executive 2015). Safe practice should be followed to prevent sharps-related injuries (Wilson 2006):4Sharps should not be carried by hand.4Sharps containers that comply with national

standards should be readily accessible in places where sharps are used.4Used sharps should be handled as little as

possible and disposed of immediately after use into an appropriate sharps container.4Sharps containers should not be overfilled.

When the containers are three quarters full, the lids should be closed and secured.

4Needles should never be recapped or re-sheathed following use.4Disposable syringes and needles should be

discarded as a single unit.

Safe handling of linenLinen, such as bed sheets, blankets and towels, contaminated with blood or other body fluids is potentially hazardous to those who handle it, and it should be considered an infection risk. Safe practice to minimise the risk of infection from contaminated linen involves: 4Wearing gloves and an apron when in contact

with contaminated linen and ensuring that hands are thoroughly washed after contact.Taking care when changing bed linen or soiled patient clothing, to a oid contaminating the environmen4Ensuring that a linen bag is near to hand when

changing lin n.Contaminated linen should be placed in an appr priately coloured, soluble laundry bag to m imise direct handling by laundry workers. Typi ally, linen bags for contaminated linen will be red. This bag does not need to be unpacked when it reaches the laundry but will dissolve during the ashing process. Care should be taken at ll times to avoid over-filling linen b gs. They must be secured and removed from the patient care setting as soon as possible. Shaking linen should be avoided to minimise the dispersal of microorganisms into the environment (Bloomfield et al 2008). Used linen should be placed immediately in the linen skip and care should be taken not to permit any contact with clothing, which may increase the risk of cross-infection (Pellatt 2007). In the home, soiled linen can be washed in a standard washing machine; however, if one is not available and hand washing of linen is required, carers should be advised to wear domestic-strength disposable gloves (Worsley et al 1994).

Management of patient care equipment The NMC (2010) emphasises the importance of reducing the potential risk of infection from the use of equipment in delivering patient care. Equipment for patient care may be single use, single patient use or reusable (RCN 2012). Single-use equipment includes needles, syringes and disposable washbowls, which should be used once only and discarded. Single patient use equipment can be used on more than one occasion for one particular patient and will be discarded when no longer required. An example

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NURSING STANDARD march 18 :: vol 29 no 29 :: 2015 41

of single patient use equipment is an oxygen mask. It is important to recognise that such equipment will require cleaning between uses. Examples of reusable equipment include commodes, bedpans, hospital beds and dressing trolleys. Thorough decontamination of this equipment is required between patients, and it is important to follow local guidelines regarding decontamination procedures.

Environmental control and appropriate patient placement All healthcare professionals have a duty to ensure that the necessary actions are taken to reduce the risk of patients developing healthcare-associated infections. The cleanliness of the healthcare environment should be maintained at the highest possible level and the necessary procedures should be undertaken to ensure that all furniture is decontaminated thoroughly to prevent cross-infection (Prieto and Kilpatrick 2011). It is important for this to include beds and mattresses as well as bathroom fixtures and fittings. Infection control audits should be conducted regularly, in accordance with local guidelines, to ensure that any deficiencies in cleaning or hygiene standards are promptly identified and rectified.

Before transferring patients to a ew environment, a risk assessment hould be performed that is deemed mo t appropriate for their care needs to determi e th ir risk of becoming infected or in cting others. Standard precautions ar impl infection con ol measures that reduce the risk of transmission of p thogens through ex o ure to blood or ody fluids among patients and healthcare work s (WHO 2006)

Isolation procedures inv lve creating an effective barrier between n infected and a non-infected area to prevent cross-infection (Gould 2009). The need for isolation depends on various factors. These include the ease with which the infection is transmitt d, th route of transmission – for example airborne or contact with the skin – whether infections are resistant to antibiotics, and the presence of vulnerable individuals, such as those who are immune suppressed. Within the acute hospital setting, isolation procedures comprise: 4Source isolation – isolating an infected patient.4Cohort source isolation – segregating

several patients with the same infection in one area.4Strict source isolation – segregating patients

with serious contagious infections in isolation units.

4Protective isolation – isolating patients who are particularly susceptible to infection.

In the community setting, these principles must be adapted to the context of care. It is important to follow local policy when caring for a patient who requires isolation procedures, to seek advice and guidance where appropriate from the infection control team, to reduce the number of healthcare professionals who come in contact with the patient, to use standard precautions, and to explain these precautions to the patient and his or her relatives.

AsepsisThe term asepsis means the absence of pathogenic or d sease-causing organisms (Perry and P tter 2006). Aseptic tech ique is used to prevent the spread of pat ogenic microorganisms that may be pr sent on the h nds on equipment into n open wound or b dy cavity or to a oth r susceptible site, such as a urinary c theter or intravenous cannula (Foster and Hil n 2004). Aseptic technique involves a p ocedure that is non-touch in nature. The ba ic principle underpinning any aseptic non touch technique is that a susceptible site, s ch as a wound or c nnula site, should not ome into contact with any item that is n t sterile. Ada ta ion of aseptic non-touch t chnique may be required in community settings but it is important that the principles of aseptic on-touch technique are maintained (Swanson and Jeanes 2011). Aseptic non-touch tech q may be achieved by ensuring that the area where a procedure is to be performed is clean, by performing effective hand hygiene procedures before and, where appropriate, during the technique, by using sterile equipment and minimising potential contamination by not touching sterile equipment (RCN 2012).

ConclusionPrevention of infection is a key role for all healthcare professionals, including nurses. Infection prevention must be underpinned by an understanding of how infection can be spread and by complying with strategies that promote infection control. These requirements form the basis of the NMC essential skills cluster on infection prevention and control. Nursing students must acquire the relevant knowledge and skills required for risk assessment and develop their practice to prevent or minimise the risk of cross-infection and maintain patient safety NS

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