Nursing Essay: Critically Analyse The Performance Of A Basic Wound Dressing

Question

Task: For this part of the assessment, students will be required to write a 750 word essay, appraising the performance of a basic wound dressing using the “simple wound dressing” clinical skills appraisal form.

a) View the video recording of the performance of the wound dressing (this video is available in the Assessment Tab on Study Desk).
b) Appraise the nurse’s simple wound dressing performance using the “simple wound dressing” clinical skills appraisal form (this can be found on page 234 of the Skills in Clinical Nursing textbook). Please be sure to make notes about the performance of the skill while you are watching the video.
In an essay format, write a 750 word appraisal of the simple wound dressing skill completion. Within the appraisal, include the written feedback you would provide to the person performing the skill. Aim for a balance of feedback that is constructive and includes both positive feedback (what they have done well) and areas that need developing. Your feedback should be supported by an appropriate rationale (this is the reason for your feedback) explained to the person performing the skill and supported by reference to academic literature. An example is provided here (appropriate referencing should be included to support your feedback).

Answer

The wound dressing is an effective method of faster healing that tends to create a moist environment around the wound. Since wound dressing is direct contact with the wound there is a great need to maintain aseptic and sterile conditions while performing the procedure. The present essay aims to critically analyse the performance of a basic wound dressing demonstrated on video based on clinical skills appraisal form. The essay will address both positive and negative points noted supported by rationale and feedback.

In the procedure of wound dressing, the nurse has explained the patient regarding the procedure in order to obtain consent which is the crucial initiating step as it helps in making patients aware and involves in the care process (Reeves et al., 2017). She adjusted the bedclothes and check for the patient’s comfort like position. The needy step was performed by the nurse which is the positive element in the procedure of wound dressing because it permits easy access to the wound with maintaining dignity (Masters et al., 2018). It was noticed that the way she washed her hand before commencing the procedure is not appropriate in line with the standard procedure of hand washing. She will be recommended to wash for at least 20 seconds as it will be effective to remove all dirt and bacterial contamination (Reeves et al., 2017). It was noted that while performing the wound dressing she communicated with the patient regarding the followed step. It is a good method to engage the patient in the procedure and also make them inform(Reeves et al., 2017).

The major fault noticed is methylated spirit was bottle kept on the surface of the tray while sanitizing it. She will be reminded to place it at the lower shelf as it has contaminated the whole surface area and could lead to transmission of infection to the patient and other dressing objects (Hor et al., 2017).However, it is noticed that nurse at the time of placing the dressing object over the tray, the bottle was still placed on the aseptic area and caused the dressings to get exposed to contamination before the commencement of the procedure. She will be reminded of the importance of keeping away the contaminated objects from the sterile area as it could infect the patient and cause severe situation (Glennie et al., 2015). The other mistake noted that the nurse has opened away from the sterile field and then the trolley was brought near the patient. It is not the correct procedure, the object kept below the waist height is considered dirty therefore she will be advised to prepare the gauze and other dressings in the sterile area (Glennie et al., 2015).

She used yellow prongs for arranging the dressing equipment and used blue prongs to place the sterile towel and cotton balls. She has contaminated the cleaning procedure as it is noted that she has used the same prong for cleaning the wound and squeezing the cotton balls over and again. Moreover, she used the contaminated blue prong to prepare the sterile gauze for wiping the saline solution. Both the prong held in right and left hand was continuously making contact. This procedure followed by the nurse has contaminated the patient's wound and could lead to a severe infection or increase the length of stay in the hospital. She will be directed to soak the cotton balls in saline solution and squeeze it all with the sterile prongs. With the use of one sterile prong, the cotton ball should be picked and transfer it to the used prong using ANTT to clean the wound without making it contact with a sterile prong (Dhivya et al., 2015). The nurse should be mindful to clean the wound in all direction from top to bottom and inside to out, but in the procedure, she has only cleaned the wound in one direction which might lead to inappropriate dressing and infection (Glennie et al., 2015). She will be reminded the fact while performing wound dressing, the nurse should work in a sterile area and as it is an effective way to prevent infection which would otherwise lead to delay in wound healing (Masters et al., 2018).

Lastly, the discussion concludes that the procedure followed by the nurse does not follow the standard protocol and guidelines of wound dressing and wound care policy. It has caused contamination of the dressing objects and open wound which will cause infection and may deteriorate the health of the patient. Maintaining sterile and clean are is prerequisites for wound cleaning which could be achieved by following five moments of hand hygiene, correct way of hand cleaning and working objects.

Reference
Dhivya, S., Padma, V. V., &Santhini, E. (2015). Wound dressings–a review. BioMedicine, 5(4).https://dx.doi.org/10.7603%2Fs40681-015-0022-9
Glennie, R. A., Dea, N., & Street, J. T. (2015). Dressings and drains in posterior spine surgery and their effect on wound complications. Journal of Clinical Neuroscience, 22(7), 1081-1087. https://doi.org/10.1016/j.jocn.2015.01.009
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O'Sullivan, M. V. N. (2017). Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ QualSaf, 26(7), 552-558. http://dx.doi.org/10.1136/bmjqs-2016-005878
Masters, J. P., Achten, J., Cook, J., Dritsaki, M., Sansom, L., & Costa, M. L. (2018). Randomised controlled feasibility trial of standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for hip fractures. BMJ open, 8(4), e020632. http://dx.doi.org/10.1136/bmjopen-2017-020632
Reeves, B. C., Andronis, L., Blazeby, J. M., Blencowe, N. S., Calvert, M., Coast, J., ... & Magill, L. (2017). A mixed-methods feasibility and external pilot study to inform a large pragmatic randomised controlled trial of the effects of surgical wound dressing strategies on surgical site infections (Bluebelle Phase B): study protocol for a randomised controlled trial. Trials, 18(1), 401.https://doi.org/10.1186/s13063-017-2102-5