Capstone Reflection and Portfolio: Burn Wound Infection Prevention

This capstone project reflects on a nursing student's experience in addressing infection prevention in burn units. The project focuses on the prevalence of healthcare-associated infections (HCAIs) in burn patients and the contributing factors, such as loss of skin barrier, immune deficiency, and invasive treatments. The student's aim was to reduce HCAI incidence through improved hand hygiene and a safe practice culture. The project includes a self-assessment, revealing strengths in time management, communication, and problem-solving, alongside knowledge gaps in burn wound management and hand hygiene protocols. The reflection utilizes Burton's framework to analyze the project's implementation, assess goal achievement, and identify areas for improvement. The project highlights the importance of evidence-based practice, critical thinking, and continuous professional development in nursing, with a focus on implementing effective infection control measures to improve patient outcomes.

Running head: CAPSTONE REFLECTION AND PORTFOLIO
Capstone reflection and portfolio
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction:....................................................................................................................................2
Aim of the project:.......................................................................................................................3
Self assessment statement:...............................................................................................................4
Critical reflection of the project:......................................................................................................6
What:............................................................................................................................................8
So what:.....................................................................................................................................11
Now what:..................................................................................................................................12
Professional Practice Portfolio:.....................................................................................................14
Personal Details:........................................................................................................................14
Summary of Capstone Experience outcomes:...........................................................................15
References:....................................................................................................................................18

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Introduction:
This report will attempt to represent a capstone experience that I have had in the past year
and will explore the learning experience with respect to my self assessment and my professional
portfolio. First and foremost, a capstone project can be described as the culminating project, a
multifaceted assignment that attempts to culminate the entire academic experience. According to
the Mazi et al. (2013), a capstone project or a capstone experience incorporates identification of
any existing problem prevailing in the real world setting followed by application of learned skills
and methods in order to arrive at a strategic solution that can address the problem directly.
Elaborating more, it has to be mentioned that a capstone experience helps in defining an existing
issue, discover and implement the techniques required to master the issue and implement the
solution to the real world problem setting in order to make a positive difference in the society
(Rowan et al., 2015). Hence, undoubtedly it can be stated that the capstone experience projects
have fundamental importance in the health care setting and the value based nature of these
projects hold significant value in the health care setting. As per the article by the Page et al.
(2014), the capstone experience provides the nurses with the opportunity to implement their
knowledge and expertise on a real world based problem scenario with respect to the clinical
practice setting. As a result this experience provides them with the opportunity to expand or
enhance their critical thinking and learning skills. It has to be mentioned in this context that the
capstone project represents a research based problem solving session. According to the Barajas‐
Nava et al. (2013), in the profession of nursing, the importance of leadership, self assessment,
reflection, and critical analytical abilities are a prerequisite in order to be able to avail steady
profession growth, all the while providing care that is safe and effective. Hence, it can be easily
deduced that the capstone project provides the nurses with the opportunity to improve or build all

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the above mentioned abilities before embarking on the professional journey. Along with that, it
has to be acknowledged in this context that for the nurse it is crucial to master the art of evidence
based practice (Lee et al., 2013). Now evidence base practice can be defined as the practice of
integrating the best available evidence in the internet focused on clinical expertise and care
applied by the health care professionals in order to improve the patient outcomes and enhance
the safety and effectiveness of the care that has been provided to the patient (Burns, 2014). The
capstone experience provides the students with the opportunity to implement extensive research,
synthesize relevant and authentic information and apply that information in order arrive at a
solution regarding the problem under focus for the study. Hence, it has to be mentioned in this
context that the capstone experience has a very significant role in the nursing degree.
Aim of the project:
For this capstone project, the research aim focuses on the infection prevalence for the
burn wounds in patients. It has to be mentioned in this context that a vast majority of people all
over the world have been reported to acquire health care associated infection or HCAI
(Azzopardi et al., 2014). According to the authors, close to 165000 Australians were found you
be acquiring health care associated infections on a yearly basis. And among the vast majority if
the different people acquiring the HCAI, a large portion of the large figure is contributed by the
burn patients. There are various contributing factors to the burn patients being more vulnerable
to the healthcare associated infections. According to the Srigley et al. (2014), the burn patients
have already lost the skin barrier of protection that can ward off the risk of infection to some
extent. Along with that the burn patients are often immune deficiency and they often go through
invasive treatment procedures. Moreover the long term hospice stay also adds to the infection
risk and the culmination of the above mentioned factors contribute to enhancing the vulnerability

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of the burn patients towards acquiring a variety of different HCAIs. I would like to mention the
fact that during my placement experience, I had the opportunity to practice in a burn unit, where
I encountered the fact that the frequency of acquiring different health care associated infections
in the burn patients were far more accelerated when compared to the rest of the units of the
health care facility I worked in. Hence I had chosen the research topic for my capstone project to
be “Infection prevention in burn unit”. The primary goals or objectives of this project had been
to reduce the incidence rate of health care associated infections in the burn unit patients. We had
emphasized in one of the most important and prominent infection control techniques used in the
health care, hand hygiene. The staffs of the unit were encouraged to commence on a diligent
hand hygiene technique to reduce the occurrence of the burn associated infections. The other
objectives for the project had been to create a safe practice culture in the unit and providing an
opportunity for the staff to improve and enhance the knowledge regarding the importance of
hand hygiene for preventing infections (Jeschke et al., 2015).
Self assessment statement:
According to the Bulman and Schutz, (2013), competence can be defined as the
combination of knowledge, skills, attitudes and judgment required to provide professional
nursing services with respect to the nursing professionals. Now it has to be mentioned that
nursing is a professional field where there is a significant pressure of adhering to the ever-
changing guidelines, practice standards and legislations; and hence in order to develop and
enhance the competence levels a thorough and consistent self assessment performed regularly
and periodically. According to the Kashiwagi et al. (2016), it has to be mentioned that for the
students or new professionals the self assessment can serve as a potent tool for self learning. It
has to been proceed to be empowering the students with knowledge and skills. The purpose of a

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self assessment program is to ensure that the students or the participants undertaking can have
the opportunity to recognize their strengths and weaknesses so that they can take actions in
accordance; that will help them build upon their strengths. The self assessment is basically the
process that helps the health care professionals to be lifelong learners and equip them with the
sills for autonomy in both the learning experience and the professional practice. As per the
article by the authors, the process of self assessment is comprised of three components, self
observation, self judgment and the self evaluation. I had taken the assistance of a questionnaire
tool for the self assessment and I would like to mention in this context that it had been an
exceptional opportunity for me to discover my strengths and weaknesses at the same time. It has
to be mentioned in this context that in order to be a professional with the competence and skills
to be continuing to provide a care that is not just safe and effective to my patient but to be
undergoing professional practice all the while being updated to the different practice legislations
and protocol standards. By this self assessment I had discovered the fact that I have very limited
knowledge regarding the burn wounds of the patients and how it gets infected and what can be
done to prevent it. Along with that I had also discovered the fact that I have very limited
knowledge regarding the hand hygiene practice standards and protocol guidelines issues by the
World Health Organization. However the strengths that I have discovered about myself had been
that I have good time management skills, good team leading skills, effective communication
skills, effective problem solving skills, analytical thinking skills, commitment to the professional
development; clear understanding of the professional boundaries and change acceptance. I would
like to mention in this context that this self assessment activity has helped me understand the
professional and personal issues I have which can serve as challenges in not just the path of
successful completion of the project but also in the picture for my professional growth in the

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future in the field of nursing. Along with that, I would like to mention the fact that this self
assessment tool had been an excellent tool for me to gain the confidence to be able to complete
this capstone project.
The learning and developmental goals I have set for this project include that by the end of
this project I will have extensive knowledge and skills regarding the management of burn
injuries, their infection risk and how to take infection control risks to be able to prevent the
infection of the burn injuries. The second goal I have set for my professional development is to
be able to have an extensive evidence based knowledge and understanding on the hand hygiene
protocol, how it can be implemented in the health care scenario and how to maintain compliance
to the hand hygiene protocol in the real world health care scenario.
Critical reflection of the project:
Reflection has immense value in professional development; it provides the professionals
with optimal frameworks so that they can revisit their previous practice and maintain practices
concurrent with the latest guidelines. According to the Shircore et al. (2013), reflective practice
can be defined as the practice of studying, exploring, and along with that analyzing the different
contextual factors associated with the experience event and be able to understand whether or not
they had been able to achieve the objectives and goals set for the experience or event. It has to be
mentioned in this context that reflection is professional tool that has many a components and
there are a variety of different models and frameworks. Although all the reflective processes
have very similar components, critical thinking, evaluating, and learning from practice that gives
the insights into self-assessment and practice. Hence, it has to be mentioned that this particular
practice has immense value in the context of evidence based practice as well. Researchers are of

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the opinion that reflective practice and documentation has been proved to be a valued tool for
professional practice and educational development that helps them generate and retain valuable
knowledge and expertise that is valuable in their field of profession but also generate self
awareness of their strengths and flaws. It has to be mentioned that for a profession that involves
providing care interventions and support to the patients, it is very important for the profession to
refrain from making errors. According to the Kashiwagi et al. (2016), the reflective process helps
the nurses or other health care professionals keep from making similar errors in the future
enhancing the safety and effectiveness of the care provided. Hence, it has to be mentioned that
reflection holds a significant importance in revisiting any experience and be able to judge how
successfully the project has been implemented and along with that whether there have been any
flaws left behind in the process of project. Along with that the reflection will also be able to
judge to what extent the project goals have been achieved, the skills or knowledge obtained, how
effective have been solution decided for the problem selected for the capstone project. From the
different variety of reflection frameworks that are available, the reflective framework that has
been chosen for my project is the Burtons reflective framework.
On a more elaborative note, it has to be mentioned that the Burtons reflective framework
is a fairly straightforward systematic and very easy to implement framework. This
developmental reflection framework had been introduced in the 1970s and ever since had been
utilized by different health care professionals for the purpose of a simple yet effective reflection
framework. This model comprises of only three segments, the first element is “What”, that
describes the nature and details of the event or experience. The second element of the reflective
model is the “so what”, which is the segment where the implications of the project and discussed

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and lastly, the third and final element of the reflection framework is the “now what” where the
future implication of the event or experience is discussed (Jayatilleke & Mackie, 2013).
What:
This is the most important and most 9impactful section of the reflection model, where the
entire experience or in this case the capstone project will be explained in detail. It has to be
mentioned in this context, that this particular segment of the model represents five key questions
for the professionals along with the event, What were the roles of the people involved?, What
was my role?, What were the problems?, What happened? And finally what did I do? Hence this
particular segment scrutinizes not just the experience of the capstone project but also emphasizes
on the roles of all the stakeholders associated with the project. First and foremost, the capstone
project for this study had been infection prevention in the burn units through the emphasis on the
hand hygiene. The population that has been selected for this study had been all the staffs of
hospitals; however the special emphasis is going to be on the staffs of burn unit. The time frame
for this particular project had been close to a year. The evaluation method that has been chosen
by me for the project had been obtaining, processing, analyzing and evaluating the HCAIs rate
before and after the project.
It has to be mentioned in this context that the Burn care units have been reported to be the
only unit that is far more prone to the variety of health care associated infections than the rest of
the units. And hence, the importance of infection control measures need to be robust, effective
and time saving for this particular staff. There is various types standard protocol that can be used
for the infection control or prevention of the health care associated infections. However, as for
the project we had limited resources, we had to decide on the most relevant and cost effective
type of infection control measure, the hand hygiene. Now it has to be mentioned here that the

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most of the occurrences of the infection is facilitated by the contaminated hands if the health care
providers. According to the guidelines mentioned by the World Health Organization, routine
hand washing is by far the most effective and low expense measures to prevent and reduce the
frequency of health care associated infection (Who.int, 2018). Hence, for this project, we had
selected the hand hygiene technique to be the solution for infection management of burn injuries.
The primary objective for this project had been decreasing the Decreasing the incidence of
infection among patient in the burn unit through emphasizing on hand hygiene. And along with
that provide Proving opportunity for health care worker upgrading the knowledge regarding the
importance of hand hygiene for preventing infections (Tekin et al., 2014).
The strategies that had been selected for this project focused on changing the education
levels of the nursing staff regarding hand hygiene and infection control and along with that
implementing better hand hygiene practices in the facility, especially in the burn unit. The first
strategy that we had selected and implemented had been providing ongoing education, in-service
trainings to staffs by using various instructive postures, brochures and pocket card regarding the
importance of hand hygiene. As mentioned by the authors the most of the infection risk in the
health care facility is the lack of knowledge and education among the staff regarding how to
implement best hand hygiene practice and the need for its implementation. In support the authors
have stated that, a vast majority of medical staff had only brief and superficial knowledge
regarding the WHO recommended hand hygiene protocol and the detrimental impact of the lack
of compliance to the hand hygiene practices on their health and the health of the patients
(Who.int, 2018). I would also like to mention that by the virtue of the extensive research that we
had performed for the study had helped us avail the information that there is a massive lack of
compliance to the hand hygiene practices in both the developed and developing counties and

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along with that, the average time spend for the hand washing practices range from 6.6 to 30
seconds. Hence, the lack of education and training in the staff and awareness about the hand
hygiene had been identified as the crucial need for our project to implement. However, soon we
had discovered the fact that only training and educational posters or brochures were not enough
for enhancing the safe hand hygiene compliance or reduce the incidence of the burn injury
infections. Hence the second strategy we developed focused on monitoring the progress of hand
hygiene program, by creating multidisciplinary team that emphasize the importance of hand
hygiene on regular basis. The effective actions taken by the team had been effective in changing
the education levels of the staff regarding the hand hygiene practices and acquainting them with
the five moments of hand hygiene recommended by WHO. The third strategy for the project had
been Establishment of a process of periodical monitoring and feedback on the rates on HCAIs.
This had been successfully performed by the multidisciplinary team with collaboration of the
burn unit nurses and had been a very important step for us to understand the impact of our
solutions and the progress of the project (Öncül et al., 2014). The fourth and last strategy that we
had implemented in the project had been creating adequate supply of taps and other essential
things that are needed to perform hand hygiene. Now, as per a report shared by the local
authorities, it had been discovered that the lack of supplies and adequate resources also act as
barriers for successful and adequate hand hygiene practices and add to the burden of hospital
acquired infection rates, especially in the burn injury, surgical units and critical care units.
Hence, the adequate supply of taps, making sinks available in necessary and strategic places and
mild antibacterial soap along with alcohol rub helped in facilitating the progress of the project
and had helped in making the successful (Uhlemann et al., 2014).

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Now in order to discuss the role I have played in the project it has to be mentioned that I
had been serving as the supervisor of the project and a part of the multidisciplinary evaluation
team. I had played a central role in planning the strategies, taking part in the educational
program, and in monitoring the progress of the project. It had been an exhilarating opportunity
for me to implement the entire project in a real world setting and overcome the barriers that had
been present. First and foremost barrier that I had encountered had been the resistance from the
older staff of the burn unit that refused to participate in the training sessions and workshops due
to heavy workload, lack of awareness and cooperation and burnout due to the staff shortage.
However, we had been able to overcome the resistance by motivational counseling attempted by
my multidisciplinary team and the cooperation from the health care facility administrative
authority for which I am very grateful. The second barrier that we had encountered had been
time constraint and financial limitations for the supply of the resources and the trainers of the
educational workshops. However, I had written to the trainers selected personally explaining our
plight in the issue and requested them to provide the training without any expenses and to which
they had agreed graciously. We had also prepared the pamphlets and posters on our own to
ensure that minimal resources were invested which helped us buy necessary hand hygiene
supplies for the staff.
So what:
The second part of the reflective framework had been the analysis part involving three
different questions, What was the outcome?, What did you learn?, and What was important?
Considering the outcome of the project, it has to be mentioned that our project had been
successful in educing he percentage of HCAI in the burn unit by a 7.5% in the initial 6 months.
And after the follow up of feedback sessions and training, the rates increased to 8.5% in the next