Reflective Practice and Enquiry Based Learning

This report discusses the importance and practice of conducting personal and patient hygiene in nursing care through reflective practice and enquiry based learning. It compares nursing interventions and competency standards for hygiene and explores the perspectives of nurses on personal and patient hygiene.

Running head: REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Name of the Student:
Name of the University:
Author note:

1REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Executive Summary
The nursing care aspect of personal and patient hygiene is essentially for ensuring that a
hygienic, safe and clean healthcare environment is provided to the patient, resulting in healthy
treatment, quick recovery and prevention of Health Care Associated Infections. The following
paragraphs of the report extensively discusses the importance and practice of conducting
personal and patient hygiene by the nurses, by conducting a work related enquiry in an inpatient
setting of a local hospital. The nursing interventions of hygiene conducted and hand washing by
the chosen healthcare organization have been compared with the competency standards outlined
by the National Health Service and Department of Health and NICE. Lastly, the report also
discusses nursing perspectives of personal and patient hygiene competencies and practices with
the aid of reflective practice.

2REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Table of Contents
Part 1: Work related Enquiry in Nursing Practice...............................................................3
Introduction......................................................................................................................3
Discussion........................................................................................................................4
Personal and Patient Hygiene: Importance..................................................................4
Essential Care Standards of the National Health Service............................................6
Work Related Enquiry on Personal and Patient Hygiene............................................8
Patient and Personal Hygiene: Nursing Enquiry (As designed by the Author)...........9
Work Related Enquiry: Insights and Communication...................................................10
Part 2: Reflective Practice in Nursing...............................................................................11
References..........................................................................................................................14

3REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Part 1: Work related Enquiry in Nursing Practice
Introduction
Ensuring the deliverance of adequate treatment and care is a responsibility of utmost
importance by the nurse (Gould et al. 2018). It has noted by authors Fernando, Gray and Gottlieb
(2017), that for the prevention of ‘Healthcare Acquired Infections’ (HCAI), nurses must adhere
to appropriate standards hygiene. Nurses must supervise patients in their activities of self-care
and hygiene during specializes circumstances of inadequate mobility. (Doronina et al. 2017).
This report aims to enlighten on the nursing care aspect of hygiene, with the aid of an enquiry
and reflective practice.
Discussion
Personal and Patient Hygiene: Importance
According to Sundal et al. (2017), conducting hygiene prevents the transmission of
HCAI, ensures positive patient health along with administration of patient feelings of comfort
and cleanliness.
Nurses are exposed regularly to infectious diseases. Hospitals also harbor patients
carrying various infections. This makes hospitals susceptible to negative health implications on
the healthcare staff as well as patients at physiological, psychological as well as financial levels
(White et al. 2015). Rahmqvist et al. (2016), noted that, HCAI may be caused due to lack of
adherence to standard practices of hygiene, resulting in dissemination of infections. Examples of
such inadequate standards of healthcare hygiene include, not washing the hands of the patient
before or after meal consumption, nurses not washing hands adequately prior to patient feeding

4REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
or administering medications to the patient and not cleaning the hospital floors with
disinfectants. Hence, as observed by Seale et al. (2015), the importance of adhering to hygiene
lies in the prevention of HCAI – which must be performed by using hair masks, gloves,
sanitizers and disinfectants.
Authors Feo and Kitson (2016), observed that nurses are also required to assist patients
with restricted mobility in the conductance of of self-care and hygiene. Successfully practicing
such aspects makes the patient feel satisfied resulting in feelings of security, comfort and
cleanliness. Additionally, as examined by Miranda et al. (2016), nurses adhering to high
standards of patient assistance and patient hygiene practices also helps the family of the
concerned patient feel relieved with the idea that their near and dear one is getting required care
and attention. Patients must also feel independent, empowered and respected. Hence, as
researched by Fox et al. (2015), nurses must encourage patients to express their personal
preferences and simultaneously seek to make the patient feel dignified and respected.
Further, providing aid to the patients in the performance of their activities of hygiene and
self-care proves provides nurses necessary information for screening, diagnosis and assessments
(Jiang et al. 2015). In the process of assisting patients nursing observation results in obtaining
important information on their mobility status, airway patency, vital sign and clinical stability,
oral cavity health, sleep status, perceptual abilities, self-care performance and psychological and
psychosocial health of the patients (Tobiano et al. 2015).
However, authors Ocegueda et al. (2016), noted that, the practice of nursing care aspects
such as patient and personal hygiene must be accompanied with the dissemination of culturally
and gender appropriate care. This will require the nurse to consider the unique cultural, religious

5REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
and spiritual needs of the patient, in addition to the gender during the provision of assistance in
performance of hygiene and self-care. This will result in the patient feeling that his religious and
cultural needs further leading to high levels of satisfaction.
Essential Care Standards of the National Health Service
As opined by (Callaghan et al. 2016), nurses must adhere to the competencies of nursing
set by the ‘Essential Standards of Care’ formulated by the Department of Health, National Health
Service (Cole 2015). Registered nurses must also adhere to these standards and competencies,
since these will aid in the provision of quality nursing service and beneficial patient health
outcomes. As a nurse associate, I am also required to adhere to registered nursing associate
proficiency standards regulated by Nursing and Midwifery Council (NMC) and Health
Education England (HEE). According to these standards, as a TNA in my workplace, I must
display professionalism and accountability by administering person-centered , compassionate
care, must participate in health promotional activities such as public health assessments for
preventing diseases and healthcare discrimination, timely monitor the changing needs of the
patient, actively work in interdisciplinary teams, improve the quality of patient care by being
vigilant towards risks and patient safety needs and contribute to integrative care by recognizing
the roles of various caregivers, health professionals and interdisciplinary departments (Nursing
and Midwifery Council 2018). Hence, the nursing care aspect of maintaining high quality
personal and patient hygiene includes stringent adherence to the following 10 competency
standards (Halcomb 2016):
 Access and Assessment of the Patient (Standard 1 and 2): Before administering the
required steps of treatment and diagnosis on the patient, as a TNA I am required to
engage in adequate documentation, outlining, performing and presentation of the results

6REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
of an appropriate patient assessment, which will include the clinical symptoms of my
patient as well as the personalized needs of my patient in terms of hygiene of their mouth,
hair, eyes, ears and nose. I also educate and inform my fellow patients on how to use and
the location of equipments pertaining to hygiene and toiletries in the hospital of
healthcare organization.
 Planning (Standards 3 and 4): In my practice, I am required to document needs of self
care and hygiene of the patient and include information on personal preferences and
needs. I am then required to relay this important data to the associated nurses and
caregivers who have been delegated for the care of the patient.. I am required to assist my
supervisor nurses who are registered, trained and experienced in meeting the hygiene
needs of the patient. I am also required as a TNA in my practice, to active follow the
supervision and training provided by nursing superiors
 Implementation (Standards 5 and 6): In my practice, TNAs like me, registered nurses
and healthcare professionals who have been appointed for managing needs of the patient,
review and monitor if any changes occur in the preferences and needs of the hygiene and
self care needs of the patient, after every week. We then proceed further by transferring
the clinical care given to the patient to another department or specialization, in case the
clinical status of the patient changes. I am required to provide an environment of dignity,
confidentiality, respect and adaptation in accordance to the dynamics preferences and
needs of the patient. Likewise, toiletries and hygiene associated equipment which have
been provided by me for use by my patient, are kept flexible and adaptable in accordance
to the changing requirements.

7REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
 Documentation (Standards 7 and 8): During the provision of assistance to the patient in
terms of meeting his or her unique needs of hygiene and personal care, as a TNA, I
engage in family centered approach which will includes relaying the the care and
treatment plan formulated in accordance to their clinical condition to the family members
so that may be aware and approve of the same. I also outline key insights obtained from
observing the patient’s performance of hygiene and self care in situations without nursing
assistance. This will information will prove to be useful for me, since I utilize the same in
conducting further assessments, treatments and adaptation of the treatment plan
disseminated to the patient.
 Patients and Caregivers (Standard 9): I ensure in my workplace that each patient has
his or her own facilities for toileting and hygiene and must not be shared by any other
patients. I also ensure that the patient is made aware of emergency hygiene and toileting
equipment for the management of situations which are critical and immediate.
 Patient follow up (Standard 10): I ensure that an multidisciplinary team is involved in
the caring of the patient and hence necessitates that the nurse engages in communication,
following up and assessment of changing patient needs to the healthcare professionals of
diverse specializations such as dentists, occupational therapists, speech and language
therapists, dieticians and pediatricians or any other professional who is involved in the
care of the concerned patient.
Work Related Enquiry on Personal and Patient Hygiene
For the conductance of a nursing work related enquiry the inpatient settings of a local
hospital was chosen. The identity of this organization will be kept confidential in accordance to
the codes of privacy and confidentiality formulated by the National Health Service and the

8REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Nursing and Midwifery Council (Nursing and Midwifery Council 2019) as well as those
mentioned in the research by Griffith et al. (2015). The intervention were also compared with
care competency standards formulated by the Department of Health (Halcomb 2016) and hand
hygiene standards set by the National Institute for Health and Care Excellence (NICE 2019).
Patient and Personal Hygiene: Nursing Enquiry (As designed by the Author)
Nursing Care Process and Interventions by Nurses Essential Care Standards of
Personal and Patient Hygiene
(Halcomb 2016)
Nurse ensure that each patient who has been admitted are
treated with Octenisan washes until the patient’s status of
Methylene Resistant Staphylococcus Aureus (MRSA) has
been determined. The nurses of the concerned organization
also ensure that such washes are maintained in patients who
have been identified as positive of MRSA.
Standards 4, 6, 8
Nurses ensure that they procure informed permission and
consent from the patient to know whether they prefer to be
assisted or supervised while performing practices of hygiene
and self-care. Nurses are responsible for engaging in
assistance and care coordination for patients who are not
sound mentally or who have disrupted mobility.
Standards 1,2, 4
Nurses in the organization provide a patient centered
approach to treatment which includes empowering the
patient to take part in their personal hygiene care
independently.
Standards 2, 4, 6, 9
Nurses are also required to administer a family centered
approach to treatment which involves participation by the
patient’s family members to help the patient perform
hygiene and self-care.
Standard 7
Nurses perform assessments of the hygiene needs of the
patients concerning the self-care requirements while the
patient is in bed, at the bedside or in the toilet.
Standard 1, 4, 5 and 8
Nurses ensure that the privacy of the patients are maintained
by using an ‘engaged’ or red badges in bathroom doors or
curtains.
Standard 9
Nurses encourage patients to use to their own toiletries of
clothing in addition to hospital resources.
Standard 4, 6, 9
Nurses administer oral assessments and ensure healthy oral
hygiene in the patient
Standards 1, 5, 8, 10
Nurses wash the feet of the patients daily and provide anti-
embolism stockings
Standards 1 and 5

9REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Nurses offer patients hygiene practices to choose from such
as showering, shaving, dry shampooing or hair washing.
Standards 2, 4, 9
Nurse assess patients for signs of pressure or dermal
damages.
Standards 1, 5, 8, 10
A multidisciplinary team including nurses and occupational
therapists review and conduct patient assessments.
Standards 10
Nurses practice family centered approach to treatment by
relaying the patient hygiene details to the family members.
Standard 7
Nurses are provided facilities of hand washing and
disinfection, are trained in hand decontamination techniques
and ensure personal as well as patient hand washing before
and after food consumption and direct contact.
NICE Quality Statement on
Hand Decontamination (NICE
2019)
Work Related Enquiry: Insights and Communication
The above work related enquiry of the chosen healthcare organization reveals compliance
to most of the standards designed by Department of Health (Cole 2015). It was observed that
nurses did not adhere to the competency Standard 3 which necessitated the delegation of
registered or trained nurses for managing patient’s hygiene needs (Halcomb 2016). The above
nursing standard of hygiene of the chosen organization did not mention about culturally
competent care which is required to administer comfort and security to patients who are
culturally diverse (Hughto et al. 2017). As researched by Piras, Lauderdale and Minnick (2017),
registered and trained nurses are also required to be involved in the hygiene care of the patient
due to their high professionalism. It was also observed that the nurses followed personal hygiene
standards of disinfection, hand washing and usage of aprons, masks or caps.

10REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
Part 2: Reflective Practice in Nursing: Gibb’s
Description
As a Trainee Nurse Associate (TNA), I was taught that maintenance of hygiene prevents
the transmission of harmful diseases. I also learned that is important for all nurses, to conduct
assistance and supervision of hygiene practices in the patient, since this will make the concerned
patient feel secured and comfortable and also result in family members of the patient being
assured of the fact that their loved one is receiving care of the highest quality by the hospital or
healthcare organization (Sunkesula et al. 2015).
Feelings, Evaluation and Analysis
TNAs like me are required to practice this aspect of nursing care in accordance to the
standards and principles formulated NHS, NICE and NMC as researched by Pandya-Wood,
Barron and Elliott (2017). I must also comply with Department of Health’s competency
standards outlined in ‘Essentials of Care’ (Halcomb 2016). Hence, considering these standards,
TNAs, like me are required to cater to the following protocols, as researched by Dasan et al.
(2015): dissemination of patient centered approach hygiene care, control and prevention of
infectious diseases, adherence to healthy oral hygiene, utilization of personal protective
equipment, provision of an environment which is hygienic, conductance of documentation,
maintenance of hand, feet and nail care of the patient along with the utilization of equipment for
toileting. While the thought of remembering and meeting so many requirements made me feel
nervous at first, I evaluated that despite the tediousness, such practices will teach me the
importance of patient self-care and hygiene. I analyzed that henceforth, I must dedicate myself to
such standards for future improvement.

11REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
According to Standard 1 as a TNA I am require to maintain the patient’s confidentiality,
dignity and respect, as well as making sure that the patient has enough liberty to use personal
toiletries along with those which are supplied by the hospital. I must also obtain consent and
permission from the patient and provide hygiene care which is culturally sensitive to the patient.
I must also ensure that I monitor any situation where the patient manages his own hygiene and
self-care without assistance (Halcomb 2016). As researched by Papastavrou, Efstathiou and
Andreou (2016), availability of an environment which is private, dignified and consensual, is
beneficial since it results in the patients feeling less anxious, comfortable and secure. Also,
patients feel emotionally positive since they perceive that there unique cultural identities are
being respected and care for (Behar-Horenstein et al. 2016). While such a standard made me feel
confused at first as to why a patient may feel comfortable at privacy, I evaluated from my
patient’s experiences that positive patient emotional wellbeing is essential and further analysis
made me realize that maintaining confidentiality is the best way to ensure the same.
According to Standard 2, it is my duty as a TNA to ensure that a patient centered
approach to treatment is given in the form of ensuring that the patient receives sufficient supply
of personal self-care equipment, as well as assistance and supervision in accordance to changing
needs and demands (Halcomb 2016). Authors Paul et al. (2017) observed that, administering
such a patient centered approach to treatment is advantageous sine it ensures emotional
wellbeing of the patient where she or he perceives that nurses are sincerely attending to her or his
unique needs. As researched by Theile et al. (2016), the adequate supply of toiletries for personal
use is beneficial since it allows the patient to feel empowered and capable of performing
personal hygiene. While such standards made me feel irritable at first at the thought of always
enquiring the patient’s needs, careful evaluation and analysis revealed to me, how happy my

12REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
patients seemed when provided with personalized treatment, inspiring me further to practice
patient-centeredness.
Standard 3 requires me to maintain appropriate practices of control and prevention of
infection along with helping supervisors in the management of my concerned patient (Halcomb
2016). I must wash hands regularly, carefully dispose wastes, replace linen, washbowls and
laundry for each patient daily as well as provide personalized equipment for toileting for each
patient. Maintaining such standards leads to prevention of transmissible diseases along with
patient perceptions of satisfaction and trust (June and Choi 2016). While I was intrigued at the
importance behind such a simple activity, I could evaluate and analyze that washing of hands is
one of the easiest and best ways to prevent healthcare associated infections.
According to Standard 4, I must make sure that the patient receives adequate supplies
personal care and hygiene and also obtain permission before providing the patient with supplies
of the hospital (Halcomb 2016). As examined by Šaňáková and Čáp (2018), maintaining such
standards by nurses ensures that the patient does not feel embarrassed when he or she does not
have his or her own personal self-care resources. As per Standard 5, I must motivate patients to
dress, shave, wash or clean themselves without assistance so that they feel empowered to achieve
independence as noted by Cheng et al. (2017). As per Standard 6, I must also make sure that the
patient possesses adequate supplies of required sensory aids. A health oral cavity, ensures
positive patient health and thus, I must conduct and oral assessment of my patients as per
Standard 7 (Halcomb 2016). Both male and female patients have gender appropriate needs,
which I must consider, according to Standard 8, so that patients feel dignified and respected
(Haider et al. 2017). Self-care and personal hygiene standards also encompass healthy foot care
and skin, which I must maintain as a TNA as per Standard 9, since this will avoid the emergence

13REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
of pressure ulcers or infections in the patients (Halcomb 2016). Such standards made me feel
overwhelmed at first at the complexity of my responsibilities and made me doubt my
capabilities. However, I evaluated that careful reading of the NICE and NHS guidelines would
guide me appropriately to achieve the same. I analysed that TNAs must adhere to the NMC
Codes since these help in improving future nursing professional care.
Conclusion and Action Plan
I have realized and understood that for practicing high quality nursing practices, I must
ensure that my personal, as well as my patient’s needs for self-care and hygiene are met
adequately. I also learned that I must comply with certain national standards in order to
effectively practice the nursing care aspect of hygiene. Hence, my future action plan will consist
of:
 Being sensitive to the cultural needs of my patients
 Practicing hygiene and hand washing standards as per the NICE and NHS guidelines
 Adhering to the NMC and HEE proficiency standards for Nursing Associates

14REFLECTIVE PRACTICE AND ENQUIRY BASED LEARNING
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