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MCRO316 Healthcare Systems Question: Needle stick injures (NSI) which is a injures caused by needles accidentally lead to rupture the skin. This topic is very important for the safety of workers in the health field, as well as patient safety. The World Health Organization (WHO) mentioned that 1 out of 10 healthcare professionals around the world suffers every year from needle stick injury (Adefolalu, A., 2014). There is a lack of research/evidence about this topic in the United Arab Emirates. The purpose of this article is to present an overview of injuries caused by needles and we will use the Gibbs reflecting model which is encourages you to think systematically about the phases of an experience or activity, and you should use all the heading to structure your reflection (Gibbs, 1988) to reflect on the clinical experience, and to be capable of identifying the risk factors. We also will set recommendation preventive strategies that help to prevent needle stick injuries among nurses. The injuries of needle stick are an occupational and very potential hazard that is familiar to the workers in the field of healthcare. The problem was selected from clinical practice in the hospital because it is possible to face or to go through this problem in health facilities. Accidental injuries of the skin in medical health settings are caused by many types of needles such as disposed needles, cannula needle, intravenous (IV) catheters as well as needles for blood collection (Muralidhar, Singh, Jane, Malhotra and Bala in 2010, Hashemi A, Al SA Indah L feathers, 2012). All of the workers in the field of healthcare have the risk of developing some diseases transmitted through blood because they are providing care for the patient all the time (Shaghaghian, Pardis, and Mansoori, 2014). Health care workers are liable to more than 30 life threatening blood borne pathogens, but some are important to healthcare providers including the human immunodeficiency virus (HIV), the hepatitis C virus (HCV) and the hepatitis B virus (HBV). (Mehta et al., 2010). As it is shown in the statistics of the organization of the World Health in 2009, there are 2.5% of the HIV virus, and 40% of hepatitis A and C virus began to spread all over the world due to the exposure to needle stick (Sharma, Gupta and Arora 2010 Shaghaghian, Pardis and Mansoori, 2014). As we mentioned before in this report we will follow the Gibbs reflective cycle to reflect on what we have observed in the clinical setting about needle stick injury. Starting with the scenario, the incident occurred during the clinical rotations in the hospital. One of us was responsible for patient X who is 68 years old and was admitted to the surgical unit. She and the preceptor went to the patient room to give an intravenous injection as a doctor prescribed. However, the patient X was very upset and anxious about his condition. So the preceptor wore gloves and wanted to inject the patient immediately without any explaining. Thus, Patient X moved her hand directly because she felt frightened and experience pain, as a result, the preceptor pricked her hand instead of patient hand. These things happened because of many reasons. Firstly, the nurse did not follow the right steps of administering medication (IV injection). Secondly, she did not specify the patient’s name and MRN . In addition, she did not explain why she is giving medication and for what. Moreover, she didn’t educate the patient about the side effect of the drug. From that experience, we learned that an effective communication with the patients before administering any medications through injection is essential to promote patient safety and prevent injuries caused by needles. As a part of our role, she did well when she tried to remain the patient calm when the nurse went out of the room. However, she didn’t do well when she could not be an advocate for the patient at the same time. If we was instead of the nurse, maybe we will have a different reaction. For instance, we will wash my hands properly by using the hand washing technique, moreover, do a blood test for the patient to determine if the patient has had any disease transmitted through blood, also we must follow Surveillance programs, this program is to investigate the factors that cause injuries and to ensure that injured person gets a proper treatment and what the practical strategies of dealing with diseases (Canadian Centre for Occupational Health and Safety, 2016). Our goal for the future is to ensure our safety as well as the patient safety by developing technical and interpersonal skills, cognitive and knowledge to prevent needle stick injuries and preventing needle stick injuries. Recently, the health care organizations have made the hierarchy of control concept as a prevention model; it is used for prioritizing prevention interventions by the industrial hygiene profession. As shown in the sharps injuries prevention hierarchy, the first and main priority is reducing and eliminating the use of sharps and especially needles where it is possible. Next is isolating the hazard, thereby protecting whoever exposed to sharps, by using an engineering control. If the previous strategies are not applicable or will not guarantee full protection, we have to focus on work-practice controls and the personal protective equipment (Centers for Disease Control, 2009). There are a number of reasons that lead to needle stick injury in the United Arab Emirates, especially at the organizational, national and individual levels. At the organizational level, there is a lack of an effective system for reporting accidents of NSI, lack of medical device and limit the supply of prevention after exposure. In the UAE, there is a policy of deporting nonlocal health care staffs who have found to have a blood-borne virus. This legislation will let them ask themselves whether to report these injuries or not. Non-reporting these injuries effectively will increase the risk of infection if not get a medical advice (Jacob, Newson-Smith, Murphy, Steiner & Dick, 2010). Furthermore, CDC (Centers of Disease Control and Prevention) recommends universal precaution instructions on the prevention of a sharps injury, focus on the needle design and type, the different ways of handling needles, and focus on the way of disposing needles in the sharp containers. Furthermore, the CDC emphasized that increases workload in the clinical area will lead to injuries. The majority 70% of United States hospitals have eliminated unnecessary use of needles through the application of IV delivery systems that do not permit (and in some instances do not require) needle access. Health care organizations can eliminate or reduce the use of needles by using other ways to deliver medication and vaccination when available and safe for patient care (A. Hashmi et al., 2012). A Study in the United Arab Emirates develops several solutions and prevention strategies to minimize injuries. Such as raising awareness of universal precautions &personal protective equipment, recognize risk factors to provide vaccination, and provide best practices of one hand to recap the needle and dispose it safely on sharp containers. (Jacob Smith Newson, Murphy and Dick Steiner, 2010). Stankovic (2011) said that use of medical devices and developing appropriate prevention guidelines and educational programs are the most effective way to reduce needle stick injuries (Shaghaghian, Pardis, and Mansoori, 2014). Furthermore, Gadzama (2012) said that use effective communication with patients before injecting is also important to prevent NSI (Bawa, AjinomaSeydou, and Omar, 2014). In general, Association of Registered Nurses (AORN) recommended to determine the overfilling of needles and disposed it safely on a sharp container (Zakaria, 2014). The HAAD (Health authority of Abu Dhabi) follows the principles and recommendations to promote the high quality of care and safety in health care settings by keeping the health care professionals updated with the method of preventing needle stick injuries and by identifying the latest technology and scientific equipment (Policy and Management of Health 2014). In the end, needle stick injury is one of the concerns of health professionals because it’s a continuing method of transmitting the pathogen to patients and to healthcare providers. By collaborative efforts of the health care team can greatly overcome with this problem because knowing the risk factors of causing needle stick injury can help to discover the solution easily. For the best achievement of these efforts must follow educational programs continuously, and use safe devices and comprehensive precautions to minimize the issue of NSI. Answer: Introduction: Percutaneous injuries caused by needle sticks are a serious health concern for health care workers. They are prone to this form of injuries as they use hypodermic needles, blood collection needles and intravenous stylets to connect patients to IV delivery system. As this form of injuries lead to parenteral introduction of infectious material by needle or sharp instrument, it increases the risk of transmission of blood borne pathogen like Hepatitis B, malaria, diphtheria, Human Immunodeficiency Virus (HIV) and others (Muralidhar et al., 2010). According to the World Health Organization report, 2 million workers are exposed to infectious diseases each year due to needle stick injuries (WHO | Needlestick injuries, 2017). Syringe needles and crowded ward has been regarded as the most common cause of needle stick injuries (Balouchi et al., 2015). This report presents an overview of needle stick injuries by means of reflection on a clinical experience of a nurse. It highlights the issues caused by it and action needed by health care staffs to manage and prevent such issues. Reflective Account: Critical reflection on clinical experience is a useful exercise to reflect on an event, evaluate activities and determine ultimate impact. Gibb’s mode of reflection is an effective tool to engage in systematic process of reflection to get an overview of past event and learn from those experiences (Lawrence, 2008). The report uses the Gibb’s reflective cycle to reflect on experiences in clinical setting due to needle stick injuries. The event related to needle stick injuries is summarized through six phases, which are as follows: Description- The incident occurred during one of the clinical rotation in the hospital. One of the nurse was assigned under the care of Mr. A, a 55 year old patient with hip injury. He was scheduled for a surgery. The nurse was assisting the clinician during the surgery in operation theatre. One hour prior to the surgery, the nurse had the duty to provide an intravenous injection to patient. However, the patient was very restless at that time as he was going for the surgery. The nurse was in a hurry to complete this task and go to other wards. She started injecting immediately without explaining to patient. As a reflex, the patient withdrew the hand all of a sudden due to the pain and the injection need pricked the hands of the nurse. Feelings: After the event, the nurse became very much worried because she knew she was exposed to the infection. The immediate action that she took was to conduct first aid on the puncture side and then she gave the intravenous injection to the patient again with a fresh needle. The nurse developed feelings of fear and insecurity due to the exposure of bodily fluid of patient. Evaluation: The evaluation of the event can be done by breaking down the incident that occurred. Despite workload, the first responsibility for the nurse was to follow the right steps of administering medications. However, the action of the nurse showed that the nurse did not followed appropriate methods resulting in the injury. Secondly, another important duty for a nurse is to inform patient about the rational for giving medication. However, the nurse did not followed both this important clinical action resulting in the injury. The nurse focus was on only completing her work responsibility; however she did not paid attention to doing it in the correct manner in accordance with clinical guideline and standards of nursing care. Research on medication administrating safety has revealed that medication error or injuries during medication administration occur because of the laxity of health care staff and lack of appropriate communication with patients. Inadequate education about patient safety, fatigue, excessive workload and faulty dispending system also exposes nurse to such errors (Keers et al., 2013). In this case scenario of needle injury sustained to the nurse, it can said that the negative event occurred due to excessive work load, poor communication process and lack of education about patient safety in nurse. Analysis: On further analysis of the event, it can be said that the needle injury could have been avoided had the nurse followed the right process needed for basis intravenous administration safety. The core responsibility of nurse during IV medication administration is to provide education to patient, reduce risk of adverse outcomes, integrate medication administration as part of patient care and support positive outcome. According to the standards of practice, the nurse have to perform six rights of medication administration which are right patient, right drug, right dose, right time and right documentation (Smeulers et al., 2014). The area where the nurse could not follow her responsibility was that of educating patient before administration and reducing risk of adverse outcome. The nurse has not explained educated Mr. A about the reason for giving injection. Giving patient adequate information about this might have made him calm and he would not withdrawn his hand. Hence, the event of needle injury could have been avoided had the nurse followed the right method of communication with patient. Another mistake by the nurse was that they are required to wear gloves during any clinical procedure, however she did not wore it increasing her exposure to blood borne pathogen. A study by Memish et al., (2015) has also revealed some even wearing glove does not help due to malpractice of workers. The research done among health care workers in hospitals revealed that lack of safety devices also lead to percutaneous injuries. In this event of injury sustained by the nurse, it was also found that nurse did not immediately report about the event either due to fear of consequence, lack of time and perception of low risk of infection. However, for the safety of nurses, it is important that they immediately report such events. Action plan- To reduce future events of needle stick injuries during clinical activities in hospitals, the action plan is to engage nurse in continuous training and education to prevent adverse event. As this kind of event exposes nurses to fear and stress, education will help nurse to develop confidence during handling needles and providing injection to patient. Psychological training attitude and communication has the potential to reduce stress and anxiety among nurse during clinical practice. Learning effective communication and cognitive skill will be necessary to promote safety of patient and prevent percutaneous injuries. This will lead to improvement in performance, attitudes, awareness as well as injuries. One of the important future action for the nurse would be to engage in injury prevention training as this will guide them about safety and occupational accidents and the methods to prevent (Moayed et al. 2015). The WHO reports that health care workers are at risk of needle stick injuries when they handle needles, recap them, use it for transferring body fluid between containers, work quickly, fail to dispose needles in puncture resistant containers and accident bump into a needle when working in crowded area. In such case, the responsibility of the worker is to use devices with safetu features, follow standards precaution and hygiene practice and report about injury immediately to employer (Wilburn & Eijkemans, 2004). Hence, according to this requirement, the action plan for improving the action of the nurse in the future will to adapt control measure in hospital setting. This includes eliminating the need for unnecessary injections and substituting injections by administration through other routes such as transdermal patches or tablet. Even when they need to use it, they must ensure using personal protective equipment (PPE) like gloves, mask and gowns to prevent transmission of infection. Work practice control measures that can be adopted by nurse includes establishing routine steps for safe handling and disposal of sharp devices before proceeding with a clinical procedure (Rohde et al., 2013). While reflecting on the needle stick injury, it was found that nurse did not followed any steps for post exposure management apart from first aid. Hence, to improve this act of negligence, the future course of action for the nurse will to take necessary prophylaxis immediately after exposure. In addition follow up and reporting about the needle stick injury will be extremely important for appropriate post exposure management. This would not only protect nurse on personal level, it will also promote assessment of occupational hazard in the workplace. Hence, instead of fearing for adverse consequence, nurse must report about such incidents to facilitate quick implementation of preventive intervention (Rohde et al., 2013).  Hence, with these strategies nurse can take active role in preventing percutaneous infection and needle stick injury. Conclusion From the reflective account of a nurse in relation to needle stick injuries in clinical setting, the report gave an overview about the cause of such injuries. Consistent with research studies on the causes of injury, the reflective account also showed that workload, fatigue, lack of awareness of safety practices and crowded wards lead to such adverse event. Based on the evaluation and analysis of event, the action plan mentions providing adequate training for IV administration safety and changing their attitude towards infection and risk event reporting to decrease such incidents in the future. However, organizational role is also important to facilitate safety of staff during handling needles. Recommendation: The following are recommendation to increase safety of staff and reduce needle stick injuries. These are as follows: It is recommended that health care organizations promote a culture of safety by means of appropriate policies and training programs of staff to limit exposure to blood borne pathogen. It is necessary for health staffs to eliminate hazards by substituting injections by different route of adminsterting medications. For example, nurses can consider tablets or transdermal patches for patients instead of injections. Workplace practice control is also needed such placing sharp containers at eye level and following safe practice for needle disposals. Personal Protective Equipment (PPE) should be actively use by nurses to prevent needle stick injuries. Reference: Balouchi, A., Shahdadi, H., Ahmadidarrehsima, S., & Rafiemanesh, H. (2015). The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of Kerman: A Cross-Sectional Study. Journal of clinical and diagnostic research: JCDR, 9(12), DC13. Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), 1045-1067. Memish, Z. A., Assiri, A. M., Eldalatony, M. M., & Hathout, H. M. (2015). Benchmarking of percutaneous injuries at the Ministry of health hospitals of Saudi Arabia in comparison with the United States hospitals participating in Exposure Prevention Information Network (EPINet™). The international journal of occupational and environmental medicine, 6(1 January), 467-26. Moayed, M. S., Mahmoudi, H., Ebadi, A., Salary, M. M., & Danial, Z. (2015). Effect of Education on Stress of Exposure to Sharps Among Nurses in Emergency and Trauma Care Wards. Trauma monthly, 20(2). Muralidhar, S., Singh, P. K., Jain, R. K., Malhotra, M., & Bala, M. (2010). Needle stick injuries among health care workers in a tertiary care hospital of India. Lawrence, P. (2008). Reflecting on events: Pat lawrence uses the gibbs reflective cycle to explain how the care he provides can be improved.(cover story). Emergency Nurse, 15(9), 16. Rohde, K. A., Dupler, A. E., Postma, J., & Sanders, A. (2013). Minimizing nurses’ risks for needlestick injuries in the hospital setting. Workplace health & safety, 61(5), 197-202. Rohde, K. A., Dupler, A. E., Postma, J., & Sanders, A. (2013). Minimizing nurses’ risks for needlestick injuries in the hospital setting. Workplace health & safety, 61(5), 197-202. Smeulers, M., Onderwater, A. T., Zwieten, M. C., & Vermeulen, H. (2014). Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study. Journal of nursing management, 22(3), 276-285. WHO | Needlestick injuries. (2017). Retrieved 14 June 2017, from Wilburn, S. Q., & Eijkemans, G. (2004). Preventing needlestick injuries among healthcare workers: A WHO-ICN collaboration. International Journal of Occupational and Environmental Health, 10(4), 451-456. doi:10.1179/oeh.2004.10.4.451

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