FINAL EVALUATION REPORT

            Abstract

            Practice based investigation ought to be performed in all practice settings while the results and recommendations are to be applied to all as well. However some of these practice settings such as the private hospitals have their own special; features and administration that makes conduction of any research challenging. I was undertaking my research which involved the task of exploring the risks of infection control within operating theaters among hand hygiene.  It is during my research period that I realized how difficult it was to undertake any research in a private institution and in that case a hospital. This paper therefore will evaluate and develop evidence on how difficult it is to acquire skills based on practice and ethical considerations relevant in the practice setting. I did fail in my attempt to get ethical approval for my research in the organization and this made me to be determined more to research on pitfalls and challenges that I and other students went through in their attempt to carry out a research in this kind of private organization. Information was acquired from different sources including secondary and primary sources where later I was not able to analyze and come up with conclusions and recommendation on my research since I was not permitted to continue with my research by the ethical committee in the private settings.

            Analysis of the research approach and findings

            Earlier on before engaging in the research, I was only limited to my thinking as I thought that I was only to learn on how to be a good practitioner to all professionals working in high peril environments such as operation process in operating theaters which are susceptible to various communications errors and infection prevention concern.

I strongly believed that hand hygiene is one of the most ignored and forgotten activity in theatre operations and how the new practitioners who are emulating the already registered professional surgeons may copy the wrong things from them. I thus was determined to prove my theory by engaging in a research which would enhance me to prove how health associated infections especially via microbial contamination would be caused by reduced hand hygiene of operators in the theatre. However in undertaking the research I was able to learn that the general start in being able to become a good practitioner is not only focused while in operating theatres. However, performance measure starts with the environment outside the operating room where a practitioner can be able to see a challenge and work towards solving it and later is when one can be able to effectively work in the inner circle of the medical operations. I used to think that private hospitals are the best in all they did starting from their organizational structure but it is after my research that I was able to see what really happens in the private settings. Most of the students emulate and aspire to carry out research in these institutions but the challenges are numerous with so much experience to be learned from this kind of challenges for they that agree to push on their research till completion.

            According to other scholars who also investigated on the same issue it is clear that this is an emerging issue in which hand hygiene in operation theatres are not upheld. Some of the scholars have argued out that the hand surface contacts all the way from the waiting bay to operating rooms to the recovery rooms is not the sole cause of infections in the patience (Megeus et al 2015). Environmental contamination together with poor cleaning practices is another problem that causes infections to theatre patients.

 

Most have argued that it makes no difference in ensuring that hands are washed before, during and after the operation as they think that expertise and academically they are taught on how to handle vulnerabilities and how to control infections which to them is just but enough (McInnes et al 2014).

            In my observation, I was able to realize that there was need for improvement in the operation strategies in the hospitals. More awareness needed to be created and knowledge on hand hygiene practice ought to be transferred especially to all practitioners whether qualified academically or whether working as staff as unqualified in the hospitals and in theatres (Pittet 2001). Trainees within practice program are the major concern for all hospitals as they are the doctors to be in charge tomorrow. Neglecting the simple task of washing hands all through the basic practices have caused one patient out of twenty five patients to be infected with health care associated infections during their health care and this has contributed to approximately 722000 infections annually (Anderson et al 2014).

            While collecting data I was able to acquire quantitative and qualitative data. Quantitative data enhanced me to be able to describe central tendency of hand wash activity for most of the practitioners including the trainees. This involved the mean times and how often these doctors observed hands hygiene through observation, interview and survey method. Whereas the qualitative method enhanced me to acquire inferential statistics which explained the correlation between poor hand hygiene and infection control in theatres specifically.

            I was focused on the major issue of hands hygiene which would involve improvising a technique that would ensure each practitioner washed their hands within the duration of 40-60 seconds.

However my requests to the administration to improvise a running tap at the entrance of the theatre with provision of detergent as well was accepted after a long face to face discussion with the manager.

            My methodology was structured to be extensive to all the participants. However, I was only able to investigate a few personnel one of them being the manager through conducting of personal interview with him. The limit of methodology that I used was due to the fact that my research was rejected hence I could not go against the hospitals strict restriction on research by students.

            According to my personal interview with the newly employed manager in the private hospital, he was as helpful as he clearly explained to me that they would not allow me to conduct my study as it is a threat to the hospital as they thought that I would expose them to the public hence costing them their patients flow. According to him research is only to the junior doctors in the hospital than to the students since they believe that the junior doctors has what it takes in researching and in being discrete.

            Some of the superior surgeons in the hospital and other theatre practitioners were so busy in their work that they did not offer any help in the research due to their busy schedule.  Also investigating the patients was not allowed by the private hospital principles as they disregard it. I was therefore left with the option of using one on one interview with the manager as my main support tool who worked within the department.

 

 

 

The demonstration of an ethical approach to research and your practice setting

            Ethical clearance is important in the medical field as it ensures that certain ethical principles are adhered to. I however did not necessarily need the ethical clearance             since I did not involve others in my study as I was only limited to observing and carrying out the one on one research with the manager which required no clearance.

            Ethically participation is voluntarily and any withdrawals from participating from the research anything while those who participated, they are guaranteed of confidentiality and inscrutability. My project ensured that all the participants were able to acquire a leaflet which had the information that they were to help collect (Lenfant 2003). However the nature and the rationale for undertaking the research were well explained to them. I had to assure them that any information that they would provide would not be published without their consent. I therefore offered them with a written report of what data I was to publish for them to verify that it was the right information they had given and if they signed for the acceptance of me including their part then I did include that but failure to permission led to me not to include that data in the report.

            Research of ethical issues in undertaking this project within a private set up posed a lot of difficulties. This kind of setting restricts such kind of research as the administration is insecure that the results may work out more harm than good. This would show the negligence of the hospital, ignorance of their practitioners and this would act as a threat to the organization.

 

This has therefore led to many private hospitals refusing these projects and in most cases they scare away students indirectly by offering them with minimal facilities and information for their research.  The participants are given such a large workload thus leaving them, with minimal time to participate in the research interview or answering of questionnaires.

            This kind of unpredicted harsh environment for carrying out my research gave me an eye opener which enabled me solve the problem but yet conduct my research. I therefore did seek to ask one question at a time to each practitioner instead of giving them a couple of questions in a questionnaire. I ensured that these questions needed just a yes or no question. In collecting data on whether these practitioners received recent training on hands hygiene I ensured that I asked a sample of the practitioners while on their small interval breaks.

            The participants were effective in their support in the research. They provided relevant information that helped to have a clue on the issue of hand hygiene but not fully adequate as the hospital was against the research. Discovering that most of the practitioners had stayed without being trained on hands hygiene posed that they were harm to themselves and also to others. This led to more research so as to know whether the right policies and guidelines in the hospital or not. This enhanced me to take action by proposing that the theatre management ought to be changed since the ones that were there had not conversant with the significance of hands hygiene in the hospital. Observing some of them use the same gloves for a different task endangered the patients as the bacteria’s were transferred to the bloodstream from the air resulting to more vulnerabilities of infection.

 

Constant follow ups through emails to the volunteering customers reminding them of how important this research was to them and involving them in them asking questions and me being able to answer them made me able to show my participants how valuable they were in my research.

            Carrying out this research was not only of benefit to me but it was for the greater good of all the participants and in general the hospital itself and the patients as well. Full participation of the participants showed how their valued their patients health and theirs’ also.

The result of the research attributed to acquiring scientific valuable information to the participants on hands hygiene significance. The results also enhanced immediate intervention of the hospitals administration into controlling the infection thus providing better services to the patients. Using the data collected from observation, the hospital will be able to offer enough gloves and offer training to all staffs in the hospital and will be able to ensure that they offer clean environment in the operating rooms.

            While undertaking research which involve ethical engagement even in the future projects in search an organization, it is important to ensure that one protects their participants fully to avoid their privacy leaking out which may cause them to lose their jobs. It is also essential that the research puts first the health, human rights and care for their participants before their own interests.

 

 

 

            The development of evidence-based practice

            Throughout the project I was able to experience personal development as there were so many lessons to be learnt. My interaction with people was enhanced as I dealt with a group of professionals and staff as well.  I was also able to increase my knowledge on the theatre operations as I worked closely with the theatre operators. Hygiene has become one of my personal habits since I learnt of the importance and influences that may occur due to poor hygiene.

            Reading and researching more made me realize that there were so many other scholars who were concerned with medical care (Shah et al 2015).  However not all aspects of medical concerns are attended to in the medical departments and this enabled me to realize the gap that existed in the medical research and this drove me to researching on the problem.

The literature review also enabled me to understand some of the challenges that other scholars faced in their research and this enhanced me to evade and to be better able to face these challenges (Shah et al 2015).  I was also able to identify some of the methods that yielded better results in the private set-up and new methods that were not yet used I was able to utilize them such as the pilot study.

            My research enhanced me to understand how poor hygiene is a causal effect of infection and this enabled me to realize that the best way to curb this ill-treatment is by maintaining hands hygiene of the highest degree as academic approach and skills may not be enough for this careless mistake of unhygienic.

 

Conclusion and recommendation

            Application of proper hand hygiene in the future set up would result to minimal infections and actually those that have not been caused by the practitioners themselves. Semi-annual training on proper hygiene would remind practitioners of how this activity is of importance while the newly joined practitioners would have a chance to be trained on the same. This would enhance the development of a generation of professional practitioners who are responsible for their act of proper health care.

            When the hospitals agrees to correct some of their mistakes by changing the organizational structure in the hospital through inclusion of hygiene supervisors in the organization would ensure collaborative and cohesion support towards acquiring of good human health through good health hygiene. The issue of concern is whether these organizations are financially stable to offer hygienic facilities as required because most of these facilities are profit oriented thus expenses are minimized. It is thus recommended that extra funds in hospitals be set-apart for the training and purchase of hygiene equipments and hiring of hygiene professionals. A department of hygiene also ought to be established in private hospitals to ensure that hygiene is achieved.

            Private hospitals should support student practitioners and should allow them conduct clinical research on their institution as they have the best of interest while undertaking the research. This will enhance them be more experienced so that they can be able to be better practitioners even after their studies. Everyone deserves a chance and the hospital should be willing to give the students that chance by at least allowing and permitting them with ethical clearance and the ethical committee approving them.

References

Anderson, D.J., Podgorny, K., Berríos-Torres, S.I., Bratzler, D.W., Dellinger, E.P., Greene, L.,    Nyquist, A.C., Saiman, L., Yokoe, D.S., Maragakis, L.L. and Kaye, K.S., 2014.       Strategies to prevent surgical site infections in acute care hospitals: 2014 update.         Infection Control & Hospital Epidemiology, 35(06), pp.605-627.

Lenfant, C., 2003. Clinical research to clinical practice—lost in translation?. New England           Journal of Medicine, 349(9), pp.868-874.

McInnes, E., Phillips, R., Middleton, S. and Gould, D., 2014. A qualitative study of senior            hospital managers’ views on current and innovative strategies to improve hand hygiene.     BMC infectious diseases, 14(1), p.611.

Megeus, V., Nilsson, K., Karlsson, J., Eriksson, B.I. and Andersson, A.E., 2015. Hand      Contamination, Cross-Transmission, and Risk-Associated Behaviors: An Observational     Study of Team Members in ORs. AORN journal, 102(6), pp.645-e1.

Pittet, D., 2001. Improving adherence to hand hygiene practice: a multidisciplinary approach.      Emerging infectious diseases, 7(2), p.234.

Polit, D.F. and Beck, C.T., 2004. Nursing research: Principles and methods. Lippincott    Williams & Wilkins.

Shah, N., Castro-Sánchez, E., Charani, E., Drumright, L.N. and Holmes, A.H., 2015. Towards     changing healthcare workers' behaviour: a qualitative study exploring non-compliance         through appraisals of infection prevention and control practices. Journal of Hospital        Infection, 90(2), pp.126-134.