Reflective practice holds considerable importance in the nursing profession. A crucial aspect of reflective practice is to help the nursing practitioner to analyze, understand and learn from his or her lived experiences and then take necessary actions (Brown & Schmidt, 2016). The following reflection is extracted from my clinical placement in the hospital where I witnessed a nurse doing wound dressing on one of my clients. The patient had a JP drain and the drain site had a small leak, so the nurse needed to inspect and change the dressings. The nurse had to set a sterile field first which she did along the patient’s legs. The patient moved twice, and the sterile field could have gotten contaminated easily due to the spilling of normal saline into the sterile field. The nurse instructed the patient to lay still. When the nurse was cleaning the incision area, the normal saline from the soaked cotton ball/gauze was dripping onto the sterile field, contaminating the sterile field. Also, she used the same cotton ball to clean the incision and the area around it. This could have led to infection or sepsis. As students, we are taught to use one cotton ball/gauze per swipe to avoid contamination of the wound site. My client developed a fever and flu-like symptoms the same night and was placed in isolation. The physician did order some blood work and a chest X-ray to rule out any infection. The results did come back normal. However, the contamination of the sterile field and the improper cleaning of the surgical incision could have led to a serious infection or sepsis in the client. I would like to reflect on this experience using Carper’s ways of knowing. Empirical knowingCarper noted the empirical way of knowing as the “‘science of nursing’. Empirical knowledge is extracted from the research and this kind of knowledge is organized systematically into general laws and theories. One of the best approaches to employ empirical knowledge is the application of evidence-based practice”, (Brugger & Madison, 2015). According to the evidence-based practice guidelines, “the purpose of creating a sterile field is to decrease the number of infiltrating yet contaminating microbes”, (Tennant & Rivers, 2019). Therefore, contamination of the sterile field can introduce entry of microbes into the patient which could lead to a serious infection, posing a potential threat to patient safety. Evidence-based practice also highlights that the sterile field must be placed close to the patient and should not keep exposed or opened for a long time (Tennant & Rivers, 2019). Due to shortage of supplies (dressings), the nurse had to leave the sterile field twice to get the extra dressings. As a result, the patient’s wound site and the sterile field were open/exposed for a long time. A nurse should always ensure that he/she has adequate supplies before setting up the sterile field. Although the nurse had set the sterile field close to the patient, it was still placed in a way that could have contaminated the sterile field easily. I will position the patient in such a way that spilling of the normal saline over the sterile field can be avoided, and thus preventing contamination. I would also ensure that I have adequate supplies before setting up the sterile field, and if needed, I would ask for help to get some additional supplies. This way I can remain with the patient and prevent accidental contamination of the sterile field.AestheticsCarper defines an aesthetic component of nursing as an “art” which incorporates aesthetic, empirical, and personal ways of knowing, and through it creates new understanding of a phenomenon, (Brugger & Madison, 2015). As per my experience in the clinical shift, I saw that the attending nurse was indifferent to the effective wound management of the patient. She showed little concern for the health of the patient as she violated the basic hygiene principle of wound management. When the nurse was cleaning the incision area, the saline-soaked cotton ball/gauze was dripping onto the sterile field causing contamination of the sterile field. She also used the same cotton ball/gauze to clean the incision area which increases the risk of developing sepsis. As per my aesthetic value, I will always show my primary concern for my patient’s health and will abide by guidelines of aseptic conditions. This time, since I was a student, I did not raise my voice against the nurse even knowing that what she was doing is wrong. Going forward under the same stereotype situation, I will always raise my voice and will take necessary actions based on the situation. One way to address this situation would be to talk to the nurse in private about the whole thing and see her response, another way would be to intervene politely when I see contamination of the sterile field and offer new set of supplies while the nurse can still be with the patient.The personal way of knowingThe personal way of understanding refers to the information that we have in ourselves or we have gained based on experience (Brugger & Madison, 2015). From my personal knowing or personal knowledge, I would like to highlight that it is important to inspect the wound site even if there is a slight leakage in the drain site. I have gained this knowledge during my second year of undergraduate course where we are taught about the importance of sterilization and wound management. As a student, we are taught to use one cotton ball/gauze per swipe of the wound site in order to avoid contamination. Thus, when I saw that the attending nurse was cleaning the incision area with the same cotton ball while cleaning and the saline dripping in the sterile field, I immediately understood that she is not following the basic rule of the sterilization and hand hygiene. Sandy-Hodgetts et al. (2016) stated that in order to prevent surgical wound dehiscence and to prevent the chances of cross-contamination during wound dressing proper aseptic approaches must be undertaken. Some of these aseptic approaches include proper maintenance of hand hygiene, cleaning and dressing the wound site with sterile equipment and avoiding contact with the other objects present in the surroundings.The ethical way of knowingAn ethical way of knowing is understanding what is right or what is wrong and staying committed to taking the necessary actions (Brugger & Madison, 2015). From my clinical shift, I understood that the attending nurse was not following proper aseptic techniques and thus endangering the life of the patient. My client immediately developed a fever on the same night post wound dressing. The blood tests and the X-ray, however, ruled out any microbial infection or sepsis. However, contamination of the sterile field and improper cleaning of the surgical incision might/could lead to the development of septicemia and thus endangering the life of the patient. According to the nursing bioethics, “a nurse must practice depending on the ethical principle of beneficence and non-maleficence. Principle of beneficence and non-maleficence are closely related. Beneficence deals with balancing the benefits of the treatment via avoiding harm to the patient (septicemia). The principle of non-maleficence states that harm must not be disproportionate to the overall benefit of the treatment” (Johnstone & Facn, 2019, pg. 42-43). To conclude, “Carper’s ways of knowing” in nursing allow us to understand ourselves and nursing practice at a much deeper level; to appreciate nursing as both an art and a science”, (Brugger & Madison, 2015). From the above discussion, I would like to state that while conducting professional nursing practice, I will always make sure of applying the ethical, aesthetics value and my empirical knowledge. Apart from this, I will also use my personal knowledge gained from reflective practice and this will also help me to enhance my critical thinking skills.
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