Undergraduate Programme

Assessment Submission
(Students should retain a copy of all assessments)

Registration Number: 1622223

Module Code: CFP203

Assessment Number: A1

Assessment Title: Portfolio of Evidence

Number of Words:

Work which is submitted for assessment must be your own work. All students
should note that the University has a formal policy on plagiarism which can be
found at http://www.quality.stir.ac.uk/ac-policy/assessment.php.

Assessment Template Version 4.0 (Modified 10/10/07)

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Section A: One Reflective Account

Hand hygiene is an essential component for everyday practice in the health sector.

“The realisation of the potential for the spreading of infection within both hospital and

community is a concern for patients, clinicians and management within the NHS.”

Beet et al (2007)

For workplace activity 2 from unit 3, part B of the Cleanliness Champions package, I

had to observe two members of staff from the ward I was on placement at whilst they

washed their hands by following the steps provided by the NHS. For this activity, I

asked my mentor and a staff nurse if they would help me to complete the workplace

activity. Because my mentor had previously observed me washing my hands for a

previously observed me washing my hands for a previous workplace activity she

knew why I was asking her to do this but the other staff nurse who had volunteered

didn't know so I spent some time explaining this to her. I let her know that it was an

essential part of the course and that she would also be helping me to complete an

assignment. She was very obliging to this.

We went through to the treatment room to carry out the activity. I explained the

activity again and asked them if they knew the six steps of hand washing without the

use of a prompt. Both volunteers said yes. Even though they knew the procedure,

the three of us read through it again. My mentor was first to wash her hands. After

remembering to take off her jewellery, she turned the tap on and let it run for a short

period of time to get the water to a sufficient temperature. After this she applied soap

from the soap dispenser to her hands and carried out the hand washing procedure,

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whilst talking me through the different steps, in order. My mentor took a considerable

about of time when washing her hands, spending time going through the steps, while

giving a short commentary on each. After completing washing her hands, she turned

the tap off with her forearm and proceeded to dry her hands thoroughly with paper

towels before disposing of them hygienically in the bin.

Before we discussed my mentor's technique, I asked the other staff nurse if she

would wash her hands the way she would when normally carrying out hand hygiene.

There were a few differences in technique between my mentor and the staff nurse's

technique but not many. The staff nurse began washing her hands like my mentor

did. She removed all of her jewellery except from her wedding ring, turned on the

tap, dispensed soap and began to wash her hands. The only differences between

the two demonstrations were that the staff nurse got a couple of the steps of the

procedure in the wrong order and she didn't move her wedding ring so that she could

wash under it, but, overall, she washed her hands very effectively.

After we had finished the task, we sat down and discussed how I felt they did once

completing the activity. Firstly, I gave my mentor feedback for how I felt she had

done. In my opinion, I could not find any faults with the was she washed her hands.

Each step of the hand washing guidelines was followed in order, at no time after

beginning to wash her hands was the tap touched and paper towels were disposed

of in the bin provided. We then went on to discuss how I felt the other staff nurse did

when washing her hands. She knew that she had mixed up the order of two of the

steps of hand washing but said she did not realise that she didn't move her wedding

ring in order to clean the finger under it. The three of us discussed the fact that is it

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incredibly easy to forget to take off jewellery, to turn the tap off without thinking about

contaminating your hands again and forgetting to follow the steps of hand washing in

the right order.

The fact that when I was observed washing my hands I was quite nervous I think I

made a point of spending some extra time when carrying out each step. I am not

sure that I would be as thorough when washing my hands in practice. I expressed

this concern with my mentor and she agreed that she probably exaggerated and

animated how she would wash her hands whereas washing one's hands the way the

other staff nurse was probably more realistic. I felt slightly silly when asking my

volunteers if they would mind if I observed them washing their hands as I though

they might have thought of me as being annoying but as we discussed hand hygiene

the topic of how essential it is in nursing came up. I was also later informed that the

activity benefited my two volunteers as they said they were more conscious of what

they were doing when washing their hands.

Overall, I feel that carrying out the workplace activity was a beneficial experience

and, after observing people myself I will be more aware of my actions when washing

my hands.

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Section C: Essay

Turnbull (2004) observes that people with learning disabilities face discrimination

from many sources, whether it is from a member of the general public on the street

or even a healthcare professional. It is becoming increasingly more difficult for a

person with a learning disability to gain access to a suitable standard of care in the

health sector. Turnbull (2004) also states that many healthcare services are

becoming more service-centred as opposed to patient centred which could be

detrimental to the health of people with learning disabilities.

The Scottish Executive (2002), cited by Grant et al (2005) listed barriers to adequate

healthcare, these include:

Physical barriers: Poor access to facilities, for example, wheelchair access.

Administrative barriers: Simple things like waiting times in doctor's surgeries are too

long for people who become agitated or restless. Appointment times are too short for

people who have difficulties when communicating.

Communication barriers: Doctors are unable to understand different types of

communication which then leads to people with learning disabilities being unable to

describe what is wrong with them.

Attitudinal barriers: People generally have negative attitudes towards people with

learning disabilities. This could then prevent them from receiving the care they need.

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Knowledge barriers: Healthcare professionals have limited knowledge or experience

of treating for people with learning disabilities.

“People with learning disabilities have everyday health needs, just like everyone

else. Some people with learning disabilities, however, face particular problems in

having their everyday health needs met.” The Scottish Executive

In most cased, the GP is the first point of contact for people when gaining access to

healthcare. The Scottish Executive acknowledges that a great number of GP

practices do not know they have patients with learning disabilities. This then makes

meeting the needs of both adults and children with learning disabilities very difficult.

This is due to both a lack of data and poor communication and understanding.

Gibson (2006) notes that GP's often don't have the confidence when working with

people with learning disabilities, however, many GP's do admit this and feel that

further training and information would help aid this problem. Gibson (2006) also

observes that nurses are crucial sources of information when reporting on the health

status of people with learning disabilities. He also states that nurses do have positive

attitudes towards people with learning disabilities but some still lack the skills and

knowledge to cater to people's needs properly.

The Scottish Executive also observes that people with learning disabilities have a

greater need for access to healthcare than the general population but more often

than not these needs don't get recognised, therefore don't get treated.

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Grant et al (2005) looks at how preventative healthcare is not an issue addressed by

health services relating to people with learning disabilities. Simple health screenings

like smear tests are bypassed for people with learning disabilities as it is not deemed

as important in some cases. It is essential that a specialist nurse helps when dealing

with preventative healthcare so people don't go untreated if problems do arise.

In a speech given by Stephen Ladyman MP (2004) it is noted that there are four key

principles that should be adhered to. These are independence, rights, choice and

inclusion. All of which are basic human rights. It also observes that people with

learning disabilities have more complex needs that the general population but they

do not access health services as often as they should to ensure their needs are

catered to. The inequalities affecting people with learning disabilities are cast, which

is unacceptable.

Turnbull (2004) states that there is a deficit in staff knowledge in regards to people

with Learning disabilities and the fact that acute health services are not used to

treating people with learning disabilities and therefore aren't designed or prepared

for these situations. Turnbull (2004) also mentions that barriers in communications

cause large problems for both healthcare professionals and people with learning

disabilities. Steps to improve this may include making information easily

understandable and accessible.

“Everyone of us is entitled to equal access to health and social care.” Ladyman

(2004)

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In the speech that Stephen Ladyman delivered he notes that health services rely

strongly on specialist services when treating people with learning disabilities.

Realistically, acute services need to gain better knowledge and understanding in

these specialist fields so they don't have to rely on other healthcare professionals.

Team working is essential to help make a difference foe people with learning

disabilities when gaining access to healthcare services. Outside parties like carers

are key components when communicating with services.

The Department of Health released a document in 2006 called The White Paper: Our

Health, Out Care, Our Say. In this paper it talks about how the Department of Health

have promised to begin regular, full health checks for people with learning disabilities

as it will help them gain access to the system which will aid them when seeking good

quality healthcare. The report also states that people with learning disabilities want

choice and control when dealing with their lives. Looking at this point, access to

healthcare is not their sole concern, employment and housing are factors which are

affected by having a learning disability.

“Close to 3000 people with learning disabilities live as inpatients in NHS residential

accommodation.” Department of Health (2006)

This is leading to people becoming institutionalised which, in a way, eliminates some

choice from their lives. Living in the community lets people with learning disabilities

live their lives more independently whereas in NHS residential accommodation,

people's health needs can be neglected which leads to a decline in health status.

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Because people with learning disabilities generally suffer from poorer health

compared to the general population, mortality rates of people with learning

disabilities are higher. The Scottish Government (2008) states that people with both

learning disabilities and severe mental illness have higher mortality rates that the

general population. Due to factors such as medication types, people with learning

disabilities may consequently suffer from other medical problems such as heart or

kidney failure. The Journal of Intellectual Disability Research notes that studies have

looked at people with learning disabilities that live in the community compared with

those who live in institutionalised settings. The study showed that mortality rates

were raised for both males an females compared to the general population but no

real difference was found for what type of setting they lived in.

Turnbull (2004) observes that changes in accessing healthcare is changing slowly.

Examples include longer appointment times being introduced at GP practices and

priority when attending outpatient clinics to avoid restlessness. Priority may also be

given when waiting for procedures like surgery. Concerns brought up by carers are

being addressed and things like staying with patients while in general hospitals is

becoming easier. Grant et al (2005) states that communication between staff,

patients and carers is set to improve by involving both the patient and the carer when

deciding plans of care and treatment. Overall, with various implementations, access

to healthcare for people with learning disabilities will soon be much easier.

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References

Grant, G, Goward, P, Richardson, M, Mamcharan, P, Learning Disability, A Life Cycle

Approach to Valuing People (2005), Open University Press, BERKSHIRE

Turnbull, J, Learning Disability Nursing (2004) Blackwell Science Ltd, OXFORD

Online Resources

Department of Health, Our Health, Our Care, Our Say: A New Direction for

Community Services (2006) Date accessed: 01-06-08

Gibson, T, Welcoming the Learning disabled in Practice (2006) Practice Nursing,

Volume 17, Number 12. Date accessed: 26-05-08

Journal of Intellectual Disability Research (1995) Volume 39, Number 16, Blackwell,

OXFORD, Date accessed: 26-05-08

Beer, M, Fear, M, Panton-Valentine Leukocidin: Raising Practitioner Awareness,

British Journal of Community Nursing, Volume 12, Issue 9. Date accessed: 26-05-08

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