Introduction
This essay explores the critical nursing care considerations for Liam, a 24-year-old post-surgical patient diagnosed with Methicillin-Resistant Staphylococcus Aureus (MRSA) in his surgical wound. Specifically, it addresses two key areas: firstly, how to explain the importance of hand hygiene to Liam using therapeutic communication principles and the steps necessary to ensure he demonstrates correct hand hygiene techniques before discharge; secondly, the Personal Protective Equipment (PPE) required by nurses when providing care to Liam. MRSA is a significant healthcare-associated infection, known for its resistance to many antibiotics, which heightens the importance of infection control measures (Public Health England, 2019). This essay aims to provide a sound understanding of these issues, demonstrating their relevance to patient safety and nursing practice. By drawing on evidence from peer-reviewed literature and authoritative NHS guidelines, the discussion will outline practical and patient-centered approaches to care, alongside a limited but clear critical perspective on the challenges involved.
Explaining Hand Hygiene to Liam Using Therapeutic Communication Principles
Therapeutic communication is a cornerstone of nursing practice, aiming to build trust, provide emotional support, and facilitate patient understanding (Bramhall, 2014). To explain the importance of hand hygiene to Liam, who questions its necessity while on antibiotics, a nurse must employ empathy, clarity, and active listening. Firstly, acknowledging Liam’s perspective is essential. For instance, responding with, “I understand that being on antibiotics might make hand hygiene seem unnecessary,” validates his feelings and opens a constructive dialogue (Arnold and Boggs, 2019). This empathetic approach fosters trust, making Liam more receptive to information.
Next, the nurse should provide a clear, accessible explanation of why hand hygiene remains critical, even with antibiotic treatment. MRSA is a highly transmissible bacterium, often spread through direct contact, including contaminated hands (Loveday et al., 2014). Antibiotics may not fully eradicate the infection immediately, and poor hand hygiene risks reintroducing bacteria to the wound or spreading it to others. Therefore, washing hands before and after touching the dressing creates a barrier against further contamination. Using simple language and avoiding medical jargon ensures Liam comprehends this rationale. For example, the nurse might say, “Even with antibiotics, bacteria can still be on your hands and get into the wound, slowing down healing or affecting others around you.”
Furthermore, therapeutic communication involves checking for understanding. Asking open-ended questions such as, “Can you tell me why you think handwashing might help now?” encourages Liam to reflect on the explanation and clarifies any misconceptions (Bramhall, 2014). This approach also aligns with patient-centered care, prioritising Liam’s involvement in his recovery process. While this method is generally effective, it is worth noting that some patients may resist advice due to frustration or lack of immediate visible benefits, a limitation that nurses must navigate with patience and persistence (Arnold and Boggs, 2019).
Ensuring Liam Demonstrates Correct Hand Hygiene Technique Before Discharge
Before Liam is discharged, it is imperative that he demonstrates competency in hand hygiene to prevent reinfection or transmission of MRSA. The nurse can follow a structured, evidence-based approach to achieve this. Initially, education on the correct technique, as outlined by the World Health Organization’s (WHO) ‘Five Moments for Hand Hygiene,’ is necessary (WHO, 2009). Specifically, Liam should be taught to wash his hands using soap and water for at least 20-30 seconds, covering all surfaces, including between fingers and under nails, before drying with a clean towel or disposable paper. The nurse should provide a step-by-step verbal explanation, supplemented by visual aids or leaflets if available, to reinforce learning.
Following this, a practical demonstration by the nurse allows Liam to observe the technique in real time. Subsequently, Liam should perform the procedure under supervision, enabling the nurse to provide immediate feedback on any errors, such as insufficient duration or missed areas. This ‘teach-back’ method is widely recognised in nursing education as an effective way to confirm understanding and skill acquisition (Kornburger et al., 2013). Repeating this process over several sessions ensures consistency and builds confidence. Additionally, documenting Liam’s progress in his care plan is vital for continuity of care, particularly if community nurses are involved post-discharge.
One potential challenge is that Liam may struggle to maintain compliance at home due to environmental factors or forgetfulness. To address this, the nurse could problem-solve with Liam, suggesting reminders such as placing handwashing prompts near his dressing change area. While this strategy shows a reasonable attempt at addressing a complex issue, it may not fully guarantee adherence, highlighting a limitation in infection control education that requires ongoing support (Loveday et al., 2014).
PPE Requirements for Nurses Providing Care to Liam
When caring for a patient with MRSA, nurses must adhere to strict infection control protocols, including the use of appropriate PPE to protect themselves and prevent cross-contamination. According to NHS guidelines and the Health and Safety Executive (HSE), standard precautions for contact transmission necessitate specific equipment (Public Health England, 2019). Firstly, disposable gloves are mandatory when handling Liam’s wound dressing or coming into contact with bodily fluids, as they act as a barrier against bacterial transmission. Secondly, a disposable apron is required to protect the nurse’s uniform from contamination, reducing the risk of transferring MRSA to other patients or surfaces.
In some instances, additional PPE such as masks and eye protection may be necessary, particularly if there is a risk of splashing during wound irrigation or if Liam exhibits respiratory symptoms that could aerosolise bacteria (Loveday et al., 2014). However, for routine wound care without such risks, gloves and aprons typically suffice under standard contact precautions. Importantly, PPE must be donned and doffed correctly to avoid self-contamination, following the sequence recommended by Public Health England: putting on apron, then gloves, and removing gloves first, followed by the apron, with hand hygiene performed immediately after (Public Health England, 2019).
A critical perspective reveals that while PPE is essential, its effectiveness depends on consistent adherence and correct usage, which can sometimes be compromised under time pressures in busy clinical settings (Loveday et al., 2014). Moreover, over-reliance on PPE without complementary measures like environmental cleaning can limit infection control outcomes, underscoring the need for a holistic approach in nursing practice.
Conclusion
In conclusion, addressing Liam’s care as a post-surgical patient with MRSA involves both patient education and stringent infection control measures. Using therapeutic communication principles, such as empathy and clarity, nurses can effectively explain the importance of hand hygiene, overcoming Liam’s initial resistance by fostering trust and understanding. Ensuring correct hand hygiene technique before discharge through demonstration, supervised practice, and problem-solving further equips Liam to manage his condition safely at home. Simultaneously, nurses must utilise appropriate PPE, including gloves and aprons, to protect themselves and others from MRSA transmission, while recognising the practical challenges of consistent adherence. These strategies, grounded in evidence from NHS guidelines and academic literature, highlight the dual focus on patient empowerment and practitioner safety in nursing practice. The implications of this discussion extend to broader infection control policies, emphasising the need for ongoing training and support to address limitations in both patient compliance and clinical environments.
References
- Arnold, E.C. and Boggs, K.U. (2019) Interpersonal Relationships: Professional Communication Skills for Nurses. 8th ed. Elsevier.
- Bramhall, E. (2014) Effective communication skills in nursing practice. Nursing Standard, 29(14), pp. 53-59.
- Kornburger, C., Gibson, C., Sadowski, S., Maletta, K. and Klingbeil, C. (2013) Using “teach-back” to promote a safe transition from hospital to home: An evidence-based approach to improving the discharge process. Journal of Pediatric Nursing, 28(3), pp. 282-291.
- Loveday, H.P., Wilson, J.A., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J. and Wilcox, M. (2014) epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86(Suppl 1), pp. S1-S70.
- Public Health England (2019) Guidance for the laboratory investigation, management and infection prevention and control of cases of MRSA. Public Health England.
- World Health Organization (2009) WHO Guidelines on Hand Hygiene in Health Care. WHO.
