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Introduction
In this essay, I aim to reflect on an incident which I observed during my first year clinical placement. Reflection is about learning from your experiences and I think is a crucial part of my learning experience as it helps to recall how I felt and acted and allows me to gain a deeper insight and knowledge into my experience on placement. Although reflection is more centralised around trained professions, it’s vital in all aspects of a person’s life (Lishman 2015). I will be using Gibbs’ Reflective Cycle (1988), it is one of the most well-known reflective cycles and it helps the person reflecting as it has six distinct stages: description, feelings, evaluation, analysis, conclusion and action plan (Howatson-Jones 2016).

Description
I was working during my first clinical placement in Medical 2 and was looking after a sixty-year old gentleman, Mr. Murphy (pseudonym) who was after having replacement knee surgery a couple weeks beforehand. My preceptor was out on this day, and I was assigned to work alongside a different registered nurse on the ward. The doctor had given the clear to remove the clips from the wound, and the nurse I was working with was going to remove them. I decided I would observe as I thought it would help benefit me for when I studied it in college. I was talking to the patient as the nurse went to gather everything she needed. Before she came into the room she went into one of the other bays to help another patient. I noticed when she came into the room she put on PPE, but she never washed her hands or used alcohol gel. I thought about what to do or say, but by the time I had built up enough courage to say anything to her, she had already started removing the clips from Mr. Murphy’s wound. She didn’t use an aseptic technique while removing the clips or dressing the wound, and I recalled about being taught the five moments of hand hygiene in my Skills lab in college.

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Feelings
I was in total shock by this. At the time of the incident, I had many thoughts going through my mind and I didn’t know how to react. I had thought that the nurse would have washed her hands before doing the procedure, especially since she had been with another patient beforehand. I knew it was wrong, but I felt too intimidated to say anything because she was a nurse who had years of experience and I was only a first year student nurse. As expressed by (Pittet and Allegranzi 2009) hand hygiene is the biggest act to prevent the spread of healthcare associated infections such as MRSA and Clostridium difficile. I couldn’t understand how a skilled and experienced nurse could compromise a patient’s health and safety. The following day I spoke to my preceptor and she decided that we should speak to the nurse together. I felt at ease knowing my preceptor was with me, when she questioned the nurse she admitted to not having washed her hands as she completely forgot to. My preceptor stated to her the importance of hand hygiene and an aseptic technique while dressing a wound, she then assured us that it would never happen again, and it was mistake on her behalf.

Evaluation
This incident was very difficult and testing for me. There was both good and bad things during this experience, the bad thing is that the patient was put at risk, which is unacceptable. I’m disappointed that I didn’t stop the nurse before she started the procedure on Mr. Murphy, I should have stood up to her and been more assertive. Although the unfortunate event, I am pleased that the nurse has now changed her habits and performs adequate hand hygiene which is a good thing. This incident has been very useful as I have learned from the nurse’s mistake and also from the weak communication I had with the nurse.

Analysis
(Mathur 2011) states that in most clinical areas, obedience to the suggested hand-washing routine remains excessively low. I think that I should have been more assertive with the nurse and made sure she washed her hands, even as a student nurse it was my responsibility to ensure the patients health was priority. Good hand hygiene is the most significant, easiest and cheapest way to prevent healthcare associated infections (Tschudin-Sutter et al. 2010), so in future, I think to prevent these infections nurses should always perform good hand hygiene. As part of the five moments for hand hygiene nurses must perform hand hygiene before clean/aseptic techniques (World Health Organization 2009). If the nurse was in a rush to attend the Mr. Murphy she should have made sure that she had performed the appropriate hand hygiene first and then apologised for running late when she got to him, his health should not have been endangered.

Conclusion
It’s clear to me that I should have acted sooner and stopped the nurse to make sure she washed her hands before starting the procedure. I realise that my absence of action during the incident put Mr. Murphy’s health at risk. I can see that I must try and grow my confidence in the clinical area, particularly communicating with my colleagues. I needed to keep Mr. Murphy’s wellbeing at the front of my mind as he was the priority, and when I saw poor practice being carried out I should have intervened before it was too late. Although hospital staff shortages which accelerate the intense pressure staff are under (Teng et al. 2010) they do need to be reminded when doing something wrong to prevent patients’ health and safety being put at risk.

Action Plan
In the future I will be more assertive and ensure the health of patients and clients is made the priority. I think I need to develop my assertive skills and be able to stand up to other nurses when they’re in the wrong, whether I’m a student nurse or once I become a registered nurse. Nurses in the clinical area need to be aware of the risks of bad hand hygiene and how essential aseptic technique is when handling and dressing wounds and I will make sure I practice these skills when needed in the clinical area.
Conclusion
I think this experience has had been both good and bad, undeniably, I have learned the importance of hand hygiene and aseptic techniques in the clinical area. It has aided me to identify the importance of practicing the skills that I have learned in college in the clinical area. After completing this essay, the Gibbs Reflective Cycle has helped me to analyse my feelings and the overall experience which will certainly help me in the future.

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