PDT4170 Developing Professional Practice Module

Introduction

I have been in the nursing career for the past 20 years. After working in an orthopedic and surgical unit for 13 years, I took up the challenge to be a community nurse in the year 2015. Being a community nurse, I am required to manage the biopsychosocial needs and perform nursing skills for elderly patients in their homes. I have a great passion in caring for the elderly population and this inspired me to pursue my advance diploma in Gerontology.  With my years of experience, I am a resourceful nurse to my patients and my colleagues. I am clinically skilled and highly competent as a geriatric nurse. As a community nurse, we continuously evaluate our knowledge through competency checks, continuous education and quality improvement projects.

Community nurses conduct thorough assessment of patients in their homes and are equipped to bring hospital to home (Bhattacharya et al., 2020). We carry out investigations and nursing procedures at patient ‘s home or nurse post in senior activity centres. We are required to bring along laptops, medical equipment and supplies (Muhsin et al., 2020).  The luggage is the heartbeat of a community nurse. We ensure that all requites are available to cater to patient’s medical and nursing needs on site.

The purpose of this work-based project is to create a luggage that minimize challenges faced by nurses while delivering care in the community.

Acknowledgement 

I would like to take this opportunity to thank the Lord for giving me the strength and knowledge to complete this project. I thank my family for their patience, words of love and encouragement. My sincere thanks to my department supervisors for acknowledging the challenges and agreeing to proceed with the project. I thank my colleagues for participating in the project.

Topic: Design and implement a storage luggage cum portable multi- purpose workstation that minimize the risk and challenges faced by nurses while delivering care in the community.

Background 

According to the World Health Organization (2010) a well-functioning health system responds in a balanced way to a population’s needs and expectations by improving the health status of individuals, family and communities, defending the population against the threats, protect people with financial consequences, facilitate equal access to person- centered care and allowing people to participate in decision affecting their health and health system (Miller, 2020). Community nurses deal with patients and perform a vast number of skills outside the traditional hospital environment (Burch, 2011). In addition to the nursing skills, they are required to carry out screening and assessment. They provide education and training catering to the needs of patients and their families. The basic human needs are to be recognized as a person and importance of ‘being’ was recognized as a common aspect of personhood (McCormack and McCance 2016).

The community nurses conduct home visits for many patients who are bed bound requiring high care needs. Therefore, we are required to carry sufficient supplies such as medications, wound care products, education booklets or brochures in the luggage (Curl et al., 2017).  

The current nursing era involves the use of technology for documentation of assessment and   coordinate care and support between different services (Kelly, and Symonds, 2017). Thus, community nurses are required to commute with laptop, weighing scale and other medical equipment.

There are several challenges and risk involved while we are out in the community or patient’s home. We are faced with storage and operational challenges. Storage challenges include time taken to retrieve items, space limitations in patient’s home and lack of infection control especially in cluttered, infested homes (Cameron et al., 2012). The operational challenges include lack of clean area for nursing procedures and space need to use laptops or perform documentations.

Rationale for Initiating the Project

I work in the community nursing setting in a restructured hospital in Singapore. My job assignment in my department includes review of the luggage inventory list every 6 months. Currently, zip lock bags and pouches are used to categorize these items into a hard-shelled cabin sized luggage (Norman, 2015). Most of the pouch measures at an average range of 20cm x 25cm. The packing of luggage varies according to staffs’ preferences.

The community nursing team defined the luggage as a multi- purpose bag for carrying supplies in an orderly manner to patient’s home (Ziebarth, 2014). The luggage should allow nurses to provide care effectively to patients at their homes.  It identifies a nurse in the community because it serves as part of uniform.

In addition to the luggage, the nurses also carry a backpack containing additional items such as equipment for vital signs monitoring, gloves, sharps disposal box, laptop and brochure files. When a nurse is required to perform a nursing procedure, the entire luggage has to be opened up to retrieve the requites (Maurer, and Smith, 2012). The risk of lapse in infection control is high as all items are exposed in the work area and no clean area to perform nursing procedures. There is no available data of patients developing an infection from microorganisms brought into their home via nursing bag. However, there have been studies of bags being cultured and found multi-drug resistant pathogens on the outside and inside bags (Kenneley & Madigan,2009). According to Centres for Disease Control and Prevention, 2012 this can become a reservoir for infectious disease and poses a risk for transmission.   The weight of each luggage is about 7- 10kg. This is excluding the additional weight of the backpack.

Due to the load of the luggage and commuting from place to place, community nurses are exposed to occupational hazards such as back aches or physical exhaustion (Stanhope, and Lancaster, 2013).

The aim of the project is to minimise the challenges faced by nurses while delivering care in the community.

Evaluation on Personal learning Strategy

Prior to implementing the project, a discussion was held with the nurse clinician from community nursing team. The target of the project is for community nurses to hold a multi- purpose and ergonomically friendly luggage that can prevent occupational hazards such as back ache and physical exhaustion (Van Iersel et al., 2016). With this proposed innovative design, efficiency and comfort of community nursing can be improved by reducing time wastage in searching for items and limiting spread of infection. With the increasing community healthcare needs around the world, there will be a demand for such luggage to be used by community nurses (Mathieson, Grande, and Luker, 2019). As nurses of this current era, we have the responsibilities to keep a dynamic balance of health care needs in the society and advancing technology.

During my Masters in Nursing Programme, I was taught on several leadership and change management theories. The knowledge on these theories have given the knowledge and confidence to facilitate this work-based learning opportunity.

Reddin’s Theory of Planned Change

Change is the only permanent thing in the society. In case of any profession, it is crucial that change is accepted to help advance. In case of nursing as well, it is important the change is well embraced to help overcome the issues that one might have in their profession (Swann, 2012). Keeping the knowledge and skills up to date is important and that is what should be implemented in this case as well. A change that is to be implemented in a scenario like such would help the entire community and would bring about a positive effect over patient care. The change which is planned is full of purpose and collaborative in nature that helps to bring about improvements with the help of an agent of change. Reddin’s Theory of Planned change is based on the Lewin’s theory of change. It is a seven step theory and the steps include problem diagnosis, setting goals in a mutual manner, emphasis on groups, gathering the maximum information, implementation discussion, using rituals and ceremonies and interpretation of resistance (Graessel et al., 2011).  This theory was used in this case wherein the use of a functional luggage was targeted.

Diagnosis of Problem 

As mentioned before, in order to provide care to the people while they are not in a facility and very much in a community, the community nurses need to carry along a luggage with them containing the equipment. There are a number of issues that are often associated with the same. The community nurses of a hospital in Singapore had great challenges with handling of luggage before, during and after every patient’s home visit (Swann, 2011). One of the issues that they commonly face are the challenges in storage. The carry on that they have to move with needs regular packing and unpacking which is counter productive and requires a lot of time and effort for the nurses. This time is compensated from patient care and therefore should be reduced. In some cases, it is also observed that there is limitation in space in the patient’s house. Using laptops and performing documentation therefore becomes an issue when there is a lack of space. Due to this issue the nurses often cannot carry out their work in the most easiest way. In addition to this the storage of items often hamper their integrity or may get damaged due to travelling. For instance, the vials containing liquid medications may get broken causing loss of medication. The organisation of materials cannot also be done in the manner they can be done in a facility. Therefore, organisation cannot be done with respect to their expiry and therefore it can lead to further wastage of healthcare materials (Moynihan et al., 2012). In hospitals and pharmacies, the medications are arranged according to their expiry so that the ones who’s expiry are the nearest are kept in the nearest of reach. This cannot be done when carried in a luggage due to less space and inability to organise. Another issue with luggage for nurses is the problem with infection control. The infection controlling mechanisms that can be undertaken in a facility cannot be taken inside a luggage and therefore the risk of infection increases among the patients. Infection risks also increase as there is often lack of proper sanitised spaces in the house of the patients (Reed, 2012). As a result, the nurses are unable to provide a clean and sanitised area for treatment.

Mutual Setting of Objectives

The team comprise of nurse clinician and registered nurses from community nursing. A team meeting was organised to propose mutual objectives to improvise the luggage. The team meeting was held to ensure that the involvement of the whole team was available and inputs from each member could be taken into consideration. This is another important aspect of nursing leadership and has been well taken care of in this aspect. There has been a number of aspects which were taken care of while designing the luggage. The first consideration was the storage. The luggage was compartmentalised for easy access. In this was the nurse did not have to open the entire luggage to retrieve objects. This would ensure that there is less spillage within the luggage and the objects inside are better organised. This would further tend to the issue of sanitisation as a smaller number of objects would be exposed and hence it would be easier to keep them sanitised. There were a number of sections that were planned in the luggage which were different in size and structure catering to the requirements of the nurse. The material that would be used for designing the bag would be waterproof in nature. This would ensure that the luggage would be easier to disinfected. It should be surface disinfected with common disinfecting agents and would not hinder the quality of the material (Noureldein et al., 2021). Additionally, it should be able to withstand chemical and heat. Both of these agents are often used to disinfect materials within the hospital infection control policy. This would ensure that the luggage and all of its compartments are well sterilised and therefore a better infection free environment and treatment can be provided to the patients (Marjanovic et al., 2019). In addition to taking care of the disinfection aspect of the luggage it is also supposed to be functional and is supposed to provide the most functional space when there is not much available space in the house of the patient. In this case the luggage would be designed in a manner that it would have an attached work top which can be used as a desk for the nurses (Paul et al., 2012). They often lack place to perform documentation and the work top would work as a temporary table for the nurses. The desk should also be equipped with light so that even in case the environment is not well lit the functions can be performed without any issues. Along with these, there is also a charging port to be installed. This would be useful to charge equipment such as laptops and mobiles which are often a part of diagnosis and documentation for their portability.

Group Emphasis

The participation of every team member was deemed important for a successful implementation of a storage luggage cum portable multi- purpose workstation for community nurses. A collaboration was arranged with the innovation team for design and prototyping of the luggage (Swann, 2011). Importance of every team member was re-emphasized. There were regular team meetings to help generate the prototype of the luggage and to ensure that all the necessary requirements of the luggage were being met. The team was further subdivided into sub groups wherein different roles were provided to each sub group. All the members and all the sub teams were to brainstorm and provide for their ideas about the luggage design and prototype would be developed based on the same. Total 5 sub-groups were created with 2 members each.  They were named team A to E. Team A was responsible for gathering information and setting up the initial goal which was to be decided to be final by the whole group. Team B were to decide the budget of the luggage. Team C were to talk to vendors about the material and equipment that were necessary to generate the luggage. Team D were to be responsible for the assembly of the luggage. Team E would finally evaluate and test the item. The final decision was to be done with the help of all the members of all the teams.

Maximum Information

Team members were briefed about the aims of improvisation, ideas were exchanged, time frame and deliverables were discussed. The design and protype were finalised. The progress was updated to all team members periodically via emails to prevent uncertainty or discrepancies. The planning was done verbally and even documented to ensure proper implementation (Moe, Hellzen, and Enmarker, 2013). The documents and planned ideas were emailed to each member. Moreover, the progress was also emailed along with the next idea. The timeline was made and was strictly followed.

Discussion of Implementation 

The best ideas from all members of the team were included in the conclusion of work plan. Team members shared their creative ideas on having various compartments, ways for easy retrieval of items, creating workspace for documentation and maintain hospital infection control practices. All of the ideas were considered and the best was selected with proper voting and the ones which were backed with proper research. The cost effectivity was also ensured and thereafter the final decision was taken. The items from the luggage inventory list were revised. It was documented and the team responsible for the same went ahead to plan the objects accordingly. A coordinator was appointed who would ensure proper functionality of the project and would take decision wherein the team would be indecisive. A time chart was drafted during the brainstorming session with community nurses, project coordinator from office of innovation and vendors for luggage. The budget was planned and application for innovation grant was submitted. After the grant was received, the work was again planned to implement the luggage development.

Conclusion

Therefore, the above paragraphs conclude that given the type of work the community nurses perform it is important for them to carry a practical luggage to the patients. There are often a number of issues that they face while providing care to the patients at the comfort of their homes. There are always associated risks of infection and spillage in the common luggage bags that are used by them. Moreover, due to a lack of space it is often difficult for the nurses to carry out documentation in the patient’s homes. Therefore, the development of a multipurpose and functional luggage would be helpful for them. In this case the luggage that was developed was made out of water and heat proof material. It was further designed to be light in weight and having a number of compartments for the objects required for care to be carried in. The luggage could also be used as a table as and when required. In totality the development of the luggage and its assessment helped us realise that is was a practical and applicable piece.

References

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