Reflective Note - swabbing for MRSA & VRE
Hi guys.
I am still alive and well. One of the most extraordinary things that has happened since my last post is the weekend where Mike’s parents caught us. However, I am not going to be writing about that. I am in the school library working on my 8-10 page frail elderly paper.
Today I have been productive finishing up a reflective progress note on my clinical experience from last week:
On Thursday April 3rd, 2008 I came in feeling comfortable with the idea that I would be doing a glucometer with a resident. Little did I realize that I would be giving oral meds, and a narcotic at the same time.
In addition to the skills mentioned above, I also had the opportunity to perform a specimen collection procedure, before the verbally arranged time to write the clinical math quiz. While at the nursing station, the R.N. on the floor was nice enough to inform me about a swab procedure that needed to be done on a newly admitted patient. She asked if I would like to do it. I asked her about the length of time it would take, and found out it would take only 30 seconds. Considering I had at least 15 minutes before I needed to meet with my mentor about the math quiz, I accepted the offer. The R.N. was considerate enough to ask if she could be present during the procedure, but I suggested that I thought it would be best that my mentor be present instead. This way, she could document it on my skills checklist. After tracking down my mentor, I explained to her about the swabbing opportunity that came up.
I knew swabbing would be a valuable opportunity to me, and appreciated my mentor adapting to an unforeseen situation that came up. The learning experience equipped me to be ahead of the game, because I have not yet been taught how to properly carry out a swabbing procedure in the lab. Due to this reason, I was scared because I was not sure exactly what I was supposed to do. I am definitely glad that my mentor was there to supervise my steps during this critical learning experience. If she was not there, I would have experienced a great deal of distress. There I was standing, facing the resident, from the resident’s right side, while my teacher was holding my resident’s left hand. Still facing the resident, I told the T.V. I would swab her left nare first. After saying this, I realized when I mentioned “left nare”, it was actually from my left, which was actually the resident’s right nare when she sits facing me. Due to my misjudgment, the mentor had to get up and move to the resident’s right side. In my mind I thought of myself as an idiot.
I caused an extra unnecessary step for the resident to see. Good thing it was not a life threatening step. After my mentor moved, I was on T.V.’s left side. My first swab involved me putting the swab stick into the resident’s left nare and moving the swab stick in a circular motion. The second swab went into the patient’s right nare when I was on the resident’s right side. Somehow I could not get the stick in very much, and did not know why. My mentor decided to take the stick herself. She mentioned something about blockage. I don’t remember the reason for this, but the mentor managed to get the needed swab. Afer doing the nares, I became scared about the thought of doing a rectal procedure. The thought of me performing an invasive procedure became real and terrifying in my mind. After the resident took off her pants, the lady’s bottom was exposed. Up until this point in all my clinical practice, I had never had to see a resident’s rectal area up close. A part of me wished that my mentor would do it, but I knew if she did, I would not gain the experience. I had to locate the target spot to insert the first swab stick. Once the stick went in, I learned from my mentor that the stick was not in far enough. My mentor assisted me with this. The fourth and last swab went into the resident’s rectum, and once it was over, a huge weight was lifted. Having my mentor’s presence to monitor my steps at this time helped ease my discomfort. I even had the chance to bring the specimen down to the lab specimen refrigerator on the main floor. If my mentor did this step herself, I would not have seen what happens to the specimen after it gets collected by a nurse. This was a positive experience that was more than what I expected. Since I contributed to the screening process for methicillin resistant staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE), I developed an interest in doing a little bit of reading on the topic. Both MRSA and VRE are causing an increased proportion of nosocomial infections worldwide. According to Green and colleagues (2002), “Adherence to province-wide control programs have led to decreased rates of nosocomial MRSA in Ontario” (http://microbiology.mtsinai.on.ca/publications). It is my understanding from reading BCHealthFiles, that VRE are not easier to catch and do not cause more severe infections than other enterococci bacteria. It is important to screen for VRE because “the antibiotic vancomycin is sometimes the only antibiotic that can treat serious infections caused by some enterococci bacteria. Therefore, serious infections caused by VRE may be very hard to treat because they are resistant to vancomycin.” Utilizing my knowledge from last semester’s theory class, both MRSA and VRE can be transmitted through contact. The facts state that the microorganism lives 20 minutes on objects for MRSA, and up to 9 months for VRE. If the lab results determined that my resident has either MRSA or VRE, infection control would be a topic that stands out strongly in my mind. I believe that wearing a gown and glove when in contact with any infected area would be necessary. It would also be wise to have gown and gloves when giving direct personal care. Hopefully the results come back negative.
Last week, when I found out about the possibility about me performing a new skill, for a few seconds I was ecstatic at the thought of me being presented with a skill that my mentor can document on my skills check list. Next time in clinical, I would first be cautious of the client’s preferences before becoming excited. When I talk about preferences, I am referring to the client’s level of comfort with a male performing the invasive procedure.
Since I have seen it done before, I am familiar with the steps involved with swabbing, from opening the packaging, to the actual swabbing, putting the swab stick in the tubing, and storing the specimen. I intend on the swabbing procedure being a little quicker.
Did anyone read all the way to the end? I know it’s long.