This this communication is primarily interpersonal; the



   This essay will
attempt to explore and analyse some of the key building blocks to what makes a good nurse. Hero to most nurses,
Florence Nightingale said that a good nurse is to be a good woman, that is she
should have the following qualities: Quietness, gentleness, patience, endurance
and forbearance (Nightingale, 1881). In 2015, the NMC (Nursing & Midwifery
Council) published their annual equality and diversity report and stated that
36% of the UK nursing workforce are now male (NMC, 2015) making the infamous
Florence Nightingale’s definition rather dated and inapplicable to today’s
practicing nurses. McLean (2011) gave his definition of a good nurse to Nursing
Times by comparing it to the film “The Wizard of Oz”; Dorothy’s three
companions in the film represent her anxieties that she does not have the
“heart”, “nerve” or the “brain” to be the person she wishes to be. He suggests
that being the good nurse that you wish to be requires that you have heart,
brain and courage. Many people would agree that today’s frontline nurses have
these qualities.


   The first half of
this essay will focus specifically on communication within nursing, one of the
highly-valued ‘six Cs’ of nursing that came about after the Francis report of
the Mid-Staffs hospital and its disgraceful quality of care delivered by its healthcare
professionals. Infection control, another essential element of the nursing
profession will also be analysed, including its importance, relevance and various
techniques to achieve it.


   A staple book for
any student nurse; The Royal Marsden Of Clinical Procedures answers the task of
defining communication as a universal word with many definitions, many of which
describe it as a transfer of information between a source and receiver (Kennedy
Sheldon, 2009). In nursing, this communication is primarily interpersonal; the
process by which information, meanings and feelings are shared through the
exchange of verbal and non-verbal messages between two or more people (Brooks
and Heath, 1993, Wilkinson, 1991). Sully et al, (2010) shares similar views on
what communication is, they say that ‘all of us practise skills in
communication. Communication skills are transferable across different walks of
life and different practice circumstances. Communication is a complex process.

It involves a number of interacting factors: (1) physical, e.g. someone with
dementia; (2) psychological, e.g. an anxious student and (3) social, e.g. a new
mother in her home. How we as practitioners respond in each unique situation
requires skilled thought. Effective communication, therefore, requires
self-awareness, attention to the unique nature of this episode and a
willingness to respond sensitively and flexibly by the use of verbal and
non-verbal skills.’


   These definitions
clearly highlight the importance of effective communication in the nursing
profession. Even from the get go, such as introducing yourself correctly and
competently to a patient is essential to build a trusting and effective nurse-patient
relationship. A project called ‘#Hellomynameis…’ was created by Dr Kate Granger
MBE & her husband; Chris Pointon to improve compassionate care in
healthcare after she received poor communicative care herself when she was
suffering with cancer. She felt like her care wasn’t very personal and didn’t
know the names of the healthcare professionals caring for her. An extension of
the campaign is how a simple introduction is the first step on the ladder of a
therapeutic relationship (Granger and Pointon, 2014). Hellomynameis was even
mentioned in the Government response to the Francis report (Granger and
Pointon, 2014).


   In the required
reading of the NMC Code that all nurses and midwives must follow, point seven
is ‘communicate clearly’. To achieve this, you must: ‘7.1, use terms that are
in your care, colleagues and the public can understand. 7.2, take reasonable
steps to meet people’s language and communication needs, providing, wherever
possible, assistance to those who need help to communicate their own or other people’s
needs. 7.3, use a range of verbal and non-verbal communication methods, and
consider cultural sensitivities, to better understand and respond to people’s
personal and health needs. 7.4, check people’s understanding from time to time
to keep misunderstanding or mistakes to a minimum. And finally, 7.5, to be able
to communicate clearly and effectively in English’ (NMC, 2015).


   One particular, interesting
method of communication to aid young people with learning difficulties is Makaton.

Makaton is the UK’s most popular recognised communication system for people
with learning difficulties and it is used by more than 100,000 children and
adults. Makaton is a language programme using signs and symbols to help people
communicate. The programme is designed to support spoken language, and the
signs and symbols are used with speech in spoken word order (Makaton Charity,
cited in J, Vinales 2013). Ferris-Taylor (2007) suggests that the importance of
being able to communicate with healthcare service users and families is paramount.

Nurses can do much to reduce the impact of communication difficulties. Mencap
(2004) highlighted the importance of communicating with individuals with
learning disabilities in their published ‘TreatMeRight!’ document which found
that three quarters of healthcare staff in the UK had no training in
communicating specifically with people with a learning disability, and therefore
could not understand them. Vinales (2013) established that during the
evaluation after an introductory lesson of Makaton to second year nursing
students in a university in Birmingham, the students were asked whether or not
it would have been beneficial to have had a Makaton session in their first
year. Eighty-five per cent of respondents said they would have liked a Makaton
session in year one of their training, to help when meeting clients, families and
carers who use the system.


   My first placement
as a student nurse was with the charity mentioned, Mencap. I was placed in two
sites: a two-female household with varying learning disabilities and a much
busier five-male house. I did some research into Makaton prior to the placement
in case any of the tenants used it as a form of communication or as an added
layer of language on top of verbal communication. Once on placement, I
discovered that none of the tenants used Makaton, but on reflection I am very
glad I did some research into the topic as I now have a few basic words and
hand signals I could use in the future if I came across a Makaton-user and I’ve
learnt it is not a form of sign language but it’s a visual prompt for
particular words to assist people with learning disabilities to communicate if
their verbal communication is affected by their learning disability.


   On placement with
Mencap, I very quickly adapted and learnt how to read non-verbal communicative
signs from the individuals under their care from my four weeks. I read
everyone’s health files and care plans to get a basic understanding of their
learning disabilities and any accompanying mental, physical or medical issues
that needed to be addressed.


   Toocaram (2010)
supports and further enhances Mencap’s ideology by saying that every conscious
person can communicate regardless of the severity of their disability. She goes
on to suggest that if nurses can embrace and practice a total communication
approach with vulnerable groups of people including the elderly, children,
people with learning disabilities, people with mental health problems, the
physically disabled and people with sensory deficits, then they should be able
to communicate well with everyone else.


   Within the practice
of communication, barriers and challenging issues sometimes arise. One
difficult issue to address is communicating with a patient displaying anger,
aggression and violence. Duxbury and Whittington (2005) suggest that nurses are
likely to be exposed to anger and aggressive behaviour during their practice.

Anger is felt or displayed when someone’s annoyance or irritation has increased
to a point where they feel or display extreme displeasure (Adams and
Whittington, 1995). Gudjonsson et al (2004) proposes that people often get
angry when they feel like they’re not being heard or when their control of a
situation and self-esteem are compromised. He suggests that many health
professionals are unfortunately renowned for failing to acknowledge patients as
people and this can stimulate an angry and arguably legitimate behavioural
response. Dougherty and Lister (royal marsdennnnn page 220) suggest that people can become angry
when they feel they have not been communicated with honestly or are misled
about treatments and their outcomes. To prevent people’s frustration escalating
into anger or worse, health professionals need to ensure that they are
communicating with people openly, honestly and frequently.


   Infection control
is certainly a well-discussed topic in the world of healthcare. According to Hayley
et al (1985, cited in Wilson, 2006), ‘infection is a common but often avoidable
complication of healthcare which has a major impact on the patient and the
health service. It has been estimated that up to one-third of hospital-acquired
infections could be prevented by improved infection control practice.’ The
Health and Safety at Work Act (1974), a document that every organisation/business
must adhere to and display advises that patients are most at risk but
healthcare staff are also legally obliged to take reasonable and practicable
precautions to protect themselves, other staff and anyone else who may be at
risk in their workplace. Therefore, infection control is an area of healthcare
which helps to protect everyone and is a critical part of care delivery. The
RCN (2010) define infection prevention and control as the clinical application
of microbiology in practice. Wilson (2006) suggests that ‘patients receiving
healthcare are at an increased risk of acquiring infection due to invasive
procedures, devices or conditions that impair normal defences against
infection. In addition, the healthcare environment provides plenty of opportunities
for micro-organisms to transfer between patients and for antimicrobial
resistant strains to emerge and spread’.


   As mention above,
the NMC Code (2015) which is adhered to by all nursing and midwifery staff in
the UK also contains its own guidance on infection control: ‘19.3 keep to and
promote recommended practice in relation to controlling and preventing


   Infection control
is so important and its need to be regulated that Ward (2016) states that every
single NHS organisation in the UK has to have a team of people responsible for
infection prevention and control (IPC). This team has a variety of roles within
the organisation, but work together to support its IPC infrastructure and
services, reporting results, findings and current legislation to the Trust
Board and the chief executive. Ward also informs us that within NHS
organisations, someone is designated as the infection control doctor. This
might be the consultant microbiologist, public health doctor or an infectious
diseases consultant. Whoever this is, they are seen as the lead for the IPC
team and often chairs an infection prevention and control committee and liaises
closely with an appointed IPC nurse. Evidently, infection prevention and
control is a highly regulated and practiced aspect of healthcare for the NHS.


   One of the most
talked-about topics within infection control is hand hygiene. Wilson (2006)
suggests that the hands of healthcare staff are the most common vehicle by
which micro-organisms are transmitted between patients and hands are frequently
implicated as the route of transmission in outbreaks of infection. Research
into staff hand hygiene has been carried out multiple times through history.

One particular case carried out by Gorman et all (1993) found that over a
period of one month, the same type of Klebsiella pneumoniae bacteria was
isolated from the respiratory secretions of six patients in an intensive care
unit. Four of these patients developed infections caused by this organism. The
source of the organism was found to be in the condensate from ventilator tubing
which collected in a foil dish which was emptied by respiratory nurses when
full. Although hands were washed after contact with tracheal secretions, they
were not washed after contact with this condensate, therefore, spreading the
bacteria and infecting the other patients.


   Ward (2015)
suggests that hand hygiene/decontamination (including both handwashing and the
use of alcohol hand rub) is the most important intervention in the control of
cross-infection due to the fact that most cross-infection in healthcare
settings is caused by the transfer of micro-organisms on staff hands. The World
Health Organisation (WHO, 2009) identified five key moments when a nurse should
be decontaminating their hands, these are: Before touching a patient, before
clean/aseptic procedures, after body fluid exposure/risk, after touching a
patient, and after touching patient surroundings. It is clear that these
organisations to protect the health of the people are wanting nurses to
constantly consider if their hand hygiene is kept.


   To efficiently wash
the hands and kill any infectious organisms, Lucet et al (2003) suggest that
simple mechanical washing of the hands with soap and water will achieve this.

Ward (2015) outlines this process in the following steps: Wet hands under
running water, apply soap, wash all areas of the hands, rinse soap off fully
and finally, completely dry hands. Ward also summarises to us the commonly-used
specific technique of fully decontaminating the hands, knows as the Ayliffe
technique, developed in 1978. The Ayliffe technique was developed after the
knowledge that healthcare staff were missing certain areas during handwashing,
in particular, the thumbs, tips of the fingers, between the fingers and thumbs
and the wrists. The newly developed technique ensured that all areas of the
hands are fully decontaminated. It is common place to see he technique printed
and placed by the majority of hand-washing sinks/stations in NHS organisation
for staff, patients and family to follow to correctly decontaminate their hands
and protect everyone from potentially harmful infectious diseases.


   In 2005, the
National Patient Safety Agency told us that there is an ever-increasing
interest in the value of alcohol-based hand rubs for routine hand
decontamination. They found that 60-95% alcohol solutions are rapidly micro-biocidal
and active against Gram-negative and positive bacteria, fungi and some viruses.

Although there is doubt about their efficiency against non-enveloped viruses.

There is also evidence to suggest that alcohol gels are ineffective against
spores and should not be relied on for routine hand-washing after contact with
patients with Clostridium difficile (commonly referred to as C. diff) (Hoffman
et al 2004).


   It was always
believed that to efficiently wash hands and kill off any potentially harmful
organisms, the temperature of the water should be as hot as you can comfortably
take it, at least 38°C for
effective decontamination (National Restaurant Association Education
Foundation, 2006). But only last year, research was done into hand washing water
temperatures by Rutgers University and GOJO Industries. NHS Choices (2017)
published a document with the findings that the study found using colder water
(15°C) was just as effective
at getting rid of bacteria as using hot water (38°C).

Contrary to current guidelines, which recommend using hot water when we wash
our hands, this study found using colder water (15°C) was just as effective at
getting rid of bacteria so perhaps guidelines and legislation will soon need


   Prior to joining
this adult nursing course, I was a dental nurse for three years in an NHS
practice and infection control was paramount in that setting too. The donning
of gloves for every patient, sterilisation of instruments, the decontamination
of the surgery between patients and checking water lines for legionella were
just some of the infection prevention and control measures dental nurses
undertake every day, but one incredibly important measure I took was to avoid a
needle-stick injury. As the practice was an NHS service, I nursed patients from
all backgrounds and walks of life including patients with blood-borne viruses
such as hepatitis C and HIV (Human Immunodeficiency Virus). As dental nurses
are constantly handling sharp instruments, anaesthesia needles, scalpels and are
regularly aspirating blood from the mouth during dental procedures,
needle-stick injuries are one of the top incidents to avoid. For this reason, a
sharps policy was in place.


   ‘Sharps’ include
needles, scalpels, broken glass or other items that may include a laceration or
puncture. Sharp instruments frequently cause injury to healthcare workers and
are a major cause of transmission of blood-borne viruses (Health Protection
Agency 2005). The National Audit Office (1999) tell us that sharps injuries account
to 16% of occupational injuries in hospitals but many more go unreported so the
figure is likely to be much higher. Ward (2015) tells us that for this reason,
in 2010, European employment ministers agreed a directive aimed at preventing
sharps injuries in the healthcare setting. This became UK law in May 2013 in
for form of The Health and Safety (Sharps Instruments in Health Care)
Regulations 2013. The new regulations put most of the responsibility onto the
shoulders of the employers, it said that those practicing with sharps such as
nurses need to control the risk by practicing safely, including the following:
Not resheathing or recapping needles, not bending or breaking needles, to
dispose of sharps immediately after use, wear gloves while handling sharps
(while these cannot prevent injury, there is evidence that the glove actually
removes a significant portion of the blood from the needle prior to in entering
the skin during an injury), disposing of needles/sharps and syringes/holders as
one unit rather than disassembling after use and proper to disposal and finally
to use safer sharps devices where available and provided.


   If, unfortunately,
a needle-stick/sharps injury does occur, there are procedures set in place by
the trust/organisation. The NHS’s procedure (2015) goes as follows: ‘If you
pierce or puncture your skin with a used needle, immediately follow this first
aid advice: Encourage the wound to bleed, ideally under running water. Wash the
wound using running water and plenty of soap. Don’t scrub the wound while
you’re washing it. Don’t suck the wound. And finally, dry the wound and cover
it with a waterproof plaster or dressing.’ It is then recommended the injured
participant seek urgent medical advice either from occupational health or A.

A risk assessment will need to be completed to assess possible blood-borne
virus contamination based on how, when it happened and who used to needle. Once
this is done, usually a blood test will be required to check for HIV and
hepatitis B and C. Blood tests may also be required from the other person’s
blood, with their consent.