Washing Journal Reflective Journal Awareness:

¶ … Washing Journal Reflective Journal Awareness: Learning to think and gain insight into how to solve a problem As a nursing student I am committed to learning skills, procedures, rules, guidelines, regulations and theories of healthcare. I know I am here because I want to make a difference in people's lives. So if I really am committed, I must learn more than what I mentioned in my journal above. I must learn to be creative, and to think "outside the box" of healthcare industry and patient care expectations.

One of the problems I saw in high school classes and in some of the college classes was that instructors and professors did not teach us how to think, or how to solve problems. Too often it came down to studying for the test, memorizing material, and "learning" how to get a certain grade depending on our ambition.

The other problem was, no teacher I had in any of my classes was very emphatic in showing students how to do the research needed to complete assignments - and how to look at the solution to the problem a better way, through researching strategies that others have followed in their search for solutions to other problems. So I am going to approach the issue of setting up a hand-washing program in a middle school.

I am going to very carefully embark upon a creative strategy for setting up a program which will address how to solve the problem and how to make it fun for kids in the process.

Awareness: Here is the problem broken down: one: many students are not washing their hands after using toilet facilities; two: bacteria and viruses are commonly known to be carried and passed on through hands; three: "hand-washing is the single most important intervention to prevent the spread of disease" (Sindt, 2006); four: "Effective health behavior intervention has been hampered by inadequate insight into the nature of change" (Duran 2003); five: I am very new at devising a strategy to solve a community health problem. May 26, 2006.

Critical Analysis: doing the research: Before I research the problems of kids not washing hands and the health care realities associated with that, I need to research behavioral changes specifically related to nursing theories. In doing that, I found a helpful article in the Journal of the American Academy of Nurse Practitioners (Duran, 2003).

The process of health behavior intervention, Duran writes, is "traditionally conceptualized" as a "dramatic shift from one behavior to another"; but too often, this strategy "can actually impede the process" since an "expert" handing down advice to "the relatively passive client" is often "ineffective." In other words, nurses and doctors too often think that just because they are respected purveyors of health care knowledge, their patients (clients) are going to change behavior upon being given advice.

But by using the Transtheoretical Model (TTM), Duran continues, a health care professional can employ an "incremental, continuous, and dynamic process" along a "continuum" in order to establish clear and definable stages of change. So, first, I want to first find out what kinds of other problems TTM has been employed. When I typed "Transtheoretical Model" into "advanced search" in the database "EBSCO," 104 articles came up.

Not all were relevant, of course, but some were really interesting: TTM has been used (in empirical research projects) to solve problems involving "debt reduction"; obesity; smoking; "Fruit and Vegetable Consumption among Male College Students"; alcohol abuse; "non-adherence" to mammography screening in older women; "partner assaultive men"; condom use among bisexual men; and many more. May 27, 2006.

Critical Analysis: the need for hand washing: In March, 2006, an article in Review of Cornea & Contact Lenses (Sindt 2006) addresses symptoms of avian influenza in humans (which include fever, sore throat, conjunctivitis, pneumonia, among "other severe, life-threatening complications).

While the point of the article I read is that infectious disease journals suggest avian flu may enter the eye first prior to "invading the respiratory system," it is also mentioned, and I am now cognizant of this, "numerous epidemics have been traced to contaminated hands of healthcare workers." Not just to students, not just to male fans at baseball games using common toilets, but to healthcare workers. "Compliance with hand-washing guidelines...in most healthcare settings does not usually exceed 40%..." The article states.

We have a big problem here if our own professionals don't wash their hands. Another study (Nursing Management, 2006) I found reports that even "hand-cleaning initiatives are in vain because nurses risk spreading infection by wearing dirty uniforms" in Northern Ireland. The problem is "too few outfits, poor changing facilities," and more. Amazing, I think to myself, that people in the healthcare industry aren't able to or willing to observe proper hygiene.

Next I read an article in Social Behavior and Personality journal (Monk-Turner, et al., 2005), which reports that while the "vast majority (95%)" of students at a "major university" said in a study that they washed their hands regularly after using the toilet facilities, a much smaller percentage actually did wash hands. The study found that of 410 students observed in university rest rooms, 85% of the women washed their hands, while only 69% of men washed hands.

Within the total of 313 who "washed hands," only 64% used soap (120 women; 81 men), and a mere 10% washed for 15 seconds or longer (which is what the Center For Disease Control recommends). A wondered, if college students aren't very good at washing hands, how are middle school students going to be persuaded to perform this most basic act of good health? And I know I must proceed not by lecturing students because I'm so smart, but through logical, practical stages. May 28, 2006. New Perspective: TTM strategies present scary data creatively.

Working with school district health professionals, and a nurse, counselors, faculty and administration from a middle school, I begin to devise a creative program for hand-washing, kicked off with a school-wide assembly.

But meanwhile, the first stage of TTM-directed change for my middle school nursing project is Precontemplation; teachers in all classrooms first period will hand out a simple but professionally-thought-out questionnaire on "How We Get Sick," which in all likelihood will show a lack of knowledge on the part of kids regarding the health risks inherent in not washing hands. The second TTM stage, contemplation, will actually take place during the school assembly (alternatively, a video could be prepared and shown in classrooms).

These data will be entertainingly, creatively, professionally presented through a powerful multi-media project produced in-kind by our local university's film arts department. The multi-media project will show in graphically unforgettable style that empirical scientific studies reveal that "as many as 2.7 million bacterial cells per square inch" are found "on common school surfaces such as water fountains, desks, computer keyboards, bus seats, and cafeteria trays" (Journal of Environmental Health, 2006).

Drinking water fountains had the "highest amount of bacteria" - 2.7 million bacterial cells per square inch; a cafeteria tray has "more than 10 times as many germs as a toilet seat (33,800 bacterial cells vs. 3,200 bacterial cells)"; a student's hand had 1,5000 bacterial cells. The preparation stage will take place at the end of the assembly, when a plan for change is presented. The action stage plan which I worked out this evening (May 28), will be to.