Hand washing is a skill. More precisely, effective hand washing is a skill. It can be taught and learned. Effective hand washing can be evaluated and analyzed because it is a skill with well-defined steps of execution. This paper presents an analysis of hand washing as skills. It features the steps involved in hand washing, measurable dimensions of behaviors in hand washing, sampling techniques in the analysis of hand washing, observation schedules, and the methods of presenting data among other dimensions of hand washing.
Hand washing is comprised of various behaviors. The following is an outline of the behaviors that comprise hand washing. One of the environmental cues that stimulate hand washing includes the presence of flowing water on a faucet in a sink and soap. One cue to wash hands includes visual cues encouraging hand washing, multimodal reminders for hand washing placed in convenient locations and on the line of sight (Nevo et al., 2010).
Step two: the second step involves putting the hands in the flowing water.
Step three: the third step involves pumping the liquid hand washing soap on one hand.
Step four: the fourth step involves rubbing the hands together in order to form the foam.
Step five: the fifth step involves placing the hands under the flowing water in order to rinse the soap off the hands.
Step six: the sixth step involves turning off the faucet in order stop the water from flowing.
Step seven: the seventh step involves retrieving a paper towel from the dispenser that is conveniently placed in proximity to the sink.
Step eight: the eighth step involves dried the hands with the paper towel and disposing of the used paper towel appropriately.
Target Outcome Behavior for Step Four
The fourth step involves rubbing the hands together in order to form the foam. This step involves other elements that inform the target outcome behavior. Firstly, the target outcome behavior involves rubbing both hands together for between twenty and thirty seconds (World Health Organization, 2009). The period for which the hands are rubbed together is one of the measurable terms. It should not be less than twenty seconds. Observable things during this step include scrubbing all the surfaces on the hand. The specific actions that should be observed as part of the target behavior change include scrubbing the back surface of the hands. This should be done with both hands. Additionally, surfaces such as the wrists, and the spaces in between the fingers should be scrubbed thoroughly. For people with long nails, scrubbing under the fingernails is also one of the observable items in the target behavior change (World Health Organization, 2009).
Effect of Measurable Behavior Dimension on Target Outcome Behavior
The identified measurable dimension in the hand washing task is the length of time for which the hands should be rubbed. The identified measurable dimension has an effect on various elements of the target outcome behavior. Firstly, the length of time for which the rubbing of hands is done affects the duration of the hand washing exercise. The recommendation by the World Health Organization (2009) is that the entire hand-washing exercise should take between forty to sixty seconds. By spending and entire thirty seconds scrubbing the surfaces of the hand, an individual is likely to spend at least the recommended forty seconds washing their hands.
The environmental cues and stimuli have an effect on the latency and the inter-response time. A high number of environmental cues reduce the inter-response time by making hand-washing more frequent. The availability of the facilities and materials that are required for the hand washing exercise affect both the rate and the latency of the target acquired behavior. The availability of sinks where individuals can wash their hands reduces the time between when an individual gets the stimulation to wash their hands and the time they wash their hands. The availability of these facilitates and materials also increase the rate at which the opportunities for hand washing are utilized.
Advantages and Disadvantages of Continuous versus Sampling Techniques
In the analysis of the hand washing exercise, on can elect to one of the many techniques to collect the requisite data. Using the continuous method has its advantages in that it allows one to observe the entire hand-washing exercise. The entire interval recording of the hand washing exercise gives the analyst more data, especially on elements such as the effectiveness of the hand washing method used. On the other hand, partial recording only gives information regarding the interval of the hand washing exercise that was recorded. The disadvantage of this method is that inferences can only be made for the interval in which recordings have been made. Alternatively, an analyst can use the momentary time sampling (Matson, 2009). One of the advantages the analyst does not need to attend to the behaviors of the individuals involved in the hand washing exercise for the entire period. The method of recording is also relatively easy to implement considering the fact that that it is done at particular intervals rather that continuously. Some of the advantages include the fact that one can easily underestimate the behavior of those being monitored. This is because the behavior being monitored may end before the interval for which the recording is being made (Matson, 2009).
The determination of the observation schedule in the analysis of hand washing is dependent on several factors. For the purpose of the targeted behavior, in this case, the most appropriate observation schedule involves eight observation sessions in a day. The eight sessions are distributed throughout the day. Additionally, each of the eight sessions spans for a period twenty minutes. The observation should be performed for a period seven days. When the observation is done for seven days, each with eight periods, there are fifty-six sessions in which the observations are made. It is vital that the sessions are scheduled at different times of the day. This schedule is appropriate given that the recording will be done using the momentary time sampling.
The various steps highlighted in the step list for the hand washing exercise. It is relatively easy to determine the step an individual is in during the hand washing exercise. This can be done even in partial recording where the entire hand-washing exercise is not recorded. The various steps outlined in the task list have indicative behaviors through which one can tell the stage in which the individual being recorded during the hand washing exercise. The stages feature measurable elements and as such, assessing the behavior in this stage can be done by making reference to these measurable and observable elements. For instance, one can assess the behavior in the fourth step by determining the length of time in which the individual rubs their hands together. The behavior can also be assessed by determining whether all the recommended surfaces are scrubbed effectively as recommended by World Health Organization (2009).
Assessing the behavior can be done using a variety of functional analysis methods. One of the methods that an individual can elect to apply is the descriptive functional analysis. This method employs the direct observation of the target behavior. The observation is done in natural conditions. The environment is not manipulated, and the events during the observation are not subject to systematic arrangements. Alternatively, one can use the indirect functional behavior analysis methods. In this method, observations of the target behavior are not performed. Rather, the recollections of an individual regarding the behavior are used (Cooper, Heron & Heward, 2007).
Charting and Graphing Methods
The findings of the assessment can be graphed and charted through a variety of ways. Firstly, the results can be presented in a table that details the various variables considered in the assessment. However, the use of charts and graphs makes the results more comprehensible compared to results presented in a table. In this regard, one can use a bar graph to present the results. The data can be presented on the x and y-axis of the Cartesian plane. This makes it easier for one to understand the results. Alternatively, one can use line graphs. The results are also present on the x and y-axis on a Cartesian plane. However the results are plotted on a line rather than bars. Depending on the type of data, pie charts can also be used to present the results. Pie charts are more appropriate that other charting and graphing methods where one needs to draw comparisons between the same variables, but for different individuals.
The following are mock results for a client observed for eight sessions a day over seven days. Each of the sessions lasted twenty minutes. The focus was on the fourth step of the hand washing exercise.
Figure 1 showing the marginal difference in the time spent rubbing the hands
Interpretation of Results
The results show that the hand washing exercise was not guided by information. The erratic increase in the amount of time spent rubbing the hands together does not show deliberate actions informed by knowledge of proper hand washing procedures. I would recommend explaining to the client how to wash their hands effectively and demonstrating practically.
Cooper, J., Heron, T. and Heward, W. (2007). Applied behavior analysis. Upper Saddle River. Prentice Hall Publishing.
Matson, J. L. (2009). Applied behavior analysis for children with autism spectrum disorders. New York: Springer.
Nevo, I., Fitzpatrick, M., Thomas, R., Gluck, P. Lenchus, J., Arheart, K. and Birnbach, D. (2010). The efficacy of visual cues to improve had hygiene compliance. Journal of the Society for Simulation in HealthCare, 5 (6): 325-331.
World Health Organization. (2009). Hand Hygiene: Why, How & When? Retrieved from http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf