NR 224 Week 8 Sterile Gloving Skills Reflection Example

Skills Reflection: My Second Sterile Glove Touched the Cuff of the First, Three Times in One Week, and What Practice Actually Fixed

Student Name

College of Nursing, Chamberlain University

NR 224: Fundamentals: Skills

Instructor Name

Month Day, Year

Skills Reflection: My Second Sterile Glove Touched the Cuff of the First, Three Times in One Week, and What Practice Actually Fixed

One Occasion, Told Plainly

In Week 5, during the practice session for indwelling catheter insertion, I contaminated my sterile gloves three times in one afternoon, each time in the same way. I would put on the first glove correctly, touching only its folded inside cuff with my bare hand. Then, pulling on the second glove with my gloved hand, I would slide my gloved fingers under the cuff of the second glove, as taught, and pull. As the glove went on, my gloved thumb brushed the skin of my wrist just above the cuff. Each time, my instructor said "Contaminated," and I started again with a new kit. The third time, I did not notice it myself. She did.

In the graded check-off on the following Monday, I passed. But the check-off was not the occasion that taught me anything; the practice session was, because I did the same wrong thing three times and only knew about two of them.

Hands and Head Are Separate Problems

My first assumption was that I did not know the procedure well enough. That was wrong. I could recite every step, including "keep the gloved thumb away from the bare skin," and I could explain why: the skin of my wrist is not sterile, and a sterile glove that touches it is no longer sterile. My head had the rule. My hands did not.

When my instructor slowed down and watched my hands, she saw the reason. My gloved thumb was pointing inward, toward my other wrist, as I pulled the second glove on. With the thumb pointed that way, it was almost impossible not to touch the skin as the glove slid up. The fix was not more knowledge but a different movement: holding the gloved thumb out and away, abducted, so that only the four fingers under the cuff did the pulling. That is a matter of hands, not head, and it could not be fixed by rereading the procedure.

Evidence, Even Here

Ericsson (2004) described deliberate practice as practice aimed at improving a specific aspect of performance, with immediate feedback and opportunities to repeat and correct. That description matches what worked for me, and what did not. What did not work was repeating the whole catheter insertion, start to finish, over the weekend, because the gloving took ten seconds of a twenty-minute procedure and I was not watching for the thumb. What worked was practicing only the gloving: twenty times on Sunday, with a practice pair of sterile gloves from the lab, filming my hands on my phone from the side and watching each attempt immediately afterward.

In the first five attempts, the thumb touched my wrist twice. In the last ten, it touched once, on attempt 14, when I rushed. The video showed me the problem in a way my instructor's comments could not, because I could see my own thumb turn inward in the moment before it touched. The count is small and I am the only one who checked it, but it is a count, and it moved.

Why Passing the Check-Off Did Not Settle It

It would be easy to treat the Monday check-off as the end of the story. I passed it, and the gloving was clean. But passing once, slowly, with full attention, in a quiet lab, tells me only that I can do it under those conditions. Attempt 14 in my Sunday practice, the one where I rushed, is the more honest data point. It shows that the old movement is still there and returns when I hurry. On a unit, most sterile procedures happen when I am behind, interrupted or anxious, which is exactly when attempt 14 happened.

That is why the plan below keeps practicing after the check-off rather than stopping at it. A skill I have passed but not made automatic is a skill I will perform correctly on good days and incorrectly on the days that matter most.

A Plan Somebody Could Check

The plan for the rest of the program is specific. Before any clinical day where I may perform a sterile procedure, I will glove five times at home and watch the video of at least one attempt. In the skills lab before each future check-off that involves sterile gloves, I will ask the lab assistant to watch only my gloving, once, and tell me whether my thumb stayed out. My clinical instructor can check this plan by asking to see the most recent video on my phone or by watching me glove once at the start of any clinical day.

I will also watch for the same kind of problem in other skills. The thumb was a habit that felt natural and was wrong, and I would not have found it without someone watching my hands rather than my steps. The next skill where this could happen is likely to be medication preparation, where I draw up from vials. I will ask for my hands to be watched there too, not only whether the dose is right.

What Carries Into the Next Course

Next term's course moves from the lab to real patients, where there will be no instructor calling out "Contaminated." The most important thing I take from this reflection is not the correct thumb position, useful as it is, but the knowledge that my hands can repeat an error that my head does not notice. In the lab, that error cost me a new kit. On a real patient, a contaminated glove that I do not notice becomes a catheter carrying bacteria into a bladder. So the habit I want to carry forward is to stop, look at my gloved hands, and ask myself whether anything touched them, before the next step, every time, even when I think nothing did.

What I still have not settled is how to catch an error that nobody is watching and that I do not notice myself. Video helped in the lab. On a unit, the closest equivalent may be asking a colleague to watch the gloving step of my first few sterile procedures, which I intend to do, even though it will feel slow and slightly embarrassing.

References

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10, Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022