User:Marekpawlowski/SELF/Perioperative Nursing/Donning Sterile Gown and Gloves/Psychomotor Skills Practice Instructions

#	Step	Instructions	Good Skills (Learning Objectives)	Common Errors	Guidance
1	Gather supplies	Articulate all needed supplies are gathered and ready: - Correct size of sterile gown(s) and gloves selected - Packaging checked for integrity and expiry dates
2	Open table drape and gown and glove packs	Articulate the sterile draping of the field, gown and glove’s packs are opened and laid onto the sterile table
3	Surgical hand scrub	Articulate surgical hand scrubbing and drying
4	Prepare Gown	Pick up. Grasp the sterile gown in the middle by the inside neckline/shoulders only and step away from the sterile gowning trolley. Keep it lifted away from your body and any non-sterile surfaces (including your scrubs), and do not let it brush the table edge, your clothing, or the floor. Position. When in a clear area, partially unfold the gown (opening that first fold like a book), and without letting the remaining folds open yet, adjust your grip on the partially unfolded gown until your hands are holding the gown just below, and to either side, of the inside of the neckband. Fully Unfold. When your hands and body are properly positioned, open the fold fully to let the remaining folds of the gown unfold under gravity, giving the gown a shake as needed, and making sure the gown does not touch any adjacent surfaces or the floor	You will be assessed on whether you can: Open the gown from the inside surface without touching outside; touches only gown neckline/inside collar area Step away from the sterile trolley after grasping the sterile gown without contamination. Locate the neckband and hold inside front of the gown just below the neckband with both hands Hold the gown away from the body and allow it to unfold completely. Keep hands high enough that the gown won’t touch the floor, let the gown fall and unfold completely	- Failing to step away in a clear space after picking up a sterile gown, leading to the possibility of contaminating the gown - Grasping gown improperly; allowing the gown to brush against body, table, or other surfaces - Failing to hold the gown away during donning (increasing the possibility of contaminating its outer parts)	The gown should be folded such that any part of the folded package that you pick up will be the inside surface of the gown. It should be clearly visible to an observer (camera or in-person) that the gown is unfolding in an open area without risk of contamination, and that it does not touch the ground.
5	Slide both hands and forearms into arm holes and sleeves.	Don the gown. Keeping the hands at shoulder level, and away from the body, slide hands and arms into the two sleeves until the hands are close to the cuffs. Secure the cuffs. As your fingers reach the cuffs, grab the insides of the cuffs, pinching them together so that the fingers do not pass the ends of the sleeve cuffs. Hands must remain inside the sleeve cuffs before gloving to maintain sterility during the closed gloving technique.	You will be assessed on whether you can: - Keep hands at shoulders level and away from the body - Locate sleeve holes and hold gown by the shoulders - Ensure that the gown is the correct way round - Insert your arms smoothly without exposing hands - Keep the gown front facing the sterile field	Hands protruding through cuffs Gown contacting non-sterile surfaces	Feeling for the change in fabric from the sleeve fabric to the rougher cuff fabric is a good way to gauge when to grab the fabric and pinch the cuff closed.
6	Ask or positions self for the circulating nurse to secure the gown	Instruct. Request that the assistant pulls the gown up for you and secures the top tie. Hold on. While they are pulling the gown up, maintain a strong grip on the insides of the cuffs, and ask the assistant to stop if their pulling of the gown sleeves is threatening to pull the cuffs so high that your fingers poke through.	You will be assessed on whether you can: -Guide the assistant to hold the inside of the gown at each shoulder and pull it onto your shoulders fully, touching only the inside of the gown -Guide the assistant to tie or fasten the gown at the neck and the inner belt of the gown at the waist while maintaining sterility and not pulling your fingers through	The assistant touches outside of the gown and contaminates the sterile gown - Extending fingers through the sleeve cuff	Remember to communicate with your assistant (both to signal you are ready to have them help, and whenever they need to stop or change something they are doing) A gown that is too small for you will have sleeves so short this is very difficult to do without having your fingers protrude.
7	Open glove packet without contamination	Open. With your hands remaining inside the gown sleeves, open the folded paper inner glove packet that was previously dropped onto the sterile field, keeping sleeve cuffs fully covering your hands, orienting the gloves to the correct left/right hand before donning, and touching only the inside of the packet (avoid contact with the outer edge/1-inch border).	You will be assessed on whether you can: Keep hands and fingers inside gown sleeves and avoid contamination,	- Extending fingers through the sleeve cuff - Touching glove package or sterile table with skin Setting up the gloves in the wrong orientation	Your hands will feel like clubs, but if you can pinch the cuffs from the inside with two fingers strongly enough, you will be able to use the other fingers through the cuff material when trying to manipulate the glove packet and glove. You may need to press on the creases in the paper fold around the gloves to get it to lie flat enough.
8	Position the first glove for donning	Pick up one glove by the folded cuff edge with a sleeve-covered hand (this will be your manipulating hand). Orient the other hand (the glove receiving hand) with the palm facing up and the forearm level. Place the glove on the gown sleeve of the glove receiving hand with the glove palm facing down, the glove fingers pointing towards yourself, and the glove’s folded cuff edge lined up with the seam that connects the sleeve to the gown cuff. With the fingers of the glove receiving hand, Grasp the bottom rolled cuff edge of the glove through the gown cuff to stabilize it.	Pick up one glove by the folded cuff edge with a sleeve-covered hand. Orient the hand intended to receive that glove appropriately and keep the forearm level. Place the glove on the receiving gown sleeve, aligning the glove fingers with the sleeve opening and positioning the glove opening at the cuff edge. And Grasp the bottom rolled cuff edge of the glove from inside the gown sleeve. Keeps both hands within gown sleeves to avoid contamination and performs coordinated movements throughout.	Dropping the glove fingers protruding through the gown sleeves Placing the glove in the wrong orientation so that it will not go on easily Attempting to put a glove on the incorrect hand. Lowering hands or arms below the waist and on the sides of the body	Most people choose to put the first glove onto their non-dominant hand using their dominant hand as the manipulator hand. This is personal preference. Proper placement of the glove is the key to the next step. Manipulating the gloves with the hands in the sleeves is one of the trickiest parts of the gloveing, and maintaining the orientations is important for reducing the number of adjustments you need to make further on. This is one of the harder steps of the skill. When first learning this skill and practicing, this step is worth doing a few times successfully before moving on so that you know what it should look like and feel like when done properly.
9	Pull on the first glove	Cover. While holding the glove’s folded cuff edge from inside the gown, grasp the opposite edge of the glove’s folded cuff with the manipulating hand (still keeping it inside its sleeve cuff) and stretch the still folded cuff of the glove over the sleeve cuff of glove receiving hand (palm to back), keeping both hands in the sleeves, and fully covering the sleeve cuff with the glove. Advance. Then grasp the edge of the glove with the manipulating hand, and unfold the cuff to cover more of the sleeve and pull the glove cuff up past the wrist while advancing the glove receiving hand through the sleeve cuff and into the glove without pulling the sleeve cuff out of the glove cuff. Settle the fingers and thumb into the appropriate digits of the glove	You will be assessed on whether you can: Perform the unfolding and pulling maneuver with smoothness and without forcefulness of motion that would be likely to break the glove	- Poking the fingers of the maneuvering hand through the cuff and touching the glove with bare fingers Poking the fingers of the glove receiving hand through the sleeve cuff before the glove is fully over the sleeve end Using too much force and tearing the cuff of the glove when pulling it over the wrist and up the forearm Missing the finger and thumb spots in the glove because of misalignment or twisting while pulling Pulling the cuff of the sleeve too far into the glove and not being able to free up the fingers and thumb from inside the sleeve cuff Dropping hands below the waist	Grabbing the glove cuff by too small an area, or making too big a motion when unfolding the glove cuff over the sleeve and pulling the glove up risks tearing the glove Coordinating the motion of pulling up the glove cuff while simultaneously advancing the fingers out of the sleeve cuff smoothly takes some practice.
10	Adjust the first glove	Adjust. If there is a misalignment, use the manipulating hand still in the sleeve to gently pinch the glove and provide countertraction while shifting the hand to be gloved fingers into the proper glove fingers or improving alignment as necessary. Pull. Pull back on the gown sleeve behind the glove cuff to bring the sleeve cuff to sit between the thumb base and the wrist, leaving a secure length of overlap between the glove cuff and the gown cuff.	You will be assessed on whether you can: Adjust misalignments gently and appropriately and get the sleeve cuff to the correct position with respect to the hand while maintaining full coverage with the glove cuff	Using excessive force to adjust and seat the fingers properly, risking tearing the glove Leaving the gown sleeve cuff bunched up around the fingers or palm of the hand impeding use of the hand Pulling the gown sleeve too far back, risking it coming out of the glove cuff and causing contamination	It isn’t essential to get every finger seated perfectly every single time, as even the most practiced clinicians end up having to do a bit of adjustment, but the better the alignment and the smoother the emergence of the fingers from the cuff into the glove digits, the fewer adjustments you need to make and the lower the risk of tearing or weakening a glove. You also do not need to get the glove adjusted perfectly in this step as it will be much easier to do it later when you have two gloved hands to do the adjustment.
11	Position the second glove for donning	Keeping both hands in sleeves throughout to avoid contamination, repeat the positioning step with the second glove: Open. With your hands remaining inside the gown sleeves, open the folded paper inner glove packet Pick up the other glove by the folded cuff edge with the gloved hand (this is now your manipulating hand). Orient the new glove receiving hand with the palm facing up and the forearm level. Place the glove on the gown sleeve with the glove palm facing down, the glove fingers pointing towards yourself, and the glove’s folded cuff edge lined up with the seam that connects the sleeve to the gown cuff. With the fingers of the glove receiving hand, Grasp the bottom rolled cuff edge of the glove through the gown cuff to stabilize it.	The same criterion for step 6 will apply here. You will be assessed on whether you can: Orient the hand intended to receive that glove appropriately and keep the forearm level. Place the glove properly on the receiving gown sleeve. And Grasp the bottom rolled cuff edge of the glove from inside the gown sleeve. Keep the glove receiving hand inside the gown cuff to avoid contamination and move in a coordinated manner. Maintain the glove-receiving hand within the gown cuff to prevent contamination and perform movements in a controlled and coordinated manner.	Dropping the glove Advancing fingers through the cuff Placing the glove in the wrong orientation Lowering hands or arms below the waist and on the sides of the body	Like with the previous glove, proper placement of the glove is the key to the next steps going smoothly. Manipulating the second glove with a gloved hand is considerably easier! Remember to maintain the orientation - it should be much easier than with the first hand.
12	Pull on the Second Glove	Cover. While holding the glove’s folded cuff edge from inside the gown, grasp the opposite edge of the glove’s folded cuff with the manipulating hand (now in a glove) and stretch the still folded cuff of the glove over the sleeve cuff of glove receiving hand (palm to back), keeping fingers of the hand being gloved in the sleeve cuff, and fully covering the sleeve cuff with the glove. Advance. Then grasp the edge of the glove with the manipulating hand, and unfold the cuff to cover more of the sleeve and pull the glove cuff up past the wrist while advancing the glove receiving hand through the sleeve cuff and into the glove without pulling the sleeve cuff out of the glove cuff. Settle the fingers and thumb into the appropriate digits of the glove	You will be assessed on whether you can: Perform the unfolding and pulling maneuver using smooth, coordinated movements and without excessive force that may tear the glove, or excessive traction on the sleeve cuff. Loss of sleeve coverage will be considered contamination.	Poking the fingers of the glove receiving hand through the sleeve cuff before the glove is fully over the sleeve end Using too much force and tearing the cuff of the glove when pulling it over the wrist and up the forearm Missing the finger and thumb spots in the glove because of misalignment or twisting while pulling Pulling the cuff of the sleeve too far into the glove and not being able to free up the fingers and thumb from inside the sleeve cuff Dropping hands below the waist	Practice doing this smoothly and coordinating the advance of the fingers through the cuff and into the glove.
13	Adjust the second cuff and the fingers of each glove as necessary	Pull. Pull back on the gown sleeve behind the second glove cuff to bring the sleeve cuff to sit between the thumb joint and the wrist, leaving a secure length of overlap between the glove cuff and the gown cuff. Adjust. Gently adjust both gloves as needed, providing countertraction to allow shifting of fingers into the proper glove fingers or improving alignment as necessary.	You will be assessed on whether you can: Adjust misalignments gently and appropriately and get the sleeve cuff to the correct position with respect to the hand while maintaining full coverage with the glove cuff	Apply excessive force seating fingers into the glove, properly, increasing the risk of tearing the glove Leaving the gown sleeve cuff bunched up around the fingers or palm of the hand impeding use of the hand Pulling the gown sleeve too far back, risking it coming out of the glove cuff and causing contamination	Adjusting the gloves should be much easier with another gloved hand to do it. Interlacing the fingers and stretching and clenching the hands can help the gloves “settle”
14	Secure the sterile gown	For a disposable gown: Retrieve the belt card attached to the gown belt, and pull it off of the SHOtRT side of the tie, leaving it attached to the long tie. Hand the card smoothly to the assistant without contaminating gloves. Instruct the assistant to hold the card keeping the long tie under very light tension. Turn around 3600 In the direction which wraps the tie around the gown. Regrasp the tie attached to the still sterile side of the card, pull it free without contamination, and tie securely For reusable gowns without cards: Instruct the assistant to secure the back of the gown while maintaining sterility	You will be assessed on whether you can: Execute the full maneuver with smoothness and control. Demonstrate good communication and coordination with the assistant to avoid mishaps	Pulling the card off the wrong side, Turning the wrong direction Turning so quickly the card or tie is pulled out of the assistant’s hand Pulling the card out of the assistant’s hands instead of the tie out of the card, Touching the assistant’s non-sterile hands while handing over the card or a tie Fails to clearly instruct the assistant to secure the back of the gown. Fails to maintain sterility during the process	Disposable gowns have a tie at the front which is supplied attached to a piece of card. For practice these can be re-assembled. For reusable gowns, the ties are generally in the back and the twirl does not need to be practiced. It is good clinical practice to be familiar with both gown securing techniques.
15	Final check of sterility and proceed to sterile field	Articulate the following: “Gloves intact and cuffs covered, hands above waist and in view, no contact with non-sterile surfaces—ready to proceed to the sterile field.”

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