The one thing I found most difficult when working with the district nurses was understanding how to manage cleanliness and sterile fields when dressing wounds. You may very well hear a range of different view points about what is acceptable practice for Aseptic Non-Touch Technique (ANTT) in the community. On my first day, the nurses felt compelled to drill into me the idea that we were working in someone’s home and that ideal ANTT procedures are not always possible. I imagine most university students are as uncomfortable as I was having just come from clinical skills demonstrations that offer a perfect situation for ANTT.
However, often the practice I saw was unnecessarily hurried and avoided maintaining proper ANTT because of time constraints rather than an established lack of opportunity. Some homes we visited were rather cluttered and very dirty and the lack of a reasonably clean surface to set the sterile field on was a challenge. Even so, there was often a tendency to forget to keep the sterile gloves sterile by not reaching in one’s pocket to get out a pair of scissors (when a fresh pair of sterile scissors should have been used). Some DNs would explain that even though they were using a sterile dressing pack, that the procedure was a ‘dirty’ procedure that did not require they maintain the sterility of the gloves. But practice and opinions differed so greatly from nurse to nurse and patient to patient that it became very difficult to get a sense of what was good practice and what was poor practice. By the end of my first week I had seen the same patient three times and observed three relatively different ways of approaching the ANTT needed for that patient’s wound dressing. Some DNs went to great lengths to explain their motives and others became angry when questioned about their choices during the ANTT procedure.
All I can recommend is that, if you start to feel uncomfortable about how ANTT is being used, read, read and read some more about ANTT. Get a very clear idea in your head about what it is for and why we do it. If you understand WHY we use ANTT, then chances are you’ll be able to evaluate the situation for yourself and come to your own conclusion about whether the patient was kept safe from infection during the procedure.
I feel that unfortunately, working on one’s own day in and day out can lead to poor practice creeping in. When no one’s watching, I worry that there is a tendency to let standards gradually slide and forget why you were using ANTT in the first place. Some DNs have thanked me and told me that they are glad to have students along because knowing a student is watching reminds them to make certain their practice is of a high standard and that student questions make them reflect on their own actions. Other DNs have told me that they think I am rudely questioning their practice that that I should remember my place as a student. Be prepared to encounter both attitudes from practitioners, but never stop thinking about what is and is not good practice.