Did I just see your spine?

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I am a lowly nursing student, eager to see the sights, sniff the smells, and live the life of super-caring nurse lady. Well, in clinicals, I had this really nice lady who had to have her wound vac dressing changed. The WOCN came in and got all of her supplies together. She allowed me to assist and for another student and our instructor to look on. Patient had a back wound with MRSA and the wound was open to her spine. Literally, I saw her spine. I saw muscles, ribs, everything. I was asked to open some of the sterile packages to assist, but I felt uncomfortable. I asked WOCN if I needed to wear sterile gloves, etc, but she just said that no, it was a clean procedure. I had major objections, internally, but said nothing as this is the WOCN, and I am a lowly nursing student. I donned gloves and opened packages. She had me remove forceps and scissors(sterile) and give them to her. I did. She was discarding the used sponges in small biohazard bags, but then was putting them...on the floor and on the bed. Blood was getting on everything. However, my patient was so still that she would have easily allowed a sterile drape to be placed. It was so amazing as to how still she was. I went to hold her hand while the sponges were being removed and it was nearly broken(my hand). Smartly, I grabbed a stuffed toy, inserted it, and removed my crumpled claw. It was amazing to witness the inside of the human body in this way, and since I had never seen blood, guts, I was amazed that I didn't get sick. However, I am still bothered by the clean/sterile technique. Should I be? Should it have been sterile? Or am I overstepping my lowly student bounds?

Specializes in Emergency.

"I AM A LOWLY NURSING STUDENT"

Speak for yourself.

Specializes in Med-Tele, Internal Med PCU.

The best advice would've been to ask the wound care nurse right then and there. Especially with someone whose willing to teach and allow others to observe I'd have to think she'd have been receptive to questions in the hallway, post procedure.

I too am only a student and would have thought a stage 4 or 5 dressing change would be sterile. Although I am remembering working in the out patient wound care clinic and it was all clean procedures, we were told "they can't using sterile technique at home ..." or words to that effect.

Specializes in tele, oncology.

I try to stay as close to sterile technique as is possible in those kinds of situations personally. However, given that she already had MRSA in the wound (and therefore likely in the blood also), she was probably on all kinds of antibiotics as well.

As far as the getting yuckiness all over, gross. I grab the trash can and position it within easy reach (with a fresh bag over the top) so that I can just drop the nastiness straight into it, then bag it up and throw it in the biohazard trash when I'm done.

I agree, asking her privately afterwards to explain the rationale behind clean vs. sterile would have been entirely appropriate.

Specializes in Family Nurse Practitioner.

I don't believe I've even seen and I know I haven't done a "sterile" dressing change. They have always been clean technique and I don't really see how they could be truly sterile. I bet someone on the wound care forum would know the answer and rationale.

Specializes in HCA, Physch, WC, Management.

I dunno but I personally don't want to touch stuff that was in someone's open wound (MRSA or NOT!) with bare hands, thanks. Maybe I'm entirely too obsessive about germ spreading but then again... I don't believe there is such a thing.

And we're not "lowly". I've been very well-educated thus far, though I may not know everything there is to know. I still know enough to speak up when something doesn't seem right. You should learn to listen to your gut instincts.

Specializes in Family Nurse Practitioner.
I dunno but I personally don't want to touch stuff that was in someone's open wound (MRSA or NOT!) with bare hands, thanks. Maybe I'm entirely too obsessive about germ spreading but then again... I don't believe there is such a thing.

And we're not "lowly". I've been very well-educated thus far, though I may not know everything there is to know. I still know enough to speak up when something doesn't seem right. You should learn to listen to your gut instincts.

I might be wrong but I don't think not wearing any gloves was the issue, just clean or sterile. :)

Here's a trick I learned when holding/or someone wants to hold your hand and squeeze: offer 2 fingers .. the index and long finger. Won't hurt if they squeeze and your hand doesn't become "crumpled" ... you can really get hurt with the whole hand thing

:mad:

We never do sterile dressing changes anymore, just clean. The very complex ones are done by the wound healing nurse, I don't *think* they are sterile, but I'm not certain, so I can't say for sure.

I agree that the nurse should have immediately placed the old material in a refuse bag of some sort, though.

You can always ask afterward, in the hallway. Never in front of the pt, though.

Thank you all for your responses. I did talk to the wound and ostomy care nurse, which she was, after the procedure. She told me that it was a clean procedure, but I was confused because she used sterile tools. I found it odd to use sterile items if a procedure is just to be clean, however, that is what happened. The reason I referred to myself as a lowly nursing student is because, like all "students", none of us has been doing that type of work for 20+ years, as she had. I am not in a position of authority, as no student would be, in regards to her experience. Therefore, when dealing with an experienced nurse and just being a baby in nursing, having only been in school-not in practice-school, then yes, a lowly student nurse one would be. It irritated me to no end that some were seemingly offended by my statement. Being concerned about my patient was the reason why I asked the question for clarity, and I don't believe that she didn't care, I just knew what I knew from class, as other students do. So I suppose I should apologize to those who took offense, but, at the same time, get over yourselves. You are a baby in nursing, just like me. At the end of the clinical day, you go home, and you study, and you test, and you pray to pass the NCLEX. Do not be tempted to forget that. My theory instructed also informed me that unless the procedure was done in the OR, it would be clean, however, the mess everywhere was just disgusting and unwarranted and she should have done better with that.

Thank you! Won't get crumpled again!

Specializes in SRNA.
The reason I referred to myself as a lowly nursing student is because, like all "students", none of us has been doing that type of work for 20+ years, as she had. I am not in a position of authority, as no student would be, in regards to her experience.

You are correct in that nursing students do have the experience that seasoned nurses do, however I still wouldn't classify any nursing student as "lowly" and would not dismiss my critical thinking skills because of my status as a student. Students from previous cohorts at my school have influenced change and improvements clinical practice at the clinical venues we utilize by observing and commenting on practices that could be compromising patient care and infection control.

Of course nursing students don't go about this by directly challenging any HCP they are working with in an obviously offensive way, but by knowing who to speak with if you have questions or concerns about the way a procedure is done. So, from my point of view, nursing students can influence change in practice, especially as we are in school currently reviewing the most recent evidence-based best practices. Don't discount yourself and your burgeoning skills.

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