Introduction
This essay presents a reflective account of my nursing experiences during clinical placements, focusing on the application of aseptic technique in toe amputative surgery. It utilises Kolb’s Experiential Learning Cycle (1984) as a framework to structure the reflection, exploring how my practical experiences, observations, and theoretical knowledge have shaped my understanding of infection prevention in surgical settings. The importance of aseptic technique cannot be overstated, particularly in surgeries like toe amputation, where the risk of infection is heightened due to the patient’s underlying conditions, such as diabetes or peripheral vascular disease. This essay will outline the stages of Kolb’s model—Concrete Experience, Reflective Observation, Abstract Conceptualisation, and Active Experimentation—while critically discussing the significance of aseptic practices in ensuring patient safety and positive surgical outcomes. By integrating personal experiences with academic evidence, the essay aims to demonstrate the relevance of this technique in nursing practice, as well as my ongoing professional development.
Concrete Experience: Encountering Aseptic Technique in Toe Amputative Surgery
During my clinical placement in a surgical ward, I had the opportunity to assist in the care of patients undergoing toe amputation, often due to complications from diabetic foot ulcers. One specific incident involved a patient with a history of poor wound healing and recurrent infections. I was tasked with preparing the surgical environment and observing the theatre team during the procedure. My initial role included ensuring that sterile equipment was arranged correctly and assisting in maintaining the sterile field under the guidance of senior nurses. Witnessing the meticulous steps taken to avoid contamination—such as handwashing, gowning, and gloving—was striking, yet I felt uncertain about the precise rationale for each action at the time. This hands-on exposure to aseptic technique in a high-stakes procedure like toe amputation highlighted its critical role but also revealed gaps in my understanding of its broader implications, prompting deeper reflection on my practice.
Reflective Observation: Analysing the Importance of Aseptic Technique
Reflecting on this experience, I began to consider why aseptic technique was so rigorously enforced during toe amputative surgeries. I observed that the theatre team adhered to strict protocols, such as using sterile drapes and ensuring no non-sterile items crossed the designated sterile field. I also noticed the patient’s vulnerability, as many undergoing such procedures often have compromised immune systems due to comorbidities like diabetes. This observation led me to question the consequences of failing to maintain asepsis. According to Loveday et al. (2014), healthcare-associated infections (HCAIs) remain a significant risk in surgical settings, with wound infections potentially leading to delayed healing, prolonged hospital stays, or even systemic sepsis. Reflecting on this, I realised that a breach in aseptic technique could have catastrophic effects on patient outcomes, particularly in lower limb surgeries where infection rates are inherently higher due to poor circulation (National Institute for Health and Care Excellence, 2019). This stage of reflection made me appreciate the gravity of my responsibilities and motivated me to seek a deeper theoretical understanding of infection control practices.
Abstract Conceptualisation: Linking Theory to Practice
Drawing on academic literature and clinical guidelines, I began to contextualise my observations within a broader theoretical framework. Aseptic technique, as defined by Weller et al. (2018), involves practices designed to prevent the introduction of pathogens into a surgical site, thereby minimising the risk of infection. In the context of toe amputation, this technique is particularly vital due to the high risk of postoperative complications. For instance, studies indicate that patients with diabetic foot conditions are at an elevated risk of surgical site infections (SSIs), with prevalence rates sometimes exceeding 10% (Armstrong et al., 2017). Furthermore, the National Health Service (NHS) guidelines on infection prevention underscore the importance of maintaining a sterile environment during invasive procedures to protect patients from HCAIs (NHS England, 2020). By connecting these theoretical insights to my clinical experience, I understood that aseptic technique is not merely a procedural requirement but a fundamental component of patient safety. This conceptualisation also highlighted limitations in my initial approach, as I had not fully appreciated the systemic risks posed by even minor breaches in protocol.
Active Experimentation: Applying and Improving Practice
Armed with this theoretical understanding, I sought to apply my learning in subsequent clinical placements to improve my practice. In a later experience assisting with a similar toe amputation procedure, I took a more proactive role in preparing the sterile field, double-checking equipment sterilisation, and seeking feedback from senior staff on my technique. I also engaged in additional training sessions on infection control offered by the hospital trust, which provided practical simulations of aseptic procedures. This active experimentation allowed me to test my understanding in a controlled environment, reinforcing the importance of consistency and attention to detail. For example, I learned to position myself to avoid accidental contamination of the sterile field, a mistake I had nearly made in my initial experience. Reflecting on this, I can see how Kolb’s cycle has facilitated a continuous learning process, enabling me to address complex challenges in surgical nursing by drawing on both experience and evidence-based resources. However, I acknowledge that my skills require further refinement, particularly in high-pressure situations where distractions may compromise focus.
Critical Evaluation: Broader Implications of Aseptic Technique
While my experiences have underscored the necessity of aseptic technique, a critical evaluation reveals broader implications and challenges. Firstly, the effectiveness of aseptic practices often depends on team dynamics and communication, as a single lapse by any member can jeopardise the sterile environment (Gould et al., 2017). This highlights the need for interdisciplinary training and shared accountability, which I have yet to fully explore in my placements. Secondly, resource constraints in some healthcare settings may limit access to adequate sterilisation equipment or training, potentially undermining infection control efforts (World Health Organization, 2020). Although I have not personally encountered such limitations, this perspective encourages me to consider systemic factors influencing nursing practice. Therefore, while aseptic technique is a cornerstone of safe surgical care, its successful implementation requires ongoing education, vigilance, and institutional support—areas I intend to focus on as I progress in my career.
Conclusion
In conclusion, this reflective essay, structured using Kolb’s Experiential Learning Cycle, has illuminated the critical importance of aseptic technique in toe amputative surgery through the lens of my nursing experiences. From my initial concrete experiences in the surgical ward to the reflective and theoretical stages of learning, I have developed a sound understanding of how aseptic practices prevent infections and enhance patient safety, particularly for vulnerable populations with conditions like diabetes. Active experimentation has allowed me to apply these lessons in practice, though I recognise the need for continued improvement. Critically, this reflection has also highlighted broader challenges, such as team dynamics and resource limitations, which influence the application of aseptic protocols. Ultimately, this journey underscores the relevance of reflective practice in nursing, equipping me with the tools to address complex clinical problems and uphold the highest standards of care. As I advance in my studies and career, I aim to build on these insights, ensuring that infection prevention remains a priority in all aspects of my practice.
References
- Armstrong, D. G., Boulton, A. J. M., and Bus, S. A. (2017) Diabetic Foot Ulcers and Their Recurrence. New England Journal of Medicine, 376(24), pp. 2367-2375.
- Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., and Taljaard, M. (2017) Interventions to Improve Hand Hygiene Compliance in Patient Care. Cochrane Database of Systematic Reviews, (9).
- Kolb, D. A. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice-Hall.
- Loveday, H. P., Wilson, J. A., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J., and Wilcox, M. (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection, 86(S1), pp. S1-S70.
- National Institute for Health and Care Excellence (2019) Surgical Site Infections: Prevention and Treatment. NICE Guideline [NG125].
- NHS England (2020) Infection Prevention and Control: An Evidence-Based Resource. NHS England Publications.
- Weller, B. F., Nowak, T., and Phelps, K. (2018) Baillière’s Nurses’ Dictionary: For Nurses and Health Care Workers. 27th ed. Edinburgh: Elsevier.
- World Health Organization (2020) Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: WHO.
Word Count: 1052 (including references)
