GOWNING TECHNIQUE

Name: Dagooc, Alleya Mesha M. Grade:__________________

Year and Section: BSN 2D Date: September 14, 2021

Legend:

1- Excellent

2- Very Satisfactory

3- Satisfactory

4- Needs Improvement

5- Poor

PROCEDURE RATIONALE 1 2 3 4 5
1. Reach down top the sterile table and grasp the whole gown In case of gowning,
directly upward. maintains sterility at
the outfit and position.
2. Step far enough away from non-sterile area or objects. To maintain the zone's
and object's sterility.
3. Hold the neckband with both hands and gently shake the To wear the garment in
folds of the gown. a suitable and efficient
manner while
maintaining sterility.
4. Slip the hands into the armholes, holding hands upward in To make it more
the level with the shoulder. comfortable to take the
next steps and to make
it much easier to
access. 
5. Swing belt to be tied at the back by the circulating nurse. To maintain the zone's
and object's sterility.

Scoring:

1x ____________ = __________

2x ____________ = __________

3x ____________ = __________

4x ____________ = __________
 5x ____________ = __________

Total divided by no. of items = __________

Comments:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_______________________________________

________________________________ _______ _______________________________________

Student’s Signature over Printed Name Clinical Instructor’s Signature and Date over

GOWNING AND GLOVING THE SURGEON

Name: Dagooc, Alleya Mesha M. Grade:__________________

Year and Section: BSN 2D Date: September 14, 2021

Legend:

1- Excellent

2- Very Satisfactory

3- Satisfactory

4- Needs Improvement

5- Poor

PROCEDURE RATIONALE 1 2 3 4 5
A. GOWNING THE SURGEON:
1. Open hand towel and hold end part for the Surgeon to grasp To be utilized by
the opposite end of the towel. surgeon and dry hand.
2. Grasp the gown in one hand. To avoid
contamination to other
equipment.
3. Shake out stretched hands holding it at the neckband. To maintain sterility.
4. Offer inside of the gown to the surgeon. Maintain sterility and
preserve a safe distance
from contamination.
5. Releasee the gown. To maintain sterility
 and avoid
contamination.
B. GLOVING THE SURGEON:
1. Squeeze lubricant or powder on the surgeon’s palm Arm gloves may be
easily inserted by using
lubrication or powder.
2. Grasp the right glove firmly with the four gingers under the To avoid
turned back-cuff. contamination, always
start with the right
hand to avoid
contacting the interior
of the gloves.
3. The palm of the glove should be facing the surgeon. Stretch Correct positioning
the cuff enough to introduce his hands. while extending the
cuff enough to allow
for easy insertion of
the hand.
4. The surgeon place his hand into the glove. Unfold the Unfolding the cuff
turned back cuff of the glove over his sleeve. secures the arm with
the glove, and the
gown's cuff prevents
germs from entering
the sterile fields.
5. Repeat procedure for the left hand. To complete the
process in a sterile
field.
6. Discard wrapper into the waste container. Prevent microorganism
contamination and
spread.

Scoring:

1x ____________ = __________

2x ____________ = __________

3x ____________ = __________

4x ____________ = __________

5x ____________ = __________

Total divided by no. of items = __________

Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_______________________________________

Dagooc, Alleya Mesha M.

Student’s Signature over Printed Name

Clinical Instructor’s Signature and Date over printed name