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JOANNE Tollefson
Clinical
Psychomotor Skills
A s s e s s me n t s k il l s f or nur s e s // 5 t h E di t ion
Tollefson 5ed SB 9780170216364 CVR 1pp.indd 2 16/05/12 12:57 PM

INTRODUCTION
Nursing bodies in Australia have developed the Australian Nursing and Midwifery Council
(ANMC) National Competency Standards for the Registered Nurse as the minimum requirements
for registration as a nurse (see the current version of these standards in Appendix 1). The
competency standards are instrumental in determining the model for tertiary nursing.
‘Competency’ denotes an entry-level standard for practice across a global range of
nursing activities to uphold, amongst other considerations, legal accountability, patient
rights, safety issues and trust. Although professional pride and the transferability of skills
are two of the outcomes of utilising competency standards, competency is very difficult to
determine when most of the work done by nurses is interpersonal and therefore resists
measurement of output. This difficulty in assessing skill competency is outlined by the
ANRAC below.
Competence is the ability of a person to fulfil the nursing role effectively and/or
expertly. It is an inner, highly differentiated characteristic of a person, which is
applicable to the very demanding and very specific context of nursing. It is an ability
that effectively encompasses the entire demands of the nursing role; and therefore
nursing competence itself possesses a complexity that increases with experience and as
responsibilities become more intricate.
ANRAC Nursing Competencies Assessment Project, 1990, vol. 1, p. 22
Clinical Psychomotor Skills outlines the practical aspects of competencies necessary

for the skill assessment of registered nurses. The text is structured to enable theoretical
knowledge to be applied experientially. This assists students to effectively master the
practical applications of the theory they are learning. The the tools in this book minimise
the difficult in assessing student skill competencies and are already used extensively
throughout Australian nursing schools.
New to this edition

This edition includes five new skills, which were requested by academics and clinicians:
● personal protective equipment
● administering an enema
● stoma care
● height, weight and waist circumference measurement
● pressure area care.
Minor adjustments to some of the skills have been made upon the recommendations of
clinicians and clinical facilitators, students and preceptors, who have kindly critiqued them
and sent their comments to me.
Psychomotor skills assessment

Psychomotor skills are only one aspect of the overall competency of an individual nurse.
Other aspects to be assessed include specialised knowledge, cognitive skills, technical
skills, interpersonal skills and (personal) traits. Students do demonstrate some of these other
aspects when they are performing psychomotor skills, and the observer or expert nurse will
reassess overall performance as new ‘cues’ are added to the dataset of the observation.
From this, over time, an idea about the competencies of the nurse can be derived.
Students as beginner practitioners benefit from guidelines and direction, and need to
have complex interactions simplified into recognisable and achievable steps to enhance
their learning and to reduce any possible distress. If skills are broken down into steps, the
student is better able to concentrate on the complexities of the situation than if the task
INTRODUCTION vii
were an overwhelming whole. Initially, these skills are taught in the safety of the laboratory
using demonstrations and discussions with the laboratory leader, who is a skilled, current
nursing practitioner. The skills and the linked theory can be read, digested,
conceptualised and discussed before the student attempts a new skill on a vulnerable
person. This increases student confidence and fosters critical thinking.
The information that forms the theory underlying the skills in this book comes from a
number of sources. Nursing fundamentals texts were used as a base, and searches of
various databases found recent, research-based material to make the information as current
as possible. For this edition, any evidence-based material from 2008 to the publication date
that was found has been included. The databases searched were CINAHL, Medline,
Cochrane Library, Joanna Briggs Institute, Proquest 5000, Ingenta and Informit.
Government, medical and health-related websites were accessed for evidence-based
information as well. This edition has benefited from a number of evidence-based summaries
and clinician information releases produced by the Joanna Briggs Institute in 2009–2011.
However, many of the basic nursing-care skills in this book still do not have solid evidence-
or research-based foundations so are carried out following the traditional methods.
The information presented is not exhaustive in relation to the subject but does give the
student and assessor a mutual, basic understanding of the procedure. It is expected that
foundational nursing texts and medical surgical texts will be used to supplement the
material in the theoretical links to practice. Use of diagrams and lengthy explanations have
been minimised to enable the book to be easily carried into and used in clinical and
assessment situations.
Using this assessment tool

This book has been developed to guide the student when learning a new skill, and needs to be
studied in conjunction with the relevant policies and protocols of the facility’s clinical setting.
The knowledge provided here is generic and needs to be adapted to and integrated
with the specific context (i.e., type of facility, geographical location, staff available, shift,
time of day, day of the week, season and so on) and the individual differences between
patients (i.e., age and developmental stage, culture, gender, wellness, needs and desires,
diagnosis, stress levels, ability to communicate and so on).
This book contains many of the major psychomotor skills taught throughout the three
years of an undergraduate-nursing program. It is meant to be used throughout the entire
three years of study, both on clinical placement and theory-building encounters during
semester. At the end of three years, the student will have a record of the skills that have
been assessed and the results they have achieved from the start to the finish of their
nursing education.
This textbook can be used in skills laboratories, or during demonstrations and
discussions by the laboratory leader on various aspects of a skill. It can also be used as a
summative assessment tool by the facilitator or preceptor. In this use, they give structure to
the assessment process so that feedback and comments on the student’s performance can
be more comprehensive, constructive and objective. The facilitator or preceptor can utilise
the student’s individual performance in various areas of each skill as exemplars of the
student’s ability to meet many of the ANMC competencies.
The clinical skills competencies in this book are meant to encompass entire skills, not
just a task or procedure. The student who has had limited exposure to clinical situations
must still demonstrate a level of competence to be deemed competent. The balance and
integration of the skills and knowledge acquired by the student determines their competency, not
viii INTRODUCTION
within one skill, but as an overall judgement of their readiness for nursing. Students are assessed
on their ability to interact with the patient, to solve problems and to effectively manage the time
and resources at their disposal; they are also assessed on their ability to complete the procedure as
efficiently as possible while cleaning up afterwards and finalising their documentation. Each clinical
skill competency has two or three pages that give an overview of the procedure’s theory, which is
mandatory for the student to know. However, and as noted at the beginning of each part of this
book, the content of each clinical skill is a summary of the most important points in the procedure
and are not exhaustive on the subject. Evidence-based information has been included where it was
available. The student is expected to have read widely, attended laboratory and tutorial sessions
and absorbed the material from them, and discussed issues with the clinical educator or with
registered nurses, to broaden their knowledge prior to implementing a skill in the clinical setting.
In this assessment tool, each criterion is linked to one or more of the cue standards in the
ANMC Competency Standards for the Registered Nurse; the number of the appropriate ANMC
Competency Standard has been written beside each criterion to facilitate linking the student’s
performance with the relevant standard. The facilitator can gather many cues in relation to
one competency standard before giving the student a formal judgement of their performance
and verbal or written observation of their progress for each ANMC Competency Standard.
Performance criteria
The performance criteria have been broken into arbitrary sections. However, the entire
skill should be seamless. If it is at all possible, the student should not be assessed on their
first attempt to complete a procedure. Practice improves performance and fosters
confidence in the student. I decided to use a three-point scale, rather than the five-point
Bondy-rating scale, for simplicity and to decrease the discrimination that the educator
would need to decide between very similar ratings. This is because the distinctions
between like ratings (such as dependent/marginal) are always subjective and debatable,
unless there is a lot of supporting examples for the educators to follow. The criteria for
completion – ‘Competent’, ‘Requires Supervision’ and ‘Requires Development’ – are meant
as a guide for the student in their progress towards becoming a confident and competent
practitioner of nursing. A brief description of the criteria for completion follows:
● ‘Competent’ indicates that the student is able to complete the procedure/skill efficiently
and without any cues from the clinical facilitator. This student can discuss the theory as it
relates to the practical situation for the individual patient. The clinical facilitator would
feel confident that the student is able to perform this procedure, or one similar, without
supervision. This would be equivalent to ‘independent’ on the Bondy scale.
● ‘Requires supervision’ indicates that the student is able to complete the procedure.
However, they may require direction, prompting or more time to complete the skill. The
student can discuss the theory behind the procedure in a general way. Conversely, the
student may be able to complete the psychomotor skill but not discuss the rationale
behind what they are doing. The clinical facilitator would not feel confident allowing the
student to complete this or a similar procedure without at least some supervision. This
would be equivalent to ‘assisted/supervised’ on the Bondy scale.
● ‘Requires development’ indicates that the student is unable to complete the procedure
without assistance from the clinical facilitator. This student has difficulty in linking
theory to the practice. The clinical facilitator would not allow this student to complete
this or a similar procedure without supervision. This would be equivalent to ‘dependant/
marginal’ on the Bondy scale.
INTRODUCTION ix
I would like to thank Elspeth Hillman, RN, BN, PGCert Ed, MN, who has assisted in the
research of the skills and who has acted as my clinical sounding board for each skill, for
her significant contributions to this edition.
I would also like to thank Dr David Lindsay and Dr Lee Stewart and their staff at James
Cook University School of Nursing and Midwifery for providing support during the revision
of this book.
I hope that you find this book helpful in the development of clinical skills – so that you
can provide excellent care to your patients.
Joanne Tollefson
RN, BGS, MSc, PhD
RESOURCES ACCOMPANYING THIS TEXT

For Students - www.cengagebrain.com
Login through Cengage Brain for access to student skills preparation quizzes. These
quizzes test your knowledge and understanding of the skills in each chapter. The marking
system gives instant feedback to assist with revision.
For Instructors
The Instructor companion website, accessible from http://login.cengage.com, contains an
instructor’s manual to guide tutors and instructors in understanding and assessing a
student’s preparedness for the clinical environment.
Clinical Nursing Skills DVD: This DVD provides relevant and engaging visual teaching
demonstrations to match all of the skills covered in the text.
ABOUT THE AUTHOR

Joanne Tollefson (RN, BGS, MSc, PhD) was a Senior Lecturer at the School of Nursing
Sciences at James Cook University. She is a registered nurse with many years of clinical
experience in several countries and extensive experience in nursing education at both
the hospital and tertiary levels. Research interests include competency-based education
and clinical assessment, development of reflective practitioners for a changing work
environment, chronic pain and arbovirus disease in the tropics. Joanne is also a two-time
recipient of the National Awards for Outstanding Contributions to Student Learning (Carrick
Award, 2007 and Australian Teaching and Learning Council Award, 2008).
ACKNOWLEDGEMENTS
The publisher would like to thank the following reviewers for their incisive and helpful
comments:
Maree Bauld Victoria Kain Jacqui Sawle
Teresa Downer Jackie Lea Monica Schoch
Julie Harris Karen Livesay Carol Thorogood
Fiona James Sandra Oster Matthew Walsh
x INTRODUCTION
PART 1
Aseptic technique
1 Hand hygiene
2 Personal protective equipment
3 Aseptic technique
4 Surgical scrub
5 Gowning and gloving
Note: These notes are summaries of the most important points in the assessments/procedures, and are not exhaustive on the subject. References of
the materials used to compile the information have been supplied. The student is expected to have learned the material surrounding each skill as
presented in the references. No single reference is complete on each subject.
1
1
Hand hygiene
Indications
Hand hygiene is a basic infection-control method that reduces the number of micro-organisms on the
hands, reducing the risk of transferring micro-organisms to a patient. Hand hygiene encompasses both
handwashing and use of alcohol-based hand rub (ABHR). Hand hygiene reduces the risk of cross-
contamination, i.e., spreading micro-organisms from one patient to another. Hand hygiene reduces the
risk of infection among health-care workers and transmission of infectious organisms to oneself. Hand
hygiene must occur at the start of and end of each shift, prior to and following each incident of patient
contact, or contact with any contaminated or organic material including body fluids, excreta, non-intact
skin and wound dressings, equipment, before moving from a contaminated body site to a clean body site
during patient care, before donning gloves and after their removal, before preparing medications or food,
following use of the toilet, and prior to and following meals (Smith, Duell & Martin, 2012). WHO (2009)
condense these times into ‘5 moments of hand hygiene’ which are: 1) before touching a patient; 2) before
a procedure; 3) after a procedure or body fluid exposure risk; 4) after touching a patient; and 5) after
touching a patient’s surroundings. Grayson et al. (2009) recommend an additional ‘moment’ – after
removal of gloves. Contact with contaminated hands is a primary source of nosocomial infection.
Handwashing with soap and warm water is undertaken if there is visible soil or following gross
contamination of the hands. Smith, Duell and Martin (2012) recommend that handwashing with soap
and water be used every third time the hands are cleansed.
Preparation of hands
This includes inspection for any lesions and removal of jewellery (rings, bracelet, watch). These
precautions protect both the nurse and the patient. Inspection for any lesions (open cuts, abrasions) will
allow the nurse to select the appropriate soap or handwashing solution and will dictate whether further
precautions – for example, gloving or non-contact (some agencies prevent nurses with open lesions from
caring for high-risk patients) – are needed. Jewellery harbours micro-organisms in its nooks and
crannies, and between the jewellery and the skin. Removing jewellery will reduce the number of micro-
organisms to be removed and provide for greater access of soap and friction to the underlying skin, as
well as protecting valuable property from damage during the course of care. A simple wedding band may
be left on, but must be moved about on the finger during washing so that soap and friction are applied to
the metal and to the underlying skin to dislodge dirt and micro-organisms. Even a simple band should be
removed in any high-risk setting (NHMRC, 2010). Prior to handwashing, protective clothing should be put
on as necessary so that touching hair or clothing does not later contaminate clean hands. Long or
artificial nails, or nails with chipped or old nail polish, harbour four times the micro-organisms than either
unpolished or freshly polished nails do, so nails should be clipped short and nail polish removed (Grayson
et al., 2009). NHMRC (2010, p. 42) emphasises that it is the patient’s right to question health-care workers
about their performance of hand hygiene.
Gather equipment
For hand hygiene the following are needed.
● Running water – ensure it can be regulated to warm, as this is less damaging to the skin than hot
water, which opens pores, removes protective oils and causes irritation. Cold water is less effective
at removing micro-organisms and can be uncomfortable.
● The sink – a convenient height and large enough to minimise splashing since damp uniforms/
clothing allow microbes to travel and grow.
● Soap or an antimicrobial solution – used to cleanse the hands. The choice is dictated by the condition
of the patient. Antimicrobial soap is recommended if the nurse will attend immunosuppressed
patients or the pathogens present are virulent. A convenient dispenser (preferably non-
hand-operated) increases handwashing compliance.
● Paper towels – preferred for drying hands because they are disposable and prevent the transfer of
micro-organisms. Ensure removal without contaminating the remaining paper towels, which could
lead to cross-infection (Dougherty & Lister, 2011).
● An orange stick – this (or similar device) may be required for cleaning under fingernails.
2 PART 1: ASEPTIC TECHNIQUE

Handwashing
Turning on the water flow
Using whatever mechanism is available (hand, elbow, knee or foot control), establish a flow of warm water
to rinse dirt and micro-organisms from the skin and flush them into the sink.
Thoroughly wet hands and apply soap

When wetting hands, do not touch the inside or outside of the sink. The sink is contaminated and touching
it will transfer micro-organisms onto the nurse’s hands. Care must also be taken not to contaminate the
taps, sink or nozzle of the soap dispenser with dirt or organic material which is washed off the hands
(Dougherty & Lister, 2011). Wet hands to above the wrists. Keep hands lower than elbows to prevent water
from flowing onto the arms and, when contaminated, back onto the cleaner hands. Add liquid soap or an
antimicrobial cleanser – five millilitres is sufficient to be effective; less does not effectively remove
microbes and more would be wasteful of resources. If only bar soap is available, lather and rinse the bar
to remove microbes before you start to wash your hands, and do not put the bar down until you have
sufficient lather to last the duration of the wash. Lather hands to above the wrists.
Cleaning under the fingernails

Under the nails is a highly soiled area and high concentrations of microbes on hands come from beneath
fingernails. The area under the nails should be cleansed of debris with either an orange stick or the nails
of the opposite hand. Some authors suggest cleansing the nails prior to washing; others suggest that
cleansing during washing is more effective. Cleaning this area under flowing water is most effective for
removing debris.
Washing hands
Lather and scrub your hands for at least 15 to 30 seconds before care or after care if touching ‘clean’
objects (clean materials, limited patient contact such as pulse taking), and one to two minutes if engaged
in ‘dirty’ activities (Larsen & Lusk, 2006) such as direct contact with excreta or secretions. This provides a
clinical or medical aseptic hand wash.
Scrub one hand with the other, using vigorous movements since friction is effective in dislodging dirt
and micro-organisms. Pay particular attention to palms, backs of hands, knuckles and webs of fingers.
Dirt and micro-organisms lodge in creases. Lather and scrub up over the wrists and onto the lower
forearm to remove dirt and micro-organisms from this area. The wrists and forearms are considered less
contaminated than the hands, so they are scrubbed after the hands to prevent the movement of micro-
organisms from a more contaminated to a less contaminated area. Repeat the wetting, lathering with
additional soap and scrubbing if hands have been heavily contaminated.
Rinsing hands
Rinse the forearms, hands and fingers, in that order (Laws, 2009) under running water to wash micro-
organisms and dirt from the least contaminated area, over a more contaminated area and off into the
sink. Rinse well to prevent residual soap from irritating the skin. (Note: general hand-washing differs here
from the surgical scrub of the hands.)
Drying hands
Using paper towels, pat the fingers, hands and forearms well to dry the skin and prevent chapping. Damp
hands are a source of microbial growth and transfer, as well as contributing to chapping and then lesions
of the hands.
Turning off taps

Using dry paper towels, turn hand-manipulated taps off, taking care not to contaminate hands on the sink
or taps. Carefully discard paper towels so that hands are not contaminated. Turn off other types of taps
with a foot, knee or elbow as appropriate. Apply lotion to hands to prevent chapping. Chapped skin
becomes a reservoir for micro-organisms.
Alcohol-based hand rub (ABHR)

Hands must be visibly clean and dry prior to using the ABHR. Hand hygiene using a waterless ABHR has
been demonstrated to reduce the microbial load on hands when 3 ml of the 60–80 per cent ethanol-based
1 Hand hygiene 3
solution is vigorously rubbed over all hand and finger surfaces (use the same attention to the palms, back
of the hands, finger webs, knuckles and wrists as during the traditional hand wash) for 10–30 seconds,
until the hands are thoroughly dry. The use of ABHR is effective for minimally contaminated hands. Use of
ABHR increases compliance and reduces skin irritation. Messina, Lindsey, Brodell, Brodell and Mostow
(2008) state that the rate of cutaneous adverse reactions is 0.47 per cent, much less than the 20 per cent
claimed for soap or antiseptic solution hand washing. Thorough handwashing is still required for
contaminated hands or following ‘dirty’ activities (Pincheansathian, 2004; Morritt et al., 2006). ABHR is
more expensive than soap or antiseptic hand washing solutions, but has been demonstrated to save time,
increase compliance and reduce infections (Messina et al., 2008). Rathnayake (2011, p. 2) recommends
using ABHR routinely in preference to washing with soap and antiseptic solutions and water when the
hands are minimally contaminated.
Part of hand hygiene is the maintenance of healthy and intact skin. Moisturising the hands contributes
to healthy skin (NHMRC, 2010, p. 41) and restores moisture and oils that repeated use of soaps or ABHR
remove. Hand moisturisng reduces chapping and drying and should be undertaken as frequently as is
individually necessary. Applying the lotion prior to breaks and while off-duty is a good beginning.
Emollients that are compatible with the ABHR or the antiseptic soap in use in the facility should be
employed to ensure there is no reduction in the effectiveness of either.
References
Crisp, J. & Taylor, C. (Eds.). (2009). Potter & Perry’s fundamentals of nursing (3rd Australian ed.). Chatswood, NSW: Mosby Elsevier.
Dougherty, L. & Lister, S. (Eds.) (2011). The Royal Marsden Hospital manual of clinical nursing procedures (8th ed.). Oxford: John Wiley & Sons.
Grayson, L., Russo, P., Ryan, K. et al. (2009). Hand hygiene Australia manual. Australian Commission for Safety and Quality in Health Care and
World Health Organization.
Hogston, R. & Marjoram, B. (2011). Foundations of nursing practice – themes, concepts and frameworks (4th ed.). London: Palgrave Macmillan.
Larson, E. & Lusk, E. (2006). Evaluating handwashing technique. Journal of Advanced Nursing, 10, 546–50.
Laws, T. (2012). Chapter 32: Infection Prevention and Control. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …
D. Stanley, Kozier & Erb’s fundamentals of nursing (2nd Australian ed., Vol. 2, pp. 739–792). Frenchs Forest: Pearson.
Messina, M., Lindsey, A., Brodell, B. A., Brodell, R. M. & Mostow, E. N. (2008). Hand hygiene in the dermatologist’s office: To wash or to rub?
Journal of the American Academy of Dermatologists, 59, 1043–9.
Morritt, M. L., Harrod, M. E., Crisp, J., Senner, A., Galway, R., Petty, S., et al. (2006). Handwashing practice and policy variability when caring
for central venous catheters in paediatric intensive care. Australian Critical Care, 19(1), 15–21.
National Health and Medical Research Council (NHMRC). (2010). Australian guidelines for the prevention and control of infection in healthcare.
Commonwealth of Australia.
Pincheansathian, W. (2004). A systematic review of the effectiveness of alcohol-based solutions for hand hygiene. International Journal of
Nursing Practice, 10, 3–9.
Queensland Health (2010). Infection control guidelines, p. 5. Accessed 15 June 2012 at http://www.health.qld.gov.au/chrisp/ic_guidelines/
contents.asp.
Rathnayake, T. (2011). Evidence summary: Asepsis: Clinician information. Adelaide: Joanna Briggs Institute.
Rathnayake, T. (2011). Hand hygiene and alcohol based solutions. Adelaide: Joanna Briggs Institute.
Smith, S. F., Duell, D. J. & Martin, B. C. (2012). Clinical nursing skills: Basic to advanced skills (8th ed.). Upper Saddle River, NJ: Pearson.
World Health Organization. (2009). Guidelines on hand hygiene in healthcare. Geneva: Author.

CLINICAL SKILLS COMPETENCY
HAND HYGIENE
Demonstrates the ability to effectively reduce the risk of infection by handwashing/
performing hand hygiene
Performance criteria C S D
(numbers indicate ANMC National Competency Standards for the (competent) (requires (requires
Registered Nurse) supervision) development)
1. Identifies indication (2.5, 4.2, 9.5)
2. Prepares and assesses hands (2.5, 3.2, 9.5)
3. Gathers equipment (7.1, 7.3)

●
warm, running water
●
soap
●
paper towels
●
or alcohol-based hand rub
4. Turns on and adjusts water flow (2.5, 3.2, 9.5)
5. Wets hands, applies soap (2.5, 3.2, 9.5)
6. Cleans under the fingernails (2.5, 3.2, 9.5)
7. Thoroughly washes hands (2.5, 3.2, 9.5)
8. Rinses hands (2.5, 3.2, 9.5)
9. Dries hands (2.5, 3.2, 9.5)
10. Turns off the water (2.5, 3.2, 9.5)
11. Demonstrates ability to link theory to practice (3.2, 4.1, 4.2)
Student:
Educator: Date:
1 Hand hygiene 5
2
Personal protective equipment
Indications
Preventable infections associated with health care produce pain and suffering for the patient and family,
prolong health care stays and create an economic burden on the health system (NHMRC, 2010, p. 7).
These infections occur in all settings that involve patient care (e.g., acute care, long-term care, child care,
office-based care) and their prevention is a critical aspect of nursing care.
The following factors all influence the risk of infection following exposure to pathogens:
● the health status of the patient
● their immune competence
● their age (e.g., neonates and the aged are more susceptible to infection)
● the virulence of the pathogen
● the length of stay in the hospital
● the length of exposure to the pathogen (e.g., surgical procedures, indwelling catheters).
People can harbour pathogens without signs or symptoms of disease. Personal protective equipment
(PPE) is worn to prevent transmission of infection from the reservoir of infection to a susceptible host
(i.e., from patient to nurse, from nurse to patient or from nurse to his/her own family/friends as well as
from the patient to his/her family and friends and vice versa). Some patients’ family and friends will
need to be taught how to use PPE.
Using PPE is part of the ‘standard precautions’ used in health-care facilities, many or which have a
system (e.g., cards, colour coding, care plan notations) to assist in determining the level of risk, and the
equipment needed for various patients and for procedures.
Personal protective equipment refers to a number of barriers, used either singly or in combination, to
interrupt the transmission of contaminated material. These are used when, in the clinical judgement of the
nurse, there is a risk of: transmitting an infection to a patient; contaminating sterile materials (e.g., when
preparing medications, intravenous fluids); or danger of exposing the nurse’s mucous membranes, eyes,
respiratory tract, areas of broken skin or clothing to another person’s bodily secretions, blood, excretions
or other body substances. The decision to use the equipment is based on an assessment of the risk of
exposure to blood or other bodily fluids, the mode of transmission of the micro-organism and the body
substance involved.
Gather equipment
This is done prior to initiating interaction with the patient or visitors and is dependent on the procedure
to be undertaken and the clinical judgement of the nurse as well as hospital policy. A thorough
understanding of the modes by which infection is transmitted is necessary to apply infection prevention
measures and therefore the use of PPE.
Equipment includes the following.
● Goggles or safety glasses plus surgical masks or a full face shield – required when there is a risk
of airborne, droplet or spray contamination of the mucous membranes (eyes, nose, mouth) of
the nurse, which are portals of entry for pathogens. They are rigid plastic and usually reusable and
are used for procedures involving the respiratory tract or for procedures that generate splashes and
sprays (NHMRC, 2010, p. 49) and are put on before scrubbing.
● Surgical masks – fit loosely over the mouth and nose and are only used once. They are fluid
resistant. They prevent splashes from reaching the nurse’s mouth and nose, and provide some
protection from a droplet spreading infection. They also protect the patient from droplets expelled
from the nurse’s respiratory tract (Xue, 2010a). Disposable masks are preferred. The top of the
mask has a metal strip embedded in the band. To apply the mask, place it across the bridge of the
nose and tie the upper ties behind the head (or loop them over the ears and tie under the chin).
With the bottom of the mask under the chin, tie the lower ties at the nape of the neck or over the top
of the head. Next, pinch the metal strip so it sits snugly over the nose. If glasses are worn, the
edge of the mask should be under the glasses to minimise fogging. Masks are worn only once and
discarded promptly when no longer effective (i.e., damp, or the procedure is complete). Surgical
masks should be replaced when they become damp or soiled; the front of the mask should not be
touched; and the mask should be removed immediately after use (do not leave it dangling around your
neck). Hand hygiene needs to be completed before untying the ties and after discarding the mask.

P2 Respirator masks have a ‘duckbill’ and are sturdier than surgical masks, offering greater
protection against airborne and droplet infection as well as contact from splashes and sprays. This
mask is better fitted to the face and is also only used once.
● An apron – impervious plastic, protects the nurse’s uniform from contamination by droplets or
sprayed substances. Aprons are used when the risk of contamination is small, or confined to the
front of the nurse’s uniform.
● A gown – protects exposed body parts and prevents contamination of clothing by potentially
pathogenic substances (Xue, 2010a). Gowns are made of cloth (reusable) or impervious material
(disposable) and are used when possible contaminants are widespread, or to protect the patient
from the microbes carried by the nurse. Aprons/gowns are used to minimise cross-contamination
of body substances from one person to another via a nurse’s clothing. They should be used when
there is a risk of contamination with blood, body substances (except sweat), secretions or excretions
or when there is close contact with the patient or equipment or materials that may contaminate the
nurse’s skin or uniform. A patient’s gown worn over the nurse’s uniform provides no protection for
the nurse nor prevents cross-contamination. Gowns are usually reusable and will need to be
laundered prior to next use.
● Gloves – either sterile or non-sterile and protect both the nurse and the patient. The use of gloves is
determined by the procedure. Sterile gloves are used for aseptic procedures and contact with sterile
sites and contact with non-intact skin or mucous membranes. Non-sterile gloves are used when there is
potential for contact with contaminated fluids, excretions or instruments during general care, and for
patient protection if the nurse has broken skin on his/her hands. They are put on just prior to undertaking
a procedure, removed immediately after the procedure and discarded in the contaminated waste bin.
They are changed after each episode of patient care and between patients. Non-sterile gloves should
remain in their original box until needed, not kept in a pocket (Xue, 2010c, p. 3). This reduces the gloves’
incidence of contamination from hands and pocket debris, and maintains their integrity.
● The sharps container – while not strictly a piece of PPE, is nevertheless an important part of nurse
protection and containment of contamination. Although there are many devices available that have
been engineered to eliminate the risks of sharps injuries (e.g., needleless and retractable safety
devices), many procedures require the use of sharp instruments. When sharps are used, handling
must be minimised, (instruments rather than fingers used to grasp sharps when possible; use of
neutral zones such as basins for scalpel transfer; and disposable needles should not be ‘processed’ –
bent, broken or recapped after use). All used disposable sharps (e.g., blades, needles, catheter stylets
and glass vials) must be placed into clearly labelled, puncture proof, leak proof and untippable point-
of-use containers to minimise the chances of a sharps injury and nurse contamination (Xue, 2010b).
Hand hygiene
Perform appropriate hand hygiene procedure (see Clinical Skill 1).
Evidence of therapeutic interaction

Interacting with the patient, carers or visitors is an important aspect of minimising harm to the patient
and demonstrating respect for them as individuals. Wearing goggles, a plastic apron and gloves could
indicate to the patient that they are ‘dirty’ and need to be treated in a different manner to other patients.
Patients should, therefore, be familiarised with the health-care facility’s infection prevention strategies
and informed of the specific risks they face because of their medical or surgical status. Patients should
also be encouraged to disclose any health-risk status they may have (e.g., immune compromised, or
positive for hepatitis C, for instance). Both patients and visitors should be encouraged to minimise
infection risks by following basic hand and respiratory hygiene practices, and be provided with information
as necessary. Patients must be informed that it is their right to ask health-care professionals if hand
hygiene has been performed and if PPE should be used.
Safely and effectively dons/uses PPE

The sequence recommended by the NHMRC (2010, p. 55–6) for putting on PPE to minimise the risk of
transmitting pathogens is shown below. This differs from the sequence used in surgical scrubs as outlined below.
2 Personal protective equipment 7

● Aprons – to be placed over the head and the ties fastened behind the back.
● Gowns – to be picked up, held out in front and allowed to unfold (without being contaminated by body
substances) while the nurse grasps the neckline. Arms and hands are slid into the sleeves. The back
of the gown is overlapped and tied to cover the back of the uniform and keep the gown close to the
body to prevent inadvertent contamination.
● Masks – to be held by the upper ties, and placed over the nose and mouth. The upper ties are tied at
the back of the head or strung over the ears and tied under the chin. The lower ties are tied at the nape
of the neck or the top of the head to secure a tight fit to the face. The aluminum strip is smoothed over
the nose. If glasses are worn, the mask fits under them to reduce clouding from exhalation.
● Eyewear (goggles or a face mask) – to be placed over the eyes (and face) and are settled on the face
(and over glasses) for comfort and to exclude the possibility of contamination from splashes.
● Gloves (clean) – to be put on using the principles of infection control – minimising the contamination
of the surface that will be in contact with the patient. If wearing a gown, the gloves are pulled up
over the cuffs, and if no gown is used, the gloves protect the wrists (see Clinical Skill 5 for putting
on sterile gloves).
Removal of the PPE

Personal protective equipment is designed to be used only once and so must be removed when a specific
procedure is completed or a session of patient care is finished. This prevents contamination of other sites,
other people and the environment. It is to be removed in the area where the patient care occurred. The
correct sequence is: removal of the gloves; hand hygiene; removal of the eyewear, gown and mask.
Gloves are removed by pinching the outside of the wrist of the glove on the non-dominant hand and
peeling the glove off the hand. Keep the soiled glove in the still-gloved hand and slide the ungloved fingers
inside the wrist of the remaining glove, and peel it off the dominant hand and over the first glove. Discard
the bundle in the contaminated rubbish receptacle.
Perform hand hygiene.
Remove eyewear by touching only the headband or earpieces. Discard it into a container for cleansing
or into the waste receptacle if disposable.
Carefully remove the apparel (gown, apron, surgical mask) by undoing the ties, folding the
contaminated surface inside (touch only the areas that have been next to your own skin/clothing) and
rolling the material into a bundle with the contaminated side inwards before disposing of it into the
contaminated rubbish receptacle or linen hamper as appropriate. Take care not to contaminate yourself
while removing the apparel, for example, hand hygiene should be undertaken when gloves are removed
and prior to touching ties of gowns, masks or aprons, or removing face shields or eye protection.
Clean, replace and dispose of equipment

Dispose of single-use safety equipment into the contaminated rubbish receptacle in the patient’s
area. Non-disposable items such as goggles or face shields will require cleaning according to the
manufacturer’s instructions. The front of the shield or goggles is considered contaminated and should not
be touched with bare hands. Generally, cleansing with a mild detergent and warm water, and drying well
prior to replacing the equipment is sufficient. If there is gross contamination or the contaminating
material is definitely infectious, disinfection using an instrument-grade disinfectant is required (NHMRC,
2010, p. 51). Hand hygiene is again performed as a last infection control measure.
References
Berman, A. & Snyder, S. (2012). Skills in clinical nursing (7th ed.). Upper Saddle River, NY: Pearson.
Commonwealth of Australia. (This document is extensive and is available online at: http://www.nhmrc.gov.au. It should be consulted by all
health-care workers to gain an adequate understanding of managing the risks of spreading microorganisms.)
Xue, Y. (2010a). Aprons, gowns, face masks and eye protection. Adelaide, Joanna Briggs Institute.
Xue, Y. (2010b). Sharp and needle stick injuries. Adelaide, Joanna Briggs Institute.
Xue, Y. (2010c). Summary evidence: gloves. Adelaide, Joanna Briggs Institute.

USE OF PERSONAL PROTECTIVE

EQUIPMENT
Demonstrates the ability to choose personal protective equipment appropriate to the
situation and utilise the equipment to prevent interpersonal transmission of micro-
organisms that are transmitted by contact, droplet or airborne mechanisms.
1. Identifies the indication (2.5, 4.2, 5.1, 9.5, 10.1)
2. Demonstrates problem-solving abilities, such as obtaining personal

protective equipment prior to handwashing (5.1, 7.1, 9.5)
3. Identifies and gathers appropriate equipment (7.1, 7.3)

●
goggles/face mask
●
apron or gown
●
gloves
●
sharps container
4. Performs hand hygiene (7.1, 9.5)
5. Evidence of therapeutic interaction with the patient, carers or visitors

(2.3, 9.1, 9.2)
6. Safely and effectively dons/uses the appropriate equipment (7.1)
7. Disposes of/replaces used items safely (9.5, 10.1)
Student:
Educator: Date:
2 Personal protective equipment 9

3
Aseptic technique
Aseptic non-touch technique
The National Health and Medical Research Council (NHMRC) (2010, p. 85) states that ‘aseptic technique
protects patients during invasive clinical procedures by employing infection-control measures that
minimise, as far as practically possible, the presence of pathogenic organisms’. A standardised framework
of aseptic non-touch technique (ANTT) has been adopted which involves guidelines for protecting patients
from contamination and infection during clinical procedures. Aseptic technique aims to prevent pathogenic
organisms, in sufficient quantity to produce infection, from being introduced to susceptible sites by hands,
surfaces and equipment (NHMRC, 2010, p. 86). Cleaning and drying surfaces and equipment is the first
consideration. To achieve asepsis of hands and hard surfaces, a disinfectant should be used either to
clean, or following the cleaning process. For hand hygiene, using a non-touch technique and new,
sterilised equipment contribute to asepsis.
The core infection-control components of ANTT are summarised below.
● Key part and key site identification and protection – this involves determining the key part (i.e., the part
of the equipment, dressing material or cleansing material) that will come into contact with the
susceptible key site (the part of the patient that is vulnerable, such as incisions or open wounds).
Protection of the key parts means that these areas only come into contact with other key parts or
the key site. Non-touch of the key part is a vital component of maintaining asepsis. For example,
a key site (incision) can only be touched by an aseptically clean key part (a sterilised gauze square
dampened with sterilised normal saline using a sterilised forcep).
● Non-touch technique – requires not touching the key parts directly but using a sterile instrument,
dressing or solution to do so.
● Hand hygiene – an essential component of ANTT. (See Clinical Skills 1 and 4.)
● Glove use – sterile gloves are used if it is necessary to directly touch any key parts or key sites. If
not, non-sterile gloves are usually used. Risk assessment by the health-care worker determines
whether they can perform the procedure and maintain asepsis without touching either the key part
or the key site and contaminating it. Long procedures are usually more difficult and inexperience
often dictates the need to use additional infective precautions, such as sterile gloves rather than
non-sterile gloves.
The aseptic field is established either to ensure asepsis or promote asepsis. Critical aseptic fields
ensure asepsis. These fields are used when key parts and key sites cannot be protected easily using non-
touch techniques or when key sites are extensive and a large working area or long duration of contact is
required (e.g., in the operating theatre). Usually, sterilised equipment, sterile gloves and other barriers
such as gowns are required. Critical aseptic fields are used in surgical ANTT. Critical micro-aseptic fields is
a subtype of the critical aseptic field and includes key parts that are protected from contamination by their
own sterile cover (e.g., capped syringes, sheathed needles or packaged sterile gauze). Used along with a
non-touch technique, they provide an aseptic field for key parts and contribute to a general aseptic field,
which promotes asepsis.
The NHMRC (2010) outlines two ANTTs as follows.
1. Standard ANTT – clinical procedures managed with standard ANTT will characteristically be
technically simple, short in duration (approximately less than 20 minutes) and involve relatively few
and small key sites, and key parts. Standard ANTT requires a main general aseptic field and non-
sterile gloves. The use of critical micro-aseptic fields and a non-touch technique is essential to
protect key parts and key sites.
2. Surgical ANTT – surgical ANTT is demanded when procedures are technically complex, involve
extended periods of time and large, open key sites, or large or numerous key parts. To counter
these risks, a main critical aseptic field and sterile gloves are required, and often full-barrier
precautions are needed too. Surgical ANTT should still utilise critical micro-aseptic fields and non-
touch techniques when practical to do so (NHMRC, 2010, p. 89).
Indications
Aseptic technique (surgical asepsis) is used when preparing for and undertaking any invasive procedure,
i.e., one that penetrates the body’s natural defence of intact skin and mucus membrane. The principles
used in the practice of aseptic technique (Crisp & Taylor, 2009, p. 708; AORN, 2006; Laws, 2009) are that:

● sterile objects remain sterile only when touched by another sterile object
● only sterile objects may be placed in an aseptic field
● sterile objects/aseptic fields become contaminated by prolonged exposure to air
● sterile objects or aseptic fields should be kept in view
● a sterile surface that comes in contact with a wet contaminated surface becomes contaminated by
capillary action
● a fluid flows in the direction of gravity or by capillary action
● the edges of an aseptic field are considered contaminated
● skin cannot be made sterile, but washing reduces the number of micro-organisms on it
● sterile gloves are used to further prevent transfer of micro-organisms
● conversation should be minimised to reduce the spread of droplets
● whatever sterile object is opened for one patient can only be used for that patient
● unused sterile supplies are discarded or re-sterilised if they are to be used for another patient.
These principles are similar and compatible with the transmission-based precautions recommended
by the NHMRC (2010) and by Rathnayake (2011b). Conscientiousness, alertness and honesty are essential
qualities in maintaining surgical asepsis. Unless these principles and guidelines are strictly followed,
patient safety is compromised and infection may occur. Nurses must assess their patients for risk and
choose to use an aseptic technique if there is an increased chance of infection even in non-invasive
procedures where clean technique is often used (Flores, 2008). The following is very general and could
be used for any aseptic procedure (e.g., dressing change or catheterisation).
Evidence of therapeutic interaction

Explaining the procedure will reduce the contamination of sterile items. Explanation of the positioning and
the expectations of the patient will ensure his/her cooperation, reduce the risk that he/she will touch and
contaminate something sterile and reduce the necessity of talking during the procedure.
Gather and prepare equipment

The equipment required is dependent on the procedure to be done. All supplies must be available before
you proceed to the patient’s room so that the critical aseptic field, once established, is not left unattended.
A critical aseptic field left unattended is considered contaminated. Any additional items that are needed
for the procedure that are not on the trolley will have to be brought and added by a second person, which
is an unnecessary, time-consuming action.
● A trolley – collected and to be wiped down with the solution recommended by the facility to establish
a clean (not sterile) work surface. This removes much of the bacterial load from the trolley surface
and helps prevent cross-contamination. Let the trolley dry thoroughly to eliminate the transfer of
micro-organisms via moisture. Place all unopened plastic-, paper- and cloth-wrapped items on the
bottom shelf of the trolley, and leave the top surface as clean as possible for the aseptic procedure
(Rathnayake, 2011a).
● A large plastic bag – for discarding used materials, is taped to the side of the trolley, or sometimes
the bed. Place it closer to the patient than the trolley top surface so that contaminated material is
not brought over the critical aseptic field. Open the mouth of the bag wide enough so that material
can be dropped into the bag, preventing contamination of forceps or gloves.
Confirm the sterility of the packages

Check the colour change of the sterility indicator, the use-by date and whether the package is dry, has
tears, water damage, stains or, in the case of a bottle, a broken seal. The sterility indicator indicates that
the package has undergone sterilisation. Out-of-date sterile objects have been shelved for an extended
period of time and their contents are not sterile because of the time factor. Tears and punctures create
a pathway from the exterior to the interior of the package for micro-organisms to gain access. Stains,
dampness or water damage indicate that the wrapping has been wet and micro-organisms have travelled
into the package by capillary action. A broken seal on a bottle indicates the contents have been exposed to
the air and are contaminated.
Take the trolley to the patient’s bedside.
3 Aseptic technique 11
Position the patient comfortably
Positioning the patient reduces or eliminates movement during the procedure, which can contaminate
sterile items. Consider the patient’s position in relation to the time they will need to stay still, and to the
body part which needs to be accessible for examination or treatment. Pain medication (if required) should
be administered approximately 30 minutes prior to a procedure. Toileting requirements need to be
anticipated and attended to prior to positioning the patient and setting up the critical aseptic field. Maintain
privacy to enhance the patient’s dignity.
Wash hands
Hands are washed for two to six minutes (as per hospital policy) (Osborn, Wraa & Watson, 2010) to
remove micro-organisms and prevent cross-contamination.
Open the package

Initially, remove the outer plastic wrap (in prepackaged supplies) and drop the inner, sterile tray onto the
clean trolley surface. The still-wrapped tray package (e.g., dressing tray or catheter tray) is placed flat on
the top surface of the clean trolley, with the initial folded flap facing the nurse. Touch only the outside
surface of the wrapper to maintain the sterility of the inner surface. Using thumb and forefinger, grasp the
flap is grasped and folded out, away from the nurse to eliminate reaching over the then-exposed sterile
contents and risking contaminating them. The side flaps are carefully folded out, using the right hand for
the right flap and the left hand for the left flap, again to prevent the need to reach over sterile contents.
Finally, the last flap is folded towards the nurse to form a critical aseptic field. Adjustments to the position
of the critical aseptic field are made from underneath (the outside surface of) the wrapper. The inside
surface of the wrapper has formed a sterile surface, with the object (dressing tray, catheter tray, bowl,
etc.) in the centre of the critical aseptic field. The area inside a border 5 cm from each edge is sterile.
Add the necessary sterile supplies

Use the following methods to place supplies on the sterile tray. All packages are opened while standing
back from the established critical aseptic field to avoid contaminants falling from the packaging material
onto the field.
● Peeling pouches – grasp the opposite edges of the two sides of the wrapper and carefully peel down,
fully exposing the item (gauze squares, instruments, IV catheters, etc.). Without reaching across the
critical aseptic field or touching the non-sterile wrapping to the critical aseptic field, drop the item onto
the critical aseptic field from the wrapper, making sure it is within the 5 cm border. Items are dropped
from about 15 cm so that the packaging material and your hand do not touch the critical aseptic field.
● Unwrapping hospital-wrapped items – grasp the item in your non-dominant hand with the top flap
opening away from you. Remove the sterilisation tape and, using your dominant hand, open the flap
away from you, folding the corners well back from the item. Take care not to touch the contents of
the wrapper as you carefully and fully expose the item by folding the side and front flaps away from
the contents. Grasp the loose corner material from the wrapper and secure it at your wrist with your
dominant hand before carefully dropping the item onto the critical aseptic field. This keeps the now
unsterile wrapping material from inadvertently contaminating the critical aseptic field.
● Opening solution bottles – ensure there is a container available for the contents of the bottle on the
critical aseptic field before you open it, and read the label three times to make sure you have the
correct solution. Break the seal on the solution bottle and remove the cap. Place the cap on a clean
surface, inside up. Check the label and then hold the bottle with the label covered by the palm to
protect it from inadvertent splashes or dribbles that might obscure the writing. Hold the bottle
directly over the container and about 10 cm up to prevent accidentally touching the critical aseptic
field, and pour slowly to prevent splashes, since moisture will contaminate the field by facilitating
micro-organism movement through the sterile drape. Some agencies consider previously opened
bottles to remain sterile for 24 to 48 hours. If this is the case, recap the bottle immediately without
touching the inside of the lid to maintain sterility. Write a time and date clearly on the label and
initial it. To re-use such a bottle, pour a small amount of the contents into the sink or plastic bin
prior to pouring it into the sterile container to clean the lip of the bottle.

● Hand hygiene – an alcohol-based rub or another surgical hand wash is required prior to an aseptic
technique as hands have been contaminated by touching the packaging of the items that are put onto
the critical aseptic field. Depending on hospital policy or your own risk assessment (NHMRC, 2010),
you may need sterile gloves.
Manipulating the items

Rearranging items on the critical aseptic field is to be done with sterile forceps included in commercial
dressing trays. These are a different colour and the most easily accessible of the forceps. As some sterile
trays do not include an extra forceps, add one with the other sterile supplies. After all additional items
have been placed on the critical aseptic field, the forceps is carefully picked up, touching nothing else.
Using the principles of asepsis, the forceps is used to conveniently manipulate the items on the field. If
the forceps are used for anything wet, keep the tip lower than your wrist to prevent liquids from running
down the forceps by gravity and then back to the tips to make the forceps unsterile. When this is
completed to your satisfaction, discard the forceps either into the disposal bag (if plastic) or onto the
bottom shelf of the trolley (if metal). If wearing sterile gloves, the items on the field can be manipulated
directly with the fingers.
Perform the required procedure

Use the principles of the aseptic technique to perform the procedure.
Clean, replace and dispose of equipment

Contaminated disposables are to be sealed in the disposal bag, which is then wrapped in the (disposable)
wrapper that has formed the critical aseptic field. This material should then be placed in the contaminated
garbage bin in the dirty utility room. The trolley is to be wiped down with the recommended solution. If
gross contamination has occurred, soap and water should be used prior to the solution. Return the trolley
to its position in the clean service area of the unit. Shelve solutions to be re-used in front of unopened
solutions so that they can be used quickly and to avoid waste. Wash dry and return non-disposable items
to the Central Sterile Supply Department (CSSD) for re-sterilisation. Place non-disposable linens in a
laundry skip (contaminated if necessary) so they can be returned to the laundry for washing.
Documentation
Documentation is not necessary. Aseptic technique is a process used in other procedures and is therefore
not recorded.
References
Association of Operating Room Nurses (AORN) Recommended Practices Committee. (2006). Recommended practices for maintaining a sterile
field. AORN Journal, 83(2), 402–12.
Crisp, J. & Taylor, C. (Eds.). (2009). Potter & Perry’s fundamentals of nursing (3rd Australian ed.). Chatswood, NSW: Mosby Elsevier.
Flores, A. (2008). Sterile versus non-sterile glove use and aseptic technique. Nursing Standard, 23(6), 35–9.
Laws, T. (2009). Chapter 32: Integral Components of Client Care. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …
D. Stanley, Kozier & Erb’s fundamentals of nursing (2nd Australian ed., Vol. 2, pp. 739–792). Frenchs Forest: Pearson.
Osborn, K., Wraa, C. A. & Watson, A. B. (2010). Medical-surgical nursing: Preparation for practice. Boston: Pearson.
Commonwealth of Australia. (This document is extensive and is available online at: http://www.nhmrc.gov.au. It should be consulted by all
health-care workers to gain an adequate understanding of managing the risks of spreading microorganisms.)
Rathnayake, T. (2011a). Asepsis: Clinician information. Adelaide, Joanna Briggs Institute.
Rathnayake, T. (2011b). Surgical site infection: A sterile field. Adelaide, Joanna Briggs Institute.
Smith, S. F., Duell, D. J. & Martin, B. C. (2012). Clinical nursing skills: Basic to advanced skills (8th ed.). Upper Saddle River, NJ: Pearson.
3 Aseptic technique 13
ASEPTIC TECHNIQUE
Demonstrates the ability to effectively and safely establish and maintain a critical
aseptic field.
1. Identifies indication (2.5, 4.2, 5.1, 9.5, 10.1)
2. Evidence of therapeutic interaction with patient, e.g., gives explanation

(2.1, 2.3, 9.1, 9.2)
3. Gathers equipment (7.1, 7.3)
4. Confirms the sterility of the packages (7.1, 9.5)
5. Demonstrates problem-solving abilities, e.g., positions patient comfortably

(5.1, 5.2, 5.3, 7.1, 9.5)
6. Washes hands (7.1, 9.5)
7. Opens the tray/package (7.1, 9.5)
8. Adds necessary sterile supplies (7.1, 9.5)
9. Uses sterile forceps to handle sterile supplies (7.1, 9.5)
10. Performs required procedure (7.1)
11. Cleans, replaces and disposes of equipment appropriately (9.5, 10.1)
12. Documents relevant information (1.1, 1.2, 1.3, 2.6, 9.2, 10.2)
13. Demonstrates ability to link theory to practice (3.2, 4.1, 4.2)
Student:
Educator: Date:

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Sollte trotz der Anstrengungen des Medizinmannes die
Verhexung nicht gehoben werden können und der Chané- oder
Chiriguanoindianer sterben, so wird er oder sie in einem großen
Tongefäß unter der Hütte begraben. Bevor der Sterbende richtig tot
ist oder gleich nach dem Tode, wird er so zusammengefaltet, daß die
Knie unter das Kinn kommen, und die Arme werden kreuzweise über
die Brust gelegt. Am Rio Parapiti hat jahrelang ein Chanéindianer
gelebt, der auf diese Weise zusammengefaltet worden war, der aber,
bevor er in die Graburne gestopft worden war, von einem weißen
Manne gerettet wurde. Der Tote wird angekleidet, mit einer
Wasserkalebasse im Knie, in das Gefäß gesetzt. Das Wasser soll
der Tote mithaben, wenn er auf den Bergen umhergeht, sagte mir
der Chanéhäuptling Vocapoy. Das Gefäß wird in der Hütte vergraben
und als Deckel ein anderes Gefäß darübergestülpt.
Bei Tatarenda in der Nähe von Yacuiba verbrennt man, wie ich
gehört habe, nach dem Begräbnis die Hütte. Dies ist jedoch nicht
das Gewöhnliche. Dagegen pflegt man die Hütte einige Zeit nach
dem Begräbnis zu verlassen, um später wieder hinzuziehen. So
geschah es z. B. in einem Chanédorf am Rio Itiyuro, in welcher ich
kurz nach dem Begräbnisse war.
Die großen Maisbiergefäße (Abb. 113) werden als Sarg
angewendet. Herrscht Mangel an Gefäßen, so begräbt man oft auf
andere Weise. In einem Chanédorf, Copéri, am Rio Parapiti, begrub
man kurz vor meiner Ankunft ein Kind in einer Haut unter der Hütte.
Auf den Gräbern ihrer toten Verwandten verleben diese Indianer
ihr Leben, und oft ist es so voll in der Hütte, daß ein Nachbegräbnis
in alten Töpfen notwendig wird.
„Der Christ schleppt seine Toten weit von seinem Hause fort. Wir
Indianer, die eine größere Liebe für sie hegen, bewahren sie in
unseren Häusern.“ So ungefähr sprach Vocapoy einmal zu mir, als
das Gespräch auf diese eigentümliche Begräbnisart kam.
Wird ein Chiriguano von einem Jaguar getötet, so wird er mit
dem Kopf nach unten begraben, damit er nicht als ein solches Tier
umgeht. Diese Vorstellung vom Jaguar, der ein Mensch war, ist
besonders unter den Quichuas verbreitet, wo dieses merkwürdige
Tier, wie schon erwähnt, Uturunco genannt wird (vgl. S. 12). Heult
der Fuchs des Nachts nahe dem Dorfe, so stirbt jemand.
Abb. 113. Chiriguanograb. Caipipendi.

Stirbt der Mann, so soll die Frau das Haar kurz schneiden. Hat
sie ihn sehr geliebt, tut sie es zweimal. Erst wenn das Haar wieder
lang gewachsen ist, darf sie eine neue Ehe eingehen. Stirbt ihr Vater
oder ihre Mutter, so schneidet sie das Haar kurz, stirbt ihr Kind, ihr
Bruder oder Schwager, so schneidet sie es halblang. Unter langen
Haaren versteht man, daß sie bis zur Schulter reichen. Meine Frage,
ob auch die Männer bei Trauer ihr Haar schneiden, wurde mit einem
Gelächter beantwortet. Sie begnügen sich damit, eins der
allerlängsten zu verkürzen. Die Männer dürfen sich erst ungefähr ein
Jahr nach dem Tode der Frau wiederverheiraten.
Hat die Frau Trauer, so trägt sie keinen Schmuck. Als ich bei
Maringay war, hatte seine Schwiegertochter ihr kleines Kind
verloren. Während alle anderen Frauen im Dorfe zahlreiche
Halsketten trugen, hatte sie keinen einzigen Schmuckgegenstand.
Sie nahm auch an keinem Feste teil.
Die Indianer, welche die Missionare taufen, sehen es nicht immer
gern, daß sie ihre Toten auf dem Kirchhof begraben müssen. Sie
wollen wenigstens, daß die Toten Wasser mit ins Grab bekommen.
Man befreit sich nicht so leicht von alten, ererbten Vorstellungen,
um sie gegen neue einzutauschen.
Tafel 18. Chanéfrau mit Kind. Rio Itiyuro
[74] Karl v. d. Steinen: Unter den Naturvölkern Zentralbrasiliens.

Berlin 1894.
[75] Psidium guayava.
[76] Corrado: El Colegio Franciscano De Tarija y sus misiones.
Quaracchi 1884. S. 526–527.
[77] P. Chomé, S. 320. Derselbe Pater spricht auch von dem
Brauche der Couvade bei diesen Indianern, S. 321. Lettres
édifiantes. T. XXIV.
[78] P. Chomé: Lettres édifiantes. T. XXIV, S. 317.
[79] P. Chomé, l. c. S. 319.
[80] Chomé, l. c. S. 318.
[81] Im Thurn l. c. S. 190.
Dreizehntes Kapitel.
Aus dem Leben der Chané- und
Chiriguanoindianer (Forts.).
Häßliche Worte, Homosexualität, Selbstmord,

Schamgefühl u. a.
In der Sprache der Weißen gibt es, wie bekannt, eine Anzahl
Worte, die man in anständiger Gesellschaft nicht anwenden darf.
Gewisse Körperteile dürfen Personen desselben Geschlechts nur
mit lateinischen Namen nennen, während Personen verschiedenen
Geschlechts in der Regel gar nicht miteinander darüber sprechen.
Ein Wort kann für häßlich gelten, während ein anderes Wort für
denselben Gegenstand beliebig angewendet werden kann. Der
Grund, warum ein Wort verboten ist, ist sicher oft schwer zu
ermitteln.
K. v. d. Steinen[82] und Koch-Grünberg[83] haben darauf
hingewiesen, daß auch die Weiber unter den Indianern am Xingu
und Rio Negro von den Geschlechtsteilen ganz offen, als von etwas
Natürlichem reden. Ebenso ist es bei den Indianern, die ich kennen
gelernt habe. Als ich nach Worten fragte, welche die allerintimsten
Dinge berührten, gaben auch die Weiber, ja die jungen Mädchen, auf
die allernatürlichste Weise Auskunft darüber.
Es gibt indessen Worte, die verboten sind. Solche Worte sind bei
den Chorotis „ametché“, das ein Schimpfwort ist, „ictivähi“, das
homosexuellen Geschlechtsverkehr bezeichnet, „huéle“, das Onanie
bedeutet, und „tévi“ bei den Chanés und Chiriguanos, das dieselbe
Bedeutung wie ictivähi hat. Das Unnatürliche im Geschlechtsleben
ist auch hier so schändlich, daß es sich nicht paßt, darüber zu
sprechen.
Es gibt auch Indianer, die niemals über solche Gegenstände
sprechen wollen. So beschaffen war z. B. ein Chiriguano, den ich auf
meinem ersten Ausflug den Rio Parapiti herunter mithatte. Er stellte
sich sogar so, als hätte er niemals von etwas Derartigem reden
hören. Als ich ihn über die Homosexualität bei seinen Landsleuten
befragte, stellte er sich dumm und sagte ungefähr: „Pflegen das die
Weißen zu tun?“
Unter den Indianern gibt es gleichwohl, wie auch bei uns, solche,
denen es Spaß macht, obszöne Geschichten zu erzählen. Ein
solcher war der alte Chané Bóyra, er, der den Schimpfnamen
yúruhuasu, Großmaul, hatte. Je schlimmere Sachen er erzählte, um
so mehr amüsierte sich der alte Bóyra. Zuweilen erzählte er so, daß
sogar mein Freund Batirayu, der zu dolmetschen pflegte, sich richtig
genierte. Der alte Chiriguano Yambási war auch einer, der alle
möglichen Unanständigkeiten zu erzählen wußte.
Bóyra erzählte, wie der Fuchsgott, Aguaratunpa, und die
Iguanaeidechse, Téyuhuasu, in einem homosexuellen Verhältnis
zueinander standen. Bóyras Erzählung war so außerordentlich
realistisch, daß ich sie hier unmöglich wiedergeben kann. Er erzählte
auch, wie der Fuchs sich mit einem Waldhuhn[84] „Kése-Kése“
verheiratete, das auch ein Mann war.
Aguara (der Fuchs) kam einmal zur Hütte des Waldhuhns.
„Wie geht es dir, Bruder?“ sagte der Fuchs.
„Gut, komm, setz’ dich, Bruder“, sagte das Waldhuhn.
Der Fuchs setzte sich. Das Waldhuhn hatte viele Erdratten
„angúyatúto“ aufgehängt, die es getötet hatte.
„Willst du Erdratten essen?“ sagte das Waldhuhn.
„Ja“, sagt der Fuchs und aß eine. Er verlangte dann noch eine
und noch eine usw.
Schließlich bat er darum, zwei für seine Kinder mitnehmen zu
dürfen. Das Waldhuhn gab sie ihm. Der Fuchs, der keine Kinder
hatte, fraß auch diese auf.
„Hast du eine Frau?“ sagte der Fuchs.
„Nein, ich wohne hier mit meiner Schwester,“ sagte das
Waldhuhn.
Der Fuchs ging hierauf fort. Als er zu einer Pflanze „supua“
gekommen war, hing er seinen Penis auf, nahm eine Frucht herunter
und setzte sie an die Stelle, wo der Penis gesessen hatte. Die
Supua sieht nämlich wie eine Vulva aus. Der Fuchs nahm dann die
Tembeta heraus und verstopfte das Loch. Er kam dann an ein Haus,
wo einige Frauen wohnten.
„Wollt Ihr Tiru (Frauentracht), Halskette und Haarband mit mir
gegen ein Pferd tauschen?“ sagte der Fuchs.
„Wo hast du dein Pferd?“ sagten die Frauen.
„Mit dem komme ich morgen“, sagte der Fuchs. Er bekam nun
Tiru, Halskette und Haarband, legte alles dies an und begab sich auf
einem anderen Wege nach dem Hause des Waldhuhns. Als er
dorthin kam, war niemand zu Hause. Er legte sich da in die
Hängematte. Nach einer Weile kam das Waldhuhn nach Hause.
„Woher kommst du?“ sagte das Waldhuhn.
„Von meinem Vater“, antwortete der Fuchs. Der Fuchs kochte
nun zwei Erdratten und aß sie auf. Dann kochte er noch zwei und aß
auch diese auf. Hierauf kochte er noch zwei und aß sie auf.
Am Abend fragte der Fuchs die Schwester des Waldhuhns: „Wo
willst du liegen?“ „Hier“, sagte sie.
„Dann lege ich mich neben dich“, sagte der Fuchs. Ein bißchen
davon legte sich das Waldhuhn. Als die Schwester eingeschlafen
war, streckte der Fuchs die Hand aus und faßte das Waldhuhn an.
Dieses kam und legte sich neben den Fuchs.
„Bist du verheiratet?“ sagte das Waldhuhn.
„Nein, meine Mama hat mich nicht verheiraten wollen“,
antwortete der Fuchs ...[85]
Der Fuchs schlief nun zwei Nächte bei dem Waldhuhn und wurde
schwanger. Nach einiger Zeit gebar der Fuchs.
Eines Tages kamen einige Vögel dort vorbei. „Gib mir Bogen und
Pfeil, ich will schießen“, sagte der Fuchs. „Du kannst wohl nicht
schießen, du bist ja kein Mann“, sagte das Waldhuhn.
„Ich bin ein Mann“, sagte der Fuchs, nahm Pfeil und Bogen und
ging fort. Als er zur „Supua“ kam, nahm er seinen Penis herunter
und setzte ihn sich wieder an.
Man erzählte mir von einem Chanéindianer von Yacundai am Rio
Parapiti, der sich in fremden Dörfern als Schmarotzer
herumzutreiben pflegte. Die Indianer wurden zuletzt seiner über, und
als er einmal vollständig betrunken war, schändeten ihn einige
Chiriguanoindianer im Caipipendital. Er begab sich nach diesem
Schimpf nach dem unteren Rio Parapiti. Als die Kenntnis von dem,
was ihm in Caipipendi passiert war, dorthin gedrungen war, hängte
er sich in Verzweiflung über diese Schande.
Eigentümlicherweise wird es unter diesen Indianern nicht als eine
Schande betrachtet, in einem homosexuellen Verhältnis der Aktive
zu sein, der Passive wird aber tief verachtet. Er wird als ein Weib
betrachtet. Dies ist der Grund, warum ein Teil rücksichtslose Weiße
unverbesserliche Indianer mit — einem Klistier bestrafen. Ein so
gekränkter Indianer verschwindet für immer. Man nimmt an, daß er
Selbstmord begeht. Mittels „tévi“ bestraft ein Indianer seine
ungetreue Frau und verläßt sie dann. Chanéknaben habe ich „tévi“
spielen sehen.
Nach Westermarck[86] ist die Homosexualität sehr verbreitet unter
den Indianern Amerikas. Die Auffassung, daß dies eine
Schändlichkeit ist, ist keineswegs überall so ausgeprägt, wie bei den
hier erwähnten Indianern.
Über Onanie habe ich bei den Chanés und Chiriguanos nichts
gehört. Sie soll dagegen bei den Chorotis von den Männern, die
beim Tanz von den Frauen übergangen werden, betrieben werden.
Perversitäten im Verhältnis zwischen Männern und Frauen, die
im alten Peru gewöhnlich waren, scheinen hier nicht vorzukommen.
Primitive Säugetierstellung beim Koitus soll bei den Chacostämmen
gewöhnlich sein.
Mataco gab mir eine Wurzel, die sie als Aphrodisiakum
anwendeten.
Das Verhältnis zwischen Menschen und Tieren ist in den Sagen
der Indianer so intim verflochten, daß man nicht immer bestimmen
kann, ob sie das eine oder das andere meinen. Die Sagen, welche
die Liebesverhältnisse zwischen Menschen und Tieren schildern,
sind keine Schilderungen von Bestialität, die bei diesen Indianern
unbekannt zu sein scheint.
Das Schamgefühl ist bei diesen Völkern sehr verschieden
entwickelt. Es scheint mir sehr stark von der Kleidertracht
abzuhängen. Keiner dieser Indianer oder Indianerinnen, von denen
ich hier erzähle, betrachtet es, soweit sie nicht vollständig verdorben
oder zivilisiert sind, als unpassend, den Oberkörper zu zeigen. Die
Chiriguano- und Chanéfrauen sind viel verschämter als die Chorotis
und Ashluslays, wenn sie die Geschlechtsteile zeigen. Die letzteren
wollten sich höchst ungern vollständig entkleiden, um photographiert
zu werden. Den ersteren wagte ich so etwas nicht einmal
vorzuschlagen.
Saß man des Abends am Feuer in der Hütte und war mit der
Familie bekannt, so schienen sie gleichwohl ganz ungeniert zu sein.
Die Choroti- und Ashluslaymänner sind sehr schamlos. Die Männer
unter den Chanés und Chiriguanos dagegen weniger. Es ist sehr
gewöhnlich, daß die Chiriguano- und Chanéfrauen, in einer
Gesellschaft konversierend, stehend Wasser lassen und den Urin
das Bein herunterlaufen lassen, was ja als weniger sauber gelten
darf. Die Männer gehen dagegen immer abseits, um dieses
Bedürfnis zu verrichten.
Abb. 114. Junge Chanéfrau entblößt den Oberkörper, um sich
photographieren zu lassen. Rio Parapiti.
Der Geschlechtsakt geht, wie erwähnt, bei den Ashluslays oft in
Gegenwart von Zuschauern vor sich. Bei den Chorotitänzen mußte
man sich in der Dunkelheit vorsehen, nicht über die liebenden Paare
zu stolpern. Dergleichen sieht man niemals bei den Chiriguanos
oder Chanés. Da viele in derselben Hütte liegen, sieht man
gleichwohl auch bei ihnen vieles, was man immer sieht, wenn man
Schlafgäste hat. Dies nicht zum wenigsten ist der Grund, daß das
Geschlechtsleben selbst für die kleinen Kinder keine Geheimnisse
hat.
Offenbar steigert das Zusammenleben mit den Weißen das
Schamgefühl. Die Indianerinnen genieren sich sogar, die Brust zu
zeigen. Die Moral sinkt in dem Maße, wie das Schamgefühl steigt.
Dies sollten alle diejenigen bedenken, die für nackte
Heidenkinder Kleider nähen.
Viele meiner Leser finden vielleicht, daß dieses Kapitel nicht in
meinem Buche hätte enthalten sein sollen. Es scheint mir gleichwohl
richtig, etwas über die Abweichungen auf dem geschlechtlichen
Gebiete zu sprechen. Es trägt zum Verständnis der Menschen, die
ich hier schildere, bei. Natürlich habe ich hier nicht über all den
Realismus, der bei den Gesprächen am Lagerfeuer manchmal
zutage trat, sprechen können.[87]
Die natürliche Seite des Geschlechtslebens fassen die Indianer
so ganz verschieden von dem, wie wir es in der Regel sehen, auf. All
die Verderbnis, die in der zivilisierten Gesellschaft ist, treffen wir bei
diesen Menschen nicht, verschiedenes findet sich aber schon hier.
Was besonders die Homosexualität betrifft, so zeigen, wie bekannt,
die Verhältnisse bei den Naturvölkern, daß die Ursache des Übels
viel tiefer, als in unserer Hyperzivilisation liegt.
[82] K. v. d. Steinen: l. c. S. 25.

[83] Koch-Grünberg: l. c. Bd. I S. 133.
[84] Penelope.
[85] Als allzu realistisch ausgelassen.
[86] Westermarck: Ursprung und Entwickelung der Moralbegriffe.
Bd. II. Leipzig 1909.
[87] Wenn unsere täglichen Zeitungen, die wohl für die
Öffentlichkeit bestimmt sind, über alles mögliche schreiben, so
braucht man ja in einer Reiseschilderung nicht allzu prüde zu
sein.
Vierzehntes Kapitel.
Aus dem Leben der Chané- und
Chiriguanoindianer (Forts.).
Häuptlinge und Gesetze.

Die Häuptlinge bei den Chanés und Chiriguanos haben eine
ganz andere Stellung als bei den Ashluslays und Chorotis. Sie
haben eine bedeutende Macht. Unter den Häuptlingen finden sich
die großen Häuptlinge, die über mehrere Dörfer herrschen, und die
Dorfhäuptlinge, die nur über ein Dorf oder einen Teil eines solchen
gebieten. Von großen Häuptlingen, die ich kennen gelernt habe, sind
bemerkenswert die alte Vuáyruyi, die Häuptling über die
Chanédörfer am Rio Itiyuro ist, Taruiri, der über den größeren Teil
des Caipipenditales herrscht, Mandepora (Abb. 111), der früher eine
bedeutende Macht in und um Machareti hatte, und Maringay im
Iguembetal.
Jetzt haben die Häuptlinge keine anderen Zeichen ihrer Würde,
als silberbeschlagene Stöcke. Nach Corrado trugen sie früher einen
großen Haarbüschel auf dem Kopfe, „yattira“, sowie grüne Steine,
die an den Ohren hingen. Bei den Festen und Tänzen hatten sie das
Recht, die „yandugua“, eine mit einem Bündel Straußenfedern
geschmückte Stange, und „iguirape“, einen mit eigentümlichen
Figuren geschnitzten Stab, anzuwenden. Von diesen habe ich nur
eine Yandugua erwerben können. Die übrigen habe ich nicht einmal
gesehen.
Die Häuptlingswürde scheint in der Regel erblich zu sein. Doch
sind Tüchtigkeit und die Kunst, seine Worte wohl zu setzen,
erforderlich.
Vocapoy hat mir seinen Stammbaum mitgeteilt, den ich hier
wiedergebe, da er sehr lehrreich ist, und ich zu glauben wage, daß
es den Leser interessieren kann, einen indianischen Stammbaum zu
studieren.
Vo c a p o y s S t a m m b a u m .
Wir finden somit, daß der eigentliche Häuptling am Rio Itiyuro

eine Frau ist. Ich habe die alte Vuáyruyi besucht. Sie empfing mich,
in ihrer Hängematte liegend, mit großer Würde. Da die Frau alt und
schwach ist, regiert Vocapoy und sucht, so gut wie er kann, die
Seinen gegen die Weißen zu schützen, die ihr Land vollständig in
Beschlag genommen haben. Ich fragte Vocapoy, warum Vuáyruyi,
als Frau Häuptling geworden ist. „Ihr Vater Hinu Parawa hat sie
sprechen gelehrt“, sagte Vocapoy. Es wird somit von diesen
Indianern, um regieren zu können, als höchst wichtig betrachtet, die
Sprache in seiner Gewalt zu haben. Diese Menschen können die
Klugheit höher schätzen, als die Stärke. Niemand wird Häuptling,
wenn er nicht ein älterer Mann ist. Der Mann der Vuáyruyi war nicht
Häuptling, sondern nur „Prinzgemahl“. Die Dorfhäuptlinge gehören
ebenfalls dem Geschlechte Hinu Paravas an.
Taruiri ist auch nicht der richtige Häuptling, sondern vertritt einen
jüngeren Verwandten, der infolge seiner beständigen Betrunkenheit
als untauglich betrachtet wird. Taruiri herrscht im Caipipendital, wo
sein Gebiet noch frei ist, von den Weißen aber wohl bald usurpiert
werden wird. In Ivu ist ein Chiriguanohäuptling, der auch
Medizinmann ist. Dies ist das einzige Beispiel von Theokratie, das
ich kennen gelernt habe.
Die Häuptlingsfamilien bilden unter den Chiriguanos und Chanés
eine Art Aristokratie. Mehrmals habe ich Indianer sich mit ihren
feinen Familienverbindungen großtun hören. Ein Chiriguano, der
mich eine längere Zeit als Dolmetscher begleitete, war eifrigst
bemüht, mir einzuprägen, daß er mit den bekanntesten
Oberhäuptlingen verwandt war.
Wie der Verfasser dieses Buches als Sohn von Adolf
Nordenskiöld vorgestellt zu werden pflegt, so pflegten die Indianer in
ähnlicher Weise die Söhne ihrer „großen Männer“ vorzustellen.
Ich bin sogar hinter ein bißchen Betrügerei mit dem Stammbaum
gekommen. Ein Chané behauptete, direkt von dem großen Hinu
Parava herzustammen, was aber nicht wahr sein soll.
Will man bei diesen Indianern hübsche Sachen aus alten Zeiten
finden, so hat man sie zuerst bei den Häuptlingsfamilien zu suchen.
Sie bewahren die alten Kleinodien.
Immer mehr beginnen die weißen Behörden die Häuptlinge zu
ernennen. Man kann also in einer Gegend einen von den Weißen
gestützten Häuptling und einen legitimen finden.
Die Häuptlinge haben eine große Macht, und man gehorcht
ihnen, im Gegensatz zu dem, was bei den Chorotis und Ashluslays
der Fall war, soweit ich gesehen habe, immer. Sie besitzen den
Boden (wenigstens in gewissen Gegenden), aber nicht für eigene
Rechnung, sondern für den Stamm. Braucht man in einem Chané-
oder Chiriguanodorf Träger, so erhält man sie von dem Häuptling,
und kein Indianer weigert sich, die Befehle des Häuptlings
auszuführen.
Obschon der Häuptling einen so großen Einfluß hat, arbeitet er
doch in derselben Weise, wie die übrigen Indianer. Vocapoy z. B.
trug selbst das schwere Holz zum Maisbierkochen nach Hause, und
seine Frau mußte kochen und fegen, wie die anderen Frauen. Dem
Beispiele der Weißen folgend, haben jedoch jetzt einige der
zivilisiertesten und reichsten Indianer, wie Taco, Diener aus ihrem
eigenen Stamme, aber dies ist nicht das Ursprüngliche. Dagegen ist
es, wie ich an anderer Stelle schon erwähnt habe, nichts
Ungewöhnliches, daß die Mataco-Vejos und die Tapiete für die
Chiriguanos und Chanés arbeiten.
Als wir im Dorfe Vocapoys von der Jagd heimkehrten und mit
dem Häuptling unsere Beute teilten, nahm seine Frau alles an, ging
aber dann in den Häusern herum und gab den Nachbarn alles, was
sie erhalten hatte.
Man kann hier nicht von reich und arm in demselben Dorfe
sprechen, obschon auch der Anfang zu einem Adelsstand
vorhanden ist. Dagegen gibt es arme und reiche Dörfer. Einzelne
verhältnismäßig reiche Indianer gibt es, diese leben aber, wie Taco,
wie die Weißen.
Der Häuptling ist Richter und
war früher Heerführer.
Vocapoy sagte mir, Totschlag
werde in der Weise bestraft, daß
der Totschläger dazu verurteilt wird,
bis zu einem halben Jahre für die
Familie des Getöteten zu arbeiten.
Ein Dieb bekommt bis zu fünfzig
Rutenschläge und wird, um nicht
getötet zu werden, nach einem
anderen Dorf geschickt. Nach Abb. 115. Kalebasse.
Vocapoy ist es die Hauptaufgabe Chiriguano. Itapenbia. ⅙.
des Häuptlings, Blutrache zu
verhindern, indem man die Verbrecher fortschickt, damit sie nicht
gemordet werden. Vater-, Mutter- und Kindesmord sind, seiner
Behauptung nach, in seiner Gegend unbekannt.
Nach Batirayu, dessen Angaben zuverlässiger als die Vocapoys
sind, beschäftigt sich der Oberhäuptling der Chanés am Rio Parapiti
mit keinen anderen Verbrechen, als mit Mord, Verführung einer
anderen Frau und Verhexung. Mord mit vergiftetem Chicha, „bád-
dyási“, kam früher bei den Chanés vor. Mörder und Verhexer wurden
verbrannt. Der Verführer einer Frau wurde aller seiner Habe beraubt.
Im übrigen wurden Diebstahl und andere Verbrechen durch Duell
geschlichtet. Hatte jemand gestohlen, so riefen der Gekränkte und
der Dieb ihre Verwandten herbei, und man kämpfte auf dem offenen
Platz im Dorfe.
Die Behörden der Weißen greifen jetzt immer mehr in die
Rechtsverhältnisse der Indianer ein.
Im Krieg mit anderen Stämmen führte der Häuptling den Befehl,
wie sie es auch bei den Empörungen der Indianer gegen die Weißen
getan haben.
Nach Vocapoy besitzt der Häuptling den Boden für den Stamm.
Batirayu sagte, das Recht an dem Grundbesitz werde so geordnet,
daß jeder anbaut, was er will. Schon bebauter Boden hat seinen
Besitzer, wenn er auch jahrelang brachgelegen hat. So wird auch
Brachland vererbt.
Die Erbschaften werden im übrigen dadurch bedeutend
eingeschränkt, daß der Tote einen Teil seiner Kostbarkeiten mit in
das Grab nimmt.
Wie bei den Ashluslays und Chorotis, ist auch hier das
Besitzrecht gut ausgebildet, und die Frauen besitzen auch das, was
sie anwenden und herstellen. Wie bei den genannten Stämmen, ist
auch hier die Mildtätigkeit sehr groß, wenn sie auch dank unserer
„Zivilisation“ und der Mission weniger ausgeprägt ist.
Das Chiriguanogemeinwesen — das ursprüngliche
Chanégemeinwesen kennen wir nicht — hat eine viel festere
Organisation gehabt als das Gemeinwesen bei den Chorotis und
Ashluslays. Die Chiriguanos waren ein Eroberungsvolk, das
wahrscheinlich die Chanés unterjocht und mutig und erfolgreich
gegen die Inkas gekämpft sowie lange der Invasion der Weißen
Widerstand geleistet hat. Hätte es statt der vielen Häuptlinge nur
einen einzigen gegeben, so hätte die Eroberung des
Chiriguanolandes ganz sicher das Leben doppelt so vieler Weißen
gekostet, als jetzt. Leider haben in den Kämpfen der Weißen gegen
die Indianer beinahe stets einige Häuptlinge auf der Seite der Feinde
gegen ihren eigenen Stamm gekämpft. Bei dem letzten, durch den
Kampf bei Curuyuqui entschiedenen Aufruhr hatten die Weißen eine
Hilfstruppe von ein paar tausend Indianern, mit denen sie zusammen
deren Stammfreunde bekämpften.
Wie sich alles im Leben der Indianer verändert, wenn die Weißen
ihr Land erobert haben, so verwandeln sich auch die sozialen
Verhältnisse. Wenn Vocapoy, Maringay, Mandepora und einige
andere in den Tongefäßen unter den Hütten liegen, dann ist das
Ende herbeigekommen, dann haben die Indianer keine anderen
Gesetze als die der Weißen, keine anderen Behörden, als deren
Vögte. Die Chanés am Rio Parapiti haben, wie erwähnt, keinen
Oberhäuptling mehr. Batirayu ist diese Würde angeboten worden, er
will aber nicht der Knecht der Weißen sein, dazu ist er zu stolz. „Es
ist nicht wie in alten Zeiten“, sagte Batirayu zu dem wunderlichen
Weißen, der das Vertrauen und das Verständnis der Indianer suchte.

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Tollefson 5ed SB 9780170216364 CVR 1pp.indd 2 16/05/12 12:57 PM

Clinical Psychomotor Skills outlines the practical aspects of competencies necessary

New to this edition

Psychomotor skills assessment

Using this assessment tool

RESOURCES ACCOMPANYING THIS TEXT

ABOUT THE AUTHOR

2 PART 1: ASEPTIC TECHNIQUE

Thoroughly wet hands and apply soap

Cleaning under the fingernails

Turning off taps

Alcohol-based hand rub (ABHR)

4 PART 1: ASEPTIC TECHNIQUE

1. Identifies indication (2.5, 4.2, 9.5)

2. Prepares and assesses hands (2.5, 3.2, 9.5)

3. Gathers equipment (7.1, 7.3)

4. Turns on and adjusts water flow (2.5, 3.2, 9.5)

5. Wets hands, applies soap (2.5, 3.2, 9.5)

6. Cleans under the fingernails (2.5, 3.2, 9.5)

7. Thoroughly washes hands (2.5, 3.2, 9.5)

8. Rinses hands (2.5, 3.2, 9.5)

9. Dries hands (2.5, 3.2, 9.5)

10. Turns off the water (2.5, 3.2, 9.5)

11. Demonstrates ability to link theory to practice (3.2, 4.1, 4.2)

6 PART 1: ASEPTIC TECHNIQUE

Evidence of therapeutic interaction

Safely and effectively dons/uses PPE

2 Personal protective equipment 7

Removal of the PPE

Clean, replace and dispose of equipment

8 PART 1: ASEPTIC TECHNIQUE

USE OF PERSONAL PROTECTIVE

1. Identifies the indication (2.5, 4.2, 5.1, 9.5, 10.1)

2. Demonstrates problem-solving abilities, such as obtaining personal

3. Identifies and gathers appropriate equipment (7.1, 7.3)

4. Performs hand hygiene (7.1, 9.5)

5. Evidence of therapeutic interaction with the patient, carers or visitors

6. Safely and effectively dons/uses the appropriate equipment (7.1)

7. Disposes of/replaces used items safely (9.5, 10.1)

2 Personal protective equipment 9

10 PART 1: ASEPTIC TECHNIQUE

Evidence of therapeutic interaction

Gather and prepare equipment

Confirm the sterility of the packages

Open the package

Add the necessary sterile supplies

12 PART 1: ASEPTIC TECHNIQUE

Manipulating the items

Perform the required procedure