• Megan Filoramo

How sterile technique taught me about cognitive distortion, 27 years later.

“Don’t touch anything. Don’t break the sterile field.”


I can still feel the pit in my stomach, the deep anxiety, as I prepared to catheterize a mannequin in my first semester nursing lab. The professor was one of THOSE nurses, the ones that are portrayed as maniacal sociopaths in old movies, the ones that give nursing school a bad name. It was either maintain the sterile field or cause certain death of the aforementioned plastic mannequin from sepsis. Death of the mannequin was known to result in failing the basic skills lab of Clinical 1. No joke.

Fast forward a few weeks to my first catheterization of a real live patient. I was terrified. Thankfully, my professor was off torturing someone else so I was doing it with the assistance of the floor nurse. I very carefully laid out the sterile field. I put the gloves on with perfect technique. I attached the syringe to the balloon and tested it.


And then I brushed the curtain with my hand.


I thought I was going to vomit. The nurse hadn’t seen it but I knew that I had to say something. I didn’t even have a thought to entertain an angel/devil duo on my shoulder, patient safety came first.


“I touched the curtain.” I told her, sure that this was the end of my nursing career.

“What?” she asked.

“I touched the curtain. I broke the sterility of my gloves.” The shame was unbearable.

“Oh, ok. Well quick, go get another pair.”


I was shocked to the core. No fire and brimstone. No tirade about the imminent and unpreventable death of my patient from urinary sepsis. No immediate expulsion from the program.


Shocked enough that I still remember it 27 years later.


It turns out there is a third option between a perfect, incident free insertion of a foley catheter and certain death. It turns out you can just get another pair of gloves.


So why do I tell you this?


This idea of polarizing options, of all-or-nothing thinking, came up for me this week in a less obvious, less dramatic way. It presented as the option between being productive or wasting time. Let me explain.


I was REALLY tired on Sunday night. I had had an incredibly busy week followed by out of town guests for the weekend. You know that feeling of doing all the things you wanted to do but then being exhausted because of it? So I decided ahead of time that Monday night I would “take off”. I would just relax and recuperate. So self-care-ish of me. Right?


It was a great plan… until Monday night actually came. As I sat down on the couch to relax, the floodgates opened and all the ideas of things that I should be doing came crashing down on me. Sure, I could relax and read (or scroll TikTok) but I only have 2 weeks until my daughter leaves for college, my house is a mess, my business is waiting to be run, my conference lectures need to be written and of course I should exercise. Time is precious and it shouldn’t be wasted. I could be productive or I could be lazy. Sound familiar?

Let’s talk about all-or-nothing thinking and why it’s a problem.


It’s the absoluteness of all-or-nothing thinking that can lead to negative interpretation of things in our lives that are not necessarily negative. It skews us towards the worst case scenario.

We can start with the example of productive vs. lazy but this can also translate to any of the following.

Enough vs. Inadequate

Sufficient vs. Insufficient

Satisfied vs. Dissatisfied

Good vs. Bad

Success vs. Failure.


Fancy, psychological people call it cognitive distortion and distorted thinking leads to stress and anxiety.


When we let this type of thinking go unchallenged, it robs us of achievement and can result in self-deprecation. We ignore the small gains which can be the kindling for the fire of motivation that will result in long term habit change. Now that I am aware of it, it shows up everywhere! (again with the absolute thinking)


And to make things even worse, when we apply this all-or-nothing principle to other people it can lead to harsh judgement and resentment. Just what we were hoping for to increase happiness in our lives.


Here’s the thing. If we engage in all or nothing thinking ie: productive vs. lazy, it blocks the creativity of a third option, the option of being not productive but not lazy either. Maybe I can be not busy and relaxed without self judgement. This third option is a viable possibility if we stop and let it in (like the option of getting a new pair of gloves).


It is really only a 2 step process to overcome this issue.

Step 1: Identify where all-or-nothing thinking is showing up.

Step 2: Ask yourself, “what is a third option/possibility in this situation?”


Yup, that’s it.

Once you break the confines of absolute thinking, your creative, brainstorming mind will take over.


Take a minute to try it now. What is some decision that you are struggling with in your life right now? Write down the pros and cons of both sides? Really dig in and find all the reasons you should pick one option over the other.


Or maybe it isn’t a decision. Maybe it shows up as something you are trying to do consistently; exercise vs being a big slug, eating right vs not eating right, prioritizing family time vs. constant busyness.


Now, ask yourself, “what is another option, a different one than the two polarized sides?”


It may take sitting with this question for a minute before you start to get some answers but I assure you, if your brain can manage all the other things you do during the day, it can manage this.


Get ready to blow your own mind. This is really a game changer.


One mess up does not have to lead to sepsis and death.

There is ALWAYS another pair of gloves.



Does this resonate with you? Come on over and follow me on Facebook at NursingBeyondtheJob.

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