Clinical Exemplar

Running head: CLINICAL EXEMPLAR
Clinical Exemplar
Danielle Finethy
University of South Florida
CLINICAL EXEMPLAR
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Clinical Exemplar
Throughout my time in nursing school I have had many clinical experiences and
interactions with patients, families, and other staff members that have helped to shape me as a
nurse. In my final semester of the program I was fortunate to complete my internship in the
Critical Care Unit at Bayfront Medical Center in St. Petersburg, Florida. During this time I was
able to learn a lot about myself and how I operate in the function of nursing. This clinical
exemplar will help to describe a situation that I feel helped to foster my sense of belonging in
this career and instill the belief in myself that I am competent and will be able to succeed. A
clinical exemplar is a first person account of a situation encountered by a nurse that allows the
sharing of the experience with professional colleagues (Owens & Cleaves, 2012).
During my internship I was often caring for the same patients as many of the critical care
unit patients are there for extended periods of time. There was an 86 year old woman who was
brought in, against her wishes and at the demand of her son, after suffering respiratory distress at
the nursing home where she lived. The first time that I cared for her she had already been on the
unit for about five days and she had signed her own papers for do-not-resuscitate (DNR) orders.
She was on bipap therapy and was not being given any nutrition because she refused to have
surgery to get a PEG tube placed and was NPO due to the continuous bipap. She was extremely
weak and had multiple pressure injuries on various areas of her body. Her arms were slightly
contracted and she was unable to use the call button on her own. At this point in her admission
she was able to verbally communicate and alert and oriented to her surroundings.
I cared for her a few other times soon after this first day and she became familiar with me
and would frequently ask me for things that aided in her comfort such as cold washcloths on her
forehead, providing her with oral care, or extra pillows to support her arms. I was happy to help
CLINICAL EXEMPLAR
this patient as I had never seen her son visit her or any other visitor besides the case worker from
the nursing home she lived at. I have a lot of compassion for elderly individuals that are no
longer able to help themselves to take care of activities of daily living, especially when their own
family is not able or willing to participate in their care.
On the last time that I cared for this patient she had been on the unit for almost three
weeks and was never able to be taken off the bipap without complication. She was one day postop from receiving a tracheostomy and six days post-op from receiving a PEG tube placement.
She had since rescinded her DNR orders and was made a full code. Her providers ordered for
her to receive a trial on a trach collar just one day post-operative from receiving the
tracheostomy. In my experience with this patient I had a gut feeling that this trial was not going
to go well and I was at her bedside while the respiratory therapist (RT) began changing her from
a ventilator to a trach collar set-up. I left the patients room briefly just before the change was
completed to help with another patient. I returned to the nurses station about five minutes after I
had left the patients room and made sure to keep an eye on her vital signs as well as her room.
As I anticipated, her oxygen level was starting to desaturate after being taken off the ventilator
and as I looked into her room she was raising her hand the best she could to call for help.
I entered the patients room and she was visibly scared and was mouthing to me to help
her. I asked her if she was having trouble breathing and mouthed yes, please help me. I then
reacted by alerting the RT that the patient was not tolerating the changes made and we needed to
place her back on the ventilator. When I returned to the room with the RT the patient was still
very scared and I held her hand to help to ease her anxiety. She was much more comfortable
once placed back on the ventilator and she expressed her thanks to me many time for paying
attention to her and recognizing her distress before anyone else.
CLINICAL EXEMPLAR
This experience may not have been the most critical of situations but for me it taught me
the importance of getting to know your patient and always being aware of their needs.
Anticipation of patient status and needs is definitely a skill that will be improved upon with time
and experience as a nurse, but it was reassuring to me that I was able to spot something that
stood out to me as a potential problem.
CLINICAL EXEMPLAR
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References
Owens, A. L., & Cleaves, J. (2012). Then and now: Updating clinical nurse advancement
programs. Nursing, 42(10), 15-17. doi: 10.1097/01.NURSE.0000419437.60674.45

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Running head: CLINICAL EXEMPLAR

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