Running head: CLINICAL EXEMPLAR

A Clinical Exemplar
Marlee Griggs
University of South Florida

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Nursing School Clinical Exemplar

A clinical exemplar uses a personal story from a nurses experience to highlight their
current nursing practice. It provides insight into ones thought process, decision making, and
nursing judgment skills. It also provides an avenue for one to reflect on the situation that
occurred and gain a deeper understanding of ones role as a professional nurse. Reflecting back
on decisions made-whether the situation went well or not, allows one to grow and change their
practice for the better. Although there are many uses for clinical exemplars, Tschannen and
Aebersold utilized clinical exemplars throughout their study to highlight their work and portray
to others the success they were able to achieve (2013).
During my preceptorship on the progressive care unit at Bayfront Health, I worked with a
patient that had been admitted for altered mental status. The patient had been found on the
ground at home, and it was unknown how long he had been down. When I went in to assess the
patient in the morning, he was calm and cooperative. He was alert and oriented to person only,
and had to be reminded what day of the week it was and that he was in the hospital. The patient
was a high fall risk and also had a sitter that was present with him in the room. As the day
progressed the patients behavior began to deteriorate. He became increasingly agitated and
belligerent towards the sitter. He began cursing at the sitter and accusing her of pushing him onto
the bed and trying to keep him there. He also believed that President Obama had told him that he
was free to go home, but we were going against the President and making him stay. The patient
also threatened to leave, removed his telemetry monitor, and tried to pull out his nasogastric
tube. The patient became very restless and kept getting out of bed and trying to walk to the chair
even though he was very weak and unsteady while walking.

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The sitter asked for assistance in working with the patient because he was extremely
agitated with her and told her not to touch him. The patient was scheduled to receive Valium,
and so I attempted to offer the patient that medication because I knew it would help him calm
down, but the patient refused to take it. He clearly stated that he did not want to receive the
medication because it would make him fall asleep for the next eight hours and he wanted to go
home. I went into the room multiple times and attempted to use therapeutic communication to
acknowledge the patients feelings and his frustrations. I was able to diffuse the situation for
short amounts of time, but the patient remained agitated and confused. I also felt that the patient
was upset with the sitter and her presence in the room seemed to heighten his agitation. I relayed
this information to the nurse, but she did not feel there was anything that could be done. I also
asked the nurse to come in and see the patient because I did not know what else could be done
for the patient to help diffuse the situation. The nurse decided to give the patient his valium
through the nasogastric tube against his wishes, and the patient was upset when he realized that
she had given the medication to him.
I did not agree with how this situation turned out, and I feel that other avenues should
have been explored before a medication was administered against the patients desires. I think
this situation taught me that you need to use your available resources before resorting to that type
of decision. I know therapeutic communication would not have been a long term solution, but it
could have helped diffuse the situation until other options were explored. I do not want to be a
nurse that makes decisions based on ease, but one that looks at what is best for the patient and
strives to show dignity and respect to my patients through the care that I provide. I hope that if I
am faced with a similar situation in the future, that I will be a patient advocate and strive to do
what is best for the patient.

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References

Aebersold, M., & Tschannen, D. (2013). Simulation in nursing practice: The impact on patient
care. The Online Journal of Issues in Nursing, 18(2). doi:
10.3912/OJIN.Vol18No02Man06