A clinical exemplar is a story that is narrated by a nurse, or in this case a nursing student, about an experience with a patient or a clinical situation. This story writing process is a way to improve a nurse’s self-care though reflective writing. This type of writing also enhanced learning and knowledge.
Above is my clinical exemplar about a patient and situation I had during my preceptorship.
After receiving feedback from both classmates and my professor, I revised my resume. Attached above is my final resume.
After watching the video, “Man Gives Birth to His Child”, I reflected on my reactions and feelings if I were assigned this birthing couple/person. My first initial reaction would be to ensure I did not mess up any pronouns. I would want the family to feel safe and secure in the hospital setting. Through actions of inclusivity of their gender and sexuality, I believe they would have a greater opportunity to feel safe and comfortable. I would also treat the family the way I would treat any birthing couple and person; with compassion and patient-centered care. The birthing person had very specific wishes for his labor, as a nurse I would try to include these wishes throughout his labor. In a nutshell, my reaction and feelings would focus on inclusivity and making sure the patient and partner feel welcomed at this hospital.
To make this birthing couple feel welcomed at the hospital it is important to incorporate inclusivity into their care. Some methods to increase inclusivity in the hospital setting would include asking the individuals pronouns and making a conscious effort to say the correct pronoun and ensuring the other members of the team are aware of the correct pronouns. It is also important to explain everything to the patient prior to completing the action, this allows the patient to feel prepared and decline if they don’t feel comfortable. As nurses these actions can help make the patient and their significant others feel comfortable, especially in a vulnerable situation, like childbirth.
In a situation like the situation that was brought up in the video, using female-specific language can impact the delivery of care. Using female-specific terms for someone who identifies as a different gender can create issues with patient-centered care. The patient many feel as though the nurse is not listening or respecting their wishes, this can lead to issues with communication and comfort in the hospital setting. A short-term issue for the patient could include their time at the hospital may be uncomfortable and difficult, they may feel judged or disrespected. Regarding long-term issues, the patient may have anxiety returning to the hospital or assume all healthcare services do not respect their wishes. This can lead to extended periods without care and not attending appointments due to fear or discomfort. Every member of the health care team should be aware of the patient’s pronouns and provide inclusivity regardless of their personal beliefs. This will allow for the best care to be provided to the patient and their family.
While watching the nursing report provided, I was shocked to listen to the way the nurse giving report spoke about the patient. In the 40 second clip, I was stunned to hear so many biases. Many comments that the nurse giving report said made me extremely uncomfortable. The first comment was within 5 seconds of the beginning of report when she said, “let me give you report, so I can go.” Although this comment is not necessarily related to bias, it still seems inappropriate to say to the other nurse. The second comment that made me uncomfortable was the pronunciation of the patient’s name. The nurse giving report addressed the patient’s name incorrectly and then proceeded to say “who knows where he’s from” insinuating that he is not from here due to his name. This is also an extremely inappropriate comment and shows the nurse’s bias towards the patient. The last comment that stood out to me was the comment about how the patient was injured. The patient had reported his injury was due to a sports accident related to skateboarding. However, when the nurse giving report commented on why the patient was admitted, she used air quotes when addressing the skateboard accident insinuating it was something else has caused his injury instead of a sports injury. These comments made me extremely uncomfortable and showed the reporting nurse’s biases.
These statements are extremely important to address because of many reasons. First, comments like these are inappropriate regardless of the situation or patient. Secondly, the nurse giving report is displaying a distaste for the patient and not treating the patient with the kindness and respect all patients deserve. These comments could take away from the care the patient should be receiving. These comments the nurse is making makes it seem as though she does not respect the patient enough to prove important care for him. Due to this, the patient could suffer physically after surgery and/or mentally.
My initial reaction if I was the nurse receiving this report would be extremely shocked and then have a difficult time responding to the initial comments. However, after my shock subsided, I would feel upset and angry with the words and biases the nurse giving report was saying. I do think I would be able to address the comments the nurse was making. I also think I would bring these comments to the attention of the charge nurse to further discuss the actions that should be taken.
One of the most uncomfortable situations I have witnessed that displayed bias was in my first clinical rotation. This specific rotation was on a rehab unit with patients recovering from knee, hip, etc. surgery that typically received opioid pain medication. I was in a room with a patient taking a head-to-toe assessment when the rounding team of providers stopped in. I stepped out of the room to give the patient and providers time to speak. While in the hallway I was taking notes on my head-to-toe findings, when I heard one the providers begin to discuss pain management. The patient was upset with the topic and the provider became upset with the patient. After they left the room, the provider addressed the group and said the patient was only upset because they were a drug addict and did not deserve pain medication due to their addiction. The provider then went on to say the patient was from a certain town that was known for addiction and assumed that was why the patient was so upset about the change in medication. One of the other providers asked if the patient could be upset because the change to his medication was not previously discussed with them. The original provider laughed and said no the only possible explanation was the patient being a drug addict. This was the first time I have ever witnessed a bias in the hospital and was shocked to no one truly stand up for the patient.
After volunteering at the hospital with the Hospital Elder Life Program, I was amazed with the thorough and thought-out program the hospital created. My knowledge of delirium and preventative factors has changed because I now realized the importance of the HELP program. The preventative factors are small details that anyone that works in the hospital can do to help reduce the patients risk of delirium. Through asking the patients their background history, how they have been sleeping, and other risk factors, the volunteer is able to inform the staff of the patient’s risk of delirium. I am grateful for this experience because it was a very well-rounded volunteer involvement, and it also gave me an opportunity to learn something knew that I plan to incorporate into my future nursing care.
The most meaningful aspect of my volunteer experience was interacting with the patients and understanding that the volunteer work was truly helping the individual. Oftentimes the patients were extremely grateful of someone coming to speak with them. I learned many interesting and amazing things from the stories the patients told me. I enjoyed the experience because I was able to spend time with multiple patients and allow them to freely discuss anything they wanted.
The learning goals I created before my shift volunteer shift were met through my three shifts. I plan to integrate this knowledge moving forward by incorporating it into my assessments. I feel as though I am very aware of the preventative measures to decrease the risk of delirium and plan to implement that with the care of my patients. Again, I am thankful for this experience to fully understand the importance of decreasing delirium through preventive measures.
Before volunteering at the HELP program, I feel as though I have a relatively well-rounded knowledge of delirium and the factors to prevent delirium. Last year in nursing school we spent a lot of time going over delirium and ways to prevent it. This was extremely important because delirium is becoming more prevalent in hospitals, especially in the elderly population. Delirium occurs when a person becomes confused or disoriented to person, place, time, and/or location. This can make a person’s hospital stay longer than anticipated and affect their health. The factors to help prevent delirium include having the patient go for walks or doing range of motion exercises, frequent reorientation, adequate nutrition, ensuring they have their glasses or other devices, and making sure they are sleeping at night. These factors will help prevent delirium in patients that are at risk of developing it.
This past summer, I worked at a hospital and cared for a patient that had unfortunately developed delirium. I was working a night shift and the patient was extremely confused and disoriented to time. They kept getting out of bed, assuming it was morning. The patient did not get adequate sleep and was even more confused in the morning. This experience solidified the knowledge I was given last year in class.
My goals for the HELP program volunteer experience are to help the patient reduce their risk of developing delirium by reorienting them and providing the preventative measures that we have learned about. Another goal would be to get the patient to do ROM exercises. Since I will be volunteering, I cannot physically help the patient get up and go for a walk, but I would like to help them do ROM exercises. My last goal would be to be aware of the warning signs of delirium and be able to notify the staff working with the patient if they seem to be more disoriented to person, place, situation, or time than in previous encounters.
I do not think I am nervous about this volunteer experience. I feel as though I am ready to talk with the patient and see if I can help them prevent delirium by speaking with them and helping them person ROM exercises. My feelings prior to volunteering are feelings of excitement to be able to help someone and hopefulness for a good experience! For the aging population, I am aware of the community services that help pay for health or living expenses and help provide rides to patients that are unable to drive.
Volunteer work at the Preble Street Food Pantry Oct 1st (4 hours) and 17th (4 hours) 8 hours total.
The clinical population for the Preble Street Food Pantry is the homeless population of Portland, Maine. This population would include adolescents, young adults, middle-aged adults, and the elderly. The primary focus of the food pantry is preparing food for breakfast, lunch, and dinner to give to the people and families in need in the greater Portland area.
There are many Social Determinants of Health that are relevant to the clinical population. Two concerns are economic stability and neighborhood and built environment. Both of these Social Determinants of Health are relevant for the clinical population because neither are stable with a homeless population. The people in need have no place to live or sleep so the neighborhood and build environments are very limited as well as their economic stability. I would advocate for these clients by helping them find homeless shelters or stable living. I would try to work with the area and clean it up to provide a safer outside environment. I would also help the clients apply for jobs to help stabilize their economic status.
Within the food pantry, everyone is working together to prepare food for the clients. One way that incorporating interprofessional collaboration could create positive outcomes for the clients is by interprofessional teamwork and team-based care (IPE Competency 4). These positive outcomes for the clients could be achieved by having a nurse or provider help give out food in the community and provide care to clients that are in health care needs. One of the most problematic issues within the homeless population is not being able to receive health care. The clients could receive health care by having health care providers tag-along with the distribution of food.
Throughout clinical this semester, I met so many welcoming and kind individuals. Each patient made a difference to me and made an impact on my clinical experience. I hope I was also able to make an impact on their lives as well. One patient that I felt I left an impact on was someone who had been at the facility for a while and did not have many supporters.
This patient has been at the care facility for a very long time and had hardly any visitors. When I was assigned this patient, my main goal was just to give them someone to talk to and spend the day with. I spent the day helping this patient with activities of daily living. They joked about the breakfast that the facility gave out and I helped clean sticky fingers from the syrup. They also allowed me to brush their hair and play cards with them. I knew that my main goal was to give them a day that was just about them. Since the patient seemed to be lonely, I strived to speak with them as much as I could throughout the day. I could tell they were greatly enjoying their time with me, and I was happy that I was easing their burden ever so slightly.
At the end of the day, I circled back around to the patient’s room. They seem to be waiting for me and I ask them how their day was going. They said that they had been waiting for me to come back to see them and were glad I stopped by again before I had left. They said that they appreciated how much time I took out of my day to spend with them and that they were so glad I was their student nurse for the day. I was happy that I had help but was sad that I couldn’t spend more time with the patient.
I did not realize how much of a difference I had made in that individual’s life until the next time I was at clinical. I was working with other patients that day but decided to stop in and say hello to them. They were extremely happy to see me and had said they had started doing some of the fun things we had done the week prior, such as playing cards. They thanked me again for spending the day with them and showing them ways to keep this situation fun. I realized that my impact on them that day had truly helped them, and I was grateful for the experience.
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