Running head: NURSING CLINICAL EXEMPLAR

Nursing Clinical Exemplar

Eric J. Hutto
USF | College of Nursing

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Nursing Clinical Exemplar

One vital component to being a competent nurse is the ability to reflect on different
situations and clinical decisions. A clinical exemplar provides nurses the opportunity to examine
different situations while incorporating their thoughts, feelings, and intellect. According to
Greenville et. al (2015), the use of narratives is a pedagogical approach that provides a reflective
and interpretive framework for analyzing and making sense of texts, stories, and other
experiences within learning environments. It is something that the nurse remembers as important
or significant and has made an impact on the nurses clinical judgment.
During Medical Surgical II Nursing Clinical rotations in the intensive care unit, one of
my first patients was a 78-year-old woman who had a lower GI bleed and hemoglobin was less
than 3 grams per deciliter (g/dL) (whereas a normal hemoglobin level for a female is between 12
15 g/dL). The patient coded twice the night before and she was in a more critical condition as
her blood pressure was steadily decreasing. Eventually, she became severely hypotensive and my
preceptor had to reach the maximum dose on her norepinephrine and epinephrine drip
medications. The patient required a blood transfusion, but due to her Jehovah Witness religion
affiliation, there was a conflict with the implementation. The interesting fact is the patients
religious affiliation was determined by her health history from two years ago when she was seen
at the facility. Upon her current admission, she was not in a condition to speak or notify the
healthcare team if she was still affiliated with Jehovah Witness practice. The only source of
information the healthcare team had was the patients daughter who had not seen her mother for
three years prior to the hospital admission. At 8:54am, the rounding nurse practitioners called a
code blue situation as the patient slipped into ventricular tachycardia. Time of death was
announced at 9:01am.

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While it was a very unfortunate scenario, the process of a code was very interesting to
watch and be able to participate. I was able to cope well with the patients death, but there was a
very small detail that continued to bother me through the rest of my shift: What if the patient was
no longer affiliated with the Jehovah Witness faith? How would the healthcare team have
intervened differently? Since the patient never verbally expressed or confirmed her religious
affiliation upon her current admission, could it be possible she may have no longer been part of
the religion? These are all questions I asked to my preceptor and she did not have an answer.
One ethical principle I believe was violated was beneficence. Guido (2014) defines
beneficence as actions one takes to promote good. Beneficence may also be viewed as the
promotion of health, often defined by the patients perception of how he or she defines health
and considering how that individual perceives what is good. I do not think that beneficence was
truly honored in this scenario since there was a lack of confirmation regarding the patients
religious affiliation. Although it was highly unlikely the patient chose to depart from her religion
(considering her age), this was still a very critical point of information that could have
determined the implementation of a life-saving intervention. Conversely, the healthcare team
could have been honoring nonmaleficence by withholding the blood transfusion. Guido (2014)
describes the detriment-benefit analysis as focusing on the benefit of a treatment (or lack thereof)
to the patient as opposed to the harm it may cause in the moment. Since it was assumed the
patient was still Jehovah Witness, the healthcare team was considering the fact that a blood
transfusion could have posed unfavorable religious consequences. Applying the MORAL model
in this case is very difficult, but it works. According to Guido (2014), the first step in the
MORAL model is to massage the dilemma by identifying, defining issues and considering the
opinions. In this case, the dilemma is how to save the life of the patient considering that she is

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assumed to be affiliated with Jehovah Witness based on the assertion of the patients daughter.
Next is to outline the options by considering the pros and cons of each possible intervention
and alternative. The main intervention in question is the blood transfusion. The pros would be
that it can help with the patients oxygenation. Cons would be the religious consequences that
would affect the patient. For example, the patient could be exiled from her Kingdom Hall or
her spiritual wellness could be compromised. There is also the possibility that the blood
transfusion could produce other complications in the patients condition. Resolve the dilemma
refers to analyzing the options and choosing which option is best. In this case, the healthcare
team decided it would be best not to deliver the blood transfusion. Act by applying the chosen
option refers to the supportive care that the patient was placed on as she continued to decline in
her health status. Look back and evaluate refers to reflecting on the chosen intervention and
deciding if it were the correct choice that produced the best outcome. While I do not entirely
agree with whether the intervention (or lack thereof) was the best option, it is very
understandable to consider the importance of a patients cultural background and how it impacts
his or her health care.
In closing, the clinical experience has shaped my views of the importance of cultural
factors in an individuals healthcare. I believe that as healthcare providers, it is extremely
important to honor the wishes of patients regardless of any differences in values, morals or
religion. The clinical situation has also shaped my view of death. It has solidified my
understanding that death is something that is guaranteed in life, and it is not always the worst
outcome. Sometimes death is the best outcome for patients who may not be able to live the same
quality of life before being diagnosed with a terminal illness or chronic condition. All in all, this

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clinical situation has prepared me to make ethical and informed decisions about a persons
healthcare.

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6
References

Guido, G. (2014). Application of ethics in nursing practice settings. In Legal & ethical issues in
nursing. (6th edition; pp. 36, 44). Boston, Massachusetts: Pearson.

Greenfield, B. H., Jensen, G. M., Delany, C. M., Mostrom, E., Knab, M., & Jampel, A. (2015).
Power and Promise of Narrative for Advancing Physical Therapist Education and
Practice. Physical Therapy, 95(6), 924-933 10p. doi:10.2522/ptj.20l 40085