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Clinical Exemplar
Sarita C. Watford
University of South Florida
Running Head: NURSING CLINICAL EXEMPLAR 2
NURSING CLINICAL EXEMPLAR
Nursing Clinical Exemplars are tools used in nursing academia for timely and thoughtful
feedback (Carter et al., 2018). A key component in nursing is being able to reflect on clinical
decisions made throughout their shift. A clinical exemplar allows for the student nurse to reflect
upon their day and critically think about situations. A clinical exemplar can be used to provide
the student a way to incorporate how they feel and intellectualize about patients. According to
Carter et al (2018), the use of clinical exemplars enables students to reflect so they may identify
mistakes and recognize gaps in knowledge.
My Story
During one of my last clinical shift my nurse and I received report from the nurse that
one of our patients was not expected to make it through the day. At that moment my nurse and I
decided that we were going to stay positive and pray this patient stays makes it. The patient had
pancreatic cancer and had an adverse reaction to chemotherapy. That reaction is what made him
sicker and from there is health started to decline further. Upon first assessment of the patient his
presentation seemed normal. Other than the generalized edema he didn’t present as a dying
patient. I have done a few clinical hours on the hospice floor so I know what dying patients
present like and this patient didn’t have the signs. Matter of fact when I was talking to him and
telling him what I was about to do I could have sworn that he made gestures to let me know he
Running Head: NURSING CLINICAL EXEMPLAR 3
understood. He didn’t make eye contact but his arms moved and he made grunting noises when I
would talk to him. My gut feeling was this patient was still with us, fighting.
As the day went on his gestures and grunting stopped and there weren’t any other
objective signs of him being alert. This patient was a DNR so all we needed to do was keep him
comfortable. He had discharge orders to hospice so while he was in my care I made sure he did
not suffer. The situation was definitely critical but, I did my best to make sure it wasn’t stressful.
There was no one to consult or ask about any aspect of the patient’s care, because all of that had
been determined. The patient was dying so it was our job as his nurses to make sure him was
comfortable.
I made sure his wife sitting as the bedside knew I was there if she needed me. She was
settled with the outcome and although it was hard to see her husband in such a state she found
comfort in the care he was getting. I asked her what kind of music he liked and she told me 80’s
easy rock. We decided to let his favorite music play from the television. I am an 80’s easy rock
fan so most of the songs I knew and would sing them while I was at his bedside checking on
him. I talked to him as if he was still fully there. I commented on the music and told him how
much I liked it. According to Wagner (2015), during this stage of dying, body functions slow and
the person with the illness has minimal awareness. Hearing is the sense that may remain intact
until the very last moment which makes music a useful tool for comfort measures (Wagner,
2015).
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At a certain time during the day the PCT and I administer perineal care; now here is
where things got a little shocking and I felt some sort of medical intervention was needed. When
we pulled back the covers I noticed the patient’s scrotum was doubled in size and filled with
fluid. His scrotum looked like an overly filled water balloon that was about to explode. I’m not
easily shocked but the appearance of his scrotum shocked me. I had never seen anything like
this before. I had already noticed the generalized edema but I wasn’t prepared for this. I quickly
ran to get my nurse and she wasn’t shocked at all which put out my panicky fire and led me to
believe that this was a normal occurrence. She explained that it was indeed normal so we
proceeded with cleaning the area. I decide at that moment I need to read up on what happen the
body during the dying process.
I found out the next morning, not too long after we discharged him to hospice the patient
died. As I reflect on the situation, I can honestly say that I wouldn’t have done anything
different. I pray that he found comfort in my care and that I as able to relieve him and his wife of
any anxiety. Most times its the little things that matter most. Seeing patients as more than just a
task to complete or work to be done is important. There is a certain standard of care that I want
to administer to my patients. My goals are to be as humane, kind, and caring as I possibly can. I
am there to help them through what may be the worst days in their life. Music has always been a
cure for many things in my life and I like to think many people feel the same.
Running Head: NURSING CLINICAL EXEMPLAR 5
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Reference
Carter, R., Salamonson, Y., Ramjan, L. M., & Halcomb, E. (2018). Students use of Exemplars to
Wagner, E. A. (2015). Flying away: Music as a Means for Letting Go at the End of Life. Journal