Clinical Exemplar

When I envision my future in the nursing profession, I look forward to the privilege of
providing compassionate care and support to patients during a time when they need it the most.
Reflecting on my past clinical experiences, there are many patients who have inspired and influenced
my nursing practice. It has been an honor to work with patients whose courage, optimism, and
kindness have impacted me both personally and in my nursing practice. Conversely, I have also
encountered patients who chose to face their diagnoses by shutting down, projecting their fears and
negativity onto others. Although this type of patient presents a unique challenge, the lessons that I
have learned while working with them are invaluable.
While completing clinical at MGH on an orthopedic unit, I was assigned to a patient who
changed my nursing practice. The patient was a 55-year-old women who was post-op day 1 from a
lumbar spinal fusion. After receiving report and reviewing the patient’s medical records, I went to
introduce myself and take morning vitals. As I entered the room, I was immediately told by the
patient to get out because she did not want a student nurse involved in her care. I politely responded
that I could see that she was upset and would be back to check in on her in a little bit if that was
alright with her, which she agreed to. After leaving the patient’s room, the CNA assigned to work
with my patient pulled my clinical instructor and I aside and informed us that the patient was
experiencing delirium. The new onset of delirium began between the change in night to day shift and
had not been documented yet in her medical record. My clinical instructor gave me the option of
switching patients or keeping the same patient. I elected to take on the challenge of keeping the same
patient. This type of assignment is a common occurrence in nursing and this experience would
provide me with foundational skills to help me handle a similar patient in my future practice. Given
the patient’s delirious state, I was hopeful that when I re-entered the room, we could start fresh.
Unfortunately, that was not the case. As soon as the patient recognized me, she started swearing,
threatening, and spitting her coffee at me. As this was my first encounter with such a confrontational
patient, I took what she said to heart and struggled with how to respond. After numerous insults and
threats, I realized that despite how uncomfortable I felt, being a nurse meant providing empathetic
and high-quality care to every patient regardless of how they treated me. Being a nurse is being able
to look past the negative attitudes and actions produced by a disease and see an individual who is
scared, sick, and in need of compassionate care now more than ever.
With my new perspective, I went back into the patient’s room and filtered through her
negative comments to find one that could guide my care for her. She repeatedly was talking about
how her calf hurt and that nobody was listening to her. After hearing this, I went to the supply room
and retrieved an ice pack for her calf. It was a small gesture, however, when she saw that ice pack in
my hand, her whole attitude changed. She took my hand and said “Thank you, I’m just in so much
pain and so confused.” From then on, she was receptive to my care. I left clinical that day with a
sense of fulfillment knowing that I was able to work through a difficult situation and make a true
connection with another person.
Although I know that not all difficult assignments have a happy ending, the experience I
gained is immeasurable and will continue to guide my care. As a nurse, I will strive to provide
sympathetic and high-quality care to every patient I am assigned to. I will always look for ways to
change a patient’s experience from a negative to positive one. Above all, I will always look at the
whole person, not just the disease, and provide a shoulder to cry on or a hand to hold in times of fears
and uncertainty.