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Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Kristine Martin
University of South Florida

CLINICAL EXEMPLAR

Harvey & Tveit (2014) describe a clinical exemplar as a clinical situation that stands out
as the quintessence of nursing; they are recalled time and time again and stand out as milestones
in our nursing career. Clinical exemplars may recount a variety of circumstances including the
nurses first encounter with a condition or circumstance, demonstrate new knowledge and
identify areas in nursing that need improvement. By sharing our stories through clinical
exemplars, nurses are able to influence the ideas and actions of those who these stories are
shared with.
As a nursing student, there have been many new situations I have been exposed to, each
of which has helped me grow as a nurse. There is one particular clinical experience that has
made a significant impact, and will influence my actions as a nurse for the rest of my career.
During my fifth, and last, semester of nursing school I was completing 180 clinical hours on the
pediatric medical surgical unit. My preceptor and I admitted a six-month-old baby girl who was
born prematurely at 26 weeks for failure to thrive. After just a few days on the unit, the patient
became jaundiced and starting presenting with ascites. Her ascites continued to worsen, so much
so that her lung expansion was affected and she required high flow oxygen. The team of
physicians working her case were unsure of the cause of her symptoms and thus began the long
process of ruling of different diagnoses. Understandably, the family was distraught and frustrated
with the progress made on their daughters health; they felt as though nothing was being done to
help their child improve. From this stemmed the first impact made on me by this patient: patient
advocacy. My preceptor relentlessly advocated for this patient and her family to make sure she
was getting the care she needed and was not getting left behind. We worked to speed up the
ruling-out-process and make the parents, and patient, feel more comfortable.

CLINICAL EXEMPLAR

Although we had seen this child progressively get worse over the past two weeks, there
was one particular day that was different from the rest. My preceptor and I had been assigned to
this patient the previous day and there had been no change in her status up until that day.
However, when doing my morning assessment on the patient I noticed she was more
uncomfortable than the day before; she had become inconsolable and her respirations and pulse
were increased. After bringing this to the attention of my preceptor, we went to assess the patient
together. We saw that the patient had begun using accessory muscles to breath and had
supraclavicular retractions. We contacted the attending physician and requested the patient be
prescribed PRN Motrin and sweet-ease in an attempt to bring her comfort. After administering
the Motrin and providing Sweet-ease, the patient had no change. My preceptor then decided that
we needed to complete the Pediatric Early Warning Scale (PEWS) to determine if the infant was
at risk. According to Ennis (2014), the PEWS score is beneficial in the early detection, prompt
referral, and timely, appropriate management of children at risk for clinical deterioration. With a
score of 7 out of 10, my preceptor decided that we needed to call the attending to discuss
transferring the patient to the pediatric ICU. This was the second impact: determining when a
patient needed a higher level of care. Although I knew my patients condition was getting worse,
I hadnt thought that she needed to be transferred to the PICU. This situation made me realize the
importance of thinking ahead and noticing when a patient might need a higher level of care than
what could be provided on the medical-surgical unit
To conclude, I learned a great deal form this experience. Although the patients condition
was not favorable, it made me realize how import it is to advocate for you patient and pay close
attention to their needs. Because of this experience, I continuously assess my patients with the
mindset: am I able to provide them with the best care using the resources available to me? This

CLINICAL EXEMPLAR

experience is one I would consider a milestone, something that I refer back to frequently, and a
story I will tell to my peers in hopes to influence their actions just as mine were influenced.

CLINICAL EXEMPLAR

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References

Ennis, Linda (2014). Pediatric early warning scores on a childrens ward: A quality improvement
initiative. Nursing Children & Young People, 26(7), 25-31. Retrieved from:
http://eds.b.ebscohost.com.ezproxy.hsc.usf.edu/ehost/detail/detail?
vid=3&sid=1da298b7-3f88-4d62-8c43-ea3bf825ec2a
%40sessionmgr101&hid=113&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#AN=103890294&db=cin20

Harvey, C. & Tveit, L. (2014). Clinical exemplars to recognize excellence in nursing practice.
Orthopedic nursing, 13(4), 45-53. Retrieved from:
http://eds.a.ebscohost.com.ezproxy.hsc.usf.edu/ehost/detail/detail?vid=1&sid=0e170174967c-493f-8c6f508c339cc548%40sessionmgr4010&hid=4102&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ
%3d%3d#AN=107399825&db=cin20