Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Tanners (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanners clinical judgment model (see below).
Background

Recently I worked three shifts in a row, so I had the pleasure of working with majority of the same patients
for the three nights I was there. One patient in particular had a very difficult story that stuck with me and taught me
a lot about caring for people. This man was 60 years old and before January was a hardworking retired military man.
At the beginning of January he suffered a brain aneurysm and the next day went to surgery to have it clipped. His
wife told me that after surgery all he could talk about was getting out of the hospital and going back to work. Two
days after his surgery, this patient had a stroke, and then another one a few days later. The second stroke affected the
patients pons and his wife was aware that he would never be the same. This patient was admitted for bibasilar
pulmonary embolisms on February 27th.

Noticing

During report the patients wife and daughter were at the bedside with this patient. When the wife left she
told my preceptor and me that sometimes he pulls at his lines. This was alarming because the patient had an IV in
his hand and a PEG tube in his abdomen, however, there was a virtual sitter at the bedside. When communicating
with this man at the beginning of the shift his speech was very slurred and he was oriented to person and place. As
the night went on this patient became more confused and agitated. He thought he was at an air force base and that he
needed to catch a flight. The patient also rang the call bell several times, and when I would go in there he would
have it up to his ear like a telephone. The patient stated that he was talking to chief.

I found working with this patient extremely heart wrenching at first because his condition was so new.
When I was documenting in Connect Care I could see the last filed documentation, and could not believe I was
documenting the complete opposite just two short months later. My heart was sad for this man and for his family
whom have undergone such a huge loss in such a short amount of time.

Interpreting

As the shifts went on, caring for this man became easier. I was able to stop being sad about his condition, and give
him the same care that I would give an oriented patient. The patients confusion would come and go, so I determined
it was best to always provide him with explanations of the care he was receiving, and treat him as I would anyone
else. At one point he became agitated, but I still provided him with the same care that I would any other individual. I
used a calm approach when working with him in order to make him feel safe and secure. During the times when he
was more oriented he would cut up and laugh with me. This is why I felt so strongly about not treating him like he
wasnt there. I am not the judge of which ones and when patients should be treated differently, or treated equally. I
was proud of myself for the non-judgmental and compassionate care I was able to provide this man with while he
was admitted on my unit. I will never forget the important lesson that working with this patient instilled in me. I am
faithful that no matter the case, I will always provide my patients with individualized compassionate care that every
individual deserves.
Responding

What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.

I provided this patient with care that protected and promoted his dignity. I treated him with respect, and not
like a disability. An article by Milika Matiti, Elizabeth Cotrel-Gibbons, and Kevin Teasdale discussed the importance
of promoting patient dignity in the healthcare setting. They spoke of dignity as a basic human right, and discussed
that it is present in the Nursing Code of Ethics. I treated this patient with respect and dignity regardless of the
hardships he has faced clinically. I knew that this patient was someones husband, father, grandfather, son, and
friend; I took that into consideration when providing him the best care that I could in order to promote his dignity.
This article discusses nursing care being, unrestricted by considerations of age, color, creed, culture, disability or
illness, gender, nationality, politics, race, or social status, (Matiti, Cotrel-Gibbons, & Teasdale, 2007). I think as
new nurses it is extremely important for us to remember to always treat our patients as humans, and not as their
presenting disability or illness.

References:
Matiti, M., Cotrel-Gibbons, E., & Teasdale, K. (2007). Promoting patient dignity in
healthcare settings. Nursing standard , 21 (45), 46-54.

Article link: http://journals.rcni.com/doi/pdfplus/10.7748/ns2007.07.21.45.46.c4584

Reflection-on-Action and Clinical Learning

Based on your experience as a student nurse on a unit with a preceptor, reflect on the differences of working one-on-
one with a preceptor versus a student nurse in a group of students and one instructor.

When working in the hospital as a group of students to one instructor we were always assigned one patient,
and at the most two. Our jobs were more task oriented such as, assessment, give medications, document, and bed
baths. Immersion has opened my eyes to the real world of nursing. The reality of having five patients that all hit
their call bells at once, or all try to get out of bed at once, etc. Immersion has allowed me to practice time
management as well as prioritizing, because lets face it; it is impossible to be with all patients at the same time. I
am lucky enough to be paired with an awesome preceptor who is knowledgeable and eager to help me learn. I can
say that I have grown more as a nurse in the last 7 weeks than I have through all of nursing school, thanks to
Immersion!

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.