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Formal Reflection/Clinical Exemplar

Danielle Johnson

College of Nursing, University of South Florida

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My time in the clinical setting has taught me many things about the world of nursing and

patient care. I have completed many new tasks and asked many questions along the way. Every

shift is a learning experience, and one shift specifically comes to mind when I reflect on my

clinical rotations. During this shift, I was required to think critically to help a patient avoid

severe health implications.

Noticing

On one of my shifts, my preceptor and I had a patient with late-stage metastatic cancer.

He was in his sixties and had been at Moffitt for three days already. His level of consciousness

was declining. He could answer who he was and where he was but did not always understand his

current situation. He would also get confused about whether his wife was there or the fact that he

was spending the night in the hospital, not just having an outpatient appointment. He was very

frail and confused, which made him a high fall risk. It took at least two people to assist him to

the bedside commode to use the restroom. Throughout the morning our patient was going in and

out of sleep. After our first couple of times in his room, I noticed that he was holding his hands

on his abdomen and seemed a bit irritable. I pointed this out to my preceptor, and she said he

may have to urinate. We were both unsure when he had last used the bathroom during the night

shift. We roused him and assisted him in getting onto the bedside commode. Once he was seated,

he kept returning his hand to his abdomen. We gave him time to urinate or defecate but after a

long period, he did neither. He was not a vocal patient and did not speak much with us, but we

could tell he was uncomfortable.

Interpreting
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At this point, our concern was possible urinary retention or urethral obstruction. I asked

my preceptor if it would be too hasty to do a bladder scan. She agreed that it would be a good

idea to complete a bladder scan to see if there was urinary retention before it led to a bigger

issue. Our patient had a history of benign prostatic hyperplasia (BPH) which is the most common

cause of urinary retention (Serlin, et al., 2018). If the patient is retaining urine and it is not

addressed the patient is at risk for renal injury (Serlin, et al., 2018). I questioned whether a

bladder scan required a provider’s order and my preceptor confirmed that we did not need an

order for this scan.

Responding

Upon doing a bladder scan on the patient we discovered that he was retaining a large

amount of urine. We had two options following the scan. We could wait and see if he would void

on his own in a timely manner or we could notify the provider of the situation and await further

instruction. After taking into consideration his discomfort, his history of BPH, and the risks of

urinary retention, we decided to notify his provider. The provider got back to us swiftly and

asked for us to place a Foley catheter. Catheterization can be both diagnostic and therapeutic

because it tells us how much urine was retained while also relieving our patient (Dougherty &

Aeddula, 2022). The patient’s wife was concerned about catheterization because when the

patient was catheterized in the past it caused a lot of inflammation and trauma to his urethra

lining. We discussed the reasoning for this procedure with her and she agreed that the risk of

urinary retention outweighed the risk of possible trauma to his urinary tract. I knew this would

be a successful treatment if we were able to empty his bladder by causing minimal discomfort

and trauma and maintaining a sterile technique to decrease his risk of catheter-acquired urinary

tract infection (CAUTI).

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Reflecting

During the catheterization, our patient did have some discomfort during the initial

insertion, but I was able to insert it quickly enough that it did not last for too long. The patient

showed obvious relief once the catheter began emptying his bladder. Additionally, the patient

voided over 300 mL of urine so that was more evidence that catheterization was the correct

decision.

In this situation, I think I did a good job paying attention to my patient and noticing his

cues of discomfort. I also think it was good that I thought to ask about doing a bladder scan to

rule out possible urinary retention. In the future, I will make sure to ask the nurse I am receiving

reports from more questions about my patient’s urinary habits and patterns.

Conclusion

In conclusion, I have found my time in the clinical setting to be an extremely challenging

yet educational experience. It has expanded my problem-solving skills and made me a more

confident nursing student. I am excited to take what I have learned into my practice as a

Registered Nurse.
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References

Dougherty J.M., Aeddula N.R. Male urinary retention. [Updated 2022 Aug 10]. In: StatPearls

[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK538499/

Serlin, D. C., Heidelbaugh, J. J., & Stoffel, J. T. (2018). Urinary retention in adults: Evaluation

and initial management. American Family Physician, 98(8), 496–503.

https://www.aafp.org/pubs/afp/issues/2018/1015/p496.html