Clinical Exemplar

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Running head: CLINICAL EXEMPLAR
Clinical Exemplar
Jaleesa Clark
University of South Florida
CLINICAL EXEMPLAR
An exemplar is a story of a real patient that is told in order to illustrate an RNs

practice/experience. The exemplar is written in the first person. It describes in detail a particular
clinical situation that includes the nurses thoughts, feeling, intentions, actions, critical thinking
and decision-making process (Pacini, 2006). According to Black (1997), clinical exemplars
enable nurses to demonstrate the critical thinking and decision making that define the delivery of
excellent patient care. Exemplars are an important tool for making the invisible work of nursing
visible to nursing colleagues, other health care professionals, and the health care consumer.
While completing my preceptorship on a labor and delivery floor, I had the pleasure of caring for
a variety of patients and experiencing different situations that required interventions. The
following exemplar describes one experience in particular that made a lasting mark on my
budding nursing career.
A woman was in labor with her first baby and her husband was present as her support
person. She had an uncomplicated pregnancy and went into natural labor. She received Pitocin
to augment her labor and an epidural for pain management. After about ten hours of labor, the
womans baby was experiencing variable heart rate decelerations which were resolved with
maternal position changes. Once the woman was completely dilated and effaced, she began to
push. However, her babys heart rate dropped with each contraction and subsequent pushing
effort. I worked with my preceptor to implement the appropriate interventions to perform
intrauterine resuscitation. I stopped her Pitocin drip, opened up her Lactated Ringers IV fluid to
bolus her, and applied 10L of oxygen by face mask to the patient. Because the baby was in
distress and the woman still had awhile to push before the baby was delivered, the provider had
to make a decision on how to proceed. The provider consulted with the on-call maternal fetal
CLINICAL EXEMPLAR
medicine provider, who decided to try to use a vacuum to assist with the delivery of the baby.
The patient was beginning to worry about the health of her baby and was wondering if a csection would be more beneficial for the baby. The provider explained that at this point it might
cause more harm to perform a c-section since the baby was so far down the birth canal so she
would use the vacuum one time which she believed would be successful but if she wasnt
successful then they would consider a c-section. Because the vacuum was going to be used, the
nursery had to be called into the room and many other staff members also came into the room to
offer assistance. The vacuum assisted delivery was successful with one attempt. During the
delivery, I was on one side of the patient and her husband was on the other side; each of us
supporting one of the patients legs. After the baby was delivered and assessed by the nursery
team, it was determined that the baby was stable and did not require transfer to the nursery or
NICU. However, the mother suffered significant perineal lacerations which required repair. She
was in a lot of pain which was atypical for a woman with an epidural. The nurse anesthetist was
called into the room to bolus extra medication into the epidural catheter and she discovered that
the catheter had been dislodged and was no longer working. The provider used lidocaine as a
local anesthetic but the patient was still crying in pain. The provider then ordered IV and IM
morphine to try to control the patients pain during the repair. It was a very stressful situation
and there was a lot of activity and extra hands in the room and I was beginning to feel bad
because I felt like there was nothing that I could do to help the patient. Then I realized that what
I could offer her was comfort during this difficult time. At this point, the patients husband was
over on the couch in the room holding the baby skin to skin providing kangaroo care since the
mother was unable to do so at the time. I walked up and grabbed the patients hand and started
talking to her. She was concerned about the condition of her baby. I explained to her that the
CLINICAL EXEMPLAR
baby was assessed by the nursery nurses and neonatologist and was determine to be stable and
that if he wasnt, they would have taken him to the nursery for further assessment and he would
not have been able to stay in the room with them. That seemed to ease some of her anxiety. I
also told her to look over at the couch at her husband to see her newborn baby lying on his chest
looking right in her direction. I stayed by her side and continued to hold her hand and talk to her
until the repair was completed. She was worried that she was squeezing my hand too tightly but
I was relieved that Id found a small way to comfort my patient in her time of distress. Although
the situation encountered complications, the outcome was positive. Once the repair was finished,
I cleaned the patient up and brought her baby over to her to hold.
This experience was a reminder of some of the aspects and capabilities unique to the
nursing profession. There are many non-medical interventions that have the power to make a
difference in someones life. As nurses, sometimes, we have the ability to impact a patients
experience with a simple smile, touch, kind word, or gesture. This situation made me self
evaluate and make a conscious decision to always remember that providing basic human comfort
can make a world of difference. My passion for nursing was birthed through my experience as a
patient in the hospital. This experience warmed by heart as I realized that I was finally in a
position to impact patients lives in similar ways as my own life was touched.
CLINICAL EXEMPLAR
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References
Black, P. (1997). Use of the clinical exemplar in performance appraisals. [Abstract]. Neonatal
Network, 16 (5), 73-78. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9325873
Pacini, C. (2006). Writing exemplars. [PDF document]. Retrieved from
https://www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/Writing_Exempl
ars.pdf

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Running head: CLINICAL EXEMPLAR

An exemplar is a story of a real patient that is told in order to illustrate an RNs

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