Clinical Exemplar

Running head: CLINICAL EXEMPLAR
Clinical Exemplar
Paige Stevens
University of South Florida
CLINICAL EXEMPLAR
Clinical Exemplar
Clinical Exemplar is defined as a real patients story that illustrates the nurses ability to
use critical thinking and decision-making skills that outline the delivery of excellent patient care
(Describing Practice Through Clinical Narratives, 2015). Below is a brief journal on how I
encouraged a pediatric patient to become more involved in her own care, as well as shorten her
hospital stay.
On May 29th I had a client that had been hospitalized and diagnosed with a spontaneous
pneumothorax since May 16th. She was currently on suction at 20cm for her chest tube. She was
getting agitated with her situation and had complaints of wanting to go home as soon as possible.
She was not egger to start exercising, which would promote tissue profusion. Her right lung had
collapsed twice after being taken off of suction and the clinical staff was planning to reassess her
situation in 4 days. The client stated she was upset and wanted to go home. She expressed that
she did not want to get up and move or use her incentive spirometer hourly. The client appeared
restless and agitated. She did not have signs of decreases oxygenation. She denied having any
difficulty breathing and denied pain. The presence of restless and distressed behavior showed
that there was a problem with coping related to the clients hospitalization.
Further information was needed to make a thoughtful decision. It is important to note that
the mother is at the bedside and that she is involved in the care of her daughter. Family and
friends also visit daily for 2+ hours. Her chest tube hinders mobility, but her mother has offered
to hold the chambers while ambulating. They are both educated on how to properly hold the
drainage system. The client also expresses enjoyment when interacting with peers.
I decided that I would indeed need to involve the preceptor and the mother. The situation
could become critical if the client refused all ambulation and breathing exercises. If she refused
all exercises, she could develop pneumonia and impede tissue profusion. Fortunately, the client
was involved minimally during breathing exercises and did attempt marginal ambulation.
CLINICAL EXEMPLAR
I decided to act now and consult with my preceptor prior to discussing the situation with
the mother. The preceptor expressed that educating the client on her situation and the difference
exercises will do to her hospitalization may help her show initiative. I then educated the mother
first so she could be encouraging the client throughout the clients hospitalization. The mother
agreed that the client just needed a small push towards being involved in her care.
After education to both the mother and daughter, I allowed the client to hear her
respirations through the stethoscope. This helped her understand her situation and give her
incentive to do a couple more laps around the unit each shift. I knew that I had made the right
decision when the client became more excited to complete additional laps and reach a higher
number on her incentive spirometer without having to be coached through it all.
Interventions that I delegated was to the mother and fellow nurses to encourage the client to
continue to grow stronger and work towards her goal.
I made the right decision because the client expressed improved mood and worked harder
to do more laps, so that she could improve and work towards discharge. I did achieve my
outcome because the client made the decision to worked harder and she appeared happier.
I think that I did well at educating the family and the client on her situation. I also feel that
offering the client to listen to her respirations was a good choice because it gave visualization of
what was happening, which the client could understand well. Something I could have changed
was implement the education plan earlier in the hospitalization because the client was withdrawn
for multiple days before I decided on my plan.
Reference
Describing Practice Through Clinical Narratives. (2015). Nursing and Patient Care Services.
Massachusetts General Hospital. Boston, MA.

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