Running head: CLINICAL EXEMPLAR 1

Patient Advocating Clinical Exemplar

Shukhratilla Shamshitdinov

University of South Florida

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Patient Advocating Clinical Exemplar

A clinical exemplar is a unique way of capturing the exceptional nature of nursing

practice that at times go unnoticed. A clinical exemplar allows the individual to reassess

meaningful pass situation from which critical thinking and decision making had an impact on the

delivery of patient care (Black, 1997). This is just one of many exemplars that reminded me of

the purpose I chose nursing as a profession.

The patient was a 52-year-old female with history of hypertension, anxiety, substance

abuse, bipolar disorder, hyperlipidemia (HLD), diabetes mellites (DM), who presented to the

emergency room for the evaluation of chest pain (CP) and shortness of breath (SOB) on the

5/30/17. Patient had been experiencing CP and SOB (during activity) for the past couple of days

(onset of symptoms 5/27/17). Patient described her chest pain as sharp and stabbing radiating to

the sternum associated with dyspnea (duration of symptoms- episodic). Patients symptoms got

worse with activity and movement. Patients symptoms were relieved with morphine, rest, and

oxygen. EKG showed normal sinus rhythm. XR Chest came out normal. Troponin was within

normal range. The patients lab values were all within normal range except for her glucose level

which was 181. The patient was admitted to 6 main for observation and evaluation of chest pain.

While taking a shift change report, I witnessed the night shift nurse referring to the

patient as drug-seeking alcoholic who just wants medications, and it seemed like she avoided

the patient throughout her shift. By acknowledging all the information provided from the night

shift nurse, I decided to take this opportunity to do my assessment on this patient first. While

interacting with this respectful lady, it became clear that the patient had been subject to being

raped in her early teens. Since that incident patient stated that she has been leading unhealthy

lifestyle and been abusing drugs. By taking my time and talking to her, I let the patient know that
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someone cared about her and that her health and wellbeing meant a lot to us. I took this

opportunity to educate the patient about different types of diet, exercise, and activities she could

implement in her daily lifestyle in order to get her hyperlipidemia, HTN and diabetes under

control. I also took my time to educate the patient about harm of smoking and persuade her into

checking out groups like smoking anonymous and narcotic anonymous. I thought it would be

appropriate and notified the charge nurse about the negative demeanor of the night shift nurse,

after all as a prudent nurse she should have not neglected the patient and treated all of her

patients equally. After the conversation and throughout the rest of the shift the patient requested

my assistance by ringing the call light, and every time I came she asked me questions regarding a

pain and certain discomfort and what that meant and If the pain medication would help. This way

I knew exactly what was going on with my patient and what intervention I needed to take to

father evaluate her requests.

This situation was somewhat critical, observation is an important aspect in the

management of patients chest pain. Patient came to the hospital and was admitted for evaluation

of chest pain, which should have been a concern and a priority to the attending nurse. If the

patients symptoms were to reoccur necessary protocols should be implemented accordingly and

in timely manner otherwise this could lead to possible harm to the patient. Since patient is

lacking definitive diagnosis and additional testing is being done, it is essential for the nurse to

monitor and assess patients chest pain regularly until a diagnosis is attained. According to

Cannon and Peacock (2009), an accurate assessment of a patients pain helps identify the likely

cause of the pain and leads to prompt and appropriate responses in alleviating the pain and

treating the cause.

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Following this case and through observation, our main concern within the hospital setting

is to quickly get the patients stable with the ultimate goal of an expedite discharge. We focus

heavily on our job and how to quickly get it done often forgetting about patients feelings and

concerns. This experience has taught me that one of the hardest and most important attributes of

being a nurse and rational human being is to be nonjudgmental. After all, we are all human and

deserve to be treated with respect and dignity.

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References

Black, P. J. (1997). Use of the clinical exemplar in performance appraisals. Neonatal Network:

The Journal of Neonatal Nursing, 16. Retrieved from:

http://www.ncbi.nlm.nih.gov/pubmed/9325873

Cannon, C. P, & Peacock, F. W. (Ed). (2009). Short stay management of chest pain.

Contemporary Cardiology, ISBN 978-1-60327-948-2. doi: 10.1007/978-1-60327-948-2