Directions for Exemplar on Specific Clinical Event Describe a specific clinical event or situation with the last 6 months in which you played a key role that illustrates how you demonstrate clinical competence.
When writing you a narrative, please address all the points below:
Directions for Exemplar on Specific Clinical Event
* Describe the patient situation:
The patient is known as a difficult patient that many new nurses do not like to get as an assignment
*What was your role in this situation I was the RN assigned to the patient for the shift
*Why did you choose this patient as your patient scenario I decided to write about this patient because it shows that by giving these patients a little bit of control back and not trying to exert dominance goes a long way.
*How did you incorporate the principals of relationship-based care?
Directions for Exemplar on Specific Clinical Event
By building a trusting relationship with my patient I am able to create an environment that is calm and comfortable for my patient, their families and me.
*What have you learned from being in this patient situation?
Not to assume that what the patient is perceived as is actually how he/she is
*Give an example of how you have changed at least one aspect of your nursing practice
I no longer take the opinion of others and automatically assume the patient is going to be difficult. I have many times been assigned patients that have difficult personalities and have not had any issues.
*How have you seen yourself progress from an Advanced Beginner RN to a Competent RN
I have become more confident with my skills as well as my ability to address and diffuse difficult situations.
Directions for Exemplar on Specific Clinical Event
Background on my patient population:
I am a Bone Marrow Transplant nurse in a well-known cancer institute. Due to the nature of the disease and the transplant process of patients are with us for a long time. Most patients are with us for a minimum of a couple of months and some are with us for much longer.
Our patients also get readmitted a fair amount. Due to the nature of this type of nursing, we get to know our patients and their families very well. We become to some almost a part of their family.
We practice primary nursing as best as we can which means we are assigned to a patient and when we are working we likely have the same patients. This again provides for a more relationship-based nursing atmosphere.
The point that I would like to make with this examplary is that very often these patients are given a diagnosis of cancer are sent to the hospital for chemotherapy and then come to my unit for a bone marrow transplant.
Within a very short amount of time we rip them away from their families, put them in a private room, tell them when and what to eat, when to sleep, to make sure to save all their urine and stool in “hats”, wake them up in the middle of the night for labs and medicines all while they are febrile, putting out liters of stool a day, vomiting uncontrollably.
Directions for Exemplar on Specific Clinical Event
Cancer does not discriminate. These patients include doctors, lawyers, high powered businessmen and women who are every day in control of so much and now they are in control of nothing, not even their own bowl functions.
How do we expect these patients to react when we walk in whenever we want and demand they take their shower now, take their medications now, do as we say now.
Unfortunately, given that our patient to nurse ratio is not 1-1 we cannot always accommodate them and what they want for everything but giving them some control and say in their care goes a long way.
Directions for Exemplar on Specific Clinical Event
As a side note: BMT (bone marrow transplant) patients are in private rooms because they are on protective isolation for a very long time. The chemotherapy that they are given obliterates there white blood cell count in preparation for the transplant.
This leaves the patient with no immune system and the inability to fight infection. Many patients have a difficult time with the fact that they are staring at the same 4 walls of their room and are unable to leave the unit. It becomes almost like a prison to some and it does terrible things for their metal status.
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