A clinical exemplar is a patient nurse interaction that has proved to be especially important or meaningful to a nurse. It can be something traumatizing, touching, an incident that has gone wrong, or simply something good and meaningful.
I graduated from nursing school in May of 2010, and started my career as a nurse shortly after in June. I was hired to a Medical/Surgical Oncology floor. I had been practicing as a nurse on my own for approximately 6 months when I first met JE. JE was a very unfortunate 21 year old boy who was a paraplegic. JE was very well known to our floor due to the fact that he was admitted so often due to non-healing wounds on his body. I first met JE when I came into work and received report. I was shocked and disappointed when I learned the medical history of this poor guy. After getting to know him and his father, I learned that JE had a very hard life that had brought him to where he was at, lying in that hospital bed. When he was 18 years old, he was in a bad car accident and was hospitalized due to a brain and spinal cord injury. Continuous swelling around his spinal cord caused him to be paralyzed from the waist down. Things continued to decline after that. A year later his mom died. Due to his injuries, he was prescribed narcotics and started using them more frequently after the death of his mother. He did not take care of himself, and began getting wounds on his coccyx and sacrum from constant pressure. JE’s first admission to our hospital was due to an infected wound. One of our doctors took him to surgery and debrided his wound, and placed a wound VAC dressing. He returned to our floor, where I took care of him. Many of the nurses were judgmental and rude to him because of some of his life choices. I on the other hand, treated him no differently than any of my other patients, and treated him with compassion and nurturing. JE soon trusted me and opened up to me. I understood his condition, and helped him cope and get through the dressing changes and the pain. JE was soon discharged with outpatient dressing change orders. It wasn’t too long before he was admitted again, and again. First it was for the wound care, but soon after another problem occurred. Due to his condition, he obtained multiple small bowel obstructions. After several medications and interventions, a rectal tube was ordered to keep the stool away from his wounds. Success was seen in JE’s bowel problems in a fairly decent amount of time. Before I knew it, he was being discharged home again. It had been a few months since I saw JE, so I assumed he must have been doing well at home. Before I knew it, he was back, and this time, he looked sick. His entire body was massively swollen, and his abdomen was so distended, he looked 9 months pregnant. Everything from stool softeners, to muscle relaxers, to Endoscopies and Colonoscopies were attempted to help JE recover from this bowel problem. I felt that as soon as we started seeing progress, he regressed and became even worse. I was assigned to take care for JE often because he requested me to be his nurse. This didn’t bother the other nurses at all, because they were not fond of taking care of him. Eventually, JE and I were able to maintain a routine of care, and were able to successfully get him to have a bowel movement every day. This was done with suppositories, repositioning, and continuous care. This was working well enough, that the doctors and case managers collaborated to discuss possibly discharging him home, in hopes that he would continue this same regimen. JE’s father didn’t visit very often, but as he was progressing, I asked his father to stop by and talk about what we have been doing each day to keep his bowels moving. Once his father learned the importance of JE’s care, he would come to the hospital and learn what he needed to do more often. Finally JE’s discharge day came. I stressed to his father the importance of continuing the care at home. JE was extremely excited because he had spent over 4 months straight in the hospital. I helped him get dressed, and sent him home, just as excited as he was. About a week later I was working, and my unit secretary calls my phone. She informed me that JE’s dad was on the phone and needed my help. I thought it was strange that they would call and ask for me, but I took the call to see what was going on. His father informed me that Jeff was not doing well. His abdomen was more distended than ever, rock hard, he hadn’t had a bowel movement in 4 days, and he was vomiting. I told him that he needed to take JE to the Emergency Room immediately. The next few days were rough on JE. He was back on our floor, and not doing well. I was his nurse again, a few days later, and he was yelling down the hall for me to help him. As I entered his room, I immediately smelt an aroma of stool. JE was hanging his head over the side of the bed and vomiting stool. The sight of it alone made me gag. I immediately went into nurse mode and pulled it together. I gave him medication, placed an NG tube, and cleaned him up. There were talks of placing a colostomy by his doctor, but he was sure that the surgery would kill him. Soon after that it was a steady decline in JE’s health. I continued to care for him on a daily basis. He was depressed and discouraged. I did everything I could to cheer him up and stay positive for him. I had a few days off, and of course kept JE in my prayers the whole time. When I returned, I found that JE’s doctor had gone out of town, and the covering doctor took him to the operating room and placed a colostomy. He was recovering in the critical care unit. JE was eventually transferred to our floor and I took care of him for the last time. His dad was by his side every minute, but JE was not himself. He was declining, and fast. His father thanked me and the other nurses for our care; he was more than appreciative for everything we had done for his son. One day, the doctor had to take him back to the operating room because his bowels were leaking into his abdomen. That day, I heard them call a code blue to the operating room overhead. My heart sank in my chest because I knew it was him. About an hour later I heard the code blue again, this time in critical care. I assumed it was him again. Later I was able to talk to the doctor, and he said that JE became septic. They were able to bring him back, although the odds were not in his favor. After a few days, more than 10 codes were called on JE. Eventually his dad decided that he was only being tortured and withdrew all life support. I was very upset by JE’s death. The only thing that helped me cope with his death was that I made a difference in the last year of his life. I treated him like a normal 21 year old boy that didn’t have so many comorbidities, and treated him with compassion and sincere care. I helped him and his family, cope with his disease. I ended up sending flowers to JE’s funeral. A month or so later JE’s father sent a card to the hospital with my name in big, bold letters on top. It was a thank you card for the care I gave to his son and himself as well.
This is why I know I am meant to be a nurse. Things like this will continue to touch me for the rest of my nursing career. I will never forget JE, as he made a huge impact on my life, as I did in his. He made me want to be a better person, and give every patient the care that they deserve. Patients are very sick, and the last thing they want or need is a judgmental, heartless nurse. This situation has made me understand how important my career is, and how taking a few minutes to talk to a patient and advocate for them, can go a long way. I will continue to work with compassion and never stop caring about my patients.

References

BJC Healthcare. (2007, December 1). Retrieved April 22, 2012, from Clinical Nursing Suite: http://www.clinicalnursinginstitute.org/uploadedFiles/BJC_HealthCare/Health-Care_Professionals/Clinical_Nursing_Institute/Development_Program/exemplarFormat.pdf
Black, P. (1997, August 16). PubMed. Retrieved April 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/9325873