Running head: CLINICAL EXEMPLAR

Patient Care Clinical Exemplar

Joshua Jenkins
University of South Florida

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Patient Care Clinical Exemplar

Doing my preceptorship in the Trauma Intensive Care Unit (TICU) afforded me

the opportunities to work alongside nurses giving care to incredible sick individuals.
Many of these patients had been injured in motor vehicle collisions and due to the poor
state of their health, were fighting an incredible difficult uphill battle for their lives. This
clinical exemplar outlines the struggles of one such patient. A clinical exemplar is a story
told from the first person point of view of the nurse to help others understand the
experiences, challenges, emotions, and lessons of an event (Owens & Cleaves, 2012).
The patient was a 43 year-old female admitted to the TICU after being struck by a
vehicle. At approximately 9:30am, an elderly drivers Chevrolet Tahoe swerved onto the
curb and struck the bench where the patient was sitting. The patient was admitted with a
blood alcohol level of 0.24, severe hip fractures, spinal fractures, and multiple other
injuries through her body. The patient had a history of severe alcoholism, cirrhosis,
ascites, esophageal varicies, Hepatitis C, chronic depression, and, as the surgeon wrote in
his notes, a rock hard liver. Following the initial surgery to stabilize the bleeding, the
patient was admitted to the TICU to have repeat abdominal wash-out surgeries, a wound
vac applied, and for close hemodynamic monitoring.
The patient spent several weeks in the TICU, and I had the opportunity to care for
her on multpilpe occasions. I was able to build a relationship with her mother and aunt,
who had come into town from across the country to be present. I learned about the history
of alcohol abuse, and the patients relationship with her boyfriend, who was enabling the
alcoholism. Over the weeks, I was able to watch the patient progress. On my first day
working with here, there was no pupillary response, ammonia levels were dangerously

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high, and the patient was extremely unstable. As the days and weeks passed, the patient
became more stable, with first pain being expressed with posturing and grimace, then
eyes opening and making contact with us.
Over the weeks I was able to continue my relationship with the family. Maybe it
was because I wore a different outfit than the other nurses, but it seems like they
responded well to me as a familiar face taking care of their loved one. Even on days when
I was not caring for her, the aunt would want to say hello and tell me how her niece was
progressing. I never dug for information, but she would want to share it with me.
Several weeks later the patient was released to the post-trauma floor, but became
unstable again and was readmitted to the TICU. We continued our care for the patient
until I was away from the hospital for over a week. It was upon returning to my next shift
with my preceptor that I learned she had passed away. I never explored too deeply about
what happened.
I learned during my dealing with this patient and her family the importance of the
relationships that we as nurses build with our patients and their families. We are the
experts who are able to help them understand why different procedures are happening.
We are able to teach them the signs we are looking for to evaluate progress, and we are
able to educate them about what they are going to need to progress care once they leave
our facilities. I was able to have these discussions with the family and help them cope
with the difficult situation they were facing.
During care, I was concerned about making sure I was helping the patient and
helping the family. After I learned of her death, I was saddened, because I knew this
patient was an unfortunate case, but I was hoping that she would make it out of the

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hospital. I had hoped this mother could take her daughter home, and it made me sad that
she did not get to. However, I know that during the time I was working with the patient, I
was able to help this family. I learned to remember the importance of the work that we
do.
This patient was just one example of how important nurses are. We have
enormous impacts on the lives of patients. Physicians stop by once throughout the day,
but it is the nurses who are able to talk to the families, educate them, and comfort them. It
is important to remember that, regardless of learning the tasks required, the detailed
documentation, and the seemingly basic work that nurses do, we are making an impact in
the lives of others. I will carry the lessons that I learned from working with this patient
throughout my career.

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References

Owens, A. L., & Cleaves, J. (2012). Then and now: Updating clinical nurse advancement
programs. Nursing, 42(10), 15-17. doi:10.1097/01.NURSE.0000419437.60674.45