Running head: COMMUNICATION

Communication with a Quarrelsome Patient, a Clinical Exemplar

Amanda Seeds
University of South Florida

COMMUNICATION

Communication with a Quarrelsome Patient, a Clinical Exemplar

A clinical exemplar is a tool used by nurses to enable demonstration of their critical thinking
and proper decision making, which define the excellent patient care delivered (Black, 1997).
Exemplar can be further defined as a depiction of an actual patient scenario that is articulated as
to describe a registered nurses practice; it portrays a certain clinical situation including the
nurses feelings, thoughts, actions, intentions, critical thinking process and decision making
(Pacini, 2006). With this, I am going to illustrate my clinical exemplar involving the impact of
communication with a quarrelsome patient.
I was beginning my shift on a medical/surgical unit with a patient who was to be discharged
home with a peripherally inserted central catheter (PICC) for intravenous (IV) antibiotics. In
morning report, it was shared that this patient was becoming aggressive both verbally and
physically (he thrusted an IV pole at a nurse). This was the day the PICC was to be placed and
the patient was to be discharged. However, he grew increasingly combative and refused the last
inpatient dose of IV antibiotics and the placement of the PICC. So, I assessed and calmly spoke
with the patient to gain more insight into his behavior. He stated that his transportation would
arrive before the medication finished infusing and it would take too long for the PICC to be
placed.
I could see that the patient was quarrelsome and made a plan to help ease the agitation and
ultimately aid in the patient becoming more cooperative with receiving the needed treatment. I
then notified him that the antibiotics were already on the floor and the infusion could begin as
soon as he allowed it. I also shared with the patient that the IV team had been contacted and he
was the next patient to be seen by the team, for the PICC to be placed. In speaking with the

COMMUNICATION

patient, I also provided education and explained the importance of him continuing on the
antibiotics, both inpatient and outpatient (after the placement of the PICC). The patient
mentioned that he felt trapped and grew increasingly anxious in his room (he had diagnosed
anxiety). So, it was decided that it was best for the patient to walk to the floors solarium as to
have an opportunity to leave his room, become calmer and behave more appropriately.
After some time had passed, I evaluated the patients affect and behavior. It was apparent that
he had returned to the appropriate behavior that was noted as his baseline upon admission. The
patient agreed to his last dose of inpatient IV antibiotics and to the PICC placement for
outpatient use. I felt relieved when the patient decided to continue treatment, as the infection that
was being targeted could have worsened and become critical had he continued to refuse the IV
antibiotics and PICC.
By using the nursing process and my knowledge of evidence-based practice, pertaining to the
use of this particular antibiotic, its treatment regime and the infection being treated, I knew that it
was in the patients best interest to finish the planned course of treatment. Having the ability to
apply the nursing process, as previously stated, and use proper communication skills with this
patient, enabled this situation which could have potentially led to the patient leaving against
medical advice, into excellent patient care; the patient allowed the proper treatment plan to be
continued and did so with appropriate behavior and affect. I feel as though we must not overlook
the importance of therapeutic communication and patient education when providing care to
patients, as this is paramount in delivering excellent patient care.

COMMUNICATION

4
References

Black, P. J. (1997). Use of the clinical exemplar in performance appraisals. Neonatal Network:
NN, 16(5), 73-78.
Pacini, C. M. (2006). Writing exemplars [PDF document]. Retrieved from
https://www.med.umich.edu/NURSING/framework/application/WritingExemplars.pdf