Running Head: CLINICAL EXEMPLAR

Patient Assessment Clinical Exemplar

Kayleigh Shelton
University of South Florida

CLINICAL EXEMPLAR

A clinical exemplar is a real story of a clinical experience or

patient told to demonstrate the practice of a nurse (Ruka, Brown &
Procope, 1997). It includes my thought process, intentions, and
feelings in the specific situation (Ruka, Brown & Procope, 1997). Below
is a real-life experience that taught a valuable lesson of high
importance to me as a final year BSN student.
Becoming a new nurse is very exciting, yet extremely nervewracking. As a brand new nurse transitioning between shadowing an
experienced nurse (knowing that they are there to help) and becoming
an independent Registered Nurse, it is just plain scary! We are tossed
all of this miscellaneous information and expected to ferment it all with
our clinical experiences. Being someone who realizes the weight of
importance our competencies bring on our patients, I want to know
every little thing! It turns out- we cant know every single thing. It was
with a very eye opening experience that I have finally understood how
it is that we can graduate without knowing everything. It is the
importance of assessment that makes us able to practice safely.
Assessment is something we have learned from the very first day and
have carried out in all 700+ of our clinical hours. Yes, we do have to
know other things, but our main competency is to be able to identify
when there is an issue with our patient, and then we can collaborate to
provide the best solution to our patients problem.

CLINICAL EXEMPLAR

The day that it really hit me about the essential importance of

preforming competent assessments was during my preceptorship.
During this time I am still under the watch of an experienced RN, but I
am basically working independently to practice caring for patients on
my own. I had a patient who was 71 years old and admitted for chest
pain. I received report from the previous nurse just like any other
morning. The nurse reported to me that the patient had severe aortic
stenosis, black stools (although he is taking iron), and has not been
getting out of bed. She explains that the patient is Spanish-speaking,
but can speak English.
After report I go and check on all of my patients, introduce
myself, and see if they need anything. Upon entering the patients
room I said Hello, my name is Kayleigh and I will be taking care of you
today. Is there anything I can get for you? The patient responds, Yes,
okay and waves me away. This to me seemed odd, as if he didnt
quite understand what I said. I began an assessment where I asked if
he could tell me his name and date of birth. The patient responded,
Yes, okay. I further requested him to tell me his name and date of
birth. The patient just smiled. At this point it was clear that the patient
might be able to understand some English, but not enough for a
competent assessment.
Knowing a little bit of Spanish, I was able to ask the patient some
questions to establish his level of consciousness. I then asked him in

CLINICAL EXEMPLAR

English if he knows what his medications are as I showed them to him.

He responded, yes. I asked him again in English if he has been able
to go to the bathroom and if he wants to take his stool softener. The
patient also replied yes. My instinct told me he did not understand
again, so I explained in Spanish that he was getting insulin for his
diabetes. After that I asked one of the NAPs who was fluent in Spanish
to come translate for me. She asked him about his bowel movements
and the stool softener, and he told her he has been having diarrhea.
Knowing this I was able to hold his stool softener. He also told her that
he hasnt been out of bed since he has been in the hospital, but he can
walk with a walker if he had one. Knowing this I was able to get a
walker at bedside.
Finally, for my physical assessment I started by listening to his
heart and lung sounds. The patient had a murmur so pronounce that I
could hear it anywhere I placed my stethoscope on his chest and even
abdomen. The murmur was expected with his aortic stenosis, but for a
new nurse like me, I wanted to investigate more. I of course assessed
the patient further, but then I went in his chart to review his previous
notes. I looked at the bedside assessment note from the day before
and to my astonishment the patients heart sounds were documented
as normal. This blew me away, because certainly I didnt think the
murmur was of new onset. I investigated further and found it

CLINICAL EXEMPLAR

documented on previous assessments. The patient remained stable

and with no new complaints or symptoms.
The point of all of this is to show how principal and important a
simple assessment can be. A nurse that is able to identify a change in
the patients health is the type of nurse that we should all be from
starting out until retiring. Fortunately the patient remained stable and
had no new decline in health. The thorough assessment provided more
information that made the patient more comfortable and also got him
out of bed. I am confident that using the translator will help identify
problems in the future and contribute to a more speedy recovery. This
experience really demonstrated the importance of an assessment and
that we can be competent nurses even if we dont know everything.
Being adequate assessors is detrimental to being a nurse. As long as
we can do that appropriately, everything else will build on that with
experience.
Reference
Ruka, S., Brown, J., & Procope, B. (1997). Clinical exemplar. A blending of health
strategies in a community-based nursing center. Clinical Nurse Specialist:
The Journal For Advanced Nursing Practice, 11(4), 179-187 9p.