Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Mid-Point Guide for Reflection
Tanner’s (2006) Clinical Judgment Model
Describe the most challenging moment or event you experienced recently. What actions did you take and what
would you have liked to do differently? What specific actions are you taking to improve the outcome in future
situations or to prevent recurrence of the situation? To answer this question, use the guide for reflection using
Tanner’s clinical judgment model (see below).

Background
It was my second week on the unit. After receiving report with my nurse, Michele RN, she asked me who I would
like to take care of; normally I would seek her recommendation but this particular instance I knew. She was a middle
aged women recently diagnosed with pancreatic cancer that metastasized in a matter of days. Several family
members of hers had passed from this insidious disease. When I first met her, she was a full code. By the end of the
day, her family decided to make her a DNR.

Noticing
Walking in the room with Michele, I introduced myself and updated the whiteboard. As I turned around, I noticed
the patient was lying diagonally with her head tilted to the opposite side. She was alert and oriented times two,
unable to move her body, and would occasionally fall asleep while we were talking with her.

Interpreting
We noted that this behavior was linked to low oxygen related to low hemoglobin; all of this connected to the
metastasizing of her cancer. We gave iron IV per the MAR and called the doctor requesting an order for oxygen. In
addition we also requested a palliative care consult. Palliative care came to the room and discussed with the family
the goals and outcomes they shared for the patient. The doctor was peaceful, creating a healing environment for the
family to express their concerns and emotions.

Responding
The American Cancer society produced excellent research regarding caring for someone when they have cancer.
They offer online community centers, where caregivers, family members, and friends are more than welcomed to
heal together through their loved ones’ cancer processes. This article also discusses the expected changes one can
anticipate if they have a cancer diagnosis, including emotional and physical. Also offered are recommended ways to
cope. Humor and hope are the top two things that help patients and families cope with a cancer diagnosis; however,
these are not to be mistaken for a patient being upbeat and happy with a cancer diagnosis. The American Cancer
Society stands by that a patient can still be in denial despite exhibiting positive behavior.

American Cancer Society. (2016, April 29). When Someone You Know Has Cancer. Retrieved October 20, 2018,
from
https://www.cancer.org/treatment/understanding-your-diagnosis/talking-about-cancer/when-someone-you-
know-has-cancer.html

Reflection-on-Action and Clinical Learning

Working with a preceptor one-on-one is undoubtedly more fulfilling than working in a group. While working in a
group setting prepared me for this type of clinical practice, having the opportunity to work alongside someone alone
gives me the privilege to develop a relationship where we understand each other’s strengths and weaknesses. There
is more time and feedback that can be delivered without feeling rushed. So far, I have had a wonderful experience
on MRMC’s Med/Tele. I feel like I will knock the NCLEX out of the park. If I were in a group, I am unsure how my
confidence would be; meaning, I have more time to ask questions to my preceptor and have that quality to discuss
pathologies, healing processes, and increase my overall learning.

Write your midpoint program outcome objectives and discuss you have met them. This section should address all 5
midpoint objectives.

1. Mid-point:_Community and collaboration: student will demonstrate proper SBAR report during patient
admission process in front of preceptor prior to midpoint evaluation._
GOAL NOT MET AS OF 10/20/2018.

2. Mid-point: Caring and the health care ministry: student will provide discharge teaching to a given patient
within student’s assignment in front of preceptor before midpoint evaluation.
GOAL MET 10/13/2018.

3. Mid-point:_Servant leadership and global health: student will perform cultural assessment while preceptor is
present on given patient within student’s assignment before midpoint evaluation.
GOAL MET 9/14/2018.
4. Mid-point:_Safety, quality, evidence-based practice: student will review hospital policies for reporting critical
results and patient status with preceptor before midpoint evaluation.
GOAL MET 10/5/2018.
·
5. Mid-point:_Professionalism and commitment to life long learning:_student will answer patients and healthcare
promptly throughout immersion process; student and preceptor will discuss areas of development for student prior to
midpoint analysis.
GOAL MET 10/20/2018.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of
Nursing Education, 46(11), p. 513-516.