Running head: FIRST IMPRESSIONS: AN EXEMPLAR

An Exemplar: First Impressions are not Always Right

Shannon M. May
University of South Florida

FIRST IMPRESSIONS: AN EXEMPLAR

An Exemplar: First Impressions are not Always Right

Throughout many times in a nurses career we are faced with questions such as, did I do
the right thing in that situation, or was I the reason that situation happened to that patient? In the
case of clinical exemplars the student or nurse is able to take a situation and analyze the data and
their own feelings in order to determine if things could have come out differently, or if the nurse
acted in the appropriate manner for the clinical situation at hand. Self-reflection is essential in
order to analyze your decisions, which will enhance clinical growth, maturation, and education.
Clinical Exemplar
Clinical Exemplar Purpose
There are many different reasons that clinical exemplars are important. Without selfreflection we cannot learn from the situation. Through situational reflection the student can
experience a wealth of knowledge and know what to do if the situation should arise again in the
future. The purpose of the [Oregon] model is to promote deep understanding of knowledge and
skills used for providing nursing care and to structure student clinical experiences so that they
are relevant to identified learning outcome and the developmental level of the student (Nielsen,
Noone, Voss, & Mathews, 2013, p. 302).
My Clinical Exemplar
As a respiratory therapist in my past I had no concept about skin care on a patient, aside
from oxygen tubing rubbing on a patients face. During my short time in nursing school I have
realized how quickly a patients skin can become damaged and the importance of the Braden
Scale. Upon receiving report during a clinical one day, I quickly grew curious about my patient.
He was a sweet elder gentleman who was as tall as a giant. He previously had a major stroke and

FIRST IMPRESSIONS: AN EXEMPLAR

was bedridden. The wife that never left his side, explained to me that this happened less than a
year ago, and that she was having trouble taking care of him by herself at home.
I explained to the wife that I would be there to help him today and perhaps she could get
some rest. She politely declined and said that she does not leave his side. As I began my morning
assessment, I realized upon turning him that he had a sacral ulcer that was to the bone. This made
me very aware of his skin condition on the rest of his body. All points of pressure were
excoriated and broken down. For a moment I would look at the wife and think to myself, how
did it get this bad? Why did she not seek help from somewhere or someone else? There had to be
a reason why. I was determined to talk to her about her life with her bedridden husband at home
together.
As we sat together I asked her questions such as, how do you care for him by yourself?
She responded that it was very tough and she has her daughter-in-law and her son that come and
help turn him occasionally. I asked her if she wanted me to talk to someone in order to get her
some help at home. He was a very heavy and tall man to turn. I explained to her that his skin is
badly broken down and if she had some help at home it will be better for him, and help take
some of the stress off of her and her body.
As we talked I gathered more and more pieces of the puzzle. They had been married for
almost 50 years. She tried applying for some help in the past but they said she made too much
money because of all of the property that they owned as a couple. She said if they help me then
they will make me sell our property to help pay for his services, and he and I grew this property
together. He would not want me to sell any of it. I asked her if there was any way that she would
be willing to talk to someone about her situation. She replied back very quickly, I already have in
the past and I will not sell my property!

FIRST IMPRESSIONS: AN EXEMPLAR

I quickly realized that if I wanted to make a difference in their lives for the better then I
would need to take another approach. After all, I knew all the research that showed, Older
adults receiving care from nurse care coordinators (NCCs) demonstrated use of fewer hospitalrelated resources, lower health care expenses, and less strain experienced by family care givers,
improved self-management behaviors, and decreased use of costly health services
(Vanderboom, Thackeray, & Rhudy, 2015, p. 19). I was more concerned with his care when he
returned home and her health as she took care of her husband for 50 years.
Conclusion
Upon talking to her for almost half an hour, I finally got her to agree to talk to a NCC and
decide upon a course of action for their return home. I felt this need to protect the patient while
he would be out of my hands at home, and a sense of compassion for his wife who wanted the
best for him but did not have the resources to give him the best. My slight anger at the situation
turned into a situation that taught me one of the most important lessons of my nursing school
endeavors thus far. Which is, we are all doing the best we can with what we are given. We want
more for our loved ones, but we as nurses must approach the situation, not with disdain, but with
an open, curious, and caring heart.

FIRST IMPRESSIONS: AN EXEMPLAR

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References

Nielsen, A. E., Noone, J., Voss, H., & Mathews, L. R. (2013). Preparing nursing students for the
future: An innovative approach to clinical education. Nurse Education in Practice,
13(Selected papers from the 4th International Nurse Education Conference Nursing
Changing the landscape for nursing and healthcare education: evidence-based innovation,
policy and practice 17-20 June 2012, Baltimore, USA), 301-309.
doi:10.1016/j.nepr.2013.03.015
Vanderboom, C. E., Thackeray, N. L., & Rhudy, L. M. (2015). Original Article: Key factors in
patient-centered care coordination in ambulatory care: Nurse care coordinators'
perspectives. Applied Nursing Research, 2818-24. doi:10.1016/j.apnr.2014.03.004