Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Janelle Gosch
University of South Florida

Clinical Exemplar
Being a nurse means being ready to handle any experience that you might face on a daily
basis. A clinical exemplar is a story told in order to illustrate a nurses experience, describing
details about a particular clinical situation including the nurses thoughts, feelings, intentions for

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actions, critical thinking and decision making process (Pacini, 2006). This paper is a reflection of
a previous clinical experience that conveys a memorable and significant situation to myself.
W. J. is a 64-year-old woman who came to the hospital with gastrointestinal bleeding. She
was admitted to the floor and started on colonoscopy bowel prep. While patient was on bedside
commode, she became unresponsive.
Some information observed before the incident were that the patient was concerned about
how much blood was in her stool and also stated that she did not feel like herself. This was
concerning to me because she was producing large amounts of dark red bloody stools.
While I was assisting the client to the bedside commode she became unable to hold herself
up. She leaned forward in the chair and almost fell off. I was able to catch her from falling. Her
eyes were open but not able to focus on me or anything in specific. She was unable to respond to
verbal or painful stimuli.
This patient had a history of atrial fibrillation, coronary artery disease and had previously
have 4 stents placed within the last 5 years. My first reaction was to call for help. This patient
could possibly be experiencing a heart attack or stroke. This situation is critical. I check for a
pulse, which was fast and thready. Nurses and patient care assistants came to assist me in the
patients room. The charge nurse was also notified.
This patient was in a double bed room. A patient care assistant was delegated to assist the
other patient out of the room while we lifted the unresponsive patient from the bedside commode
to the bed. Getting the patient into bed was the safer decision; if CPR is needed we need to have
the patient lying flat. The patient was unable to hold herself up and was leaning off the
commode. She was at risk of falling off the commode and causing more harm to herself. After
patient was lifted and placed in bed. Other members of the healthcare team were delegated to

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obtain vitals signs, blood sugar, and EKG. Other nurses were delegated to get fluids and IV
tubing. Other members gathered extra sheets and towels to clean up the mess in the room.
After obtaining vitals and blood sugar, which were all within normal limits, W. J. began
to arouse. She was able to answer level of consciousness questions correctly and seemed back to
herself before the incident. Luckily, she never lost pulses and was able to wake up after being
placed in bed. The decisions made were quick and the standard protocol in emergency situations.
We believed that this patient experienced a vagal episode or vasovagal syncope. There is an
article written by Krediet and colleagues that suggests the use of leg crossing to control
vasovagal syncope. But in this situation it is hard to tell what is happening. If the patient had a
history of syncope this would be a good practice to try.
I think I responded to the situation really well. I was not in shock or stunned by the event.
I was able to act fast and call for assistance. We worked as a team and were able to get the patient
to a safer environment and monitor her for further complications. The situation could have gone
completely opposite so in the future I will always expect the unexpected.

References
Gillespie, Mary. (2009). Helping novice nurses make effective clinical decisions: the situated
clinical decision-making framework. Nursing Education Perspectives, 30(3), 164-170.

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Krediet, C., Dijk, N. V., Linzer, M., Lieshout, J. V., & Wieling, W. (2003). Management of
vasovagal syncope, controlling or aborting faints by leg crossing and muscle tensing. ACC
Current Journal Review, 12(1), 74.
Pacini, C. M., PhD, RN. (2006). Writing Exemplars. Nurse Action Days, 1-3. Retrieved April 18,
2016, from https://www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/Wri
ting_Exemplars.pdf
Tanner, C. A. (June 2006). Thinking Like a Nurse: A Research-Based Model of Clinical
Judgment in Nursing. Journal of Nursing Education, 45(6), 204-11.