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Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Bryan Trinh
Portfolio
University of South Florida College of Nursing
May 26, 2016

CLINICAL EXEMPLAR

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Clinical Exemplar

An exemplar is a story of a real patient that is told in order to illustrate a registered


nurses practice. The exemplar is written in the first person and describes a particular clinical
situation that includes the nurses thoughts, feelings, intentions, actions, critical thinking, and
decision-making process (Pacini, 2013). An example of a clinical experience that had an
influence on me was a situation when the main reason a patients wound wasnt healing was
because of the patients knowledge deficit on proper wound healing and the patients reluctance
to get better.
On this particular day of preceptorship, I had a patient that had a wound on his abdomen
that was not healing. He had a history of multiple hernia repairs and even had a present hernia on
the right lower quadrant of his abdomen. On our initial assessment of the patients abdomen; the
hernia was very pronounced. The patient stated The doctors said they cant operate to repair the
hernia because I have had too many previous hernia repair surgeries. The patient also stated At
least it doesnt cause me pain. The wound on the patients abdomen was circular in shape and
very raw. If it was a pressure ulcer, it would be rated stage two. When the gauze covering the
wound was removed; serosanguinous drainage was present. The patient stated I have been
changing my own dressing for years. He then demonstrated his dressing change, which
consisted of removing the old 2x2 gauze and taping on another 2x2 gauze. My preceptor and I
immediately knew that was a problem since the dressing change is supposed to be a wet to dry
dressing change.
We immediately starting asking questions to gather information on the situation.
Questions consisted of Do you know how to properly do a wet to dry dressing? Are you in need
of supplies? Do you have a place to live and access to a shower? It became clear that the patient

CLINICAL EXEMPLAR

was most likely homeless, but would not admit it. He stated I have access to water and gauze; I
just want to get out of here as soon as possible. We decided to notify the physician because the
patient did have discharge orders. This could become a serious situation if the patient did not get
the education and supplies needed to care for his wound when discharged. His wound could
become much worse, leading to readmission and infection. The best decision that could be made
at that time was to get the patient supplies and educate the patient on proper wound care.
A large box of supplies was sent to the floor containing abdominal pads, gauze, saline,
tape and q tips. The only belongings the patient had was a back pack, so we brought a few patient
belonging bags and filled them with as much supplies as possible.
It was then time to properly change the dressing and educate the patient on the
importance of cleaning the wound and applying wet to dry technique. We educated the patient on
how evidence shows that using proper technique and cleansing will promote healing. The patient
said he understood the instructions and that he will shower daily and perform the appropriate
dressing change. After final discharge was put in, the patient thanked us and left but said I will
probably end up here again if the wound gets any worse. We told him it was less likely to
happen if he followed through with everything we taught him but he just did not seem to
confident in himself no matter how hard we emphasized the importance of the education we
were giving him.
In the end I felt like I made the right decisions about educating the patient and providing
the appropriate supplies for him. If the patient is not readmitted than the desired outcome would
be achieved. I feel like with the help of my preceptor I did really well making the right choice
and educating the patient. Even though the patient was eager to leave and said he was fine and
didnt need any more help; I feel like we could have gotten social work involved with the

CLINICAL EXEMPLAR
patients current living situation to better reduce the chance of readmission. As healthcare
providers it is our job to provide the most efficient care for our patients and also provide them
with the best education available. Sadly in the end it is still mainly the patients responsibility to
care for their own health and wellbeing. If a patient isnt compliant or is reluctant to change,
there is only so much we can do, but I will not let that deter me from doing my best to care for
my patients.

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References

Pacini, C. (2013). Writing Exemplers. Presentation Notes: Nurse Action Days.


http://med.umich.edu/nursing-PDE/framework/docs/writingExemplars.pdf

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