Clinical Narrative

As I sit down to try to write this clinical narrative, it amazes me at the amount of
memories nursing has given me. It feels like yesterday I obtained my diploma and started my
career. When patients and families ask me how long I have been a nurse, I am uncertain with
their reaction to my response of five years. Some are impressed, yet others seem almost
disappointed. I am amazed that I have been a nurse for five years. I can still remember that very
first time someone asked me how long I have been a nurse and I could only answer honestly with
one month. In these five years of nursing, I have learned and grown more than I could ever
imagine.
It was terrifying walking into the intensive care unit (ICU) on my first day as a nurse. I
had no clue what to expect. I felt assured in my education, but lacked confidence in my
experience. All the other new graduates in my class had experience as certified nursing
assistants, whereas I did not. Each day at work I learned something so new and I loved what I
was doing. I worked very hard and aimed to be the best nurse. My orientation was six months
long and I was ready for my first day without my preceptor. I took my two patients with sureness
and clocked out at the end of my shift with the same amount of confidence. I had become an ICU
nurse and felt like I knew it all.
One of my preceptors, Janet, won a very prestigious award in which our hospital threw a
beautiful ceremony for her. She presented a speech and one story in her speech has always stuck
with me. She reminisced on a coronary artery bypass graft patient that she was taking care of on
post op day one. The patient had been stable, extubated and doing great. All of a sudden he
started bleeding profusely from his chest tubes and quickly became unstable. The doctors
determined they were going to have to rush him back into the operating room. Janet, being the
primary nurse, was incredibly busy hanging blood products and attempting the get the patient
prepped for surgery. The team was very quickly pushing the bed down the hall when Janet ran to
the patient and placed a warm blanket on him. The patients surgery went well and he returned
later that night back to the ICU for recovery. The next day, Janet again was his nurse. He started
crying when he saw her and thanked her for the blanket that she placed on him the day before.
He told her that was the only thing he remembered and was just what he needed to comfort him
in that scary time.
When I heard Janet tell that story, I was confused. Having only been a nurse for one year,
I believed that hanging the blood, starting the vasopressors, and keeping the patient alive would
have been the most gratifying thing. Instead, it was hearing that the patient was comfortable. I
thought to myself how I would never have time for that and a blanket would not have been my
first priority. I have switched career paths since the ICU and have been working in the post
anesthesia care unit (PACU) for three years. Every day, I am still learning and advancing in my
nursing career. I have advanced through Benners theory from novice to expert. Comparable to
Benners theory, each experience I have had has built on from a previous experience and has
helped me expand and gain clinical experience (Benner, 2000). I know that I will continue to
grow as a nurse and I strive to take the upmost care of my patients.
In the PACU we recover all types of patients. Every patient is different but one common
denominator for PACU patients is pain. Every patient has had surgery and a majority of them
awake from surgery hurting. PACU nurses are professionals at giving narcotics. If you ask any
PACU nurse what their favorite medications are, he/she will likely answer with Fentanyl and
Dilaudid. There is something that fascinates me about pain. Pain is subjective and different for
each person. It is a topic that no single person can master. When I became an employee at the
University of Colorado Hospital, I learned that they had a Pain Champions Committee. I
immediately expressed to my educator that I wanted to join that committee. I was in luck
because there was a need for a PACU representative and I have since loved attending the
meetings and learning more about pain. Since becoming a PACU nurse, managing patients pain
on a daily basis, and being our unit representative for the Pain Champions, I have become
intrigued with integrating the theory of Comfort Care into my daily practice.
Comfort Care is a theory by Katharine Kolcaba (1995) that is defined as the satisfaction
of basic human needs for relief, ease, or transcendence that arise from stressful health care
situations (p. 287). Kolcaba believes that patients communicate to nurses their perceptions to
which their needs are met; therefore the nurse can attempt to enhance comfort. Comfort care is
patient-centered and nurse-sensitive; successful nurses are the nurses that make their patients
comfortable (Kolcaba & Wilson, 2004). This is a huge theory to follow when being a PACU
nurse. My goal every day is to aim to make my patient as comfortable as possible.
Unfortunately, many RNs place stereotypes on patients with chronic pain. We assume
they are going to want a large amount of narcotics and never achieve comfort. One day I
received an assignment of a young lady having an ureteroscopy. This particular procedure is
considered to be uncomfortable but not incredibly painful. As I was looking up my patient before
she arrived in the PACU, I noticed she had chronic pain. She was on multiple opioids at home. I
could not help but to anticipate that her pain would be difficult to control. She arrived from the
OR and immediately was crying and stating how much she hurt. Instead of running to the pyxis
and grabbing narcotics I assessed her pain. I asked her what hurt and what helps her pain. It was
not her procedure that was causing her pain but her positioning in the OR that had caused her
back to hurt. She told me that a back rub would help. I asked her to roll on her side and I rubbed
her back for five minutes. During the back rub, her crying subsided and she later thanked me for
taking such good care of her and actively listening.
Five years ago, I would not have even thought to ask her what helps her pain. And three
years ago, I probably would not have rubbed her back because I would have been more worried
about getting her medication, charting and time management. The moment I rubbed her back, I
immediately thought of my first ever preceptor, and that warm blanket. I realized I learned more
than just nursing skills from Janet. It will always be more important to keep patients stable and
safe but sometimes they just need comfort. They want someone to listen to them and want to
know that the nurses care. I realized how much my nursing practice has changed and advanced. I
will not be the first person to master pain management but that does not stop me from trying. I
want to thank the UEXCEL board for your consideration and time and I hope you enjoy learning
about my projects and passion to help comfort our patients.






Benner, P. E. (2000). From Novice to Expert; Excellence and Power in Clinical Nursing
Practice. Menlopark, California: Addison-Wesley Publishing Company. (LOE 8)
Kolcaba, K. Y. (1995). The Art of Comfort Care. Journal of Nursing Scholarship, 27(4), 287-
289. (LOE 7)
Kolcaba, K., & Wilson, L. (2004). Practical application of comfort theory in the perianesthesia
setting. Journal of Perianesthesia nursing, 19(3), 164-173. (LOE 7)