Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Amy Keller
University of South Florida

CLINICAL EXEMPLAR
Clinical Exemplar
According to Pacini (2006), a clinical exemplar is a first-person story of a real patient
told by the RN in order to illuminate the RNs practice. This sort of storytelling, which
emphasizes the RNs thoughts, feelings and actions, is intended to provide insight into the
nurses clinical decision-making process and value system. In the following clinical exemplar, I
describe a real-life encounter with a patient during a recent 12-hour shift at my clinical site.
As a student nurse, one is exposed to new and challenging situations each and every day
and after 15 months of clinicals, I have certainly seen my fair share of code blues and rapid
responses. That said, I have also discovered that you dont have to be involved in a dramatic,
code blue every single day to truly make a difference.
More Than Skin Deep: A Story of Healing
Mrs. G wasnt in any immediate danger on the day I was assigned to take care of her. The
elderly woman had undergone extensive right-sided neck surgery to remove a melanoma
approximately two weeks prior and the wound was having trouble healing. Two sections of the tshaped surgical incision had split open (dehisced) slightly and the patient needed antibiotics,
wound care and other supportive measures. During shift change report, I learned that Mrs. G had
other challenges. She had lost her left leg years earlier and had been admitted to the hospital with
signs of skin breakdown around her coccyx, buttock and heel. Shes not eating much of
anything. Shes very anxious and upset. She refuses the pain medication and shes been snapping
at everyone, the night nurse explained. Oh and she has a son and daughter, but no one has
come to visit.

CLINICAL EXEMPLAR
When I returned to her room to do my initial assessment, Mrs. G became somewhat
panicked. As I examined her wound, she flinched and cried: Its getting worse, isnt it? Its
going to split right open, isnt it? In fact, the wound appeared to be improving compared to what
had been described in her chart earlier and I told her so. Are you sure? Youre not just saying
that? she inquired skeptically. As I inspected the rest of her skin, I saw the stage 2 pressure
ulcers on her backside. She moaned and cried out as I applied the medicated cream to her skin. I
asked Mrs. G what her pain level was and if she needed any pain medication. Its a 9, she
shrieked, but I dont want a pain pill. It makes me feel funny. Im just going to have pain. I
explained that we could do a better job of controlling her pain, but Mrs. G resisted. When I
suggested it was necessary to turn her to take some pressure off her bottom, she also refused.
Im sorry, honey, she said, tears welling up in her eyes. I dont mean to be ugly. I know youre
trying to help but nothings going to help. I just dont know why this is happening to me.
When I returned to Mrs. Gs room a little while later, I could see that she was still
distraught. Her breakfast tray was untouched. She was crying softly, but still refused any pain
medication. I pulled a chair up to her bedside and sat down. I can see youre scared, I said.
Damn right, Im scared, she told me. My neck is splitting open. Im probably going to die. I
held her hand and listened as she told me about losing her leg seven years earlier. Mrs. G
described her lifelong career as an equestrian coach and how she had prepared countless girls to
ride in competitions. All that ended, she said, when she fell off one of the horses and badly
injured her left leg. The leg became infected and despite numerous surgeries, it eventually had to
be amputated. We talked about how Mrs. G had adapted to life after losing her leg. She told me
how proficient she was at getting around on one leg using a wheelchair. She told me how she
didnt let the loss of her leg stop her and every morning, shed hop into her wheelchair and take

CLINICAL EXEMPLAR
her little dog outside for a walk. Her dog and those outings were all she lived for, she said but
she felt all that was over now. There was nothing she could do anymore and she feared she would
probably just die.
When her tears stopped, I looked over at the uneaten food on her breakfast tray and asked
her if she hadnt liked the selections. She said she didnt like any of it and wasnt hungry.
Looking at her frail, thin body, I knew that her poor nutritional status and immobility were
contributing to her impaired skin integrity and complications. I explained to her that eating is a
very important part of the healing process and how the body needs protein, Vitamin C and other
nutrients to heal properly. She listened intently and then we talked about possible foods she
would find palatable. After we discussed her nutrition, I explained how pressure ulcers form and
why it was important that she shift positions frequently and that we turn her to take the pressure
off her heel and buttocks. Mrs. G said she was afraid to turn because she felt the neck wound
would open up more. But I explained that the tech and I would move her carefully and we would
keep her head facing forward as the doctor instructed so as not to put any stress on her incision.
Mrs. Gs face softened a bit and with a skeptical okay, she let me get the tech and reposition
her on her side. I returned to the nursing station and made a phone call to nutrition services and
asked them to prepare a food tray with the items shed requested.
As evening fell and my shift neared its end, I heard lively conversation coming from Mrs.
Gs room. I walked in and saw she was on the phone talking to someone. A half-empty
milkshake and two empty pudding cups were sitting on her tray. After hanging up the phone,
Mrs. G looked over at me and smiled. You know, lying on my side helped, I think. My bottom is
much less sore. I smiled back and told her I was glad she was feeling better.

CLINICAL EXEMPLAR
References
Pacini, M. C. (2006). Writing exemplar [PDF document]. Retrieved from
https://www.med.umich.edu/NURSING/framework/application/WritingExemplars.pdf