Running head: CLINICAL EXEMPLAR: THE DUTY TO CARE

Clinical Exemplar: The Duty to Care

Ahsha Young
University of South Florida

Clinical Exemplar: The Duty to Care

Clinical exemplars, in a nutshell, are simply nursing stories. Theyre the kinds of stories
that shape and mold our nursing career path and remain inside our minds for years to come, even
after weve worn our last set of scrubs. Harvey and Tveit (1994) define clinical exemplars as
stories that describe our nursing practices and act as an avenue to express the uniqueness of the
nursing experience. Similarly, Owens and Cleaves (2012) describe clinical exemplars as first
person stories written by nurses with the purpose of detailing a specific clinical situation and
sharing an experience with other nursing professionals. The following clinical exemplar will
touch upon a clinical event that has changed my perception of my future role as a nurse.

CLINICAL EXEMPLAR: THE DUTY TO CARE

Clinical Exemplar

My particular experience occurred on the very first day of my pediatric rotation, where I
was assigned to the pediatric intensive care unit (PICU). I was extremely nervous to start the
assignment because I hadnt had much experience with children, especially not children dealing
with medical illness. The nurse I was assigned to was extremely nice, however, and put me a
little more at ease with the nursing process and the procedures on the unit.
On that day, our assignment included a 17 year old boy that Ill call T.J. At a very young
age, T.J. was involved in a pedestrian versus auto accident that made him quadriplegic and the
recipient of a permanent tracheostomy. Ever since then, his parents have shouldered most of the
responsibility for his care; I recall being amazed at how well they cared for him. T.J.s mother
was very in-tune with her sons medical needs, his baselines, and his mannerisms. I watched her
and T.J.s father converse with him as they might anyone else and T.J. responded back with
smiles and eyebrow movements. Overall, the entire family was very sweet and so gracious to the
nursing staff.
T.J. was admitted to the PICU after his mother noticed that he had some abnormal oral
and tracheal secretions. She indicated that something just didnt feel right and that she wanted to
get him checked out at the hospital. Prior to my assignment, he had already been in the hospital
for at least a week or so. The medical and respiratory teams suspected that T.J. might need a
different sized tracheostomy tube because, apparently, there was some difficulty placing a new
tube at some point during his hospital stay. Also, most importantly, on this admission T.J. had
already coded about four or five times in the PICU, with at least one of the codes stemming from
the suctioning of his trachea. Ultimately, it was not quite apparent what exactly was wrong with

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3
T.J., but it was evident that he was a critical, unstable patient. It was imperative that we kept on
top of his respiratory and cardiac status while caring for him.
Later in the afternoon, my nurse and I decided to clean T.J. up a little and do a more
thorough assessment of his skin while T.J.s mother stepped out the room to get a break from
being at the bedside. Given his unstable respiratory status, we made sure to have a member of
the respiratory team nearby just in caseturns out we would soon need her! While partway
through positioning T.J., we noticed his oxygen saturation (SaO2) level dramatically descend
from the high 90s to the 70s. Once he became unresponsive, we immediately called a code blue.
We got the backboard under him, put on the shock pads, and I helped the team with
compressions. With each round, I kept hoping that he would come back to us again.
I think the most powerful part of this event for me was observing T.J.s family throughout
the code. After the code was called, the charge nurse immediately called the parents so that they
could hurry back to the room. They were present at the bedside for a majority of the resuscitation
effort, watching and waiting for T.J.s condition to change. Unfortunately, however, he ended up
passing away. To this day I really cant imagine what that family must have felt while watching
their son pass away in front their eyes. Thus, I was completely in admiration of the hospital staff
and the way they were in tune with the needs of the family. From the chaplain to the nurse to the
patient care tech, everyone showed the upmost respect to the patient and the grieving parents.
As I was helping the nurse clean up the patient, I went to place a plain white sheet over
T.J.s body. However, the nurse gently stopped me and said that we should use the colorful
pediatric sheets instead so that T.J. wouldnt have such a grim appearance. I dont think I would
have ever thought to consider such a simple, but powerful, adjustment. We cleaned him up,
removed all of the IV lines, and changed T.J. into some of his clothes to protect his dignity and

CLINICAL EXEMPLAR: THE DUTY TO CARE

so the family could view him properly. My nurse then went above and beyond her duties and
began to pray over T.J. with the family. They were heartbroken, but extremely grateful for the
kindness they were shown.
Conclusion
I believe this particular event resonated with me because it taught me how important it is
to always be respectful of patients and their families. I, now even more strongly, believe that
showing empathy and kindness are two of the most important things you can do as nurse. Sure
its easy to get caught up in the dramatics of certain kinds of people and situations, but I think to
give the best care one must always remember that people are human and will, without fail,
showcase an endless gamut of human emotions. Ultimately, I vow to keep in mind that it will
never be my right to judge, but it will always be my duty to care.

CLINICAL EXEMPLAR: THE DUTY TO CARE

References
Harvey, C. V., & Tveit, L. C. (1994). Clinical exemplars to recognize excellence in nursing
practice. Orthopaedic Nursing , 13(4), 45-53. Retrieved from
http://journals.lww.com/orthopaedicnursing/pages/default.aspx
Owens, A. L., & Cleaves, J. (2012). Then and now: Updating clinical nurse advancement
programs. Nursing, 42(10), 15-17.
http://dx.doi.org/10.1097/01.NURSE.0000419437.60674.45