Running head: CLINICAL EXEMPLAR 1

Clinical Exemplar
Jacqueline N. John-Morton
University of South Florida
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Clinical Exemplar
Introduction
Clinical exemplars are reflective tools that allow nurses and other health care

professionals describe real clinical experiences in order to examine and re-evaluate decisions, thoughts,

and emotions that took place during the time of the experience. In a study by Silvia Mamede, structured

reflection was found to enhance student learning, and was determined to be a useful addition to current

clinical teaching methods (Mamede, 2014). The clinical experience that I am going to reflect on

happened during one of my night shifts on the Mother Baby unit at Florida Hospital Tampa.

Clinical Experience

The patient was a baby boy born at 1009 on March 29, 2017. He was born at the

gestational age of 40 weeks and 2 days. Upon doing my first shift assessment, I noticed that the babys

vitals were on the upper range of normal. His heart rate was 156, and his respirations were 57. (I even

double checked to make sure I was counting correctly, I got HR: 154 and RR: 57). The baby seemed like

he was okay, but I just wanted to double check with my preceptor. I asked if the vitals I had gotten were

okay for this baby. She explained that even upper range normal for vitals is okay, but that if I have a

weird feeling I should keep a close watch. I asked her if I could go ahead and do the babys cardiac

screening since we had to complete the babys discharge requirements that night. She said that I could.

I went into the patients room and explained that I would be completing the cardiac

screening for the babys discharge. The mother of the patient asked if we could go ahead and do the

entire discharge routine for the baby so that she could sleep for a couple hours. She told me that we could

keep the baby in the nursery after the screenings, and that she was fine with formula supplementation.

My preceptor agreed, and she sent me on my way to complete the babys discharge. There was another

patient who was hemorrhaging so my nurse went to help.

I put my patient (the baby boy) on the cardiac monitor. His O2 Saturation was reading

89. My first thought was Oh no thats too low, was my gut feeling right? Then, the O2 dropped to 72. I

replaced the pulse oximetry lines to see if I had a bad connection, but the reading stayed in the 70s for a
CLINICAL EXEMPLAR 3

minute. I also noticed that the baby was starting to breathe differently. My first thought went to

retractions. I grabbed the nurse who was sitting at the front desk. She said that it was my connection to

the cardiac monitor, but I explained that I had already reconnected it. Then, I pointed out the babys

breathing, and how it looked like retractions. She dismissed that as the baby sucking on his pacifier too

hard.

I didnt feel right so I went to find my nurse. She was talking to the patient who had just

hemorrhaged, and trying to comfort her. I noticed the charge nurse was leaving the room so I followed

her out, and asked if she could look at my patient (the baby boy). She came into the nursery, and agreed

with me, and called for NICU. The baby was taken to the NICU, and the doctor later explained to me that

the baby had an enlarged heart. The NICU nurse said that if I hadnt advocated for this patient, he might

not have had a good outcome at all.

Conclusion

According to the article, Pulse oximetry screening for critical congenital heart defects in

asymptomatic newborn babies: a systematic review and meta-analysis, it was concluded that pulse

oximetry is a noninvasive and inexpensive way to initially screen for congenital cardiac abnormalities.

This supports the decision that I made to complete this part of the babys discharge early. I thought that

the baby was having something go wrong with his heart because of his high vital values so pulse oximetry

and performing a cardiac screening was the best way to get the data that I needed to confirm the

suspicions that I had.

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References

Mamede, S., Van Gog, T., Moura, S. (2014). How can students diagnostic

competence benefit most from practice with clinical cases? The effects of

structured reflection on future diagnosis of the same and novel diseases.

Academic Medicine. 89 (1): 121 127. DOI: 10.1097/ACM.0000000000000076

Thangaratinam, S., Brown, K., Zamora, J., Khan, K., Ewer, A. (2012). Pulse oximetry

screening for critical congenital heart defects in asymptomatic newborn

babies: a systematic review and meta-analysis. The Lancet. 379 (9835) pgs.

2459 2464. DOI: 10.1016/S0140-6736(12)60107-X