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This clinical exemplar is a document that describes a meaningful experience I had with a patient during my preceptorship on a labor & delivery unit. Here I describe a patient experience and the lasting effects it has had on me and my decision to go into maternity.

Coming into gerontology, to be honest, I wasn’t too excited. Growing up you hear about how awful it is to get older and it made me decided early on that older adults aren’t the population I wanted to be working with. I didn’t really have a big change in heart regarding this population until we had our two guest speakers come to class and talk with us. That day was a major turning point for me and made me more open to work with older populations. It also made me reflect on how I react, behave, and interact with older adults. They gave me the insight I needed to change my views and to not look at older individuals as weak or fragile. 

After that once class, on my drive home, I reflected on how I thought of my grandparents. It made me realize how much more capable they were than I thought. I was always so quick to open something or grab something off the floor for them because I thought I was helping them. Little did I know I was actually hurting them by not allowing their body to move in such a way.  Since then, I’ve allowed the older adults to attempt first, then ask for help. Rather than assuming they need my help.

Another major turning point for me was the LifeBook project. I was fortunate enough to interview one of my grandmothers. A year ago, my other grandmother passed and after her passing I realized how little I knew about her outside of her being a mother and memere. The LifeBook gave me an opportunity to learn things about my gram that I didn’t know or even know how to ask. I was grateful for the opportunity to learn more about my grandmother because without this project, both her and I, probably would have never found the time to sit down and talk the way we did during that interview. Even though it was my grandmother, I felt I was learning just as many new things about her as my partner. The project gave me tools to help better work with the populations of older adults. 

I love going to school at UNE because we get to do our clinical in the greater Portland area. It gives us an opportunity to see patients from all kinds of different backgrounds and demographics. Last semester I got to go all throughout MMC maternity units. One week I got to spend time in the NICU. I got to work with a patient was born at about 28-30 weeks gestation (I don’t exactly remember) and he was born to teen parents. This little baby’s home was about an hour and a half away from the hospital, north of Portland. 

This situation came with many challenges, one being that the parents were teenagers and had never cared for an infant before. I worked with a great nurse that day who told me about all the education the nurses will have to give before the infant is discharged. These parents needed to learn how to change a diaper, mix bottles, warm bottles, swaddle, safe sleep, how to set up a car seat, and milestones the parents should be looking for. Another challenge that came up was the distance in which separated the infant and their parents. Due to their age and their lack of access to vehicles, it was hard for them to get to the hospital. Only one parent had their license, but they legally couldn’t drive the other. This added an extra hurdle because these parents would need to find someone else to drive them so they both could go. With them living so far away from MMC, this could be a potential issue of not being able to access the proper care quickly enough if they needed to while at home. The nurse informed me that one of the grandmas was very supportive. She did work a full-time job though, so it made it difficult for her to assist the parents. These parents needed to jump through hurdles for education, transportation, and access. 

I think the NICU staff at MMC was doing a great job. The parents didn’t come in the day I was there, but they did call in. My nurse wasn’t quite sure about their financial situation but that could greatly negatively impact their lives. I got to listen to my nurse speak to the parents and I thought she did a great job using simple language to explain to them how their child was doing. The nurse was able to educate them on their condition and provide any education that was prevalent at the time. I think getting a better idea about their home and financial situation could help to paint a better picture for the infant. The infant seemed to have a small support system compromised of his parents and grandmother.

So much has changed since I initially wrote my About Me in February of 2021. I’ve learned so much in such a short period of time and never realized how many posts I’ve made on this site. Today I worked on changing my site, mainly by ‘cleaning up’ the look of it. It was quite cluttered with all my course work in the menu. I’ve changed my site now by putting ALL of my nursing course work under one tab. I’ve also added a resume tab that will hold my resume and clinical experiences. Lastly I’ve updated my About Me page since so much has changed!

When I first decided I wanted to go into nursing the thought of natural disasters came to my mind. Worried about what my role would be and more worried that I won’t be prepared. During a disaster, of any kind, a nurse will play an important role. Nurses are responsible in helping to initiate the start of the disaster protocol. They also will work to triage patients and evacuate ones that can. Lasty a nurse can help to treat people during disasters. Nurses have many hats to wear when it comes to disaster nursing. Therefore, having a plan and sticking to it is very important, so people don’t get confused about what their role entails. 

Nurses are very compassionate people. It’s no wonder why nurses are seen as one of the most trustworthy professionals. I’ve seen a lot of nurses be selfless because they are. When it comes to disaster nursing though this may cause an ethical dilemma within themselves. When looking at the ANA code we see some contradictions, or what I believe to cause contradictions. I feel like the self provision being #5 while patient is #2 just goes to show how nurses think as to what they believe is important. I personally know that I would feel selfish putting myself before a patient. But as we’ve seen with nursing burnout, nurses need to start thinking of themselves first. I feel like the way these provisions are written it almost makes provision #5 seem more as a choice rather than a duty to self. I think a lot of nurses, in the event of a disaster, would have personal ethical dilemmas regarding these provisions. 

In a world full of difference, death is the one thing we all share. We will all reach the end of our road one way but the way in which we go out is unknown, for most. When I first heard of death with dignity it was not called that, but rather referred to as euthanasia or physician-assisted suicide. I first heard of these terms in high school and remember how bad they sounded. Just the name alone it doesn’t sound like a pleasant thing, and it reminded me of putting down an animal. Once I was educated about the topic I went back to thinking of animals. I thought this sounded negative because it reminded me of putting down animals but then I remember we do this prior to the pain and suffering the animal will endure. I remember finding out my childhood cat had cancer all throughout his body. Rather than treatments and surgeries we decided to end his suffering and put him down. Why can’t we do this for humans?

Come to find out years later we can do this to humans. I grew up in a religious household but never grasped to their principals or beliefs so ethically this doesn’t challenge my beliefs. I believe, like all patients, even terminally ill ones should have a say in their care. This can include treatments, surgeries, and death. I know personally if I was given a terminal illness, I would want to remember my life as the way I intended it to be. This wouldn’t include being sick all the time, going in and out of hospitals, and being so fatigued form treatments, I can’t spend time with loved ones. As a future nurse, it is ingrained into our minds and practice to advocate for our patients. Some might look at this and think we are harming our patients. The way I see it is that our job is to “do no harm”. By providing patients with options and allowing them to choose their care, I believe this is causing far less harm than removing that choice. Patient safety goes beyond getting better and improving. Sometimes it’s the ability to identify the patients needs and helping them choose what’s best. Nurses are also here to help protect our patient’s autonomy by advocating. If someone would rather die as they are now, rather than enduring pain and suffering then that is the patient’s choice and medical professionals should be in support of them. 

I think death is so scary because it’s so unknown to us. Most of us have no idea when/where/ or how we will pass and that is terrifying. By giving that choice to someone it can bring them comfort. Rather than spending their last months fearing the inevitable, they can have the choice as to how/ when/ and where. It can also provide comfort to their family since the decision will be placed in the hands of the patient and not loved ones. Family will also not have to watch their loved one suffer for a prolonged amount of time. All patients should have the choice. 

Prior to this course I’ve never heard of emotional intelligence. I never thought that our emotions and ability to be both self-aware and socially aware could be scaled on something like this. The test I took was a forty-question quiz that would provide two options to every question. After finishing the test, I had to then understand my score. I’d have to say I was consistent in that I scored a 5s and one 6. For self-awareness, self-management, and relationship management I received a 5. For social-awareness I received a 6. At first, I really didn’t know what this meant because I wasn’t sure what I was being scored out of. I soon realized that my score for each section was out of 10, or 40 total (EI Quadrant Descriptors). 

            Once I got a better understanding of my score, I then was able to reflect on it. I was surprised by some of the results. I always have felt that I am a very self-aware person. With this test though I only scored a 5 out of 10. This signifies that I do have some self-awareness but still have plenty of room for improvement. Self-awareness is broken up into three categories: emotional self-awareness, accurate self-assessment, and self-confidence. With this section being broken down further I can now identify where I most likely made my score go up and down. I would say once I am emotionally aware I do have an accurate self-assessment. I don’t always have that emotional awareness though to get me to that next step. Lastly, I believe I most likely lost points with my self-confidence. Doubting myself is something I’ve always struggled with. To help my self-awareness I need to be more confident in myself as well as getting better with being always aware of my emotions. As a nurse I need to be confident, and I need to be self-aware of my own emotions that way I can help others with theirs. 

            With self-awareness comes self-management. In this section I scored a 5 again. Self-management is further broken into five sections: self-control, transparency, managing oneself, adaptability and achievement orientation. When it comes to “keeping my cool” in front of others I will say I do a good job with that. Even though I may be panicked inside I can “fake it until I make it” is most situations. Transparency is something I do struggle with at times. Depending on the situation I do get very stuck on an idea and have trouble seeing the other side. This is something I’ve been working on for the past 6 years and feel like I’ve improved but still have much more improvement to go. There’s much I need to improve with this section. I will give myself credit thought in my adaptability and my goal-orientated mindset. This is part of the reason why I wanted to go into nursing. I love being able to set a goal and reaching it. I need to continue to be adaptable, managing myself well, and setting goals. 

            The section in which I thought I’d score the lowest in ended up being my highest score. Social awareness is something I’ve struggled with since I could remember. I’ve lost multiple friendships due to lack of social awareness. I’ve always struggled with picking up social cues and reading body language. Social awareness is broken into three sections: empathy, organizational awareness, and service orientation. All three of these things are something I’ve always struggled with. I honestly think that being in nursing school has helped this section of my EI drastically and is the reason why I was able to score a 6. I believe the nursing skills I’ve gained in the past 10 months have been reflected in the score I received. I will need to continue to work on my social awareness since I will be dealing with so many different people in my future. 

            The last section of the EI test is relationship management and I received another score of 5. This section is broken into seven sections: visionary leadership, developing others, influence, convincing, conflict management, building bonds, and teamwork. I thought that I would have scored higher in this section because I’ve been in multiple leadership positions in the past. When reflecting on the leadership roles I’ve held, I’ve realized they’ve all been in situations that I have lots of confidence in. This makes me go back to think about working on my confidence to become a better leader. I’ve always loved working in a team, and I have the flexibility to be both a leader and a follower depending on the situation. Relationship management is so important to the nursing field. To have a successful unit teamwork needs to be present. As well as conflict management, leadership, the ability to develop others, and building bonds. 

            All sections of the emotional intelligence test have given me an insight to who I am and how I deal with emotions. I was both surprised and not surprised by my results. I’ve realized I still have so much more to learn and work on. I was pleasantly surprised that my social awareness is much higher than I had anticipated. It just shows me that I need to be more confident in my ability to be social and communicate with others. I found it very helpful that the EI test further broke down their four sections into more specific questions. It helped me to identify what exactly are my strengths and weaknesses. If I’ve learned anything from this though it’s those things aren’t always how I see them and that’s something I need to continue working on. These skills will help better develop my role as a nurse and my role in an interprofessional team. 

EI Quadrant Descriptors. (n.d.). Retrieved from http://www.globalleadershipfoundation.com/cgi-bin/eiscore.pl

When I first heard about the Electric Health Record, I immediately thought of a great way to send and find information from one facility to another. I think of programs like EPIC that allow health systems, such as MaineHealth, to share patient information across the state. From the perspective of a college student, I think of EHR as a useful tool for someone who moves away from their primary care provider. Health information exchange is a great tool that can both benefit the patient and provider. For providers, especially nurses, it allows us to better provide for our patients. We can do this by being up to date with any appointments, medications given, or interventions. For example, if a patient goes to one facility and receives a prescription and then goes to another, the nurse can see this on their EHR. HER can help enhance communication while decreasing the number of unnecessary tests and procedures. 

 I found the presentation to be really helpful getting across the information regarding EHR. I didn’t know the large scale that it works on. I always thought of it as a local thing for health systems but not cross-country. My future in nursing will be shaped by the EHR. If my future facility uses the EHR, I will be able to get a bigger picture regarding my patients. Benefits of EHR include coordination between providers, reduction of unnecessary tests and procedures, and allows providers to have direct access to health records (Benefits of health IT). I’m excited to see how the medical field will continue to change with the use of EHR. I hope to see a reduction in mistakes (medications, procedures) and an increase in positive patient outcomes.

Benefits of Health it. HealthIT.gov. (2017, September 15). Retrieved October 21, 2021, from https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/benefits-health-it. 

Prior to jumping into her nursing career, Smity was a leader I looked up to. I still look up to her even though she’s hundreds of miles away. As I went through my interview, I realized that the leader I knew wasn’t the same leader who now works as a nurse. I asked her about her job, and she said, “I’m overworked and tired”. She began to explain to me a typical day for her job. She gets into work and before she clocks in there are signs everywhere asking for nurses to pick up extra shifts on her unit. Once she clocks in, she immediately goes onto the floor and gets her assignment. She explained to me that the “hallway patients” are the worst because they just keep getting added to her assignment. After her shift she rushes home to go to sleep. I asked her if she would ever consider a leadership position on her unit, and she quickly responded back with “hell no”. 

 Smitty not wanting to seek a leadership position sounded like a foreign language to me. She’s someone who naturally falls into leadership positions, so I was surprised to hear her response. When analyzing Smitty’s EI she has social awareness, self-awareness, motivation, and empathy. I know this because of years of friendship with her but also, I found more about her in the interview. I asked her why she didn’t want to pursue a leadership position. She went onto explaining the difficulty it has been being a new-grad ER nurse in Pittsburg. She explained to me that the mess that is happening in hospitals is something that she can’t even fix. She’s acknowledged her needs both mentally and physically and knows that taking on an additional role would not be best for her or her patients. “I’ll be stretched too thin”, she told me, “And I don’t want to break”. I found her answer to be respectable. She knows her potential, but she knows that she wouldn’t thrive in this setting. 

Knowing the mental toughness that Smitty and her coworkers must have I asked what Smitty does for herself and what does the hospital do for them. She said how she’s found a schedule that really has been working for her. She works out before going into her night shift, works, then comes home and sleep. On her days off she said she tries to do at least one thing for herself. This could be hanging with friends, watching a movie she’s been waiting for, or cleaning her apartment. She said to me, “it wasn’t an easy transition, but I’ve found a system that is working for me”. She then went on to talk about the support she has at work. Smitty told me that her hospital has a wellness team that anyone can meet with anytime about anything. She’s found this helping as she’s witnessed a lot of death and didn’t have the easiest time coping with it. Once a month on each unit they will have someone come down and perform an activity with the staff such as yoga or meditation. In the hospital there is a room with comfy massage chairs, low lighting, and just a room to relax in. “No one ever has time to go to it though”, she said. She acknowledges the hospitals efforts to help the staff but “it’s just not enough”. Smitty explained to me that a lot of people feel guilty for using these services. Everyone is so short on time, so no one wants to take time out of their shift and focus on themselves. This is what has motivated Smitty to keep a journal. Since she does come home with a lot of baggage, she likes to leave it all on the pages of her journal. She finds it to be a great tool to go back and reflect. 

            I think it’s great having friends who are already in the nursing field who I can ask for advice or their routines. I think Smitty stepping back and not taking any leadership roles show signs of how developed her EI is. It takes courage to take a step back and to identify what your own personal needs are. “Put on your own oxygen first before others. If you’re dead, then who will you help?”. Smitty said she hopes to move back home to MA and “it’ll probably happen” she said regarding a leadership position. Taking to someone who is so aware of themself, and their surroundings has taught me a lot for what I will need to do in the future as a nurse. 

In every class and clinical setting, they always say “mental health nursing is everywhere”. Understanding emotional responses, especially that to trauma, can help define you as a nurse. When someone has experienced trauma, it can control their life. An individual can become paranoid, anxious, or socially isolate themselves. Psychological stress also can be seen in physical symptoms. Physical symptoms could look like fatigue, insomnia, weight loss/gain, or even low immunity (getting sick). As health care providers we typically are focused on treating the physical symptom. By betting understanding trauma and its physiological effects, we can better treat our patients. Trauma can also affect someone spiritually. They could find themselves questioning their faith, wondering why them. Others might find comfort in religion and find themselves being more spiritual. Trauma can also hinder friendships and relationships. Someone might feel like they aren’t being understood and further isolate themselves. Family and friends can also feel overwhelmed and not know how to deal with the situation. Trauma affects all aspects of our lives and can occur at any time. 

Trauma that occurs during one’s childhood can be categorized as adverse childhood experiences (ACEs). Similarly, to other trauma, people who have ACEs have psychological, phycological, spiritual, and social difficulties. The stress of trauma during the developmental period can have negative neurological effects. Those with ACEs more frequently participate in risky behaviors such as heavy drinking. It can also increase one’s chance of developing depression, diabetes, asthma, and cancer (Adverse Childhood Experiences). By learning how to use trauma informed care in my practice I can better provide for my patients. How I behave and what I say can determine how much a patient feels comfortable sharing things with me. There won’t be a special device that can tell me who and who hasn’t experienced trauma in their life. I will have to learn how to convey trauma informed care to build between relationship with patients and create positive healthcare outcomes. 

Adverse Childhood Experiences (ACEs). (2019, November 05). Retrieved from https://www.cdc.gov/vitalsigns/aces/index.html