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Summer Exemplar

Nursing graduates share significant clinical experiences

"The following exemplars offer a peek into the moments of life as a nursing student that shape and help inform who they become as professional nurses. The exemplar writing assignment is to "describe a significant moment in practice where the student had an impact on the patient or the patient had an impact on the student." One of the prompts is to "write about a time when you knew you had become a nurse". These stories from practice describe pain and pain relief, fear and courage, despair and hope and the search for health that defines the journey of all nurses and patients. The faculty of the Cedar Crest College Nursing Department are so proud of our students and all that they do in the name of healing. We hope you enjoy their stories."
~Professor Amy Edgar

These are the stories written by the July 2013 nursing graduates.
*please note that the names of all patients have been changed for confidentiality.

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Kelly Boatner

Math is such an enjoyable challenge for me. Finishing a hard math problem and getting the right answer always puts a smile on my face. So when my pediatrics nursing class put emphasis on calculating fluid requirements, I knew it would be one of my favorite rotations in my nursing education. Little did I know that my excitement for math would make such a difference in the care I gave to my patient on one mid-summer day.

It was my first day on the pediatrics medical surgical unit and I could not have been more enthusiastic about the day to come. I followed a nurse into the room of a one day post-operative appendectomy patient and the nurse introduced me to a 10-year-old female and her mother. The young girl and I smiled at each other and she laughed as I made a reference about the television show “iCarly” that she was intently watching. I instantly felt a connection with my patient. The patient’s diet had been advanced as tolerated just in time to order breakfast, for which she had no appetite. She was advised to “keep sipping on water to stay hydrated”. After completing my assessment on her, I began going through the chart and researching her medications and I took a closer look at her IV fluids that were running at 35 ml/hr. This prompted me to calculate her hourly fluid requirements and my joy of solving the math problem quickly became a concern when I realized that she was receiving less than half the fluids she required. The nurse was not alarmed by this because the patient was able to supplement her fluid needs with oral fluids. Around 1100 the patient began dry-heaving, experiencing a single episode of emesis, and had an increase in her pain level to an 8 on a 0 to 10 scale. The patient’s mother began raising concerns about the care given to her daughter.

Reflection of the moment refers to Benner’s (2001) domain of The Helping Role as I was able to provide emotional support for my patient and her mother. I remember being present with the patient and using touch to comfort and communicate with her in order to ease any pain and calm her anxiety while we waited for the pharmacological interventions to take effect. By lunch time I noticed a significant change in my patient’s mood. She became lethargic and I assessed her mucous membranes. She was dry and her lips were cracked, still with a lack of appetite and a decreased intake of oral fluids. The patient’s mother stated that her daughter “did not look well”. The fluid requirements for my patient based on her weight were 74.4 ml/hr and the lack of oral fluid intake and a urine output of 300 ml over five hours plus one emesis was leaving the patient with a deficient fluid volume. I discussed this with the registered nurse and we worked together to formulate a plan of care that included having the doctor increase her IV fluid rate. This gave me a sense of accomplishment because I was able to assess the needs of my patient and recognize the signs when those needs were not being met.

Taking a closer look at Benner’s (2001) domain of managing patient crisis brings awareness to the fact that nurses act as a backup system for the doctors that are writing orders for patients and are capable of changing treatment plans as a patient’s condition dictates. Since the doctor was not with the patient throughout the morning, he was not able to see that her condition was deteriorating and that action needed to be taken. The patient’s IV fluid had been increased for two hours prior to the end of the clinical day and I could already notice that the patient’s mood had changed for the better. This patient made a lasting impression on me because something as simple as a math problem and a little nursing intuition made such a difference in the care given to patients.