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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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Mayrenne Carmona

On a cold, rainy afternoon, I headed to the hospital to select two patients to care for the next day. When I arrived, one of the nurses asked me if I spoke Spanish, I said yes, and then she ask to translate what a patient was endlessly repeating in Spanish. The patient was CM, an 80 year old female admitted with cellulitis on her right lower extremity. She had a history of asthma, DMII, HTN, CHF, CVA, and osteoarthritis. I approached her and greeted her warmly, then asked: “Mrs. CM is there anything you need?” She replied: “I want to know where my daughter is! I am afraid to be alone. I then told her that her daughter had gone to the cafeteria to eat. I also told her that I was going to be around for a couple of hours if she needed anything. She thanked me and calmed down. Shortly after her daughter came back. She told me it was quite difficult to have her mother hospitalized because she has had to miss work and had three small children. I informed her that I would take care of her mother the next day until 2:30 pm. The nurse expressed gratitude because she had requested the hospital translator, but no one had come yet. This illustrates Benner (2001) helping role, where the nurse serves as a cultural mediator and maximizing the chance of patient’s participation competencies.

I totally empathized with her because my mother does not speak English. I understand because when I moved here sixteen years ago I barely spoke any English either. This situation is very difficult for the patient, family and of course the health team who cannot communicate freely with the patient. I have to say that her nurse was truly cultural competent because her non-verbal communication was extraordinarily compassionate, she genuinely tried and cared. This situation touched my heart because I identified with all the parties involved. I felt extremely fortunate to serve not only as a nurse but as a person.

The next morning the day started as any other clinical day, early vital signs, taking report, assessment of the systems, and attending to any need my patients could have. Around 10 am in the morning I felt that something was not right with CM, she looked particularly tired. I knew she did not eat anything for breakfast despite my attempts. Her blood sugar was within normal range. Her hemoglobin was a little low but not much. She was not the same person I had seen early that day. The domain identified here is the diagnostic and monitoring function (Benner, 2001). She was very sleepy, and it was hard to keep her awake. Her respirations seemed unusually shallow. When I opened her gown to listen to her lungs I noticed sub-sternal retractions, and her oxygen saturation was varying between 84 and 87. Her lungs sounds were much decreased with coarse sounds at the bases. I informed the nurse of the findings and requested if she could give her respiratory treatment immediately. Benner’s (2001), domain of effective management of rapidly changing situation was exhibited here. Some time passed by, the respiratory therapist came in to the room. It seemed the patient had other medications at home that the hospital was not aware of because of her language barrier. Illustrated here is monitoring and ensuring the quality of healthcare practices (Benner, 2001). I am so glad I was there to help; this patient may think that I helped her a lot, but in reality she helped me more. She intensified my desire to help and strengthened the importance of paying attention to early signs before the patient deteriorates. It is unbelievable how fast an elderly patient can deteriorate if the nurse does not act rapidly. Sometimes we need to be more aggressive in our patient care, maybe these two years of clinical have made more aware of small signs, or maybe I was able to recognize the change in the patient status because I did not have as many patients as the nurse.

Whatever the reason, I am glad I was there with CM that day. During the day, I also used the teacher, coach function by helping the patient and her family to learn, in their own language and with easy words; the diagnosis, the treatment and prevention, as well as essential facts of chronic diseases CM had (Benner, 2001). It feels fantastic to help and be able to fulfill my role by caring for the body, but most importantly the soul. This is the reason I became a nurse, to help defend, protect, prevent complications, and teach with the deepest desire and commitment of my soul.