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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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Diane Tolaj

It is 0700 on a gloomy, Medical-Surgical clinical morning. It is the end of the week, a huge exam on Monday, and a ten page paper due Tuesday. Stress and anxiety are heightened. All I can think of is “I can do this. Eight hours of clinical today and I get to go home.” I enter A.L’s room and introduce myself. She takes one look at me and continues to stare out the window. I approach a little closer and kneel down to eye level with the patient, wondering if she is hard of hearing, I repeat “Good Morning. I am Diane, a student nurse from Cedar Crest College who will help take care of you today.” A.L. slowly turns her head towards me and says “Please.” I barely hear this, as I am completely focused on the tears streaming from her bright blue eyes.

All the anxiety and stress has dissipated and what I am feeling is confusion. I critically analyze the current situation in my mind and wonder, “Does she want a student nurse, or is something else wrong?” So, I decide to do the one thing I can think of. I sit down next to her and remain silent. Now, the confusion is clearly evident in A.L’s eyes. She looks at me, tilts her head to one side, and asks, “what’s wrong dear?” My jaw drops in shock! Here is this unhappy woman asking me what is wrong! I reply, “I was going to ask you the same question.” For the next five minutes we both just sit there. She continues to cry, silent tears streaming down her face.

As I prepare myself to rise from the chair and go get the primary nurse, A.L reaches for my hand and says, “Stay.” I sit back down. She turns to me and says, “Honey, why can’t I just die already?” I think to myself at this moment, “Oh how I wish this were a rhetorical question!” but I respond, “What do you mean?” She replies the following. “My dear, I am 65 years old and I have end stage COPD. I fight to breathe every day of my life. I am in and out of hospitals every week. They poke and prod at me. Look at me! I am a human pincushion! I am swollen all over, I am always in so much pain, and I can’t even control my own poop! I have lived my time! I do not want to do this anymore! Why can’t I just be comfortable?” At this point, I pat her hand and say, “A.L., I will be right back. I want to help you.” I leave the room, go find the nurse, and tell her what just occurred.

The primary nurse pages the attending physician. When he arrives, the primary nurse asks that I repeat to him what the patient told me. The physician nods the entire time he is listening to me. When I am finished he states, “I am glad you told me this. Maybe it is time we speak to A.L. regarding her code status and possible hospice”. We conclude our meeting.

I take care of A.L. to the best of my ability. I bathe her, provide her with pain medication, turn her every two hours, and help her eat. At the end of the day, the physician comes up to the unit and pulls the primary nurse and me aside. He places a sheet of paper in front of us. It reads “DNR/DNI (do not resuscitate/do not intubate).” Next, he shows us another paper. It reads “Hospice Admission Assessment” and below that, A.L’s signature. I enter my patient’s room and for the second time today, my jaw drops. There she is, sitting up, smiling for the first time! She says to me “Thank you for being such a good nurse. It’s because of you that I am finally going to be comfortable!”

According to Benner (1984) “nurses’ need to allow patients to ventilate their feelings, often without speaking at all themselves” (p. 58). This is the Helping Role domain of nursing that Benner emphasizes. During the time that A.L. was divulging her concerns to me, the best thing I could do was just listen. Sometimes, we learn more from our patient’s then objective data can provide, solely by listening to their subject views (Benner, 1984).

There is also a domain in nursing practice called Organizational and Work-Role Competencies in which emphasis is placed on working as a team and this is crucial to the success of providing the best patient care possible (Benner, 1984). Passing along to my team members, the primary nurse and the attending physician, what A.L. states, facilitated collaboration in her care. Ultimately, what A.L. wanted was to be placed on hospice. She didn’t want to be “poked and prodded” anymore. By working together as a team, the best interest of our patient was met and her wishes granted. A.L. would finally be comfortable and I helped facilitate such.