Running head: THE POWER OF ASSESSMENT

Clinical Exemplar: The Power of Assessment

Claudia Rodriguez
University of South Florida

THE POWER OF ASSESSMENT

Clinical Exemplar: The Power of Assessment

A critical component of a student nurses clinical experience is the sharing of memorable
situations. A clinical exemplar is defined as a clinical experience that is particularly significant to
a nurse and conveys particular meaning (Harvey & Tveit, 1994). These experiences are
milestones in the nurses career (Harvey & Tveit, 1994). A clinical exemplar tells the story of the
nurse in a given situation and helps describe the nursing practice and serves as a way for nurses
to share their emotions (Harvey & Tveit, 1994). The following paragraphs explain my experience
with a patient entering the stage of end of life in the neuroscience intensive care unit (ICU).
A 94-year-old woman who had suffered a stroke was admitted to the ICU the night before
my assignment. My preceptor and I took report from the nurse and did a head to toe assessment
together. The patient, who had a DNR order, was able to follow some commands and had muscle
strength of 2/5 in all four extremities. At 9:30 am my preceptor and I were in the patients room
again to administer medications. The patient appeared as before with no changes.
At 11:00 am I went back to the patients room to do another head to toe assessment. As I
was waiting for the blood pressure to read, I noticed a piece of paper taped on the wall, almost
hidden behind a chair. The paper was the patients living will, which stated that the patient did
not want any extraordinary measures taken to keep her alive. I continued to assess the patient and
this time the patient appeared much weaker, unable to follow commands despite repeated
stimulation. The patients eyes now remained half open instead of closed as they had been
before, and they appeared glassy.
The patients presentation during the 11:00 am assessment was significantly different
than her presentation earlier that morning. The appearance of the patients eyes made me recall a
lecture we had on end of life. I remembered that the eyes of a dying person looked glassy. The

THE POWER OF ASSESSMENT

patients vital signs were stable, but based on her presentation I felt that the patient was not doing
well. I informed my preceptor about the patients change in presentation. After looking at the
patient, my preceptor agreed that the patient was weaker than before and decided to call the
palliative physician on the case.
The patient appeared to be in the process of dying. If it was decided that the patient was
in fact in the active stage of dying the family needed to be notified in order to say their goodbyes.
Although the patient had a DNR, the patient was receiving tube feedings. With the permission
from the family, I believed it would be best to remove the patient from the monitors and
discontinue feedings to maximize comfort, as the patient had outlined in her living will.
I made the right decision to notify my preceptor of the changes in the patients condition.
After doing a quick assessment on the patient, the physician stated that the patient was entering
the active stage of dying and the family needed to be notified immediately. The family agreed to
withdraw care and the patient was transferred off the unit to a palliative care suite. I noticed the
changes in the patients presentation and did not procrastinate in notifying the nurse. I do not
think there was anything else in this situation that I could have done better. Due to the quick
response from my preceptor and I, the family was able to properly say goodbye to their loved
one.

THE POWER OF ASSESSMENT

4
References

Harvey, C., & Tveit, L. (1994). Clinical exemplars to recognize excellence in nursing practice.
Orthopaedic Nursing, 13(4), 45-53.