Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion: JENNIFER CRUMB, PSBU

Mid-Point Guide for Reflection

Tanners (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanners clinical judgment model (see below).
Background

Around 1pm during one of my shifts on PSBU, my patient went into Supraventricular
tachycardia (SVT). My preceptor immediately called the cardiologist on call and asked for a
beta blocker to bring my patients heart rate down. The cardiologist refused to order a beta
blocker, instead insisting on Adenosine, PRN. Through further investigation, and looking at
hospital policies, it was apparent that a cardiologist should be at the bedside when administering
this high risk drug.

Noticing

Throughout this ordeal, my patient was alert and oriented. Tensions were high at her
bedside, and everyone kept talking about her, but not to her. While waiting for the cardiologist to
come to the room, he was speaking very loudly about her outside her room. This led my patient
to have high anxiety about the situation, and caused her HR to go even higher. My patient was
especially nervous about this medication because she was told her heart would stop, then start
back. She had a DNR order, and her husband had just left for the night.

Interpreting

Describe the clinical judgment or clinical reasoning that you performed. The example should include alternatives
you considered, and rationale for your decision.

Through the commotion and the intense energy in the room, I considered what I could
personally do in this situation. I could either focus on the medical aspect to see how the
medication would affect this patient, or I could focus on her comfort. I chose the latter. Because
the cardiologist was being so loud before coming into my patients room, I went over and quietly
shut the door. I then sat beside her and held her hand. I talked to her about her children and
grandchildren. I talked to her about how she and her husband had met, and how long theyd
been together.

By calming and comforting her, she was able to communicate more clearly with the
cardiologist when he finally joined us at the bedside. He decided Adenosine was not what was
needed after all, and a beta blocker would suffice. My patient was administered Propranolol, and
her HR returned to within defined limits. This, along with calming distraction techniques,
allowed for my patient to rest and heal.

Responding

What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.

Patient centered care is a goal of the most successful healthcare institutions. Included in
patient centered care, is including the patient in healthcare decisions, explaining the situation
completely. When a patient is included in their care, better outcomes are achieved due to
decreased anxiety and increased patient self-management. (Elwyn et al., 2014) By talking to my
patient and calming her anxiety, she was able to communicate well with the cardiologist during
this stressful situation. According to Elwyn et al., 2014, communication between healthcare
professional and patient will need to be tailored to each specific situation. I will remember this
as I care for patients when I am a practicing RN.

Reflection-on-Action and Clinical Learning

Based on your experience as a student nurse on a unit with a preceptor, reflect on the differences of working one-on-
one with a preceptor versus a student nurse in a group of students and one instructor.

Based on my experience thus far, working one on one with my preceptor has been very
different from working in a group of student with just one instructor. Among these differences
are: I have more autonomy, more skills are expected from me, and working from beginning of
shift to end of shift, I am able to both give and receive report. I feel that, though Ive learned a
lot from my instructors, there is not enough one-on-one time, as there are many other students
per clinical group. Also, I feel that working with fellow students keeps me in my comfort zone,
which doesnt allow for as much personal growth as I would like.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.

References

Elwyn, G., Dehlendorf, C., Epstein, R., Marrin, K., White, J., & Frosch, D. (2014). Shared
Decision Making and Motivational Interviewing: Achieving Patient-Centered Care
Across the Spectrum. Annals of Family Medicine, 270-275.