Precious White

Personal Exemplar
There have been many patient situations that have stuck out in my mind. But one
happened recently in my practicum clinical. It was on floor 5T at Lehigh Valley Muhlenberg
hospital. The situation occurred during day shift but more toward the end of our shift. We were
getting a new admit due to 3 of our 6 patients being discharged throughout he day. It was a 48-
year-old male who was transferred to our floor from the ICU. His admission diagnosis was a
COPD exacerbation and he had a PMH of: multiple sclerosis, blood clots, numbness and
weakness in upper extremities, and overall generalized weakness. The nurse from ICU called my
nurse to give report, who then handed me the phone to receive report being as though he was
going to be my patient once he came onto the floor. The ICU nurse gave me all the patient’s
history and complications, such as him having airway difficulties from intubation, and then
ended the call with “he’s a very nasty and rude guy”. I kindly said thank you and hung up. My
preceptor as well as the tech heard the last part of what the ICU nurse said, as the phone was
loud enough to hear if you were sitting next to me. The comment made about the patient put the
tech in a bad mood from then on out. Once the patient arrived on the floor, my preceptor and I
went in to introduce ourselves, saw that no meds were needed at that time, did a complete
assessment, and asked if there was anything else we could do while we were in there. He kindly
asked if the tv could be turned to Fox news channel being as though he couldn’t do it himself due
to the weakness and numbness in his upper extremities. I used the television guide on his bedside
table and turned to Fox news for him. He then asked if he could have a nicotine patch ordered
because no one has done so yet, and we told him that we would message the doctor for that
request. We left the room and the patient was content for the moment. He pushed his call bell
about 15 mins later and I got up to answer it. He wanted to order food and to also ask for
something to help with his nausea. It was at this time that I decided to get to know him a bit
more. After addressing the nausea and food issue, I began to ask him what brought him into the
hospital. Even though we can see the reason in the notes on his chart, I like to get the patient’s
perspective on why they ended up in the hospital. He began to tell me that he smoked about a
pack and a half per day and that his diagnosis of COPD wouldn’t keep him from doing what
makes him happy. Although he had the type of attitude that nothing or no one will change his
mind, I still decided to do some educating on the disadvantages that smoking has on his health,
not to mention having it around the chronic oxygen that he was at home with. He seemed
somewhat receptive and then asked about how much longer I had to do in school. We discussed a
few other things, and before you know it, it was 30 mins later. I told him that I would be in later
before my shift ended and he thanked me for being the only one who treated him like a person
and took the time to get to know him. After I left the room, the tech came in to take his vitals.
She already had preconceived notions of the patient due to the comments the ICU nurse said
about him, so she went in the room hostile. As I was giving meds to the patient next door, I heard
yelling and screaming as well as a big commotion coming from the patient’s room. After
finishing up with the current patient, I ran into his room to see what was going on; and the
patient was complaining about the tech. His words were, “She’s a crazy lady and she’s trying to
kill me!” I asked why he thought that and he said because she grabbed his arm and didn’t say
what she was doing. He proceeded to tell me that she then starting erasing things off the
whiteboard and turning the tv channels. I reassured him that everything was okay and that I
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would go figure what was going on. I left the room to ask the tech what happened, and she told
me that the patient was over exaggerating. She stated that she erased her name off the white
board because the patient was saying that he was going to report her, and she didn’t want him to
know her name. She then said she was turning the tv back to Fox news like he had asked,
because somehow the channel got changed. According to the tech, the patient started to use his
teeth to try and bite off the blood pressure cuff and was trying to harm her. I asked why she
thought he treated her that way when he was nothing but pleasant to me and my preceptor. Her
response was, “I don’t know, and I don’t care; all I know is that he’s an arrogant jerk who
doesn’t like me because I’m older than him and won’t fall for his mess. He’s only nice to you
and the nurse because you two are young and give in to his every need. He’s entitled and is
enabled by everyone including his parents. His parents had the nerve to ask for plastic cups to
put in his bathroom. This isn’t a hotel.” The tech continued to ramble on about why the patient
frustrated her. My response to her was, “Well, don’t you think you went in the room with an
attitude because you heard what the ICU nurse said? Do you think he could have sensed your
frustration and interpreted it as you trying to hurt him?” The tech’s response was that she did
nothing wrong and that the ICU nurse was right.
This situation is so memorable because of how effective therapeutic communication and
relationships are with your patients. This is something we’re taught in one of the first courses of
the nursing program here at CCC, and it just amazes me how it stays true and relevant even now
and more so in the future as “the nurse”. During the whole time the tech was talking to me about
he patient, I could only feel frustration with what she was saying. I felt like she was not giving
the patient a chance. I felt like she was more worried about not having to do any work for the rest
of her shift before the patient came to the floor. If I was able to get a word in while talking to the
tech, I would have said something like, “If you would have gotten to know him, you would have
seen that he’s a very pleasant guy who just happened to be in a vulnerable situation.” I would
have told her that patients like him need a bit gentler approach to care. I wanted to tell her that,
me being a student, shouldn’t have to explain this to her being as though she’s been in the
healthcare field for 15 years. This patient needed support through this rough time, not more
stress and judgment.
The concept of liberal arts that I can relate this situation to would be philosophy,
specifically the ethical and moral values of people. According to Bernhard (2011), judgement is
a response that is deep-rooted within everyone due to today’s society. She talks about how
judgement is done sometimes unintentionally and subconsciously and will take a lifetime of
conditioning to change (Bernhard, 2011). Bernhard also states, “Judgment is what we add to
discernment when we make a comparison (implicit or explicit) between how things or people are
and how we think they ought to be. So, in judgment, there’s an element of dissatisfaction with
the way things are and a desire to have things be the way we want them to be” (2011, para 8). I
feel like this sums up how the tech thought of the patient, which ultimately guided her actions to
treat the patient as such. We as individuals within the healthcare field need to work harder at
acknowledging and distinguishing our personal thoughts and feelings from the quality care that
each patient deserves. I know that I have worked on my self and how I view patients, and even
how they perceive me as a nurse. I have, with the guidance of this program, have incorporated
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therapeutic relationships into my everyday patient interaction; which has made be become a
more holistic and well-rounded nurse.
When analyzing that situation described above, I can relate several of Benner’s
competencies. Some of them are: eliciting and understanding the patient’s interpretation of his or
her illness, understanding the particular demands and experiences of an illness: anticipating
patient care needs, administering medications accurately and safely, maintaining a caring attitude
toward patients even in absence of close and frequent contact, and anticipating problems: future
think. The first competency because the patient in my scenario knew that smoking was unhealthy
and maybe the reason for his hospital visit but needed to voice his interpretation of his illness.
The second competency listed because the patient had a PMH of COPD, therefore anticipation
was needed for oxygen ordered and teaching given based on the admitting diagnosis. The third
competency listed because a nausea med needed to be given but checked first in the records to
see when the last time it was given. The fourth competency relates to the situation directly in us
not knowing the patient and not being the ones who were with him for the first few days, so a
caring attitude needed to be even more enforced to make up for the lack of frequent contact with
the patient. The last competency relates to the situation by understanding the information given
during report. The ICU nurse mentioned that the patient had a difficult intubation and so this
information allowed my preceptor and I to anticipate and to be ready for any respiratory issues
that may have needed an emergency response.
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References

Bernhard, T. (2011). Why judging people makes us unhappy. Retrieved from

https://tinybuddha.com/blog/why-judging-people-makes-us-unhappy/

Benner, P. (2001). From novice to expert. Upper Saddle River, NJ: Prentice-Hall, Inc.