Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Final Guide for Reflection

(Example MUST be different than that provided at mid-point)

Tanner’s (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 Tanner’s clinical judgment model (see below).
Background

I had a 72-year-old female who came in for shortness of breath and edema. She seemed relatively healthy expect we
were suspecting that she had C. diff because she was constantly having loose stools and it was at least 4 stools in the
first two hours. Well, she had gone to get an echo but was coming back and lost responsiveness while ambulating to
the bed with blood pressures of 60’s/30’s. We called a rapid response and immediately gave a fluid bolus. Her body
started recovering once we got her back into the bed, though. Later on, she is now fully recovered from the
hypotension. She is drinking some ensure with her family and talking as if nothing happen. We were content with all
of our patients and went to lunch. We had heard/saw the code blue being called as we are coming back from lunch.
Apparently, she had been drowning to death for some time. She was aspirating all of her liquids and was oozing
ensure from both her nose and mouth. She had become unresponsive and my coworkers called a code blue while
watching our patients. They coded her for 24 minutes. We brought the family in during the code, they watched the
code for a few seconds, and told us no more CPR. We prayed as a group with the code team and the family.

Noticing

Now, after the situation is complete, I wish I had saw the signs. Although, when she drank anything, she gave no
signs of aspiration like coughing. I just wish that there was something further that we could’ve done. Although, both
rapid response nurse, providers, and code team said that there was nothing that could’ve prevented this, I just wish
that we caught it faster.

Interpreting

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

We gave report to the CCU nurse that would’ve taken her if she had lived. I am not sure that there were alternatives
to the situation. We used clinical judgement when we called the original rapid response by seeing that something
wasn’t right and that she had a second of unresponsiveness.

Responding

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

Some signs and symptoms other than coughing of aspiration include: bluish tones, shortness of breath, fatigue,
fever, wheezing, sweating without exertion, breath odor, and difficulty with swallowing. I think it is important to
know other signs and symptoms in order to avoid this again.
https://hrstonline.com/hrst-u-2/article-library/aspiration-pneumonia/

Reflection-on-Action and Clinical Learning

Socialization is best facilitated when the new nurse feels part of a group. How has this precepted experience and
working one-on-one with a dedicated preceptor helped you to become socialized into the nursing profession?

I think I have more of an advantage of working on the CPC at Memorial already since I know all the nurses and
already call them some of my really good friends. Everyone was willing to help me and give me experiences I
wouldn’t necessarily get on an unfamiliar unit.

Write your final practicum goals and discuss your progress toward meeting them. Please address all 3 goals.

1. Participate in rounds by acting as primary nurse

a. My preceptor never gave me the ability to act as the primary nurse based on the doctor that was
rounding at the time.

2. Be able to assess changes and determine the best way to implement strategies to avoid further damage
a. I think prior to my code, we knew to call a rapid response because something wasn’t right with our
patient.

3. Be more confident in advocating to the provider

a. I think that I am very confident in talking to the providers now. I called each one and advocated
for my patients each time.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.