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61 views2 pages

Reflection1 All

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Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion


Mid-Point Guide for Reflection

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 think the most challenging moment I have experienced recently is have a patient with status epilepticus. This
patient had suffered from a “non-incidental trauma” and recently has been suffering with seizures. The physicians
wanted a 24 hour EEG done and the patient had sutures down both sides of its head. Once the patient was hooked
up, it was not happy. The patient cried for hours and the patient did not want anything. Throughout the shift the
patient continued to have a couple of seizures only last from 6-9 minutes.

Noticing

This patient was very irritable, fussy, and cried nonstop. I think the most challenging part is not being able to
console this patient. My preceptor and I tried numerous of interventions to help relieve some of the discomfort but
nothing to work. I spoke with the physician on getting medications involved but the physician was worried that if
something was given it could mess up the EEG. I felt that the father was extremely frustrated and wanted something
to be done. Unfortunately, there was only so much we could do for this patient.

Interpreting

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

I was able to communicate to the physician on my concerns for the patient and express the frustration the father was
having. The physician allowed us to give a very small amount of Benadryl. This only offered a brief period of relief.
I grabbed “sweeties” and hoped that it would help. This also only offered a short period of relief. The four hours of
relief resulted from the two seizure medications.
Responding

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

It was challenging to find information that pertained to this patient. I feel that with the patient undergoing the EEG,
it really put a stop on certain interventions that could have been done. There were medications we wanted to give but
unfortunately if we did, it could mess with the results of the EEG. During the care we provided to the patient, we
still made sure that the patient was safe. According to Smith, McGinnis, Walleigh, and Abend (2016), it is important
to administer the appropriate anti-seizure medications. By making sure the patient is getting the appropriate dosing
and medication, this can help stabilize them. For this patient, if the seizure lasted longer than an hour, we would give
lorazepam. According to Smith, McGinnis, Walleigh, and Abend (2016), the article focused on management of
status epilepticus and if there was evidence on the preferred medications of either lorazepam or diazepam. In the
article there was not much support on the use preferential use and that with lorazepam, it was more likely the
patients would be sedated (Smith, McGinnis, Walleigh, & Abend, 2016). This patient’s seizures during my shift
only lasted for 6 and 9 minutes (the patient only had two during the shift). We were unable to determine if
lorazepam could have had more of a sedated effect on this patient.

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.

During my immersion experience, I feel that being one to one with a nurse throughout the shift really helps me learn
better. I feel that at times when there is a group of students it can be overwhelming. I feel that I am able to really
focus and ask questions with my preceptor instead of waiting on the instructor. Also, during my immersion
experience, I feel that there is more opportunity to work on different skills when there is only one student versus
multiple students wanting to try.

Smith, D., McGinnis, E., Walleigh, D., & Abend, N., (2016). Management of status epilepticus in children. Journal
Of Clinical Medicine, 5(4), P 47 (2016), (4), 47. doi:10.3390/jcm5040047

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

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