Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

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

Recently I had a patient who respiratory arrested on another unit and arrived on the CCU intubated. When my
preceptor and I took on this patient, we began searching through the chart to get a better understanding of the
situation. My preceptor guided me in interpreting the lab values and radiology results to help me see the big picture;
this patient was critically ill and might not ever be extubated. We had the same patient over the course of a week
together and my preceptor helped me to assess that this patient was declining, and the outcome was looking grim.

Noticing

The difficulty of this situation came from the fact that we noticed the wife did not seem to grasp just how sick her
husband was. She was thinking, as most people do, that the hospital would help him get better and heal and that he
would eventually be coming home with her. My preceptor and I noticed that the wife was very anxious about her
husband’s condition; she had many questions and concerns and would be very detailed about every hospitalization
or sickness he had in the past year. My preceptor noticed through the wife’s words and actions that she either was
not understanding the diagnosis or was in some sort of denial over how sick he really was.

Interpreting

My preceptor spoke to me about our next plan of action. From her experience, she suggested that we need to address
the critical aspect of this patient’s illness and the possibility of a terminal outcome with the wife. Although it would
be a difficult situation, it was one that needed to be taken care of, so the wife could make informed decisions and be
prepared for the worst if need be. Following this step, we would then consult palliative care and, depending on the
wife’s wishes, pastoral care. My preceptor explained to me that the earlier palliative care could be involved the
better.

Responding

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

After this particular experience, I wanted to look more into the role of palliative care in similar situations. I found a
journal article through an internet database search that researched the effect palliative care could have on patients
and their significant others. It found that involving palliative care in difficult diagnoses increased the amount of
hope a patient and their significant other had towards their malady. From this journal article I realized just how
multifaceted of an approach palliative care is; it focuses not only on improving the physical state of the patient but
the mental state as well. Aside from attending to the patient’s symptoms and pain, this discipline of care also focuses
on helping to manage stress. From this article I can see that involving palliative care enacts a more holistic approach
to improving a patient and their families quality of life.
Kylma, J., Duggleby, W., Cooper, D., & Molander, G. (2009). Hope in palliative care: an integrative
review. Palliative and Supportive Care,7(3), 365-377. doi:10.1017/S1478951509990307

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.

The biggest difference I have noticed working one-on-one with a preceptor is that they really start to have a grasp
for my strengths and areas of improvement. Now that my preceptor and I have worked together around 100 hours, I
believe that she has started to understand my learning style as well and tries to incorporate this to help me better
understand a new concept or skill. I think that in a group of students, it’s difficult for an instructor to really have a
thorough understanding of each student’s strengths, weaknesses, and learning styles. My immersion experience has
also allowed me to really transition into a role where I assume much more responsibility of my patients and has
increased my confidence and comfortability in my care.

Write your midpoint program outcome objectives and discuss you have met them. This section should address all 5
midpoint objectives.

1. Communication and Collaboration: To give a complete end of shift report to the oncoming nurse of one
patient by mid-point.

I have met this goal as of 9/14/18. My end of shift report is something that I would like to continually
improve and feel more comfortable doing. I still needed guidance from my preceptor during my report.

2. Caring and the Health Care Ministry: To educate one patient and/or their family on any procedures or new
medications in a reassuring and uncomplicated manner by mid-point.

I have met this goal as of 9/7/18. I provided a patient with discharge information and medication
reconciliation. We discussed her new medications, dosages, and proper times to take them.

3. Servant Leadership and Global Health: To respond to a difficult situation or emergency in a calm and
appropriate manner by midpoint.

I have met this goal as of 9/11/18. I responded to a Code Blue with my preceptor and participated in
compressions. I did my best to remain calm and helpful to this situation.

4. Safe, Quality, Evidence-based Practice: To recognize and report changes in patient status and critical results
using policies and procedures in place by midpoint.

I have met this goal as of 9/12/18. One of our patients that was intubated had a noticeable change in their
lung sounds between the start of shift and reassessment at noon. This was recognized with the help of the
respiratory therapist and reported to the physician.

5. Professionalism and Commitment to Lifelong Learning: To seek out at least 2 experiences to perform and
master a new skill by midpoint.

I have met this goal as of my midpoint (9/19/18). I have now become proficient in safely removing arterial
lines from a patient. I also believe that I have sought out many more than just 2 experiences to perform and
learn.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.