Clinical Exemplar

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Running head: PATIENT ADVOCACY CLINICAL EXEMPLAR
Patient Advocacy Clinical Exemplar

Kellycha Santos
University of South Florida
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PATIENT ADVOCACY CLINICAL EXEMPLAR
Patient Control Clinical Exemplar
On the morning of March 1st, 2016 I walked into St. Josephs Hospital with a bitter sweet
feeling as this was my last day as a student nurse. During my preceptorship I learned many
things of which included developing autonomy and my critical thinking skills and also
advocating for my patients. Working on a medical surgical with patients of many cultural
backgrounds and health conditions enabled me to grow as a student nurse. For my clinical
exemplar I have chosen to write about a scenario that occurred during my first few days in
preceptorship and changed my views on how I advocated for my patients. According to
Thompson (2005), exemplars help to uncover knowledge embedded in clinical practice and
that nursing theory must be shaped by real-world experiences.
The patient was a 79 year old female that presented to the emergency department with
bronchitis and a urinary tract infection. The patient also showed signs of increasing confusion
which was said to be due to the untreated urinary tract infection. The plan of care was initiated
and the patient recovered significantly. Due to the patients condition improving the doctors
began to sign off on her case and she was set to be discharged. The patients son began to appeal
to Medicaid in order to keep his mother in the hospital because he felt like nothing was being
done for her; this situation was ongoing for a month. During my time caring for the patient the
patients son began to report different findings such as edema on the patients right inner labia,
and a bloody nose and swelling on her right leg. The patient was also found to have had no
bowel movement for six days despite reports from the son of her eating all her food and
receiving Relistor, Miralax, Colace and two enemas. The second day I cared for the patient she
seemed to appear lethargic and drowsy and did not respond to any questions.
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During day three of caring for the patient the son requested a Foley catheter to be inserted
because she was not urinating despite her diaper being wet frequently. The patients son then
mentioned to the night nurse that he was making plans to take his mother to a hotel. During the
following days the son did not want the patient care technicians to care for the patient because he
wanted to do it himself. The Department of Children and Families got involved due to fears of
abuse. The son was no longer allowed to stay in the room with his mother overnight and the
patient was discharged to an assistant living facility. In addition to this, the social worker from
the hospital also wanted to take the son to court to get the power of attorney transferred.
When my preceptor and I began to notice that there was something going on with the son
we knew that something needed to be done. In addition to the bronchitis and the urinary tract
infection the patient also had a history of dementia. With the patient having dementia it was
impossible for her to speak out against what was going on, she was defenseless. As nurses to this
patient we had to advocate for her and put a plan in to mention. Initially we decided to observe
the situation to make sure that we were correct that the son was in fact acting in ways that put his
mother in harm. The patients son grew increasingly aggressive and withdrawn and did not want
anybody to have contact with his mother. He wanted to give medications, change her and bathe
her. After we realized that something was going on we involved the charge nurse and the nurse
manager and decided to speak to the social worker. The social worker then involved the
Department of Children and Family and I believe that the necessary steps were taken to protect
this patient from harm.
Reflecting upon this experience I realize now that advocating for the patient is crucial. In
this particular scenario where the patient could not advocate for herself and the power of attorney
was not advocating in her favor, it is our responsibility as nurses to keep our patients from harm.
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I believe I made the correct steps in alerting other members of the healthcare team and the
patient was ultimately kept out of harms way. Continuing my career as a nurse I now fully
understand the importance of being your patients number one advocate because you are their
voice when they have none and they depend on you.
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References
Thompson, G.T. (2006). The concept of presencing in perioperative nursing. AORN. 82(3).
doi:10.1016/S0001-2092(06)60343-8

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Running head: PATIENT ADVOCACY CLINICAL EXEMPLAR

Patient Advocacy Clinical Exemplar

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