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Clinical Exemplar Jaymie McAllister, SNApril 24, 2014A clinical exemplar is a, “first person story written by a nurse that describes a specific clinical event or situation. Writing the exemplar allows the nurse to describe and illustrate his/her current clinical practice in a way that can be easily shared and discussed with professional colleagues” (Clinical Exemplars). This exemplar is being written to express my disappointment in seeing unethical behavior from a nurse within the clinical setting. During my clinical hours, I have not experienced very many incidents of what I would consider poor ethical or moral behavior from the nursing staff. Throughout all my semesters spent completing clinical hours, there is one particular incident that does come to mind that made me feel uncomfortable. I can't recall what type of unit I was working on at the time, but I was assisting my preceptor during medication rounds in the morning. One of the patients that we had was an older man who appeared to be homeless and according to the nurse, was a drug addict. It was clear to me at the time that he was going through the typical symptoms of withdrawal, but from what substance I am not sure. My nurse consistently talked badly about this patient, and even occasionally within earshot of other patients and in open areas where anyone could hear what she was saying. This in itself made me very uncomfortable, but the way she cared for this patient was even worse.Approaching this patient's room with medications, the nurse had to administer an intramuscular injection. At the time, I was unable to administer medications myself, so I was simply observing. Naturally, I had a lot of questions regarding needle size, injection sites, etc. When I asked my nurse what size needle she typically uses for IM injections, she stated that usually she uses a 22 -gauge needle, but since this patient was a drug addict she was going to use an 18 gauge. I asked her why she would use such a large needle and she simply replied that she doesn't want him to enjoy the needle going in like he usually would when he injects drugs, so she wanted it to hurt as much as possible. Even though I was relatively new to nursing, I was very appalled by this answer and this nurses logic. Before I judged her for this decision, I double-checked with my clinical leader and she said there was absolutely no literature to support that and in fact my nurse was making an unethical and very wrong judgment.Though I have not seen very many unethical actions from the nurses at this hospital, I have heard countless nurses be judgmental and unkind in regards to the large homeless population that the hospital encounters. This particular nurse took it upon herself to judge this person and practice unethical nursing skills in regards to his care. I believe that she violated the ethical principles of beneficence and nonmaleficence. Maybe she thought she was helping the patient by using such a large needle, but beneficence was violated because she was acting judgmental of the patient, especially for saying that she doesn't want him to enjoy the feeling of being injected, "like he usually would". Nonmaleficence was violated because the nurse is purposefully inflicting more harm than necessary on this patient. Regardless of his drug use history (which in his chart I recall there being no history of IV drug use, specifically), it is not appropriate for a nurse or healthcare provider to purposely harm a patient. Obviously, 18 gauge needles exist for a purpose and sometimes are used in practice, but if a medication can be given by a less painful, smaller needle, by all means I am going to use the less painful method, and more than likely any patient I asked would prefer the smaller needle as well.I sincerely hope I don't encounter any more incidences of unjust or unethical behavior by my fellow nurses. Now that I have some experience under my belt, however, I will be more inept to speak up and question what they are doing and proceed to care for my patients with compassion and respect. Everything is a learning experience, and this nurse has taught me what type of nurse I do not want to be.ReferenceClinical Exemplars. (n.d.).?. Retrieved April 24, 2014, from ................
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