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 had a patient who was admitted the night before who was a term baby. The baby was diagnosed with Down syndrome
and was having seizures. When the seizures were brought up to the mother she mentioned that she noticed the baby
would sort of spasm in her womb but didn’t think much of this. Unlike a majority of babies diagnosed with Down
syndrome this baby did not have any cardiac issues. The baby had almost virtually no lung expansion or exchange and was
put on CPAP.

Noticing
Upon doing an assessment, I noticed that this baby was the floppiest baby I had ever handled. He had absolutely no
muscle tone which made doing his care rather difficult due to the handling. His lungs had almost no lung sounds and the
baby had serious subcostal and substernal retractions.
This was my first time ever having a patient that had seizures. In school we really only learn about seizures that adults are
experiencing so I followed my nurse’s lead most of the time. The main differences I noticed between this newborn and
the adults we learn about was the movements as well as interventions performed. The newborn had a sort of backwards
circular arm stroke as his seizure rather than a whole body twitching. Also with adults you turn them on their side and
administer ativan or some benzodiazepine right after they stop seizing. With the newborn, we have to keep them in the
crib and we don’t have them supine but we don’t exactly turn them on their sides either. We tried to hold the baby’s arms
down but we were unable to. We took note and documented the length of the seizure and what signs the baby was
exhibiting but we mainly just observed so we were able to fully inform the doctor after the fact.

Interpreting
Describe the clinical judgment or clinical reasoning that you performed. The example should include alternatives you
considered, and rationale for your decision.
I mainly followed my nurse’s lead during this situation because I had never had experience with a seizing adult let alone a
baby. We followed up with the doctor and gave a full report. The doctor then prescribed Phenobarbital for the baby
which we started administering that afternoon and dosage was based upon the newborn’s weight. The doctor had
discussed us giving Ativan but due to the baby’s diminished lung capacity and expansion, the risks outweighed the
benefits and we went with the Phenobarbital.
Responding
What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.

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.
I have absolutely loved working one on one with a preceptor rather than with a group. I think the learning experience is
more tailored to the student’s needs and the preceptor is able to organize care based upon what you have done and what
you need to do next. For example during clinical a lot, my teachers would get what I had done confused with what
another student had done. Also I think it gives the student the ability to have the chance to practice a wide range of skills
that they necessarily wouldn’t be able to in a group setting. One major problem I had with clinical was the fact that skills
weren’t evenly distributed among students. For example I have never given insulin but some of my classmates gave it
every week. The immersion experience allows me to have the one on one discussion with my preceptor about what I want
to get out of the experience and what skills I want to obtain. I have loved immersion so far and even though the unit I am
on isn’t busy and is very repetitive, I do think the experience is helping me solidify my assessment skills.
Write your midpoint program outcome objectives and discuss you have met them. This section should address all 5
midpoint objectives.
 I will give a full end of shift report about a patient to the oncoming nurse by midpoint.
o I have given end of shift report in SBAR format about two patients to the oncoming nurse.
 I will successfully take care of a patient on room air or in an incubator by midpoint.
o I have taken care of patients on room air, in an incubator, and on CPAP as well.
 I will successfully start a peripheral IV by midpoint.
o I have not met this goal because there haven’t been any opportunities to perform an IV.
 I will safely administer oral medications by midpoint.
o I have safely administered oral and IV medications. I have given multivitamins and phenobarb to my
patients. I also have safely hung TPN.
 I will successfully hang IV fluids through peripheral access by midpoint.
o I have successfully hung TPN and lipids that were through an IV access.

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