Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Final Guide for Reflection
(Example MUST be different than that provided at mid-point)

Tanners (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 Tanners clinical
judgment model (see below).
Background
One of my patients had a heart attack at another facility and was transferred to my unit,
the Interventional Cardiac Unit (IVCU), for a heart catheterization. She had chronic back pain
and was prescribed several narcotics. In the hospital, the patients narcotics and anti-anxiety
medications were prescribed for specific times. These times were different from the times the
patient took them at home, which made the patient very anxious and not happy. The patient
would always ask for her pain medication and anxiety medicine right at the time she would
normally take it at home, which was multiple times throughout the day.
Noticing
Although my preceptor and the nurse practitioner that I was working with labeled the
patient as a drug seeker, I decided to get to know her story before labeling her. I could tell that
when the narcotics were wearing off that the patient had a physical addiction to the medication.
She would become very agitated and restless when it was almost time for her next dose. The
patient discussed with me that she felt as if she was on too many narcotics, and that she did not
understand why someone would prescribe her this much medication knowing that some of these
medications were addicting. She explained to me that she had unbearable back pain, and she saw
a pain management specialist who prescribed her all of the narcotics she was currently taking.
The patient told me that she was recently experiencing constipation from the opioids, and that
she wanted to find a way to stop taking so much medication.
Interpreting
Describe the clinical judgment or clinical reasoning that you performed. The example
should include alternatives you considered, and rationale for your decision.

I did not consider this patient to be a drug seeker. She expressed concern of being
prescribed so many different narcotics, and she stated that she would like to come off some of
these medications. She also was not happy with the side effects of these medications. Of course, I
did question whether or not she was a drug seeker at first because of her constantly reminding
me when her pain medication and anti-anxiety medications were due, but when I spent more time
with her I realized she was just afraid to be in pain. It also made me question whether or not this
patient was a drug seeker because the nurse practitioner and my preceptor came to that
conclusion.
Responding
What written evidence have you drawn upon for the care of your patient in this example?
Provide cites/references.
According to Meers and Alldredge (2014), there are certain behaviors that are considered
drug seeking behaviors. Unlike a patient who sincerely exhibits symptoms, drug seekers often
present with a cacophony of improbabilities-a constellation of behaviors and medical history that
is difficult to confirm or seems unlikely (Meers & Alldredge, 2014, p. 46). Other telling signs
include disappointment at the suggestion of non-pharmacological treatment (Meers &
Alldredge, 2014, p. 46). Having these different drug seeking behaviors in mind will help me to
differentiate between a patient who is seeking drugs and one who simply has chronic pain.
Reflection-on-Action and Clinical Learning
Socialization is best facilitated when the new nurse feels part of a group. How has this
precepted experience and working one-on-one with a dedicated preceptor helped you to
become socialized into the nursing profession?
The Interventional Cardiac Unit (IVCU) at Memorial Regional Medical Center really
made me feel like part of a team. In the morning while getting patients ready for heart
catheterizations, everyone works together to get all of the patients ready. One person will do the
admission assessment while the other nurses hook the patient up to the heart monitor, start an IV,
and shave the procedure site. My preceptor really has shown me the importance of working as a
team. There were several situations where different patients had vasovagal responses, and it was
imperative for the nurses to come together to help these patients. When a patient would have a
vasovagal response, one nurse would stay with the patient the entire time. Another nurse would
grab the Atropine and other drugs needed to increase the patients blood pressure, and another
nurse would give the patient a bolus of fluid. Without this teamwork, the patient would have
been in a critical situation for a lot longer. There would also be a nurse that would call the doctor
and inform them of what was going on. My preceptor always included me in these situations and
really made me feel part of the team, and she showed me the importance of team work.

References
Meers, G.W. & Alldredge, B.R. (2014). Learn to spot drug-seeking behavior. Review of
Optometry 151(2).
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.