Question

Case Presentation

Jane King is a 22 year old female who has just begun her BSN nursing program. She is in her first clinical experience, and although she has been taught about giving bed baths, she is not sure that she is at all comfortable doing this. Her patient today is a 78-year-old male renal failure patient with limited mobility. Within her 8-hour assignment, Jane will need to complete all of her patient’s personal care.

Although Jane has cared for young children in baby-sitting jobs since she was 11 years old, she has no experience caring for adults. She is particularly concerned about perineal care. Yes, Jane has had instruction—but what about the actual experience of doing peri care? This is new to Jane, and she doesn’t know what to do.

Case Analysis

This is a time when the learning experience isn’t solely about Jane. As she tries on her new identity, she hasn’t had any of these experiences, and doesn’t know what to do. Because this is her first semester in her nursing program, she hasn’t had much time to ‘feel, think, and act” like a nurse professional. However, this patient is in a difficult situation in which he needs her care.

Compassion and engaged role modeling from Jane’s clinical instructor will help her take the next step in her own professional identity formation. As one takes on a new identity, there can be some sadness in “letting go” of the person’s previous perception of him- or herself. The clinical instructor needs to be aware that just as the student is constructing a new sense of professional identity in nursing, this often occurs in crisis (as in this situation), and often “deconstruction”—grieving the loss of the previous identity—occurs as the person takes on this new understanding of self. This example illustrates how such a situation reaches beyond role or job title. This student is experiencing a formative moment, and it is likely that she will be able to re-tell the story years from now. This is precisely why positive, insightful role modeling is needed by the clinical instructor. The student needs to see what the instructor does, how she treats the patient and the student, and what it means to provide professional nursing care in difficult situations. Furthermore, the instructor needs to ask the student to reflect on this experience within the next few days and discuss the student’s thoughts and reactions with the instructor. Role modeling, reflection, feedback, and encouragement are important strategies to help students as they incorporate additional identities into their own sense of professional identity.

1.What statements or non-verbal cues might Jane be communicating to indicate that this situation is about professional identity?

2.What are examples of instructor behavior and interaction with Jane and her patient that would be helpful in this situation?

Answer 1

ANSWER: THE STATEMENTS OR NON VERBAL CUES THAT INDICATE THAT THIS SITUATION IS ABOUT PROFESSIONAL IDENTITY:

• concern about perineal care
• she is new to BSN program and do not have time to think, feel and act like nurse
• sadness for letting go the previous identity
• no experience of adult care
• facial expression - fear, anxiety, sadness.
• low voice tone of jane may communicate her situation
• her workstyle behavior

ANSWER 2: EXAMPLES OF INSTRUCTOR BEHAVIOR AND INTERACTION THAT CAN BE HELPFUL IN THIS SITUATION:

• motivation: The instructor can motivate the jane in providing care to adult patient, she can also encourage her to achieve goals. She can set short term goals so that Jane will gain some strength.
• supervision: by providing continuous monitoring and supervision to Jane during her care to patient give confidence to her that she is performing care in correct way. Also instructor can do corrections of her.
• feedback: Instructor behavior to give feedback to Jane is also useful in this situation. This provide the security to a patient as well correct and encourage jane to get professional identity.
• role modeling: Instructor can give example and can show herself to Jane as role model so that she can prepare herself as her ideal, shape herself as good nurse.
• resource availability: Instructor can arrange resources for Jane that will be helpful for her to gain knowledge and strength. For example instructor can provide some guides or demonstration.
• sharing jane's thought and experience: Instructor by telling jane to share her concern, feelings, and anxiety and experience that she has faced in clinical can help to understand Jane more clearly and this could be beneficial for her further decision and for betterment of Jane.