Diana Mason's Editorial, "Don't Ever Let Go of the Thread" (October 2008) was timely, considering my recent deep reflections on nursing practice. My six-year-old son was hospitalized for eight days with an acute illness. As a mother and nurse (at the same hospital, but on a different unit), I was overwhelmed by my feelings about all providers' patient care practices and my beliefs in high-quality health care.

Mason's column discusses the need for self-reflection and the use of the clinical narrative. The impact of exemplar narratives is powerful. I learned to write clinical exemplars 15 years ago from Patricia Benner, a professor of nursing whom Mason mentioned, and thus felt compelled to write an exemplar of one particular nurse and her practice while caring for my son. Doing this was therapeutic and allowed me to meaningfully recognize this extraordinary nurse. I could have written a book-length exemplar about my son's hospitalization, and it would have revealed the significant variability in practices and several opportunities for improvements that I observed. Instead I wrote the exemplar about one outstanding nurse and addressed other care providers and department directors personally.

Many experienced and expert nurses may believe that my account of this nurse's care reflects standard nursing practice. Unfortunately, this experience taught me that it's not as standard as we would like to believe. This nurse's manager and director plan to use my written exemplar during orientation and training as a way of exemplifying the importance and meaningfulness of nursing practice.

Hildy Schell, MS, RN, CCNS, CCRN

San Francisco

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