Service Learning Project Self Reflection

Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.

Our clinical site was at Community Access, an agency that runs transitional homes and permanent housing for underserved populations, such as those suffering from mental illness or youth who have aged out of foster care. This was an assignment with considerable autonomy, with two students at each residence.  After several weeks, it became apparent that the little amount I was able recall from a mental health course two years prior was not adequate for tangible progress to be made. Most of the residents frequently displayed disorganized thought processes rendering communication extremely difficult  I began refreshing myself on psychotic disorders, and reading articles on motivational interviewing, conducting group discussions, and synthetic marijuana usage, which clients were often observed using openly at one clinical site. I tried to be non-judgmental, to listen actively, to rephrase and ask for clarity when needed, and refrained from making overt suggestions or giving out advice.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

The service leaning project was intended to raise awareness of the health impacts of smoking and of the alternatives to smoking that are currently available on the market.  The main advantage of this project was that it was located in the client’s residences in an environment they are presumably comfortable in, and conducted by nursing students with whom they had established relationships. It was an opportunity for each participant to begin or to continue contemplating their readiness to reduce their tobacco use. Our focus was less on sharing knowledge, but a limited amount of information was imparted with a view of harm reduction.

Objective 3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting.

At the conclusion of this semester’s clinicals, I feel that I have made progress in building relationships with some residents.  Many residents frequently display disorganized thought processes or abuse substances, making sustained dialogues difficult to accomplish.  Changing behavior in clients who do not have psychiatric conditions is already a difficult task; I do not expect dramatic or rapid improvements in certain members of this population.  A realistic goal that has been met is the beginnings of establishing the trust needed in a therapeutic relationship, which is seen when clients greet us by name and increasingly stay with us to talk.

Objective 4:  Establish environment conducive to learning and use a plan for learnersbased on evidence-based practice.

The service learning project required a fair amount of research on how to conduct discussion groups: establishing rapport, introducing each participant, being transparent about the process by stating the purpose of each phase, asking permission to ask questions and before introducing new topics, building clients’ sense of self-efficacy by eliciting solutions and statements of past successes from clients, as opposed to suggesting answers. I had a good look at motivational interviewing and have tried to internalize its concepts of asking for permission before broaching topics, and asking for individuals to come up with their own ideas of what has worked for them in the past.

Objective 5:  Utilize informational technology when managing individual and families in the community.

We were given individual logins to the Community Access database to begin documenting client interactions, and met with the instructor after every clinical back at school so we could discuss our experiences in a private space.  Clients were not discussed in the clinical sites.

Objective 7.  Incorporate professional nursing standards and accountability into practice

At our first two clinicals, we were given a very thorough introduction by their director and the site coordinators about their agency’s mission, which is to assist clients with psychiatric conditions to transition from shelters and institutions into independent living. The site coordinators gave us an idea of what to expect during our weekly clinical. The residents are sometimes isolated and forming relationships can take time; this is why the clinical became a two-semester commitment. A less structured approach is often more effective, as some clients may have had negative experiences with healthcare workers in the past. Some clients have not sought healthcare in many years, and our goal as nursing students is to encourage such clients to take an interest in their health and effect some change, even if this process is long and the progress seems small.  Building trust was critical, and I hope I provided an accepting and interested presense, which may offer future opportunities for interaction.

Objective 8. Collaborate with clients, significant support persons and members of the health care team

Every week at the clinical site began with a briefing from the site coordinator, who would inform us of client incidences, hospitalizations or upcoming medical visits.  We followed up with a resident who had received stitches for a cut and reviewed his daily care routine.  The service coordinators often accompanied the clients to medical appointments, and most of the clients who were regulars in the common areas were relatively compliant with keeping appointments.

Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services

Most of the residents at Community Access are living on very limited incomes in a rapidly gentrifying area. I am not aware of long-term public supportive housing that exists for persons with psychiatric conditions, such as Housing Authority senior residences.  In a previous era, these residents may have been institutionalized and granted little input into how they lived. Deinstitutionalization returns individual rights, but can leave individuals who lack self-care skills without any support at all.  Family support appears to be limited for some due to their families’ limited financial resources. Many residents were raised in households below the poverty line and are experiencing the legacy of the difficulties that poverty entails, such as drug use.

The reintegration of individuals living with psychiatric disorders into the community is admirable, but work remains on how to implement this successfully.