This is my clinical narrative analysis for Community Health Nursing at King’s County Hospital. It gives a detailed description of my experience during clinical. It shows how I portrayed professionalism during my interaction with clients and the other health care team members. It also shows how I became an integral part of the institution.
Objective 1: I showed up to clinical every Wednesday before 8:30 am, dressed professionally. My school ID and also the ID that was created for me at Kings County Hospital both attached to my shirt pocket so that the staff and clients could know who I am. I ensured clients confidentiality by taking the clients to the corner of the room during our discussions. I also made sure that I did not discuss any information about the client to people who were not involved in their care. In other to prepare for clinical, I went to the internet to see what services were provided in the ambulatory center of King’s County hospital. I also reviewed my nursing textbooks on topics such as Hypertension, Diabetes Mellitus, Heart Disease and Pregnancy. I wanted to prepare for any question that the client might ask and also to teach with confidence. During clinical, if I did not know the side effects of a particular medication I would look it up on my phone or ask a staff nurse. I made sure that I asked permission before using the blood pressure machine or looking up client’s information on the computer.
Objective 2: I mostly spoke to the clients when obtaining information because I know how important the voice of the client is. I also observed facial expressions and body language and listened to the tone of their voices when they discussed the impact their illnesses have on their lives. If they did not remember all the medications that they were taking, then I asked both the clients and staff nurses permission to read the clients electronic medical records and I also ask the staff nurses to clarify any information that I was unsure of. I made sure that I asked questions on how they felt about their illness and their life thus far, their beliefs on health and religious beliefs, their nationality, customs and practices because I wanted to be respectful with how I approach these clients, teach and I also wanted to make them comfortable so that I could obtain information. This helped me with building a relationship with them and helped them with expressing their concerns and feelings. With the data obtained from my interview with the clients, I plan their care using the nursing processes and the client’s preference. Unfortunately, I gave medication to a client only once. It was a client with high blood sugar. Her sugar was 240 and I gave her novolog insulin according to the doctor’s order and the nurse permission. After teaching various clients about meal planning and physical activities, I reflected back on my teaching so that I can improve on it for the next client. I ensured that I covered the information that were important to the client’s regimen especially medications so they could have a better understanding as to why they were taking it. Physical assessment for my hypertensive clients include monitoring height, weight and blood pressure. I compared these data with that on their electronic health record to track their progress in managing Hypertension.
Objective 3: Through my experience, I was an active listener. I wanted to make sure that the clients knew I was present. Certain times I had to repeat what the client said for clarity. After teaching I made sure that I asked if they had any questions or concerns. There was one occasion when I went into the doctor’s office with a client and I had to tell her that hypoglycemia means low blood sugar. I know that understanding information given is one way of preventing noncompliance so I had to use the lay man term for hypoglycemia.
Objective 4: Teaching for the clients were done in the corner of the room, in the doctor’s office before he came or after blood pressure monitoring in the cubicle when it was me and the client present. I used handouts for meal planning and physical activities to help with my teaching and recommended websites that clients can use to gain more information about their illness such as the cdc.gov and nih.gov. I allowed clients to choose food for the meal planning and guided them when they need assistance.
Objective 5: The computer as well as my phone were good informational technology sources. I access the computer with the permission of the staff nurse and the client when I needed to know more information about their health history. I made sure that I told the nurse that I was done with the computer so that she could log off. I used my phone to see the purpose, interactions and side effects of the medications that were given to the clients.
Objective 6: I used the CDC.gov website in order to gain information about physical activities and the DASH diet used for the treatment of hypertension. I brought some handouts on the DASH diet with me to clinical. I was able to help one client with the meal planning using these handouts. I also recommended some physical activities that she could to help with the management of Hypertension. I looked up information on the Indian Health Service website to see how I could create a plan of care for an American Indian client. I learned that there is a high disparity of Heart Disease in this population and I wanted to test myself on how to plan care for a client in this ethnic group. I know that East Flatbush have a small percentage of this ethnicity. I also read about the Special Diabetes Program which is an effective evidence base strategy to decrease Diabetes in American Indians. These strategies can also be used in other ethnicities. This Community Health clinical experience has made me gain more respect for Community health Nurse. At this point I am still focus on becoming a Geriatric nurse but Community Health Nursing is also a possibility in my future because combating chronic diseases in the community might help reduce its prevalence in the older adults. At the end of every clinical, I reflect back on my interaction with the clients so that I can improve on my teaching and implementation strategies. I understand that community health nurses are responsible for judgment calls so I researched different websites to learn about the management of chronic disease, learn about clients’ culture and involve their suggestion so I could specify the plan of care.
Objective 7: I maintained clients’ confidentiality at all times and made sure that I encourage autonomy into their plan of care. I encourage clients to read the patient bill of rights and explained any concept that was unclear to them. I made sure that I informed the nurse about any variances in the client’s health and offered assistance when they needed help with blood pressure monitoring or blood sugar monitoring.
Objective 8: I used clients as a main source of obtaining information about their health. When they were not able to remember a medication used in their treatment regimen, I then asked a family member if one was present or the nurse. I did a more in-depth teaching for clients depending on their reason for non-compliance. For example, a client needed more help in planning physical activity so I used a handout from CDC.gov website to help her plan activities for the whole week. Some clients work part time jobs but did not have insurance so I took them to the different insurance personnel located on the first floor of the ambulatory care center at King’s county Hospital.
Objective 9: Some clients who had insurance before decided not to sign up for insurance because they were not able to pay for the monthly premiums. I helped these clients by stressing on healthy food choices that are available in fast food restaurants such as salad and grilled chicken and substituting water for soda drinks. Some clients claimed that they don’t always understand what the doctor says so I ensured that I used lay man terms to explain medication regimen and side effects. I had one client who came to the clinic for the first time, the nurse told her to go to the first floor so that she could get information on how to get a blue clinic card. The client looked confused so I went with her to the first floor, and directed her on exactly where to go to obtain that information.
