It was a guidance counselor in high school who suggested I pursue a nursing degree. Shortly afterwards I made a final decision to obtain my associates degree in  nursing while trying to balance life as a young first time mom. Sixteen years later I have a  16 year old straight A student for a daughter and an ambitious ten year old son.

My ten years of bedside nursing and my 16 years of parenting has equipped me to be a well rounded women. As a seasoned nurse I am proud to say after ten years of bedside nursing I still approach every patient and circumstance  with enthusiasm and compassion. I still wake up everyday of my life ready to solve a problem give a helping hand or just be A shoulder to cry on.I am grateful for all the fortunes that have come my way and I have learned from all the mishaps I have had to endured.

Nursing is my passion which I am fortunate enough to make my career.

When I first began my nursing career I was so happy and relieved to have passed the license exam. My first thought was “Thank God I passed no more studying for me.” Ten years later in retrospect the notion that I was “done learning” was so far from the truth. The truth is being a nurse is a lifelong commitment to learning. Furthermore passing the NCLEX is recognized only as assuring minimal entry level competency. While years of experience is respected it is my personal opinion that certifications and obtaining higher levels of education hold the highest honor and respect.

A vast array of knowledge is a mandatory requirement for a great nurse to possess. Simply because of the nature of our profession, nurses play a significant role is hospitalizations, clinics and private practice. As the largest health care occupation our duties are not limited to just hands on patient care as I once thought.

Rooted with the commitment to helping people the nursing profession has evolved. Currently many branches of nursing exist. With the evolution of nursing as a profession the requirements for higher education and certification is necessary. Evidence based practice is driving health care today. In order for nurses of today to ensure a meaningful contribution to patient health and well being one must have a higher level of education and understanding.

The RNBS program has equipped me with the necessary knowledge and understanding i need to move forward in my nursing career.I have in fact sharpened my nursing skills utilizing pertinent information from my leadership , community, research, case management, urban and professional nursing coarse.

My leadership coarse  helped me understand that there is a difference between leadership and management and that great leaders facilitate management by inspiring and empowering their staff.

My community coarse allowed me to gain exposure to the out patient setting where the nurses roll and scope of practice is significantly  different  yet as important for the community. That is when I began to really understand the branches of nursing which exist. I have a new found respect for the outpatient clinic, now I understanding how important it is to be proactive by facilitating in the health and well being of the community prior to an acute exacerbation needing hospitalization.

Evidences base practice is directing the health care field.My research coarse equipped me  with the necessary knowledge I need to understand research, its importance to the health care field ,  decipher current research and perhaps be apart of future research.

Like  my community health coarse my case management  and urban coarse gave me insight of the other aspect of nursing which are very different  yet as important as bed side nursing. I was given the oppritunity to interact with a set of preschoolers from an underprivileged community during my clinical rotation for urban. Working with the young  child at school was a great experience, those children were so pleasant and full of life.

After ten year of bedside nursing obtaining a bachelor degree is one of my goals that I can now say is almost compete. My only regret is that i didn’t come back to school sooner. I truly enjoy interacting with fellow nurses out side the clinical setting and I appreciated my teacher for bestowing on my a wealth of knowledge.  I look forward to completing my bachelor degree and moving on to my masters.

Sample Cours work #1

Pro Nursing Angela Batista

Spring 2017 3/8/17
Wit Reflection Paper

 

The movie Wit is an excellent movie that shines light on a patients perspective of being hospitalized. I believe that the film was designed to evoke sympathy for Vivian the patient, with the use of extreme circumstances, which was a brilliant strategy.

Vivian was a highly-educated woman with no living family willing to endure intense treatment with the slim chance of staying alive. As I suffered with Vivian watching how the staff treated her and the deterioration of her health progressed, I couldn’t help but to come to terms with the fact that the staff’s inhuman behavior is in fact common practice. I have a vivid memory of “the grand rounds” when the doctors were around Vivian’s bed discussing her treatment and its effect on her in medical terms, examining her as if she was a “dummy”. (FYI my tears really came down.)

As a professor with a PHD, Vivian didn’t allow herself to become enraged with the staff. Vivian even identified within herself similar tendencies, in her own pursuit for greater knowledge and understanding. But human life is very valuable, it deserves respect dignity and appreciation. We are human being with complex brains living in a complicated world enduring an array of circumstances, unfortunately Vivian herself, having no partner, no children and no family, only fully understood this on her death bed. Humans on average possess five senses the sense of touch, taste, sight ,smell and hearing, all of them have to be taken into account at all times. Patients should not be viewed as bed numbers or medical records. They should always be viewed as human beings with at very least common sense, and if the common sense is lacking we, as health care providers, must be sensitive to that as well.

 

I recommend every healthcare professional take the time to view content like this movie Wit periodical during their career. It serves as a helpful reminder that true patient centered care can only be achieved if the patients is treated as a respected team member. Not a crash dummy.

 

 

 

 

 

 

 

 

Sample Course Work#2

Nutritional Challenges Among Urban Children: Combating Childhood Obesity

by Angela Batista

Introduction

Good nutrition is important for children. Children need adequate intake of key nutrients while their brains and bodies are developing. Healthy eating habits begin in these formative years. Unhealthy eating habits leads to childhood obesity.

What dose it mean to be obese? Adults with a BMI of 30% or higher are considered obese. Childhood obesity is a condition in which a child is significantly overweight for his or her age and height. Obesity essentially is too much body fat.

The impact of childhood obesity

Obesity is too common, very serious and extremely costly. Obese children tend to grow up and become obese adults and are at a risk of obesity related health complications that can be detrimental. Combating child hood obesity is essential for the health and well being for the children of today which will become the adults of tomorrow.

According to the CDC an estimated 112,000 excess deaths per year are associated with obesity. There are in fact more then 30 chronic health conditions associated with obesity, Type 2 Diabetes, high cholesterol, hypertension, heart disease and numerous cancers just to name a few.

Overweight and obesity in childhood is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit healthcare costs annually. An obese 10-year-old child who continues to gain weight throughout adulthood has lifetime medical costs that are $19,000 higher compared to a healthy-weight 10-year-old who maintains a normal weight throughout life.¹

Obese children become obese adults, who raise obese children, who become obese adults, it is a vicious cycle that wont end without intervention.

Challenges in tackling childhood obesity

12.7 million children and adolescents are consider obese in the U.S.A.. The prevalence of obesity was 9.8% among 2-5 year old’s compared with 17.5 % of 6-11 year old’s and the highest level of prevalence went to the adolescents at 20.5 % of 12-19 year olds.² Further more, from 1999 to 2014 national Health and nutrition Examination Survey revealed a steady increase trend in childhood obesity prevalance from 13.9 in 1999-2000 to 17.2 from 2013-2014 and a steady increase in adult obesity from 30.5 in 1999-2000 to 37.7 in 2013-2014. More then one third of adults were obese in the USA from 2011-2014.³

One of the challenges in tackling childhood obesity is access to affordable healthy food. Less nutritious, calorie-dense foods tend to be less expensive. More than 15 million U.S. children live in “food-insecure” households — having limited access to adequate food and nutrition due to cost, proximity and/or other resources.⁴ Low income individuals are at increased risk for both food insecurity and obesity.⁵ One study suggest your zip code matter more then your genetic code, experts in the field are saying urban design is making people obese.⁶ Foods with large shelf life and high profit margin are the most accessible in the low income urban neighborhood.

Food deserts are also prevalent in low income neighborhoods. Limited access to safe places to be physically active can contribute to building habits of a stagnant in active lifestyle, which can contribute to obesity.

Toxic stress occurs when children are exposed to repeated and ongoing traumas, such as physical, sexual or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, repeated exposure to violence in the home or in their neighborhood and/or the accumulated burden and stress of family economic hardship. More than half of U.S. public school students live in poverty, which can contribute to toxic stress as well as to obesity.⁷

The racial inequalities with regards to obesity is significant. Obesity is a major health problem for Black And Hispanic Americans.

Search of the Literature

Despite culturally sensitive obesity preventive interventions, obesity rates are increasing with in the African American adolescent population. This well documented known fact is supported with surveys conducted by the CDC In 2014 the CDC reported that the obesity rate among African American adolescents (20.2%) was second only to the rates of Hispanics youth (22.4%). Almost 9 percent of Black, 7.6 percent of Latino, 4.4 percent of White and 1.3 percent of Asian children are extremely obese (ages 2 to 19).³

Eliminating health inequalities could reduce medical expenditures by $54 billion to $61 billion per year, and recover $13 billion annually because of work missed due to illness and about $250 billion per year due to premature deaths, according to a study of data from 2003 to 2006.⁸

Youth ages 10 to 17 who have experienced two or more adverse family experiences have an 80 percent higher chance of obesity than children who do not experience such events, according to an analysis of the 2011–2012 National Survey of Children’s Health (NSCH).⁹

The prevalence of obesity among African American teens has been attributed to low level of physical activity and unhealthy eating habits. So exactly why are African American adolescent having an increased prevalence of obesity? One descriptive correlation study concluded that adolescents social economic status (SES), gender, and residential status were statistically significant predictors of eating behaviors, physical activity, BMI and body fat. Furthermore the studies revealed that adolescence with a low ses consumed foods higher in fat and calories than did adolescents of higher SES.¹⁰

Furthermore, there was a meta synthesis of a parental disconnect between perceived and actual weight status of children. Universally parents were more likely to misperceive their child’s weight and this was especially true for parents who themselves were overweight.¹¹

A cross-sectional sample of 576 parent-child dyads with children aging from 5 to 12 were involved in the study. A comparison of parent’s classification of their child’s weight was compared to the classification of their child’s weight status based on BMI age-gender percentile. The results revealed that all the parents of children with a BMI greater than or equal to the 95^th percentile classified their child in categories other than extremely overweight, and 75% of the children with BMI from 85^th to less than the 95^th percentile were misclassified as about right or underweight. The conclusion of the study revealed that most overweight children’s parents underestimate their children’s weight.¹²

In order to recognize that overweight children need treatment, parents must first identify their children are overweight or obese, understand their association of health risks, and have the ability to change their child’s weight status (Uzark, Becker, Dielmah, Rocehini, & Katoh, 1998).

Studies also show that motivational interviewing (MI) elicits internal motivation for behavior change while addressing the ambivalence and discrepancies between a person’s a current values and behaviors (e.g., “Heavy is healthy”) and their future goals (e.g., “I don’t want my child to get diabetes.”).¹³

Potential interventions

In recent year numerous efforts have been made to combat the growing global problem of obesity among children. One such intervention stemmed from the American Academy of pediatric saying primary care pediatricians need to take on a central role with trying to prevent childhood obesity.

The Steps to growing up healthy is a primary care based obesity prevention program that utilized a motivational interventions (MI) Frame work and selected behavior strategies to reduce obesogenic behavior in Latino and black children 2-4 years old. Community health workers (CHW) were utilized to bridged the gap between the clinical setting and the home.

MI using patient centered strategies such as open ended questions, positive affirmations and reflective listing was delivered in brief dose during regular well visits which only lasted a total of 20 minuets ,studies called this brief motivational counseling or (BMC). Key behavioral strategies incorporated into the BMC targeted reducing or eliminating sugar sweetened beverages consumption, changing the type or amount of milk consumed, decreasing screen time like tv watching to less then 2 hours a day, and increasing physical activity to at least 60 minuets per day. The CHW reinforced behavior strategies with regular phone calls and home visits.

The utilization of a program like the Step to growing up healthy have proven to be effective with the prevention of children becoming obese. In addition to being a proven primary prevention strategy The Steps to Growing up Healthy lends it self to a growing body of evidence and research needed to combat early childhood obesity before the children become an obese adults. The study was innovative in its focus on very young children, the use of routine clinic visits to address obesity management, and the testing of two different types of contact with CHWs in prevention/reversal of obesity.¹⁴

Non-profit organizations like the Boys and Girls Club is an excellent facility that serves underprivileged children for little to no cost. The Boys and Girls organization has an excellent program called Healthy Habits. This program is a publicly funded organization that is helping to combat childhood obesity.

Stakeholders

Engaging the entire community in obese prevention strategies is necessary to combat the growing epidemic of child hood obesity. Communities service sectors must collaboratively join the effort to combat child hood obesity. The key stake holder in the fight against childhood obesity would include parents, primary health care providers early education care schools like pre k program directores the WIC program and the parks department just to name a few.

It goes without saying that effective parent participation in childhood obesity would contribute significantly to the reduction of childhood obesity, decrease the likely hood of family turmoil related perhaps the lose of a child due to obesity and reduce the likelihood of toxic stress in the family due to the prevalence of a chronic condition associated with obesity like diabetes and respiratory illness.

As mentioned earlier Primary care provides have been called upon to take on a central role with trying to prevent childhood obesity. It is the duty of all healthcare providers to participate in the improvement of the health within the community in which he/she serves. A reduction of childhood obesity would mean a reduction in chronic complication requiring treatment in the acute care setting ultimately reduce the health insurance cost toward obesity, having the added benefit of contribute to making healthcare a more profitable business for health care providers.

Pre k programs would benefit from a well constructed obesity prevention program which they would be able to integrate and implement into the curriculum. The newly integrated pre k program would benefit from the recognition of being a program which benefit the health and well-being of the public with evidence based proven obesity reduction interventions and ultimately contributing to effectively combating a global epidemic like childhood obesity.

The WIC program has a special interest with regards childhood obesity, There program is designed to help the lower income mother and children and facilitate in the improvement of the health and well being of the public. The lower income mother and child have been identify as the same group of people who suffer the most with obesity. The wic program is a great government funded program which can facilitate in the battle against obesity in light of the fact that the population the wic serves is the same population that is at the highest risk of becoming obese.

Having safe sufficient useful recreational space is directly related to the reduction of a obesogenic environment. The parks department involvement in the creation, maintenance safety of the public recreational space is proven to be a vital component to the reduction of obesity with in then community.

The old cliche “It Takes a Village to Raise a Child” still stands strong and it couldn’t be more true in the fight agents childhood obesity. With the collaboration of parent health care workers schools and agencies like the parks department the epidemic of child hood can cant reach record lows.

Policy Recommendation

Policy change is a powerful tool to effect social change. The passage of one piece of legislation can achieve widespread, lasting results that can surpass individual efforts in communities across the country. Enacting new policies can also help institutionalize these changes so that they become permanent practice1.

A policy I would recommend be adapted nation wide would be for schools to make breakfast a part of the school day. “Breakfast after the bell” is one such program that has proven to work. In 2013 Colorado mandated the policy which required schools with 70 percent or more students eligible for free or reduced-price school lunch in 2015-2016 school year to serve breakfast in the class room, after first or second period, during an early recess, or from carts offering grad-and go- breakfast out side the cafeteria. Reports suggest that schools offering breakfast in the classroom can see their participation increase from 30% to 80%.¹⁵

Providing school age children with well balanced nutritional meals in a class room setting is one way to combat obesity. School age children siting in a structured environment supervised by teachers would increase the likely hood that the children would eat the healthier food choices provide by the school and get accustomed to eating food they wold have otherwise never tried to eat at home.

Another policy which would help to eliminate childhood obesity would be to incorporate BMI screenings in schools. Incorporating BMI screening in school would help reinforce the importance of addressing healthy weight outside of the clinical setting, it also lends its hand to early detection with perhaps some intervention like hand outs being sent home from school.

A band on junk food in schools would reduce the likely hood of creating a obesoginc environment for high risk children. A band on junk food with replacements of healthy food choices would increase the likely hood that children would consume unhealthy foods during the school day. Essentially the school day is a significant portion of a child’s life.

Conclusion

Childhood obesity is a growing global problem. Threw researcher evidence base practice and cooperation from the community at lager the epidemic of childhood obesity can be fought and won. Obese children tend to grow up and become obese adults and are at a risk of obesity related health complications that can be detrimental. Combating child hood obesity would mean that the children of today will become the healthy adults of tomorrow.

References

¹News & Media. (n.d.). Retrieved April 07, 2017, from https://corporate.dukehealth.org/content/over-lifetime-childhood-obesity-costs-19000-child

²Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Jama, 311(8), 806. doi:10.1001/jama.2014.732

³Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. (2015, October 28). Retrieved April 07, 2017, from https://www.cdc.gov/nchs/products/databriefs/db219.htm

⁴Key Statistics & Graphics. (n.d.). Retrieved April 07, 2017, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx

⁵http://frac.org/pdf/frac_brief_understanding_the_connections.pdf

⁶H. (2012, May 14). Does Zip Code Matter More Than Genetic Code? (HBO: The Weight of the Nation). Retrieved April 07, 2017, from https://www.youtube.com/watch?v=-8jNJsAeSFY

⁷http://www.southerneducation.org/getattachment/4ac62e27-5260-47a5-9d02-14896ec3a531/A-New-Majority-2015-Update-Low-Income-Students-Now.aspx

⁸Obesity and African Americans. In U.S. Department of Health and Human Services Office of Minority Health

⁹Mathew DB and Radel LF. Adverse family experiences among children in nonparental care, 2011-2012. National Health Statistics Reports, 74. 2014

¹⁰Tate, N. H., Dillaway, H. E., Yarandi, H. N., Jones, L. M., & Wilson, F. L. (2015). An Examination of Eating Behaviors, Physical Activity, and Obesity in African American Adolescents: Gender, Socioeconomic Status, and Residential Status Differences. Journal of Pediatric Health Care, 29(3), 243-254. doi:10.1016/j.pedhc.2014.11.005

¹¹Doolen, J., Alpert, P. T., & Miller, S. K. (2009). Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners, 21(3), 160-166. doi:10.1111/j.1745-7599.2008.00382.x

¹²De, A., Jordan, K. C., Ortiz, K., Moyer-Mileur, L. J., Stoddard, G., Friedrichs, M., . . . Mihalopoulos, N. L. (n.d.). Do parents accurately perceive their child’s weight status? Retrieved April 07, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/19559989

¹³DiLillo V, West DS: Motivational interviewing for weight loss. Psychiatr Clin North Am 2011, 34(4):861-869.

¹⁴Gorin, A. A., Wiley, J., Ohannessian, C. M., Hernandez, D., Grant, A., & Cloutier, M. M. (2014). Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health, 14(1). doi:10.1186/1471-2458-14-72

¹⁵USDA Program Helps Schools Feed More Students for Free. (n.d.). Retrieved April 07, 2017, from http://www.foodservicedirector.com/ideas-innovation/health-wellness/articles/usda-program-helps-schools-feed-more-students-free

Philosophy

To become a nurse mean that one has decided to undertake a profession in caring and assisting in the well being of mankind. The nursing profession is not for everyone, but those that chose this path wholeheartedly in life stand to reap the rewards of a profession that is both honorable and gratifying.

My mission is to implement what is necessary for the health,welfare ,maintenance,and protection of those in need, without prejudice, in a compassionate matter and in accordance with American nurses Associations standers of practice.

I believed that it is every nurses duty to keep up to date with his/her skills and knowledge. Healthcare as a whole is consistently evolving and nurses must be fully aware and informed of changes in order to provide the best care possible with precision and poise . Taking the time out to read journals, articles, and attending refresher coarse should be one of the nurses many priorities. To facilitate in a growth of knowledge, effective communication among interdisciplinary in a healthcare team is paramount as well. Engaging in conversation with a social work, a physical therapist, or a respiratory therapist with regards to their specialty ,as it pertains to perhaps your patient, can become an opportunity where a wealth of knowledge can be gained.

A patient centered approach to care is my model. I believe a patient must be involved in his or her care in order to attain the best results. This means educating patients and involving them in their plan of care and listening to their concerns. Understanding that each patient situation is specific to his her her own is key. Knowing that some patients are able to cooperate more then others. Being able to identify with patients weaknesses, and facilitating when necessary is important for the nurse/ patient relationship and their overall health.

Furthermore mutual respect for everyone on a team is essential. My model “team work makes the dream work” I believe that everyone should strive to establish and maintain a productive relationship with co-workers in order to optimize the work place environment for example, a doctors ,fellow nurses, nurses aids, clerks, house keeping and environmental. It has bin my experience that no job is to small or to big and when every one on the team is appreciated the “work” gets done well. To often individuals get caught up in job titles are not looking at the bigger picture.

Last but not least I believe that in order to have an abiding love for nursing a nurse must attain and achieve a healthy work/life balance. The utilization of good time management is key and it lends its self to an overall feeling of well being.

During my Fall 2016 semester at city tech I did my clinical rotation for community health nursing at Williamsburg Community Health Center. There were nine behavioral objectives which served as a guideline for my clinical progress. Below there is a brief summation of my clinical objectives and a description of how I was able to fulfill them.

Williamsburg community Health Center  is located at 279 Graham ave Brooklyn N.Y. 11211. Williamsburg Community Health Center is an outpatient extension of Woodhull Medical Center.
In 1967, Mayor John Lindsay and Governor Nelson Rockefeller envisioned a “dream “hospital for North Brooklyn to replace an obsolete public hospital located in green point. The cities financial crisis in the 1970s delayed the opening of the hospital until 1982. The hospitals name was the result of an essay contest held in a local school. The prize winning essays author traced the  original land owner of where the hospital now sits, of whom he identified as Richard M Woodhull. Mr. Woodhull was credited with having laid out the village of Williamsburg into an actual city. Today Woodhull Medical Center severs the residents of north Brooklyn, including Bushwick , Williamsburg, Green point Bedford Stuyvesant and fort green. As a member of the New York City Health and Hospitals Corporation Woodhull  treat all patients regardless of their ability to pay.

My clinical objectives were as follows:
Ojective1: Demonstrating individual professionalism through personal behaviors and appearances.

On my clinical rotation I made sure I arrived at the center on time for every clinical day in business casual attire. Fortunately Every Wednesday morning the staff conducted huddle, which was the day my partner and I went to the clinic. The lead the huddle and  I was able to hear all significant issues the clinic had and interact with the entire staff.After huddle we had the opportunity assist the nurses on duty with patient care,I demonstrated professionalism by maintaining patient confidentiality, making sure that doors were closed in examining rooms when patients were being examined, ensuring patient privacy was maintained. I never forgot to log off of computers after accessing patient EMR. I made sure I never spoke about patients conditions or concerns in public or in common areas. I demonstrated sensitivity to the client’s cultural, religious and linguistic differences.

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

While at Williamsburg community center I was able to engage with the pediatric population and assist while the nurse gave immunizations to the children. During interaction with mother and child I made curtain I employed analytical reasoning and critical thinking skills when communicating. I also assessed the impact of developmental, emotional, cultural and religious influence on babies’ current status. Prior to interacting with families I made sure I washed my hands. Although I was not able to do full body assessments on the children I was able to identify if children had met expected mild stones appropriate for age with regards to gross and fine motor skills. I was also able to interact with adults over the phone, I assisted the primary nurse with call backs of patient she deemed needed immediate attention. One particular patient missed her previous appointment and needed to come in as soon as posible for lab work . We were able to relay to patient the regency of the situation and booked her as a walk in. She came in that afternoon to get her hemoglobin A1C and all other labs that needed to be done before her next appointment with her primary M.D.

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.

I communicated well with the staff during huddles. I gave emotional support while listening effectively and respectfully to the patients concerns. I made sure I used simple terms that were easy to understand. I clearly and effectively communicated with my instructor, peers and others involved in patient care at the clinic.

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

At the clinic I established an environment favorable for learning making sure that the immediate area maintained a calm and relaxed atmosphere. I seized the opportunity of teaching patient about a healthy blood pressure and weight during the triage period, where the patient and I were in a private quit room. I assessed patient level of understanding of medication adherence proper dosing and side effect of there  medication by asking them simple questions and requested for the patient to return demonstration ,which they did.

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

The nurse at the clinic utilized the EMR (electronic medical records) quit frequently. Vital signs were logged via the EMR, immunization were logged via EMR. Labs were tracked by way of the EMR. Patient visits were tracked via EMR from admission to discharge from the clinic. I utilized the internet for my class presentation as well, looking up important information like demographic was much easier to obtain by way of the internet. Furthermore Communicating with my peers was facilitated with the internet.

Objective 6:Demonstrate a commitment to professional development.
I am currently a Register Nurse with ten years of acute care bed side experience and currently I am enrolled in this BSN program to nurture my professional development. Participating in the weekly huddles at the clinic was a great learning opportunity for me. I gained insight on  the administration duties, responsibilities and problems the clinic faced . Now I am able to identify and connect with other aspect of patient care .

Objective 7 : Incorporate professional nursing standards and accountability into practice.

In accordance with American Nurse Association I continuously make sure I adhere to the standards of my profession. Ensuring that I never over step my boundaries, while in clinical rotation, I would always refer to my clinical instructor or supervisor in charger before proceeding with any interaction with patient at the clinic. When teaching patient about there healthy blood pressure and medication side effect, I made sure the primary nurse was aware of my interaction with patient and that she approved of my interventions.

Objective8: collaborating with clients, significant support persons and members of the health care team.

During my clinical experience I was able to collaborate effectively with the staff at the clinic which was evident when we as a team were able to get a patient who had missed her previous appointment to come in that day and get her blood work done. Further more, While getting ready for our service learning group project, it was imperative that we as a group of nursing students understand the population for which we are teaching. Through research I gained a wealth of knowledge about the patients of Woodhull hospital. As a group we identified nutrition as a problem which needed to be addressed, and we decide to comprise a teaching plan for the patients at Woodhull hospital. Our teaching plan is full of important information that the community of Woodhull hospital both staff and patients can utilize for years to come.

Objective 9: Recognized the impact of economics, politic, social and demographics forces that affect the delivery of health care services.
I have long recognized the negative impact our health care system faces due to economics, politics and social demographics as it pertains to the acute care setting. During my clinical rotation in a community center I am now able to understand their issues and concerns as well. I was also able to make several  connections between the acute setting and the outpatient clinic. Understanding that our health care systems are in fact connected and impacted by each other is an important aspect to understand. Knowing how to effectively manage chronically ill patients in and out- patient setting with limited resource and minimal staff is a difficult challenge. More over trying to reduce chronically ill patients re-admissions into the hospital in a city with such a large population as New York also poses a set of challenges . The frustrations staff have when we have a E.R full of patient and not enough staff is an emotion I have long bin familiar with. Now I empathize with the staff of the community clinics as well. Knowing there is no easy solution is part of the battle. Willing to participate in the fight against an unhealthy New York is part of the battle as well. As a registered Nurse I’m willing and able to participate in the fight against an unhealthy New York. I will do my part however small or big.
I had a great clinical experience at Woodhull Community Center. Now I have a better understanding of how patients manage there conditions on a long term basis as an out patient. I believe  as a community health nurse creating  an environment where learning and compliance can be fostered is essential while trying to overcome the battles associated with being part of a net work that caters to the entire population regardless of their ability to pay for services rendered.This was the case at Williamsburg Community Center. I appreciated having had the  oppritunity to engage with the staff and patients at the center. The connection I have made with both staff peers and patients I will forever remember. As my knowledge in nursing grows so dose my love and respect for nursing, nurses and patients.