For this semester, I was enrolled in Community Health Nursing and completed my clinical rotations at Woodhull Hospital. Specifically, I was assigned at their off-site clinic Cumberland Diagnostic Treatment Center. Community Health Nursing focuses on public health issues and how to raise awareness of such issues. Throughout the semester, I completed the course’s objectives it was required of me which include the following:
Objective 1: Demonstrated individual professionalism through personal behaviors and appearance.
As a community health nurse, the most important thing to do is uphold a professional image. While a registered nurse should always maintain a professional image, it is more imperative that a community health nurse do so because he/she is a public figure of the organization. Throughout my clinical rotation, I obeyed the dress code required being a white dress shirt, blue/black slacks and comfortable work shoes. When interacting with clients, I greet them and ask permission to shadow the head nurse with assessments. I made sure to arrive the clinical site on time and have all due assignments prepared. During post conferences, I made sure to either actively participate in discussions or actively listen to my peers.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
At Cumberland Diagnostics Treatment Center, I was placed on the OB/GYN unit so most of the clients I interacted with were women of child bearing age or transitioning to menopause. I obtained client information by being present in the client-nurse interviews and reading electronic medical records. Because of this unique client group, every client is assessed for depression or risk of depression. They are given a questionnaire to fill out and if they score a ten or above, they are referred to a specialist for further evaluation. We ensured care was given at a timely manner and privacy was endorsed. A complete physical assessment is done for brand new clients visiting the clinic for the first time. At the beginning of each appointment, I observed the nurse asking the client the reason for the visit to know the client’s priorities. If the client is transferred from the nurse exam room to the physician’s office, the nurse ensures that the client see her before the end of each visit for continued education, summarization of the visit and verify follow up appointments.
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 Cumberland Diagnostics Treatment Center, they follow PCMH: Patient Care Medical Home. The providers want their patients to feel like at home when handling medical issues. This includes having the patient follow the same provider at every visit, unless it is an emergency and the provider is not there at the time. At the obstetrics clinic, the nurses communicate with the mother and social worker to have the infant enrolled in the adjacent pediatrics clinic. By following this philosophy, it encourages consistent care so the patient is familiar with the members involved. This helps build a meaningful relationship with the staff and patient. At the start of each clinical meeting, I observe the nursing staff on both OB/GYN and pediatrics conducting huddles to update everyone the daily census.
Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence based practice.
At the clinic, providing education to the patients is critical because we want to ensure the patients know how to care for themselves and prevent any unwanted events. We emphasize and encourage the all patients to attend their follow up appointments, perform monthly breast exams, and demonstrate proper breast exams, daily moderate exercise, and safe sex practices. The clinic has an abundance of pamphlets about various material such as information about different contraceptives, pregnancy fitness, and information about each trimester in pregnancy. At the end of each meeting, the nurse reinforces to the patient the next plan of action such as the date of next appointment or diagnostic tests that need to be done.
Objective 5: Utilize informational technology when managing individuals and families in the community.
All medical records are organized electronically through Woodhull’s EMAR and each nurse has a login/password. The nurse documents the notes in the patient’s chart and saved appropriately. When the nurse is transitioning between one patient to the next, the nurse ensures the note is completed before calling in the next patient. This promotes confidentiality of the patient’s records and reduce the chances of incorrect documentation.
Objective 6: Demonstrate a commitment to professional development.
Keeping up with current events about client care is necessary when educating the community. My nurse preceptor and I exchange current events about obstetrics care and how to reach out to low income families who may be reluctant to attending medical appointments. When we have client interactions, we ask each other whether we missed anything that the client needs to be aware about and review what was taught when documenting in the EMAR.
Objective 7: Incorporate professional nursing standards and accountability into practice.
As a registered nurse, I should be following the American Nurses Association Standards whether it be at work or in the clinical setting. I maintain respect with the patients and ask permission to sit in their interviews with my nurse preceptor. According the hospital policy, all staff and visitors must show proof of flu vaccination and wear it on their IDs. Cumberland also follows the same mission statement as Woodhull Hospital. The mission statement states:
The mission of Woodhull Medical and Mental Health Center is to provide comprehensive and compassionate health services of the highest quality to all those needing care in an atmosphere of dignity and respect. We strive to promote and ensure wellness, serving as advocates, innovators, and educators in partnership with the diverse communities we serve.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
I attend the morning huddles with both OB/GYN and pediatrics to update the census for the day and whether walk-ins are available. During interviews with the clients, I work with the preceptor nurse to see if there are any opportunities for education with the client. For example, if a client is present for a OB revisit and is not having her first baby, we would review certain aspects that the client is unsure of rather than repeating information she already knows. The nurse also ensures that the client has met with her social worker and nutritionist so her baby is insured and healthy for delivery.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
This semester was during the time of the inauguration of the new 45th President of the United States and the public has expressed issues regarding immigration status and the uncertainty of whether they themselves or their loved ones will be deported. The head nurse has noticed a trend that there are occasions when the clinic has been particularly quiet despite the prime time for clients to arrive for their appointments. A theory suggested was fear of attending medical appointments. Even though some clients have doubts of public health care facilities, the nurses and providers still strongly encourage their clients to continue attending their scheduled appointments. There are messages at the clinic emphasizing privacy of their records and counselors to reach out to discuss this fear.