Clinical Evaluation: Self Reflection
Introduction
           The clinical setting with which I was involved with was the Cumberland Diagnostic and Treatment Center in Brooklyn, New York. I was specifically involved with the obstetrics and gynecology (OB/GYN) department where I dealt with obstetrics, which “is the health profession or medical specialty that deals with pregnancy, childbirth, and postpartum period (including care of the newborn). The midwife and the obstetrician are the professionals in obstetrics” (Cunningham et al., 2014). Moreover, I also deal with various cases involving gynecology, which is “the branch of physiology and medicine that deals with the functions and diseases specific to women and girls, especially those affecting the reproductive system” (Emans & Laufer, 2012). This meant that I was in regular contact with pregnant women as well as with couples who were interested in family planning. This included those that wanted to go through fertility treatment, etc. The following is a self-reflection paper that relates my practical experience in this clinical setting with what I have learned in class during my didactic learning. I am going to use the Clinical Evaluation Tool and write about the correlation of my experiences in terms of the 9 clinical objectives.
OBJECTIVE 1: Demonstrates individual professionalism through personal behaviors and appearance.
           In the courses that we had studied, we were told about the idea of maintaining client confidentiality. This is something that is extremely important in the health care setting. This is because a person can have various different kinds of problems with their health that they might not want others to know. For instance, a person might have cancer and he would not want his or her children to find out so that they do not feel the stress of the illness. This is why client confidentiality is extremely important. This is something that I also found to be true in the clinical setting that I worked for, especially in cases of couples who were there for fertility treatment. Moreover, I also found that in the clinical setting, there was no teacher and no tests or exams. This meant that I had to learn about the various aspects of the job on my own. Furthermore, I was expected to complete all my designated jobs and work within a stipulated timeframe or deadline. Overall, I found that I had to act professionally in all capacities, such as dressing, talking to the clients and dealing with the managers. This was something that was different from the didactic learning, where it was much more informal. The experience was very informative and insightful, as it allowed me to learn about how to apply all my learning and knowledge in a practical environment.
OBJECTIVE 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community.
           Providing care to the clients, especially expecting mothers or other family members is not as easy as it might sound on paper. Different people would have different ways of dealing with their problems and it is important to understand the context of the problems as well as the background information of the clients before applying a particular type of intervention for them. For instance, it was extremely important for me to complete all physical tests of the clients before proceeding with their diagnosis. Various ailments or complications might have similar signs and symptoms, which is why I found that it was very important to rule out any other problems and to be sure of what is wrong with the person. This requires proper testing of blood and other measures to ensure that the patient is diagnosed with the right ailment instead of something else that is based on assumptions or improper analysis of the signs and symptoms. Moreover, it is extremely important to keep the patients’ safety as the paramount idea. Furthermore, it is also important to keep myself safe as well. For instance, many patients have to be injected with medication or their blood has to be drawn using needles. The patient might have some infectious disease that is passed on through the blood, which is why I found it extremely important to observe needle safety. This meant keeping the needles away from myself and to dispose of them properly so that I did not end up pricking myself or letting others prick on improperly discarded needles.
OBJECTIVE3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individual and families in the community setting.
It has to be noted that effective communication is extremely important in the health care setting. One of the things that can make communication quite difficult for people is the diversity of the clients. Patients and clients can come from many different ethnic, social and cultural backgrounds, which means that they would have different languages, customs, traditions, etc. This means that there would be a communication barrier between the nurses and the clients. This is why it is important for the health care professional to be able to communicate with a diverse group of people. I learned that more than knowing the language of the diverse groups, it is important to know how to talk to them. I learned that the most important thing is to treat everyone with a great respect and to never look down on anyone. Moreover, it is not only important to have effective communication with the clients, but also with the managers and other members of the organization. This is because working in health care is like working in any other organization and there are bound to be conflicts with the management. Effective communication means that such conflicts would be resolved so that the clients do not suffer. I learned that it was extremely important to be open and clear about one’s intentions and also to be assertive but not overtly aggressive. This allowed me to get my voice across and also minimize any conflict that I faced in the workplace.
OBJECTIVE4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
           One of the things that I realized while in a clinical setting was that what one has learned in the class is applicable to a certain extent; however, there are times when a person has to apply other forms of learning as well. For instance, research and technology in OB/GYN is being updated all the time. This means that there are always new tools, diagnostic techniques and various other new ways of improving upon the treatment options of the patients. Many patients tend to face various kinds of problems, which require solutions that are based on conclusions of studies that have been completed before, making evidence-based practice an extremely important part of dealing with patients. This means that patients’ problems are solved on the basis of how similar problems have been solved in other settings that have been properly documented. In this regard, I learned that different clients would have completely different problems; however, they can all be solved through using an evidence-based practice approach to problem solving. Other than that, it is also important to note that the family members of the clients tend to have many questions about the clients and their health status. It becomes an integral part of the job to talk to the family members all the time and to provide them with the necessary information related to the clients’ health and recovery. Other than that, the community at large also has to be educated about various things. For example, the health of the pregnant mother is extremely important and the clinic has initiated several ways for informing and educating the community about the dangers of unhealthy pregnancies, such as the mother being obese (Poston, Harthoorn & Beek, 2011).
OBJECTIVE5: Utilize informational technology when managing individual and families in the community.
           One of the most interesting aspects of working in the OB/GYN was how information technology is now being used to help patients. For instance, I learned that whenever a patient or client first comes to the clinic, a complete profile of the patient is created in the form of an electronic medical and health record. This is something that allows the different doctors to take one look at the patients’ records and know their whole history. For example, if a pregnant woman becomes a patient at the clinic, her complete history is converted into an electronic record. If that woman comes back the next time and she sees another doctor, the doctor would not have to ask the woman for all her history again, as that would all be present in the records. These records not only hold the patients’ medical history but also results of their previous tests, their vital statistics at the time of previous visit, any prescriptions or medication that they might be on, and any other relevant and important medical information that the doctors and nurses would be required to know. Many patients tend to be somewhat suspicious of these electronic medical records; however, they are assured that their privacy and confidentiality are strictly enforced. This is because the information system is layered with several types of security measures and they cannot be accessed by anyone who does not have the proper credentials for legal access.
OBJECTIVE6: Demonstrate a commitment to professional development
Professional development is something that every worker needs to go through to be successful in his or her career. This is because growth and development not only makes the person much better at the job, it also results in the person becoming much more receptive to his or her own strengths and weaknesses. During my time in the clinical setting, I felt that I was continuously evaluating myself in terms of my work. For instance, when I first started, I would compare myself with the work of the senior people working in the organization. I would feel that I was not as experienced as them and that I was still learning the ropes. This, I believe, is the right attitude to have. This is because if one does not evaluate the work that he or she is doing, the person would not be able to gauge what improvements are required. By engaging in self-evaluation, I was able to identify my strengths and weaknesses, which meant that I was able to enhance and improve upon my strengths and get rid of my weaknesses. Moreover, I felt that by being aware of my place in the organization, I was able to understand my role much better. This allowed me to adjust to the organization and also resulted in me better understanding how the health care facilities, especially the OB/GYN department in the clinic works. This not only helped me in gaining some good experience, it also allowed me to understand my own capacities as a health care professional.
OBJECTIVE7: Incorporate professional nursing standards and accountability into practice.
Following the code of ethics of nursing is something that is extremely important for all nurses. This is because if a nurse does not follow the proper protocols and is not able to stick to the code of ethics of ANA standards, there can be various legal ramifications for the nurse (Cleary et al., 2012). For instance, in my time spent in a clinical setting, I realized that nurses tend to face several different kinds of ethical dilemmas in their work. One of the biggest ethical dilemmas was in terms of advising the patients of fertility treatment. Couples of various different religions, such as Christianity, Judaism and Islam would come to the clinic and seek help with fertility issues. This meant that they would have their reservations about getting the clinic, as they felt that getting artificially inseminated, etc. would go against their religious beliefs. In this regard, it was extremely important for the nurses to remain completely impartial and not provide any kind of advise that might go against the religious beliefs of the couples. This put a lot of responsibility on the nurses, as they had to adhere to not only the strict ethical standards and code of ANA but also to that of the organization. The organization’s code of ethics was extremely strict in terms of dealing with the patients in particular manner. This included not soliciting the patients with any kind of wrongful advice. This is why I felt that I had to be extremely careful in talking to the clients so as not to indulge in any unethical behaviors.
OBJECTIVE8: Collaborate with clients, significant support persons and members of the health care team.
Working in the clinic, I felt that coordination between the various stakeholders was extremely important. This was because even though the main focus of the nurses were the clients who had to be taken care of, the nurses also had to communicate and coordinate their respective efforts with the other staff members as well as the upper management and the overall organization. This meant that the nurses had to be aware of the clients’ preferences as well as the rules of the organization. The important thing was that the nurses were able to balance between providing the client what he or she wanted without any conflict with the organization’s rules. In many cases, mostly with women who came to the hospital seeking fertility advice, it was common practice to refer them to third-party fertility clinics. This meant that it was an important job of the nurse to make the appropriate connections for the clients with other community agencies.
OBJECTIVE 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
One of the things that I was able to realize during my experience in the clinical setting was how there was a big gap between what one wants to do as a nurse and what is allowed by the organizations’ rules and regulations. For instance, considering the code of ethics, it is important to note that both the ANA code of ethics as well as the clinic’s code of ethics did not allow for the nurses to treat a patient without his or her consent. In many cases, there would be times when a patient would be brought who would not be in a position to provide informed consent and none of the immediate family would be available at once either. In such cases, the nurses would have to make certain choices. This, I felt, was a big gap in the system and it required some changes to be made into the system. Furthermore, I also felt that there were various gaps in the organization related to such issues as dispute resolution and conflict management. These were some of the areas in which I felt that the organization can greatly benefit from improvements. For instance, I felt that the organization would greatly benefit from having a much better dispute resolution system, whereby the nurses could input their grievances and the HR department would be able to mediate between the conflicting parties to solve the issue (Mackie & Mackie, 2013). Another gap that was quite visibly present was that there was disconnect between the upper management and the lower staff. This is because the lower staff felt alienated and did not feel as being part of the system, mostly because many of them had been hired on contract rather than having permanent status as employees. This is something that I believe could be improved in the organization, as having happier employees means that the organization would thrive.
Conclusion
I had a wonderful time in the clinical setting and I was able to learn so many things with my experience as a nurse in the OB/GYN department. One of the things that I came to realize during this whole experience was how much the didactic learning tends to differ from practical experience in real life. This is because even though we tend to learn about many things in the books, it is only through practical experience that one learns about the intricate details of being a part of an organization. This is especially true for health care, as it allows the nurses and other medical professionals to truly learn how to act and work in a practical environment.
References
Cleary, M., Horsfall, J., Jackson, D., & Hunt, G. E. (2012). Ethical conduct in nurse education:
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Cunningham, F., Leveno, K., Bloom, S., Spong, C. Y., & Dashe, J. (2014). Williams Obstetrics 24/E.
McGraw Hill Professional.
Emans, S. J., & Laufer, M. R. (2012). Emans, Laufer, Goldstein’s Pediatric and Adolescent Gynecology.
Lippincot Williams & Wilkins.
Mackie, K. J., & Mackie, K. (Eds.). (2013). A handbook of dispute resolution: ADR in action. Routledge.
Poston, L., Harthoorn, L. F., & Van der Beek, E. M. (2011). Obesity in pregnancy: implications for
the mother and lifelong health of the child. A consensus statement. Pediatric research, 69(2),
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