My Clinical Evaluation
Anessa Madraymootoo
Introduction:
Throughout this semester’s clinical placement at the adult clinic at Woodhull Medical Center I have obtained some of the best experiences and exposure to healthcare provided in the community setting. At first I was unsure of what difference there would be in the approach to healthcare at the community level but on my first day of clinical I was in awe to see how integrated all the health care professionals worked to ensure optimal patient health care and goal achievement. Throughout this semester I was able to broaden my knowledge on nursing interventions as well as given the opportunity to put theory learned in nursing classes throughout the years in to practice. This clinical placement was an eye-opening experience that truly allowed me to grow professionally and also gave me to opportunity to realize my strengths and weaknesses and gave me a chance to work on each of them. The nurses and other healthcare professionals at this clinical site were all welcoming and ensure that I felt like I was part of the team by letting me sit in on care-plan meetings and even one of my favorite things, the diabetes educational sessions. Due to the exposure at the clinical sites I was able to effectively plan and compose a service learning project with my fellow classmates about healthy lifestyle choices a diabetic should be aware of as from our observation and research there is a high rate of diabetics in the community with many of them unaware of how to effectively manage blood glucose levels.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
During this semesters clinical placement at Woodhull Medical Center I have encountered a vast amount of diverse individuals. This has given me the opportunity to exercise professionalism with each encounter. Many believe the that it is the first impression that makes an imprint which is one the main reasons I strived to ensure that I was appropriately dressed in business attire with identification always visible. I always planned ahead especially when taking public transportation to ensure that I was on time since my buddy nurse expects me to be there. Throughout this clinical placement I was able to attend many nurse-patient education sessions where private information was disclosed and to comply with HIPAA I was aware that all information must not be discussed elsewhere to maintain client confidentiality. During this clinical placement I also was given the chance to learn a lot about community nursing as it is much different from inpatient care. Many times I found myself using my Skyscape phone application to review medications during patient education session as a refresher. My nurse buddy also offered educational opportunities by teaching my about different types of vaccinations and the course in which they are given to clients. All assignments were completed to my best ability and knowledge in a timely manner.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
During this clinical placement I was able to shadow a registered nurse while he was completing a client interview as well as when he reviewed previous nursing and medical records to complete a pre-visit checklist. During the client interview it was vital that cultural competency and awareness was exercised as individuals from various backgrounds attended the adult clinic. Telephone translators were always available and utilized during interviews and educational sessions to ensure the client fully understood what was being said as well as to ensure that they were given the opportunity to ask questions and received clarification. Many of the clients who were seen had the diagnosis of hypertension and diabetes; therefore a great number of the questions asked during these interviews were geared towards medication compliance as well as diet. For clients who were diabetic part of the physical assessment that was part of checklist to be completed was the condition of their feet and if the client understood the importance of a good foot care routine. Care plans were initiated and evaluated for clients who were returning for follow-up appointments, each of the interventions were prioritized based on the clients individualistic needs and was discussed in a way that the client understood. Some mediums that were utilized to ensure that the message was understood included, utilizing translators, pamphlets, checklists and picture charts for teaching blood glucose monitoring. As with many illnesses it is vital that a client understand the importance of compliance to decrease the chances of adverse or deadly outcomes, especially with diabetes that can cause a great amount of complications if not adequately controlled. Therefore the importance of timely and safe nursing interventions was highly practiced throughout my clinical setting. For the clients who were returning for follow up visits the nurse was then given the opportunity to evaluate the effectiveness of the initial care plan, together we assessed hemoglobin A1c level to obtain an idea of how well the client was able to control their blood sugar levels in the past few months. For many of the clients there were significant decreases in their overall hemoglobin A1c numbers. Some other activities that I was also able to perform at this site were taking the vital signs of clients upon arrival to the clinic. Hand hygiene and personal protective guidelines were followed before and after each client interaction. I was also given the opportunity to administer influenza vaccines to patients who consented and were educated on the risks and benefits of having the vaccine.
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.
During this semester’s clinical placement I was given the opportunity to engage with as well as be exposed to clients are various cultures, races, ethnicities, and religions. From each of these encounters I obtained more information about these individuals’ values, perspectives, practices in regards to health and well-being. Therapeutic communication is essential to achieve optimal patient goal outcomes. Factors such as the client’s primary language and education level can significantly impact communication. Throughout clinical my nurse buddy and I utilized translators primarily for Spanish speaking clients to ensure the effectiveness of the communication. Assessing the client’s educational status and cultural values and beliefs are also very important when communicating with different clients, as many cultural groups have preferences when it comes to communication. Some cultural groups would prefer that the healthcare provider directly speaks to the head of the household while other client may be willing to engage with the healthcare provider themselves. Such assessments are necessary to ensure compliance and ensure that the clients feel valued and respected. Other assessments that are necessary when communicating with clients would be to assess for any visual or hearing impairments which would create barriers to communication. If such barriers were found I client various adaptation should be taken to meet the needs of the client such as using larger fonts as well as to be sure the client has hearing aids or that the message is loud enough for the client to hear.
Not only is it important to effectively communicate with the presenting clients it is also essential to communicate clearly and effectively with peers, the clinical instructor and members of the healthcare team. Throughout the semester my classmates and I have been working hand in hand on our service learning project. Mediums through which we communicated and updated each other on our progress included meeting after clinical hours, texting, and emailing each other. Being that the service learning project yields one overall group grade, it was essential that we kept each other up to par, updated on deadlines and offer constructive feedback and assistance when needed. Throughout our clinical placement I also had the opportunity to speak to my professor about my progress in the course as well as receive feedback on my parts of the project. Documentation is a vital part of nursing as many insurance companies relies on documentation for reimbursements. During this clinical placement I was not given the opportunity to document interventions or end of visit reports, however, I did get to observe my nurse buddy documenting. From this observation I learned how to integrate both subjective and objective data to formulate a nurse’s note. Information that was included in such notes written included the client’s diagnosis, care plan changes, vitals, any complaints or concerns stated by the client as well as any treatments that were offered during the visit.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
One major component of this semester’s clinical placement was to establish and formulate a teaching/educational session for adults in the community setting. In order to effectively accomplish this I utilized assessment skills by observing what type of clients are in the community as well as utilizing online demographic to obtain information about the race, educational level as well as the primary language of those in the surrounding community. From this research I learned that the community is mostly composed of Hispanics therefore in order for the teaching plan to be effective it is essential that information handed out will be offered in Spanish as well as English. Also with collaboration with other member of my team and healthcare providers at the clinical site we were able to have a student translate our presentation with the help of one of the nurses at the geriatric clinic. Also, we tailored the informational session to run about ten to fifteen minutes long as client tends to become uninterested with longer presentations. Another factor incorporated into our presentation was a cultural component; I was able to attend a health fair where I obtained useful information about common Hispanic snack and meals that can be altered so the client can have better control over their blood glucose levels. After the informational session about healthy lifestyle choices and diabetic foot care, we plan to ask a few questions to see how many the clients who attended retained and obtained from the presentation. Pamphlets and other handouts about healthy lifestyle choices will be handed out to reinforce what was presented during the session.
Objective 5: Utilize informational technology when managing individual and families in the community.
At Woodhull Medical Center, most medical and private information about the clients were electronically kept. To ensure the all primate medical information was confidential the computer screens were always locked when away to be sure that any private information was not visible by anyone that was not directly involved in caring for the client. All paper assessment checklists, care plans and printed laboratory and radiology results were securely kept in cabinets and reveled to the clients as requested. Documents that were old, void and needed to be discarded were place in a bin with a lid that shreds the files as well prevents anyone without the key from picking up the shredded files. To comply with HIPAA no documents with client information including name, date of birth, phone number, diagnosis, treatments, medical record number were not to be carried home or discusses in public areas.
Objective 6: Demonstrate a commitment to professional development.
As nurse I understand that I have a lifelong responsibility to learn and adapt to new and improving evidence based practice in order to be competent. Throughout this semesters clinical placement I used a variety of resources and literature to further my knowledge and develop the teaching plan of care used for the service learning project. Sources of information included the American Diabetes Association, Healthy People 2020, Centers for Disease Control, as well as various nursing journals and articles in order to obtain information about the best practices used to combat diabetes as well as modifications that can be made by making better lifestyle choices. Community nursing is very different from nursing in an inpatient setting, in order to adequately interact and engage with clients in the community it was also a necessity that I researched cultural practices, values and beliefs of those in the community to understand their perspectives of what health and well-being is. One of the most important qualities that a nurse must possess is being culturally competent, aware and sensitive. When clients feel that their cultural values and beliefs are respected and not judged the more likely the client will be to instill trust and facilitate a therapeutic relationship. After each client encounter it is also very important to self-evaluate to assess what could have been done better or what needs improvement. I personally believe that no one is perfect and that there is always room for improvement and skill perfection. Receiving feedback from peers as well as clinical evaluation from clinical professors has geared my self-reflection and evaluation of my strengths and weaknesses in which I continuously strive to improve on a daily basis.
Objective 7: Incorporate professional nursing standards and accountability into practice
Throughout clinical placement standards established by the American Nurses Association regarding responsibilities and duties that need to be fulfilled as a nurse was practiced throughout. Nurses have specific duties and codes of ethics to follow such as seeking to protect the health and safety of clients as well as respecting clients and the boundaries of the patient nurse relationship. Professionalism was practiced throughout all clinical encounters; clients were greeted with respect by their last name. I also introduced myself as a nursing student so the client knows who I am. All established standards of the hospital were followed; evidence of influenza vaccine was handed in to human resources in order to obtain health clearance. Also, another rule of the hospital that was followed throughout my clinical placement at Woodhull medical center was that an ID badge is to be worn above the waistline at all times. One of the major goals of the Woodhull clinic is to serve optimal care to clients no matter their race, skin tone, ethnicity, culture or religion. I can proudly say that the patient care that I have observed during this clinical placement was one of the best. Clients were truly at center of each interaction and so much was done to ensure that clients were able to understand and achieve all health goals established. Nurses worked hand in hand with clients to ensure that they always had a supply of prescribed medications even if they do not have time to wait to see the doctor due to other obligations.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
During my clinical placement at Woodhull, I was able to attend a few diabetic education classes, in which about eight to ten clients were given the opportunity to learn about effective management techniques and healthy lifestyle choices. From these classes, my classmates and I were able to interact and communicate with members of the healthcare team at the hospital such as the dieticians and nurses to obtain a vast amount of information to share during our service learning project community presentation. I learned that many of the clients in the community had a knowledge deficit regarding how to effectively achieve optimal blood glucose levels as well as not aware of healthy lifestyle choices that can be made. From this assessment the goal of the community presentation was to raise awareness by education clients who attended on healthy lifestyle choices that can be made every day such as healthy alternatives to snacking, diabetic foot care and the importance of medication compliance. To ensure that the clients had enough information to make such changes, handouts that were obtained at a health fair was given out to those who attended in both Spanish and English. During my clinical placement I also got to observe my nurse buddy referring clients to other community agencies and medical specialties such as podiatry for those with diabetes as well as social services to receive coupons for nutritional supplement such as glucerna. It is very important that as nurses we guide clients to using all available resources in the community in order to achieve the best health and wellness outcome.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
One of the assignments during this semester was a windshield survey of the community in which a great amount of information was obtained about the economic, political and demographics of those individual living around the hospital. From this survey, online data, patient interactions and interviews as well as information gained from healthcare professionals at the clinic I was able to come to a realization that many clients in the community have hypertension and diabetes as their main diagnosis. However, the community lacks the availability to fresh food markets but has an abundance of fast food restaurants. Client seen in the clinics were sometimes unaware of what food choices they should make in order to adequately control their blood pressure and glucose levels. For these reasons, my fellow classmates and I chose to focus on educating clients on healthy lifestyle choices in clients with diabetes, as diabetes effects nearly every body system in the long run if not effectively managed. During the community presentation preparation, we attended health fairs and some of us had to chance to attend diabetic educational classes where we saw how to effectively interact with many different cultures and individuals so that what was being taught was understood and can therefore be applied in the everyday lives of these clients. Many of the clients enjoyed and appreciated information about how they can still eat their favorite cultural food but with moderation, rather than telling them that foods high in carbohydrates and fats should be avoided at all times. Many of the clients in the community were predominantly Spanish speaking individuals therefore it was essential to have a means to ensure that all information was also understood by them as well as those who spoke English. This was achieved in our community presentation by having handouts available in English and Spanish as well as having a bilingual classmate and nurse to serve as translators for information said as well as for questions that clients had.
Conclusion:
I was very fortunate to have this clinical experience. I was given the opportunity to engage with many health care professionals and clients which allowed me to obtain a lot of information about how to effectively communicate with clients of various cultures. This clinical experience was like no other and I will be forever thankful for the opportunity that I was given to engage in professional behavior and also expand my knowledge and experiences in clinical and patient intervention areas. The service learning project also served as a valuable educational opportunity to gain insight about the community and then gave me the chance to specifically tailor an educational session to serve that particular population. The experiences of this clinical setting will always serve as a stepping stone and a period of reflection in my professional career.
