For my Community Health Nursing’s clinical site I chose Lutheran Family Health Centers that coordinate health fairs, blood pressure and Body Mass Index screenings at the Salvation Army Corps in Sunset Park and Our Lady of Refuge Church in East Flatbush of Brooklyn. People in these communities are mostly hypertensive and non compliant with their medication regimen. As part of the health care team we put an effort to change their health behavior by providing teaching on signs, symptoms and risk factors of hypertension and diabetes, methods of controlling the symptoms, healthy food, activities and lifestyle choices. To achieve these goals we first tried to meet the following objectives:
Objective 1. Demonstrates individual professionalism through personal behaviors and appearance.
During the clinical I scheduled my time to arrive 10 to 15 minutes earlier of the scheduled time and was always among the first students at the site. The first few minutes of the first day at the site were a little confusing but after I sought guidance from Professor Gellar and Ms. Foresta, the Community Health Nurse representing Lutheran Family Health Center, I learned about what is expected from us and how the experience would affect our knowledge about community nursing. We were assigned to do blood pressure and BMI screening as well as teaching the community members how to prevent, control, and manage their weight and high blood pressure. When recording the BMI and blood pressure on the paper we folded the result section of the page for confidentiality purposes. Despite having limited time to do the screening (approximately 2.5 hours) we managed to check around 50 to 90 clients per site, which according to Ms. Foresta was a good number. During the clinical I tried my best to abide by nursing ethics, by always dressing professionally and maintaining patient’s confidentiality, especially when they refused to provide their personal information.
Objective 2. Employ analytical reasoning and critical thinking skills when providing care to individuals and families in a community setting.
Before we started our clinical at the site we had training on SBIRT (Screening Brief Intervention and Referral to Treatment) and, particularly, on motivational interviewing skills, which greatly affected implementation of my interviewing skills at the site. I was able to utilize some of the aspects of motivational interviewing as reflection and affirmation. These skills helped me get closer to my clients and learn more about their culture and values, health beliefs and health behavior. Based on this knowledge I planned and prioritized my care for a particular client. While four weeks of the clinical class was not enough to evaluate long term outcomes, the impact our teaching made on our clients was vivid. For instance, I had a relatively young client (48 years old), whose BP appeared to have been reduced over the course of one month. When I saw her the first time her BP was around 160/78 and by the last time it went down to 124/67. She mentioned that she had modified her diet and is now trying to walk more.
Objective 3. Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in a community setting.
Both of our clinical sites have diverse population and often times we had difficulty to communicate with our clients. In these situations I tried to engage a fellow student, other community member, or a volunteer to help me with translation and communication of the information to the client. Sometimes when no one was available to help I used visual charts to inform the patient about their blood pressure. I then used language appropriate booklet to record the BP results for the patient and handed it out along with other related material to the client. There were also situations when clients presented with very high blood pressure and did not want to follow my advice. In these situations I usually asked Professor Gellar and Ms. Foresta for assistance to convince the patient to take actions.
Objective 4. Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Although, a nutrition class was provided to the community members by a representative from Food Bank, only 25 members could participate at a time. This number does not cover even half of the population who comes to food pantry on Wednesdays to Our Lady of Refuge Church. Therefore, our group has decided to teach the volunteers who distribute the food items at the food pantry. We think this teaching will yield better outcomes since these volunteers are there in the church on the permanent basis, know the community well and potentially see the outcome of their teaching.
Objective 5. Utilize informational technology when maintaining individual and families in the community.
Unfortunately, the only technological devices we were able to use at the site were blood pressure monitors and our cell phones. We used our cell phones to calculate the BMI of the clients. It would have been nice if we had portable lab tops to enter the client’s information to a registry and analyze the consistency of his BP checkups and the fluctuations in his blood pressure. This would have given us opportunity to optimize the processing time, better maintain patient confidentiality, and more accurately evaluate the outcome of our intervention.  Nerveless, we used discretion to register patients’ BP results and did not insist on getting their personal information when they did not feel comfortable disclosing it to us.
Objective 6. Demonstrate a commitment to professional development.
Understanding community health nursing was much easier when clinical experience went along with lectures and readings through the chapters of the Community Health Nursing: An Alliance for Health by Holzemer, S., and Klainberg, M., B. (2014). I think this is an optimal method of providing a nursing student with an experience he or she would remember for a long time. Personally, I will remember the challenging areas of community nursing as to balance nutritional deficits and health outcomes in ethnically diverse and underserved population. These challenging moments impacted my nursing values and beliefs often times leaving me thinking what specifically I, as an individual, and we, as a group can do to minimize the disparity.
Objective 7. Incorporate professional standards and accountability into practice.
In my clinical practice being a nursing student or a working professional nurse I have always strived to use the American Nurse Association’s standards as guidelines: by maintaining my patients’ confidentiality, showing respect and compassion, delivering safe and competent care, seeking guidance in uncertain and complicated situations.
As per agency procedures, I did not disrupt the process of food distribution, did not take pictures of the patients and folded the screening sheet with the BP readings. I was fully aware of the agency’s mission to engage the community in healthier behavior by making them check their BP on regular basis, modify their diet and lifestyle, comply with their medication regimen, and raising their awareness about available and affordable to the community health programs.
Objective 8. Collaborate with clients, significant support persons and members of the health care team.
The mode of our clinical did not allow us contact, for instance, health care provider of our clients. We also were not able to engage other health care members. However, we did assess the overall health status of the community and its need for other health services as nutritionist, physiologist, endocrinologist, cardiologist, social services and many more. It would be nice to organize and conduct health fairs on primary topics of concern for this community preferably in Creole, Spanish and Russian on a regular basis. Additionally, the community will benefit from the services of travelling lab. On my part, I provided patients with information about available programs to address their health concerns. When possible I tried to engage family members in the care for the clients by teaching them about the disease, how to manage and control the symptoms.
Objective 9. Recognize the impact of economic, political, social, demographic forces that affect the delivery of health care services.
As mentioned in the previous objectives the communities at my clinical sites are greatly underserved. Many of the community members do not have health insurance and therefore, are deprived from the basic health services. Moreover, there is a great need of culturally competent nurses in the area. As a result of ineffective communication the population in most cases is not aware even of those services that are available to them. Therefore, in addition to the services discussed in previous objective the organizations that oversee and coordinate health programs at these sites should attract more culturally competent nurses to the sites.
 I am very satisfied with the experience I gained through the Community Health Nursing class. I had the opportunity to implement newly learned motivational interviewing skills, to explore the duties of community health nurse from within, to impact individuals’ health behavior, to test my personal characteristics within community health settings and many more. I am also pleased with the professionalism and courtesy of the instructors and grateful for the shared knowledge.
