Abelardo Rodriguez, Jr.
As a community nursing student of New York City College of Technology, this course (NUR 4010) has shown me how critical the role nurses play not only in the hospital but in the community as well. It has been a privilege to observe and participate in the learning experience at the Stein Senior Center. This Self-Reflection Narrative will show how I fulfilled the nine Community Health Nursing Objectives of our clinical course (Summer ’14).
OBJECTIVE #1: DEMONSTRATES INDIVIDUAL PROFESSIONALISM THROUGH PERSONAL BEHAVIORS AND APPEARANCE
During our time at the Stein Senior Center, I was expected to act as nursing professionals by the staff, seniors, and our professors. The expectation was that I comply with the required dress code i.e. no shorts, shirts, jeans, and sneakers, only casual wear and fulfilling the duties expected, such as assessing, (therapeutic) communication, and teaching the attendees of the center. In preparing for my clinical learning, prior to the clinical I would go over our clinical objectives for the following morning and I would read the assigned chapters the night before the clinical and apply our theory based learning with the clinical experience. Since we begin our day at 9:00 AM, I always try to come in 30 minutes early to have time to prepare myself both physically and mentally. As we begin our pre-conference, we; the City Tech nurses, usually share our previous experience and reflect on our actions. It is also a perfect time to clarify any concerns or questions we may have for the professor.
OBJECTIVE #2: EMPLOY ANALYTICAL REASONING AND CRITICAL THINKING SKILLS WHEN PROVIDING CARE TO INDIVIDUALS IN THE COMMUNITY SETTING
Upon interacting with the seniors, and after establishing rapport and a trusting relationship with them it was easier to obtain information about their health and any issues or concerns they may have. The Stein Senior Center is a well, drop-in center; it is not an acute or long-term care center. So, although I was not able to administer medications, during our blood pressure screening sessions I was able to conduct medication teachings and help clarify and address some of the seniors’ health concerns (i.e. how to use a glucometer, what is the difference between a beta-blocker and calcium channel blocker). One client in particular had asked me if I could show her how to take her blood glucose level. As I explained to her the following steps, I had her do a return demonstration to evaluate if she fully understood my explanation. In my evaluation she showed a full understanding of the steps in taking her blood glucose level. Another client that came to mind; who belonged in the same ethnicity as me sought my advice in maintaining her Diabetes and Hypertension. Since I have a full comprehension of the culture, I am well aware of the practices, specially the diet. In our culture our diet mostly consists of rice (carbohydrates) and fried foods, increasing our risk for heart disease and diabetes. In my teaching I helped her develop a diet plan with portion control on rice and other carbohydrate containing food, also to limit fried, salted, and high cholesterol foods. I also showed her an example of the DASH Diet. At the end of the teaching, I had the client address what are some foods acceptable for the DASH diet and other foods to avoid that may worsen her diabetes and hypertension.
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
As I communicated with the elderly, I maintained a professional demeanor while respecting a nurse-client relationship. Throughout our conversation I implemented my therapeutic communication skills by using open-ended questions in order to obtain the necessary information to address the issues at hand. While communicating with the elderly, I used a clear and simple language and proper body language; i.e. eye level with the client, proper body posture, maintaining eye contact, and uncrossed legs or arms. Also, while helping out at lunch, which was a very appreciated event, I interacted with hundreds of seniors, easing the process of setting up a pleasant meal time session. I used restating, gesturing, silence, and body language (such as a smile) to communicate effectively and efficiently.
OBJECTIVE #4: ESTABLISH ENVIRONMENT CONDUCIVE TO LEARNING AND USE A PLAN FOR LEARNERS BASED ON EVIDENCE BASED PRACTICE.
The Stein Senior Center provided an environment conducive to learning in a sense that it was clean, well lit, and quiet and had many different rooms to conduct different activities. As aforementioned in the previous objectives, I helped developed a diet plan for an elderly lady whose culture is the same as mine. We determined to limit her consumption of high cholesterol, salt, fried and carbohydrate foods. Apart from my teachings and the other nurses, the Stein Senior Center also provides other informative lectures from different aspects of healthcare such as dieticians, an insurance company employee, and there was also a teaching conducted by the fire department on emergency preparedness and what to have in case of emergency. In evaluating if our teachings were effective, my colleagues and I developed a pre-test and post-test to determine if the seniors comprehended the material we presented to them. The results of the seniors’ test were quite positive.
OBJECTIVE #5: UTILIZE INFORMATIONAL TECHNOLOGY WHEN MANAGING INDIVIDUAL AND FAMILIES IN THE COMMUNITY
During this course we were required to present a service learning project concerning two relevant subjects for the population. Those subjects were fall prevention, and hearing and vision. To obtain information we conducted internet researches, and used our previous textbooks (i.e. Medical/Surgical Nursing) on the topics, providing the causes, risk factors, prevention, and intervention. The senior center also provided their members access to internet computers for the elderly to use and do their own research with the topics they’re interested in (as per the deputy director- the seniors do like to keep up with new technology). As per the course’s requirement we were required to type blogs every week and post it up on the blog section of our CUNY Black Board account.
OBJECTIVE #6: DEMONSTRATE A COMMITMENT TO PROFESSIONAL DEVELOPMENT
As a student and a professional, I demonstrated commitment to my professional development by continuing my nursing education in a higher degree or level of practice. I based my decisions and interventions solely on evidence based nursing practice and reflecting on my actions and its rationale. I accepted every challenge that came my way throughout this endeavor of seeking knowledge. I continued to use and hone my critical thinking skills to provide safe and effective care, and also to find solutions to difficult problems, if and when those problems came up.
OBJECTIVE #7: INCORPORATE PROFESSIONAL NURSING STANDARDS AND ACCOUNTABILITY INTO PRACTICE
I incorporated professional nursing standards and accountability into practice by abiding by the centers standards, policies and procedures. Also by maintaining confidentiality as per HIPPA’s rules; i.e. during blood pressure screening I privatized our session and kept the names of our clients private. I also provided assessment and teaching as per a registered nurses’ scope of practice.
OBJECTIVE #8: COLLABORATE WITH CLIENTS, SIGNIFICANT SUPPORT PERSONS, AND MEMBERS OF HEALTH CARE TEAM.
At the senior center, I collaborated with the deputy director, his staff, my professor, my colleagues, and the clients for the delivery of their care. With our service learning project teaching we were able to address and find solutions in preventing falls, information on screening for vision and hearing and help them find facilities around the neighborhood offers the resources the members need. Our teaching helped the members by guiding them to modify some of their lifestyle choices i.e. eating healthier, participating in exercises or other recreational activities, and screening for early prevention.
OBJECTIVE #9: RECOGNIZE THE IMPACT OF ECONOMIC, POLITICAL, SOCIAL, AND DEMOGRAPHIC FORCES THAT AFFECT THE DELIVERY OF HEALTH CARE SERVICES
Upon creating a relationship with the Stein Senior Center members, I have observed that most of the members were economically challenged and living in a neighborhood that has a high cost of living, including for such necessities as rent and groceries. Although the center provides meals for their members for only a $2.00 donation, the meals were only serving during lunch. In this case, I referred the members who had a very low source of income (mostly from retirement benefits) to a social worker and informed them about programs such as the SNAP (Supplemental Nutritious Assistance Program- the social worker may also help referring them to these resources) to help them afford quality and healthy foods around their area. Other programs that may help the seniors pay for their medications should also be considered. Another problem in the neighborhood is the crime rates, where people even the elderly, are subjected to crimes such as robberies. For the victims, help can be attained by the CRIME VICTIM SERVICES run by Ms. Teresa Navaro whose office resides within the Stein Senior Center. I would also suggest an increase in police officers presence in the area.
Overall, the experience at the Stein Center was an eye opening one. It showed me how important these types of center are for the neighborhood. It helped me gain more insight into the nursing profession and how to become a more effective client advocate. This course has taught me how to work with very few resources and how to obtain others without any or extra cost to my clients. It has shown me how to use the system and the public services of my state in order to help those who are in my care. This also confirmed my belief that community nurses are one of the first lines of defenses in the neighborhood for health prevention.