Introduction:
Attending nursing school has provided me with various different opportunities and has taught me an abundance of skills that has shaped my practice as a nurse.   With each clinical session, I have taken advantage of observing the skills practiced by nurses within each facility. My experience thus far at Woodhull Medical Center has taught me various different components that differ from my initial experiences within the hospital setting. Healthcare is transitioning from the acute care setting towards healthcare on a continuum. The continuity of care focuses on preventative care within the community. The clinical experience I had at the adult medical clinic at Woodhull Medical Center has provided me with the skills to excel and become more integrated in this new model of health care. I have had the opportunity to work with clients of different cultural backgrounds to create plans of care, observe how the interdisciplinary team of health care professionals collaborates to provide an effective care plan that is tailored to meet the clients need. It is very enlightening to see clients come back and provide feedback to healthcare team about what worked and what could be adjusted. I was also able to utilize the resources from health fairs to develop an education session for diabetic clients that educates and encourages them about how to make healthier lifestyle choices, and control their blood glucose levels. After this exception clinical experience I have developed cultural competency to accommodate to the needs of the diverse population of clients and tailor a care plan using a team approach to meet their needs.
Objective One: Demonstrates individual professionalism through personal behaviors and appearance.
During my clinical thus far at Woodhull Medical Center I have been given the opportunity to interact with individuals of various different cultural groups that differ from my own. From these experiences, I have learned how to expand my cultural competence and understand the cultural values and norms of individuals from different ethnic groups. When attending clinical, I always dress professionally and keep my ID visible therefore clients can identify me as a student rather than a strange person in the room with the nurse. I always introduce myself by stating my name, that I am a student and verbalize that I will just be observing. Every Wednesday the staff nurses at the medical clinic at Woodhull, there is a meeting to acknowledge the daily objectives, concerns, new protocols, etc. I always leave early to ensure that I have enough time to attend these meetings and observe how professional nurses collaborate to solve problems within the clinic. While at this clinical I have learned a vast amount about patient teaching and how to utilize different tools to accommodate to the educational needs of clients of different cultural backgrounds.
Objective Two: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
 Throughout my experience at the adult clinic at Woodhull Medical Center I worked alongside the staff nurse on shift as she provided care to clients. Before the nurse called the patient into the room we discussed some information or background about the client if the client has attended the clinic before. Upon assessing the client, I paid close attention to the client’s cultural values and how their beliefs impacted their health. This was very important when preforming an assessment of a new client to grasp a better understanding of the client’s views on health and wellbeing. When new clients came to the clinic I assisted the staff nurse to obtain baseline vital signs. I always began my introducing myself, letting the client know I was a student and ask the client for permission to obtain vital signs. Next, I performed hand hygiene, donned a clean pair of gloves and proceeded to obtain vital signs if permission was granted then performed hand hygiene upon completion. After the client has exited the room, the nurse gave me feedback and provided information regarding what she was documenting and we would discuss our findings of the client interview and assessment and things we could have done better to enhance the client’s experience and accommodate to their needs. Discussing the assessment and interview was very insightful to me because I was able to identify details that I may have missed upon the assessment or interview. This opportunity also allowed me to gain perspective of what a thorough client assessment consists of. If the client has been to the clinic before, the nurse and I would look through the client’s records to determine if the client was a possible candidate to receive the influenza vaccine before it was offered. When the client came in for a vaccination I was allowed to administer vaccinations and educate the client under the observation of the staff nurse. Prior to administering the influenza vaccination, I asked the clients a variety of questions including if they had the vaccine in the past year and if they wanted it, as well as if they were comfortable with a student nurse administering the vaccination. If permission was granted, I asked the client which arm they preferred assembled my materials and performed hand hygiene and put on a clean pair of gloves. Before beginning I explained the side effects and under which circumstances they should seek care from the Emergency department.
Objective Three: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting.
My experience at the adult medicine clinic has enhanced my ability to communicate with members of cultural backgrounds that I was not familiar with. The adult medical clinic serves a large population of Hispanic clients. Therefore, it was important for me to familiarize myself with their cultural values as well as the differences that associated between generations. I observed during clinic that Hispanics value strong familial connections and favor including their family in their healthcare decisions. I always introduced myself to the client and their families and tried to grasp an understanding of their cultural values and beliefs throughout the first few minutes of the interview by utilizing therapeutic communication. One important tip I learned from the staff nurse is paying attention to how the client’s age changes their preferences in conjunction with their cultural values. For example, the nurse would ask a younger client of Hispanic descent which language they preferred rather than just speaking to them in Spanish. Following the patient interaction, the staff nurse and I would discuss our assessment findings to determine if there was an information that was excluded. During this time, I asserted any questions I encountered to staff nurse, and if she was unsure I redirected these questions to my Professor.
Objective Four: Establish environment conducive to learning and use a plan for learners based on evidence based practice.
 To prepare for the group project in the geriatric clinic I have utilized materials offered at health fairs I have attended at Woodhull Medical Center during clinical hours. I evaluated the clients that have attended the clinic throughout my weekly visits to the clinic. Since there is a large Hispanic population that attends the clinic it became evident that I had to provide materials that could meet the needs of these Hispanic clients. My group members and I researched materials from the American Diabetes Association (ADA) to obtain literature about healthier lifestyle choices including diet and recipes. I also found resources that differentiated between fruits that were high and low in sugar content. My peers and I also found materials about proper foot care that included pictures to accommodate to clients at different educational levels. Researching materials that can meet the needs of clients that speak different languages, with different cultural backgrounds, and at different levels of education produces an environment that is conducive to education for all of the clients that will attend.
 Objective Five: Utilize information technology when managing individual and families in the community.
 A goal that I accomplished while working with clients is developing a therapeutic relationship while at the clinic. I utilized therapeutic communication the obtain an understanding of the client’s needs for clients of various different cultural backgrounds. Through the utilization of cultural competency, I was able to assist the staff nurse with the assessment process. After discussing the assessment findings with the nurse after the client left the room I utilized the principles of the HIPPA laws to maintain confidentiality to protect the client’s privacy with the information disclosed to me during my clinic experience. I also signed a confidentiality agreement with Woodhull Medical Center prior to beginning my clinical rotation.
Objective Six: Demonstrate a commitment to professional development.
In the profession of nursing, we must conform the growing changes of the health care delivery systems. With new findings being discovered through research every day, nursing has become an oncoming education process to provide awareness of best intervention and outcomes during practice. While preparing to educate my clients for the diabetes education session in the geriatric clinic I focused on literature which included evidence based practice. I also used resources from well-known associations such as American Diabetes Association to yield the best outcomes for my clients. In community based setting, there are various barriers that make health care become a challenge, one of the most significant in this community is lack of health food sources within the community. With constant education, I am determined that clients can receive best outcomes with reinforced education.
 Objective Seven: Incorporate professional nursing standards and accountability into practice. Â
Prior to beginning my nursing rotation, I received reading materials from Woodhull Medical Center which outlined their policies, mission and included a confidentiality agreement. Before signing any materials, I read them to gain a better understanding of rules and goals of the facility. After gaining an understanding of what is expected of me, I knew that I was accountable of my own actions within the clinical setting. If I had any questions or doubts before completing an action I would refer to the American Nursing Association’s Standards to guide my decisions.
Objective Eight: Collaborate with clients, significant support person and members of the interdisciplinary health team.
There were various times throughout my experience at the adult medical clinic at Woodhull Medical Center that I had the opportunity to observe the collaboration between the interdisciplinary team and the client. The nurse was recruiting patients that had been coming to the clinic for a while for blood sugar screenings on nurse visits, that he thought would benefit from the class. Most of the patients were older adults that spoke primarily Spanish and could only comprehend or say few words in English. To address the needs of their community there were three translators to accommodate to the majority Hispanic audience members. In addition to the translators, the interdisciplinary team was composed of a dietician, pharmacist, doctor and nurse. It was interesting to see how an interdisciplinary team of health care professionals explained diabetes in a variety of different perspectives. These professionals provided education in a way that was very simple and easy to understand. Each professional on the team acknowledged topics that demonstrated their understanding of the Hispanic culture and how they can modify cultural norms to engage in healthier choices. The clients were given the opportunity to ask questions and interact with one another. At the end of the class the health care team pointed out one individual who had success with controlling his blood sugar and asked him to share how he controls his sugar with the other clients. Attending this diabetes education class was extremely interesting and informative. I was shocked at how much effort the health care team took to prepare material and meet the needs of the Hispanic clients within the community to communicate and reinforce the importance of controlling their blood sugar. Â
Objective Nine: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
 There are various factors that impact the delivery of healthcare within this community. To accommodate to the needs of low income residents that may not have access to a wide variety of resources. Members of the healthcare team offered coupons and vouchers to receive free or reduced-price items to best fit their health needs. I have observed within the neighborhood that a big factor is the surrounding environment which may make healthier food choices more challenging. The presence of fast food chains makes it difficult to make healthier food choices due to cheap cost and convenience. One challenge I observed is encouraging clients to choose healthier foods and fruits that have less sugar content for diabetic content. Another challenge in the health delivery within this facility is the lack of staff to accommodate to the needs of the community. While attending this clinic I have participated in food fairs as well as education sessions directed to encourage diabetic clients to gain control of their health and wellbeing by introducing healthier alternatives that can be utilized in cultural dishes. I have also attended a staff meeting where the concerns of the staff nurses being burnt out was addressed and a new plan was explained to be implemented in the upcoming summer.
Conclusion:
I have learned an abundance of skills secondary to my clinical experience at Woodhull Medical Center. My experience at the adult medical clinic has allowed me to interact with individuals of cultural backgrounds that differ from my own. I had the opportunity to gain a better understanding of their cultural values and beliefs. It was very insightful to see how their cultural beliefs and practices impacted their health. I have developed a competence of the cultural values of the large Hispanic population that is present within the community. The collaboration and interaction utilized amongst a variety of health care professionals has provided me with a greater understanding of the role of the nurse within the interdisciplinary team. In addition, I also observed how essential it is to advocate for our own needs as health care professionals. The skills obtained throughout my clinical at the adult medical clinic at Woodhull have taught lessons that have become vital to my career as a nurse.
