My first community health nursing experience took place at Our Lady of Refuge Church located in Flatbush, Brooklyn, NY. I entered the course with the only kind of nursing experience I had, which was working in a hospital setting. There, I always had the time and resources to take a full medical history and conduct a nursing assessment of my clients. Community health nurses do not always have this luxury, so prioritizing your time is of the utmost importance, in order to successfully get your goals met. My goal here, was to measure, record, and educate the clients on hypertension.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
To help learn what being a community health nurse means, I was placed at clinical site, Our Lady of Refuge Church. Our clients are identified as, the residents within the community who attend the soup kitchen services once a week. My colleagues and I are there to help distribute food to low income families, and offer them free blood pressure screenings, and education. Through observation and critical thinking, I learned that there are a frightening number of people living with high blood pressure, with minimal knowledge on the risks they face from this illness. We ask the clients to document their name and contact information before assessing blood pressure. Some individuals are hesitant to give their personal information to us, and so, I reassure them that their information is kept confidential, and that we only ask for it so that we can follow up with them later, regarding their blood pressure. This puts them at ease, and they are more likely to help us, help them when they are told that their personal information stays with those working with the church.
I was assigned a service learning project that combines the experiences at the clinical site and interventions to the health care issues we’ve found within the community. Working as a group, with the other members in my clinical course, allows the other nurses to share insight on how they would provide help to their clients. Each week, my group members and I discuss how the project is going, and we seek guidance from our clinical professor when we get stuck on a particular issue. The professor helps us to better understand the objective, through examples, giving me confidence in my responses. Working in groups can be a challenge at times, because I feel dependent on others for the timely completion of all aspects of the project. At the beginning of the course, we divided the project, and assigned due dates to each member, to prevent any discrepancies in our course work. This method has been a success, with all parties easily accessible to comments, and concerns. Post conference each week at clinical continues to enhance my knowledge and understanding on the community based needs. It also gives us the opportunity to discuss how we feel we have positively affected our returning clients, through observation of some improved blood pressures.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
As a nurse, a clear medical history and thorough assessment is important to provide optimal care to the client. Working at the clinical site, however, only gives me a small window of opportunity to gather information on my client. After waiting on line for hours to access the soup kitchen, most of the clients are not eager to spend anymore time there, checking their blood pressure. I try to only ask questions that are relevant to the main problem. As I apply the blood pressure cuff, I ask for basic demographics. After measuring the blood pressure, and I see the values are elevated I ask if the client is currently taking antihypertensives?, seen a physician recently?, and if they are aware of what a normal blood pressure is? The client is already putting their coats back on, as I quickly provide some education on the risks of uncontrolled high blood pressure, and how they can control it. Giving medications to clients is not a part of my duties here, but I do encourage the client to follow their doctors orders. Personal safety measures apply the same when working within the community as they do in my work place. This means that I utilize proper hand washing techniques to prevent the spread of germs from one client to another, myself included.
Thankfully there are French and Spanish speaking students at clinical, to help me better understand the clients. I am bilingual as well, which did come in handy with a few Russian speaking clients. Being culturally competent is key. I learned a few words and phrases in the Spanish language to greet those who don’t speak English, and there are a lot of them. Getting them to come over to your table, and measure their blood pressure is the easy part, but when it’s time to explain the meaning of the blood pressure, having a translator present is important to avoid any miscommunication. I was surprised to hear from the coordinator of the blood pressure screening program, that without us there, she has no one to translate for her, which made me appreciate more, the time spent there.
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.
Communication within the healthcare team is important in order to provide for optimal care to the clients. Sharing thoughts with my peers during clinical is easy, and taking the extra step to hear from the regular volunteers at the Church has been insightful. The volunteers have been around the Church for many years, and are residents of the community themselves. They expressed their appreciation for our help, and have become our first clients in line to have their blood pressures measured each morning.
Communicating with the clients at the Church is challenging at times. Translators are available for interpreting, however, some individuals lack basic reading and writing skills. Pamphlets are available to the clients, further elaborating hypertension, but for those who never learned to read and write, this material is useless. For these clients, I give out cards with a simple picture of a scale labeled with numbers that indicate blood pressure ranges. As the values go higher, the color of the scale is darkened to indicate that those values are not good. I explain the client which part of the scale is good and which part is bad. This learning tool has been successful every time.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Before exiting the Church, my classmates and I set up a table welcoming the clients to come over to measure their blood pressure. We hang signs written in multiple languages stating our purpose, and as the residents are finishing up on the soup kitchen line, they are offered to participate. With smiles on our faces, we set a welcoming mood to the environment. All of the clients are adults, and so the plan is to assess, and educate them through one to one conversation, and educational pamphlets. To properly evaluate the learning outcome, I always ask my client if they understood, and if they have any questions.
Objective 5: Utilize informational technology when managing individual and families in the community.
Nursing informatics is the integration of specialties used to manage and communicate data, information, and knowledge in nursing practice. There are no computers, or charts at my clinical site. Information is collected through good old fashion one to one conversation, and documented with pen and paper. There is enough distance between the clients to allow for privacy, and comfort to speak openly. The information collected is kept between myself and the client, until I step away to a private area to share with my Professor, and colleagues.
Objective 6: Demonstrate a commitment to professional development.
As a health care provider, I am committed to life long learning, including the latest developments in nursing, and ways to improve on the methods I use in my practice. I understand that to be a community health nurse means being aware that every community is unique in culture, economic status, health disparities, and environment. With this experience being my first in community health nursing, I thought it would beneficial to scope out the neighborhood all together. I drove around noting what kinds of markets, restaurants, clinics, and stores are nearby. Further research within the service learning project taught me more about the demographics of the community.
A major role that a nurse has is to be an educator. To do this well, I make sure that I am confident in the material myself, before sharing with my clients. By subscribing to current nursing journals I maintain my knowledge, and learn about the latest developments. I even find that cracking open my fundamentals in nursing textbooks from time to time is refreshing.
Objective 7: Incorporate professional nursing standards and accountability into practice.
Professional nursing standards are always incorporated into my practice, whether I am in an educational or work setting. This means that I reflect my clinical judgement based on evidence based practice, and abide by a code of ethics during decision making. The agency I am currently working with would be both, New York City College of Technology, and as a guest at the Church, where my clinical experience is based on this semester. With both of these facilities in mind, acting as a professional at all times is of the utmost importance.
Our mission at Our Lady of Refuge Church is to help the needy in more ways than one. Giving a helping hand by handling donations, while sharing our knowledge in medical areas that the lack, is how we are following through with our goal.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
As a healthcare professional, the ability to communicate effectively with the team is always beneficial. Here at my clinical site, a language barrier with the clients is my greatest obstacle at times. A majority of the residents have limited English language, Luckily, my classmates are fluent in French, Haitian, and Spanish. When a client approaches me with a language barrier, I swap clients with one of my classmates who can communicate more effectively. This is best for the client to avoid any miscommunication, and make the client feel more open to asking questions they may have.
At times, the client will seek advice from me regarding community resources. This happens especially when I advise someone to see a physician to better monitor their blood pressure, because I feel a diagnosis of hypertension is required. I help the client by giving them a couple of medical clinics in the community they can visit, and are easily accessible.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
I was informed by the director of the volunteer services at the Church, that this year is different from the previous years. Due to the political changes, the numbers of residents that visit the soup kitchen dropped, out of fear of being persecuted due to their immigration status. Not only immigrants, but, Muslims have also been affected by current political agendas. We still want to help these families, and let them know that they are welcome, and safe to continue coming to the Church. To continue to help these families, we set aside boxes filled with donated foods, and deliver them to the families that are afraid to come in. This also goes for those who have become disabled, and are physically unable to pick up their donations. In addition, a sign was displayed outside of the Church, stating, Immigrants and Muslims are welcome. As healthcare professionals, it is one of our duties to advocate for our clients, no matter what their economic, political, or social standings may be.
