Narrative Self-Reflection
Introduction: During my community clinical rotation at Kings County Hospital Center, I achieved a great deal of personal and professional growth. Completing the Service Learning Project occurred simultaneously with my growth as both an individual and a nurse, as I applied my knowledge from the didactic setting to the clinical setting. This self-reflection is intended to demonstrate how I achieved the goals of all nine clinical objectives.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
Everyday for four weeks, I arrived to Kings County Hospital at 8:00 AM, and clinical would begin at 8:30 AM. Punctuality is extremely important as a professional in any field. Arriving early gave me time to settle in and prepare for the tasks ahead of me on each day. I dressed in business attire, ensuring that I portrayed professionalism to my classmates, the staff, and the patients. The white NYCCT lab coat and Kings County student nurse ID card completed my attire on each clinical day; both making me readily identifiable to anyone I interacted with. I would introduce myself as a BS-Nursing student and briefly explain my reason for being in any of the three clinics we were assigned to. During clinical pre- and post-conferences, I actively participated, asking any pressing questions and clarifying all doubts with my peers and clinical instructor. In this way, I assumed responsibility for my learning. Each clinical day concluded at about 2:30 PM, when the whole group would converge for post-conference until 3:00 PM. I maintained client confidentiality by only discussing client information when it was relevant to my learning and by being cautious in terms of where this information was discussed. It was important for me to maintain my overall individual professionalism throughout my rotation at Kings County Hospital.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
While in the women’s health, cardiac, or diabetes clinics, we would be connected to a nursing staff member who would serve as our guide during the clinical experience. This nurse provided some information about the client(s) and we were also able to glance at the charts as well. I maintained all hygienic practices when interacting with clients, such as hand-washing before and after contact. Evaluating the cultural, religious/spiritual, and developmental influences of the client allowed me to better understand the client’s perception of his or her own health. The client’s emotional state also allowed me to connect with the client and further understand his/her perspective. In community nursing, I have learned that nursing or medical interventions can only be beneficial if the client understands and agrees with the advantageousness of those interventions. Personal client beliefs really impact whether or not the client will be willing to adhere to any interventions or treatments; and it takes adequate analytical and critical thinking skills to make a difference. My experience at Kings County Hospital has really honed these skills for me. It has also aided me in my ability to think outside of the box in situations where the client was not responsive to an intervention, and I had to re-evaluate them.
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 in the community setting is crucial to client care. The nurse must be very flexible and capable of communicating effectively with clients, peers, and professionals from other health care disciplines. While on the clinics at Kings County, I assessed the client’s educational and developmental levels in order to communicate in an appropriate manner. I avoided the use of medical terminology with clients and articulated information well. I also had to quickly develop therapeutic relationships with these clients because our clinical group rotated weekly to different clinics at Kings County. Each week, we were meeting a new patient and needed to foster trust in the clients to form a nurse-patient bond. This wasn’t always easy, but it was achievable by listening to client concerns and providing accurate information. I was able to report any significant findings to the appropriate healthcare professional and/or to my clinical instructor. The communities served by Kings County Hospital have predominantly African American populations, but there were people from various cultures and ethnicities in the hospital. My ability to apply culturally sensitive/competent care improved.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
In our everyday rotations, I established environments conducive to learning by making the patient comfortable with me and speaking to them in private. We assessed our patients weekly in order to come to a conclusion about the pressing health needs of the people in the community. For the final presentation of our Service Learning Project, we used the hospital conference room because it has a projector (for our powerpoint slides). My team members and I engaged the patients during the presentation in order to keep them interested. We also allowed time at the end of the presentation for questions because we were aware that some people are shy and cannot speak up in the midst of others. Our teaching plan was evaluated through the use of a short survey questionnaire at the end of the presentation, in which the clients rated the effectiveness of our presentation.
Objective 5: Utilize informational technology when managing individual and families in the community.
I utilized informational technology through the use of the computers present in the clinics. Health information was readily accessible, as well as policies and procedures of KCHC. Many of the clients have access to the internet and have read one thing or another online relating to their health condition. There are several sites that may not be as accurate in terms of the medical information posted. As a community health nurse, I knew it was my responsibility to refer these tech savvy clients to some more reputable online sources. Client records were also available on the computers; logging out after chart review or documentation was essential in maintaining confidentiality.
Objective 6: Demonstrate a commitment to professional development.
I was very committed to my personal professional development. This rotation really allowed me to take responsibility for my own learning. Community health nursing requires a greater level of individual practice than bedside nursing. The CHN is responsible for a greater array of client needs. In order to fulfill the responsibilities of a CHN, it is important to stay up to date with nursing knowledge. A client can ask you questions about anything at any given moment. The nurse must either provide the information if appropriate or be knowledgeable of resources. I utilized nursing journals available through NYCCT’s library databases to read up on diabetes management. I also became more acquainted with the details of the Affordable Care Act. In addition to staying up to date, I critiqued myself on each day; identifying areas where improvements in my abilities as a nurse could be beneficial.
Objective 7: Incorporate professional nursing standards and accountability into practice.
During the orientation process at Kings County Hospital, all of the students were made aware of the policies and procedures of the hospital, as well as the mission statement of the hospital: “to provide care to everyone regardless of their ability to pay.” Information regarding these procedures was also available on the computers in each clinic. I was sure to adhere to these policies during every clinical day. I only performed tasks that were within my scope of practice as a registered nurse (in accordance with ANA standards) and a community health nursing student. Our service learning project included diabetes and insulin administration teaching, but we knew it was beyond our scope of practice to demonstrate insulin injections on the clients. Therefore, we used oranges and water instead.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
I was able to collaborate with members of the health care team and refer to them for guidance during the clinical experience. During my assessments, I included families when possible in the client teaching. I was personally able to retrieve information from the financial counseling office about how people without insurance can still receive care. Kings County Hospital (and HHC hospitals in general) has a program in which services are billed to the client in amounts ranging from $15 to $60 based on the client’s income. The idea that client care is not limited to the patient, but expands to include the family was very much reinforced in this class. We included this in our Service Learning Project—making diet changes to incorporate healthier food options should be made for families as a whole, rather than the specific individual with diabetes or hypertension.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
It is important to recognize the disparities that exist in the health care system. Insurance practices, legal policies, the influence of special interest groups and demographic conditions all influence healthcare through resource allocation. The communities served by KCHC experience higher rates of poverty than Brooklyn and NYC overall. This affects their ability to make better diet decision and unemployment affects health insurance coverage. I kept this in mind when teaching the patients. It’s one thing to teach about wellness, and another thing for the client to actually put the interventions to use. If one does not have a supportive financial or educational background, it is difficult to maintain health and wellness in this country. I kept this in mind during my clinical experience; for example, instead of suggesting that clients avoid fast-food at all times, I suggested healthier options such as Subway sandwiches or grilled options versus fried.
Summary: Overall, my experience at Kings County Hospital was fruitful. I developed my personal and professional skills in a way that no other rotation has allowed me to. Taking on the responsibilities accorded to community health nurses was difficult at first and I have grown to really respect community health practitioners. It was personally comforting for me to see that the hospital has many resources available for disadvantaged people who already suffer the effects of social disparities daily.
