Narrative Self Reflection of Service Learning Project
Introduction:
Community health nursing most accurately defines the fusion between clinical nursing and public health practice to protect the well-being of the population. During my clinical rotation at Kings County hospital, I was granted the opportunity to further my nursing practice amongst the East Flatbush community through raw didactic settings. I feel as though the clinical and didactic settings are correlative in the sense that the two cater to the health and well-being of the client. They both foster an environment in which validates the client’s needs while producing quality care. With all the encounters that I have experienced over the course of the semester, I feel as though I’ve grown to understand that the quality of nursing involves much more than interventional care, rather, it embraces a bond between the nurse and client. I’ve learned that human touch is far more healing than any medication or intervention can do which makes all the difference in the nursing practice. Through my clinical experience, I will demonstrate how I executed the 9 clinical objectives at Kings County Hospital.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance
As a registered nurse working in the hospital setting as well as a professional nursing student, it is imperative to maintain a constant act of professionalism. I believe punctuality and a clean-cut appearance is the foundation to produce quality care to the client. First impressions are held to great heights in all walks of life, where the medical field is no different. During the first encounter, I feel as though clients will be more receptive to the clinical advisor when they present themselves in a respectful manner, are on time and well dressed. During all my clinical affairs through out the semester, I was always punctual, eloquently dressed in a pressed white coat and Identification badge present at all times. Before each patient encounter, I would review my community objectives for the day to be well prepared for the care that I would later provide. In the act that I am unsure of how to handle a certain incident or situation, I would seek out my clinical instructor for appropriate guidance instead handling the situation wrongfully. In the course of each client encounter, I preserved a constant act to maintain patient confidentiality where it is talking in a tone that only the client can here what I say or in a private area. After each clinical day, my fellow nursing colleagues and I would participate in post conference where we all actively participated in debriefings that spoke on the high’s and lows of the day as well as what we’ve learned and what we could improve on.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Working in the community setting or in the medical field, in general, can be a daunting task if one is not fully prepared. I feel with a good knowledge based foundation, interactive instructors, practice and time can build analytical reasoning and critical thinking skills. As a nurse working on a medical-surgical floor as well as a community-nursing student, it is obvious that the experience and level of exposure between the two are quite different. I feel as though the majority of my critical thinking skills became well developed during my experience working in a hospital but, on the contrary, the slow pace and lower stress level environment, at kings county, that I was exposed to, has garnered a level of patience and virtue that I later realized I’ve lacked. Through out the semester, my fellow nursing colleagues and I rotated between the diabetes, women’s health, breast and GI/wound clinic. With each clinical experience that I participated in, the environment was well controlled with no acts of chaos or confusion. Although the wait times between each client encounter at times were lengthy, there hasn’t been a time where prioritization was the main factor. During a particular experience in the breast clinic, I was granted the opportunity to sit in on a follow-up case with a client who was referred from the mammogram clinic. I worked side by side with one of the fellow physician assistants who not only educated me on policies and breast assessments but also allowed me to perform an assessment of my own, which the clients permission of course. In this particular case, the client had a sister who was diagnosed with breast cancer and decided to get a mammogram at age 67. The client was referred to the breast clinic because the mammogram clinic found a small 2mm x 2mm mass in the clients left breast, which turned out to be a benign tumor. Before the client entered the room we elaborated on the past medical history and the reason for her follow up. We collaboratively reviewed her chart in great detail. For clinical safety purposes, we performed hand washing, hygiene and donned gloves before we performed our assessment. The client was a little worried about the small mass that was found and feared it was breast cancer but the physician assistant continuously reassured her that the tumor was noncancerous but expressed that the tumor must be removed because it can later become cancerous if not treated. We didn’t administer medication in this case but were able to give the client peace of mind, which was more important. I feel the physician assistant that I was paired with was excellent in her teaching and performance by far. She went up and beyond to make the client feel comfortable which I admired.
Objective 3: Effectively communicate with diverse groups and disparities using a variety of strategies regarding the health needs of individuals and families in the community setting.
Therapeutic communication is a necessity and absolute must within the nursing practice. In the event that a client is “sick” or potentially could be diagnosed with an illness, it is imperative that the nurse communicates with the client or family members of the client in a manner that they can be easily receptive to but also deliver a sense of serenity that can make all the difference in the plan of care. Therapeutic communication relieves built of stress and anxiety that can delay a client from getting well. During my clinical encounters, I made sure of communicating with my clients therapeutically because I know that the fear of the unknown can drive a person insane. For the clients that were non-English speaking, a telephone language line interpreter was called so the patient would be able to receive vital information in their preferred language they deserve. At the end of each encounter, I didn’t document specifically but during post conference we discussed the events that happened in each encounter.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
During my clinical observation at Kings County Hospital, each client encounter was conducive to learning. One encounter in specific at the diabetes clinic, the nurse was attentive, caring and informative. She answered all the questions the client had as well and re-enforced the teaching she had done form the last follow-up appointment the client had. She educated her on diet plans and signs and symptoms of hyper/hypoglycemia as well as administered specific pamphlets the client can read at home for further information.
Objective 5: Utilize informational technology when managing individual and families in the community
In this day and age, regardless of working in the medical field or not, technology is apart of everyday life. Within the clinical setting, it allows the care provider to have the patients medical records on file, which is easily assessable and attainable. It maintains strict confidentiality because only the care providers have access to the files.
Objective 6: Demonstrates a commitment to professional development
As a professional nursing student, I demonstrate a commitment to continue my nursing practice and care. Nursing is an evolving career, which is constantly changing growing as a profession every day. It is my duty to continuously keep abreast of the specific changes that are made to the nursing practice, especially as a new nurse. I solely make an effort to critique my work as a nurse for better practice during my following years to come.
Objective 7: Incorporate professional nursing standards and accountability into practice
As a new grade nurse, I make sure to incorporate the professional nursing standards and accountability into my everyday practice. I make sure to abide by the center’s standards, polices and procedures as well. I always take accountability for my actions and abide by the mission statement at Kings County Hospital.
Objective 8: Collaborate with clients, significant support persons and members of the health care team
During each patient encounter, the health care team and I always work together to deliver quality care to the client. I understand that interdisciplinary care is important working in the medical field and I try my best to up keep that hold within my practice. It is known that not every patient is the same and they have multiple differences so it is important to critique different care plans for each patient to generate the best possible care for the individual. In certain instances after my assessment, I advise the clients of available resources that they may not know are available to them such as the social worker or dietician. When working in the diabetic clinic, one particular client had an a1c lever of 13, the nurse and I educated the client on certain food that the client should avoid such as fried foods, and high sugary contents as well as certain food that the client should consume like fruits and vegetable. Also, we recommend to the client to increase a healthy lifestyle with exercise 30 minutes daily.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
During my clinical rotation at Kings County Hospital, I’ve learned to realize that the particular community has an increased level of clients born outside the United States. A lot of the clients do not speak English which voices slight concern within the community. There is the high level of language barriers, which makes health care worker to client difficult. I’ve noticed that one health care worker get a little agitated/upset when the client didn’t speak English, so she had to use the language line interpreter. I felt a little saddened that just because a patient didn’t speak the same language as the nurse, there’s no reason to give the patient an attitude because of it. In the event that I observe any act of un-kindness such as the case listed previously, I would make it my duty to set the person aside to try and understand why do they have an attitude with a client who doesn’t speak fluent English.
Overall, I enjoyed my clinical rotation at Kings County Hospital and learned so much abut myself as well as the importance of communication and building rapport.
