Narrative Self-Refection

Introduction

This is a story about my 15-week clinical experience in my Fall 2014 NUR 4010 Community Health Nursing class. The clinical site for my Community Health class took place at Woodhull Medical and Mental Health Center in one of their wellness clinics called Sumner Avenue Houses Child Health Clinic located on 47 Marcus Garvey Boulevard Brooklyn, NY 11206. This clinic served child and adolescent from birth to 18 years of age, who were mostly Latino and African American living in the surrounding neighborhoods. For my Service Learning Project at Sumner Avenue Houses Child Health Clinic, there was a set of nine objectives that I needed to accomplish before the end of the semester. I will explain how I accomplished each objective successfully, for each week at Sumner Avenue Child Health Clinic. 

Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.

During my clinical rotation I had to maintain patient confidentiality by following the HIPAA (Health Insurance Portability and Accountability Act) Privacy Laws that provides federal protections and sets national standards for the security of patient confidentiality. I maintained patient confidentiality by not divulging any information, whether it be patient names or age, to other clients, students or healthcare workers. Before going to Sumner Child Health Clinic, arriving at 8:15 am every day, I would write down the goals I wanted to accomplish for the day, whether it is teaching one client and their family members about some disease or issues that were occur in their health or helping the nurses with assess her clients. I would prepare my teaching sessions by gathered information about the disease I was teaching about and find handouts to give to the patients I taught for the day. Each day I added a new goal to the ones from the previous weeks. I would then submit all my blogs and assignments before the due date or after each clinical experience and asks my clinical preceptor for help when I was confused about any task. I dressed business casual by wearing an unrevealing white top with blue or black slacks and flats. Every morning my nurse would give a pre-conference to the staff about the most pressing matter for the clinic, the doctors who would be coming in for the day, the number of clients who confirmed their appoints, if there will be an walk-in doctor and actions they need to take if a client comes into the clinic with Ebola.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

The nurse I shadowed during my 15 week clinical experience allowed me to interview several patients’ under her direct supervisions, while she asked the important questions I missed or did not pick up on. My nurse allowed me to assess the patients, taking their vitals, and review their charts before and after their visit, while my nurse elaborated on the patients’ health issues and the questions I needed to ask the next time I encountered a patient with similar issues. After the doctor assessed the patients, me and the nurse gave patient care and medication as ordered by the doctor. I asked all patients that came in with asthma if they knew how to take their medications and if they understood its action of their health. If the clients were confused, I would teach them about the medications they are taking, it’s actions and symptoms that require a doctor visit. I would then ask the patients if they had any questions and if they could give me short summary about what I taught them. I also taught them about actives they can participate in that can help improve their symptoms. The safety of personal and patients coming to Sumner child health clinic was of extreme importance because a lot of the patients came into the clinic with strollers, which would clog up the clinic making it hard for the staff and patients to move around. Due to this, me and the nurse would often remind the patients to leave the strollers in the waiting room or hallway on one side. These interactions helped me gather information about the child health clinic, the types of clients that come into the clinic and the health disparities they are facing. The patients’ cultural background, developmental level, emotional level and spiritual influences are important aspect I had to understand and be open to, without discriminating against the patients I met with. These four aspects are extremely important to the patients’ wellbeing and effects how patients deal with their health problems.

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.

The use of therapeutic communication skills is extremely important for effective communication between healthcare providers and patients because the patients’ voice is tremendously important for healthcare interventions. When I spoke to the patients I meet at Sumner child health clinic, I spoke in layman’s terms, in a clear voice, and in a slow pace. This allowed for better communication between me, the patients and the nurse because I gave the patient a chance to ask questions, while I listened, clarified any misunderstandings and it gave me the opportunity to be able to reflect back on the conversation. It was extremely important for me and the nurse to listen to the patients family members because the patients’ mothers were the ones communicating the patients’ problems, due to most of the patients being young children. I had to explore more about patients’ problems and ask simple open ended question to elicit more information from the patient’s family members for the reasons why the patient is in the clinic and the health problems occurring. The conversations I had with my nurse and clinical preceptor was clear, simple, concise and gave me the opportunity to asks questions when I was confused. Through effective therapeutic communication I was able to gather information and address some health disparities the patients were going through.

Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.

During my 15 week clinical rotation experience, I gave individual teachings to patients who came into the clinic with asthma symptoms, diabetes and obesity. I worked with my nurse in developing a teaching session for each patient I met with. I discussed the causes of these health problems, their risks factors, ways to prevent more health problems, diet, exercise, proper medication usage and when it was necessary for the patient to go meet with their doctors. The nurse I shadowed would provide me with the necessary handouts, pamphlets and pre/post tests I needed during my teachings. These teachings helped me establish an environment conducive to learning based on evidence-based practice.

Objective 5: Utilize informational technology when managing individual and families in the community.

For my teachings about asthma, obesity and diabetes, I had to utilize the internet to research the best ways to teach my patients about their illness through evidence based practice. I had to use the printers at my clinic to print out handouts I was gave out for my teachings. My nurse let me accesses patients electronic medical records, but I was not allowed to print out or write patients names, age, or anything that could breach patient health confidentiality. I maintained patient confidentiality by not divulging any information, whether it be patient names or age, to other clients, students or healthcare workers.

Objective 6: Demonstrate a commitment to professional development.  

I used reliable secure websites, textbooks and nursing journals for my teaching sessions, so I could provide the patients with the most up to date and accurate information. I made sure that I looked up information about the health disparities the patients that come into the clinic were experiencing and tried to finds ways to decrease these disparities whether it be informing patients about the types of support available to them in this community. After each clinical experience I would sit down and reflect on the teachings I gave and where I needed to improve. I would often ask my nurse how I did and what I could work on. The submission of blogs also helped me reflect on each patient interaction I had at Sumner child health clinic. By helping me adjust to the challenges community health nurses’ face, helped me understand the disparities of the community and how I could help the individuals living in this community improve their health outcomes.

Objective 7: Incorporate professional nursing standards and accountability into practice.

I followed American Nurses Association (ANA) healthcare standards to provide the highest level of nursing care by doing no harm to the patients I encounter and providing them with the best care to the best of my abilities. The nurse I shadowed gave me a brief orientation of Sumner child health clinical, its goals and its policies. I made sure that I was familiar with Sumner child health clinics mission statement, goals, policies and produces, especially the ones about the Ebola crises. I build a trusting relationship by arriving to the clinical site on time every day, completing the tasks assigned to me and taking responsibility for any mistakes that occurred.

Objective 8: Collaborate with clients, significant support persons and members of the health care team.

During my teaching sessions at Sumner child health clinic, I was able to collaborate with patients, patients’ family members and members of the health care team, by using effective therapeutic communication. I taught the patients about their illnesses, the medications they were taking, and activities that could improve their overall health. While the health care members working at the clinic help me prepare for my teaching session by provide pamphlets that I could handout to the patients and a private room for my teaching sessions. I was able to understand the problems/disparities the patient and health care members faced in this community and how they tried to improve the communities members overall health by providing referrals to improve patients health.

Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care.

The economy, political policies and patient demographics plays a large role in how patients received their healthcare services. I learned that Sumner child health clinic has to stop taking patients who are on Medicaid because a policy was created that does not allow them to see these patients anymore and they would have to refer these patients to another clinic in the North Brooklyn Healthcare system. This new policy forces patients, who have been coming to this clinic for many years, to go to another clinical site that may take several hours for them to get there. This may cause patients to stop go to their doctors appointments or start jumping form healthcare provide to health care provider, which will affect their health. The nurse and I had to advocate for these patients by encouraging them to go to their doctors appointments and finding clinics in the North Brooklyn Healthcare system that are closer to their homes. This will help the community members gain assurance that healthcare system is working in the community best interest, by fostering links between people and services render. Through my observations and commutation with patients and the healthcare team at this clinic I found that the economy, policies, demographics, level of educations, health habits, family and social support, insurance type, and available care centers dramatically effects people’s health status.

Conclusion/Summary:

My clinical experiences at Sumner Child Health clinic was short but extremely meaningful for me because I got the opportunity to see community nursing in another light. I used to think that community nursing was one of the most boring nursing fields to work in, but this experience changed my view about community nurses. I learned that community nursing is the first place were healthcare providers can stop or prevent certain illnesses from getting into chronic state of health. Community nurses must advocate and encourage their patients to take better care of their health and practice in healthy practices. These actions help reduce disparities, changes patients health outcomes and improves the community in this neighborhood overall health statues. Community health nursing is about patient education, advocating for individuals who are less empowered and creating an environment that will help the community become more healthier.