Introduction
This semester, Spring 2017, I was given the opportunity to participate in various community settings and activities to supplement and further my knowledge about community nursing. My clinical setting was at Woodhull Hospital’s Women Health Pavilion located on the eighth floor which served OB/GYN services to females of Bushwick. Apart from my weekly exposure to OB/GYN community nursing, I also participated in a group (with my fellow clinical classmates) effort to organize a diabetes educational presentation to the Woodhull geriatric community. Together, both of these experiences correlated with each other, offering insight on the importance of community nursing and what it pertains.  To evaluate my personal growth, in relation to my experiences in the community setting, this paper will elaborate on how I was able to achieve nine clinical objectives: demonstrates individual professionalism through personal behaviors and appearance; employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting;  effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting; establish environmental conductive learning and use a plan for learners based on evidence-based practice; utilize information technology when managing individual and families in the community; demonstrate a commitment to professional development; incorporate professional nursing standards and accountability into practice; collaborate with clients, significant support persons and members of the health care team; recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance
At my clinical at Woodhull, I dressed professionally as the hospital required. The dress code was quite strict as we were only allowed to wear a white blouse with black or blue pants. I always arrived fifteen minutes before my clinical began so that I could prepare and gather myself for the day. I assumed responsibility for my own learning by bringing in any questions I prepared for the nurse I normally shadow. I also carried a little notebook with me every day so that I would be prepared to write notes and my version of patient assessments and interventions. I maintained patient confidentiality by closing the door after patients walked into the exam room and asking other people other than the patient to wait outside while the nurse spoke with the patient about private matters. I was able to participate in morning huddles at 8:30 AM where all staff (nurses, midwives, doctors, LPNS, PCTs, etc. ) would get together to talk about the mission, goals, reminders and improvements for the day. When I did not understand directions given to me I would seek guidance, something I typically difficult. Before this semester began, I was more reluctant to ask questions for fear that I would be looked down upon but I feel that I’ve grown and matured due to the family-like and warm clinical environment.
Objective2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
At this clinical rotation, I was able to interview the patient and ask pertinent questions in regards to their specific OB/GYN needs so to further reinforce their knowledge for preventative health. Before meeting with the patient in person, I was able to navigate their medical records on the computer system logs to investigate and prepare the reason for the patient’s visit or referral. On several occasions, I was able to assess the developmental, emotional, cultural, religious and spiritual influences on the patient’s health status. For example, the neighborhood’s population comprised mostly of Hispanic people,  so by practicing cultural sensitivity, I was able to understand why many Hispanic females did not want to hear about family planning. Many Hispanics are catholic and do not believe in contraception. In this sense, nurses may only inform patients about the risks of no contraception (especially after birth) but never impose our own opinions on their health decisions. Data relevant to the client’s self-care needs would be collected such as an OB’s financial, social, and ability to take care of herself and her developing fetus. The only physical assessments taking place at this clinic was blood pressure, weight, height, and BMI because it is an outpatient clinic. I had the opportunity to assess the blood pressure and weight on several occasions. During the patient interview and teaching, I prioritized the teaching and educating based on the patient’s age of gestation and trimester. I understood that there was no point of discussing against sleeping on the side to a four weeker. Instead, I would prioritize nutrition and how to minimize nausea and vomiting that comes with the first trimester. During this clinical, there was more teaching and educating rather than administrating medications.
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.
There were times where communication with certain patients required the use of therapeutic communication. For instance, there was a time when a patient waiting to be seen by a nurse was getting riled up and demanded to be seen because she had been waiting for a long time. It turns out there were some social issues the patient was dealing with back at home and was projecting her anger to staff at the clinic. By actively listening to her and digging deeper into her situation I was able to figure out the reasons behind her unruly actions, that would otherwise not be addressed if ignored. I then was able to communicate these findings with the nurse I was shadowing and then relay it to the social worker. With other patients, I was able to gauge any barriers in communication and adjust the teaching accordingly. For example, there would be older immigrant females that would come into the clinic who received a 6th grade level of education (according to their chart) so I would make sure I simplified any explanations or education material so that they could understand. I practiced documenting assessments and interventions in my own notebook with every patient we saw and have the nurse I shadowed review it with me later.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice
Although this objective was met in my clinical rotation, I believe it was mostly achieved through the team service learning project activity. My team implemented a diabetic nutrition teaching plan for the geriatric population at Woodhull hospital which was then presented to the geriatric clinic at the end of the semester. The location we presented in was a waiting room with chairs arranged facing forward so that they could hear and see us and the poster boards clearly. At the end of the presentation, we evaluated the client’s learning by asking them what they learned.
Objective 5: Utilize informational technology when managing individual and families in the community
I always maintained confidentiality while in my clinical setting. The main source of communication between providers of care and other staff was via computer, telephone, and fax machine so one can see how there is a high risk of breaching confidentiality. I practiced small and simple techniques such as asking who was speaking when I answered the phone before giving any patient information or making sure to lock the computer screen before stepping away. Although information technology poses a risk for HIPAA violations, it has its perks. Through informatics, I was able to quickly look up certified teaching material and information on OB/GYN for the patient to take home as a reinforcement for what they have been taught at the clinic.
Objective6: Demonstrate .a commitment to professional development
As mentioned previously, educational reinforcement material that would be handed out to patients before they left the clinic would be acquired through a certified website, ensuring teaching material is up to date. At the end of each clinical, I would report to the nurse manager of the clinic/agency to reflect on my day and what I’ve learned. By the end of the semester, I was able to communicate with her my growth and how I feel more confident working with such diverse individuals who come from all walks of life. I’ve gained a better understanding of certain cultures and how they influence my care in the OB/GYN discipline to provide better care.
Objective 7: Incorporate professional nursing standards and accountability into practice
The American Nurse Association (ANA) aims to delineate the obligations, ethical, and legal issues of a registered nurse practicing in the United States of America. I believe I was able to stay within the scope of practice while at my organization and more specifically, my agency. My actions reflected that of ANA and when in doubt of performing something out of my scope, I made sure to communicate this to the nurse I shadowed and did not perform the action. I was aware that I would be held accountable for any actions performed by me. I made sure to comply with the agency standards of care by informing myself with policy and procedure at the clinic. I was aware of the agency’s mission as someone would read it aloud every single morning at huddles.
 Objective 8: Collaborate with clients, significant support persons and members of the health care team
With every OB patient seen, their mental health was screened through a checklist which the nurse then summed up into a score. There would be times when someone would score a really high score, posing a safety risk for themselves and others. I would quickly communicate this to the social worker and immediately bring these patients to her, (bypassing the nurse) in order to address the priority situation. I would sometimes explain to third-trimester patients they need to sign their newborn to be to Medicaid services and WIC so I would refer them to these agencies outside the clinic. One of the most important teaching topics we emphasized to OB patients was their need to make nutritious food, and beverage choices for their own and their fetus’s health. I encouraged them to exercise and continue with their prenatal vitamins.  I explored who their support system (or significant others) comprised of and encouraged them to be in the room during the patient teaching.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
It was obvious that economic and political influences played a role in the ability to reach our patients in terms of getting them to come to the breastfeeding classes, child birthing classes, or to simply to follow up on their appointments. I recognized these gaps in the system and thought there must be a way to mend these problems. The childbirth and breastfeeding classes would always be scheduled in the afternoon. Looking at the major population served, low socioeconomic Hispanic immigrants, their heavy working schedules did not allow for them to make it to these classes. Other clients voiced that they could not afford to come to these classes because they couldn’t afford it when in fact these classes were free. Other clients voiced that they were trying to avoid unnecessary presence at institutions for fear that they would get deported due to the fear mongering President Trump had instilled within them. I would clarify and empathize that the classes are free and we warmly welcomed all expecting mothers and fathers to join. I would also clarify that we are not affiliated with ICE and that their immigration status was not a factor in their care and that their health records would be kept confidential. I communicated to clients that they and their fetus was the priority in care. As for those who could not make the in-person classes due to their tight work schedules, I watched the nurse I shadow try to implement as much information during their scheduled appointments and provide them with other educational resources such as hotline numbers to call, support groups, or reinforcement paper material.
