This semester, I spent close to sixteen weeks at the Woodhull Adult Medicine Outpatient Clinic working with the Diabetic Nurse Educator and teaching patients how to manage their diabetes and keep their blood sugar levels under control. While I was there, I worked with patients of varying ages, cultures, and socioeconomic backgrounds. This experience has taught me a lot and has helped me to grow both personally and professionally as a nurse. Below is a summary of how I met the objectives for the Community Health Nursing clinical curriculum.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
I demonstrated professionalism by maintaining patient confidentiality, attended clinical punctually as per the school policy, and followed the recommended dress code policy of the hospital. At Woodhull Medical Center, all community health nurses are required to wear blue and white uniforms. However, community health students nurses are allowed to wear blue or black pants with a white blouse or shirt. Every week, I wore black pants with a white blouse to clinical. I also demonstrated professionalism by researching relating health information so as to improve my clinical knowledge as well as to complete my assignments (blogs, answering discussion board questions, community presentation) within the recommended time frame. I also sought clarification and guidance from my mentor or my clinical professor on issues that I did not understand.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
I did not have direct access to any of my patient’s medical records however, I was still able to learn a lot about their medical history during the teaching sessions as the patients would openly discuss their morning’s vital signs and finger stick results as well as their most recent hemoglobin A1c in class. If patients were noted to be hypoglycemic or have symptoms of it, I would give them a half of a cup of orange juice and then have their blood sugar re-checked about 15- 20 minutes later. Those patients who had blood sugar levels that were noted to be extremely high were given oral hydration first, and reassessed by doing a repeat finger stick. If the patient’s blood sugar continued to be extremely high (> 500m/dL), the patient was referred to the emergency room for further treatment. Due to the fact that this was a group class, I did not have to administer any medications. However, patients were taught when to take their medications, where to administer insulin, and how to dispose of their sharps after using them. All patients were given a pre-test and post-test as well as intermittently asked questions during the class to see if they understood the information being taught.
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.
I encountered a diverse cultural groups of patients of varying ages at the Woodhull Adult Medicine Outpatient Clinic during my clinical rotation. Despite the fact that majority of the patients who attended the clinic spoke only Spanish and my comprehension of the language is very limited, I was still able to communicate non-verbally as well as with translation help from my mentor, who is bilingual. I listened attentively to their concerns and allowed them verbalized their feelings. If there was something that I may have noted during my interaction with the patients, I would share my observations with my mentor who would follow-up and do the necessary documentation.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Every Wednesday morning before the beginning of the diabetic training class, I assisted my mentor in getting the room ready for the group discussion. I ensured that the room was not only clean, but that the chairs were properly arranged to accommodate all patients especially those who had mobility issues. Patients were offered fruit juices, whole wheat crackers, fruits, and water if they needed it. I also assisted my mentor to give out brochures and display teaching posters and other visual aids as recommended by the American Diabetes Association. Patients’ knowledge and understanding of the topics taught were evaluated using a pre-test and a post-test as well as asking patients to explain what they understood to their peers or the mentor.
Objective 5: Utilize informational technology when managing individual and families in the community.
We never used any audiovisual or computerized devices to teach the class. Instead, we used oral discussions and visual aids to impart knowledge to the patients. All classes were taught both in English and Spanish using a round table setting. I find that this setting was ideal for patients as they felt more comfortable opening up and relating their stories. Anything that was said during their discussions were kept in the strictest confidence.
Objective 6. Demonstrate a commitment to professional development.
Despite the fact that my knowledge of Spanish is very limited, I was determined to communicate whatever I knew to my patients about diabetes with the help of my mentor. I also tried to keep abreast of things by researching topics relating to diabetes and reading peer reviewed articles. Each week, I also reflected on how well I communicated to my patients and tried to improve on it at the next encounter. This experience has taught me a lot that I am motivated to become a certified diabetic nurse educator at some point during my nursing career.
Objective 7. Incorporate professional nursing standards and accountability into practice.
The American Nurse Association (ANA) states that the professional nurse will use relevant theories, researches, and evidenced-based guidelines to treat human behavior and, or responses. This will entail the usage of the nursing process (assessment, diagnosis, planning, implementation, and evaluation). All patients were treated within scope of practice and as defined by the ANA standards of practice as well as the agency’s policy.
Objective 8. Collaborate with clients, significant support persons and members of the health care team.
During my clinical rotation, I encountered a few patients who were non-adherent with their diabetic regimen for varying reasons. All patients were approached in a non-judgmental way and given information on to how to become more adherent. If support persons accompany these patients, they were allowed to participate in the class and provided feedback on the patient’s progress at home. My mentor and I would also give the doctors in the clinic a quick synopsis of the patient’s learning progress. If patients were noted to be experiencing financial difficulties and could not afford to buy their diabetic supplies, they were referred to an onsite agent who would help them with their orders.
Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
At the beginning of my clinical rotation, diabetic patients who had health insurance were given metro cards. Those patients who did not have health insurance did not receive any metro cards. I noticed that some of the patients who did not receive metro cards either skipped training classes or they dropped out altogether. Some of those patients also were unemployed and were more than likely facing extreme hardship. I recommended that all patients irrespective of health insurance status received metro cards as an incentive to attend the class and as a motivation to finish the class. Last clinical, I noticed that all patients either received a metro card or a receipt to pick one up later at the clinic. The patients were happy to have received it and I was overjoyed to see them received it.
I thoroughly enjoyed my Community Health Nursing clinical experience. As more empowered nurse, I want to listen to the voice of the client more as well as use my skills and power in helping them to allocate the resources they need so that they can live a happier, healthier, and more fulfilling lives.
