This semester I was able to demonstrate my abilities to cope with changing circumstances within the clinical setting whether it was with my patient or with the healthcare team. I was able to utilize my different skill sets in different ways. I applied therapeutic communication, time management, my knowledge of medications, and with this I collaborated effectively with my clinical group, professors, client, and within the healthcare team.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
My ability to demonstrate professionalism during the SBIRT training that was performed at the NYSIM center at Bellevue hospital located on 23st and 1st avenue. My strengths during the lesson was my ability to focus when a challenge became inherent. When disasters strike you need to exude professionalism and a sophistication to get the job done. Teamwork with the members of my team was extremely important in this exercise; I was able to work with my team and we were able to jump right into situations that warranted a nurse who was professional and prepared. When public health disaster arises, a professional nurse who is not afraid to get her hands dirty is something we need, and one who is able to use her creative assessment skills to get the job done.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. How did you see this through in the clinical setting?
The investigative technique of a nurse is where we can apply analytical reasoning and critical thinking skills. During my time at clinical, I learned that critical thinking goes beyond the textbook or a piece of paper but can be utilized during the clinical setting. If a client is suffering from a chronic illness there are ways in which we can help the client.
If a disease process is not known, we can look at the medications to know what disease process the client has! Medications give you insight into what diseases that are compromising your client’s body. I also ask members of their support system what symptoms does this person have, asking the patient works too, however, at times they don’t even know what they are suffering from. The feet and hands are an excellent way to predict diabetes, heart failure, COPD, or asthma. The skin is also an excellent method of finding dehydration. Observing the person for an altered mental status can indicate deoxygenation.
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. EXPECTED BEHAVIORS across the clinical experience, not just one individual
During clinical I came across a myriad of medical professionals from diverse backgrounds that all had different roles that I found fascinating. The different roles were physical therapists, medication aides, home health aides, physician assistants, nursing assistants, and social workers. These diverse groups gave me a inside look into how the care of the patient from all these different sources affect patient care. Different agencies were designated to care for the patient on different body systems. The nurse must communicate with all of these different agencies to make sure that the patient is getting the care that they were intended to get. A nurse should be dependable because if we are going to work with a diverse group we must understand where they are coming from. A diverse group of practitioners warrants a nurse who is able to develop different strategies of listening and communicating.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice. Again, how did you specifically demonstrate this in the clinical setting?
I used different types of therapeutic communication which are listening, using silence, reflection, and, the use of open ended questions to communicate with my client. I understood her need to communicate with people. Her past profession as teacher was synonymous with communication. My ability to communicate with her and to keep her hope alive is one of the skills I wanted to work on with her. The environment I created for her was one that was patient centered. I wanted to institute the paradigm of Watson: health, human, environment, and nurse in which the nurse would provide patient centered care. If the nurse is able to provide patient centered care then the nurse will include the environment, the client’s viewpoint of health, and the bio-physical aspects of integrating health.
Objective 5: Utilize informational technology when managing individual and families in the community.
When drawing up a community assessment for the course we studied the community boards of NYC, my client lived in community board four, the census bureau, information technology, the CDC namely goals of Healthy People 2020. We utilized the Department of Mental Hygiene database, and the Department of Environmental Protection (DEP).
I also took her vital signs weekly with my stethoscope and sphygmometer. I established baseline vital signs for her so each week. I was able to assess how high or low of if out of range she was. I also stimulated her memory with crossword puzzles, memory tests, and Rorschach tests. I used my speakers and played samba music for her, because she loves to dance and sing.
Objective 6. Demonstrate a commitment to professional development EXPECTED BEHAVIORS
Many times, our professor will give us literature from the ANA, American Nurse Today, Stroke Times, Diabetes Times, Sigma Theta Tau, Medical reserve corps, and we will discuss the Republicans plan to reform health care. These are things being discussed. I would like to engage in lifelong learning by applying to nursing honor societies and a master’s degree program.
We accessed reliable websites like AARP, HIV medication and Prevention, and we also delved into the Nurse Practice Acts to see if we were practicing current nursing ethics.
Objective 7. Incorporate professional nursing standards and accountability into practice EXPECTED BEHAVIORS .
I heavily rely on the nursing of ethics and QSEN to guide my clinical practices. These standards set the standard for quality and safety (QSEN), they are: “Patient-Centered Care, Teamwork & Collaboration, Evidence Based Practice, Quality Improvement, Safety, and Informatics (“QSEN Institute. (n.d)”, paragraph 1).
QSEN is a guide that sets the stage for healthcare workers to engage in quality healthcare and also maintains accountability. These codes of honor I abide by because are the things that will guide me in my practice and my affirmations.
QSEN Institute.(n.d). Frances Payne Bolton School of Nursing. Case Western Reserve University. Retrieved from: http://qsen.org/competencies/
Objective 8. Collaborate with clients, significant support persons and members of the health care team
When caring for a patient it is imperative that you can collaborate with social workers, case managers, nurse practitioners, and UAPs. These persons are integral to maintain the health and wellbeing of the patient and you can maintain health, environment, and spirituality of the patient. When we integrate all the members of the health care team to address the patients’ concerns and problems, I was able to implement nursing interventions.
Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
When a member of Dick Gottfried’s Community board four came to speak with us regarding healthcare in the community it became clearer what social, political, economic forces affect the delivery of healthcare services. He spoke about the Affordable care act and the recognizance of long term care insurance for the clients in the building. If a new healthcare act should take over and preside, what does this mean to current healthcare and its players? The social factors of different activities that are being provided for the members of the community. The members of the community had yoga classes, art classes, journal classes, and health awareness classes to guide them in a more productive way towards health. The creation of bike lanes within the neighborhood, state, and local policies, as well as district council and local representatives at specific zip codes.
Our clinical project was, “Spot a STROKE, Save a Life!” We held a group meeting of residents within the building on the signs and symptoms of stroke and the acronym FAST, which stands for face, arms, speech, and time. These are areas of the body that the person needs to be aware of if anything is to go awry. The face, arms, speech, and in a moment’s time the person should get to the proper stroke center immediately.
Communicating this to the group was extremely informative as it provided a platform to educate the group about stroke and to inform of them the signs and symptoms of stroke.
Advocacy, change agents, independence, and being the voice for the client are undoubtedly the most important aspects of nursing. My profession is responsible for many aspects of care from implementing change with patients’ medications, doctor’s orders, ordering assistive devices for patients, modifying patient history and summary. When I began to do these things, then I noticed that my voice, knowledge and nursing expertise.
This semester I was able to expand on these aspects of nursing care to the community and as my role as an advocate within the community with a diverse number of players and I was able to guide the plan of care with therapeutic communication, advocacy, beneficence, and veracity.
