Alicia Yang’s ePortfolio

Alicia Yang's ePortfolio
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Portfolio Description

The purpose of this self-reflective paper is to share my clinical experience as Community Health Nurse (CHN) in Visiting Nurse Service of New York (VNSNA). VNSNA is the biggest home care agency in New York, provides nurse home visit, physical therapy, social worker service, OT and home Aide service to their clients. The mission of VNSNA is to maintain clients in the community with high quality of care. This clinical assignment provides me a change to work with clients and their families in the home setting. It’s greatest experience to using cost effective, but high quality of care to clients and their caregivers. This short term care program enables the clients to remain in the community during their sub-acute period of health condition.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
I maintained client confidentiality, compliant to HIPPA regulation; never discuss client’s information with classmates or instructor in the public area; only access to clients information who was assigned to me, never declare client’s identification when posting clinical experience on blogs or discussion board, etc. keep working laptop in my eye sign all the time, or well protected area only, password protected while not in using. I received training in VNSNY in different topics such as Street Safety and Alert for the own safe of CHN, Wound identification, measuring, applying dressing, etc. I always read my assignment, anticipated if any situation may happen, found the best route of arriving to client’s house, be well prepared all the time. I finished assignments on times; able to go to and come back to post conference, completed related paper work. I would go to my clinical instructors for guidance if I have question about the assignment. I participated in clinical conferences; shared my point of view with instructors and other students. I was never late or absent from my clinical day or left early. I dressed professionally as school requirement, with dark pants, white color blouse and black leather shoes.
Objective 2: Employ analytical resonating and critical thinking skills when providing care to individuals and families in the community setting.
All of clients we assigned were not the initial visit. I collected my assigned client’s information by reviewed the medical record, interviewed, assessed, analysis the information, then delivered care to client according to his/her health condition and previously developed plan of care. I always assessed my assigned client’s educational level, culture background, religious and spiritual influence, caregiver availability, which may impact client’s learning ability before I develop plan of care for them. I also gathered significant data by nursing assessment and interviewing with clients, observed client’s physical and mental status to analysis client’s priority and other needs, then implements safe, appropriate nursing intervention in a timely manner. I had client, lives in daughter’s house temporary secondary to damage to her own house by Hurricane Sandy. She couldn’t find her glucometer; living area was packed with the items moves from her own house. She told us she couldn’t think about anything now, just wanted to moved back to her own house as soon as possible, that she can take good care of self. After got permission by client, assisted her found the glucometer and missed medications. I also realized if I taught client and caregiver to empty the hallway, make the living area neat as usual would not be realistic in this time, instead, I concerned about the home safety, suggested the hall way should be free of obstruction in order for client able to ambulates around the house by using roller walker. Client was able to pre-pour her medication, after we found the medications, observed client of pre-pouring, make sure client was able to take correct medications in appropriate time. I had treated client safely as per order and set priority of care. I evaluated client’s nursing outcomes by reviewing the previous nursing notes, compared client’s health condition, modify plan of care as needed with clinical instructors. Besides caring of client, I also paid close attention to self-safety, wear comfort shoes, not wearing jewelry and avoid carrying valuables.
Objective 3: Effectively communication skills with individuals and families in the community setting.
When talking to clients and their significant others, I tried to remain nonjudgmental, listen actively, maintain good eye contact, and encourage client to explore their experience. If I am not sure what they said, I usually verify and clarity it. I never pretend I understood it when I don’t, especially talking to client with language barriers. Use language line or interpreter if needed. Asking clients to verbalize what they perceived and encouraged them to ask questions. I always gathered and prepared all significant and necessary clients’ date before calling other caring discipline such as primary physician, physical therapist etc. I was able to communicate effectively with clients, talking slowly and repeating the word as needed, especially for hearing impairment. I was able to report and document correctly based on client’s medical status and assessment.
Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence-based practice.
I was able to develop and implement a teaching plan for my assigned clients, established environment conducive to learning, and evaluated the learning outcomes. I had developed a diet plan for one of my assigned client. He was newly diagnosed with diabetes. I prepared my teaching plan based on my clinical experiences; I also had a literature review on diabetes diet base on client’s culture background. I notified client one or two hours in advance, and let him know the discussion topic, that way he was also well prepared and welling to learn when I came. I established a comfortable and respectful teaching environment; provide him with some options for his daily meal plan. He was lived alone, financially relay on his social security income. Most of the food he chose was mostly affordable. By the end of visit, he was able to name few carbohydrate foods such as rice, bread, pasta, etc. he also chose protein intake from bean, chicken, and egg. He verbalized the importance of avoiding high concentrated sweet food, kept some snack with him all the time if felt sign and symptom of low blood sugar. This teaching plan was successful.
Objective 5: Utilize information technology when managing individual and families in the community.
I was able to utilizing principle of nursing informatics in the clinic area; maintain strict confidentiality with client record. Most of the time, the electronic client record were used, I was able to document in the laptop provided without difficulty. The client record was password protected. I never share my password with anyone, logged out immediately when the computer not in using, kept the working lap top within eye signed all the time, never use this computer in the public area. Client’s privacy was maintained.
Objective 6: demonstrate a commitment to professional development.
I used appropriate current literature in planning care for clients in the community setting, assumed responsibility for lifelong learning, engage in self-evaluation and was committed to adjusting to the challenges of independent practice in community health nurse. I reviewed the related literatures from VNSNA intranet, internet and professional journals before engaged to develop plan of care for my assigned client as needed. Sometimes I read nursing articles from library to keep myself update with some new nursing aspects. I was also able to review VNSNA’s policy and procedures as needed to maintain a high nursing practice standard via their intranet, able to access to City Tech Library via online service to find the health care related articles. In every clinical day, we discussed our concern, skill needed, any suggestion and any weakness during the preconference and post conference, even during the client visit, we can still able to called our instructors if any question. To find the car parking was the biggest concern for commute to VNS Brooklyn office, but having car also facilitate me to get to client’s house in timely manner. I was able to find a parking in I arrive that area around 8am. Working in the community required good sense of travelling, critical thinking, effective communication and assessment skill and fast response and self-motivation were essential.
Objective 7: Incorporate professional nursing standards and accountability into practice.
I was able to utilize American Nurse Association Standard to guide me during my clinical rotation, complied with VNSNA’s standard of practice, was accountable for actions in the clinical area and was aware of VNSNA’s mission statement. I was always compliant with VNSNA’s policy and procedure. For example, if client diagnosed with diabetes or checking blood sugar every visit was written in the doctor order, the blood glucose level should be either reported by client or caregiver or should be checked by CHN; daily weight were needed in the record for the Congested Heart Failure client. I had to teach client to write down the daily weight or daily blood sugar in a booklet and provided to CHN if possible. I tried my best to reach VNSNA’s mission, to provide high quality of care to client while maintain client’s independency in the community.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
I collaborated effectively with health care team to address client problem, coordinates client-care based on client needs and therapeutic intervention, identified health care resource for client/family, and guide them to make appropriate lifestyle and treatment choices. I always reported to the primary nurse regarding client’s significant finding by writing a nursing notes, or oral reported to the nurse coordinator at the end of my clinical day. One of client asked if she can received more service since recent declined of her health condition, looking for if any other service can help her. Client stated she had both Medicaid and Medicare, beside the current received short term care via Medicare, possible to addition long term care she may be able to have. After discuss with instructor, the referral were sent to VNS Choice, another branch of VNS, provide long term care to clients.
Objective 9: recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
The branch of VNSNA I had was short term sub-acute home care program in VNSNA. Most of the clients were insured by Medicare; client may or may not have other insurance to cover non Medicare part. In this program, the maximum of Home Health Aide (HHA) provided to each client were 4 hours x 5 days per week. For someone without secondary insurance such as Medicaid, if they required more then that 20 hours per weeks of HHA service to maintain them safety in the community, and yet client may not be nursing home eligibility, they may have to pay additional service out of their pocket, or stay unsafe in the community. Also there may be the gap between the insurance policy and patient’s needs. For example, client used up the maximum days in the short term care, was discharged from this program, client may be in dangerous when discharge from the short term care, Re-hospitalization probably be the other end of result. It also cause dilemma for CHN to discharge ‘not ready’ client who can still benefit from the cares. I was always advocating to patient to receive appropriate health care resources. For example, one of my assigned clients just received roller walker, unable to ambulate with it steady. After discussed with PCP on the phone if client can be benefit from physical therapy, the initial physical therapy evaluation was obtained, and then the physical therapist will follow up with client and PCP regarding the evaluation regarding the evaluation result.
In conclusion, I believe I meet all the objectives of clinical performance. The interesting and different experience in community setting benefits me from personal and professional growth. It reinforces my knowledge and understandings of maintain professional behaviors, practicing critical thinking skills, gaining effective communication techniques, and having self-awareness. I am looking forward to learn more aspect of community health in the future.

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This ePortfolio was created by: Alicia Yang

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