NUR 4010 FA 2013

Christina Ming                        Narrative Self Reflection

My clinical placement for community health nursing course took place in Bellevue Hospital which is America’s oldest continuously operating hospital and serving patients regardless of pay since 1736 and located in 462 1st Avenue, New York, NY 10016.Bellevue Hospital is well known for its emergency, trauma, psychiatric and ambulatory services. It also handles about 300,000 outpatient visits in more than 90 adult and pediatric ambulatory care clinics each year. I was assigned in ENT outpatient clinic located on third floor of the B building. My clinical experience in Bellevue Hospital is very interesting and valuable for me.

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

I demonstrated objective 1 by reporting to my clinical area on time every Tuesday and completed my assignment within designated time frame. I always dress professionally within required dress code. I prepared my clinical by reading, researching the area that I didn’t know about and always ready to help in clinic within my scope of practice. I was also eager to share and educate my knowledge to other staffs members and to client. At the same time I maintained client confidentiality according to HIPPA.I sought guidance appropriately by asking clinical instructor, clinical manager and physician if a problem rose during patient care.

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

For objective 2, I collected client’s information by interviewing client and family member, checking in medical records, asking staff nurse and other health professionals who involved in client care. I assessed client’s developmental, emotional, cultural, religious and spiritual influences that impact on client’s health status and practices before educating patient’s self-care needs.  I prioritized care based on client clinical condition and applied priority nursing intervention by arranging postoperative client in priority to be seen by physician on the next day of the clinical appointment. I always complete a whole physical assessment for operating client before the procedure, during and after procedure. . I implemented safe appropriate nursing interventions by identifying client with two ID name and date of birth, by maintaining strict sterile field on operating equipment and operating area. I also administered medications and treatments safely by assuring right medication, right dose and right amount of time (Timing for application of chemo drug after surgery). I evaluated my nursing and patient’s outcomes as indicated by return demonstration of teaching materials, free of complications, infection and control of pain management.

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 effectively communicate with diverse groups by serving as interpreter for Mandarin speakers who needed to sign for informed consent, explained benefit and risk of the procedure and what they would experience during procedure.  I also communicate effectively with clients who do not speak English and Mandarin by using telephonic interpreter services and staff interpreter as needed for preoperative teaching. I utilized therapeutic communications with the clients by answering questions of their concern, establishing trusting relationship by assessing their fear, anxiety and pain in a therapeutic manners. I communicated clearly with health care team members regarding client’s significant data and reported promptly for appropriate treatment, but I did not document that my community nurse did not expect me to do. I also communicated clearly and effectively with peers and instructor through blackboard.

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

I established environment conducive to learning and use a plan for learners based on evidence-based practice of listening music before, during and after surgery to decrease anxiety and pain. I had a chance to participate in preoperative teaching to Pterygium patient, we (my instructor and me) did not have much time to spend on teaching due to limited time frame and patient’s nervousness. I developed a plan to reduce patient’s anxiety by asking patient’s concern about surgery first, and then answered their question. After that I started to go over only relevant information about the procedure because I thought patient would not absorb much information due to anxiety. I only stressed about what will feel after procedure and contact number if patient has any concern questions during office hour and number for emergency after office hour. I also advised patient to listen music if he/she had one during waiting hour. I found out patients were more calm and trusted relationship was apparent between us. Patient demonstrated feel comfortable to talk to me and asked questions.

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

Although I do not have an access to log into the hospital electronic medical record system, I was able to check patient’s medical history on appointment sheet that printed out from the front desk and the test needed to be done before the patient was to be seen by the physician with the assistance of the manager. I strictly followed the law of HIPPA to keep my client’s confidentiality when I accessed to client information.

Objective 6:   Demonstrate a commitment to professional development.

For objective 6, I used appropriate current literature in planning care for clients provided by Bellevue hospital and Department of Health in the community setting. I utilized brochures from Department of Health for flu vaccine in educating our fellow students at our health fair and used the hand out provided from Bellevue hospital for teaching smoking cessation for my client. I read, studied and researched resources in order to provide education about prevention of disease. I assumed responsibility for lifelong learning by researching, reading nursing and medical journals, and attending conferences to catch up with up to date news and issues regarding nursing. I engaged in self-evaluation by assessing the strength and weakness of my skills and performance of nursing practice and setting a realistic goal to accomplish during my practice.

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

I  incorporated professional nursing standards and accountability into practice utilizing American Nurses Association Standards in clinical practice and complied with the hospital standard of practice by delivering safe and quality care by continuously identifying client, assessing, diagnosing, planning, implementing and evaluating of client’s outcomes. I was accountable for all my actions in cooperating clients care and was aware and maintained hospital mission by delivering quality care to every client who comes to the hospital regardless of their legal status and ability to pay.

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

For objective 8, I collaborated effectively with registered nurse, residence and surgeon to address client’s clinical issue such as abnormal vital signs, pain, medication and concern about consent and procedure. I collaborated effectively with patient care technician regarding client’s appointment, blood test, and equipment. I assisted clients for free transportation services and coordinated in preoperative teaching, during operation and follow up care in ENT clinic. I identified health care resources for my client, my fellow NYCCT students for free immunization walk in clinics at Department of Health. I also guided clients by offering hand out to make appropriate lifestyle choices and treatment options for quitting smoking like nicotine patch, gum, medications, electronic cigarette, acupuncture, and hypnotherapy. I did not personally make connections to other community agencies but I provided information for support group.

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

I recognized gaps in care system that Bellevue hospital is serving very diverse populations and language barriers in health communication is the challenges facing in Bellevue. Although telephonic interpreter services are available in hospital and that does not mean every single problem is resolved regarding language barriers that health care workers face in daily basis. In my clinical experiences, a Bangladesh speaker female who came to the clinic for pain and redness of her eyes and required to be seen by doctors for assessment. She required to go to admission first and came back for immediate appointment, she spent four hours for looking the right places, stayed in line and finally to get chance to see doctors. Client was running place to place due to lack of written communication given by health care workers or failed to provide verbal communication in client’s language created feeling of anger and frustration of spending tremendous amount of time to be seen by the doctors. My solution to this complex problem is to educate health care workers to give written information to clients with limited English proficiency so that they can show to other staffs and be able to redirect them and advice given to manager for available of bilingual health care worker in clinic.

In conclusion, my clinical experience is very interesting and rewarding for me. I have learned to work with multidisciplinary health care teams and communicate with very diverse population. I have learned a lot about physiology and disease aspect of eyes, ears and nose, treatment and preventative method that I had no previous experience. I have gained so much knowledge about preoperative teaching, great insight about flu vaccine and treatment options for smoking cessation this semester. I am so proud of myself that I have educated myself and gained much confident in teaching about health promotion, disease prevention and health maintenance to my client.

 

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