NUR 4010 FA 2013

In completing the Service Learning Project I have fulfilled nine clinical objectives as per the Clinical Evaluation Tool provided.

The first objective to demonstrate individual professionalism through personal behaviors and appearance was fulfilled by exhibiting the following eight expected behaviors. I maintained client confidentiality by not discussing specific client’s issues with other clients in the Center. In addition, when providing blood pressure screening to seniors, I had them write their complete name in one side of the sign in sheet, but wrote in their blood pressure numbers with a corresponding sequential number on the other side of the paper, in order to protect their privacy. I assumed responsibility for my own learning by reading assigned chapters in the textbook in advance. I prepared for clinical learning by keeping an open mind. I completed assignments within designated time frame, as evidenced by my timely submission of midterm paper and 4 timely responses to Blog postings. I sought guidance appropriately by asking my clinical instructor questions about Health Fair and Service Learning Project related issues. I participated actively in clinical conferences when we were discussing proposed themes for the health fair and the best ways to accomplish its success. I attended clinical punctually and in accordance with school policy, as evidenced by me being on time with exception of only one allowable absence. I dressed professionally in dark slacks, sweater top and a sensible pair of shoes.

The second objective to employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting was fulfilled by exhibiting the following eleven expected behaviors. Although I was able to use client interview, unfortunately, I was unable to use nursing and medical records, staff nurses and other health professionals to collect client information due to the limitations of the setting at Stein Senior Center. I was able to assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status. An example of that is when I was assigned to perform the blood screenings and the Hispanic woman whose blood pressure I was checking registered as a relatively high number. I noticed that she was acting anxious, frequently checking her cell phone, as if she was afraid to miss a very importance phone call. I tried to assess the situation by asking her if everything was OK. She said that everything is fine just some minor family issues. She would not elaborate more on this subject, so I just reminded her that Stein Center offers a variety of services and if was in need of help there are several professionals on premises that may help her with her situation. I was able to collect significant data relevant to client’s self-care needs by observing the client and assessing their situation by asking specific questions about their needs and abilities. I was able to complete a physical assessment of selected clients by performing their blood pressure screenings and discussing medications they are currently on. I was able to prioritize care based on analysis of data received during the blood pressure screenings and by providing the relevant educational materials relating to the importance of compliance with daily medication regiment in order to obtain optimal results. I was able to apply priority-setting in planning nursing interventions by performing teachings to the client regarding their medications, alternative therapeutic methods of to manage stress and anxiety such as Tai Chi and knitting. I was able to implement safe, appropriate nursing interventions in a timely manner by teaching the client about how to take their medications at the same time every day. I was unable to administer medications and treatments safely since it was not required at the Stein Senior Center. I was able to evaluate the outcomes of nursing care by following up with the client in one week to see if their blood pressure readings have improved. I was able to modify client care as indicated by evaluation of client outcome by reassessment of the client’s condition in one week and making a recommendation to follow up with the client’s Primary Care Provider (PCP). I was able to utilize principles of personal safety when working in the community setting by using hand sanitizer between the patients when performing blood pressure screenings to the seniors.

The third objective to effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting was fulfilled by exhibiting the following six expected behaviors. I utilized therapeutic communication skills with individuals and families in the community setting such as using silence, accepting, using broad openings making observations, restating, reflecting exploring and giving information when allowing the seniors to reminisce about their past. I utilized appropriate channels of communication by reporting abnormal blood pressure numbers to my clinical instructor. However, this this task was partially limited by the setting of the Stein Senior Center. I was able to communicate clearly and effectively with instructor, peers and the health care team. An example of that is my e-mail communications with my clinical instructor and classmates. I was able to communicate significant data to instructor and the health care team by reporting abnormal readings obtained during blood pressure screenings. I was able to adapt communication skills to the developmental needs of the client by providing information pamphlets written in the client’s native language or using clear simple wording that the client is able to understand due to the literacy and/or educational levels. I was able to accurately report and document assessments, such as blood pressure screenings, and was able to report my nursing interventions to my clinical instructor. However I was unable to document my interventions due to the limitations of the Stein Senior Center setting.

The fourth objective to establish environment conductive to learning and use a plan for learners based on evidence-based practice was accomplished by presenting the following three expected behaviors. I developed and implemented a teaching plan for an adult and or family in the community setting by conducting a Heart Healthy Health Fair at the Stein Senior Center. I provided the seniors with the educational materials about how to preserve and/or improve their overall health, provided informational pamphlets describing the signs and symptoms of heart attack and stroke, the importance of taking blood pressure medication and following a DASH diet, etc. I established environment conductive to learning by placing posters on walls pertinent to the subject matter of the health fair and by conducting a face to face informational sessions with the seniors. I evaluated client/family learning outcomes by asking the seniors to repeat the information they learned during these informational sessions.

The fifth objective to utilize informational technology when managing individual and families in the community was fulfilled by presenting the following three expected behaviors. I was able to utilize principles of nursing informatics in the clinical area by researching the questions presented to me by the client on my I-phone. I was unable to maintain strict confidentiality with client records since informational technology is not utilized when managing client’s records at the Stein Senior Center.

The sixth objective to demonstrate a commitment to professional development was fulfilled by exhibiting the following four expecting behaviors. I used appropriate current literature in planning care for clients in the community setting by researching current informational materials regarding keeping the heart healthy on various websites, such as American Heart Association, Center for Disease Control and NYC Department of Health and Mental Hygiene. I assumed responsibility for lifelong learning by conducting extensive research on the subject matter. I engaged in self-evaluation by participating in the Blogs and by writing this self-reflection piece. I am committed to adjusting to the changes of independent practice in community health nursing by advancing my education and continuing in the learning process.

The seventh objective to incorporate professional nursing standards and accountability into practice was by exhibiting the following four expected behaviors. I utilized American Nurses Association Standards in clinical practice by practicing safely and within the scope of my practice. I have successfully taught and distributed comprehensive educational materials in accordance with the client’s educational levels, physical abilities and in the client’s native language in order to improve health outcomes for the client. I complied with agency standards of practice by enforcing compliance with HIPPA requirements when recording blood pressure screenings for the seniors. I am accountable for actions in the clinical area by practicing safely and within my scope of practice. An example of that is when one of the seniors asked me for Aspirin to relieve her suffering from a severe headache instead I offered to take her blood pressure, as I was concerned because she was presenting a sign and symptom of a stroke. I am aware of the assigned agency’s mission, which is to cultivate friendly relations among the members of the Stein Senior Center and the general public; to provide services with an emphasis on group growth; to share the strengths, and wisdom of senior citizens; and referral services, and to safeguard the health and wellness of senior citizens.

The eighth objective to collaborate with clients, significant support persons and members of the health care team were fulfilled by exhibiting the following five expected behaviors. I was unable to collaborate effectively with health care team to address client problems due to the limitations of the Stein Senior Center setting. I was able to coordinate client-care based on client needs and therapeutic interventions by corroborating with other professionals at the center, such as a social worker and victim’s services coordinator. I was able to identify health care resources for client/family by referring the client to his/her Primary Care Provider in case the medication regiment was not deemed effective, as evidenced by the elevated blood pressure readings. I was able to guide clients/families to make appropriate lifestyle and treatment choices by emphasizing the importance of medication compliance and following a heart healthy diet by limiting sugars, saturated fats and sodium. I was able to assist clients to make connections to other community agencies by referring them to the social worker at the Stein Senior Center.

The ninth objective to recognize the impact of economic, political, social and demographic forces that effect the delivery of health care services were fulfilled by exhibiting the following three expected behaviors. I recognized gaps in care system by recognizing ethnic, professional and educational backgrounds of the clients, as well as their significant limitations of financial resources when seeking healthcare. I began to identify solutions to complex problems in the clinical area by educating the clients and keeping them informed about the importance of preventative care. I acted as change agent in advocating to appropriate health care resources for client/families by educating them about the importance of seeking information as well as self-education about various health issues prior and subsequent to seeking healthcare.

Summary:

I am happy to admit that my overall community health clinical experience was extraordinary. During the last 12 weeks I was able to successfully organize and implement a health fair for the members of the Stein Senior Center. I learned of multiple sources of obtaining information, how to organize, schedule, seek assistance when needed, overcome barriers, obtain products from vendors that may be beneficial to the population of the senior center, introduce vendors that will provide information on disease prevention and health improvement. I have obtained an immense amount of valuable knowledge and information on how to practice in the community setting. I learned to interact with people of diverse cultural, ethnic and religious backgrounds. Since health education is a primary focus of community health nursing, providing people with reliable, useful information about how to protect their health is the primary goal of community health nursing. By conducting a health fair at the Stein Senior Center, as a community health nurse I explain proper nutrition, demonstrated effective safety practices, promoted prevention and early detection of common illnesses, and informed members of the center about other important health issues. Finally, I was able to identify that the primary goal of community health nursing is to make health information accessible, culturally appropriate and easy to understand, so people can take greater control over their wellbeing.

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