NUR 4010 FA 2013

Introduction

This narrative will describe how well I’ve met my nine community clinical objectives for this semester. I did my clinical at Bellevue Hospital Center and was assigned to the outpatient oncology chemotherapy infusion unit. Bellevue Hospital Center is located at 462 First Avenue, New York, NY 10016. On the upper east side of Manhattan, in the Kips Bay Neighborhood. It is one of America’s oldest operating hospitals. This state of the art hospital center is one of the major referral cites in the city for complex cases.  Bellevue serves members of the community regardless of their ability to pay.

 

Objectives and goals

The first objective which was to demonstrate individual professionalism through personal behaviors and appearance. I met these objectives by: maintaining client confidentiality, never sharing patient’s personal information with anyone outside of the patient’s direct medical care, assuming responsibility for my own learning by making sure to always ask questions and being proactive, preparing for my clinicals, learning and seeking appropriate guidance when needed. Also by participating actively in clinical conferences, attending clinical punctually and in accordance with school policy and lastly by dressing in professional attire.

The second clinical objective is, employing analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting. To fulfill this objective I had to utilize client interviews (done by the assigned nurse), nursing ad medical records, staff nurses and other health professionals to collect client information that I needed. The nurse that I was working with allowed me to look at a few patients records when I arrived in the morning. This way when I observe her administering chemo treatment I would be more familiar with the diagnosis and medical history and medications being given. Looking at the patient’s medical records helped me to subjectively assess the impact of developmental, emotional, cultural, religious and spiritual influences on the client’s health status. Completing a physical assessment of selected clients, prioritizing care based on analysis of data, applying priority-setting in planning nursing interventions and implementing safe and appropriate nursing interventions in a timely manner and administering medications was part of this clinical objective. This didn’t apply directly to me. However, I often observed the nurse that I was assigned to demonstrating these tasks and I mostly performed subjective assessments. The clinical allotted time frame did not allow me to be able to be able to evaluate outcomes of nursing care. It also wasn’t within my standards of practice as a student nurse to modify client care as indicated by evaluation of clients’ outcomes. I nonetheless observed the nurses doing this on multiple occasions. And finally I completed this objective by always utilizing personal safety my clinical setting.

The third objective which was effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting. This goal was to be met through utilizing therapeutic communication skill with individuals and their families, utilizing appropriate channels of communications, communicating clearly and effectively with the instructor, peers and the health care team and communicate significant data to instructor and the health care team. I was able to adapt my communication skills to the developmental needs of the client by using non-verbal communication tool when necessary. During this clinical experience we didn’t have to do any documenting or reporting of assessment and nursing interventions, we were only observing.

The fourth objective that had to be met was, establishing an environment conducive to learning and using a plan for learning based on evidence-based practice. This objective had to be met by accomplishing these three goals: developing and implementing a teaching plan for an adult and/or family in the community setting, establishing an environment conducive to learning and evaluating client/family learning. These goals were put into action through the service learning project. My clinical group service learning project was on the importance of receiving  a flu shot and convincing people to take the flu shot, to not only protect themselves but, to also protect others.

The fifth clinical objective, utilizing informational technology when managing individual and families in the community, had to be met by accomplishing two goals. These two goals were utilizing principles of nursing informatics in the clinical area and maintaining strict confidentiality with client records. The first goal didn’t apply this semester because I didn’t have access to inputting information into any database on the computer. The second goal was met by not sharing any information that was seen in the patient’s chart with anyone that was not within the patient’s direct medical care.

The sixth clinical objective was to demonstrate a commitment to professional development. To appropriately satisfy this objective requirement a few goals had to be met. Using appropriate current literature in planning care for clients in the community setting did apply to me during this clinical rotation. While participating in the service learning project this semester, I had to utilize current literature in order to create a community teaching plan to educate people about the importance of receiving the flu shot. Assuming responsibility for lifelong learning, engaging in self-evaluation and being committed to adjusting to challenges of independent practice in community health nursing did apply. As a nurse you are constantly learning new information, this is a way of staying current and updated on new evidence-based practices.

Objective number seven was to incorporate professional nursing standards and accountability into practice. This goal was to be met by utilizing the American Nurses Association Standards in clinical practice, complying with agency standards of practice, being accountable for my own actions in the clinical area and being aware of the Bellevue’s mission statement. I met this goal by upholding Bellevue’s mission, which is to provide the highest quality of care to New York’s population and to deliver health care to every patient with dignity, cultural sensitivity and compassion, regardless of ability to pay. I always made it my goal to be culturally sensitive to the patients that I’ve encountered and to treat them with dignity and compassion.

The eight objective was collaborating with clients, significant support persons and members of the health care team. To meet this objective there were five target goals to accomplish: collaborating effectively with the health care team to address client problems, coordinate client-care based on client needs and therapeutic interventions, identifies health care resources for client/families, guide client/families to make appropriate lifestyles and treatment choices and to assist client to make connections to other community agencies. The goals that had to be met in this objective didn’t apply to me during this clinical rotation. I however, witnessed the nurse that I was paired up with performing these tasks every time I was there.

The last objective, objective number nine was to recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services. To satisfy the requirements of this objective three goals had to be met. These three goals were to recognize gaps in the care system, begin to identify solutions to complex problems in the clinical area and acts as a change agent in advocating to appropriate health care resources for client/families. This didn’t really apply to me this semester because, I wasn’t in a position to directly promote a change. I however, did recognize gaps in the health care system, for example, I noticed that sometimes when the nurses would be informing the patient’s about their medications and about possible side effects, they tend to just read it to the patient without ensuring that the patients are listening. I don’t know if they do this because they see these patients on a regular basis and the same patients are getting the same medication regiment every time. I personally feel that you should always make the patient aware of his or her treatment and to make sure that the information that you are giving to them is being received.

 

Summary

When I first chose Bellevue as my clinical site, I was excited. That excitement soon turned into nervousness on the first day of clinical, when I found out what department I was assigned to for the semester. When I heard that I would be going to the oncology department my heart dropped. This was the one department that I didn’t want to be assigned to. I had always had this idea in my mind that all I would see in the oncology department was patients being nauseous and vomiting all the time. That is something I was not too fond of dealing with, if I had any other choice. It was a place I would never have considered working in. Although I had all these negative ideas about the oncology department, I nonetheless went up to the department with a positive attitude. Before the first day of clinical was over, I had a complete and total change of mind. The outpatient oncology unit was nothing like what I had expected and I loved it. I met some wonderful, amazing and inspiring patients there. The staff were very nice, welcoming and receptive. They were willing to teach me the things that I needed to know about the unit and to show me around the unit. Now that I am at the end of my community clinical experience I can honestly say that I had a wonderful experience.  All of my negative misconceptions about the oncology department have been put to rest. Because of this clinical experience, outpatient chemotherapy units has been added to the list of places that I would like to work. I am grateful for my clinical opportunity at Bellevue hospital this semester, it was a true eye opener for me.

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