Doris Gerdes
My team and I are doing our service-learning on the community around Woodhull Medical Center. My clinical rotation takes place in their geriatric clinic. Most of the clinic’s patients suffer from uncontrolled diabetes and hypertension, which is why we decided to focus or project on those two diseases. Just as discussed in class, I realized how social, financial, and demographic affects patients’ health and access to health care. I’ve learned a great deal during this project. I learned how to better serve my patients based on their needs and I became a better communicator.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
For any healthcare professional, protecting patients’ privacy and adhering to HIPAA is very important. At the geriatric clinic, maintaining privacy is somewhat difficult; the patients walk in the nursing office or stand by the door while the nurse is already with a client. In order to ensure patients’ privacy, once a patient walks in I introduce myself as Miss Hernandez’s student and ask them if they would allow me to remain in the room; I close the doors other patient don’t walk in and hear our conversation; and make sure the computer screen is in sleep mode so they don’t see other patients’ information. I showed professionalism by adhering to the dress code, which were black or blue slacks with a white-collar shirt. I treated both patient and staff with the utmost respect. I missed a few days of clinical, but made up for my hours and handed my assignment in a timely manner.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
A male client came to the clinic for the first time; the tech measured his blood pressure and got a very high number. When I retook his BP, his systolic pressure was in the 200s. When I interviewed the patient, he stated that he was never diagnosed with hypertension. He had just come on vacation from the Dominican Republic and was scheduled to go back in a few weeks. Of course the patient was going to see the doctor, and would most likely be prescribed blood pressure medication; however, given the fact that he was going back home, he need to be taught what to do then. I explained to him what blood pressure is and the changes he needed to make to lower his numbers. I also impressed the need for him to see a doctor as soon as he returned to DR so he can get his needed medications.
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.
Being at the geriatric clinic really helped me improve my communication skills. Most of the patients are Hispanic speaking, which means I had to find another way to communicate with them. The doctor had recommended a patient to get the shingles vaccine, but she didn’t really want to get the vaccine, mostly because she didn’t know what it was or why it was needed. There was a shingles poster in the room that was both in English and Spanish. Since I can read Spanish, I showed and read it to her. At the end, she didn’t agree to the vaccine, but said she would consider doing so at her next visit. I also had the chance to educate a client who only spoke French on diabetes. I was very happy about that, since I was one of the very few that spoke either Creole or French; it made me feel a little bit special. I had the opportunity to interact with the medical team by participating in the morning huddle. During the meeting they talked about the interesting cases that were coming in for the day, the patients who cancelled their appointment and needed to be rescheduled, the days’ workload and changes that needed to be made in the future. It was good to see how the team came together to set goals for the day.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Client teaching is one of a nurse’s most important tasks. Before teaching the patient, I made sure we had privacy and were in a quiet place. I then assessed what they knew or didn’t about their disease and base my teaching on that. Once I was done, I asked them questions to see whether or not they understood what was taught and made clarifications when needed.
Objective 5: Utilize informational technology when managing individual and families in the community.
Unfortunately, I didn’t get access to the patients’ EMR during this clinical rotation; however I protected patients information by putting the computer screen to sleep when the nurse and I left the room in case a patient walks in, and if there was a form that contained patients private information on it, I put it face down on the desk.
Objective 6. Demonstrate .a commitment to professional development.
Being a nurse means that you’ll never stop learning, and in order for you to teach your patients, you need to be knowledgeable on the subjects you need to teach. One of the patients had been prescribed Tramadol and was asking me questions about the medication. Of course I knew what it was for and the common side-effects associated with taking any narcotic medication, but I still had to ask the nurse manager for help so I could ensure that the information I was providing the patient was accurate and that I wasn’t missing any crucial points.
Objective 7. Incorporate professional nursing standards and accountability into practice.
Adhering to my scope of practice is paramount; not only because I have a license to protect but also because I have to protect the patients. Before doing anything, I ensured that I was allowed to by asking the nurse manager. I asked her about the clinics procedures and policies on certain subjects as they came up.
Objective 8. Collaborate with clients, significant support persons and members of the health care team.
A lot of the clients who come to the clinic are accompanied by a family member or an aid. So, I made sure I included their companion in any teaching session and took their input. They are the ones who care for the patients; therefore, it’s important that their knowledge on how to care for the client is assessed and dealt with accordingly. While I was telling a patient that it was important for her to take her blood pressure before taking her BP medication, she informed me that she didn’t have a blood pressure machine at home. I told the nurse manager, and inform the patient that she should speak to the social worker, or ask her doctor to write her a prescription for a blood pressure kit; I also told her that her insurance might cover the kit.
Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
The community around the clinic is comprised of people that are undocumented, uninsured and unemployed. As a result, they do not seek healthcare until it’s an emergency because they’re afraid they will be rejected or worse deported. Most of the patients who come to the clinic don’t have their blood pressure and/or diabetes under control. This is because they waited so long to get medical care or their financial situation doesn’t allow them to eat healthier foods; a can of Campbell food is cheaper than a lettuce head, specially when you had to add other ingredient to it to make a decent salad. With that in mind I told the patients that the social worker is there to help get access to community resources, and provided them with a list of farmers market they can go to get free or cheaper products.
In conclusion, both doing my clinical at Woodhull and working on the service-learning project gave me a different perspective of nursing care. Until now I didn’t learn to look at the community of which my patients are part of and incorporate it in my plan of care. Understanding the community helps me understand my patients more.
