Narrative Self Reflection
Introduction: The Stein Senior Center is located at 204 E 23rd Street New York, NY.10010, in the Gramercy district of Manhattan. This center was my clinical location for the Community Health Nursing Summer 2015 for my baccalaureate degree. This center is a place where Senior Citizens ages 60 and older can meet, socialize, obtain a well-balanced meal, and get assistance and counseling with their activities of daily living. It was a good experience for me as a Community Health Nurse assigned to that center. We presented on three different topics related to Health Promotions of seniors. My group focused on Medication Safety, while the other two groups focused on falls prevention and a crash diet. The nine objectives below within my narrative self-reflection gave me a better understanding for the role of the Community Health Nurse.
Objective 1: Demonstrates individual professionalism throughout personal behaviors.
My clinical rotation at the Stein Senior Center was very interesting and we met every Tuesday and Wednesday for one month duration. Maintenance of the client’s confidentiality was of paramount importance for me. I did so by not disclosing their personal information to the public. Initials were used instead of their names when documenting their Blood Pressures and Pulses. I assumed responsibility for my own learning, by use of the computer, books, listening to the radio and watching television. I also used the internet to get information from websites that has information pertaining to the aging and maintaining a healthy lifestyle, such as one from The Department of the Aging. I utilized the information I gained from these websites and applied them in the clinical setting. I used the media, handouts which pertain to the subject and hands on instruction from my professor to prepare for my clinical learning. I then used what I have learned to teach it to the senior citizens. Bob who is the Associate Director and other staff members answered any question that I had. By completing my designated assignment within a timely manner further gives me more time to focus on helping others at all times who are within my group and to complete our class project. Punctuality at our clinical site was of paramount importance and also keeping within the dress code. I was neatly dressed and wore slacks and comfortable shoes daily. I obtained a vast amount of knowledge from the senior citizens from interviewing them and by asking questions pertaining to their health. Other staff members at the Stein Senior Center provided me with information which I kept confidential at all times. As a Community Health Nurse it is my duty to be tolerant with the senior citizens who are of different races, and are diversified in culture, and understand that the client should be the primary centered when providing care.
Objective 2: Employ analytic reasoning and critical thinking skills when providing care to individuals and family in the community setting.
During our pre-conference we discussed going out in the community and observe what type it is from the prospective of it buildings, health settings, restaurants and other amenities that are available in that neighborhood. We were assigned in groups within the center to assist and observe the senior citizens and asked about their health status. We did Blood Pressures (BP) and pulse assessments and some of the senior citizens were quite willing to participate in these assessments. When taking blood pressures and pulses I always asked questions about the medication they are currently taking and if they are in compliance with following up with their medication regimen. In addition, I asked them if they are keeping doctor’s appointments and about their lifestyles as this can help with identifying the way some individuals deal with their perception of health to maintain safety and wellbeing. They in turn stated that they will incorporate their new knowledge with their medication safety.
Objective 3: Effective communication with diverse groups and disciplines a variety of strategies regarding the health needs of the individuals and families in the community setting.
I used my communication skills at the Stein Senior Center based on the senior citizens level of understanding. These clients were alert and oriented and when doing our presentation on medication safety I asked questions on a simple level and gave information about the use of having proper lighting and having good vision to be able to read the medication labels. I also avoided using medical terminology so it won’t appear like jargon to the clients. Speaking different languages may be barriers to communication. Most of the senior spoke mostly English, and coming from another culture makes me understanding if a client speaks a language different than English language, or have difficulty hearing I will have to find a different mean to communicate with the client. I took their blood pressures and pulses in quiet surrounding so that it could be audible for documentation of proper readings. I report all finding to our professor, and using the nursing process of Assessment intervention and Evaluation is important, but remembering that the client have to be the center of care. There were approximately twenty clients present at our presentation and I held their interest as I communicated with them via the microphone so that I could be heard for them to know the proper method of medication safety.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
At the Stein Senior Center it was not a clinical setting however, when interviewing and talking to the senior citizens I was aware that all information should be confidential. In the clinical area, as interviewing my client if there is a family and friend accompany the patient. Keeping confidential with my client information will enhance trust between the client and me so I can have an opportunity to know the client health care needs to make the best and appropriate patient care decision based on evidence. I always asked my clients if they have any questions at the end of any meeting and I was not judgmental with their ideas.
Objective 5: Utilize informational technology when managing individual and families inthe community.
HIPPA law is one of the most crucial point that health care-taker should take into consideration. As a nurse I have to keep all their information private and should only be shared with someone who is appointed to be part of the care decision. All Senior citizens information should be kept secret for the provider and the patient. The seniors at the Stein Senior Center, are very intelligent and some of them use the center for internet access to gather information pertaining to their health. Privacy and confidentiality of the seniors are kept at all times. As all information about them and their family must be confidential and I used initials instead of having their full names visible, to maintain privacy.
Objective 6: Demonstrate a commitment to professional development
Taking this class help me to understand how important it is for having community health nurses. As nurses, we sometimes focus on hospital base but not community base. But in the community, there are different areas and opportunities to help people with health care issues. By eliminating some health disparities in our population we can have a healthy future and generation through our teaching techniques. Encouraging the population to follow a healthy lifestyle can prevent certain diseases from occurring. I read peer reviews, research articles, and journals. I also utilized my clinical info, which allowed me to relate to the clients problems and find answers based on these resources. I learned not to follow the empirical way. I am committed to demonstrate professional development on what I learned as I practice within the community.
Objective 7: Incorporate professional nursing standards and accountability into practice
On our first day of orientation, our Instructor gave us an insight about nursing accountability for nursing practice. As a School Nurse, I incorporate my daily clinical learning to my job as it has helped me utilize critical thinking to care for my students and be responsible for my actions. I adhered to the utilization of the American Nurses Association standard in my clinical practice as a qualified Registered Nurse and showed competency to carry out the role as a community Nurse in the community to which I’m serving. Following HIPPA guidelines I was professional at all times do so by empathizing, listening and being non-judgmental, and patient teaching.
“The Stein Senior Center Mission is to cultivate friendly relations among our 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 our senior citizens.” The clients who come to this center participates in a delicious healthy meal daily. My goal is to deliver the best care possible to the community and keep a healthier working environment
Objective 8: Collaborate with clients, significant support persons and members of the Health Care team.
During my assessment, I was able to collect the tools possible in order to allocate what systems are available to help individual senior citizen needs. I was able to teach my clients about what steps they should make to help them stay healthy and what can be made differently, and all of my communication were based on client preferences, culture/religious beliefs, and level of education. Before Lunch each day, their program usually begins with light exercise and dance. One of the workers use the microphone to keep their attention and to encourage participation with the routine workout. Our group took part in the exercise workout and dance and I can say that I enjoyed it quite a lot. I communicated with different levels of the center staff, collected information and learnt how the center was run, their sponsors and affiliations to other groups in the city. The clients at the center get most of their help from social services who helps them with transport to and from the center and with follow up with doctor’s visits. The center provides pain management interventions like yoga stretching and meditation groups to which we participated. I referred some of the seniors to health and hospitals which provides services for getting food stamps, Medicaid for low income health care insurance, and information for access to teaching groups if there are safety concerns like abuse, alcoholism, and gun violence.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
In the Gramercy district of Manhattan, the impact of economic, political, social and demographic forces is diverse. The community is of different races and culturally there are many different types of entertainments that takes place daily. Some senior citizens at the Stein Senior Center uses Medicare insurance as this is an insurance that is given to citizens 65 year and older. Some make uses of private insurances as many of them worked previously and have now retired. Many of the people that live in the community are from different cultural backgrounds. This center meet the need of citizens from the five boroughs. There are gaps in this community with the health care system. Some of the clients that frequent the center are in need of other amenities such as help with their (ADL’s), Activities of Daily Living. Some still need a little more help with seeing specialists because they are on fixed incomes. Even with help the gaps in the care system or delivery still exist due to limitation with insurance, especially if they want to consult a physician for a second opinion. There should be a constant and ongoing teaching in the community to help the clients stay healthy as to educate them about food choices, diet, and exercises due to the prevalence of obesity, diabetes, HTN and cardiac disease.
Conclusion
During my clinical experience I learned a lot. It was better than I expected and it taught me that there is a variety of areas in which the Community Health Nurse can perform, beyond bedside nursing and use expert knowledge. Apart from the client and their family, the Community nurses have a lot of responsibility in making patient care decisions and can huddle the medical team together with confidence to meet the needs of the community.
