Self Narrative
Introduction
Entering into the clinical aspect of Community Health Nursing initially felt like it was going to be just like previous clinical in other nursing classes. I can honestly say this was my favorite clinical experience and felt accomplished as a registered nurse as we spent time teaching the seniors. They were receptive and looked forward to see us every week. I also looked forward to spending time with them and had a lot of fun.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
Throughout my clinical at the Stein Senior Center, I maintained client confidentiality with the members. For example, during blood pressure screening I kept the blood pressure readings with the seniors name on it turned down so the other members cannot see it. Also when asked by the members what were their peers blood pressure reading, I would inform them that I cannot disclose their information with them because according to HIPPA that is confidential information and is prohibited. I assumed responsibility for my own learning by being prepared for class by reading assigned chapters, and doing in class and online assignments. I prepared for clinical learning by being punctual and having my equipment with me at all times. I made sure to complete assignments within the designated time frame. This was done by putting reminders on my calendar on my phone which was reviewed on a daily basis to make sure all assignments coming up are done before the deadline date. I sought guidance appropriately by contacting and talking to my professor, classmates and team leader when I was unsure about anything that involved this course. I participated in clinical conferences by actively listening and responding when necessary. I attended clinical punctually and in accordance with school policy. The day before I made sure my bag was packed, my clothes were prepared to ensure that I arrived to clinical on time. I always dressed professionally, with my hair neatly groomed and clean shoes. Dressing professionally gives a good impression on who you are and it also shows respect.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Interviewing the members was done to collect information about the senior’s health status, health history, culture and concerns. Each member that attended the facility had to fill out a medical history and demographic form, so in the case of an emergency that information about the members can be used to help care for the client. Assessment of the impact of the developmental, emotional, cultural, religious and spiritual influences on the client’s health status was done through interviews and through casual conversations with the members. Collection of data relevant to client’s self care needs was collected via interviews, measurement of blood pressure, educational games, and activities. Physical assessment was done by taking blood pressures, interviews and visual assessment. If a client had an elevated blood pressure that were higher 160/90 a complete head to toe assessment would be done and if necessary after assessment EMS would be contacted for transportation to the ER for further assessment and monitoring. Care was prioritized according to the health problem needs of the members of the community center. During blood pressure screening, I learned that the majority of the seniors have hypertension. Some of them take their medication as directed, while some do not. The priority setting was teaching these patients the importance of taking their medication as directed and making them aware of the outcomes of not taking their medication. I implemented safe, appropriate nursing interventions in a timely manner for example cleaning up any liquid on the floor, moving anything that may be in the walk way that may cause someone to fall, performing hand hygiene, and wearing hair nets, apron, and gloves when handling food. Administration of medication is not done at this facility; the patients are in charge of taking their own medications as directed by their health care professional. Evaluation of the outcomes of care were done by checking the patient’s blood pressure every Wednesday to see if there is any improvement and also asking questions after teaching to see if the patients understand. Although the community of Gramercy Park area is a very wealthy community the seniors are struggling to pay for their expenses. Food in this area is also very expensive and may not be affordable for the seniors. As a result of this, the reflection about this practice of financial problems were seen when more seniors started attending the Stein Senior Center for a meal as compared to 3 months ago when I first started my clinical at this facility. Having the Stein Senior Center in this community is a great help for the seniors by making sure they have a low cost, affordable, healthy, well balanced meal.
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 settings.
When dealing with the patients at the Stein Senior Center, therapeutic communication skills were utilized during conversations and when asking questions about the seniors’ medical history. Some channels of communication that were used were actively listening, clarifying, paraphrasing, asking relevant questions and summarizing. Clear and effective communication with the instructor, peers and health care team were done in a professional manner. When measuring blood pressure and the reading was found to be concerning, it was communicated clearly and immediately to the professor and peers to make sure that they were aware so that interventions and planning can be done for the patient. Some adaption of my communication skills according to the developmental needs of the client was to limit the use of medical jargons and use a more simple understandable language, speaking slower can help them grasp the information delivered to them, and speaking a little louder so the seniors who have hearing problems can hear better. Reports and documents, assessments and nursing interventions were done accurately by posting blogs on blackboard so other classmates can have knowledge about what each classmate were doing at their clinical location. This can be beneficial and a good learning strategy.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice
During my clinical at the Stein Center my group paired up in groups of four and educated the seniors on the importance of blood pressure monitoring, medication compliance, and management of hypertension. We also hosted a learning activity game and a power point presentation to educate them. We used the game and presentation to educate them on the importance of exercise and to teach them simple exercises they can do on their own designed specifically for seniors. The power point presentation educated them on safety and a trivia game educating them about proper nutrition. Finally, there was another game that asked questions regarding their past, which was used as a mind exercise to help them remember things from their past such as music, celebrities, and history of Gramercy Park. The environment was conducive to learning as we utilized the cafeteria, which was spacious and well lit. We also used a podium, big screen TV, and microphone to facilitate learning and to be sure we were visible and heard. We evaluated client learning by giving out pre test and post tests before and after the presentation to see how much was known prior to the presentation and how much was learned afterwards.
Objective 5: Utilize informational technology when managing individual and families in the community.
The senior center did not have electronic records or computer systems regarding the patient’s medical history and care. They did have charts with a brief history, demographics, and emergency contacts, but as they were not a facility that treats patients, their information was limited. Confidentiality was maintained as the charts were kept in the director’s office with limited access, unless there is an emergency.
Objective 6: Demonstrate a commitment to professional development
Appropriate current literature was utilized when planning care for clients as we only utilized information within the last few years. The information was relevant and from relievable sources that utilized evidence based practice. In regards to lifelong learning, I will utilize this experience as a learning experience and use future clinical rotations and work as learning experiences. The responsibility of lifelong learning is my own and I will continue to use all settings and interactions as learning experiences. It is also my responsibility to self-evaluate based on what I have learned and how I have performed under different circumstances. I am also committed to the challenges of adjusting to independent practice by speaking up and advocating for my patient even when working independently. I will also utilize all resources and be ready in the event of any situation or crisis in the community.
Objective 7: Incorporate professional nursing standards and accountability into practice.
I would need to review the American Nurses Association Standards in clinical practice and be sure to be compliant with their guidelines. I will incorporate their guidelines into my practice and be sure others in my practice are also compliant. I complied with the agency standards of practice at the Stein Senior Center by reviewing their mission statement, vision, policies and procedures, and utilizing teaching and care methods that were within the agencies scope and guidelines. I was also accountable for actions in the clinical area, as any patients that were screened and found to have abnormalities such as elevated blood pressure, were brought to the attention of our professor and the program staff. These patients were then referred to EMS and the ER for further treatment and evaluation.
Objective 8: Collaborate with clients, significant support persons and members of the health care team
Client problems were addressed through collaboration with my peers, professor, volunteers, and staff at the senior center. Client needs and interventions such blood pressure screening and exercise programs were coordinated based on lunch schedule and prescheduled activities. Healthcare resources such as safety pamphlets were distributed to seniors and abnormalities such as abnormal vital signs were referred to the hospital. Lifestyle and treatment choices were guided through teaching and presentations, such as a presentation on nutrition geared towards healthy eating for management of diabetes and hypertension. We also assisted clients to make connections to other community agencies such as local pharmacies in the area which offer free blood pressure screening when they are unable to get a reading at the senior center.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
I recognized gaps in the care system for this community as the overall community of Gramercy Park is wealthy but the senior population is struggling economically. These seniors can barely survive on their social security and rely on the senior center to offer the low cost meals that they do. In regards to the clinical area, there are problems in regards to management of hypertension and medication compliance, as many seniors cannot afford their medication and are found to be taking it every other day in order to “stretch out” their supply. Solutions for the economic problems faced by these seniors can be soliciting the local, state, and federal government for a prescription program that offers low to no cost medication for these seniors, who often choose between paying for medication of a meal. While during our short time with the seniors I was able to act for change by advocating to the center to continue their exercise and dance programs to keep the seniors active. The seniors enjoyed our program and I hope that they continue. In regards to outside resources, we referred the seniors to outside resources such as the Red Cross.

In conclusion, I came into the clinical site not knowing what was going to be expected or how well received we would be. While interacting with these seniors I learned that the role of a community health nurse is one that involves not only the clinical care in the community but also a large part is educating and guiding the public towards a healthier lifestyle. We were able to educate the seniors, screen them for health problems, and refer them to outside resources for continued care. Through this clinical I learned what a community health nurse really is and am happy that I got to participate in this learning experience.