Introduction
Our clinical rotation for this semester is Community Health Nursing and our group was assigned to the Stein Senior Center which is located at 204 E.23rd St, NYC 10010. The course was offered as a summer semester making it a very fast paced class however our group worked diligently to ensure that all course requirements were completed in the allotted time frame. This clinical was unlike any other I have ever attended. We were able to really become involved with the center to educate the members on a variety of healthcare concerns as well as participate in activities offered such as yoga classes, meditation classes, a knitting group and serve lunch. This has been by far the most enjoyable clinical experience I have had thus far in my educational career. Below is a self-evaluation of the clinical objectives set by our instructor.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance
During this clinical rotation one of my assignments was to contact a few members of the community and assess what their individual needs were in the home and any current medical diagnosis. During this time and always, I reminded the client that their privacy would always be protected and I maintained this by using initials when possible rather than whole names, protecting personal information and adhering to HIPPA guidelines. I worked with my classmates and independently to learn the course material and make sure that all learning objectives and requirements were completed and understood such as uploading all my credentials for clinicals to the certified profile website as well as participating in group work to contribute to the service learning project. To prepare myself for the learning experience in the clinical environment, I made sure I had my City Tech College ID present at all times along with my stethoscope, blood pressure cuff, any books and materials needed for each day and dressed professionally at all times. All of my assignments were completed on time. If there was any information I was not clear about, I would consult my group or instructor to make sure I was meeting all requirements as stated in the syllabus. During clinical conference, I often shared my personal experiences for the day as well as listened to others share their experience so I could learn through my classmates. I attended my clinical sessions on time every day and was ready to work the minute I stepped foot in the center. My style of dress was business casual as set by the instructor at the start of class.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families within the community setting
Throughout this clinical rotation, I did not have direct access to the center member’s health records however when needed I was able to obtain subjective information through an interview process. As stated in the previous objective, one of my assignments was to call clients in their homes to assess individual needs. Through this process I was able to learn each client’s medical diagnosis, any medications they are currently taking, if they have home health care, and what other services if any they feel they might need. All the clients were functioning as various levels of cognition with multiple influences such as religion and culture. It was my job to learn and understand each client’s developmental level and provide care based on their cultural and religious needs. For example, if a client was of a certain culture that has a diet which is very high in salt, I now had the job of educating the client on how to enjoy their foods without the high salt content. It was also my responsibility to collect data that was relevant to the client’s needs, and in order to do this I spoke with members directly, used pre-/post-tests when giving a demonstration on fall prevention and used intake forms when conducting telephone interviews. Based on the data obtained, I used the information to provide education on how to prevent falls within the home, assisted my classmates in teaching how to safely self-medicate at home and how to incorporate the DASH diet to prevent hypertension. In any nursing interventions utilized, I first determined what was the most important education needed and began teaching from there. We timed out the workshops so that our group could keep the information less than 20 minutes so as not to lose the members’ attention. I also demonstrated how to use the assistive equipment properly on myself so that no one would be hurt accidentally in the process. Medications were not administered in this rotation however we did educate the members on how to administer their own medications safely in the home. I also evaluated the nursing care I provided by examining the pre-/post-tests that our group provided. After evaluating the care rendered, I reflected on my interventions and learned that many of the seniors did worse on the post-test than the pre-test. My group and I attributed this to the fact that many of the seniors were more concerned with the incentive donuts rather than the actual tests. Client care in the future will be modified so that the seniors would focus more on the content rather than the prize by not telling them there would be a prize until the end. Patient safety was maintained throughout by maintaining a clutter free environment and medication education.
Objective 3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of the individuals and families in the community setting
Therapeutic communication was utilized throughout the rotation by listening actively to each member, asking open-ended questions and maintaining trust. Channels of communication that were used were verbal communication in English and using a translator if needed. I communicated effectively with the instructor and my classmates through emails, phone calls, text messages and directly in person. All data obtained in the course was submitted to the professor through the Service Learning Project and with the team in post conference. Communication skills were adapted to developmental needs of the client by first assessing what would be the best way to explain the information and then asking for a repeat demonstration of skills or information when possible to make sure all questions were answered. Documentation and reports of assessments and nursing interventions were done through the service learning project, class blogs and discussion boards.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice
Teaching plans for the seniors were developed through assessment of the community outside the senior center, utilization of demographics was preformed through census as posted to the NYC official website, through the use of course books and relevant nursing research. In order to establish an environment conducive to learning, our group made sure that we had all the members’ attention and maintained a quiet and non-judgmental space. Client learning outcomes were evaluated through the use of pre-test and post-tests.
Objective 5: Utilize informational technology when managing individual and families in the community
Nursing informatics was utilized in the clinical area through use of the computer lab, e-portfolio and open lab and blackboard. Strict confidentiality was used with patient profiles by protecting sensitive information and using initials when possible.
Objective 6: Demonstrate a commitment to professional development
Current nursing literature was used in the planning of care for clients through the use of current nursing research as well as our texts and any information provided by the instructor. Lifelong learning is displayed by my continued efforts to become certified in the critical care setting, continuing the BSN program and preparing for admission to further my education in a master’s program. Self-evaluation is done on a continual basis by evaluating work provided and seeking constructive criticism when available. Commitment to adjusting to the challenges of independent practice in community health nursing is completed through assessment of community needs and how needs based practice can be rendered within the parameters of resources available.
Objective 7: Incorporate professional nursing standards and accountability into practice
Utilization of American Nurses Association in our clinical practice is preformed through knowledge and understanding of the Code of Ethics and the NYS Nurse Practice Act. Agency standards of practice are upheld through verbal communication with the center directors and staff. Agency mission awareness was preformed through research on the center’s website as well as directly working with staff members.
Objective 8: Collaborate with clients, significant support persons and members of the healthcare team
Our group worked directly with the center director and the various other members of the team to learn and understand the current problems the clients face. Client-care was based on the needs of the client through community assessment and oral interviews. Therapeutic interventions were provided based on assessment results. Healthcare resources were identified through research of the NYC official website as was as through individual research within the community. Clients were guided to make appropriate lifestyle and treatment choices by addressing dietary changes, medication safety and access to health care facilities within the neighborhood. Clients were assisted to make connections to other community agencies through researching what resources are available within the community and directing each client appropriately.
Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services
Gaps in healthcare were recognized by researching what is available to clients of the center within the community especially what is available to those who receive Medicare/Medicaid. We also researched what resources are possibly available to seniors that might not have the financial means to pay for healthcare and how we could possibly help those members access that care. We began to identify solutions to complex problems in the clinical area by using a web of causation to understand how healthcare disparities develop and how we can educate clients to work the resources available to them. Our group acted as a change agent in advocating appropriate health care resources for clients and families through the service learning project so that the center directors may use our project as a means to apply for grants and other financial resources.
Summary
As previously stated in my introduction, I found this clinical to be the most enjoyable rotation I’ve had thus far. I never realized how much community nursing is similar to bedside nursing in regards to the application of the nursing process. I also gained a greater appreciation for the nurses who have chosen this aspect of nursing as their specialty as it is a very important component in the preservation of health in the geriatric population. The service learning project also gave me further insight into data collection and the nursing research process. I will definitely continue to utilize the skills we learned and carry them with me throughout my career.
