Introduction:
During this semester of Spring 2015, I am taking the Community Health Nursing course and my clinical site is Lutheran Hospital with Professor Scarlett. Although the clinical site is Lutheran Hospital, our group of ten students was broken up into three different sites, Shore Hill Road, Harbor Hill and Sunset Park Senior Center. On the first day of clinical, we were oriented at Shore Hill Neighborhood Center located at 9000 Shore Road, Brooklyn, NY 11209. On the second day, my three colleagues, Christine, Hanna, Malika and I were going to Sunset Park Senior Center located on 4520 4th Avenue, Brooklyn, NY 11220. We were oriented at this site by Mrs. Reynoso and the activity coordinator, Ms. Petra. We were introduced to other staff members and to the senior citizens of the center. The senior citizens were familiarized with the routine of the nurses going to the center to do our clinical because they had experienced in the past with other BSN students from City Tech. They were well aware of our presents. They knew that we would be taking their blood pressure (BP). As we were setting up the table every morning, the senior citizens were entering the cafeteria as time goes by. They settled down, sitting at their usual location every morning, they would come to us to get their BP taken at around 10 oâclock. They all knew the routine, they had to sign-in, fill-out the consent form, which is in three different languages, English, Spanish and Chinese. The Spanish senior citizens are all in the cafeteria on the first floor. We were notified that there is a group of Chinese senior citizens were in the basement. Luckily, Christine does speak Chinese. She and I would randomly go downstairs and were able to interact with them and took their BP. All of the senior citizens seemed to be concern with their BP. They always asked for their BP reading and they would say to us that it was good because they have been taking their medication in the morning before they came to the center. We interacted with the seniors using English, but if we had any problem with language barrier, we would ask Ms. Petra to translate. We have been taking BP for these senior citizens on a weekly basis. The following information will be a self-reflection of the course objectives from the syllabus for Community Health Nursing.
Objective 1. Demonstrates individual professionalism through personal behaviors and appearance.
Professionalism is defined as the standing, practice, or methods of a professional as distinguished from an amateur . I am currently taking my BSN courses. As a professional nurse, I must understand the location, Sunset Park Senior Center, assigned to me at the beginning of this semester. I needed to take precise consideration to observe the community to have an overview of the location and the clients that I would be communicating with. In addition, I used to live at this area 13 years ago from 1991 to 2002. For 11 years in this location, I am quite familiar with it. However, I know that many changes have taken place; I needed to refresh my surveillance of community. Surprisingly, many changes did occur. More Asian Americans moved to this location, whereas I thought it was only Hispanics population. Ms. Reynoso, service coordinator, oriented the group on the first day and explained about the place and also informed us about the Asian group in the basement. Our group planned to incorporate both Asian Americans and Hispanics senior citizens to be active with blood pressure screening but the presentation was only done in the cafeteria and was in English translated to Spanish by Ms. Petra, activity coordinator. Ms. Reynoso also mentioned to us that we were to give three presentations to the senior citizens. The time of presentation is up to us. We proposed three dates for the three presentations: March 24th, April 1st and April 22nd. We were able to present the March 24th presentation on Stress and April 22nd on Dash Diet to control hypertension on time but the April 1st presentation was moved to April 15th because by the time that Ms. Petra was available conflicted with the dancer that does therapy with the clients. We worked them out with Ms. Petra so that we wouldnât interrupt the others.
As a professional registered nurse in the bachelor program and to set good example for my practice, I must dress professional. Although at this location there are four members from the clinical group, it is a self learning experience. We must take our own responsibilities to learn how to interact with the clients and the administrative members and the entire staff of the center. Professor Scarlett would be coming by at any time during our clinical hours to have conferences with us. We would talk about the projects. So with the unexpected time for her to show up, I had to be present every clinical day on time (from 8:30 to 12:40) and have my stethoscope and blood pressure cuff because all of the clients are waiting for my group to be present to interact with them. If there may be language barrier when interacting with the clients, we Ms. Petra presents at every clinical day to help us interpret important information to the clients if needed. The interaction between us and the clients are in the cafeteria so confidentiality is not much private because the next person can hear us speaking. However, when the clients want to speak to us privately, we pulled them away from the group participation and have our conversation. Their shared information is kept confidential unless itâs life threatening situation such as harming themselves or others. If I see that the client BP is out of range whether itâs low or high, I will present the matter to Ms. Reynoso because I feel that this may be a problem to the client. Whenever I needed guidance, I always seek out for assistance such as my inability to read one of the clientâs BP, I asked my colleague to help with BP reading because I couldnât hear it.
Objective 2. Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
After the surveillance of the community, I have the opportunity to research about their cultures and religions so that I can be culturally competent with the Hispanic and Asian Americans. With cultural competency, I was able to communicate with the clients to interview them individually as I read their BP every clinical morning. I asked them about their BP and if they went to the doctor to get check-ups.
At this center, Ms. Reynoso kept records of their blood pressure readings. By asking them about their visit to the doctor is to assess if they are on medication for blood pressure because of their readings. It is known to us that the main group with hypertension is African Americans, but there is a big population of Hispanic Americans, also a concern. I always reminded the clients who are on medications for blood pressure to remember to take them on a regular schedule as directed by their physicians. Almost all of the clients that I interacted with always told me that they took their medications in the morning before coming to the center. Once in a while, a client would tell me that he/she forgot to take them and that was the reason for the blood pressure reading to be a bit higher than the usual reading on the record. Like always, I reminded them to take as directed. The next time they came to get the BP reading, it was within their normal range as compared to the record at the center.
As a professional nurse, I always assess my client health. The plan is for the client to comply with their medications. I implemented with performing blood pressure reading and providing them with information about nutrition and diet. I evaluated my clients with questions to have a clear vision if they had understand the health teaching. The presentations were the tools that helped to teach the clients about nutrition, stress, and blood pressure as our main concern with this group of senior citizens.
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.
Research of the community about the disparities and health issues within this community is the greatest tool to help in communication. To do research, Healthy People 2020, is a useful websites to research about different health problems among the disparities. NYC.gov is another useful engine to gather statistic and specific communities about health issues. Therefore, with the knowledge from the research I was able to develop communication skills based on the clientsâ preference. I believed that I was communicating with Professor Scarlett and my colleagues effectively and clearly on all matters. My group gathered information to present at the center on three different health problems based on the health concern of the community. All of the information were gathered and cited. I spoke to the clients with English with the level of understanding for them. If I needed translation, I asked Ms. Petra to help so that my clients could understand when I did my teaching. Some clients have their home attendants with them at the center, so I anticipated in educating the home attendants as well. This is such a great experience to self evaluate the quality of communication skills that I have.
Objective 4. Establish environment conducive to learning and use plan for learners based on evidence-based practice.
Evidence-based practice (EBP) is very important because everything that we do should base on the evidence that it has been practiced before. As defined, Evidence-based practice in nursing is to combine the client preferences with the best practices which have been validated through researches with clinical expertise to formulate the plan of care for the clients (Holzemer & Klainberg, 2014). Based on the clients from this center are mainly Hispanic American senior citizens, we incorporated with more visual images for our presentations. Ms. Petra is the best source for interpreting our presentation. We provided her with information for the presentation and she translated as we finished our statements for each part of the presentation. The Healthy People 2020 showed the disparities and health problems among each community and Sunset Park is known for hypertension, cardiovascular diseases and obesity. We focused on these three factors based on evidence-based practice information to present to our clients. We developed pre-presentation questions of each topic and then we evaluated our presentation by having the post-presentation questions to clarify if the clients had absorbed the information provided.
Objective 5. Utilize informational technology when managing individual and families in the community.
At the beginning of the day, we would go to the office to get the information for the blood pressure screening. Ms. Reynoso or her secretary would give us the big yellow envelope with the clientsâ blood pressure record inside of it. The consent forms in three different languages and the sign-in sheet were given to us as well. Before starting the screening on the clients, each of the clients has to sign in on the sheet and then fill out the consent form in the language that they prefer. After the two items were done, we would start to take their BP. Then we would write down the BP on their record card. If there is a BP that is out of range, we will notify the staff on the matters. To this day, there is no one who has such BP that is out of their normal range.
As we were screening the BP, we would interview each client individually. We asked about their medications intake as well as their last visit to their primary doctor. Because we would only interview them as we were screening their BP, itâs a private conversation and the BP reading was written down as for them to see the number if they could understand the language.
Objective 6. Demonstrate a commitment to professional development.
As a commitment to this class Community Health Nursing, we are following the textbook, Community Health Nursing An Alliance for Health by Holzemer and Klainberg. This literature provides information for the success for the Community Health Nursing. It is like guidance for our self evaluation of the community as nurses. Community Health Nursing (CHN) is like an independent practice for nurses within the community.
I believe the purpose for this clinical for the semester is for nurses to learn about the community and to gain cultural competency. Each assigned community is different and it is not really predictable for which community we were getting, so as nurses we have to surveillance the community and learn about the different type of cultures among the specific community they are being assigned to. We have to engage in this learning experience to have knowledge about different cultures and the disparities with many different disease processes among these communities. The Healthy People 2020 also provides more than enough information about disparities and the diseases. As far as for CHNs, they are here to implement the three type of prevention: primary, secondary and tertiary preventions. This is a lifelong learning responsibility and commitment for the âsalad bowlâ society. The society is ever changing and there is always room for learning about the different cultures.
Objective 7. Incorporate professional nursing standards and accountability into practice.
As a nurse and committed to work in this center, I have to remember the American Nurses Association Standards (ANA). I have to follow my scope of practice to be honest and to do no harm. In this center, the important part is blood pressure screening and the ongoing communication between the clients and us. We have to remember to keep the information confidential unless itâs harming the client or others. When doing BP screening, I must make sure the client sign in and fill out the consent form. These are the two requirements from the center. I must provide accurate information and to teach my client to the knowledge of my best ability. I must not have judgment on different race or ethnicity. Everyone has to be treated equally, no discrimination or prejudice.
Objective 8. Collaborate with clients, significant support persons and members of the health care team.
Collaboration is defined as working together as a group or as we called it team work. The Healthy People 2020 has shown many health problems or concerns among different ethnic groups. In Community Health Nursing, we are working together with the neighborhood such as this senior center to incorporate our knowledge with the center to implement different approach to help implement health awareness to these senior citizens. The center is affiliated with Lutheran NYU Medical Center; we are incorporating with the members from the medical center to help to associate with their senior citizen members with teaching them in different approaches. Our group in particular did presentations dealing with stress, nutrition and nutrition related to blood pressure. These are the health issues among the senior citizen members from this center. We educate them how to modify their lifestyle by suggesting for them to make healthy choices. We tried to connect with the group by having Ms. Petra to translate for us as we gave the presentation. We also printed information in Spanish and handed out for them to read. We suggested for them to go on Choosemyplate.gov to learn more about healthy choices on their plate as well.
Objective 9. Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
The senior citizens from this center are mainly elderly. They have been retired and many are on Medicaid and Medicare. Most of them go to Lutheran NYU Medical Center as for their primary physicians. There is a language barrier, but luckily there are so many interpreters available to help them with this difficulty. As from surveillance of the community, the Community Board 7 is only a few blocks away from this center. If there is any obstacles the people from the neighborhood can always seek for help. There is an office to help with translating documentations and taxation a block away from the center. There are many churches around and I heard that one church in particular give food out to the poor. All of the stores are nearby. However, most of the stores are fast food restaurants or take-outs. This may be a big problem for leading to health issues such as hypertension, cardiovascular, diabetes or obesity.
I believe more education needed to provide for the people from this neighborhood. Information about the disease processes and prevention from them need to be provided in helping with the society. We need to educate the people of how to make healthy choices.
Summary
I never thought about how important it is to learn about different community for being in such a community to have the real experience. I have lived in the neighborhood and familiarized with it, but never actually understood the importance of why learning about the community will help in my nursing career. I am very grateful for this class to learn about the âsalad bowlâ in New York City where it is not only known as the âmelting pot.â To have a good salad, mixing all of the ingredients will make it taste better.
The experience at this center, Sunset Park Senior Center, has being a very good experience for me to learn different ways to approach the senior citizens and how to interact with people who are different. When I said different, the meaning is the different culture and different ethnicity. For me everyone is the same because I came from a different country and I strived to become the nurse that will not discriminate others. I will try to use the knowledge that I gain from this experience in my practice as a nurse. Whether I will practice in the hospital or in the community, I know that I will encounter many different ethnicities. Therefore, I must incorporate the knowledge that I gained from this center toward the future.
Blood Pressure Screening is not complicated, the complication is the communication because the senior citizens mainly Spanish speaking people, and there are many different communication skills that I experienced with them. Not only communication is an important factor, the experience with disparities that I have learned will also help with the future for my practice.
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References
Holzemer, S. P., & Klainberg, M. (2014). Community Health Nursing An Alliance for Health (Second Edition ed.). Burlington, MA: Jones & Barlett Learning.
