Julieann Daly
E-Portfolio Reflection
Introduction
This paper is about my personal reflection of my clinical rotation for community nursing lab section 8530. My assigned clinical site was the Grand Street Settlement Senior Center at 80 Pitt St. New York, NY 10002. My stint was from 02/01/12 to 05/23/12, approximately three months. This experience has allowed me the opportunity to get an insight into a world that is different from what I am accustomed to working as a RN. The knowledge I gained came as I set out to achieve each objective outlined below. In the following I will explain how I was able to achieve each objective mentioned with reference to examples and firsthand information obtained during my stint as a community health nurse.
Objective (1) Demonstrates individual professionalism through personal behaviors and appearances.
Expected Behaviors:
I maintained client confidentially by speaking in a low tone during interactions, and whatever information I obtained I did not share with anyone that was not part of the patient’s management.
I assumed responsibility for my own learning by researching information that may not be familiar to me. In preparation for clinical learning, I maintained my presence within the clinical area at all times. If there was uncertainty of any information I sought guidance from my clinical instructor or an assigned staff member within the department. I also completed work assigned to me in the designated time frame.
During pre and post conferences, I was able to actively participate, that is, I shared my experiences or concerns based on my observations during clinical. I also offered recommendations when necessary.
I adhered to the policy of the school with regards to punctuality. I was always punctual and I have only one absence from clinical. I also adhere to the dress code at all times. I maintain the appropriate professional uniform required.
Objective (2): Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
Expected Behaviors:
The following expected behaviors were not applicable to my clinical setting; The uses of client interview, nursing and medical records, staff nurses and other health professionals to collect client information, completion of physical assessment of selected clients, prioritizes care based on analysis of data, applies priority setting in planning nursing interventions, administers medications and treatment safely, evaluates the outcomes of nursing care, and modify client care as indicated by evaluation of client outcomes.
Expected behaviors that were applicable to my clinical settings were as follows: The utilization of personal safety when working in the community. I was able to maintain personal safety by not being alone when out in the community. I always went out in twos and I adhered to the recommended dress code. I did not wear any jewelry and personal items were kept safely and not visible to the public. I also collected significant data relevant to the client’s care during interactions and blood pressure assessment.
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.
Expected Behaviors:
I utilized therapeutic communication skills with individuals and families in the community setting, during nurse client interaction either in groups or role play. I respected each client opinion with respect to their cultural sensitivity. I utilized appropriate channels of communication whenever there was a need for translation. For example, clients whose primary language is Spanish, the facility had a fluent Spanish speaking translator for effective communication. I communicated effectively with my instructor and peers during pre and post conferences. For instance, one of our weekly objectives was Blood Pressure Assessment for clients who commented. In event that the blood pressure readings were out of the therapeutic range, I notified my instructor who in turn notified the supervisor for the senior center. In event of discrepancies or blood pressure values that fall out of the therapeutic range the client was informed or his/her medical doctor was notified. Also, medication management was reinforced. I assumed the responsibility to report and document assessment and nursing interventions accurately during blood pressure management. Findings that were within therapeutic range, clients were encouraged to continue therapeutic regimen were reinforced on preventative methods. Findings that were out of therapeutic range, clients were informed on effective management, risk of complications and the need for regimen compliance. Documentation of findings and teaching were done as per facility policy. Communication with the health care team was not applicable for my clinical setting.
Objective (4): Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Expected Behaviors:
I assumed the responsibility to develop and implement a teaching plan for one of the seniors of my choice during my clinical rotation. Some of the teaching plans that were implemented were medication management and compliance. The senior of my choice was encouraged to bring in her prescribed home medication and was reinforced on compliance with regimen.
An environment conducive to learning was not totally accomplished due to the facility setting. Interaction with clients were done in the cafeteria of the senior center, therefore one barrier to effective teaching was environment stimuli.
During evaluation of clients learning outcomes, I did encounter certain challenges such as, clients being absent or late for 2 to 3 weeks. Hence, learning was not accomplished except in some instances, few clients were able to demonstrate verbally an understanding of what they learned.
Objective (5): Utilize informational technology when managing individual and families in the community.
Expected Behaviors: Utilize principles of nursing information in the clinical area and maintaining strict confidentiality with clients records were not applicable to my assigned clinical setting.
Objective (6): Demonstrate a commitment to professional development.
Expected Behaviors:
I assumed the responsibility to use appropriate current literature for planning care for clients in the community setting by researching evidence base practice journals, research effectiveness of prescribed meds, and use of nursing data base. I assumed responsibility for lifelong learning by counting educational carrier and attending conferences. I engaged in self evaluation by evaluating myself after a situation to see if I could have done or said things differently. I am committed to adjusting to the challenges of independent practice in the community health nursing by assuming the responsibility of knowing exactly what are the roles and responsibilities of a community health nurse, research, and self learning.
Objective (7): Incorporate professional nursing standards and accountability into practice.
Expected Behaviors:
I utilized American Nurses Association Standards in clinical practice.
I assumed the responsibility of complying with the agency standards of practice, to know my limits in the kind of care and intervention that can be provided to each client. For example, one situation that I encountered was that of a female client who upon being notified of her blood pressure being out of the therapeutic ranges refused teaching and recommendations. My colleagues, instructor, and I were informed by the facility manager that there is a limit to how much further our intervention could go. The client eventually left the center that day refusing to sign the facility AMA consent. I am aware of my facility’s mission is to expand opportunities for low income families and individuals by providing culturally relevant services that support community-building advocacy, self determination and an enriched quality of life.
Objective (8): Collaborate with clients, significant support persons and members of the health care team.
Expected Behaviors:
Collaborates effectively with health care team to address client problems was not applicable to my clinical setting.
Coordinates client-care based on client needs and intervention.
Objective (9): Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.
Expected Behaviors:
Recognizing the gaps in care system was not applicable to the clinical setting. The reason is because clients’ view of the center is for recreation and a means of providing meals. What I observed on a weekly basis was the lack of interest in health maintenance among most clients.
As a community health nurse, one will always have to use new ideas to engage most of these clients in attending and becoming interested in health maintenance. As a community health nurse, I will also act as a change agent in advocating to appropriate health care resources for clients or families by collaborating with the management team of the Grant Street Settlement Senior Center to incorporate health maintenance issues within their weekly or monthly calendars. I would advocate for a community health nurse to be a part of their agency in order to continue educating the seniors on health issues and management.
Summary: What I would have like to experience during my clinical rotation was getting out into the community and reaching out to individuals. I would have also liked to see what health care was like for the less fortunate within the shelters, prisons and even some clinics.
What I could have done differently was to have the privilege of engaging in small groups with the seniors at the center and addressing concerns or major issues. My reason for saying this is based on my experience three weeks prior to the completion of my clinical rotation. The groups’ discussions made me realize that there is much issues and concerns among some seniors that is still not being address.
In view of the foregoing, my clinical rotation was an experience I have never encountered during my life as a registered nurse. I have gained a lot of knowledge and was able to get a glimpse into a world that is different from a bedside nurse.
