Self-Reflection of Service Learning Project
Clinical Site: Community Access
By: John Nicolosi
Introduction:
This will serve as a self-reflection of the community health-nursing curriculum and explain how I met my course objectives. Community health nursing entails a multitude of assessment, planning, and evaluating. Coming into this course, I did not fully understand how much the community health nurse is responsible for. For the fall 2015 semester, I was stationed at Community Access located on 29 East Second Street in New York City. This experience has changed my view on nursing for many reasons. I have learned to use essential communication skills, and learned to set realistic goals for the residents I have interacted with thus far.
Community Access provides housing for many different types of individuals within the community. They include: homeless, low-income, mentally ill, and individuals dealing with substance abuse, to name a few. Unlike a clinical setting, we are stationed within their residence and do not always have a detailed background or medical history on these individuals. This has posed quite the challenge throughout the semester, however I feel I have made some great connections with many of the residents and have certainly created trusting relationships.
When choosing objectives for the service learning project we consulted with the NYC Department of Health and Mental Hygiene’s website for a community profile of our zip code (10003). We have chosen three objectives to focus on within the semester when providing education to our residents. Smoking cessation, heart health, and health maintenance are three major objectives we ultimately decided on. These objectives became clear to us through numerous conversations and assessments of residents within the facility. It became apparent that more then half of the residents were indeed cigarette smokers, had high blood pressure or some history (self or family) of heart disease, and ultimately were not compliant with medication regimens or even seeing a health care professional for routine check-ups.
Objective 1: Demonstrates individual professionalism through personal behaviors and appearance.
I come to Community Access everyday Wednesday morning between the hours of 8:30 AM and 12 PM, always with a smile and welcoming attitude. I am stationed in the community room, where I greet all residents as they pass and converse with the vast majority of them. From noon to 1 PM, Professor McGirr meets with the group in the fifth floor pearl building to host post-conference. I am always active in the discussion and feel I bring a substantial amount of information to the group on a weekly basis.
Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.
As I speak with the residents, I am constantly assessing their needs and thinking ahead to how I can educate them on various concerns and issues. Although, we do not handle medications with the residents directly I am always willing to educate them about their medications or answer any questions they may have. At the end of the clinical session, I always speak with the site coordinator and inform him of any pertinent information I feel the staff should be aware of. I find post-conference to be a great time to reflect on the day with my instructor and peers. I use this time to explain how I used my time at the clinical site, any interesting events that were nursing related, and to listen to others because I believe others interactions can certainly help you in the future.
Objective 3: Effectively communicate with the diverse groups and disciplines using a variety of strategies regarding the health needs of the individuals and families in the community setting.
Constant conversation with the residents has been our way of learning their stories, health issues, and concerns. Each week we measure blood pressures and record them, so we can evaluate if the resident is at baseline, has decreased or increased. We also ask the clients if they have been compliant with their medications. Health screenings are of utter importance and I always stress the need for annual physicals and blood draws. I do this in hopes that week after week the residents will consider it routine and want to be proactive when caring for themselves.
Communication has played a large part in my learning about the job of the community health nurse. At Community Access residents come to us for education but also want someone to listen to their story or experience they have had. By using motivational interviewing and open-ended questions I feel I have fostered an environment for open lines of communication and trust. For example, a transgendered resident has gone through a profound journey and although I cannot specifically identify with the problems she is facing I feel honored and helpful when I am just listening and allowing her to share her experiences. I was afraid residents would be reluctant to speak to us in the beginning of the semester, however those fears are far-gone and for that I feel accomplished.
Objective 4: Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
Discussion groups have also played a large part in our efforts to educate the residents on our objectives for the service-learning project. At my clinical site, flyers were made, refreshments were served, and gift cards were raffled as incentives to get the residents involved in the conversation. If the residents chose not to participate I was always available for one on one conversation regarding the topic of the day or any topic that may have concerned them. Information given to residents is always researched if uncertainty occurs, and is always done so using a reputable source.
Objective 5: Utilize informational technology when managing individual and families in the community.
The clinical site in which I am stationed is a residential building in which clients hold leases to their apartments. Although we had a brief training on the computer system in which Community Access uses, I have no specifically needed to chart within the facility. In the lower level of the building there are computers available for use should I need to research a particular item when educating a client.
Confidentiality was always maintained when reviewing events of the day. If a client chart was accessed it remained in the room where the filing cabinet is stationed and was read behind closed doors. During the clinical day, conversations about specific clients were kept between the individual and myself. Post conference is held within the college; although the client may not be present we still use first names only or initials when speaking of the client.
Objective 6: Demonstrate a commitment to professional development.
Throughout the semester I have often referred to journals, and academic literature when planning my educational discussion groups. I always try to educate my clients with the most up to date information (5 years or less). The textbook has served as an essential element in learning the process and responsibilities of the community health nurse. I often reference the text for information on assuming the role of the community health nurse.
Entering the field of nursing as a licensed professional commits you to a continuous education. As new best practices and evidence-based knowledge becomes available, it is important we implement it as soon as possible to provide our clients with gold standard care. With a commitment to nursing in lifelong learning, I actively expand my knowledge by reading and completing continuing education articles.
Although I am now aware the task of the community health nurse is not an easy one, I always approach my clients with an open mind and commitment to providing quality care to all I cross paths with. I am always open to change and evolution as it is imminent within the changing community and the way healthcare is now being delivered.
Objective 7: Incorporate professional nursing standards and accountability into practice.
The American Nurses Association has created a set of guidelines to which the nurse should always obey. Their website has been consulted at the commencement of the clinical and many times after to refresh my mind when practicing within the community. As nurses, it is extremely important that you never provide any services that are outside of your scope of practice, which is always kept in mind.
Although I was unaware of Community Access before the commencement of this clinical area, I was sure to research the organization prior to arriving to my first scheduled clinical. I became familiar with Community Access’ goals, vision, and policies and uphold them at all times.
Objective 8: Collaborate with clients, significant support persons and members of the health care team.
Before leaving the clinical site, about thirty minutes is spent with the site coordinator in regards to the events of the day. All pertinent information is relayed and discussed. While speaking with the site coordinator the upcoming weeks ventures are always made known.
During conversations with clients, it is always important to assess their knowledge regarding positive and healthy life choices. This is something I believe to accomplish on a weekly basis with every client I interact with. Resources within the community are often referenced using government websites and community district information.
Objective 9: Recognize the impact of economic, political, social, and demographic forces that affect the delivery of health care services.
Unfortunately, some of the clients within the community have not received the services they are in need of. As an advocate and voice of the client I actively guide and search for opportunities for these clients to receive the services they need and are entitled to. Within the lower east side’s community many challenges pose threats to the individuals. However, by providing quality education, and implementing small goals I do believe some of the challenges can be solved.
Summary:
As previously stated, I did not fully understand what it meant to be a community health nurse when the semester began. Through lectures given by Dr. Egues, the use of the textbook, and clinical experience I now have the tools necessary to be successful. I have realized that data is very important to the community health nurse as it serves so many purposes. The community health nurse will certainly use data in their everyday planning of care within the population they are serving. I am glad to have had this experience and hope to have made an impact on some of the new individuals with whom I’ve crossed paths.
