Kunga Choden
Introduction
My community health nursing clinical is held at First Steps NYC, 225 Newport Street, Brownsville, NY 11212. The center is dedicated to providing child care services from birth till 5 years of age. The goal of the center is to provide an environment where the family and child can grow together and learn the life skills necessary to succeed in the future. For children to be accepted to the center, the family must meet certain income guidelines. As nurses we were there to assist the teachers in the classroom where children are taught many important life lessons such as proper hygiene, self-control, nutrition, communication etc. My clinical group also participated in a health fair and a fall festival where we set up a booth to teach the family about controlling their child’s asthma and also addressed other health issues. I was assigned to the older 3 year old class. My class had one head teacher and two assistants, and also a master teacher. I thought that the student to teacher ratio made it possible for each individual kids to get the necessary attention they require resulting in a better learning curve.
Objective 1. Demonstrates individual professionalism through personal behaviors and appearance.
We represent not only ourselves, but also our college and our instructor when we enter any clinical facility; hence, it is imperative that we behave in a professional manner during clinical. It starts with punctuality. I believe that you are on time when you are half an hour early. I have always practiced this motto since I first started my nursing clinical. Appearance is also very important because first impressions matter. We dress in scrubs during clinical and I made sure that they were clean and neatly pressed. It is also important to have your ID on you so that others know who you are. As I am interacting with 3 year olds, it was even more important for me to watch what I say and how I act because children are very impressionable. Maintaining safety and privacy are always important with any client. I made sure to never share any names of children or had taken any pictures as that can jeopardize a child’s safety. I made sure to read the policies of First Steps so that I was aware of the rules and what we were allowed to do in the clinical setting.
Objective 2. Employ analytical reasoning and critical thinking skills when providing care to individuals and families in a community setting.
With children I really had to be careful of the words I used. I had to use language that was not only appropriate, but also in level with their understanding of the English language. For some of them English was a second language so it was really hard to communicate effectively with them. Moreover, some children were lagging behind in obtaining the required vocabulary milestones. I read to the children during my time with them and made sure that I not only read the words, but also made the necessary gestures and adjusted my tones to give them a lively experience of the reading. Children have short attention spans so the teachers and I had to really find creative ways to gain their attention. I made sure that I learned their names so that I can built rapport. I also had to play mediator when kids quarreled. It was a learning experience for me because at first I did not know how to handle such a situation. I had to monitor how the teachers dealt with these situations and applied their techniques when dealing with quarreling kids myself.
Objective 3. Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in a community setting.
As meals were provided in the facility, the first thing I asked the teacher was whether there were any dietary restrictions based on medical reasons, allergies, culture or religion. I think it is important to know as much about the children and their family so that care is tailored to their individual needs. Most of the children at the facility were from African-American families, but it is wrong to categorize them into one group as they can be from Haiti, Somalia, or the Caribbean or from right down the block. Each family has their own unique customs and beliefs that we have to respect. At the health fair and the fall festival we had the chance to interact with few parents. Most of them were very receptive to our ideas and suggestions in regards to asthma and nutrition teaching. We tried to connect them with free resources that were available in the community such as free pest-control treatment. We had to turn ourselves into the friendliest nurses so that the families felt comfortable approaching us with questions as not everyone is born a people-person. It was also important that we provided teaching while respecting the client’s choice and not seeming too judgmental of their lifestyles.
Objective 4. Establish environment conducive to learning and use a plan for learners based on evidence-based practice.
The classroom was kept organized and children were taught a ritual so that they knew where they should be at particular times. I made sure along with the teachers that it was quiet and the classroom was well lit. We also paid attention to the behavior of each individual children so that no one disrupted the learning process. It was important for me to be consistent when interacting with the children so they were aware of my responses and expectations. I had to reinforce the teaching of sneezing on their elbows so that we do not make our friends sick. I also taught them how to tie shoe laces. The children were also instructed on how to properly wash hands. They were also taught how to resolve issues such as sharing of toys and taking turns. One must be aware that not all children receive these teachings in their homes and that such lessons might seem minute, but have everlasting impact on the child’s cognitive, physical and social growth. Such lessons teaches them to properly communicate with their parents regarding their needs instead of throwing a fit. Tying shoe laces helps improves coordination, and positive self-control lessons can ensure that such a child does not end up with any disciplinary issues once they start attending regular school in the future.
Objective 5. Utilize informational technology when maintaining individuals and families in the community.
Children were shown videos on the computer to expand their learning. The parents were given useful websites in regards to asthma and nutrition teaching. Many of the parents were not completely computer literate so it was not a good idea to bombard them with too much information from the Internet. In the future, it would be a good idea to recommend parents to apps that can provide important teaching regarding their child’s nutrition or medical management such as an asthma action plan.
Objective 6. Demonstrate a commitment to professional development.
Every class is an opportunity for me to grow not only as a registered nurse, but also as a person. I always make sure that I look up information on any medical condition or concept that I do not have knowledge of during clinical. I think that every interaction that I have with another human being in an important one because it helps me become a better communicator and a more competent nurse. I always read about the world around me focusing on topics including changes in healthcare, advances in science, policy changes in the government so that I can better serve the community at hand.
Objective 7. Incorporate professional standards and accountability into practice.
As a registered nurse, I am expected to have the client’s best interest at heart. Therefore, I must always think about how my actions impact the children I am fortunate to look after. I must follow the nursing practices of beneficence, non-maleficence, autonomy, justice, and fidelity. I have to train myself to look after multiple kids to ensure their safety. Multitasking is a trait that has evolutionarily been stronger in the female population. As a nurse in the classroom, I was reading with one group of kids while I had my eyes on another two groups who were playing in another corner.
Objective 8. Collaborate with clients, significant support persons and members of the health care team.
With any care plan the client must be at the center of the care. Furthermore, the importance of a good support system cannot be overstated. Clients need this support system most when they are in a vulnerable state (financial, physical, psychological distress etc.). With children it is important to keep the parents in the loop when employing any new teachings so that they are reinforced at home. Moreover, siblings and friends also make a huge impact on the child’s behavior. Thus, it is important to monitor their influence, as peer pressure is prevalent in children especially when they grow older.
Objective 9. Recognize the impact of economic, political, social, demographic forces that affect the delivery of health care services.
Funding is always an issue for any program where the goal is social progress and not profit maximization. Finding politicians who are willing to support a constituent that cannot make huge sums of donations and a big vote turn out is also an issue. Moreover, the minority populations have always received the shorter end of the stick in regards to healthcare services. Lack of education, income inequalities and a systemic bias against these populations make the delivery of care even more challenging. Therefore, grassroots movements to gather support for causes such as building a YMCA or afterschool programs are very important. With parents it is very challenging to get their attention and time commitment as everyone has a schedule to keep. Finding incentives to increase participants in these causes will help develop a more robust parent group that will be more politically and socially active.
Conclusion
This was my first clinical where I had consistent interaction with children on a regular basis. It was a learning experience for me as I do not have children myself. I learned to tailor my communication and behavioral skills so that the children felt comfortable around me. Moreover, I saw in person how important it is to make sure that the children are provided the individual care they need. The classes at First Steps were different because teachers had a lot more time with their students so they received better teachings in the classroom. Teaching kids how to perform necessary life functions such as washing hands, putting toys and equipment in proper places, tying shoes were rewarding experiences that I will cherish knowing that I made a direct positive impact on their upbringing.
